History, examination, diagnosis and Tx Plan

Question 1

Why is it important to take a history for denture pt? (general)

Answer 1

a route map to diagnosis

85% of info for the diagnosis obtained from history taking

Question 2

If a pt required tooth extractions, what drug would promote bleeding?

Answer 2

anticoagulant

Question 3

Why is it important to take a medical history?

Answer 3

• protect pt and team
• whole patient care
• identify allergies and take precautions
• identify medically compromised at risk and take precautions and/or refer to specialist e.g. radiotherapy
• plan strategies by identifying those requiring investigations and/or medical support –> multi-disciplinary-team management

Question 4

If a patient is medically compromised, what is a scale to use?

Answer 4

1-4

1&2: easily treated at GDP

3&4: referred to specialist care team

Question 5

Pt undergoing radiotherapy seen by who?

Answer 5

multi-disciplinary-team management

GP
oncologist
general dentist
dentist in special care
surgeon

Question 6

What are things to recommend/Tx plan for a pt undergoing radiotherapy?

Answer 6

• plaque control
  diet advise
  high fluoride toothpaste (duraphat 5000ppm)
  saliva substitute
  regular review

interact with GP, oncologist, surgeon etc

Question 7

What do you do if a pt undergoing radiotherapy requires dentures or is wearing dentures?

Answer 7

postpone giving dentures

ask them to stop wearing their dentures

Question 8

What can happen to pts gums undergoing radiotherapy

Answer 8

mucositis - inflammation of the mucosa, the mucous membranes that line your mouth and your entire gastrointestinal tract.

Question 9

What are examples of medications which can cause xerostomia?

Answer 9

antidepressants, anti-hypertensives

Question 10

What are examples of drugs which cause gingival overgrowth?

Answer 10

certain antihypertensives

Question 11

What are example of PC with regards to dentures?

Answer 11

Question 12

Questions to ask for history of PC?

Answer 12

has the denture always been unsuccessful or has something happened

Has any adjustments been done before? If so, did it make a difference

Questions to ask:

• when did you start wearing the denture
• how any sets f dentures have you had? did you fid one better than the others?
• has the denture been worn successfully ever? - may be related to fundamental flaws in the design and construction or pat related problems

Question 13

What is the significance of past dental history?

Answer 13

Question 14

Do you need to get a balance between pt expectations and what the actual problem is?

Answer 14

yes

Question 15

What is the significance of the social and family history?

Answer 15

Question 16

Before clinical exam, do you ask the patient what their goals are?

Answer 16

yes, this mixed with the history. you can start to map a tx plan

just need to look clinically

Question 17

During the extra-oral exam, what are you looking out for?

Answer 17

also look at smile line lip competency

Question 18

During intra-oral exam, what are you looking for?

Answer 18

Question 19

With regards to the actual shape of the teeth, what are you noting?

Answer 19

Question 20

After observing the physical attributes of the teeth, what do you do in the physical examination? (I/O)

Answer 20

Question 21

What are special investigations you could do of the teeth?

Answer 21

Question 22

What is the classification of edentulous jaws class I to class VI?

Answer 22

Question 23

What do you call the scale for edentulous jaws?

Answer 23

Cawood and Howell classification

Question 24

Class I

Answer 24

dentate

Question 25

class II

Answer 25

immediately post-extraction

Question 26

class III

Answer 26

well-rounded ridge form, adequate in height and width

Question 27

class IV

Answer 27

knife-edge ridge form, adequate in height and inadequate width

Question 28

class V

Answer 28

flat ridge form, inadequate in height and width

Question 29

class VI

Answer 29

depressed ridge form, with some basilar loss evident

Question 30

In order to create a treatment plan, what info do you need?

Answer 30

all relevant info... not necessarily all at same visit special investigations - sensibility testing, radiographs, photographs, articulated study casts

Question 31

What is the immediate care?

Answer 31

Question 32

What is involved in informed consent?

Answer 32

all options advantages/disadvantages of each prognosis: if you don't get treatment what can happen

Question 33

Answer 33

A

Question 34

What are the goals for treatment outcome?

Answer 34

Question 35

What is something to avoid when it come to treatment planning?

Answer 35

avoid heroic maintenance of a tooth / tooth presenting with a set of a pathologic conditions that are beyond the scope of predictable treatment

Question 36

Why is it sometimes best to just extract the tooth?

Answer 36

may lead to undesirable consequences such as failure in function, aesthetics, comfort, and/or extension of infection to craniofacial anatomic spaces might have to start the denture again

Question 37

What is a summary of the factors and variables affecting treatment decisions?

Answer 37

Question 38

What should treatment planning always be?

Answer 38

evidence based clinical practice journals and articles for evidence