Medical conditions Flashcards
5 preventative ways to manage dental caries?
- Plaque reduction
- Diet modification
- Plaque modification
- Tooth surface modification
- Increase saliva flow
What are the recommended fluoride dosages?
- <18 months = brush teeth with no toothpaste
- 18 months to 6yo = use 400-500ppm (pea-sized amount)
- > 6yo = use 1000ppm
What are the two types of periodontitis and their subcategories?
- Plaque-induced gingivitis
- Chronic (most common)
- ANUG - Periodontitis
- Chronic slow-progressing (most common)
- Aggressive
Characteristics of ANUG?
- Severe pain
- Punched out I/P
- Ulcers
- Strong odour
- Systemic symptoms (fever)
Treatment of gingivitis?
- Remove calculus and overhangs
- OH
- Chlorhexidine
After treatment, when is complete resolution of gingivitis expected?
1 week
ANUG treatment?
- Acute
- Removal of plaque and necrotic tissue
- irrigation with chlorhex or hydrogen peroxide 3%
- smoking cessation counselling - Take home treatment
- Chlorhex until pain resolved
- antibiotics (nitroimidazole + chlorhex bd-tid until pain resolved)
- analgesics
- review in 48-72 hours - Preventative management
- scaling
- OH
Usual dose of Phenoxymethylpenicillin?
500mg qid for 5 days
Usual dose of Amoxycillin?
500mg tid for 5 days
Usual substitute for penicillin allergy and usual dose of this medication?
Clindamycin, 300mg tid for 5 days
What comprises the periodontium?
PDL, gingivae, cementum, alveolar bone
Two major risk factors for periodontitis?
Smoking and uncontrolled diabetes
Differences in clinical features of slow vs. aggressive perio?
Slowly-progressing:
- Pocket formation +/- gingival recession
Aggressive:
- Rapid attachment+bone loss
- familial aggregation
- plaque deposits inconsistent with perio destruction
- RARE in children (suspect T1DM, leukemia)
Treatment of aggressive perio?
- scaling +/- surgical (flap)
- Smoothing any overhang
- OHI
NOTE: antibiotics RARELY required and can only penetrate biofilm in combination with scaling)
Periodontal abscesses are mainly seen in patients with what conditions? (two)
- existing periodontal disease
- uncontrolled diabetes
According to TG, are antibiotics indicated for dental abscesses?
If so, what are first and second line abx?
Only if infection has spread beyond jaw or systemic Sx present
1st line: phenoxymethylpenicillin or amoxycillin or clindamycin
- Review pt within 48-72 hrs
2nd line:
any of the above PLUS metronidazole or amox+clav
Usual dose of metronidazole?
400mg bd for 5 days
Usual dose of amox+clav?
875mg+125mg bd for 5 days
Where can canine fossa infections spread to?
intracranially via orbital veins
Where can buccal space infections spread to?
to the neck causing deep infections
What is ludwig’s angina?
Severe bilateral cellulitis involving all neck spaces
What is the danger of trismus with dental abscesses?
There may be breathing or swallowing difficulties -> require IV abx at hospital
What are the signs of dentoalveolar surgical infection and how should it be managed?
Signs:
- No improvement in pain/swelling
- Pus
- Fever
Management:
- Drainage of pus
- Hourly mouthwash
- Antibiotics (for systemic Sx or immunocompromised)
How long is too long for dry socket to heal and what are 3 differential diagnoses?
>3 weeks DDx: - Osteomyelitis - Bisphosphonate-related osteonecrosis of the jaw - Alveolar SCC
