OSCE 2016 Flashcards
What type of hand hygiene would you perform when the patient first comes into the surgery?
Hygienic handwash
Soap and water.
Demonstrate the six steps for hand hygiene
1- Palm to palm 2- Right palm over left dorsum and left palm over right dorsum. 3- Palm to palm, fingers interlaced. 4- Backs of fingers to opposing palms with fingers interlocked. 5- Rotational rubbing of right thumb clasped in left palm, then vice versa. 6- Rotational rubbing, backwards and forwards with clasped fingers of hand in left palm then vice versa.
What PPE would you wear after carrying out hand hygiene?
Mask, apron, visor, gloves
What are the areas of primary support in the maxilla and mandible for pros?
Palate and maxillary tuberosity and rugae (secondary)
Retromolar pads and buccal shelf
What are the post-op instructions after Ex of 36.
Rest up after
No smoking or drinking for 24hrs
Do not explore the socket
Will experience numbness but don’t worry is normal
May experience pain also but take paracetamol, if the pain does get worse then indicates possible infection so see a dentist.
Swelling is normal
Bleeding should be minimal when leaving but the instruction of biting down on damp gauze should be given. If this doesn’t stop it then call NHS 24.
stitches should dissolve after 7-10days unless told otherwise
Do not rinse mouth for first day
What are the 5As for smoking cessation?
Ask Access Advise Assist Arrange to follow up
What are the 3A’s for smoking cessation?
Ask - record the smoking status with various questions
Advise - Patient on the personal health benefits
Act - on the patient’s response, refer to the pharmacy, NRT and track care etc
An actor with radiating chest pain, and left arm pain after climbing up the stairs but the pain is relieved upon rest? Diagnosis
Stable angina
What LA is safe for a pregnant person?
Lignocaine
What is the gold standard for moisture control?
Dental dam
Other benefits of dental dam apart from moisture control?
Patient protection from debris
Improved access and visibility
Increased efficiency
Infection control
Demonstrate the aids you would use for good moisture control for a FS?
Use dry guards
Cotton wool roll (don’t forget to change after washing the etch off)
Ask nurse to place saliva ejector
What are the numbers put in front of Adams pliers?
64 Adam’s pliers
65 are the coil formers
What are Adam clasps used for?
Retention
When taking a pain history what is the acronym you would use and what does it stand for?
SOCRATES Site Onset Character Radiate Associated symptoms Time Exacerbating factors Severity
What differentiates stable angina from unstable angina?
Stable angina, the chest pain is relieved when resting.
How does an MI differentiate from angina?
The pain is more severe and persistent, isn’t relieved by rest.
Is also a complete blockage in the heart as opposed to a partial blockage
In a medical emergency, how would you treat stable angina?
GTN spray sub lingually 400micrograms
oxygen 15L/min
What are all the different medical emergency medications that you will need to know about? (7)
Only stunning Men are actually getting girls Oxygen Salbutamol Midazolam Adrenaline Aspirin GTN spray Glucagon
Tx for an MI?
Crush up 300mg of aspirin allow it to absorb into oral mucosa then call an ambulance.
oxygen also
Describe symptoms of a patient presenting with reversible pulpitis.
Pt will have pain upon stimulus to hot or cold but that sharp pain will only last 10-15 s before going away. (A delta fibres)
Inflammation of the pulp will return to normal once the source is removed (caries)
Describe symptoms of a patient presenting with irreversible pulpitis.
Dull aching pain that is spawntaneous.
Can keep the pt up at night and worse when lying down.
Apon stimulus to hot, cold and sweet the pain can then linger for minutes up to hours.
THe inflammation of the pulp will not be resolved by removal of the source, therefore RCT or Ex required.
Talk through how you would set up a needle for LA Ex of 26.
Check the batch number and expiration date.
Would set up the needle with ultra safety plus system for a infiltration
25mm needle, apply topical if needed.
Aspirate and give 2/3 of cart to the buccal side
Then rest for palatal.
Double click sheath down and dispose in correct sharps bin and LA bin.
What type of LA ingredients or LA should be avoided for pt with heart problems?
High amounts of adrenaline
Why is adrenaline added to LA?
As it acts as a potent vasoconstrictor which maximises the time the LA is in that area, meaning you don’t need to give such high dosages for the same effect.
What type of LA should be given to pregnant pt’s?
Lidocaine
Avoid bupivacaine
What are the 3 types of handwashing?
Social
Hygenic must use alcohol gel after
Surgical
How would you go about giving a radiographic report?
Say what type of radiograph What teeth are present Is it satisfactory or not Apices Bone levels Caries Any fillings, crowns and RCT
Eruption order for permenant and primary teeth?
ABDCE
U- 61245378
L- 61234578
Name all of the forceps.
Upper straight/universal, premolar, molar L +R, Bayonets, Root
Lower straight, molar, root, cowhorn
Name all of the elevators
Couplands
Warwick James
Cryers
What is the difference between a Coupland and a luxator?
Couplands are round and smooth whereas luxators are sharp and are used to break the PDL before Ex
What is the standing position for Ex of teeth?
Stand behind the pt for only Ex of lower right , the rest stand in front of the pt.
