General practice Flashcards
How do we look at the smile?
1.Lips – competence, colours, pigmentation of the skin, filtrum, skin pores, fine facial hair, vermillion border demarketion
2.Incisor display – how much of the teeth is shown
3.Tooth form and shade of teeth
4.Symmetry of the smile
5.Gingival condition
6.Opacity of incisal ridges
What are the three optical properties of dental sctructures?
Opalascence – the ability of the body to look different in reflected or transmitted light
Fluorescence – the ability of the body to emit light that is a wavelength less then incident radiation e.g. crime scene fluoresent lights
Translucence – the ability of the body to appear to transmit light and reflect little of it back
What are the three factors of tooth colour?
Hue – base pigment – red, pink, green, blue and other
Value – most important – quantity of light reflected – how bright is the object can be shown with black and white images
Saturation – chroma – intensity or vividness – how much of base pigment is there within tooth structure
What shade guide do we use in SADS?
Vita classical – used commonly in many aspects of dentistry – does not sit in the tooth banana nicely thus covers it inconsistently, with some fall outside of the banana, really incosistent value
Vita 3D Master Shade Guide – amazing for dentistry – sit nicely in the shade banana, amazing value when shown in black and white when going from 1-5 (5 is darkest thus lowest value) - Number 1 is value, Letter 1 is hue, Last number is chroma A3 and 3m2 is nearly the same colour. Infinitely compatible.
How to use Vita 3D master guide?
1.Select value by leaving only M hue in guide body natural light and TURN OFF YOUR LIGHTS AND GO TO THE WINDOW. Get close to the tooth.
2.Chroma is evaluated. How saturated are the teeth
3.Hue selection. Is the tooth more yellowish then middle? Is it more red??? Move from middle (M) to either R or L
4.Remember computer generator system allow you to match shade in between value ranges or chroma
What is the most aesthetic way for a incisal line to run?
You want it to run parallel to the lower lip.
What is incisal configuration?
It is the V shaped area between the incisors. It needs to be at 90 degrees to both of the teeth making up the incisal configuration
What is importance of interdental papillae?
Black triangles are bad
How can we measure incisors?
Bioclear template that utilizes the Fibonacci gold sequence.
What is a gingival zenith?
It is the line drawn at the terminus of the gingival margin at each incisors. Low gingival zenith in central and high in laterals will result in poor aesthetics. It central incisor and canine should coincide.
When do we say a person has a gummy smile?
When we see more then 3mm of gingiva past the gingival margin in a person.
What is a buccal corridor?
It is a negative space in the corners of the smile that is not filled by tooth structure. 15.-2.5 mm is ideal.
How can we construct a rough prototype for restoration?
You can you putty or isolating material like PTFE tape and old, out of date composite just to get a nice 3D, functional structure. Do not bond as you need to remove it. Check with patient. Create a clear PVS bite reg material to register the prototype restoration so you can replace with permanent one – key guide.
What is the best bonding technique?
4th generation ethc-prime-bond-composite.
What are the steps of build up?
1.Build up of palatal wall with dentine shade
2.Apply the needed maverick colours with use of bonding resin and stains. Separate the two and use with probe to dip into both and apply to the needed translucent halo area.
3.Layer with body shade
4.Layer the most superficial layer with enamel shade
What is at of extreme importance when you have an aesthetic case?
For signs of erosion, attrition and abrasion. Parafunctional wear = poor longevity of a restoration. Patient will need a night guard.
What is a mouthguard?
A mouthguard is a protective device worn in the upper jaw
and sometimes the lower jaw, to reduce injuries to the teeth,
jaws and associated soft tissues.
What are the roles of a mouthguard?
- Attenuate the stressed and absorb energy generated by impact to prevent or minimise injury to the region
- Two main forces: direct impact to the jaw and jaw collisions
- May retain fractured or loosened teeth
- There is some scientific evidence to suggest they also prevent concussion
What are common types of mouthguards?
- Stock outguards - preformed piece of plastic - worst fit and comfort = worst protection
- Mouth-formed mouthguard - aka boil and bite - thing and poor fit = sub-par protection
- Custom made - best fit and comfort = best protection
- Bimaxillary moutguards - questionable all around
When should a patient start using a nightguard?
Ideally as soon as they start to participate in organised contact sports.
What are the benefits of a moutguard?
It help to reduce:
- The risk of injury to the maxillary anterior
- Damage to the posterior teeth of either jaw following traumatic closure of the mandible
- Intraoral and perioral lacerations
- Tongue damage on impact
- Fracture of the mandibular body and condyles
- Damage to the tmeporomandibular joint
What are some barriers to wearing a nightguard?
