FOH Flashcards
Describe the clinical presentation of this condition.
Odontogenic Infections: Acute infections present with fever, facial swelling, distress, and possible dehydration. Chronic infections may be asymptomatic but can cause a mobile or discolored tooth, halitosis, or a sinus tract.
F.A.C.E.S.
F – Fever (Acute Infection)
The body’s response to infection, leading to increased temperature, often associated with acute odontogenic infections.
A – Asymptomatic (Chronic Infection)
Chronic infections may not show any obvious symptoms but can still cause problems like tooth mobility or discoloration.
C – Chronic Infections (Sinus Tract/Discolored Tooth)
Chronic odontogenic infections can present with a mobile or discolored tooth and a sinus tract that may drain.
E – Edema (Swelling) (Acute Infection)
Swelling in the face or oral tissues is a hallmark of acute odontogenic infections.
S – Sinus Tract (Chronic Infection)
A chronic infection may form a sinus tract, leading to drainage of pus or fluid from the infected area.
Describe the causes of common oral pathological conditions in children.
“GODS”
G: Gingivostomatitis (Viral Infections) – Just as God provides healing for afflictions, viral infections like HSV-1 and Coxsackie viruses can afflict the mouth but require divine wisdom to treat.
O: Odontogenic Infections – These infections, entering the dental pulp, represent the spread of decay, akin to how sin can spread in our lives without treatment.
D: Divine Healing (Osteomyelitis) – Osteomyelitis, a bone infection from odontogenic sources, reflects how God’s divine healing can restore even the most affected areas, like bones from infection.
S: Soft Tissue Lesions – Like God’s ability to heal wounds, soft tissue lesions such as haemangiomas, cysts, and polyps require attention and restoration.
Osteomyelitis clinical presentation
Here’s an acronym for the description you provided:
“FIRE” to the bones
F: Fever – A common symptom of the infection, signaling the body’s response to the illness.
I: Infection – The underlying cause of pain, swelling, and the radiographic “moth-eaten” appearance in bone.
R: Radiographic Changes – The “moth-eaten” appearance on X-rays indicating severe bone involvement.
E: Edema (Swelling) – Swelling is another prominent symptom that accompanies the infection.
what is this? describe symptoms how do you tx it?
Primary Herpetic Gingivostomatitis: This condition causes swollen, painful gums (gingiva) and oral mucosa, along with small vesicles that become ulcers. The child may have fever, malaise, and difficulty eating or drinking.
V – Vesicles
Small fluid-filled blisters that appear on the gums and oral mucosa, which can rupture and become painful ulcers.
I – Inflammation
Swollen, red, and painful gums (gingiva) and mucosa, leading to discomfort and difficulty with oral function.
R – Rash (Ulcers)
The vesicles eventually break open and form ulcers, which are painful and contribute to difficulty eating and drinking.
U – Unwell
The child may feel generally unwell, with symptoms like fever, malaise, and irritability.
S – Swallowing Difficulty
Due to painful ulcers and swollen gums, children often have difficulty eating and drinking, leading to dehydration if not managed properly.
crazy fact abt the virus in primary herpetic gingivastomatitis
Caused by Herpes Simplex virus type 1 (HSV-1), can go to the trigeminal ganglion where it enters a latent state.
- 30-40% will develop recurrent herpes simplex infections that reappear at sites previously
infected
what is this?
H.E.R.P.E.S.
Caused by Herpes Simplex virus type 1 (HSV-1): After primary infection, the virus recedes via the sensory nerve intothe
trigeminal ganglion where it lies latent throughout the
individual’s lifetime
– Stimuli such as fever, sunlight, upper respiratory infection can reactivate virus
H: Hurtful blisters (painful)
E: Enclosed fluid (fluid-filled blisters)
R: Ring of discomfort (around the lips)
P: Preceded by tingling (tingling or burning sensation)
E: Exposed (commonly occurring on the lips)
S: Short-term outbreaks (recurring)
what is this?
Herpangina: Presents with fever, sore throat, and a cluster of small, shallow ulcers with an erythematous border in the back of the mouth (on the soft palate and tonsils).
S.O.R.E.
S – Sore Throat
A key symptom of Herpangina, where the child experiences pain or discomfort when swallowing.
O – Oropharyngeal Ulcers
A cluster of small, shallow ulcers appears in the back of the mouth, primarily on the soft palate and tonsils.
R – Red Border
The ulcers have an erythematous (red) border, distinguishing them from other types of oral lesions.
E – Erythema (Fever)
Accompanying fever and erythema (redness) in the throat and mouth, contributing to general malaise and discomfort.
Hand-Foot-Mouth Disease: Causes mouth ulcers and an erythematous rash on the hands, feet, and other areas. Symptoms also include fever and malaise.
F.E.V.E.R.
F – Fever
One of the first symptoms, leading to general malaise and discomfort.
E – Erythematous Rash
An erythematous (red) rash appears on the hands, feet, and sometimes other areas of the body.
V – Vesicular Lesions
Small, fluid-filled blisters or ulcers develop in the mouth, causing discomfort.
E – Exanthem
The rash that spreads to the hands, feet, and sometimes the buttocks or other areas.
R – Rash (Mouth and Skin)
The presence of mouth ulcers and a rash on the body is a hallmark of this disease.
H.A.E.M.A.N.G.I.O.M.A.S.
H: Hue of red to purple (smooth lesions)
A: At birth or shortly after (often present at birth)
E: Elevated (usually raised)
M: Mouth lesions (found in the mouth)
A: Abnormal blood vessels (vascular malformations)
N: Non-cancerous (benign)
G: Growing (may increase in size over time)
I: Infrequent symptoms (usually asymptomatic)
O: Often smooth (smooth surface)
M: Mild discomfort (generally painless)
A: Appearance-based diagnosis (diagnosed by visual inspection)
S: Surface changes (may change shape or color over time)
eruption cyst
B.L.U.E.
B: Bluish appearance (bluish cystic swellings)
L: Located near erupting teeth (area where a tooth is about to erupt)
U: Uncommon in upper jaw (common in the lower jaw)
E: Erupting teeth (associated with the eruption process)
Here’s an acronym for White Sponge Nevus based on its key characteristics:
W.H.I.T.E.
W: White or grey mucosa (mucosa appears white or grey)
H: Hereditary (familial, autosomal dominant condition)
I: Inherited (present in family history, frequency ~1 in 200,000)
T: Thickened, folded, spongy mucosa (mucosal texture)
E: Early childhood onset (appears in early childhood, sometimes at birth)
Generally painless, but the folds of extra tissue can promote bacterial growth
– Refer DO for diagnosis and management
: A condition with smooth, red patches on the tongue that can change over time, often with raised white borders.
.I.S.S.U.R.E.D.
F: Fissures (perpendicular to the lateral border)
I: Inflammation (food debris may cause inflammation)
S: Seen in Down Syndrome (commonly seen in children with Down Syndrome)
S: Split tongue (20% of plicated tongues may have geographic tongue)
U: Uncomfortable (can cause discomfort due to trapped food debris)
R: Residual bacteria (site for Candida colonization)
E: Easy to manage (tongue brushing recommended)
D: Debris accumulation (food debris may cause halitosis)
ere’s an acronym for Salivary Mucocele based on its key characteristics:
M.U.C.O.S.E.
M: Mucus leakage (mucous leaks into surrounding tissues)
U: Usually young people (commonly occurs in young individuals)
C: Caused by trauma (resulting from biting or a blow to the lip)
O: Occurs in lower lip (over 70% occur on the lower labial mucosa)
S: Superficial cyst (develops as an extravasating cyst)
E: Extraoral sites (can also occur on buccal mucosa and floor of the mouth)
R.A.N.U.L.A.
R: Raised swelling (smooth, soft tissue swelling)
A: Affected sublingual gland (originates from the sublingual or submandibular glands)
N: Near midline (located lateral to the midline)
U: Unusual color (often appears bluish)
L: Linked to trauma (caused by trauma to the salivary duct)
A: Affects floor of the mouth (found on the floor of the mouth)
epsteins pearls
“CYST”
C: Cystic Nodules – Small, cystic, keratin-filled nodules.
Y: Yielding to Time – They resolve spontaneously without treatment over a few weeks.
S: Site – Often seen on the roof of the palate (midpalatine raphe) or sometimes the mandibular ridge.
T: Trapped Epithelium – Caused by entrapped epithelium during palate development along the fusion line.