What would you write on the lab card for complete denture stage 1? Primary to special trays?
Please pour up primary impressions in 50:50 dental stone/plaster
Make special light cured trays with 3mm upper spacer for alginate and 2mm for silicone and polyether.
For lowers 0.5mm spacer
And an extra oral handle
What would you write on the lab card for complete denture stage 2? special trays to Jaw reg?
Please pour up secondary impressions in 100% dental stone and construct upper and lower wax record blocks on a shellac base to record the occlusal relationship.
What would you write on the lab card for complete denture stage 3? Jaw reg to tooth trail.
Please mount casts on semi-adjustable articulator using the jaw reg provided.
Then with the shade and mould set teeth for tooth trial
What would you write on the lab card for complete denture stage 4? Tooth trial to delivery?
Finished
Please prepare post dam to distance marked on casts.
Please create a finished heat-cured acrylic denture.
If you’re not happy with the tooth trail instead of going to delivery what can you do?
Re-trial
Write an ortho lab prescription card to correct an anterior crossbite.
Please construct URA to correct the anterior crossbite. A - Z-spring 0.5mm HSSW on 21 R - 14,24,16,26 Adam clasps 0.7mm HSSW A - fine as one tooth B - Self cured PMMA and FPBP
If you’re not happy with the tooth trail instead of going to delivery what can you do?
Re-trial
Write an ortho lab prescription card to correct a posterior crossbite.
Please construct URA to correct the posterior crossbite. A - mid palatal screw R - 14,24,16,26 Adam clasps 0.7mm HSSW A - tick and cross B - Self cure PMMA with FPBP
Write an ortho lab prescription card to move the canine posteriorly (retracting).
Please construct URA to move canines posteriorly.
A - 13,23 palatal finger spring 0.5mm HSSW with guard
R - 11,21 Southend clasp and 16,26 Adams clasp with 0.7mm HSSW
A - fine
B - Self cure PMMA
Write an ortho lab prescription card to move the canine palatally.
Please construct URA to move canines palatally.
A - Buccal canine retractor on 13,23 with 0.5mm HSSW and 0.5mm tubing.
R - 11,21 Southend clasp and 16,26 Adams clasp with 0.7mm HSSW
A - fine
B - Self cure PMMA
Write an ortho lab prescription card to correct overbite and move canines palatally.
Correcting Overbite & Moving canines palatally
A: 3|3 buccal canine retractors 0.5mm HSSW & 0.5mm tubing – strength & rigidity
R: Adams clasp 0.7mm HSSW 6|6 Southend clasp 0.7 HSSW 1|1
A: …..
B: Self cure PMMA
FABP for 6.5mmm O/J = 9.5mm FABP
What are the 5 parts to an Adams claps?
The bridge The arrowhead the flyover the leg the tag
Tx for ANUG?
Give pt OHI Gentle debridement under LA 0.2% chlorhexidine mouthwash for 7 days Smoking cessation and advised rest. If systemic then can give AB Metronizole 400mg 3x daily for 3 days Or amoxicillin 500mg 3x daily for 3 days
What are some predisposing factors for ANUG?
Smoking Drinking Poor OH High levels of stress Lack of rest Persistent gingivitis
What are the stages for BLS?
DRSABC Danger Response - shout and shake the patient Shout - for help call 999 Airway - is it clear Breathing - Are they breathing, listen and look Circulation - can you feel a pulse If not too all of these need to call 999 and start compressions immediately.
What are the compression rate for BLS and the ratio to ventilations?
120/min
30/2 breaths
What are the 8 hand scalers and their function?
Mini sickle - supra anywhere in the mouth Columbia - supra and sub anywhere in the mouth Grey gracey - anteriors Green gracey - posteriors Orange gracey - mesial Blue gracey - distal Yellow hoe - buccal and lingual Red hoe - mesial and distal
What are the seating positions for hand scaling?
7 o’clock for lower anterior
9 o’clock for buccal 44-48, 14-18 and lingual of 34-38
11 o’clock for the rest
What post-operative instructions would you give a pt after Ex of a tooth?
Rest
No smoking drinking for 24hrs
Avoid exploring the socket
Take paracetamol before LA wears off to reduce pain
Do not rinse the area until the next day but do then rinse with warm salty water
avoid hot food and eating on that side for 24hrs
Brush as normal
If you have any bleeding after, bite down on some damp gauze and maintain pressure for 15mins if the bleeding doesn’t stop then call NHS 24 or 111
What kind of instructions would you give a new denture pt in terms of denture hygiene and their denture?
Instruct them to wear as much as possible and that it will take time for the muscles to get used to it.
Advise of pain but if really sore to come back in.
Take out at night and clean with warm soapy water
What other solutions can be good for cleaning dentures and why?
Alkaline hypochlorites Superior cleaning properties Dissolution of plaque Removes stains Bactericidal and fungicidal properties
What are some downsides of using alkaline hypochlorites as a denture cleaning solution?
Can bleach the denture
Corrode CoCr
Leave a lasting taste
What are corticosteroids? and what can they be used for?
They are human-made steroid hormones that are used to reduce the inflammatory response from the body.
