Notebooks Flashcards
Perform a caries risk assessment
You’re looking at:
their clinical evidence (teeth; xla, caries, nctsl, gingival inflammation, swelling, redness)
their diet (diary/what they say)
social history (GA in siblings?)
fluoride use (x/per day, time)
plaque control (plaque scores, ask to demonstrate how they brush, take a look intra orally and make a rough assessment)
saliva (rate, buffering capacity)
medical History (any xerostomia, immunocompromised, dexterity issue, behavioural issue (adhd), long-term cariogenic medicine)
Take them one at a time and ask questions, build a picture of their caries risk: low or high
Taking a plaque score
Teeth: 16,26,36,46 and 11,31
10/10 - perfectly clean
8/10 - line of plaque around cervical margin
6/10 - cervical third covered
4/10 - middle third covered
Taking a BPE on a child
For ages;
7-12: 0, 1 or 2 (mixed dentition)
12-17: 0,1,2,3,4,* (permenant)
Fluoride varnish:
1.When would you use it
2.When wouldn’t you use it
3.Explain how it works
4.Explain how it’s applied
5.Explain aftercare
- To prevent caries developing
To treat hypersensitivity
2.
Patient is allergic to sticking plasters (colophony)
Patient has ulcerative gingivitis or stomatitis (characterised by ulcerated and/or inflamed gums)
Patient has history of severe asthma (allergic reaction potential)
3.
Stops demineralisation
Promotes remineralisation
Stops bacterial metabolism
*basically it stops any damage that’s happening and makes the tooth stronger against any future damage
4.
The teeth will be cleaned first
(Remove gross plaque with gaws)
The teeth will then be dried (with the 3:1)
0.25-0.5ml of FV (duraphat) will be coated on all the teeth with a little brush, starting with the lower teeth first
5.
Avoid eating or drinking for next hour
No hard foods for rest of day
Don’t be worried about the yellowish appearance, it’ll disappear after eating/brushing that evening
So yes, brush as normal
22,600ppm fluoride (a.k.a 5%)
A child experiencing dental neglect
Don’t assume anything negative. Start off with the frame of mind the parent wants to help and work with you.
Identify the problems, address any concerns you have; previous attendance, child in pain, why haven’t they had the pain dealt with, why didn’t they show up to their appointment
Offer support to the parent. Let them know what treatment/appointments would be a good idea for the child’s welfare
Ask the parent if they’re willing to work together to meet these targets, these plan aims
Keep records of the conversation for future reference in the event the conversation/agreement needs to be referred back to
(All that is stage 1 - internal handling of the problem, assuming cooperation)
If future appointments are not made/parent doesn’t cooperate with recommendations then think about step 2.
- liase with other professionals to see if concerns are shared (school nurse, GP)
- make a decision if a CAF and a child protection plan needs to be carried out
- make an agreement on a plan of action with other professionals and review at agreed intervals
- if patient still fails to attend, think about sending a letter to the health visitor
Stage 3 (for complex/deteriorating situations)
- refer to social services
Our job in these cases is: ORCR
OBSERVE (situation)
RECORD (on R4)
COMMUNICATE (concerns to other health professionals)
REFER (for CAF) if appropriate
Treating the anxious child
First, recognise the signs and symptoms of anxiety on the patient.
Second, provide a warm demeanour, calm, friendly, trustworthy
Third; give them some control
-you can have a rest when you want
-just lift your hand and we can stop
-I’m just going to use this little mirror and air (use on hand)
Management during the appointment:
Positive reinforcement (you’re doing so well)
Distraction (ask math questions or solve a tricky problem then tell me after)
Role modelling (are you going to be brave for me and open wide like a big lion)
Tell/show/do
Acclimatisation (slowly talk them through everything)
Voice control (adjust your tone)
Use topical gel before LA
Treat upper arch before lower
Tools/aids
MCDAS
Venham picture scale
Facial image scale
Extra techniques:
Ask them what scares them, why and then reframe it to them in a non-scary way
Acknowledge their fears and talk about ways to make them feel less scary and more achievable
Treating the patient with special needs
1.Higher likelihood of
2.Commonly at risk of
3.Aims of tx
4.Types of Special Needs
5.Cautions with Special Needs
6.Referral with Special Needs
1.
Fewer teeth, untreated caries, perio. disease, dental anxiety
2.
Delayed diagnosis, delayed management (of teeth and gums), pain, infection, sepsis, reduced QoL, requires more interdisciplinary planning
3.
Normal speech development
Healthy self esteem
Healthy eating habits
Good oral hygiene
4.
Muscular dystrophy, spina bifida, cerebral palsy, adhd, autism, impaired learning, cardiac defect, type I diabetes, leukaemia, cancer, blind, deaf
- Cardiac: caution (not contraindicated) with GA and LA containing adrenaline
Autism: direct communication, reduce sensory inputs, may not be able to communicate verbally - ask parent for changes in behaviour (noise,light, smell, fewer people in the room, turn off radio ect)
Cancer/Leukemia/Musculo-skeletal disorders: CONTRAINDICATED for Inhalation sedation
6.