“BUMP”
B: Buccal Mucosa – The lesion is commonly found on the buccal mucosa at the occlusal level.
U: Unchanged Unless Traumatised – It is typically symptomless unless significantly traumatized.
M: Malpositioned Teeth – Associated with trauma, malpositioned teeth, sharp tooth edges, or biting habits.
P: Pink to Red – The color varies from pink to red depending on the vascularity of the lesion.
Management
- Documentation
- Referral to Dentist - Monitor
- Surgical excision
- Local - GA
when to refer Extraction of Deciduous Teeth
refer sasi tooth
S.A.S.I.
S: Supernumerary teeth (extra teeth, often seen between 11 and 21)
A: Ankylosed teeth (primary teeth blocking eruption of permanent teeth)
S: Submerged teeth (severely infraoccluded teeth, such as 85)
I: Impacted eruption (caused by congenitally missing teeth, such as 45 affecting 85
- Indications and Rationale for Extraction of Deciduous Teeth (IRET)
IRET – Infections, Restore, Extraction, Trauma
Infections (odontogenic infections, irreversible pulpitis, pulpal necrosis)
Restore (hopeless prognosis, internal resorption, external resorption)
Extraction due to severe resorption (ectopic eruption, retained roots)
Trauma-related infection (alveolar abscess)
Consequences of Early Loss of Deciduous Teeth (MESIL)
MESIL – Midline, Eruption, Space, Incorrect sequence, Lack of guidance
Midline shift
Eruption delays or misalignment
Space loss from mesial drift
Incorrect eruption sequence
Lack of permanent tooth guidance
- Indications and Rationale for Extraction of Deciduous Teeth (IRET)
IRET – Infections, Restore, Extraction, Trauma
Infections (odontogenic infections, irreversible pulpitis, pulpal necrosis)
Restore (hopeless prognosis, internal resorption, external resorption)
Extraction due to severe resorption (ectopic eruption, retained roots)
Trauma-related infection (alveolar abscess)
E.X.O.D.U.S.
E: Eviction of Infection (odontogenic infections, irreversible pulpitis, pulpal necrosis)
X: Xchange for Healing (hopeless prognosis, internal/external resorption)
O: Opening for Restoration (extraction due to severe resorption, ectopic eruption, retained roots)
D: Divine Guidance (trauma-related infections, such as alveolar abscess)
U: Unification in Health (removal for long-term health, preventing further issues)
S: Salvation through Relief (providing relief from pain and further complications)
- Contraindications for Extraction of Deciduous Teeth (CHIC)
CHIC – Conditions, Heart, Infections, Cancer
Conditions like bleeding disorders (hemophilia, thrombocytopenia and uncontrolled asthma)
Heart conditions that risk infective endocarditis
Infections such as cellulitis or abscesses
Cancer treatments (chemotherapy/radiation, immunocompromised)
what is tx?
- Scope of Practice for Oral Health Therapists in Deciduous Teeth Extraction (CAREFUL)
Clinical assessment of indications/contraindications
Assess medical history and pain
Recognition of when referral is needed
Extraction of non-surgical deciduous teeth
Follow-up care and pain management
Understanding limitations and scope of practice
Legal considerations (informed consent, radiographs)
Contraindications of extraction for cardiac reasons include:
P.R.O.T.E.C.T.
P: Prosthetic cardiac valve (including transcatheter-implanted prosthesis or homograft)
R: Repaired defects (with residual defects at or near prosthetic patches or devices)
O: Ongoing infective endocarditis (history of previous infective endocarditis)
T: Troubling congenital heart defects (unrepaired cyanotic defects, palliative shunts, and conduits)
E: Endothelialisation inhibition (defects that prevent proper endothelialisation at repair sites)
C: Congential heart disease (with specific conditions)
T: Treatment guidance (consult with the cardiologist for antibiotic prophylaxis if in doubt)
This acronym, PROTECT, reflects the importance of safeguarding patients with these cardiac conditions during high-risk dental procedures.
- Define dentinal hypersensitivity and identify factors contributing to dentinal hypersensitivity.
Here’s an acronym for Dentinal Hypersensitivity based on the provided information:
T.R.A.I.N.S.
T: Transient pain (pain subsides when the stimulus is removed)
R: Root exposure (due to gingival recession, aggressive brushing, periodontal therapy)
A: Abrasion factors (abrasive toothpaste, attrition, abfraction, root caries)
I: Inadequate hygiene (poor oral hygiene or orthodontic treatment)
N: Noxious stimuli (thermal, mechanical, chemical, osmotic triggers)
S: Sensitive diet (acidic foods and drinks contributing to sensitivity)
Define and discuss Classic recession, Stillman’s cleft, and McCall’s festoon.
G: Gingival recession (classic recession, retreat of facial gingiva, exposing CEJ)
I: Irregular groove (Stillman’s cleft, groove or notch in the gingiva)
R: Rolling gingiva (McCall’s festoon, thickening and rolling due to recession)
Classic recession refers to the apical retreat of facial oral gingiva, typically caused by improper brushing or orthodontic treatment, leading to the exposure of the cementoenamel junction (CEJ). Stillman’s cleft is a groove or notch in the gingiva that can lead to pronounced recession. McCall’s festoon is a thickening and rolling of the gingiva due to recession, often seen after inflammation subsides.
Define dehiscence and fenestration.
D.E.F.I.N.E.
D: Depletion of bone (Dehiscence, loss of bone covering a portion of the root)
E: Exposed root surface (often at the CEJ due to bone loss)
F: Fenestration (window-like defect in the bone)
I: Involvement of mucosa (fenestration exposes root to the mucosa)
N: Normally caused by trauma (both conditions can be caused by periodontal disease or traumatic procedures)
E: Effects of orthodontics (both conditions can also result from orthodontic treatment or occlusal forces)
Differentiate: Primary Herpetic Gingivostomatitis, Necrotizing Gingivitis, and Necrotizing Ulcerative Periodontitis
Simplified Summary in Lay Terms with Mnemonic:
Primary Herpetic Gingivostomatitis is a first-time cold sore infection in the mouth caused by HSV-1, showing painful ulcers, swollen gums, and fever; it’s treated with rest, hydration, and sometimes antiviral medicine like acyclovir.
Necrotizing Gingivitis (NG) is a sudden gum infection from stress or poor hygiene, leading to red, swollen gums, ulcers, bad breath, and bleeding, treated with cleaning, antibiotics, and better oral care.
Necrotizing Ulcerative Periodontitis (NUP) is a severe gum and bone infection often in people with weak immunity, causing tissue loss, exposed bone, and pain; it needs urgent cleaning, antibiotics, and treating overall health.
Mnemonic:
“Hot, Red, Dead Gums”
H for Herpetic Gingivostomatitis (Hot sores, fever).
R for Red Gums in NG (Stress and hygiene issues).
D for Dead Tissue in NUP (Severe damage and exposed bone).
. Discuss the diagnosis and management of gingival recession, including classification.
Gingival recession is diagnosed by looking for signs like the gums moving down and exposing the tooth’s root. Treatment depends on the severity, with options ranging from basic care and grafts for mild cases to more advanced surgery for severe loss of tissue or bone.
C.L.I.M.B.
C: Class I – Localized recession, no interdental loss, no bone loss (Conservative treatment, maintain oral hygiene, graft if needed)
L: Limited to mucogingival junction, no bone or tissue loss (Class II: Non-surgical treatment, grafting if needed)
I: Involves bone or soft tissue loss in interdental area (Class III: Surgical intervention such as grafts, flap surgery, orthodontic treatment)
M: Major bone or soft tissue loss, malpositioned teeth, large gaps (Class IV: Advanced surgical treatments like bone grafting and implants)
Millers classificaition of gum recession
“I See Big Teeth”
I = Class I – Intact papillae, no bone loss
S = Class II – Surface recession, no tissue loss in interdental
B = Class III – Bone loss, and may involve malpositioned teeth
T = Class IV – Total loss of bone and soft tissue, tooth mobility
Explain Brännström’s hydrodynamic theory of pain transmission.
Brännström’s theory explains that stimuli, such as cold or pressure, cause fluid movement within the dentinal tubules of exposed dentin. This movement disturbs the odontoblastic processes at the base of the tubules, activating nerve endings and resulting in sharp pain. It is the most widely accepted theory for dentinal hypersensitivity.
Discuss the role of an OHT in managing dentinal hypersensitivity.
