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CASE PRES > History > Flashcards

History Flashcards

1
Q

What are the effects of not flossing on your patieint?

A
  • may lead to plaque accumulation
  • may lead to gingivitis and periodontal disease
  • may contribute to halitosis due to food packing between teeth
  • may lead to caries (interproximal)
  • may lead to gingival recession
  • can contribute to other medical issues such as cardiovascular disease and diabetes
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2
Q

What are the causes of bruxism (tooth grinding)

A
  • Stress , anxiety , misaligned teeth and sleep disorders
  • some medications such as antidepressants
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3
Q

What is bruxism

A

it is a term used to describe clenching, grinding or gnashing of teeth

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4
Q

Why did your patient never wore a denture before?

A

Because they cannot afford it before

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5
Q

How did your patient stop grinding?

A
  • by conservative treatment and reduce of stress and wearing a night guard
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6
Q

How would the condition of current teeth contribute to treatment planning of the denture?

A
  • the patient have gingivitis which needs to be dealt with before giving the patient a denture
  • the patient have secondary caries and this need to be removed before giving the patient a denture
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7
Q

What other options might the patient have available?

A
  • implants - not suitable as the patient have bone resorption which might be an issue in placing implants
  • complete dentures might be an option in the future but it is not indicated now, as the patient still have remaining teeth
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8
Q

What problems would you get when providing a denture to a patient that never worn a denture before?

A
  • the patient might experience discomfort at the early stages of wearing a denture
  • may have difficulty speaking which will get better by time
  • the patient may get a gagging sensation from the denture
  • Excessive salivation as the body adjusts to the presence of the denture in the mouth
  • It might cause some psychological and emotional adjustment as some patients may be embarassed from wearing a denture
  • It may require maintenance and care and the patient should be informed about this as it might cause irritation
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9
Q

What is propranolol

A

It is a beta-blocker commonly used to treat hypertension and used relieve physical anxiety symptoms

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10
Q

What is the mode of action of propranolol?

A
  • blockage of beta-adrenergic receptors [b1 & b2] that are normally activated by adrenaline
  • b1 blockage reduces effect of sympathetic stimulation of heart
  • reduced heart rate
  • reduced force of contraction
    b2 blockage causes bronchoconstriction and vasodilation
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11
Q

What are the dental implications of propranolol?

A
  • xerostomia [increased caries risk]
  • interaction with LA [enhanced duration, may interact with adrenaline]
  • hypotension when moving pt from lying flat
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12
Q

What are the side effects of propranolol?

A

fatigue and weakness
xerostomia
bradycardia
hypotension

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13
Q

How would your dental treatment be different for someone who is taking propranolol?

A
  • increased risk of postural hypotension (move chair up gradually and let the patient stand on their own time and guide them from sitting to standing)
  • may exacerbate the effects of adrenaline which can be managed by using an LA without vasoconstrictor such as Bupivacaine
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14
Q

What is atorvastatin?

A

It is a statin used to lower cholesterol levels in the blood, primarily used for people having high cholesterol levels or those at risk of cardiovascular disease

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15
Q

What is the mechanism of action of atrovastatin?

A

inhibiting an enzyme called HMG-CoA reductase which plays a key role in the production of cholesterol in the liver

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16
Q

What are the side effects of atrovastatin?

A
  • muscle pain
  • headaches
  • nausea
  • diarrhea
  • fatigue
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17
Q

What is losartan?

A

It is an angiotensin II receptor blocker commonly used to treat hypertension

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18
Q

What is the mechanism of action of losartan?

A

blocks angiotension II which is a vasoconstrictor , loasrtane inhibits the vasoconstriction effect of this vasoconstrictor leading to vasodilation and therefore a decrease in blood pressure

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19
Q

What are the side effects of losartane ?

A
  • Dizziness
  • Fatigue
  • Hypotension
  • headaches
  • coughs
  • dry mouth
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20
Q

What are the contraindications of losartane?

A
  • interact with diuretics
  • pregnancy
  • pottasium supplements
  • some NSAIDS which can increase hyperkalemia
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21
Q

What are the dental implications of losrtane?

A
  • Orthostatic hypotension ( a drop of blood pressure when standing)
    -some NSAIDs used in dentistry such as ibuprofen may reduce the effect of losartane
  • Xerostomia may lead to caries and discomfort in the mouth ( tell patient to stay hydrated , give patient water during appointment)
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22
Q

How did the patient divorce affect the patient dental health?

A

Divorce is a stressful situation which may have an impact of the patient previous grinding habit.

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23
Q

What is an amalgam tattoo?

A
  • pigmentation on the oral mucosa due to small particles of amalgam embedding in the soft tissues due to the placement of amalgam
24
Q

How to prevent amalgam tattoo?

