Mock Case Presentation Flashcards
A patient comes into practise complaining of pain, what do you do?
SOCRATES
- aim to get pt out of pain as soon as possible.
Tooth 17 was recently replaced with amalgam, why might this tooth now be causing the patient pain?
- post op sensitivity
- potential high occlusion
- amalgam close to pulp [pulpal irritation]
- heat irritation during drilling
- microleakage & secondary caries
What is depression? How can it affect a patients oral health?
MH disorder characterised by extreme sadness, hopelessness & loss of interest in activities.
- neglect of OH
- chronic stress may trigger periodontal disease
- bruxism
- delayed seeking of dental treatment
- xerostomia due to medication
What kind of drug is propranolol?
Beta blocker
What is the method of action of propranolol?
- blockage of beta-adrenergic receptors [b1 & b2] that are normally activated by adrenaline
- b1 blockage reduces effect of sympathetic stimulation of heart
- reduced heart rate
- reduced force of contraction
- b2 blockage causes bronchoconstriction and vasodilation
What side effects can occur when taking propranolol?
- fatigue or weakness
- dizziness or lightheadedness
- hypotension & bradycardia
- xerostomia
How might propranolol interfere with dental treatment?
- xerostomia [increased caries risk]
- interaction with LA [enhanced duration, may interact with adrenaline]
- hypotension when moving pt from lying flat
What kind of drug is setraline?
SSRI [selective serotonin reuptake inhibitor]
- antidepressant
What is the mechanism of action of sertraline?
- blockage of the serotonin transporter
- prevents reuptake of serotonin
- increases levels of serotonin available
How can sertraline interfere with dental treatment?
- xerostomia
- affects platelet function [bleeding risk]
- potentiates the CV effects of vasoconstrictors [epinephrine]
- can cause orthostatic hypotension
- drug induced hypersensitivity reactions
A patient attends your dental practise in pain. Their current dentist recently replaced an amalgam restoration on tooth 17 and now the tooth is causing the patient problems, they have lost confidence in dentists because of this. What should you do?
- listen to the patient
- gather history
- reassure patient
- clinical exam
- open communication with patient
- address pain
- rebuild trust
What is bimaxillary osteotomy surgery?
surgical procedure performed to correct significant skeletal abnormalities or malocclusions of the maxilla and mandible
- repositioning of both maxilla & mandible
What is the relevance of the pt being a full time carer for her autistic son?
- patient availability
- patient stress levels
- patients priorities and concerns
What is linea alba?
white linear ridge or band on buccal mucosa that extends horizontally adjacent to the occlusal plane
What can linea alba suggest?
pt is bruxist or grinds
- may indicate high stress levels
What does sensibility testing involve?
- electric pulp tests
- ethyl chloride
What is symptomatic irreversible pulpitis?
inflammation of the dental pulp, accompanied by severe and spontaneous pain that persists even after the removal of the causative stimulus
- indicates irreversible damage to the pulp tissue
- requires definitive treatment, such as root canal therapy or tooth extraction
What is symptomatic periapical periodontitis according to the american association of endodontics?
inflammation and infection in the periapical tissues surrounding the root apex of a tooth
What are the signs & symptoms of symptomatic periapical periodontitis?
- TTP [percussion & palpation]
- soft tissue swelling
- sinus tract sometimes visible
- ## PDL widening or PA radiolucency on radiograph
What type of root resorption is the retained C experiencing?
physiological root resorption [natural process that occurs to make way for permanent successor]
What are some causes of hypodontia?
- family history of hypodontia
- trauma to area
- idiopathic
If the patient was to lose the C - what options are available for them?
- Accept space
- Orthodontics to close space [unlikely due to plates & screws]
- RPD [single tooth]
- Bridge
- Implant
What type of bridge would you use to replace Cs space once it exfoliates?
mesial fixed cantilever bridge [abutment tooth being the 14]
- only fixed on one side with a wing so if debonds it will come away & not act as a plaque trap for caries development
What must you assess about abutment teeth of fixed cantilever bridges?
- Quality of enamel - better bond strength
- Periodontal status
- Root length
How many canals does a 17 typically have?
3 or 4 [sometimes 2 canals in the mesial root]
Tooth 36 is grossly carious and requires XLA, what factors determine if a tooth is restorable or not?
- extent of decay
- location of decay
- strength & integrity of remaining tooth structure
- patients OH & compliance
How much space is required for implant placement?
- 7-8mm of interdental space
- 6-8mm of bone width
- 10-12mm of bone height
What different types of root resorption exist?
- external root resorption
- internal root resorption
What is meant by a cariogenic diet?
dietary habits or food consumption that promote development of dental caries
- high sugar intake
- high fermentable carbohydrate intake
- ideal environment for the growth of cavity-causing bacteria in the mouth
- bacteria metabolise sugars and produce acids that can erode tooth enamel and lead to the formation of cavities
What materials can be used as temporary fillings after extripation of a tooth?
- Kalzinol [ZOE material]
- Glass Ionomer [RIVA - self/light cure]
Why might a bridge to replace tooth 36 not be suitable?
- pt has linea alba suggesting parafunctional habit
- high occlusal load on 6s anyway, increased in parafunctional habit pts
How can posts be removed from teeth?
- drilling
- ultrasonic scalers
- heat to soften any resin based cement
- manual instruments [pliers/post extractors]
Why do root treated teeth require cuspal coverage restorations?
- fracture resistance [root treated teeth are structurally weakened]
- sealing & protection
What type of restorations are considered as cuspal coverage?
- crowns
- onlays
What is the ideal taper when crowning teeth? Why?
ranges between 6 to 10 degrees
- sufficient retention
- resistance to displacement
When placing posts, how much of the root filling should be left?
4-5mm root filling apically
What is the ideal width of a post?
- max 1/3 of root width at narrowest point
- 1mm remaining circumferential coronal dentine
What is the ideal ferrule for post placement?
1.5mm height and width of remaining coronal dentine
What defines generalised gingivitis based on the BSP periodontal guidelines?
Code of 0 / 1 / 2
> 30% BoP
What is salbutamol?
short acting beta 2 agonist
What is the mechanism of action of a salbutamol inhaler?
Binds to and activates beta2-adrenergic receptors leading to:
- smooth muscle relaxation
- inhibition of smooth muscle contraction
- bronchodilation
What oral side effects can occur as a result of using a salbutamol inhaler?
- xerostomia
- throat irritation
- taste change
- oral candidiasis (normally as a result of combined use with corticosteroid inhaler)
What is a flixotide inhaler?
- brand name for Fluticasone Propionate
- corticosteroid inhaler
What is the mechanism of action of a flixotide inhaler?
Targets inflammatory pathways in airways:
- anti-inflammatory effect
- inhibition of inflammatory mediators (eg cytokines)
- suppression of mast cells
What oral side effect can occur from use of flixotide inhaler? Why?
oral candidiasis
- local immunosuppressive effects of steroid
- disruption of oral microbiome leading to overgrowth of candida species
- dry mouth = easier for candida to flourish
How can candida risk from use of inhalers be minimised?
- use a spacer with MDIs
- rinse mouth after use
- maintain good OH
What type of onlay are you going to place in the 37?
Composite onlay (good aesthetics and bonds directly to tooth)
What would you use to cement a composite onlay?
NX3
- dual cure composite and DBA
What is used to cement a MCC?
AQUACEM
- glass ionomer luting cement
What is used to cement a Zirconia crown?
Aquacem
- glass ionomer luting cement
What is used to bond an adhesive bridge?
Panavia
- self adhesive resin cement ?
What is used to bond porcelain veneers?
NX3
- dual cure composite & DBA