An Oral Health Therapist (OHT) plays a key role in diagnosing dentinal hypersensitivity, educating patients on proper brushing techniques, and recommending preventive measures, such as avoiding acidic foods and drinks. They may apply desensitizing agents, like fluoride varnishes, or use therapeutic interventions to seal open dentinal tubules and reduce pain. They also monitor patients’ oral health following treatments like scaling or periodontal therapy.
D.E.S.I.G.N.
D: Diagnosing dentinal hypersensitivity (identifying symptoms and causes)
E: Educating patients (on proper brushing techniques and preventive care)
S: Sealing dentinal tubules (using desensitizing agents like fluoride varnishes)
I: Intervening therapeutically (applying treatments to reduce pain)
G: Guiding preventive measures (avoiding acidic foods and drinks)
N: Nurturing ongoing care (monitoring oral health after scaling or periodontal therapy)
- Identify the active ingredients for currently marketed professional and patient-applied desensitizing agents.
P.S.A.R.S.
P: Potassium nitrate (calms nerves to reduce sensitivity)
S: Stannous fluoride (occludes dentinal tubules)
A: Arginine (amino acid found in toothpastes)
R: Reducing sensitivity (through agents like strontium chloride and glutaraldehyde)
S: Sodium fluoride (used in professional varnishes, helps in desensitization)
This PSARS acronym captures the key active ingredients and their functions in desensitizing agents.
ther agents include strontium chloride, glutaraldehyde with HEMA, and hydroxyapatite, which help block tubule openings and reduce sensitivity.
Four examples of conditions or factors that can lead to reduced salivary flow (hyposalivation) are:
S.A.L.V.A.
S: Systemic diseases (Sjögren’s syndrome, diabetes, rheumatoid arthritis impairing salivary glands)
A: Antihypertensives, antidepressants, and antihistamines (medications causing dry mouth)
L: Lack of hydration (dehydration from insufficient fluid intake or illness)
V: Vomiting and diarrhea (illnesses causing fluid loss and reduced saliva production)
A: Affected by radiation (radiation therapy damaging salivary glands)
Three barriers faced by antenatal care providers in promoting oral health are:
L.I.P.
L: Lack of Oral Health Knowledge (limited training for antenatal care providers)
I: Inadequate time (time constraints during antenatal visits)
P: Perceived Low Priority (oral health seen as less critical compared to other health aspects)
The term “restorative staircase” refers to
The term “restorative staircase” refers to a stepwise approach in dental treatment planning that starts with the least invasive and simplest treatment options and progresses to more complex and invasive ones as needed. The concept emphasizes beginning with conservative treatments, such as remineralization or small fillings, and only advancing to more extensive procedures, like crowns or root canals, if the initial treatments do not sufficiently restore or preserve the tooth. This approach prioritizes preserving as much natural tooth structure as possible
S.T.E.P.S.
S: Start with conservative treatments (such as remineralization or small fillings)
T: Targeting minimal invasiveness (begin with the least invasive procedures)
E: Expanding to more complex procedures (e.g., crowns or root canals) if necessary
P: Preserving natural tooth structure (prioritizing conservation of the tooth)
S: Stepwise approach (progressing to more invasive treatments only when needed)
This STEPS acronym emphasizes the gradual, conservative approach in restorative dental treatment planning.
Three factors that can affect the osseointegration of dental implants are:
B.O.S.S.
B: Bone quality and density (poor bone quality or low density affecting implant stability)
O: Overall health status (systemic conditions, diabetes, smoking, or medications affecting bone healing)
S: Surgical technique (precise placement and minimal trauma to the bone during surgery)
S: Stress on bone (excessive heat, improper angulation, or pressure damaging bone)
The BOSS acronym highlights the key factors that influence implant osseointegration.
Three factors that can affect the osseointegration of dental implants are:
Here’s an acronym for the factors affecting implant osseointegration:
B.O.S.S.
B: Bone quality and density (poor bone quality or low density affecting implant stability)
O: Overall health status (systemic conditions, diabetes, smoking, or medications affecting bone healing)
S: Surgical technique (precise placement and minimal trauma to the bone during surgery)
S: Stress on bone (excessive heat, improper angulation, or pressure damaging bone)
The BOSS acronym highlights the key factors that influence implant osseointegration.
- Explain the concept of osseointegration and its clinical importance in implant success.
Osseointegration is the process by which the bone fuses directly with the surface of the implant, creating a stable anchor for the restoration. This process is critical for implant success, as it ensures that the implant can withstand the forces of chewing and provide long-term function. If osseointegration fails, the implant can loosen, leading to failure of the restoration.
S.T.A.B.L.E.
S: Surface fusion (bone fuses directly with the surface of the implant)
T: Table anchor (creates a stable anchor for the restoration)
A: Allows function (ensures the implant can withstand chewing forces)
B: Bone stability (critical for long-term function and success)
L: Long-term success (essential for the implant to remain functional over time)
E: Eliminates failure (prevents loosening and failure of the restoration)
How does peri-implant health differ from tooth health, and what factors influence it?
Peri-implant health refers to the health of the soft tissue surrounding an implant, while tooth health involves the periodontal ligament and surrounding gum tissue. Peri-implant health can be influenced by factors such as oral hygiene, implant surface design, and the presence of inflammation. Unlike natural teeth, implants do not have a periodontal ligament, making them more susceptible to peri-implant mucositis and peri-implantitis if not properly maintained.
S.O.U.L.
S: Soft tissue health (like the body’s protection, the soft tissue surrounds the implant as a shield)
O: Organic care (oral hygiene and maintenance, mirroring stewardship of the body)
U: Union with the implant (implants lack a ligament, highlighting the need for care and faithfulness)
L: Living integrity (teeth and gums, like a foundation, support lasting function and health)
What are the key aspects of peri-implant maintenance treatment (PIMT) and its role in preventing complications?
Peri-implant maintenance treatment (PIMT) includes regular cleaning, monitoring for signs of inflammation, and using specialized instruments to avoid damage to the implant surface. Regular recall visits (typically every 3-6 months) are crucial for preventing peri-implant diseases like mucositis and peri-implantitis. Effective PIMT helps to ensure long-term implant success and prevents complications such as bone loss.
C: Cleaning (regular cleaning to maintain peri-implant health)
A: Assessing inflammation (monitoring for signs of inflammation to prevent complications)
R: Recall visits (regular visits every 3-6 months for monitoring and prevention)
E: Ensuring success (effective PIMT ensures long-term implant health and prevents bone loss)
What are the clinical signs and risk factors associated with peri-implant mucositis, and how can it be managed?
Peri-implant mucositis is characterized by redness, swelling, bleeding on probing, but no bone loss. It occurs due to plaque accumulation around the implant. Risk factors include poor oral hygiene, smoking, and a history of periodontal disease. Management involves improving oral hygiene, mechanical debridement, and antiseptic treatments to prevent progression to peri-implantitis.
C.L.E.A.N.
C: Cleansing (improving hygiene through proper oral care)
L: Localized debridement (mechanical debridement to remove plaque and debris)
E: Elimination of bacteria (using antiseptic treatments to prevent infection)
A: Adhering to routine (consistent maintenance to ensure ongoing cleanliness)
N: Normalizing health (restoring and maintaining healthy peri-implant tissue)
The CLEAN acronym emphasizes the key components of managing peri-implant health effectively.
Describe the diagnostic differences between peri-implant mucositis and peri-implantitis, and why they are important for treatment planning.
Peri-implant mucositis involves inflammation without bone loss, whereas peri-implantitis is characterized by inflammation with bone loss beyond the initial remodeling. Identifying the stage of peri-implant disease is crucial for treatment planning, as peri-implantitis requires more intensive management, such as decontamination of the implant surface and possibly surgical intervention, whereas mucositis can typically be managed with non-surgical methods.
I.D.E.A.L.
I: Inflammation (common to both mucositis and peri-implantitis)
D: Differentiating stages (mucositis has no bone loss, peri-implantitis involves bone loss)
E: Essential diagnosis (crucial to identify the stage for proper treatment planning)
A: Appropriate management (mucositis can be managed non-surgically, peri-implantitis requires intensive treatment)
L: Long-term health (effective treatment ensures the longevity of the implant and surrounding tissues)
What role does osseointegration play in implant placement, and what factors can affect its success?