- Poor retention or previous poor experience
- Intra-oral dryness
- Nausea
- Interference with breathing and sledging
- Psychological factors
- Cost
- Requirement of dental appoitments
What are some general design principles for mouthguard construction?
Labial aspect: 2-3 mm thickness
Occlusal: 2mm thickness
Palatal: 2mm thickness
Labila flange: extend to within 2mm of the vestibular reflection
Paltal flange: 10 mm beyond gingical margin
Even contact in the dentition with minimal pressure on soft tissue
What is standard mouthguard care?
Clean before and after use and change regularly
Rinse in cold water before and after use
Toothrush can be used
Store in secure container
What is teeth bleaching?
It is a process of using oxidizing agents to remove stain or discolouration from teeth by denaturing large chromatic organic compounds.
What are some post-eruptive causes of extrinsic staining?
- Ageing
- Plaque and calculus
- Chromogenic bacteria
- Tooth surface loss
- Food and drinks
- Smoking
- Chx mouthrinses
What are some products available for external bleaching?
- At home bleacing using trays
- In office bleacing
- Others like whitening toothpaste
What should you do prior to bleaching?
- Take a good medical history
- Take social and dental histories
- Determine patient’s chief complaint and expectations, obtain consent and inform them that composite and crowns do not bleach
- Determine the cause of stain
- Do comprehensive intra-oral exam, take x-rays and baseline photos
- Can we do some preoperative treatment? ( Known as tooth lightening: Etch tooth for 30 seconds or 2 minutes with flurosis, use fine pumice for 20 seconds, repeat twice, apply tooth mouse immediately and apply every 4-6 weeks)
- Bleacing protocl can commence
- After bleacing, shall we replace any restorations
What is the most common compound available for bleacing?
Caramide which is Urea mixed with hydrogen peroxide (hydrogen peroxide provide free-radical that oxidise larger molecules)
What are some contra-indications for bleaching?
- Children or people under 21
- Pregnant women
- Patients with unrealistic expectations
- Defective restorations
- History of teeth hypersensitivity and/or sever wear
- Untreated caries or periodontal disease
- Allergies to compounds
When is internal bleaching less effective?
- In banding or tetracycline-stained teeth
2, RCTed teeth
- Single tooth sclerosis teeth
- Teeht with congenital conditions such as dentinogenesis imperfecta
What are some side effects of bleaching?
- Pain and trauma
- Accidental ingestions causing irritation to gastro or respiratory mucosa
What are the procedural steps for at-home bleaching?
- Professional debridement
- Alginate impressions
- Construction of 0.8-1.2mm trays to the gingival margin with small holes for extrusion of bleach
- Follow the manufacturer’s guidlines on the bleaching gel application
- Book a follow up appoitment
What is some equipment that needs to be present for in-office bleaching?
- Surgery kit for light-activated external bleaching
- Face protector
- Sunscreen for facial tissues
- Protective glasses for UV light
- Light cure for setting protective agents around gingiva
- Shade guide
- Protective glasses
- Light activator system
What are some of the steps to treatment planning?
- A comprehensive examination with taking of all histories, extra-intraoral examinations and relevant tests and radiographic images
- Evaluation, proposing treatment to the patient, patient consent
- Oral health instructions using TRIM framework
- Sub/ supra gingival scaling
- Prophylaxis
- Diet evaluation
- Use of extra products
- Recall depending on patients needs
COMMUNICATING WITH THE PATIENT IS KEY
What should be included on a prescriptions script?
Remember ePrescriptions are preferred
- Patient’s name, address and DOB
- Name & address of practitioner, phone number, qualifications, AHPRA reg
- Drug name – GENERIC
- Drug form – e.g. tablets
- Drug strength- e.g 15 mg
- Drug quantity in pills (word, symbol e.g Ten,10)
- Dose & frequency of administration
- Duration of days
- Instruction clearly
- Write (For dental treatment only)
- A line to signify no other prescriptions
- Signature of prescriber
- Date of prescription
- Signature
- PBS number for prescribers
What kind of medication can we use for treatment of oral lichen planus?
- Difflam Anti-Inflammatory Antiseptic Mouth gel containing benzydamine hydrochloride 1% 2-3 hours, for 7 days for no more then 12 times a day. Do not eat 15 minutes after
- Chlorexedine and benzydamine mouthwash
- Cepacaine oral solution - cetylpyridinium chloride, benzocaine and ethanol solution
