GENERAL ORAL DIAGNOSIS AND TREATMENT PLANNING Flashcards
a. Sequence of Treatment (6m)
Emergency Phase
- Incision and drain the abscess
- Perform emergency RCT on 25 and 26 and IRM for temporary seal
Hygienic/Preventive Phase
- Supra-gingival scaling (By arch) and root surface debridement (By quadrant)
- Oral hygiene instructions (Brushing technique and flossing technique)
- Dietary analyze
- Fluoride varnish application
Restorative Phase
- Restore multiple caries with composite resin
Corrective Phase
- RCT on 25 and 26
- Replace IRM with Fiber post + Composite resin + Crown on 25 and 26
- Removable partial denture
Maintenance Phase
- Review perio
- Review prostheses
Patient with C/O of right palatal painless swelling; lower occlusal radiograph shows radiolucency in lower left of jaw. Taking aspirin. (Summative, 2005)
a. What further investigations were done and why?
Investigate whether the question is wrong (right palatal swelling, but lower left radiolucency and diagnosis of lower right swelling)
Biopsy for painless swelling, or CBCT
Patient with C/O of right palatal painless swelling; lower occlusal radiograph shows radiolucency in lower left of jaw. Taking aspirin. (Summative, 2005)
b. What is the differential diagnosis for the right mandibular swelling?
Dentigerous cysts
Keratocystic odontogenic tumor
Ameloblastoma
Pericoronitis, with spreading to fascial spaces (less possible as no pain here)
MH: DM Type 2; I/O Mobile 14 on chewing, generalized bleeding and swollen gums, 37 pain, bleeding on brushing; multiple bridges and missing teeth, bridge on 35 37
List five pathological findings from the panoramic radiograph provided (5)
NA
MH: DM Type 2; I/O Mobile 14 on chewing, generalized bleeding and swollen gums, 37 pain, bleeding on brushing; multiple bridges and missing teeth, bridge on 35 37
What further investigations do you need on 37? (5)
Probing / mobility / percussion / pulp test by test cavity / periapical radiograph / pain history
Detect recurrent caries, marginal leakage, vitality, apical pathology, crown and root integrity
MH: DM Type 2; I/O Mobile 14 on chewing, generalized bleeding and swollen gums, 37 pain, bleeding on brushing; multiple bridges and missing teeth, bridge on 35 37
c. List out your treatment strategies for this patient in the appropriate sequence (5)
Given: panoramic, periapical and bite wing
History: bleeding on probing generalized, Periodontal pocket up to 9mm, Swollen gums. Dislodged crown on 21 and 22
a. Give 6 (caries counted only as one entity) pathological features on the radiographs.
Caries, bone loss, calculus, fracture, abscess cyst ameloblastoma as radiolucecncy? furcation?
Given: panoramic, periapical and bite wing
History: bleeding on probing generalized, Periodontal pocket up to 9mm, Swollen gums. Dislodged crown on 21 and 22
b. Your treatment plan for the patient, except 47
Given: panoramic, periapical and bite wing
History: bleeding on probing generalized, Periodontal pocket up to 9mm, Swollen gums. Dislodged crown on 21 and 22
c. What is your diagnosis for 47? What is your treatment plan and why
No info provided but 9 mm pocket should be related to 47
Extraction of 47 as advanced bone loss and furcation involvement make 47 as hopeless periodontal
prognosis
Shortened dental arch can justify option of no prosthetic replacement since advanced periodontal disease
(biological price for replacement is high)
- Given: radiograph showing a periapical lesion (Summative, 2010)
a. Describe the findings on radiographs.
b. What further investigations would you perform?
a. NA
b. Pulp test, percussion test
- Given: radiograph showing a periapical lesion (Summative, 2010)
c. Write down the treatment strategies in chronological order.
Systemic: consult physician about DM status
Emergency: depends on the condition / presence of pain
Preventive: Referral for extraction if poor prognosis
Restorative: RCT
Rehabilitation: Crown on endo treated tooth / replacement if extracted
Maintenance: review perio, endo treated tooth
- Given: radiograph showing a periapical lesion (Summative, 2010)
d. What’s the problem with tooth 14? What would you do?
No answers given
- Hypertension. C/O: pain on the lower jaw and continued for a period of time and ceased. But recently pain experienced again and patient cannot fall asleep. Panoramic radiograph is provided. (Formative, 2011)
a. What clinical examinations would you perform with respect to patient’s C/O?
Intra-oral examination: check if there is any swelling or deep caries
- Hypertension. C/O: pain on the lower jaw and continued for a period of time and ceased. But recently pain experienced again and patient cannot fall asleep. Panoramic radiograph is provided. (Formative, 2011)
b. Patient said he had chest pain in clinic. Suggest two reasons for chest pain.
Referred pain from tooth
Angina pectoris due to ischemic condition of heart
Information given:
70-year-old woman with DM
Pain on lower left molar region.
PAN: Edentulous span (upper PM to PM, lower multiple span) + Root treated 37 with likely fracture on 37MO + Horizontally impacted 48 + Large radiolucency in Q4 posterior region, connected to the crown of the 48.