Osseointegration is crucial for the long-term success of an implant, as it ensures the implant is securely integrated into the bone. Factors affecting osseointegration include the material of the implant, the quality and quantity of the patient’s bone, the surgical technique, and the patient’s overall health (e.g., diabetes or osteoporosis). Any disruption to osseointegration can result in implant failure.
I: Implanted material (the material of the implant affecting integration)
N: Necessary bone quality (the quality and quantity of the patient’s bone)
T: Technique precision (surgical technique’s role in osseointegration)
E: Effects of health conditions (diabetes, osteoporosis affecting integration)
G: Guaranteeing stability (osseointegration ensures secure implant stability)
R: Resulting failure (disruption in integration leading to implant failure)
A: Aligning with bone (implant securely integrates into the bone)
L: Long-term success (successful osseointegration leads to implant durability)
How do you prevent and manage peri-implantitis in a patient with a history of periodontal disease?
Preventing peri-implantitis in patients with a history of periodontal disease involves thorough initial assessment, ensuring adequate bone and soft tissue health before implant placement, and maintaining meticulous oral hygiene. Regular recall visits and professional maintenance are essential. If peri-implantitis occurs, non-surgical treatments like debridement and antiseptic use are recommended, with more invasive treatments necessary for advanced cases.
P.R.O.T.E.C.T.
P: Prevention through assessment (thorough initial evaluation of bone and soft tissue health)
R: Regular oral hygiene (maintaining meticulous oral hygiene to prevent peri-implantitis)
O: Ongoing maintenance (regular recall visits and professional cleaning)
T: Treatment for early stages (non-surgical debridement and antiseptic treatments)
E: Ensuring long-term health (maintaining proper hygiene and professional follow-ups)
C: Comprehensive care (invasive treatments for advanced cases, like flap surgery if needed)
T: Timely intervention (early diagnosis and management to prevent progression)
What are the clinical implications of medical conditions that may require special precautions prior to or during dental treatment?
Restorative treatment planning for adult patients must consider factors like medical history (e.g., systemic conditions, allergies, medications), dental history (previous treatments, risk factors), and social factors (oral hygiene habits, diet, lifestyle). Aging, worn dentitions, increased edentulism, and prosthodontic needs are also key considerations, along with ensuring treatment addresses functional and aesthetic concerns in a holistic way.
DASH
Dental history (previous treatments, risk factors)
Aging (worn dentitions, increased edentulism)
Social factors (oral hygiene habits, diet, lifestyle)
Health (medical history, systemic conditions, allergies, medications)
Understand the principle concepts of the phases of care framework for treatment planning in dentistry:
Always Carefully Correct Dental Maintenance
SYSTEMIC
Always = Acute Phase (address ASAP concerns)
Carefully = Control Phase (stabilize dental health)
Correct = Definitive Phase (corrective or reparative care)
Dental = Definitive Phase (referrals to specialists as needed)
Maintenance = Maintenance Phase (ongoing care and prevention)
Systemic Phase focuses on reviewing medical, dental, and social histories to identify factors that may influence care.
Acute Phase addresses urgent issues such as pain or dental trauma.
Control Phase involves stabilizing oral health by managing disease and risk factors.
Definitive Phase focuses on corrective treatments and referrals as necessary.
Maintenance Phase ensures ongoing care and prevention through recall visits and reinforcement of oral health practices.
–
Systemic Phase: “Seek wisdom and understanding” (Proverbs 4:7) by considering the whole person’s health and history before making decisions.
Acute Phase: “Heal the brokenhearted” (Psalm 147:3) by addressing urgent pain and issues with immediate care.
Control Phase: “Guard your heart” (Proverbs 4:23) by stabilizing health and preventing further harm through careful management.
Definitive Phase: “Two are better than one” (Ecclesiastes 4:9) by providing corrective treatment or referring to experts for specialized care.
Maintenance Phase: “Encourage one another” (1 Thessalonians 5:11) by maintaining care and supporting long-term health with regular check-ups.
Rationalise and implement evidence-based approaches when formulating a patient’s individual treatment plan:
Evidence-based approaches involve utilizing current research and clinical guidelines to inform treatment decisions. Critical reasoning is applied to tailor the treatment plan to the patient’s unique medical, dental, and social context. This includes selecting interventions that have proven effectiveness, such as using fluoride to prevent caries or applying periodontal therapies based on the patient’s risk profile and health status.
Develop sequential, holistic and patient-centred treatment plans:
A patient-centred treatment plan is developed by considering the patient’s preferences, values, and individual needs while ensuring all aspects of their oral health are addressed. The treatment plan should be sequential, starting with urgent care needs in the acute phase, progressing through disease control and restorative treatments, and concluding with ongoing maintenance to prevent further issues. Holistic planning ensures all factors, including physical, emotional, and financial aspects, are considered to provide comprehensive and personalized care.
patient-centred care.
phases of care
Always Carefully Correct Dental Maintenance
SYSTEMIC
Always = Acute Phase (address ASAP concerns)
Carefully = Control Phase (stabilize dental health)
Correct = Definitive Phase (corrective or reparative care)
Dental = Definitive Phase (referrals to specialists as needed)
Maintenance = Maintenance Phase (ongoing care and prevention)
What factors must the treatment planning process for adult patients, consider?
CAPTURE
Complex medical histories
Aging/worn dentitions (Loss of vertical dimension & cracks)
Prosthodontic considerations
THIRD molars
Underlying endodontic considerations
Rates of edentulism and increased edentulism
Endodontic and periodontal considerations
CAPTURE emphasizes the comprehensive nature of adult treatment planning, ensuring that all aspects of the patient’s health and dental needs are addressed.
WHY??
Complex medical histories:
Biblical reasoning: “For the Lord gives wisdom; from his mouth come knowledge and understanding” (Proverbs 2:6). God calls us to be wise and diligent in all aspects of care. Understanding complex medical histories helps us serve patients well and honor their overall health, aligning our work with His wisdom.
Aging/worn dentitions (Loss of vertical dimension & cracks):
Biblical reasoning: “Even to your old age and gray hairs, I am he, I am he who will sustain you” (Isaiah 46:4). God cares for us throughout all stages of life. As we age, our bodies and teeth change, and He calls us to care for the elderly with the same compassion and diligence He offers to us at every age.
Prosthodontic considerations:
Biblical reasoning: “So God created mankind in his own image” (Genesis 1:27). Restoring function and beauty through prosthodontics reflects God’s creativity in designing us. In caring for others’ dental needs, we are called to help restore their dignity and the wholeness of their image.
THIRD molars:
Biblical reasoning: “There is a time for everything, and a season for every activity under the heavens” (Ecclesiastes 3:1). God has designed times and seasons for all things. Understanding when to address third molars ensures that we align with the right timing in care and treatment, guided by wisdom and discernment.
Underlying endodontic considerations:
Biblical reasoning: “Let all things be done decently and in order” (1 Corinthians 14:40). God desires order and restoration. Addressing endodontic issues, like root infections or damage, brings healing and order to a patient’s dental health, aligning with God’s will to restore what is broken.
Rates of edentulism and increased edentulism:
Biblical reasoning: “The plans of the diligent lead surely to abundance” (Proverbs 21:5). God calls us to be proactive, caring for others’ needs before they become overwhelming. By addressing edentulism early, we prevent further decline and provide the care necessary to restore health and abundance.
Endodontic and periodontal considerations:
Biblical reasoning: “He heals the brokenhearted and binds up their wounds” (Psalm 147:3). Just as God heals us, He calls us to heal and restore, especially the foundations of dental health, such as endodontics and periodontics. Caring for these foundational needs aligns with God’s desire for us to heal and strengthen what is broken, ensuring full restoration.
The Restorative Staircase
MICE
MO (Class I and II restorations)
Intermediate (MOD - Class III and IV restorations)
Complex (pins, cusp capping, indirect restorations, Endo & crown)
Extractions and possible replacement
MICE helps remember the stages of restorative treatment, moving from basic restorations to more complex and restorative procedures.
Comprehensive oral examination will involve??
CHAIR-P
Comprehensive oral examination
History assessment (Patient Histories)
Assessment of Oral Health Status
Individual Tailored Risk Management Plan
Risk assessment
Phases of care framework
Comprehensive Oral Examination
Clinical Importance: Ensures a full understanding of the patient’s oral health, guiding accurate diagnosis and treatment.
Message from God: “Be diligent to know the state of your flocks” (Proverbs 27:23) – highlights the importance of thorough examination for effective care.
History Assessment (Patient Histories)
Clinical Importance: Identifies risks and underlying conditions, influencing treatment decisions.
