general clinical practice need to know Flashcards
what is xerostomia?
dry mouth caused by reduced salivary flow
clinically diagnosed if unstimulated salivary flow <0.3ml
list oral problems which are exacerbated by xerostomia
caries
periodontal disease
candida infection
mucositis
give causes of xerostomia
radiotherapy/ chemotherapy
sjrogren’s syndrome
HIV
epstein Barr virus
what are the predisposing factors of oral candidosis?
prolonged antibiotic use
poor oral hygiene
denture wearer
immunocompromised
diabetes
dialysis
burn unit patient
what infections can be caused by candida?
periodontitis
denture stomatitis
UTIs
endocarditis
what classification of oral candidosis is shown here?
pseudomembranous
what classification of oral candidosis is shown here?
chronic hyperplastic
what classification of oral candidosis is shown here?
angular chelitis
what are the 3 types of erthematous candidosis?
newtons type 1- localised inflammation
newtons type 2- diffuse inflammation
newtons type 3- granular inflammation
how would you treat denture stomatitis in an immunocomprosed patient?
systemic antifungal- fluconazole
topical antifungal (nystatin)/ chlorhexidine rinse
Q
how would you treat an oral fungal infection in a patient with poor oral hygiene?
need to improve oral hygiene first
chlorhexidine rinse
how would you treat an oral fungal infection in a patient with dry mouth?
topical antifungal e.g. nystatin
avoid systemic antifungals
how would you treat an oral fungal infection in a patient with large erosive lesions?
same as an immunocompromised patient
systemic antifungal with either topical antifungal or chlorhexidine rinse
what are causes of an overhang?
poor adaptation of the matrix band
excessive force applied when condensing amalgam
what are the short and long term complications of overhangs?
food trap
difficulty cleaning
plaque stagnation
secondary caries
gingivitis and periodontal diseae
what is the preferred method for correcting an overhang?
replacement of the restoration
what are all of the treatment options for correcting an overhang?
replace restoration
finishing strips
soft flex files
list functions of a provisional crown for an EDP# and exposed RCT
improve aesthetics and provide pt with realistic expectations
improve functions of mastication and speech
resolve gingival inflammation and provide adequate gingival health prior to fitting the definitive restoration
to act as a marker for the dentist for tooth prep
prevents sensitivity
preserves tooth vitality
used as isolation for RCT
name 3 types of prefabricated crowns
polycarbonate crowns
clear plastic
metal (aluminium/stainless steel)
give disadvantages of prefabricated crowns
inaccurate fit ervically, occlusally, interdentally
if a large bank of crowns is needed it is very expensive
what factors can result in tooth mobility?
traumatic occlusion (bruxism)
trauma
periodontal disease
dental abscess
when would you intervene a mobile tooth?
progressively increasing mobility
gives rise to symptoms
creates difficulty with restorative treatment
risk of aspiration
affecting occlusion
how would you expect a mobile tooth to react to HPT?
decrease in mobility
clinical attachment will be gained
A patient has mobile lower incisors and refuses XLA. What would you advise him and what are the disadvantages of this?
Splinting may be appropriate when there is tooth mobility caused by advanced LOA/if tooth mobility is causing discomfort or difficulty in chewing.
However, splinting does not influence the rate of periodontal destruction and it may create hygiene difficulties.
It is a Tx of last resort.
What is the purpose of a post ?
To retain the core
What is a ferrule ?
a 1-2mm dentine collar required to place a post
What are the types of posts?
manufactured - pre-formed
material - cast metal, steel, zirconia, carbon, glass fibre
shape - parallel sided or tapered
How much gutta percha should be left in the canal space when placing a post?
at least 3-5mm
What is the purpose of placing a post?
Resistance/Retention for a compromised crown
How do you determine the difference between a facial palsy and a stroke?
Stroke - patient can wrinkle forehead and blink
facial palsy - face is affected on the same side where LA was given, cannot move upper or lower face
Stroke affects the opposite side of the body from the location in the brain that is affected
Explain neurologically the difference between stoke and facial palsy
The upper half of the face is supplied by both contralateral and ipsilateral innervation
The lower half of the face is only supplied by contralateral innervation
Lesions affecting the motor cortex (STROKE) result in contralateral weakens of lower face muscles but the upper muscles of the face are spared due to innervation from the opposite side
Lesions affecting the facial nerve in the brainstem (FACIAL PALSY) affect ipsilateral innervation for both upper and lower muscles
How would you manage a patient that has a facial palsy due to LA?
Reassure the patient
explain the sensation and muscle control will return once the LA wears off
Give the patient an eyepatch or tape the eye closed to protect the eye until blinking function returns
give emergency contact number
