History and Examination

Question 1

When making a care plan for a patient, what steps must you do

Answer 1

• Patient’s general health
• History
• Care options (advice, prevention, maintenance, referral)
• Clinical findings
• Disease diagnosis, extent and rate of progression
• Risk assessment
• Patient preferences and expectations
• Risk-based review interval

Question 2

What should be covered in notes

Answer 2

• Referred by
• C/O
• HPC
• MH
• SH
• Examination E/O and I/O
• Special investigations
• Provisional diagnosis
• tx plan (list each visit aim)
• Acute management

Question 3

Who can consent for a child?

Answer 3

• Child’s mother
• Child’s legally appointed guardian
• PErson who has obtained a residency order for the child from a court
• Local authority designated in a care order in respect of the child
• Child’s father if he was married to the mother at the time of birth

Unmarried fathers if they have acquired parental responsibilities in the following way:

• Marry the mother of their child
• Obtain a parental responsibility order from court

Unmarried fathers can also have parental responsibility of children aged 15+ if

• they register the child’s birth jointly with the mother at time of birth
• re-register the birth if they are the natural father

Question 4

at what age can young people consent

Answer 4

• 16 years and above can consent without consent of parent/guardian
• Minors under age of 16 can give consent if deemed gillick competent although rare in dentistry. mainly dental emergencies

Question 5

what basic general info would you like to know as patient walks through the door before taking a history

Answer 5

• date
• name
• age
• gender
• bday
• accompanying person
• who referred patient
• why is the patient here? emergency, new patient, tx, recall

Question 6

what should be asked in dental history

Answer 6

• regular attender?
• past dental history (la, ihs, or other forms of sedation, ga)
• coping abilities
• any specific difficulties, dislikes
• evaluate child’s and parents attitude towards dental tx

Question 7

what should be asked in social history

Answer 7

• type of school
• age, gender, sibling history
• parental occupation
• siblings/relatives with similar problems

Question 8

what should be asked in diet history

Answer 8

• bottle-fed duration?
• snacks/drinks and frequency
• treats- when
• type of treats

Question 9

what should be asked in re to oral history

Answer 9

• brushing- frequency, assisted
• toothpaste
• supplements
• thumb sucking, nail biting, mouth breathing

Question 10

other than e/o and I/o what else must be examined

Answer 10

• behaviour

- frank-l score

Question 11

what should you look for on soft tissue io examination

Answer 11

• BM, FOM, tongue, gingival, palate

- abscess, swelling, ulcer, lesions etc

Question 12

what should be done/looked for in re to teeth on io examination

Answer 12

• charting
• restorations
• cavities
• percussion testing
• tooth wear
• tenderness of palpation
• mobility
• change in colour
• fractures

Question 13

at what age can you do a bee

Answer 13

• PAtients above 7
• If 7-11, only BPE scores of 0,1 and 2 may be used on index teeth
• IF 12-17, a full BPE should be performed on Index teeth

Question 14

what should be noted in terms on pt behaviour

Answer 14

• frank l score
• age
• anxiety of parents and patient
• language barriers
• interaction and communication

Question 15

what further investigations can be done in a patient

Answer 15

• diet sheet/food diary
• disclosure of plaque
• vitality testing
• photos
• rx
• study models
• biopsy

Question 16

when should you not take a rx

Answer 16

• If rx is not expected to:
• change diagnosis
• change treatment
• add other useful info

it should not be taken

Question 17

indications for rx in children and adolescents

Answer 17

• detection of caries
• dental injuries (trauma)
• disturbances to tooth development
• examination of other pathological conditions other than caries

Question 18

what are some benefits of bitewings in kids

Answer 18

• detect caries that cannot be otherwise seen
• use of bitewing radiography in addition to clinical examination increases the number of inter-proximal lesions detected by 2-8
• estimate the extent of lesions
• monitor lesion progression

Question 19

name some sensitivity tests you can do

Answer 19

-unpredictable in primary dentition but

cold (ethyl chloride)
hot (warm gutta percha)
electricity (electric pulp therapy)
laser doppler flowmetry (vitality testing)
test cavity

Question 20

how to detect caries

Answer 20

COMMON methods
-visual (clean, dry tooth, good light and magnification)
-tactile sensation
-rx examination
DO NOT PROBE

ADVANCED methods

• laser-based methods (diagnodent)
• fibre optic transullimination
• dyes
• elective caries meter (ECM)

Question 21

what kinds of preliminary diagnosis should you be making

Answer 21

• Behaviour/cooperation
• Caries
• Non carious TSL
• Hypodontia, infraocclusion, hypoplasia
• supernumeraries, related conditions
• trauma
• oral hygiene
• ortho classification
• soft tissue lesions, abscess

Question 22

what factors should be taken into account when making therapy decisions

Answer 22

• age of child
• evidence of therapy outcomes
• caries risk assessment
• parental and dentist preferences and expectations
• natural history of caries progression

Question 23

what are 3 forms of therapy which could be applied to a child

Answer 23

• no therapy
• preventitive therapy
• restoraton therapy

Question 24

what are the objectives of tx

Answer 24

Emergency

• refief of pain
• prevent further infection
• maintain vitality

stabilisation of active disease

• prevention
• temporization

corrective

• restorative
• prosthetic

maintenance

• recall
• reinforce prevention

Question 25

when should you re-assese patients

Answer 25

• recall every 6 months

- if higher risk then 4 months

Question 26

what should you mention when reviewing cases with parents

Answer 26

• list problems, restorative needs, preventative needs
• explain the sequence of tx
• discuss how anxiety control and pain relief can be achieved
• explain the stage of development
• discuss with parent after each appointment what was accomplished and patient cooperation (as positive as possible)

-obtain informed consent

Question 27

what should you be able to work out from history examination and investigations

Answer 27

• caries risk level
• dx
• realistic and attainable tx goals
• preventitive programme
• recall interval