Used to treat eczema, arthritis etc
What is ledermix and what can it be used for?
It is an antibiotic and steroid medicament used to treat and reduce inflammation of inflamed pulps and slow down resorption after traumatic injuries.
What type of material is Riva?
GI
What type of material is vitrebond and Relyx?
RMGI
What type of mateiral is Dycal?
Setting CaOH
What are 3 uses of NS CaOH?
Direct pulp capping
Lining material for deep cavities
Indirect pulp capping procedures with carious dentine
What makes S CaOH a good RCT, intracanal medicament?
It eliminates any remaining microbes after chemomechanical preparation is complete
What makes S CaOH good for pulp capping?
Preserves vitality of the pulp with no inflammatory response
Stimulates the formation of a mineralised tissue barrier.
What does LIMBO stand in relation to tooth trail?
Lip support - making sure the record block isn’t too bulky and lips can get all the way around. NLA should be 90 degrees.
Incisal level - parallel to the interpupillary line and also must not be too low
Midline - incisal frenum
Buccal corridor - Buccal gap when smiling
Occlusal plane - Flat and parallel to the ATL
The contour of the occlusal rim is marked to show the flat area of the ridge. Why is this?
To show the technician where the teeth should be set along the alveolar ridge.
In the neutral zone.
When giving adrenaline, what type of technique is used to administer and wherein the body is it given?
Z track technique
In the leg
If blood appears in the syringe when giving adrenaline what should you do?
Go 1mm deeper
What effect does adrenaline have on the peripheral and central parts of the body?
Its a potent peripheral vasoconstrictor and a potent central vasodilator
For someone in anaphylaxis shock what dose of adrenaline should be given and then how often should you repeat it? (adult)
0.5mg (1 in 1000 0.5ml) This should be done every 5mins at different sites.
Explain some advice you would give to a pt after a review of their diet diary?
Identify any hidden sugars, flavoured water, sugar medications
Sweets only at mealtimes
reduce the frequency of sugar attacks
Milk and water to drink
Watch out for low pH drinks like diet coke as can cause erosion.
What is the residual alveolar ridge?
The remaining ridge is left after the loss of Ex of teeth.
It is important for the setting of posterior teeth.
Vitrebonnd is a lining material, what are the main contents of it?
Fluroaluminosilicate glass powder
What dose and type of oxygen and oxygen mask do you give to a pt in an emergency?
15L/min
non-rebreathable mask
What dose of salbutamol is given to a pt having an asthma attack?
100 micrograms
What dose of midazolam is given to a pt having continuous or prolonged seizures?
10mg
What dose of adrenaline is given to someone in anaphylaxis?
0.5mg or (1 in 1000 0.5ml)
What dose of aspirin is given to someone with suspected MI and how is it administered?
300mg of crushed aspirin so can be absorbed in the oral mucosa
What dose of GTN spray is used for someone with suspected angina?
400 micrograms
What dose of glucagon is used for someone in a hypo?
1mg IM
What are the 3 main causes of anaemia?
Blood loss
Destruction of RBC
Faulty production of RBC
Describe iron deficiency anaemia and how it looks on blood results?
Body doesnt have enough iron to therefore make enough RBC.
Low RBC count, low Hg, Hct, MCV and ferritin levels.
Describe Pernicious anaemia and how it looks on blood results?
The body cannot use vit B12 to produce RBC
Low vit B12 levels and low level of RBC
Describe aplastic anaemia and how it looks on blood results?
The body stops producing enough blood cells.
Meaning low levels of platelets, WBC and RBC
Describe haemolytic anaemia and how it looks on blood results?
When the body destroys blood cells within the body faster than they are being made.
Results in low levels of Hg
Describe sickle cell anaemia and how it looks on blood results?
This is damage to the Hg within the RBS and results in chronic low levels of oxygen
Describe thalassemia and how it looks on blood results?
Less Hg than normal
Results in low levels of Hg
What instruments are present in a CONS kit?
Probe (explorer)
mirror
BPE (CPITN probe)
Tweezers
In terms RPD what does RPI stand for and when would you use one?
RPI Rest (on the mesial side) Proximal plate I Bar Used for abutment teeth with long free end saddles.
Give an example of everything involved in the prescription of a partial denture lab card?
Must include drawing with design.
Then any modification that needs to be made must be stated, like rest seats and composite for undercuts.
Support - rests for free end saddles on the mesial aspect.
Retention can have occlusally approaching clasps engaging certain undercuts. As well as gingivally approaching clasps
Reciprocation claps to stabilise the tooth
Then the type of connector, lingual bar, plate etc
Explain how the Kennedy classification system works?
1 - bilateral free end saddle 2 - unilateral free end saddle 3 - bounded saddle 4 - Anterior saddle then any additional saddles count as a modification
Explain how the Craddock classification works?
1 - tooth-borne
2 - mucosal borne
3 - Both tooth and mucosal borne
What is the ratio of liquid to powder when mixing GI?
Liquid 2 - powder 1
What is the smile line also referred to as?
high lip line
What is the function of the periotome instrument?
Used for atraumatic Ex, to minimise damage to soft tissues and the alveolar plate
What is the concentration of F in mouthwash?
