OSCE Flashcards
Upper removable appliance components
Active component
Retention
Anchorage
Baseplate
What information would you give to a patient who smokes tobacco but is considering switching to e-cigarettes
- e-cigs are 95% less harmful
- lack of evidence so consider other forms e.g. patches
Emergency drugs (only stunning men are getting actual girls)
- oxygen
- salbutamol
- midazolam
- adrenaline
- GTN spray
- Aspirin
- Glucagon
oxygen conc for an unwell patient
15l/min
Warfarin mechanism of action
inhibits coagulation by vitamin K antagonism
Max INR for extraction in Scotland
3.5
Warfarin interactions
- metronidazole and ibuprofen increase effect
- carbamazepine inhibits
- don’t use NSAID’S as anti platelet effects increase bleeding time
Smoking cessation - 5As
- ask
- advise
- assess
- assist
- arrange follow up
Caries risk assessment components
- MH
- Fluoride
- Oral hygiene
- clinical assessment
- diet
- saliva
- social history
What should be included in a diet diary?
- everything eaten and when over the course of 3 days
- 1 weekend day and 2 week days
fitting a removal appliance - steps
- ensure right patient and right appliance
- ensure appliance matches description
- check for sharp edges
- integrity of wire
- fits into mouth without blanching/trauma
- posterior retention
- anterior retention
- activate active component
- demonstrate correct removal procedure for appliance and ask patient to do it
- book review appointment
instructions to pt after delivering removable appliance
- will feel big and bulky initially - will get used to it
- may be mild discomfort - indicates it is working
- will impinge on speak - practice reading aloud
- may drool especially first 24 hours
- wear all the time especially meal times
- Clean after every meal
- remove and store for contact and active sports
- non-compliance significantly increases treatment time
- avoid sticky hard foods and fizzy drinks
- be cautious with hot food and drinks
- emergency contact number
Retentive component used for molars
Adams clasp 0.7mm HSSW
Retentive component used for incisors
Southend clasp 0.7mm HSSW
Post-op instructions following extraction
- expect pain - recommend analgesia for 1-3 days
- bleeding unlikely but possibe
- avoid exercise that day
- do not explore socket with tongue - can disrupt clot
- avoid hard or hot foods
- pt still numb - hot foods
- avoid alcohol for 24 hours
- do not rinse out for several hours or until the next day
- rinse around 4 times a day especially after eating
Medical Emergency assessment
ABCDE
- Airway
- breathing
- circulation
- disability
- exposure
Anaphylaxis treatment
- IM injection adrenaline 1:1000, 0.5mg
- only if life threatening
Angina treatment
- 400micrograms GTN spray
- 300mg aspiring crushed or chewed if MI
asthma treatment
- salbutamol inhaler 100micrograms per actuation
hypoglycaemia treatment
- glucose tablets
- glucose 1 milligram IM injcetion
Angina symptoms
- increased breathing and circulation rate
- pale, clammy, central chest pain
Asthma features
- increased breathing and circulatory rate
- wheezing
hypoglycaemia features
- initially talking
- initially increased breathing and circulation rate
- initially alert
- irritable, confused, pale
seizure treatment
- if repeated or prolonged consider 10mg midazolam via buccal mucosa
syncope treatment
elevate legs
Reversible pulpits
- mild inflammation to pulp
- tooth may respond more than normal to stimuli e.g. heat
- stimuli tend to produce sharp pain (a delta fibres) that resolves within 5-10 secs after stimuli removed
- cause of inflammation caries - pulp-dentine complex returns to normal
irreversible pulpitis
- dull aching pain lasting minutes or hours
- worsens at night or when lying down due to increased pulpal pressure
- will become necrotic if left untreated
- tx = XLA/RCT
necrosis
- blood supply non-existent
- negative to EPT and cold sensitivity
- radiographic PDL thickening and PA lucency
- tx= ends/XLA
ANUG - actue necrotising ulcerative gingivitis treatment
- ultrasonic debridement
- chlorohexidine mouthwash, oral hygiene instruction
- metronidazole 400mg 3x a day for 3 days
- or amoxycillin 500mg 3x a day for 5 days
ANUP - Actue necrotising ulcerative periodontitis treatment
- metronidazole 400mg 3x a day for 3 days
- chlorohexidine 0.2% 10ml - 2 x a day
PROS- Primary impression lab card
- please cast impressions in 50:50 plaster:stone and make upper tray with standard handle and lower special tray with intra-oral handle in light cured PMMA
PROS - master impressions lab card
- please cast impressions
- make upper and lower record blocks, with shellac base
tooth trial lab card
- please mount casts in registration and set teeth for wax trial
- specify tooth shade
=- return wax trial dentures on mounted casts. specific instructions e.g. diastemas
final denture card - PROS
re-trial; remount casts and make specified changes for second trial
finished: please wax up for finish and process in heat cured acrylic resin
What is the vibrating line?
junction between hard and soft palate
Mandibular soft tissue landmarks - pros
- retromolar pads
- mylohyoid line
- sublingual crescent
- lingual frenum
- buccal shelf
- mentalis muscle
- labial frenum
pros - maxillary anatomical landmarks
- hamular notches
- tuberosities
- palatine fovea
- labial and buccal frenums
maxillary anatomy considerations in pros
- 1 degree support hard palate
- 2 degrees support alveolar ridge, rug area, buccal shelves
- post dam along vibrating line, in front of the palatine fovea
- incisive papilla and palatine torus must be relieved
- labial and buccal farina much not be encroached upon
Mandibular anatomy considerations in pros
- 1 degree support buccal shelf
- 2 degree support buccal and lingual slopes of alveolar ridge
- lingual pouch used for retention
- floor of mouth is mylohyoid muscle
- lingual, buccal and labial fraena must be accounted for
fissure sealants: gold standard for moisture control
dental dam
needle size for infiltration
short 25mm
needle size for inferior alveolar nerve block
long 35mm
Inferior alveolar nerve block injection site
- 6-10mm above lower occlusal plane
- needle entry at junction of buccal fat pad and pterygomandibular raphe
- syringe lies over contralateral 5
- advanced to bone contact
- if no bony contact reposition syringe distally
What LA would you give to pt with high blood pressure or heart problems?
- 3% prilocaine with felypressin
- contains synthetic vasoconstrictor so effects of la will last
LA for pt with latex allergies
- Prilocaine/Citanest 3% with felypressin
Active component for retracting a canine
Palatal finger springs and guards; 0.5mm HSSW
URA Baseplate adjustment for a pt with overbite
Flat anterior bite plane; Overjet + 3mm
URA active component for correcting a crossbite
Z spring; 0.5mm HSSW
Stainless steel constituents
- 72% iron
- 18% chromium
- 8% nickel
- 1.7% titanium
- 0.3% carbon