Message from God: “The plans of the diligent lead surely to abundance” (Proverbs 21:5) – emphasizes careful planning for better outcomes.
Assessment of Oral Health Status
Clinical Importance: Identifies current oral conditions, enabling targeted interventions.
Message from God: “Guard your heart, for everything you do flows from it” (Proverbs 4:23) – stresses the importance of protecting oral health as the foundation of overall health.
Individual Tailored Risk Management Plan
Clinical Importance: Customizes care based on the patient’s unique needs, reducing risks and complications.
Message from God: “I know the plans I have for you” (Jeremiah 29:11) – highlights the value of personalized care for better health outcomes.
Risk Assessment
Clinical Importance: Prevents complications by identifying and managing potential risks.
Message from God: “The prudent sees danger and hides himself” (Proverbs 22:3) – underscores the importance of anticipating and addressing risks.
Phases of Care Framework
Clinical Importance: Ensures organized, step-by-step care for optimal treatment and outcomes.
Message from God: “Let all things be done decently and in order” (1 Corinthians 14:40) – advocates for structured care to ensure effective patient treatment.
Social History will involving asking abt? why do we need it?
SHADFOR
Smoking status
History (Personal History)
Alcohol consumption
Dietary Habits
Fluorides
Oral Hygiene Practices
Recreational drug use
Why?
BRAD
Build an individual risk profile
Recognize factors impacting appointment attendance
Assess patient’s needs
Determine risk factors and barriers
Name all components considered for an Assessment of Oral Health Status
SCOPE-IE
Saliva (Saliva)
Care (Immediate care assessment)
Orthodontic assessment (Orthodontic assessment)
Periodontal screening (Periodontal screening)
Extraoral (Head and Neck)
Intraoral (Oral mucosa)
Endodontic considerations (Endodontic considerations)
Types of dx
Here’s a simplified explanation of each type of diagnosis:
Clinical Diagnosis:
This is the diagnosis made based on the patient’s symptoms, physical exam, and history. For example, if a patient has a toothache, the dentist may identify the issue just by examining the tooth.
Pathological Diagnosis:
This diagnosis is based on lab tests or samples (like blood tests or tissue biopsies) to find out if there’s a disease, like cancer or infection, affecting the body.
Direct Diagnosis:
This type of diagnosis is made when a clear cause of the symptoms is identified right away, such as a cavity seen directly on an X-ray.
Provisional (Working) Diagnosis:
A provisional diagnosis is an early, temporary diagnosis that the dentist uses while waiting for more tests or information. It’s like a guess based on the early signs.
Deductive Diagnosis:
This approach uses reasoning to narrow down possible causes. For example, if a patient has swelling and pain, the dentist uses logic to figure out what might be causing the issue.
Differential Diagnosis:
This is the process of considering several possible causes for a patient’s symptoms and then ruling them out one by one. It’s like a process of elimination.
Diagnosis by Exclusion:
This diagnosis is made when other possible conditions are ruled out, and the remaining condition is identified. For example, if all other causes of pain are excluded, the dentist might determine it’s due to an infection.
Provocative Diagnosis:
This diagnosis is made by triggering or testing certain symptoms to see how the body reacts. For example, a dentist might apply pressure to a tooth to see if it causes pain, which helps identify the problem.
Diagnosis Made Only by a Response to Treatment:
This diagnosis is confirmed only after the patient responds to a treatment. For example, if a patient’s pain goes away after treatment, it helps confirm the diagnosis was correct.
systemic considerations
Here’s an alternative acronym:
ARMIS
Allergies (any allergies?)
Recent injuries (recent injuries?)
Medications (oral and systemic side effects, drug interactions)
Increased risk (of bleeding, perioperative infection, medical emergencies)
Social history (relevant aspects impacting care)
ARMIS helps to remember the key factors that impact treatment planning during the systemic phase of care.
acute phase considerations
CARE
Complaints (Address the chief complaint or urgent care needs)
Assessment (Carefully consider symptoms and concerns to form a diagnosis)
Recommendation (Stabilize, treat, or refer as necessary)
Emergency (Provide immediate care for pain, trauma, or aesthetic concerns)
CARE helps remember the key steps in addressing urgent patient needs and ensuring appropriate treatment or referral.
control phase considerations
STEPS
Stabilize (Achieve a reduction of oral disease and stabilize dental health)
Targeted plan (Create a tailored preventive and corrective treatment plan)
Etiological risk factors (Identify risk factors and address underlying causes)
Practitioners (Involve various dental, medical, and allied health professionals)
Strategies (Consider periodontal, restorative, endodontic, exodontic, prosthodontic, and preventive care)
definitive phase considerations
CURE
Corrective care (Focus on corrective or reparative treatments)
Understanding (Reassess the patient’s needs to determine further care)
Referral (Refer to specialized dental and health professionals as needed)
Expert involvement (Include other health professionals such as physiotherapists, speech pathologists, etc.)
CURE captures the essence of the Definitive Phase, focusing on correcting issues, reassessing needs, and involving experts for comprehensive care.
Maintainence phase
CARE
Continued support (Focused on supportive therapy to maintain oral health)
Appropriate recall (Establish an appropriate recall period for future visits)
Reinforcement (Reinforce oral health prevention during visits)
Encouragement (Remotivate patients to maintain healthy habits)
CARE emphasizes the ongoing support and prevention in the Maintenance Phase, ensuring patients maintain their oral health through regular check-ups and encouragement.
show example of phases of care tx plan
- Discuss the 3 different types of restorative margin placements.
Here’s an acronym for the characteristics of each margin type:
Supragingival margin: This margin is located above the gingival line and does not directly impact the periodontium. It is often used in areas where aesthetics are less of a concern. The finishing is easier compared to other margin types, and it generally has the least impact on the surrounding gum tissue. It’s ideal when aesthetics are not critical and provides a simpler approach.
Equigingival margin: This margin is positioned at the same level as the gingival margin. It is often used when the supragingival margin doesn’t meet aesthetic needs. With newer materials, there is minimal impact on the periodontium, and the finishing is easier than subgingival margins. It is used when a supragingival margin would be insufficient for aesthetic purposes but still maintains good gum health.
Subgingival margin: This margin is placed below the gingival margin, making it harder to access for finishing procedures. While necessary for some restorations, such as when there’s a need for contour alterations or to hide the tooth-restoration interface, it can violate the biologic width if placed too far below the gingiva, leading to potential periodontal complications like bone loss or gingival recession.
S.E.S.T.
S: Simplicity (Supragingival: above the gingiva, easy finishing, minimal impact on gums)
E: Esthetics (Equigingival: at the gingiva level, minimal periodontium impact, used when aesthetics are needed)
S: Sensitivity (Subgingival: below the gingiva, harder to access, potential for periodontal issues like bone loss if not placed correctly)
T: Tolerance (Supragingival and Equigingival have less risk of violating biological width compared to subgingival)
Define the terms biologic width, biologic zone, and the dentogingival complex.
The biologic width is the space between the gum and the bone, and it needs to be kept intact to protect your gums and prevent problems. The dentogingival complex includes this space along with the tissue that attaches the tooth to the gum, ensuring everything stays healthy and in place.
Biologic width: This refers to the distance from the base of the gingival sulcus or pocket to the alveolar bone, typically around 2.04mm. It is essential to maintain this space to prevent any damage to the periodontium and avoid periodontal issues.
Biologic zone: This refers to the connective tissue attachment, junctional epithelium, and the sulcus apical to the restored margin. It is the protective area between the tooth and the surrounding gingival tissue.
Dentogingival complex: This term refers to the full measurement from the alveolar crest to the gingival margin, encompassing the biologic width and the connective tissue attachment. The dentogingival complex includes the biologic width and zone, ensuring the integrity and health of the periodontium.
AIM”
A: Alveolar Bone to Sulcus (Biologic Width) – This refers to the distance from the base of the gingival sulcus or pocket to the alveolar bone (typically around 2.04mm). It’s the space you want to maintain to avoid periodontal issues.
I: Integrity of Gingiva (Biologic Zone) – This is the connective tissue attachment, junctional epithelium, and the sulcus apical to the restored margin, forming a protective barrier between the tooth and gingiva.
M: Measure from Crest to Margin (Dentogingival Complex) – This is the full measurement from the alveolar crest to the gingival margin, encompassing both biologic width and the biologic zone, ensuring periodontal health.