A
  • using proper isolation (dental dam)
  • good aspiration
  • cleaning and polishing amalgam restorations and avoid leaving any debris after that
25
Q

How do you manage amalgam tattoo?

A
  • monitor and record
  • inform the patient about it
  • monitor any changes or signs of inflammation (it can be related to lichen planus)
26
Q

What might have caused the 5 to drift distally?

A
  • the loss of her first premolar and her first molar , also her previous parafunctional habits may have cause this as this can exert excessive forces on the tooth and cause it to drift mesially
27
Q

What is sensibility testing?

A

used to indirectly determine the state of pulpal health by assessing the condition of the dental pulp nerves

28
Q

What is an ethyl chloride

A

response of pulp to cold stimuli using endo frost

29
Q

What is EPT

A

electric pulp test to electric stimuli (A fibres)

30
Q

How to deal with patient knowing they have anxiety?

A
  • adressing their anxiety through history and asking them if they are anxious from dental treatment / can use MDAS scale , using open questions
  • Showing empathy and allowing the patient to express their feeling without judgement
  • Let the patient take control , for example by telling them to raise their hand whenever they want a break
  • use local anesthesia and topical anaesthetics
  • distract the patient by engaging in a conversation
31
Q

What is high blood pressure?

A

Hypertension is diagnosed when blood pressure consistently measures 130/80 mmHg

32
Q

What is anxiety?

A

mental health conditions characterized by excessive and uncontrollable worry or fear about everyday situations

33
Q

What is high cholesterol?

A

is a condition characterized by an elevated level of cholesterol in the blood

34
Q

What are some risk factors for hypertension?

A
  • age
  • obesity
  • family history
  • tobacco
  • poor diet
  • alcohol
  • genetics
35
Q

How is hypertension graded?

A

using NICE definition
Mild
Moderate
Severe

36
Q

What are the measurements for mild hypertension?

A

Systolic = 140-159mmhg
Diastolic = 90-99

37
Q

Moderate hypertension?

A

S = 160-179
D = 100-109

38
Q

Severe hypertension

A

S = 180 or higher
D = 110 or higher

39
Q

What are the symptoms of hypertension?

A
  • blurred vision
  • headaches esp morning
  • shortness of breath
  • nosebleeds
40
Q

What other medications can be used to treat hypertension?

A

ACE inhibitors
diuretics
calcium channel blockers
beta blockers

41
Q

What are the cardiovascular effects of statins?

A
  • reduction in the production atherosclerotic plaques therefore reduced CV risk
42
Q

What medications do interact with atrovastatin?

A
  • Azole antifungals
  • Clarithromycin
  • phenytoin
  • Warfarin
43
Q

How many sugar intakes per day makes someone high caries risk?

A

3+ sugars per day at separate times

44
Q

What bacteria are involved in periodontal disease?

A

P.gingvalis
prevotella intermedia

45
Q

How likely are you to develop oral cancer if you drink alcohol?

A
  • 2x likely
46
Q

What is the recommended limit of alcohol per week?

A

14 units per week , spread over 3 days with at least 2 alcohol free days

47
Q

How many units in a glass of wine?

A

2.3 units

48
Q

What is meant by loss of attachment

A

loss of attachement is the distance from the CEJ to the base of the periodontal pocket

49
Q

What dosage is PA radiograph?

A

4 uSv

50
Q

What is the dosage in an OPT radiograph?

A

20 uSv

51
Q

What is involved in step one of periodontal treatment based on BSP 2017 guidelines?

A

Explain periodontal disease, risks and benefit of treatment
OHI
control risk factors (removal of plaque retentive factors)
supra and su gingival PMPR to the crown

52
Q

Why did you choose composite?

A
  • aesthetic
  • bonds directly to tooth
  • patient preference
  • minimally invasive
53
Q

Explain the steps of caries removal

A
  • remove caries in enamel and see the distribution of caries
  • remove caries at ACJ at periphary
  • remove caries circumferentially
  • remove deep caries with a slow speed or excavator
  • modify cavity cavosurface margins
54
Q

What is a metal ceramic crown consist of?

A
  • metal substructure
  • opaque cermaic layer
  • veneering cermaic layer
55
Q

What are the disadvantages of a metal ceramic crown?

A
  • extensive tooth prep
  • Cost
  • Can get metal shine through
56
Q

How do caries occur according to Stevenson curve ?

A

Fermentable carbohydrates/sugar consumed
Strep Mutans metabolises it and creates lactic acid
pH drops below critical threshold 5.5
demineralisation occurs
caries formation favourable
saliva buffers and brings pH back up to 6.5/7

CASE PRES (7 decks)

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