MSA 2020 - part B Flashcards
What are the three different courses of action which can be taken in a case of child abuse?
Preventative Dental team management
Preventative multi-agency management
Child protection referral
Explain what would happen with a preventative multi-agency approach in relation to child abuse?
If preventative dental management fails, then proceed to contact other professionals and liaise with the child’s, teacher or GMP for example.
Come up with a plan to help, set goals and arrange to follow up.
List TWO advantages of extraction of first permanent molars of poor prognosis at this stage of development?
The space will be closed by the 7’s moving into the 6’s place.
The child will have a caries free dentition.
List TWO disadvantages of extraction of first permanent molars of poor prognosis at this stage of development?
Can increase dental anxiety due to the traumatic experience of having an Ex at such a young age
Might require GA which has its own risks.
Space may remain and lose a permanent tooth.
Which guidance document would you refer to for advice on dealing with patients on Warfarin AND within what timeframe should this test be carried out prior to the extractions?
SDCEP
72-24hrs depending if stable or not
Below what level would it be safe to continue with extractions?
below INR 4
A fit and healthy patient presents to the surgery to have the surgical removal of a carious 48.
Anatomically, which nerves must be anaesthetised to remove this tooth safely?
IAN
Lingual
Long buccal
Name for a painful, unpleasant or neuralgic sensation that lasts for a fraction of a second?
Dysaethesia
Give THREE clinical reasons that could account for this neuro-sensory deficit.
A needle may have hit the nerve during LA administration crushing the nerve or cutting it.
The nerve may have been lacerated during incisions.
Direct Trauma to the nerve from the use of extraction instruments.
What two pieces of legislation in the U.K. has sought to ensure that all new dental practice premises are built to allow people with an impairment or disability equal access.
2010 Equality Act
2004 Disability Act
This gentleman could be described as being a person with a disability.
The definition of disability varies between the medical model and the social model. Briefly describe the difference between the two models in their definition of disability.
The Medical model would describe it as a restriction or lack of ability to conduct activities in a range that is normal for people.
The social model would include people with impairments or that are handicapped but are still able to perform a task that is considered within the normal range.
Having gained consent from this patient, you are now required to examine him. You are unable to do this safely with him in his current position in his wheelchair. He is unable to weight bear.
Name TWO options that are available to allow for the improved positioning of this gentleman to allow for a safe dental examination.
Use a hoist to get the patient into the dental chair
Use a wheelchair recliner if you have one
Which particular aspect related to his cerebral palsy may affect the dentist’s access to the mouth?
What non-pharmacological adjuncts are available to overcome this and aid the dentist’s access to the mouth?
Patients have limited mouth opening due to muscle tone being affected. This can make the mouth more rigid.
Massage the muscle to relax it.
Use a mouth opening prop to hold the mouth open.
List FOUR physical characteristics which are associated with Down’s Syndrome
Wide spaced eyes Flat face esp, nasal cavity Large tongue small maxilla and larger mandible meaning class 3 relationship small ears Short neck
To confirm a diagnosis of Down’s Syndrome a genetic test is undertaken. What genetic change is responsible for Down’s Syndrome?
Trisomy 21
Meaning the person has three copies of chromosome 21
List TWO medical aspects of Down’s Syndrome which may have resulted in his lack of capacity.
Increased risk of dementia Alzheimer’s
Due to their IQ and mental capacity, don’t properly understand so therefore cannot consent.
What are the 5 things a patient must demonstrate to show they have capacity?
Acting making decisions Communicating decisions Understanding decisions Retaining the information long enough, Having memory of the decision.
What are the 5 key principles of the adults with incapacity Act 2000.
Code of practice.
Must be of benefit to the patient
Minimum necessary intervention
Take into account the wishes of the adult
Consult with relevant others such as friends and family
Excercise residual capacity.
Who appoints a welfare guardian?
The court if an adult doesn’t possess the capacity.
Who appoints a welfare power of attorney?
The patient while they still have capacity
Who can consent to dental Tx?
• Patients with capacity
• Welfare Powers of Attorney
• Welfare Guardians
• Medical & Dental* practitioners under Section 47 of AWI Act (General Authority to Treat)
Dentists need to have had specific training
MP can from the day they qualify
What are the 3 elements of valid consent?
For consent to be valid, it must be voluntary
informed,
and the person consenting must have the capacity to make the decision
List TWO features associated with Down’s Syndrome that are likely to have contributed to his periodontal disease?
Increased risk of diabetes
Poorer manual dexterity so therefore lower levels of OH
Mark has previously experienced Infective Endocarditis. In line with SDCEP guidance, he will require antibiotic prophylaxis for the removal of his 6 remaining teeth. He has no known allergies.
What antibiotic, when should you give it to him and what dose of antibiotic should be prescribed for Mark?
Amoxicillin
2g orally
Given 60mins before Tx
List FOUR risk factors for mouth cancer
Smoking Drinking Genetic UV light Diet Age HPV
Mr Clarke received adjuvant radiotherapy to treat his mouth cancer. What TWO additional pieces of information do you require to know about the radiotherapy treatment he received?
What was the dose
And what was the field of radiotherapy
What dose of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis
more than or equal to 50 gray
Describe the pattern of decay evidenced, which is unique to radiation caries.
A cervical margin and incisal edge
How would you manage these teeth given that Mr Clarke is at an increased risk of osteoradionecrosis?
Ex teeth and suture the socket to encourage healing
pentoxifylline/Vit E
liaise with oncologist
List TWO oral complications associated with radiation therapy, other than osteoradionecrosis and radiation caries, to the head and neck.
Oral mucositis
Xerostomia
List TWO preventative measures that should be implemented to reduce the risk of future dental disease for patients who have received radiotherapy to the head and neck.
Prescribe high Fluoride toothpaste, duraphat
Give good OHI
Prescribe medications to help with xerostomia like Xeratin
List ONE management strategy for established osteoradionecrosis of the jaw?
Bone graft
What TWO methods are used for manual cleaning of instruments. For each of these give an example of an instrument cleaned in this way
immersion - hand instruments
Non-immersion - electrical
How often should an ultrasonic cleaner be de-gassed?
After each time the water is changed
What is removed by de-gassing
removes oxygen and other gases from the tubes of the instruments
Why is de-gassing important?
As the gases left within the water absorb some of the cavitation energy and therefore reduce the level of cleanliness.
Why is it important to use demineralised water in the sterilizer?
Because suspended particles can impede operational values
What term can be used to describe the collective group of microorganisms within the oral cavity AND what are they referred to when attached to a surface?
Oral microbiome
Biofilm
List the FOUR key microbial stages of caries plaque formation.
Adhesion
Survival and growth
Biofilm formation
Plaque complex formation
Name TWO key virulence factors used by Streptococcus mutans to influence enamel dissolution.
Adhesion
and high tolerance of acidic environments
Name the bacterium associated with secondary endodontic infections
E.faecalis
Name ONE of its key virulence factors
Adhesion other factors spreading compete for nutrients invade host
What culture-independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure?
What is the limitation of this approach?
PCR of oral microbiological DNA and blast searching
Will also take into account dead Microbes DNA(
