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Adult Restorative > ICP-29 History and Examination of the Adult Patient > Flashcards

ICP-29 History and Examination of the Adult Patient Flashcards

1
Q

What are the principles of patient assessment and in what order are they assessed until you get to the treatment options

A
  • History
  • Clinical examination
  • Provisional/Differential Diagnoses
  • Special/Further investigations
  • Definitive Diagnoses
  • Treatment options
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2
Q

What is a screening form and why is it used

A
  • Enable a logical and structure series of questions to be asked
  • Ensure no area is omitted-
  • Enables history to be distilled into key factors that will inform: provisional diagnosis, special investigations, diagnosis and treatment plan
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3
Q

What patient information is important to get in patient history and why

A

Patient information:

  • Patient name (introduction)
  • DOB (similar names)
  • Contact details (appointments)
  • Audit trail to clinic/student
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4
Q

What needs to be included in the presenting complaint part of the patient history

A 
- May be no complaint (record it)
Commonly:
- Pain (where, how long etc.)
- Swelling
- Bleeding gums 
- Broken tooth
- Lost crown/filling
- Loose dentures
- Non-dental? - white patches
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5
Q

What is the difference between signs and symptoms

A 
Sign:
- Objective evidence of disease
- Detectbale by someone as well as other than the patient
- e.g. vomiting, bleeding
Symptom:
- Subjective evidence of disease
- Experienced by the patient with the disease
- e.g. pain, fatigue
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6
Q

What is the SOCRATES acronym used for and spell it out

A

This is used when going through patient’s pain history:
S - site
O - Onset (when)
C - Character (type of pain)
R - Radiation
A - Associations (with other signs/symptoms)
T - Time course/pattern (short sharp pain or long lasting)
E - exacerbating (relieving) factors
S - severity (1-10)

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7
Q

Why do we need to know medical history of a patient in their patient information

A
  • Medical emergency can happen at any time
  • May affect presenting complaint i.e. diabetes and periodontitis
  • May affect treatment planning
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8
Q

Why is it important to ask the patient about any steroids and bisphosphonates they are taking

A

Steroids - long term and higher dose can affect body’s response to stress as the can’t produce natural corticosteroids
Bisphosphonates - increase mineral content in bone but affects blood supply, long term doses can affect extractions as it won’t arrest so well and can cause ONJ

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9
Q

What is Audit C

A
  • 3 questions
  • Scored 0-4
  • Overall score determines advice
  • score between 5-9 = moderate risk
  • score above 10 = high risk/dependency?
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10
Q

What do you do when patient gives you the medical history proforma

A

Checked by clinician to ask about how well things like hypertension is managed etc, then once happy can sign and date it

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11
Q

What do you include in the past dental history of patient history

A
  • Dental attendance: last visit, frequency?, regular?, pain only?, registered with GDP?, Anxiety levels?
  • Treatments/experience: fillings, LA?, RCT?, Crowns/bridges?, implants?. ortho?
  • Oral hygiene regimen: How often?, manual/electric?, type of electric?, type of toothpaste?, interdental cleaning?, mouthwash and timing?
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12
Q

What should you include in the social history of a patient’s history

A
  • Occupation
  • Family situation
  • Brief diet analysis
  • Repetition of smoking and Audit C

After this you should verbally present to tutor and get tutor sign and date then proceed to clinical examinations

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13
Q

What should you include in the extra-oral examination of a patient

A
  • TMJ - clicks, tenderness
  • Facial symmetry
  • Lymph nodes - palpate
  • Lips - competent, do they meet?
  • Swellings
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14
Q

What needs to be examined when carrying out a TMJ examination

A
  • Joint: pain, sounds
  • Muscle of Mastication: insertion/body, tenderness, stiffness
  • Opening: Limitation, deviation, end feel
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15
Q

What needs to be examined when carrying out a Facial symmetry examination

A
  • Condular hypertrophy
  • Chin point
  • Swellings
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16
Q

What abnormalities need to be examined for when examining lymph nodes

A

Abnormalities:

  • Size
  • Number
  • Consistency
  • Tenderness
  • Mobility
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17
Q

What groups of lymph nodes are there that need to be examined

A

Groups:

  • Pre-auricular/post auricular
  • Occipital
  • Submandibular
  • Submental
  • Cervical
  • Supraclavicular
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18
Q

What abnormalities are you looking for when examining soft tissues

A
  • Type of tissue
  • Colour
  • Location
  • Surface texture
  • Consistency
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19
Q

What areas need to be examined in an intra-oral examination

A
  • Labial, buccal and vestibular mucosa
  • Hard and soft palate
  • Oropharynx and fauces
  • Floor of the mouth
  • Tongue
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20
Q

What specific things need to be examined when examining the tongue

A
  • Colour
  • Normal anatomy
  • Examine the dorsum, ventral surface and lateral borders
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21
Q

What do we look for when examining the appearance of the gingival tissues

A
  • Pink and healthy?
  • Red and swollen?
  • Bleeding?
  • Make a note of the OH of the gingival tissues
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22
Q

What about the gingival tissue OH do we note in the intra oral examination

A
  • Good/Fair/poor
  • Generalised/localised periodontitis etc
  • Marginal/interproximal
  • Supra/subgingival calculus
  • BPE/bleeding: immediate/delayed
23
Q