Mnemonic: “AIM for healthy gums!”
This acronym helps you remember the essential components—A for the alveolar bone distance, I for the integrity of gingiva, and M for the complete measurement from crest to margin.
- Discuss the depth at which it is considered safe to place restorative margins subgingivally.
The ideal depth for placing restorative margins subgingivally is at least 2.5mm from the alveolar crest to avoid impinging on the biologic width. If the sulcus is shallow (1.0-1.5mm), it is recommended that the margin be placed no more than 0.5mm subgingivally to avoid causing recession. In deeper sulcus cases, the margin can be placed further below the gingival crest, but the risk of recession increases with the depth of the sulcus. Probing depths can help estimate how deep it’s safe to place the restoration.
. Identify the two potential periodontal responses to restorative margins that violate the biologic width.
Bone loss: If restorative margins violate the biologic width by being placed too deep, the body’s natural response is bone loss as the gingival attachment is disturbed. This can lead to a loss of supporting bone around the tooth.
Gingival recession: The other response is gingival recession, where the gingival tissue pulls away from the tooth, exposing the root. This can cause aesthetic concerns and compromise periodontal health, making the tooth more susceptible to sensitivity and decay.
Discuss how marginal fit, contour, and subgingival restorative debris can affect the periodontal response.
Marginal Fit: The more a filling or crown fits poorly, the more likely it is to irritate your gums. Gaps around the filling can trap plaque, which can make your gums sore and inflamed.
Contour: The shape of a filling or crown can affect how easily you can clean your teeth, the space between your teeth, and whether food gets stuck.
The best shape helps you clean your teeth well, supports healthy gums, and looks natural. But if the filling or crown is too big or bulky, it can trap plaque, which can cause gum irritation and inflammation.
The fit of a dental restoration is important to prevent plaque buildup and gum irritation, which can lead to gum disease. It’s also important to ensure the restoration isn’t too bulky, and all materials are removed from beneath the gums to keep the area clean and promote healing.
Marginal fit: The fit of the restoration margin plays a crucial role in periodontal health. If the margin is not well-sealed, plaque and bacteria can accumulate, leading to gingival inflammation and increased risk of periodontal disease. Proper marginal fit reduces the risk of plaque retention and ensures better gum health.
Contour: The contour of the restoration is important for access to oral hygiene. An over-contoured restoration (e.g., a bulky crown) can cause plaque accumulation, leading to gingival inflammation. The ideal contour allows for easy plaque removal and a natural gingival form, promoting better periodontal health.
Subgingival restorative debris: Any debris left beneath the gingival margin after a restoration procedure (such as retraction cord, impression material, provisional material, or cement) can irritate the gums and interfere with healing. It’s essential to ensure that all foreign materials are removed to avoid inflammation or infection of the surrounding tissues.
Here’s an acronym for the Marginal Fit, Contour, and Subgingival Restorative Debris:
F.I.T.T.
F: Fit of restoration margin (a well-sealed margin prevents plaque accumulation, reducing the risk of gingival inflammation and periodontal disease)
I: Ideal contour (restoration contour should allow for proper plaque removal and a natural gingival form, avoiding over-contouring that leads to plaque buildup)
T: Thorough cleaning (removal of subgingival restorative debris such as retraction cord, impression material, and cement to avoid irritation and promote healing)
T: Tissue protection (ensuring good marginal fit and contour protects the gum tissues and promotes periodontal health)
Discuss interproximal embrasure, pontic, and occlusal considerations related to restorations and periodontal health.
The fake tooth (pontic) should allow normal chewing without stressing the supporting teeth.
Occlusal problems can lead to gum disease and bone loss, so treatment involves addressing inflammation first and then restoring tooth function.
The space between teeth should be shaped to allow the gums to fill properly and prevent food traps, which helps with plaque removal and healthy gums. When replacing missing teeth with a pontic or adjusting bite forces, it’s important to ensure the right fit to avoid gum problems, bone loss, and ensure proper oral health.
- Discuss interproximal embrasure, pontic, and occlusal considerations related to restorations and periodontal health.
Interproximal embrasures: These spaces should be shaped to allow the gingival papillae to fill the space properly without impingement. An ideal embrasure space allows for good plaque removal and maintains healthy tissue. If the space is too large, it can serve as a food trap, leading to plaque accumulation and possible periodontal disease.
Pontic considerations: A pontic is a prosthetic tooth that replaces a missing tooth in a dental bridge. It needs to provide a functional occlusal surface while not overloading the abutment teeth. The shape of the pontic is important for preventing plaque accumulation and promoting good oral hygiene. A smooth pontic surface leads to a favorable biologic response.
Occlusal considerations: Occlusal trauma can contribute to periodontal disease by disrupting normal force distribution and causing atrophy of periodontal tissues. When teeth are lost, occlusal forces are altered, leading to bone loss. Restoring proper occlusion with restorative or prosthetic solutions is essential for preventing further damage and maintaining the health of the periodontium.
“SPO”
S: Shaped for Health (Interproximal Embrasures) – The space between teeth should be shaped to allow the gingival papillae to fill properly, preventing impingement. This ensures good plaque removal and maintains healthy tissue.
P: Proper Function (Pontic Considerations) – A pontic is a prosthetic tooth that replaces a missing one. It must provide a functional occlusal surface without overloading the abutment teeth, while maintaining plaque-free surfaces for good oral hygiene.
O: Optimal Occlusion (Occlusal Considerations) – Occlusal trauma can lead to periodontal disease by disrupting the distribution of forces. Proper occlusion is crucial for preventing further tissue atrophy, bone loss, and maintaining periodontal health.
- Discuss interproximal embrasure, pontic, and occlusal considerations related to restorations and periodontal health.
- Define Hepatitis and HIV.
Hepatitis is when the liver becomes inflamed due to viruses (A-E) that infect the liver, causing damage as the body tries to fight off the virus. HIV is a virus that weakens the immune system by attacking specific cells, and if not treated, it can lead to AIDS, which makes the body more vulnerable to infections, cancers, and other health problems.
- Discuss the aetiology and general categories of Hepatitis.
Hepatitis is caused by five viruses (A-E), each affecting the liver differently:
Hepatitis A is spread through contaminated food and causes short-term illness; vaccine available.
Hepatitis B spreads through blood and fluids, can cause long-term liver damage; vaccine available.
Hepatitis C is spread through blood, may cause chronic liver issues; no vaccine, but treatable with antivirals.
Hepatitis D only occurs with Hepatitis B and spreads through blood; rare in Australia.
Hepatitis E spreads through contaminated food and causes short-term illness; no vaccine.
- Discuss the aetiology of HIV.
HIV is caused by a retrovirus that attacks CD4 T-cells, which are crucial for the immune response. The virus replicates inside the host’s body, impairing the immune system and increasing vulnerability to infections and certain cancers. There are two main types of HIV:
HIV-1 (most common globally)
HIV-2 (less common, primarily in West Africa)
Discuss the medical treatment and dental management of patients with Hepatitis C and HIV.
Hepatitis C: Treatment with antiviral drugs like Epclusa® and Maviret® can cure Hepatitis C in 95-99% of cases. Dental care focuses on preventing dry mouth, cavities, and fungal infections, with possible saliva tests and fluoride treatments.
SCDC
Saliva testing
Candidiasis (fungal infections)
Dental caries (cavities)
Chronic xerostomia (dry mouth)
HIV: HIV is treated with a combination of antiretroviral drugs, and regular tests monitor its progress. Dental care includes managing oral issues like gum disease and fungal infections, emphasizing good oral hygiene and fluoride use.
**HFC
**
Hygiene (Good oral hygiene)
Fluoride applications
Candidiasis managemen
- List and describe the oral manifestations of undiagnosed and untreated Hepatitis C and HIV.
Hepatitis C: Patients may experience dry mouth (xerostomia), dental caries, altered taste, burning sensation in the mouth, candidiasis, halitosis, and difficulty chewing and swallowing.
**CHART
**
Candidiasis (fungal infections)
Halitosis (bad breath)
Altered taste
Recurrent burning sensation in the mouth
Tooth decay (Dental caries)
HIV: Oral manifestations include fungal infections (e.g., candidiasis), bacterial infections (e.g., necrotizing ulcerative gingivitis and periodontitis), viral infections (e.g., herpes simplex, human papillomavirus), and oral neoplasms (e.g., Kaposi’s sarcoma). The presence of these conditions is often linked to a low CD4 count.