Clinical findings: Vertical fracture of 37 extending to root
a. What is your treatment plan? (5)
*** Actually VRF can be saved by intentional replantation, which involve extraoral RCT and cementation of tooth fragment by SuperBond 4-META/MMA/TBB
OR consider root amputation (but better prognosis in resction of distal root, i.e. here not applicable
Information Given:
72 year-old female
C/O: Pain of upper left molar region. Pain on biting.
HPC: Swollen gum 2 months ago. Spontaneous pain. Visited dentist and subsized 1 month after. DH: The dentist she visited performed “a cut” to relieve her symptoms.
MH: unremakable
I/O: Pain of percussion //Peri showing 25 – 28
a. Describe the radiographic findings in detail. (7)
b. What are the further investigation and differential diagnosis? (5)
a. NA
b.
Pulp vitality test
Differential diagnosis
- Acute periodontal abscess
- Acute apical periodontitis / abscess
- Perio-endo lesion
- Gingival abscess / pericoronal abscess
- Vertical root fracture
- Osteomyelitis
- Lateral periodontal cyst
- Pyogenic granuloma
Information Given:
72 year-old female
C/O: Pain of upper left molar region. Pain on biting.
HPC: Swollen gum 2 months ago. Spontaneous pain. Visited dentist and subsized 1 month after. DH: The dentist she visited performed “a cut” to relieve her symptoms.
MH: unremakable
I/O: Pain of percussion //Peri showing 25 – 28
c. Discuss the strategic value of 27 and 28 from the //Peri. (4)
- Conservative Dentistry (Formative, 2014)
a. What questions will you ask before the examination? (6)
Chief complaint, HPC (pain nature, duration, onset, intensity, initiating, aggravating and relieving factors), MH, DH, FSH
Conservative Dentistry
b. What special investigations will u do? (4)
EPT, pecussion, palapation, thermal test, crack detection, radiograph
Middle-aged woman
Pain on upper anterior tooth that affects sleep for the last week, increasing in intensity mentions above dry mouth
MH: depression, taking medication
Clinical photo shows fistula above 11, caries on 11M and 11D, composite restoration on 11M, multiple white spot lesions
Radiograph shows GP tracing and periapical radiolucency on 12, radiolucency on 11D, 12M, restoration on 12D with surrounding radiolucency, bone loss on 12
a. Describe the clinical photo (5)
b. Describe the radiographic findings (5)
c. What are the treatment options that you would give the patient for 11 and 12? Provide justifications (3)
Remove current defective restoration and recurrent caries and RCT for both tooth
Replace with direct restoration or indirect restoration
Extraction and followed by prosthetics replacement like implant, bridge, RPD
Prognosis depends on endodontic, periodontal status and restorability
Perio-endo leson with communcation has questionable prognosis, which may need extraction
Restorability, remaining alveolar bone support determine whether the tooth can be retained
7 years old patient presented with sharp pain during eating hot and cold food of short duration sensitivity during toothbrushing
Pain located mainly at lower molars. .
Clinical photo of upper and lower occlusal view provided. (first permanent molar enamel worn away?) A panoramic radiograph also provided
a. Give 3 differential diagnosis (3)
Dentine hypersensitivity
Reversible pulpitis
Cracked tooth syndrome
7 years old patient presented with sharp pain during eating hot and cold food of short duration sensitivity during toothbrushing
Pain located mainly at lower molars. .
Clinical photo of upper and lower occlusal view provided. (first permanent molar enamel worn away?) A panoramic radiograph also provided
b. Two investigations to be done to aid your diagnosis? (2)
Pulp test, radiograph
7 years old patient presented with sharp pain during eating hot and cold food of short duration sensitivity during toothbrushing
Pain located mainly at lower molars. .
Clinical photo of upper and lower occlusal view provided. (first permanent molar enamel worn away?) A panoramic radiograph also provided
c. What specific questions will you ask the patient and or her parents to confirm your D(x)? (2)
- Diet habit (cariogenicity and frequency)
- OH habit (Brushing frequency and method, whether brushed by patient or parents)
7 years old patient presented with sharp pain during eating hot and cold food of short duration sensitivity during toothbrushing
Pain located mainly at lower molars. .
Clinical photo of upper and lower occlusal view provided. (first permanent molar enamel worn away?) A panoramic radiograph also provided
d. Give 3 treatment options for the first molars (3)
- Fluoride varnish
- OHI with desensitizing toothpaste
- Direct GI restoration
-
If later involve irreversible pulpitis
- Pulpotomy (Incomplete root formation)
- Extraction and space maintainer
7 years old patient presented with sharp pain during eating hot and cold food of short duration sensitivity during toothbrushing
Pain located mainly at lower molars. .
Clinical photo of upper and lower occlusal view provided. (first permanent molar enamel worn away?) A panoramic radiograph also provided
e. When to extract permanent first molar if they are of poor prognosis? (1)
8 to 10 y.o.
(Generally, whenever practical the lower first molar should be extracted when there is radiographic evidence of early dentine calcification within the second molar root bifurcation. This usually occurs within a chronological age range of 8 to 10 years)
