Management Of Acute Dental Problems

Question 1

What could pain in the jaw be if it is not toothache

Answer 1

Referred pain from an MI

Question 2

What else should you make sure if a patient tells you they have been self medicating for pain

Answer 2

That they have not exceeded the recommended dose for the drug

Question 3

What should be the second question you ask yourself when treating a patient with pain

Answer 3

Is it trauma related

Question 4

What advice should you give a parent with a child who is experiencing eruption pain

Answer 4

Optimal analgesia, soft brushing and rinsing after food

Question 5

What advice should be given to a patient that has recently had an extraction and is experiencing pain

Answer 5

Optimal analgesia, avoid smoking and maintain good OH

Question 6

What advice should you give a patient suffering with pain from an ortho/ RPD appliance

Answer 6

Optimal analgesia, chlorhexidine mouth rinse
Malleable wax to sharp teeth
Keep appliance out where possible

Question 7

what should be assessed when looking at a patient with swelling

Answer 7

are they having trouble breathing
can they stick out or move their tongue
is the eye closed
is the swelling sudden

Question 8

what is the treatment if the patient has swelling that is increasing in size slowly and is painful to touch

Answer 8

may require antibiotics

Question 9

what should you do if the patient has swelling but isn’t in pain

Answer 9

assess typical jaw pain and signs of MI or if they have exceeded recommended dose for pain relief

Question 10

what advice should be given to a patient presenting with bleeding who has had recent extractions

Answer 10

rinse mouth with warm water and bite on moisturised gauze and maintain constant pressure for 20 mins - if bleeding stops, avoid smoking and exercise for 24 hours

Question 11

what should you do if a patient doesn’t stop bleeding post-extraction after pressure applied for 20 mins

Answer 11

query whether patient is on blood thinners
if not - repeat the pressure advice, if yes then call 101

Question 12

if there is trauma including lacerations on the tongue what should be the course of action

Answer 12

emergency care - NHS 24

Question 13

what should be the treatment plan if a patient has inhaled a tooth during trauma

Answer 13

emergency care - NHS 24

Question 14

what should be advised for a patient with trauma but no trauma to the tooth

Answer 14

optimal analgesia and maintain goof OH

Question 15

are primary teeth reimplanted after trauma

Answer 15

no - advise soft diet and analgesia

Question 16

what should the course of action be if a patient has had trauma which involves the pulp

Answer 16

retain broken piece of tooth in water and expose pulp with CaOH paste

Question 17

what should be the course of action if a patient presents with trauma that is into dentine

Answer 17

advise use of desensitising toothpaste to fractured surface while awaiting an appointment

Question 18

what may multiple painful ulcers in the mouth be due to

Answer 18

herpes virus

Question 19

what should you do if a patient presents with asymmetry or weakness, arm weakness and speech problems (FAST)

Answer 19

Nhs 24 - dial 999

Question 20

if patient presents with abnormal lump that has recently increased in size what should plan of action be

Answer 20

urgent care - local rapid access

Question 21

what should you do if a patient presents with altered sensation and they have not had dental care recently

Answer 21

urgent care

Question 22

what should you do if a patient presents with altered sensation and they have had dental care recently

Answer 22

advise patient to contact treatment provider within 7 days

Question 23

what should you do if a patient presents with a red/ white speckled lesion or pigmented area that has been present for more than 3 weeks

Answer 23

urgent care- rapid local access

Question 24

what is necrotising gingivitis and necrotising periodontitis

Answer 24

severe inflammatory conditions of the gingiva caused by pathogenic bacteria more commonly in immunocompromised patients

Question 25

what is a periodontal abscess

Answer 25

active period of periodontal breakdown that occurs whilst there is marginal closure of deep periodontal pocket occluding drainage

Question 26

what are perio-endo abscesses

Answer 26

leads to abscess formation from a singular tooth

Question 27

signs and symptoms of necrotising perio disease

Answer 27

pain, swelling, bleeding, halitosis, ulcerated gingival tissue, loss of attachment, malaise, fever

Question 28

signs and symptoms of perio abscess

Answer 28

pain and tenderness of gingiva increased tooth mobility fever and swollen or enlarged regional lymph nodes suppuration from gingiva

Question 29

signs and symptoms of perio-endo abscess

Answer 29

geneeralise perio disease localised pain swelling with or without suppuration on probing deep pocketing to root apex with BOP

Question 30

what is dentine hypersensitivity caused by

Answer 30

exposed dentine resulting in pain response to external stimulus

Question 31

signs and symptoms of dentine hypersensitivity

Answer 31

pain - sharp, sudden and short lived exposed root surface as a result of gingival recession

Question 32

what is pulpitis

Answer 32

inflamed dental pulp

Question 33

what tests would indicate a reversible pulpitis

Answer 33

positive or exaggerated response to sensibility testing and tooth is not tender to percussion