What do you need to note when you do a BPE on a patient

A
  • WHO probe, ‘walking action’
  • Divide the mouth in 6 (molar to premolar, canine to canine, premolar to molar on the side)
  • WHO probe has ball on the end
  • ## Record highest score per sextant
24
Q

What are the 4 main causes of tooth surface loss

A
  • Erosion
  • Abrasion
  • Attrition
  • Abfraction
25
Q

What is erosion in tooth surface loss

A
  • Loss of hard tissue by chemical means
26
Q

What is abrasion in tooth surface loss

A
  • Loss of hard tissue by friction with extrinsic agent
27
Q

What is attrition in tooth surface loss

A
  • Loss of hard tissue by contact with opposing dentition
28
Q

What is abfraction in tooth surface loss

A
  • Loss of cervical hard tissue due to enamel prism micro-fractures secondary to repeated flexure/compression
29
Q

What do shaded areas mean on hard tissue charting

A

Fillings/restorations

30
Q

What do open circles mean on hard tissue charting

A

Cavity/caries

31
Q

What do hashtags mean on hard tissue charting

A

Tooth has a fracture

32
Q

What does RF mean on hard tissue charting

A

Root filling

33
Q

What does a cross mean on hard tissue charting

A

Tooth missing/extracted

34
Q

What does a single diagonal line on hard tissue charting mean

A

Tooth to be extracted

35
Q

What needs to be noted in the occlusal assessment of a patient in the intra oral examination

A
  • Static occlusion: how teeth meet when not moving

- Dynamic occlusion: how teeth move over each other

36
Q

What do you need to note about the static relationship between a patient’s teeth

A
  • The molar relationship
  • The incisor relationship
  • Overjet/Overbite/Open bite
37
Q

Describe the molar relationships that need to be noted in a patients intra oral exam

A
  • Class I: where the distobuccal cusp of the lower 6 meets the midbuccal groove of the upper 6, lower jaw is very slightly in front of upper jaw molar wise
  • Class II: When lower jaw is a little more back, mesiomuccal cusp of lower 6 meets midbuccal groove of upper 6
  • Class III: When lower jaw is further forward, mesiobuccal cusp of lower 7 might meet midbuccal groove of upper 6
38
Q

Describe the incisor relationships that need to be noted in a patients intra oral exam

A
  • Class I: lower incisor meets mid third of the cingulum of the upper incisor
  • Class II: Lower jaw appears further back, lower incisor is behind the cingulum
  • Class III: Lower jaw further forward, in front of the upper cingulum
39
Q

What is overjet and overbite

A

Overjet - how much incisors relate in a horizontal direction, how much further in front lower teeth
Overbite - How much further in a vertical direction the teeth bite together

40
Q

What do we look at when noting the dynamic occlusion of a patient’s intra oral exam

A
  • Lateral excursions
  • Protrusive excursions
  • Interferences: when teeth get in the way of normal excursions - working and non-working side
41
Q

What are some things about removable prostheses you might need to note in a patient’s intra oral exam

A
  • Partial?
  • Tooth-borne/mucosal borne?, supported by these things^?
  • Retentive features
  • Acrylic/Cobalt-chrome
42
Q

What are some things about fixed prostheses you might need to note in a patient’s intra oral exam

A
  • Bridges
  • Type?: resin-retained, conventional, cantilever/fixed-fixed
  • Implant retained?
43
Q

What do you have to do when request radiographs

A
  • Say what radiographs you want
  • Justify it
  • Select you views?
  • Patient details
  • Need to report on radiograph and quality assure it
44
Q

What do you have to do when doing radiograph reports

A
  • State justification
  • Report quality: grade 1,2,3
  • Report findings: Describe view, teeth present, resotations present and bone levels
45
Q

Name some common further investigations that are carried out after clinical examination to get to some diagnoses

A

Radiographs

Sensibility testing

46
Q

What is the definition of a prognosis

A
  • An opinion based on medical experience of the likely course of a medical condition, tooth by tooth
47
Q

What are some things that the prognosis depends on

A
  • Clinical factors: age, severity
  • Systemic/environmental factors: smoking, disease, genetics
  • Local factors: Plaque control, dental and root morphology
48
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Important to be realistic when telling the patient the potential prognosis and outcomes of the treatments

49
Q

What are the treatment options that can be offered to a patient, must be listed on sheet ting

A
  • Do nothing, patient needs to be informed
  • Simple approach: extractions, restorations
  • Complex treatment: replace missing teeth, indirect restorations
  • Referral: implants, too severe disease, other pathology
50
Q

What phases are there in a treatment plan

A
  • Emergency phase: pain, bleeding, trauma, infection
  • Investigation/stabilisation
  • Rehabilitation
  • Maintenance and monitoring
51
Q

What needs to be done in the investigation/stabilisation phase of a treatment plan

A
  • Severity and distribution of periodontal disease
  • Severity and distribution of caries
  • Diet analysis
  • OH
  • Fluoride prescription
  • Tobacco cessation
  • Alcohol advice
52
Q

What needs to be included in the maintenance and monitoring phase of a treatment plan

A
  • Risk assessment for dental diseases
  • Recall intervals
  • Active monitoring plan
53
Q

What aspects must be included for consent from a patient to be valid

A

Voluntary:
- Patient’s decision, uninfluenced by anyone
Informed:
- Patient must know all options
- Risk and benefits of all options, including effect of no treatment
Capacity:
- Must be capable to understand all info
- Able to make informed decision based on this info

SIGNED and DATEd by patient and tutor

Adult Restorative (14 decks)

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