225ppm
But some online say 450ppm
What is the minimum possible lethal dose of fluoride?
5mg/kg of body weight
What is the tx for toxic levels of fluoride?
Give the pt milk and monitor but if serious get to A&E as quickly as possible
What are the 7 elements of caries risk?
Clinical history Diet history Medical history Fluoride intake Plaque levels Saliva flow/levels Social history
What are the 8 elements of the prevention programme for caries?
Radiographs Toothbrushing instruction Fluoride strength in toothpaste Fluoride supplements FV FS Diet advice Sugar-free medications
What is the name of the regulatory body that regulates radiation of radiographs?
IRMER (2017)
What is the max INR value that you can still carry out Ex?
4
Name some of the interactions of warfarin?
Antibiotics Ibuprofen Antifungals Aspirin Antacids many more
Why should you not use NSAIDs with warfarin?
The risk of bleeding in the GIT is too great as NSAID can cause gastric bleeding which would then be made worse by warfarin.
What AB can be prescribed to pt with systemic symptoms with ANUG?
Metronidazole 400mg 3x dailly for 3 days
Amoxicillin 500mg 3x daily for 3 days
What can cause fluorosis of the teeth?
Excess ingestion of fluoride during the development of the teeth
Name some possible tx options for a lower anterior tooth with fluorosis?
Strip crowns
Microabrasion
Composite fillings
What are the 8 ways (trauma stamp) in which to monitor a tooth after trauma?
Radiographs Mobility Colour Sinus TTP Percussion Ethyl chloride and thermal testing EPT
What is the treatment for an extruded/ luxated tooth and what advice would you give.
2 weeks of flexible splint
Avoid the area
Use a soft brush
0.2% chlorhexidine for 7 days
What are some ways in which a tooth can have NCTSL?
GORD the acids low pH
Low pH drinks
fruits and fruit juices
All can cause erosion
When a tooth changes colour due to trauma what are some possible tx options to restore the aesthetic?
Internal bleaching
veneers
What are some possible techniques for treating gingivitis chairside?
Give the patient disclosing tablets so can see all the plaque and where it is
Then give brushing technique advice. Modified bass technique
What are the different concentrations of fluoride toothpaste and FV?
1000ppm 1450ppm 2800ppm 5000ppm FV 22600ppm
What are the long term complications of trauma to the primary teeth?
delay exfoliation
Loss of vitality
Abscess risk
may require Ex
What are the long term complications of trauma to the permanent teeth?
Delayed eruption Ectopic eruption Damage to the crown Hypoplasia Hypomineralisation damage to root development - dilaceration
What is parallax?
PAL
A radiographic technique that uses two radiographs to determine the local of things
Palatal and lingual move with the machine and vice versa for buccal
What are the names for the occlusal plane curves
A-P
B-L
Curve of spee A-P
The curve of mansion B-L
What is Sjogren’s syndrome?
An autoimmune disorder that effect the salivary glands and lacrimal glands
What might a pt with Sjogren’s syndrome most commonly present with?
Dry mouth and dry eyes
How would you diagnose Sjogrens syndrome?
Blood tests by looking for the anti-La and Anti-Ro antibody
Dry eyes and dry mouth on clinical exam
Take a biopsy of the labial secondary salivary glands.
What complications do people with Sjogren’s suffer?
Dry mouth and eyes burning mouth Difficulty with speech and swallowing Denture retention High risk of caries High risk of salivary lymphoma
What are the 5As for smoking cessation?
Ask - questions about their smoking Advise - tell them benefits of quitting Acess - would they want to quit Assist - point them to services that can help Arrange to follow up - check on them
What are some endodontic irrigants and their use?
EDTA (15%) to remove the smear layer
NaCOH 3% - Dissolves the pulp and disinfects the canal. Disrupts organic position of the smear layer
Chlorohexidine 0.2% - disinfects the canal
What are the 9 types of peads trauma injuries and their Tx?
Concussion - none
Subluxation - nothing but can place 2 weeks Flexible
Intrusion/extrusion - reposition and flexible 2weeks
Lateral luxation - reposition and flexible 2 weeks
Alvulsion - replantation and flexible splint 2 weeks
Coronal root fracture - reposition flexible splint for 4MONTHS
Middle root fracture - reposition and a flexible splint for 4w
Apical root fracture - reposition and a flexible splint for 4w
dento-alveolar fracture - reposition and a RIGID splint for 4w
Radiographic film holders their size and colour?
Anterior PA - Blue size 0
Posterior PA - yellow size 2
Bitewing - red size 2 (kids size 0)
What are the 10 steps involved in fitting an appliance?
Check the appliance matches the pt Check matches your design Check for anything sharp Check the wire work Place in mouth and check for any blanching of the tissues Check the posterior retention Check the anterior retention Check the active component and activate Get pt to demonstrate putting URA in and out of the mouth Book review
What are the 10 pt instructions for a URA?
It will feel big and bulky - get used to it
It will be uncomfortable but means its working
Effect speech - read aloud
Drooling especially the first 24hrs
Wear all the time including at mealtimes, however, may take out for sports.
