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OSCE 5th year > Osce q's batch 2 1-3 > Flashcards

Osce q's batch 2 1-3 Flashcards

1
Q

Endodontics Describe a normal pulp

A

-symptom free and normally responsive to pulp testing -pulp may not be histologically normal -clinically normal pulp results in a mild or transient response to thermal cold testing lasting no more than a few seconds

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2
Q

Describe reversible pulpitis

(pulpal diagnosis)

A

-inflammation should resolve following appropriate management of the aetiology -discomfort is experiences when a stimulus applied lasting only a few seconds -occurs with exposed dentine, caries or deep restorations -no significant radiographic changes in the periapical region of the suspect tooth -pain is not spontaneous

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3
Q

Describe symptomatic irreversible pulpitis

(pulpal diagnosis)

A

-vital inflammed pulp incapable of healing and RCT indicated -characteristics may include sharp pain upon thermal stimulus, lingering pain, spontaneity and referred pain -pain may be accentuated by postural changes such as lying down or bending over -over the counter analgesics typically ineffective -common aetiologies may include deep caries, extensive restorations or fractures exposing pulpal tissue -may be difficult to diagnose as inflammation has not yet reached periapical tissues, thus not TTP -dental history and thermal tests are the primary tool for assessing pulpal status

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4
Q

Describe asymptomatic irreversible pulpitis

(pulpal diagnosis)

A

-vital inflammed pulp is incapable of healing, RCT indicated -no clinical symptoms and usually responds normally to thermal testing. May have had trauma or deep caries that would result in exposure

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5
Q

Describe symptomatic apical periodontitis

(apical diagnosis)

A

-represents inflammation, usually of the apical periodontium -painful response to biting and or percussion -may or may not be accompanied by radiographic changes depending on the stage of disease -severe TTP is highly indicative of a degenerating pulp, RCT needed

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6
Q

Describe asymptomatic apical periodontitis

(apical diagnosis)

A

-inlammation and destruction of the apical periodontium that is of pulpal origin -appears as an apical radiolucency and does not present clinical symptoms

No TTP or palpation

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7
Q

Describe a chonic apical abscess

A

-inflammatory reaction to pulpal infection and necrosis -characterised by gradual onset, little or no discomfort and an intermittent discharge of pus through and associated sinus tract -radiographically, signs of osseous distruction (apical radiolucency) -sinus tract tracing possible

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8
Q

Describe an acute apical abscess

(apical diagnosis)

A

-inflammatory reaction to pulpal infection and necrosis -characterised by rapid onset, spontaneous pain, extreme TTP, pus formation and swelling of associated tissues -may be no radiographic signs of destruction and the patient often experiences malaise, fever and lymphadenopathy

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9
Q

Describe condensing osteitis

(apical diagnosis)

A

diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of the tooth

This causes more bone production rather than bone destruction

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10
Q

When taking an endo pre operative radiograph, what 6 things should you look out for?

A

* Is there peri-radicular pathology and how far does it extend?

* The anatomy of the root canal system

* Canal calcifications

* Check the angulation of the root in relation to adjacent teeth

* Number, length and morphology of roots

* Proximity of vital structures

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11
Q

How can regular alcohol consumption cause cancer?

A

Bacteria in your mouth can metabolise alcohol to a toxic chemical which can accumulate over time and cause changes to DNA (acetaldehyde).
Alcohol can increase levels of oestrogen which is linked to breast cancer.
Alcohol can reduce your body’s natural defenses making it easier for other carcinogens to be absorbed

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12
Q

Name three oropharynx sites cancer may be detected

A
  • Base of tongue
  • Tonsils
  • Soft palate
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13
Q

Name five oral cavity sites cancer may be detected

A
  • Lateral border/anterior two thirds of tongue
  • Floor of mouth
  • Lip mucosa
  • Retromolar trigone
  • Buccal mucosa
  • Hard palate
  • Alveolus
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14
Q

What are the 7 red flags for oral malignancy?

A
  • Ulcer persists for more then two weeks despite removal of any obvious causation.
  • Rolled margins (raised periphery. Firm/hard), central necrosis.
  • Speckled appearance (erythroleukoplakia; red and white patches)
  • Cervical lymphadenopathy (enlarged ( >1cm), firm, fixed, tethered, non tender), should be picked up on during extra oral exam.
  • Worsening pain (at primary site. Neuropathic, dysaesthesia, parasthesia)
  • Referred pain (ear, throat, mandible, teeth)
  • Weight loss. Moving from local to systemic effects. Cachexia (wasting of the body/rapid weight loss due to the metabolic demand of the disease process)
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15
Q

What series of actions should be taken when seeking a second opinion?

A
  • Prior to conversation ensure that all patient details are to hand
  • Ensure the conversation is held in a place that doesn’t compromise patient confidentiality.
  • Summarise the significant points in the patients history
  • Supply a description of the pathology according to its anatomical location, structures involved, size of lesion avoiding non specific terms.
  • Outline areas of specific concern; localised infection, trismus, difficulty breathing, temperature etc
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16
Q

List some less common extraction complications

A
  • Osteomyelitis
  • Osteoradionecrosis
  • MRONJ
  • Actinomycosis
  • Infective endocarditis
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17
Q

When should use of Ibuprofen be avoided?