**FLOUR
**
Fungal infections (e.g., candidiasis)
Low CD4 count (linked to oral issues)
Oral neoplasms (e.g., Kaposi’s sarcoma)
Ulcerative gingivitis (necrotizing periodontitis)
Rashes (viral infections like herpes simplex, HPV)
Identify the different HIV antiviral medical agent classes and their mechanisms of action.
HIV antiviral medications work by targeting different stages of the virus’s life cycle: they prevent the virus from entering cells, stop its replication, mimic DNA to halt replication, prevent integration into DNA, and block the virus from maturing. The PInT-PE acronym helps remember these actions: Prevent entry, Inhibit replication, Nucleoside mimicry, Prevent integration, and Enzyme blocking.
- Identify and discuss the current Hepatitis C medications.
Current Hepatitis C medications, such as Epclusa, Maviret, Harvoni, Zepatier, and VOSEVI, are direct-acting antivirals (DAAs) that target different stages of the virus’s life cycle. These medications are prescribed based on the virus’s genotype and liver condition, with cure rates of 95-99%.
- Discuss the legal situations of HIV and Hepatitis C in the clinic.
In Australia, it is illegal to discriminate against patients based on their HIV or Hepatitis C status. Patients are not required by law to disclose their status unless a needle-stick injury occurs. If a healthcare worker is exposed to a blood-borne virus (BBV), the patient is legally obliged to disclose their status.
. Identify what HIV “PeP” is and how it can be accessed.
Post-exposure Prophylaxis (PeP) is a 28-day course of HIV medications taken after possible exposure to reduce the risk of infection, and it must be started within 72 hours. In Australia, PeP can be accessed through hospitals, GPs, or a 24-hour hotline (1800 737 669).
- Discuss what “PreP” is and what it is used for.
Pre-exposure Prophylaxis (PrEP) is a daily medication (e.g., Truvada 200 mg/300 mg) taken by HIV-negative individuals to reduce the risk of HIV infection, primarily against HIV-1. In Australia, PrEP is available through the PBS at a cost of $7 per script for concessional patients.
Types of rinses in market
C: Chlorhexidine (CHX) – The gold standard for anti-plaque and anti-gingivitis.
E: Essential Oils – Found in products like Listerine, effective against plaque and gingivitis.
S: Cetylpyridinium Chloride (CPC) – A less effective but commonly used quaternary ammonium compound.
T: Tea Tree Oil – A natural antimicrobial mouth rinse with limited clinical evidence.
Antiseptics vs. Antibiotics differences?
Antiseptics stop the growth of germs (bacteria, fungi, viruses) without necessarily killing them and are used locally. They work in multiple ways, reducing resistance.
Antibiotics specifically target and kill bacteria or stop their growth, either locally or systemically, by attacking their internal structures.
Mouth rinses today application
Plaque-control – prevention of gingivitis and periodontitis Fluoride-based – caries prevention & control
Potassium-based – control of dentine hypersensitivity
Dry mouth control agents
Breath-freshening agents, tooth whitening agents, etc.
Ideal mouth rinse should:
P.L.A.C.E.T.S.
P: Plaque control – Effective in plaque inhibition and preventing gingivitis.
L: Low interaction – Does not interfere with toothpaste ingredients.
A: Acceptable taste – Pleasant taste for patient compliance.
C: Chemical control – Controls plaque chemically.
E: Effective substantivity – Stays on teeth long enough to work.
T: Tolerable – No adverse effects.
S: Safe (Non-toxic) – Does not cause harm or toxicity.
What is the step towards a more sophisticated holistic approach to oral prophylaxis?
: The step involves combining mechanical plaque (biofilm) control with chemical plaque control to disrupt biofilm, expose bacteria, and prevent bacterial growth as an adjunct to mechanical plaque control.
What is Chlorhexidine (CHX) and how is it used?
Chlorhexidine (CHX) is a widely used product in dental care, medicine, and disinfectants, and can also be found in hygiene and beauty products. It’s a strong chemical that interacts with toothpaste ingredients like SLS. CHX works best in a salt form called digluconate, which dissolves easily in water, and it’s available in both alcohol and alcohol-free versions.
What is the spectrum and action of Chlorhexidine (CHX)?
Chlorhexidine is effective against a wide range of harmful germs, including certain bacteria (both Gram-positive and some Gram-negative) and fungi like Candida albicans. It’s especially active against bacteria that cause gum disease, such as P. gingivalis, A. actinomycetemcomitans, and F. nucleatum. When used in higher concentrations (0.12% or 0.2%), it quickly kills bacteria and then prevents their growth for a longer time. It also helps reduce plaque and inflammation in the mouth.
B: Broad spectrum – Effective against many types of bacteria and fungi.
F: Fungi – Moderately effective against Candida albicans.
G: Gram-positive bacteria – Strong activity against these types of bacteria.
P: Periodontal pathogens – Targets bacteria like P. gingivalis, A. actinomycetemcomitans, and F. nucleatum.
A: Anti-plaque and anti-inflammatory – Helps reduce plaque and inflammation.
What is Cetylpyridinium Chloride (CPC) and how is it used in mouth rinses?
Cetylpyridinium Chloride (CPC) is a common ingredient in mouth rinses in Australia. It has a low retention time in the mouth (3-6 hours) and doesn’t stay effective as long as other rinses like Chlorhexidine (CHX). To get similar results to CHX, it would need to be used more often, up to 4 times a day, but this is not always practical for patients. CPC is also used in cosmetic products, with 20 ml used for 30 seconds twice a day. It can interact with ingredients like Sodium Lauryl Sulfate (SLS) in toothpaste, and while it has similar side effects to CHX, they tend to be less severe.
Mnemonic:
C.A.S.T.
C: CPC – The active ingredient in the mouth rinse.
A: Amount – Needs to be used 4 times a day for effectiveness.
S: Side effects – Similar to CHX, but less severe.
T: Time – Low retention time, only lasts 3-6 hours.
Assess and diagnose the severity of root carious lesions, and when referrals may be necessary.
What do these I/O progress pics suggest?
Discuss Plaque Control for Pediatric Patients:
Plaque Control for Pediatric Patients:
Manual Dexterity: Younger children need help with brushing and flossing from caregivers.
Age-Dependent Regimen: Older children can use electric toothbrushes; younger or special needs children may need extra help or tools.
Orthodontic Appliances: Kids with braces need special plaque control to avoid gum swelling and inflammation.
Flossing and Mouthwashes: Flossing may be hard for young children, and mouthwashes should be used carefully based on age.
Mnemonic: “M.A.O.F.”
M for Manual Dexterity
A for Age-Dependent Regimen
O for Orthodontic Appliances
F for Flossing and Mouthwashes
Hypodontia refers to missing teeth, ranging from one or a few (hypodontia) to six or more (oligodontia) or complete absence (anodontia), often affecting lateral incisors, second premolars, and wisdom teeth. It can be sporadic, hereditary, or linked to conditions like ectodermal dysplasia and Down syndrome. Signs include visible gaps, prolonged baby teeth, and peg-shaped teeth, with treatment focusing on managing gaps and alignment.
Disorders of Tooth Development (Extra Teeth)
Extra teeth can form when the dental tissue (dental lamina) creates additional tooth buds. These extra teeth often have unusual shapes:
Conical supernumeraries: Small, pointy teeth with short roots, sometimes upside-down.
Tuberculate supernumeraries: Barrel-shaped crowns.
Supplemental teeth: Look like normal teeth.
These extra teeth often stop permanent teeth from erupting and are sometimes seen as a “third set” of teeth between baby and adult teeth.
Disorders of Tooth Development (Extra Teeth)
Extra teeth can form when the dental tissue (dental lamina) creates additional tooth buds. These extra teeth often have unusual shapes:
Conical supernumeraries: Small, pointy teeth with short roots, sometimes upside-down.
Tuberculate supernumeraries: Barrel-shaped crowns.
Supplemental teeth: Look like normal teeth.
These extra teeth often stop permanent teeth from erupting and are sometimes seen as a “third set” of teeth between baby and adult teeth.
Extra Teeth (Supernumerary Teeth): How Common Are They?
Found in 0.3–0.8% of baby teeth and 1–3.5% of adult teeth.
Most (98%) appear in the upper jaw, with 75% being mesiodens—extra teeth in the middle of the upper jaw.
Other names include paramolar (near molars), distomolar (behind molars), hyperdontia, polydontism, and supplemental teeth (look like normal teeth).