Clean after every meal
Non-compliance will result in longer tx time
Avoid sticky food and fizzy drinks
Avoid hot foods and drinks
Emergency contact number
What are the two areas of primary support in the maxilla for dentures?
The palate
Maxillary tuberosity
What are the 3 areas of secondary support in the maxilla for dentures?
The buccal shelves
The alveolar ridge
Rugae
What areas behind the upper central incisors must be relieved when designing maxillary dentures?
The incisal papilla Palatine torus (these are benign tumours along the midline of the palate)
What muscles attachments must not be encroached on when designing upper dentures?
The buccal and labial frenums
Where should post dam be marked in terms of the maxilla?
Just in front of the vibrating line and palatine fovea. Extending through the hamular notch
What are the 2 primary areas of support for the mandible when making dentures?
Buccal shelves
Pear-shaped pad (retromolar pads)
What is the one secondary area of support for the mandible when making dentures?
Buccal and lingual slopes of the alveolar ridge
What is the name for the key area of retention (for dentures) in the mandible found around the second molar?
Lingual pouch
What is the name of the muscle found on the floor of the mouth?
Mylohyoid muscle
What must the mandibular denture not encroach on?
The buccal, labial and lingual freanums
Why do we record the high smile line?
Gives you an idea of how much tooth will be showing when the pt smiles
Why do we record the centre line?
The midline of the teeth matches the midline of the pt face
Why do we record the canine line?
It dictates the size of the teeth used for the denture and where the canines will be placed.
Why do we record the rim profile?
To allow for adequate lip support
Why do we record the residual alveolar line?
So the teeth can be set in the neutral zone and the denture has less of a chance of being dislodged by the cheek and tongue.
What are the 3 types of decontamination and when do you use each?
Hand washer - when there is visible blood, eg forceps
Disinfector - Anything the pt has touched
Steriliser - Anything that has crossed the mucous membrane
What are the 5 key principles of the AWI act of 2000?
Must be of benefit to the pt Must be the minimum intervention Take into account the pt wishes Consult people close to the pt, eg friends and family Excercise residual capacity
What are the 3 criteria for valid consent?
Must be informed, voluntary and the pt must have capacity.
What does a pt have to demonstrate to show they have capacity?
They must be able to understand the procedure (risks and benefits)
Retained their decision for a period of time
Then be able to communicate that decision to you.
What are some symptoms associated with COPD?
Dyspnoea - shortness of breath
Cough - producing
Wheeze - continuous coarse or whistling sound made when breathing
Systemic symptoms like fatigue and weight loss.
Write the ortho lab card for reducing OJ of 11,12,21,22, Ex of first premolars and reduce OB.
Please construct an upper URA to reduce OJ (11,12,21,22) and reduce OB
A - Robert retractor with 0.5mm HSSW on 11,12,21,22 and 0.5mm of I.D tubing. Also, mesial stops on the 13,23 with 0.7mm flattened HSSW
R - Adams clasps on the 16 and 26 with 0.7mm HSSW
A - tick and cross as moving 4 teeth
B - Self-cure PMMA, Flat anterior bite plane OJ + 3mm
What are the 4 stages of dealing with a pt experiencing domestic abuse?
Ask
Validate
Document
Refer
What should you do during the Ask stage when dealing with domestic abuse?
Always introduce yourself
Ask the pt how they got the bruises or injury, just ask about the abuse.
Use non-judgmental language
“is everything okay at home”
“Sometimes when I see bruises like that it means that the person is being hurt by someone else, is this happening to you?”
What should you do during the Validating stage when dealing with domestic abuse?
Provide validating messages that take away the blame from the victim
“You do not deserve to be hurt no matter what happened”
“I’m concerned for your safety”
Provide some relief and comfort to the pt and help them realise the seriousness of the situation
What should you do during the documentation stage when dealing with domestic abuse?
Make sure you record everything the patient says and be very specific
Use their own words
Record names, times, location and any witnesses mentioned
Take photos if possible or record in detail
What should you do during the Refer stage when dealing with domestic abuse?
Refer to appropriate services
Give pt leaflet away with them and explain services even if they aren’t keen at the time as they may change their mind.
don’t deal with it yourself
What are the four dental features of digit sucking?
Proclined upper incisors
Retroclined lower incisors
A.O.B
Smaller maxilla so posterior crossbite
What are 4 methods to break a digit sucking habit?
Bad tasting nail polish
URA
Dummy
Positive reinforcement behavioural techniques
What is the blood test for testing if diabetes is well controlled or not? then what are the values for normal people’s blood?
Hb A1c
3.9%-5.5%
Over 6% are at risk and 6.5% are diabetes
If a diabetic pt is sweating and then suddenly loses consciousness, what could be a possible reason for this?
Hypoglycaemic shock or coma
What are some possible side effects of LA?
Nausea
Continued numbness or tingling/pins and needles
Quicker heart rate
What is the minimum Focus to skin distance (fsd) for a radiograph?
20cm
What type of collimation is used and why?
Rectangular collimation
Reduces the amount of radiation exposure to the patient
Describe the steps involved in Setting up a PA radiograph?
The identification dot is towards the biting block (coronal)
Set up so looks like a barstool and can see the bite block through the ring.