GA indications:
extensive treatment
uncooperative patient
*consent: 0-13 13-16 16+
How may a diabetic patient present
Reduced salivary flow (glossy tongue)
Xerostomia
Burning mouth
Candidiasis
Perio risk
Caries likely
Delayed wound healing
Greater risk of infection
3 types of infection and their treatment
Viral - acyclovir
Bacterial - antibiotics
Fungal - fluconizole, miconizole
Special need patients and their considerations
Cardiac, asthma, CF, cancer, renal disease
Cardiac - OH v.important to prevent IE
Asthma - avoid aspirin, nsaids (increased risk of bronchospasm)
Inhalers risk factor for fungal growth on tongue (dry surface)
CF - GA risk, sedation contraindicated
Renal disease - GA caution
Cancer - sodium bicarbonate, gelclair, biotene mouth rinse, difflam, tetracycline oral suspension
When not to do an IDB
Patient with a bleeding disorder
When not to use articaine
Sickle cell disease
When not to use citanest
Pregnant women
Safe dose calculation
2.2 x (44,66,88) = mg/ cartridge
mg/kg safe dose (5,8,7)
- Know the mg in the cartridge
- Know the safe mg number
- Know the kg of the kid
Engaging patient
30% plaque 35% bleeding
MPBS
Stable patients
20% plaque
10% bleeding
Full mouth scores
The No.1 aetiological factor in periodontitis
Plaque
S3 guidelines engaging patient
< or equal to:
20% plaque
30% bleeding
Normal pulp diagnosis
Transient response to pulp testing
Reversible pulpitis response
Discomfort to cold or sweet (sharp then subsides)
Common causes: caries, deep restorations, dentine sensitivity
Resolves once aetiology is removed
Symptomatic irreversible pulpitis
Sharp and lingering pain
(to thermal stimulus)
Spontaneous pain
Referred pain
Sleep interrupted
Pain can be worse when lying down
Typical analgesics ineffective
Common causes: deep caries, extensive restorations or fractures exposing the pulp
Can be non-responsive to percussion so rely on thermal testing for diagnosis
Asymptomatic irreversible pulpitis
Same as symptomatic except non-responsive to thermal testing too.
Indicated by evidence pulp unable to heal
Signs of Pulp necrosis
Dead pulp
RCT necessary
Non-responsive to pulp testing and is asymptomatic
Beware of false-positive results: if a tooth is calcified or recently experienced trauma, it can sometimes read as non-vital when in fact it still is! Don’t know how to tell other than verbal history
Previously treated or previously initiated therapy
PT - rct tooth
PIT - Tooth has had partial endo tx.
What must you always do when performing a vitality test
Dry the teeth
Start with an adjacent tooth before testing the tooth in question
Normal apical diagnosis
Not sensitive to TTP, Palpation and no different radiographically
Symptomatic apical periodontitis
Pain on biting/percussion
+/- radiolucency
If the pain is severe - that indicates a degrading pulp and rct necessary
Representative of inflammation in the apical tissues
Asymptomatic apical periodontitis
No pain on biting or palpation
Always: PA radiolucency
Representative of inflammation (and destruction - radiolucency) of the periodontium due to the pulp
Chronic apical abcess
Inflammation due to pulpal infection and necrosis
Intermittent discharge of pus through associated sinus tract
Osseous destruction
Little/no discomfort
A long term Inflammation of the apical tissues due to a necrotic pulp where pus is discharging through a sinus tract
Acute apical abcess
Also inflammation due to pulpal infection and necrosis. But the presentation is different.
Rapid onset
Spontaneous pain
Extreme tenderness to pressure
Swelling present
Radiolucency not always present
Fever
Malaise
Lymphadenopathy
Finding source of draining sinus
Place a GP cone in opening and push until discharge stops
Then take a radiograph
Principles for treating a patient that needs support
The treatment must benefit the patient
The treatment must be the least restrictive option
The dentist must take into account the patients views/wishes
The dentist must take into account the views/wishes of the closest guardian/carer
The dentist must provide information and encourage residual capacity
Referring an adult at risk
3 point test: unable to safeguard their own wellbeing, property or rights or other interests … because they are affected by an affliction… making them more vulnerable (to harm)
Recognise (the patient at risk)
Record (your concerns in R4)
Refer (to council who will assign a council officer to perform a risk assessment)
You don’t need consent from the patient
A person has capacity if they can:
Communicate
Understand
Remember
Reason
What to avoid when a patient presents with mucositis
Avoid:
Smoking
Spirits
Spicy food
Tea/coffee
What can aid mucositis management
2% lignocaine mouthwash
Sodium bicarbonate
Gelclair
Ice chips
Tea tree oil mouthwash
Determining what R(eciproc) to use
Put a K file in and see what goes passively
10: R25
20: R40
30: R50
Don’t skip apical gauging otherwise the canal won’t be tapered and you’ll leave bacteria in the apical aspect of the root
Apical guaging
Putting a GP cone in and seeing if you get tug back.
If it goes in passively, go up a R(eciproc) size
Removing GP from a re-rct options
Super endo alpha
Gates glidden
Eucalyptus oil (applied with k file)
Clinical evidence reasons for extraction
Gross caries
Extreme nctsl
Advanced perio disease
Infection
Root fracture
Symptomatic PE teeth
Orthodontic reasons (camof.)
Interference with denture design (overerupted)
Why might a root fracture on extraction
Thick cortical bone
Root shape (curved)
Root number (several)
Hypercementosis (thickening of cementum, typically presenting as bulbous at the Root end)
Ankylosis
Caries