Question 34

what tests would indicate an irreversible pulpitis

Answer 34

difficult to localise to single tooth, pain lasts hours and dull and throbbing, worsened by heat and alleviated by cold, pain can be spontaneous

Question 35

treatment for reversible pulpitis

Answer 35

providing a temporary dressing restore affected tooth

Question 36

treatment for irreversible pulpitis

Answer 36

first stage endodontic therapy extract the tooth

Question 37

what is alveolar osteitis

Answer 37

inflammation of a socket after extraction, most commonly after molar extraction

Question 38

who is more risk at alveolar osteitis

Answer 38

patients who smoke

Question 39

signs and symptoms of alveolar osteitis

Answer 39

pain, unpleasant taste or odour from area, swelling

Question 40

what is the initial management for alveolar osteitis

Answer 40

optimal analgesia tell patient to avoid smoking and maintain good OH

Question 41

what is more invasive care for alveolar osteitis

Answer 41

irrigate with saline and apply a suitable material to the socket - avogyl

Question 42

what should be course of action if an ulcer has been present for 3 or more weeks

Answer 42

refer for urgent care at oral surgery

Question 43

what should be the treatment for an ulcer that is recurrent and self-limiting

Answer 43

tell patient to use 0.2% chlorhexidine mouthwash, optimal analgesia and a benzydamine oromucosal spray

Question 44

below which age is chlorhexidine not suitable for

Answer 44

children under 7 years

Question 45

what may emergency presentation of ill fitting or loose dentures be a sign of

Answer 45

stroke or malignancy

Question 46

what is sinusitis

Answer 46

inflamed sinuses almost always accompanied by adjacent mucosa

Question 47

what are instructions for handling an avulsed permanent tooth

Answer 47

handle tooth by the crown, reimplant tooth in socket and bite gently on tissue or place tooth in milk and get to the dentist

Question 48

what should be course of action if a patient presents with a dislocated jaw

Answer 48

send to NHS 24

Question 49

what is bell's palsy

Answer 49

paralysis or weakness of the face, usually only on the one side

Question 50

what is the initial management of bells palsy

Answer 50

determine its not a stroke (FAST) protect the eye with a patch

Question 51

what can be signs and symptoms of salivary gland obstruction

Answer 51

pain located to major salivary gland swelling history of xerostomia dehydration fever

Question 52

what is a candidal infection

Answer 52

acute and chronic infection in the oral cavity caused by candida species - usually candida albicans

Question 53

what is the presentation for candidal infections

Answer 53

white patches on the oral mucosa resembling milk curds - plaques can be removed to reveal a raw erythematous base which may bleed

Question 54

what is erythematous candidiasis

Answer 54

red patches on the oral mucosa

Question 55

what is paraesthesia

Answer 55

tingling

Question 56

what is a burning sensation

Answer 56

dysaesthesia

Question 57

what should you investigate firstly when a patient presents with paraesthesia or dysaesthesia

Answer 57

stroke

Question 58

what is angioedema

Answer 58

sudden swelling and affects areas of skin and mucous membranes

Question 59

what must you investigate firstly with signs of angioedema

Answer 59

that airway isnt compromised

Question 60

what is osteonecrosis

Answer 60

exposed alveolar bone

Question 61

who are at increased risk of osteonecrosis

Answer 61

patients taking bisphosphonates or have had radiotherapy to the head and neck

Question 62

what is initial treatment for patients with osteonecrosis

Answer 62

chlorhexidine mouthwash (0.2%)

Question 63

what is peri-implantitis

Answer 63

inflammation affecting the soft and hard tissues around implants, leading to loss of bone support

Question 64

what treatment should be given for patients with peri-implantitis

Answer 64

non-surgical debridement and irrigate with 0.2% chlorhexidine surgical debridement and implant decontamination with saline or 0.2% chlorhexidine

Question 65

what is temporal arteritis

Answer 65

giant cell arthritis that involves damage to medium and large celled blood vessels of the head - specifically the superficial temporal arteries

Question 66

signs and symptoms of temporal arteritis

Answer 66

burning sensation swelling fever tenderness to touch vision difficulties weight loss claudication of MOM

Question 67

what is treatment for temporal arteritis

Answer 67

prescribe systemic cortico-steroids (prednisolone) order blood tests to asses C reactive protein

Question 68

what is the dose for prednisolone for an adult

Answer 68

60 mg daily

Question 69

what is trigeminal neuralgia

Answer 69

severe facial pain in the distribution of the trigeminal nerve, usually unilateral and acute episodes short lived

Question 70

signs and symptoms of trigeminal neuralgia

Answer 70

pain - severe, stabbing, lacinating and shooting triggered by touching certain areas of the face brief facial spasm or tic

Question 71

what is the management for trigeminal neuralgia

Answer 71

prescribe carbamazepine optimal analgesia long term anaesthetic block