Place the film so black is facing the beam.
When placing the bite block in the mouth, use cotton wool on the opposite side to the tooth being examined as it helps with stability.
Remember set up is the same LR - UL and LL - UR
Demonstrate and explain how you would Ex the tooth 46?
Would wash hands and put on gloves
Put the pt in an upright position and stand behind them.
Then select the lower molar forceps.
Attach the forceps as far down the root as possible without damaging the gingivae
Then with a non-dominant hand, I would support the alveolar bone.
With the other hand, I would maintain apical pressure and start buccal expansion and figure of 8 movements
Then check for no retained root or sequestrum before trying to achieve hemostasis.
What type of elevator would you use to Ex retained roots of 44?
Cryers
Also good for multi-rooted teeth as the sharp point can get into the furcation.
Why wouldn’t you use dental dam on kids?
Takes too long
Pt can become very anxious and scared by it
Allergy to rubber
What instructions could you give a patient to aid with moisture control?
Do not close your mouth, try and keep it open
Keep your tongue out of the way
Try and swallow
If during an IDB you hit bone too early, what should you do?
COme out slightly and reposition more mesially.
Describe the steps involved if you were to give an IDB?
Wash hands and wear gloves
Set up syringe 35mm needle with LA
Get pt at a comfortable height
Then find the anatomical landmarks. With you, non-dominant hand feel for the coronoid notch and the ramus of the mandible.
Ask the patient to open very wide and look for a pterygomandibular raphe. The insertion site is 2/3rds up this (about 1cm above the occlusal plane).
Approach from the premolar area on the opposite side.
Insert until contact bone, aspirate and deposit 2/3rds of the cartridge.
Pull the needle out slightly and deposit the rest to numb the lingual nerve
What are the 5 stages of Tx planning and what is their purpose?
Immediate - pain relief
Initial/stabilisation - Control of the disease and OHI
Re-evaluation - Review of diagnosis and reassess compliance, perio and provisional restorations
Re-constructive - Give all the potential Tx options anything from monitoring to complete clearance.
Pros, implants and perio surgery
Maintenance - Prevention, how often do they need to be monitored clinically and radiographically When
When should the shade be taken for crowns?
Before the preparation
What are the key things and measurements to look for when evaluating a metal-ceramic crown prep?
2.5mm occlusal reduction
1.5mm buccal shoulder in all of the aesthetic areas and this should be 1mm subgingival
Then in non-aesthetic areas, a 1mm chamfer can be placed supra-gingival
5-7 degree taper
Maintain the occlusal morphology as this reduces rotational forces
How much of an occlusal reduction is required for all-metal crowns?
1 - 1.5mm
What are the key things and measurements to look for when evaluating an ALL ceramic crown prep?
Occlusal reduction of 2.5mm is to accommodate the zirconia framework and porcelain veneer. N.B less may be required for lithium disilicate.
A 1.5 - 2mm buccal shoulder or long chamfer is required circumferentially about 1mm subgingivally in aesthetic areas.
Non-aesthetic areas should be chamfered and placed supra-gingivally
Remember for resistance and retention the prep should have a 5 to 7-degree taper as well as maintain the occlusal morphology.
*** rounded internal line angles and no undercuts
What is the provisional restoration material that is used for crown preps?
Pro-temp
What are bisphosphonates used for?
To treat osteoporosis, bone cancers and Paget’s disease.
How do bisphosphonates work?
They slow down bone remodelling by inhibiting osteoclasts.
What are some examples of bisphosphonate drugs?
Zoledronic acid
Pamidronate
Zoledronate
Anything ending with “dronate”
What are some possible risk factors for MRONJ?
Smoking Trauma Poor OH Immunosuppressed IV instead of oral If been on the drugs for more than 5 years Systemic steroids Previous history of MRONJ Anti-resorptive and anti-angiogenic drugs
What is MRONJ defined as?
Exposed bone or bone that has failed to heal after an Ex, that can be probed through a fistula as a result of drugs
How would you assess the extensions of a denture?
If the denture is under-extended then when I pulled away from the tissues the denture would drop
If the denture was overextended when I manipulated the tissues it would move the denture and cause it to drop.
How would you get good retention of a complete acrylic denture?
A tight fit which causes a vacuum seal
Futhermore, marking the post dam as far back as possible will increase the surface area and therefore, aid with retention.
The tongue can also aid
Important to no have the occlusal plane too high otherwise the tongue will dislodge the denture as will be too cramped
What is a test clinically to check retention on complete dentures?
Pulling down the front anterior teeth
How do you check for stability?
Check for any rocking when you place your fingers on the occlusal surfaces of the teeth.
Stability will be affected by under extension or if occlusion isn’t balanced
What are some possible reasons for denture fractures?
Drop it Wear and tear by repeated stress Pressure from chewing and shifts in temp Poor-fitting Poor occlusal relationship with heavy contacts Negligence Exposure to acidic foods and drinks
If there is a large amount of residual monomer, how will that affect the molecular weight and therefore the mechanical and chemical properties of the material?
Will have a lower molecular weights
This will cause it to be weaker and more irritant
What is something to look for when examining heat-cured acrylic?