Extra Teeth (Supernumerary Teeth): How Common Are They?
Found in 0.3–0.8% of baby teeth and 1–3.5% of adult teeth.
Most (98%) appear in the upper jaw, with 75% being mesiodens—extra teeth in the middle of the upper jaw.
Other names include paramolar (near molars), distomolar (behind molars), hyperdontia, polydontism, and supplemental teeth (look like normal teeth).
Extra Teeth (Supernumerary Teeth): How Common Are They?
Found in 0.3–0.8% of baby teeth and 1–3.5% of adult teeth.
Most (98%) appear in the upper jaw, with 75% being mesiodens—extra teeth in the middle of the upper jaw.
Other names include paramolar (near molars), distomolar (behind molars), hyperdontia, polydontism, and supplemental teeth (look like normal teeth).
Explain oral manifestations of hep c
Hepatitis C is a liver infection that affects the body’s ability to filter toxins, fight infections, and maintain overall health. Since the liver is linked to many body systems, including the mouth, the infection can cause several oral health problems:
Sialadenitis (Swelling of Salivary Glands): Hepatitis C can cause inflammation in the salivary glands, leading to swelling and discomfort. This happens because the virus may directly attack these glands or because the immune system is overreacting.
Xerostomia (Dry Mouth): Damage to the salivary glands can reduce saliva production, causing dry mouth. Saliva is essential for keeping the mouth healthy, so this can lead to discomfort, increased cavities, and difficulty eating or talking.
Lichen Planus (White or Red Spots in the Mouth): Hepatitis C can trigger an immune response that causes a condition called oral lichen planus, where the body’s immune system mistakenly attacks the mouth’s lining, creating patches, ulcers, or a burning sensation.
Sjogren’s Syndrome (Dry Mouth and Eyes): Hepatitis C can be associated with autoimmune conditions like Sjogren’s syndrome, where the immune system attacks the salivary and tear glands, leading to chronic dry mouth and eyes.
Petechiae (Small Red or Purple Spots): Liver dysfunction from Hepatitis C affects blood clotting, leading to small bleeding spots in the mouth (petechiae) or other areas.
Gingivitis and Periodontal Disease: The weakened immune system and reduced saliva flow can increase the risk of gum inflammation and infections.
Mnemonic: “Six Pretty Little Soft Gums”
S: Sialadenitis
X: Xerostomia
P: Petechiae
L: Lichen Planus
S: Sjogren’s Syndrome
G: Gingivitis
Diagnosing Extra Teeth (Supernumerary Teeth):
Identified when adult teeth fail to erupt or come in the wrong place.
Often discovered through routine dental X-rays.
Can be linked to conditions like Cleidocranial Dysplasia, Gardner’s Syndrome, or cleft palate.
Diagnosing Extra Teeth (Supernumerary Teeth):
Identified when adult teeth fail to erupt or come in the wrong place.
Often discovered through routine dental X-rays.
Can be linked to conditions like Cleidocranial Dysplasia, Gardner’s Syndrome, or cleft palate.
Diagnosing Extra Teeth (Supernumerary Teeth):
Identified when adult teeth fail to erupt or come in the wrong place.
Often discovered through routine dental X-rays.
Can be linked to conditions like Cleidocranial Dysplasia, Gardner’s Syndrome, or cleft palate.
Diagnosing Extra Teeth (Supernumerary Teeth):
Identified when adult teeth fail to erupt or come in the wrong place.
Often discovered through routine dental X-rays.
Can be linked to conditions like Cleidocranial Dysplasia, Gardner’s Syndrome, or cleft palate.
mesiodens
mesiodens
mesiodens
mesiodens
Supernumerary teeth
Supernumerary teeth
Supplemental
Supplemental
Mesiodens (Extra Tooth in the Upper Midline): Clinical Signs
Delayed or failed eruption of a front tooth.
Rotated teeth.
A gap (diastema) between the front teeth.
Misaligned permanent front teeth.
Mesiodens (Extra Tooth in the Upper Midline): Clinical Signs
Delayed or failed eruption of a front tooth.
Rotated teeth.
A gap (diastema) between the front teeth.
Misaligned permanent front teeth.
Problems from Extra Teeth and Related Conditions:
Erupted teeth: May cause crowding, biting issues, gaps, or cavities; conical ones are often easy to remove.
Unerupted teeth: Can block or move nearby teeth; rare issues include damage or cysts and may require early surgical removal or monitoring if harmless.
Diagnosis: Located using X-rays (maxillary occlusal, SLOB technique) or cone beam CT.
Referral: Cases should be referred to a Dental Officer or Pediatric Dentist.
Cleidocranial Dysplasia: A genetic condition (autosomal dominant) causing missing or underdeveloped collarbones and extra teeth (hyperdontia).
Extra Teeth and Related Conditions:
Erupted teeth: May cause crowding, gaps, or cavities; conical ones are often easy to remove.
Unerupted teeth: Can block or move nearby teeth; may need surgical removal or monitoring.
Diagnosis: Located with X-rays or cone beam CT.
Referral: Requires Dental Officer or Pediatric Dentist.
Cleidocranial Dysplasia: Genetic condition causing missing collarbones and extra teeth.
Gardner’s Syndrome: Genetic condition with colon polyps, tumors, and dental issues like extra teeth, abnormal shapes, or impacted teeth, often linked to jaw osteomas.
Fusion (Tooth Development Issue):
Happens when two tooth buds join together by enamel, dentine, or pulp.
May have two separate pulp chambers or appear as a single large crown with one chamber, making it hard to distinguish from gemination.
Usually reduces the total tooth count by one, unless fused to an extra (supernumerary) tooth, which keeps the count normal.
Fusion (Tooth Development Issue):
Happens when two tooth buds join together by enamel, dentine, or pulp.
May have two separate pulp chambers or appear as a single large crown with one chamber, making it hard to distinguish from gemination.
Usually reduces the total tooth count by one, unless fused to an extra (supernumerary) tooth, which keeps the count normal.
Odontomes (Tooth Tumors):
Odontomes are not true tumors but growths of calcified tooth tissue from abnormal tooth development.
Compound odontomes: Resemble small teeth (called denticles), ranging from a few to hundreds, commonly found in the front upper jaw in young people.
Complex odontomes: Irregular masses of dental tissue that don’t look like teeth.
Both types appear as radiopaque (white) on X-rays with a clear border.
Complex Odontome (Irregular Tooth Mass):
A disorganized mass of dental tissues that doesn’t resemble normal teeth.
Common in children and teens, often in the lower molar area.
Appears as a dense white (radiopaque) mass on X-rays, surrounded by a dark (radiolucent) line, often near an impacted tooth.
Growth is self-limiting and usually stops on its own.
Complex Odontome (Irregular Tooth Mass):
A disorganized mass of dental tissues that doesn’t resemble normal teeth.
Common in children and teens, often in the lower molar area.
Appears as a dense white (radiopaque) mass on X-rays, surrounded by a dark (radiolucent) line, often near an impacted tooth.
Growth is self-limiting and usually stops on its own.
Regional Odontodysplasia (Ghost Teeth):
A rare defect in tooth formation, usually affecting one part of the mouth but can involve opposite central incisors.
Teeth are poorly formed, slow to erupt, and appear ghost-like on X-rays.
Cause is unknown and often associated with abscessed baby teeth before or shortly after eruption.
Microdontia (Small Teeth):
Teeth are smaller than normal, often tapering or peg-shaped.
Localised: Commonly affects upper lateral incisors and third molars, occurring in about 2% of people.
Generalised: Very rare, linked to conditions like pituitary dwarfism.
Often associated with missing teeth (hypodontia), frequently seen in Down Syndrome and ectodermal dysplasia.
Microdontia (Small Teeth):
Teeth are smaller than normal, often tapering or peg-shaped.
Localised: Commonly affects upper lateral incisors and third molars, occurring in about 2% of people.
Generalised: Very rare, linked to conditions like pituitary dwarfism.
Often associated with missing teeth (hypodontia), frequently seen in Down Syndrome and ectodermal dysplasia.
Microdontia (Small Teeth):
Teeth are smaller than normal, often tapering or peg-shaped.
Localised: Commonly affects upper lateral incisors and third molars, occurring in about 2% of people.
Generalised: Very rare, linked to conditions like pituitary dwarfism.
Often associated with missing teeth (hypodontia), frequently seen in Down Syndrome and ectodermal dysplasia.
