History, examination, diagnosis and Tx Plan Flashcards
Why is it important to take a history for denture pt? (general)
a route map to diagnosis
85% of info for the diagnosis obtained from history taking
If a pt required tooth extractions, what drug would promote bleeding?
anticoagulant
Why is it important to take a medical history?
- 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
If a patient is medically compromised, what is a scale to use?
1-4
1&2: easily treated at GDP
3&4: referred to specialist care team
Pt undergoing radiotherapy seen by who?
multi-disciplinary-team management
GP
oncologist
general dentist
dentist in special care
surgeon
What are things to recommend/Tx plan for a pt undergoing radiotherapy?
- plaque control
diet advise
high fluoride toothpaste (duraphat 5000ppm)
saliva substitute
regular review
interact with GP, oncologist, surgeon etc
What do you do if a pt undergoing radiotherapy requires dentures or is wearing dentures?
postpone giving dentures
ask them to stop wearing their dentures
What can happen to pts gums undergoing radiotherapy
mucositis - inflammation of the mucosa, the mucous membranes that line your mouth and your entire gastrointestinal tract.
What are examples of medications which can cause xerostomia?
antidepressants, anti-hypertensives
What are examples of drugs which cause gingival overgrowth?
certain antihypertensives
What are example of PC with regards to dentures?
Questions to ask for history of PC?
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
What is the significance of past dental history?
Do you need to get a balance between pt expectations and what the actual problem is?
yes
What is the significance of the social and family history?
Before clinical exam, do you ask the patient what their goals are?
yes, this mixed with the history. you can start to map a tx plan
just need to look clinically
During the extra-oral exam, what are you looking out for?
also look at smile line lip competency
During intra-oral exam, what are you looking for?
With regards to the actual shape of the teeth, what are you noting?
After observing the physical attributes of the teeth, what do you do in the physical examination? (I/O)
What are special investigations you could do of the teeth?
What is the classification of edentulous jaws class I to class VI?
What do you call the scale for edentulous jaws?
Cawood and Howell classification
Class I
dentate
class II
immediately post-extraction
class III
well-rounded ridge form, adequate in height and width
class IV
knife-edge ridge form, adequate in height and inadequate width
class V
flat ridge form, inadequate in height and width
class VI
depressed ridge form, with some basilar loss evident
In order to create a treatment plan, what info do you need?
all relevant info… not necessarily all at same visit
special investigations - sensibility testing, radiographs, photographs, articulated study casts
What is the immediate care?
What is involved in informed consent?
all options
advantages/disadvantages of each
prognosis: if you don’t get treatment what can happen
A
What are the goals for treatment outcome?
What is something to avoid when it come to treatment planning?
avoid heroic maintenance of a tooth / tooth presenting with a set of a pathologic conditions that are beyond the scope of predictable treatment
Why is it sometimes best to just extract the tooth?
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
What is a summary of the factors and variables affecting treatment decisions?
What should treatment planning always be?
evidence based clinical practice
journals and articles for evidence