Common to result in increased porosity, i.e a bubble under the surface.
What are should you do when taking and assessing your impression?
Use enough material
Use an adhesive
Look for air bubbles
Make sure all the appropriate anatomy is captured
The functional sulcus is captured
Pt must move the tongue and good border moulding should be carried out
In an OSCE station, what is a good way to always start each station if you are meeting a new pt?
Introduce yourself and check patients’ details
“Hi I’m lawrence a third year dental student can I just check your name and D.O.B?”
Talk through the steps involved in using a luxator?
Wash hands and wear gloves
Patient head level with elbow
Place finger and thumb of non-dominant hand on either side of the tooth to be Ex (support)
Tip of the instrument inserted into the gingival margin on the buccal side with the blade angle along the ling axis of the root surface.
Once into the PDL, the luxator is worked down the length of the root with rotation and apical pressure
Cuts PDL fibres and expands socket
Talk through the steps in using a rubber dam.
Use a clamp with floss in it when placing as to not lose it.
Have only one hole in the dam for endo.
floss ligatures
Make sure the airway isn’t completely covered
What is the % of lidocaine and adrenaline content in one cart?
2% and 1 in 80.000 adrenaline
Each cart 2.2ml
1% = 10mg So 20x2.2 =44
44mg per cart
When explaining a diagnosis to a patient what should kind of tools or aids should you use?
If you have radiographs or clinical pictures they can be useful aids in helping the patient understand their diagnosis and aid them to ask questions.
What is a tooth sleuth used for?
Identifying fractured cusps
How close to an extraction must the INR be checked off a warfarin patient?
72hrs
What are the advantages and disadvantages of using a denture in terms of long term management after Ex?
Advantage
The denture can be modified if more teeth lost
Good aesthetics
Disadvantage
It is removable so pt may not feel natural with it and it may be difficult for them to get used to
What are the advantages and disadvantages of bridges in terms of long term management after Ex?
Advantage
Good aesthetics
Fixed pros
Disadvantage
Requires optimum OH
Adjacent teeth may require tooth prep (sound enamel loss) conventional bridge has 20% chance of pulp damage
Unaesthetic if recession occurs (which is likely if the patient is a smoker)
What are the advantages and disadvantages of implants in terms of long term management after Ex?
Advantages good aesthetic Fixed pros Does not damage the adjacent teeth Disadvantage Requires optimum OHI Cant do if a smoker has a higher chance of peri-implantitis Cost is very expensive
If a PEADS pt turns up to the surgery with their grandmother what would you say to get consent for tx?
The grandmother cant consent
Enquire as to why the mother isn’t here and try to facilitate future appointments so that she can attend
What are the advantages and disadvantages of Ex teeth with LA in PEADS?
Advantages Quick Removes risk of infection Disadvantages if multiple teeth will have to be done over multiple appointments may be very stressful and cause anxiety Can be a lot to manage for the child
What are the advantages and disadvantages of Ex teeth with LA and IHS in PEADS?
Advantages Reduces anxiety Some analgesic properties so easier for the child to manage Appointments quicker no recovery period Disadvantages Still requires LA And multiple visits if a lot of teeth
What are the advantages and disadvantages of Ex teeth with GA in PEADS?
Advantages One appointment Reduce anxiety Disadvantages Long waiting lists Fasting required Risks associated with GA No desensitisation so kid might always need to be tx in secondary care setting
What are some good general tips and communication tips for OSCE stations
Good body language and eye contact
The head tilt 3 nods to show you are listening to the pt
Open questions “describe the pain to me”
Repeat a summary of what they have said so far and allow them to add anything and ask questions.
Show empathy
Avoid clinical jargon
X-ray instead of radiograph and decay instead of caries]
Chunk and check, after each tx option allow pt to show they understand and ask any questions
Refer to leaflets and other sources
What LA should you avoid for pregnant women?
bupivacaine and occtypressin
What LA do you use when your patient has a latex allergy?
Xylocaine with adrenaline
For a pt with severe hypertension or unstable cardiac rhythm what local aesthetic would you use?
Mepivacaine without adrenaline
Prilocaine with felypressin
How do you position the chair for upper and lower Ex
Upper - supine 45 degrees
Lower - upright
At elbow height
What is the ABCDEFGHIJKLMN acronym for MH taking?
Allergies Blood disorders Cardiovascular and respiratory Drugs Endocrine Fits and faints GIT Hospital admissions Infection Jaundice and liver disease Kidney and genitourinary disorders Likelihood of pregnancy Mental illness Neurological
How often should you take radiographs for a pt that is high, medium and low risk?
High - 6months
Medium - yearly
Low - Every 2 years
What are the six steps of handpiece safety?
Check the back cap isn’t loose
Check the bur is secure
Run the bur along with your hand and check it rolls smoothly
Wiggle the bur and check lateral movements
Check the attachment of the handpiece isn’t loose
Check the sound is consistent
What are some side effects of vaping?
Vapers tongue
Dry mouth
Lichenoid reactions - A lichenoid eruption is a skin disease characterized by damage and infiltration between the epidermis and dermis. Examples include lichen planus, lichen sclerosus and lichen nitidus. It can also be associated with abrasion or drug use.
