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
c. Discuss the strategic value of 27 and 28 from the //Peri. (4)