What is the recommended weekly intake of alcohol?
14 units
Should be spread throughout the week and not binged
What is the acronym for Tx of alcohol abuse?
FRAMES
Feedback - compare levels of drinking to the recommended amount
Responsibility - Stress to the patient it is a personal choice and they have to want to cut back on themselves
Advise - discuss systemic and oral health effects with the pt
Menu - Self directed change
Empathy - be understanding and supportive
Self-efficacy - reinforce motivation, encourage commitment
What are some advantages of a URA?
Causes tipping Reduces OB Cheaper Easier to maintain OH GDPs can do Non-destructible to the tooth surface
What are some disadvantages of URA?
Less precise can only tip Can be removed so lost move 1-2 teeth at a time Less effective at rotations Requires specialist technician
What are the 5 displacement forces for a URA?
Gravity Active component Mastication Tongue Speech
Why is heat-cured acrylic better than self-cure?
Its more stable
Stronger
and less irritant due to less residual monomer left
How do you activate a Z spring? And how would you activate it to push a tooth right?
uncoil it
Uncoil the right spring to turn it right
What is the purpose of the alveolar contour line?
To prevent the posterior teeth from being set on a slope which would then interfere with function and displace the denture
What is the checklist of things you must do when designing an RPD?
Saddles Support Retention Reciprocation Connector Indirect retention Base plate Any additions like rest seats and composite undercuts
what does indirect retention do and how could you design your RPD to maximise this?
It stabilises the denture and prevents rotational forces
You want to place components on opposite sides of the arch and create the biggest triangle you can.
For retention in a CoCr denture, what is the length of clasp required and the size of the undercut necessary?
15mm clasp to engage a 0.25mm undercut
A lingual bar is the most common lower major connector but how must space does it require?
8mm
What are ramfjords teeth?
16,21,24 36,41,44
How do you work out the Modified plaque and bleeding scores?
For bleeding you use ramfjords teeth and have 4 sites on each tooth, you give a score of 0 or 1 if BOP. That score is divided by 24 x100 giving you a percentage.
Plaque is the same but only 3 sites and a score of 0, 1, 2 depending on levels of plaque. That score is divided by 36x100 and gives you your percentage.
For perio what are the classifications for staging?
Done by the worse site Stage 1 - less than 2mm Stage 2 - coronal 1/3 Stage 3 - middle 1/3 Stage 4 - apical 1/3
For perio what are the classifications for grading?
The worse site Work out the percentage of bone loss divided by the age of the patient. Indicates the speed of progression Grade A - less than 0.5 Grade B - 0.5-1 Grade C - greater than 1
For perio what are the classifications for stability?
Stable - less than 10% bleeding on probing, PPD less than or equal to 4mm and no bleeding on probing in sites of 4mm
Remission - BOP less than or equal to 10%, PPD less than or equal to 4mm, no BOP of 4mm pockets
Unstable - PPD of more than or equal to 5mm and PPD of 4mm with BOP
What is involved in your periodontal diagnostic statement?
Is it localised or generalised (30% or more) Stage Grade Stability Risk factors - smoking and diabetes
What probe do you use for a 6PPC?
PCP12 probe
In 6PPC what are you recording?
The PPD Recession LOA - PPD + recession (-ve if inflamed) Mobility furcation
How do you grade mobility?
Grade 1 - less than 1mm of H movement
Grade 2 - more than 1mm of H movement
Grade 3 - more than 2mm of H and V movement
GIve the symptoms of periapical periodontitis?
Pain to percussion, palpation and biting
May have radiographic changes
Give the signs and symptoms of a chronic apical abscess?
Gradual onset
Little or no discomfort
Intermittent discharge from the sinus
Radiographic signs of osseous destruction
Give the signs and symptoms of an acute apical abscess?
Rapid onset Spontaneous pain Extreme tenderness to pressure Swelling Puss formation Fever malaise and lymphadenopathy May be no radiographic sign of destruction
PEADS - how long does it take for apexogenesis to occur in primary and permanent teeth?
Primary - 1.5years
Permanent - 3 years
What sizes of toothpaste are used for children under 3 and children over 3?
Smear < 3
Pea size > 3
How often should FV be placed on a high-risk child?
3-4x a year
22,600ppm
What are some contraindications for the placement of FV?
Allergic to Elastoplast
Hospitalised for asthma in the last year
ANUG
What advice would you give to the pt for after they leave the surgery if you have just placed FV?
Avoid eating or drinking for an hour
Who can grant POA?
A person with capacity
If a person doesn’t have the capacity how can they consent to treatment?
Someone can be appointed their welfare guardian by the court
Also section 47 of the AWI act, off doctor or specialised dentist.
For the occlusal plane line, why is it important to mark on the cast for the technician?
The OVD is required so the central incisors are set on the occlusal plane, lateral incisors are set 1mm above the line and the canines are set on the line.
It also determines the curve of Spee when setting posterior teeth for the maxilla.
What is the lower ridge transfer line and why is it important to mark for the technician on the casts?
Provides a guide to the length of the occlusal table and determines the position of the last posterior teeth.
Teeth should not be set on an incline to assist occlusal balance and denture stability.