A
  • If the patient is hypersensitive to aspirin or other NSAIDs
  • If the patient is asthmatic, angieodema, urticaria (hives) or rhinitis precipitated by NSAIDs.
  • Taking low dose aspirin daily
  • Pregnant
  • Previous or active peptic ulcer
  • Caution in elderly and those taking anticoagulants
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18
Q

Name some causes of trismus/limited mouth opening

A
  • Related to surgery (oedema/muscle spasm)
  • Related to giving IDB (medial pterygoid, smasm, haematoma)
  • Damage to TMJ
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19
Q

List 3 of the most common OM diseases

A

-Oral lichen planus/lichenoid lesions -Oral leukoplakia -Traumatic lesions -Benign conditions (geographic tongue, fissured tongue) -Complex oral sensitivity disorder (burning mouth syndrome)

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20
Q

What are some causes of low RBC

A

Haemorrhage

Bone marrow failure

Lukemia

Malnutrition

Iron, copper, folate, Vit B12/B6 deficiency

Haemolytic anaemia

Splenomegaly

Pregnancy

Alcohol or drug induced

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21
Q

What are some causes of low haemoglobin levels?

A

Haemorrhaging (bleeding from wound or GI/GU tract

Less production (aplastic anaemia, cancer, cirrhosis, Hodgkins or non Hodgkins lymphoma, chronic kidney disease, Fe, Vit B12, folate deficiency)

More destruction (splenomegaly, sickle cell anaemia, thalassemia, vasculitis)

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22
Q

What are some causes of high haemoglobin?

A

Smoking and living at higher altitudes

Severe dehydration

COPD

Emphysema

Polycythemia

Congenital heart disease

Kidney and liver cancer

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23
Q

What can a high value haematocrit indicate?

A

Dehydration, congenital heart disease, chronic lung disease, burns, shock, polycythemia

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24
Q

A patient questions why they need a dental exam before starting chemotherapy.
What information should you provide?

-

A
  • it is important to be dentally fit before chemo begins
  • dry mouth is common during treatment, which affects dental health
  • mouth soreness and ulcers (mucositits) can occur 7-14 days following initial treatment, to varying degrees. Symptoms can be managed with good OH, avoiding spicy foods and topical LA
  • Infection risk must be reduced as chemo impairs immunity and causes coagulation defects.
  • When immuno-compromised infections can be life threatening
  • prioritites are to eliminate/remove source of infection and prevention
  • Dental treatment during chemo should be avoinded as much as possible
  • pt at risk of dry mouth, sore mouth, difficulty wearing dentures, fungal infections and altered taste (oral radiotherapy)
  • Increased caries risk
  • Dental treatment needs to be complete at least ten days before chemo starts
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25
Q

In an osce station you suspect a periodontal abscess, how should this be approached?

A

If pain history is given, no need to take a new one.
Explain what is seen intraorally (ie, swelling, abscess, very deep pocket etc)
Request special investigations - pulp testing and radiograph.
Pulp will respond to testing and there will be no PAP

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26
Q

What are the SDCEP guideline in the managment of a perio abscess?

A
  • Carry out careful sub-gingival instrumentation short of perio pocket to avoid iatrogenic damage (+/- LA)
  • If pus is present, drain via pocket or incision
  • Recommend analgesia
  • No ABs unless spreading infection or systemic involvement
  • Recommenduse 0.2% chlorhexidine mw
  • Review and carry out definitive perio tx
  • If systemic, pen v first line (250mg 2 tabs 4 x daily for 5 days.)
  • Amox 500mg 1 3 x daily 5 days
  • Metro 400mg 1 3 x daily 5 days
  • ABs only used in conjunction with mechanical Tx
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27
Q

What is the role of the GDP in head and neck cancer?

A
  • Early detection through soft tissue exam
  • Photos
  • Referral
  • Pre-treatment assessment
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28
Q

in terms of suspected H+N cancer, when should a patient be referred?

A
  • Stidor (noisy breathing) urgent referral
  • Persistent unexplained H+N lumps >3 weeks
  • Ulceration or unexplained swelling of oral mucosa persisting > 3 weeks
  • All red or mixed red/white patches of oral mucosa > 3 weeks
  • Persistent hoarseness lasting > 3 weeks (request chest xray at same time)
  • Dysphagia or odynophagia (pain on swallowing) > 3 weeks
  • Persistent pain in throat > 3 weeks
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29
Q

What investigations are used in the diagnosis of H+N cancer?

A
  • New pt assessment OMFS
  • Biopsy to confirm diagnosis
  • CT scan to investigate extent
  • Lymph node biopsy
  • CT scan to investigate metastasis
  • Staging and gradin
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30
Q

What should be provided for a patient at a pre cancer treatment assessment?

A
  • full exam
  • OPT and PAs are a must
  • Detailed OHI, TBI, ID cleaning
  • Fluoride - topical, duraphat TP, MW
  • Tooth mousse
  • Dietary advice
  • PMPR
  • Consider CHX mw/gel
  • Restore carious teeth
  • Removal of trauma; sharp edges on teeth/dentures
  • Imps for fluoride trays/soft splint
  • XLA or poor prognosis teeth no less than ten days before cancer tx begins
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31
Q

What are some side effects of cancer treatments?

A
  • Surgical tumour resection can produce alterations to normal anatomy
  • H+N cancer tx can have adverse effects on respiration, mastication, swallowing, speech, taste, salivary gland function, mouth opening and outward appearance.
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32
Q

What are some clinical signs and symptoms of a fractured mandible?

A
  • Pain, swelling, limitation of function
  • Occlusal derangement
  • Numbness of lower lip
  • Loose or mobile teeth
  • Bleeding
  • Anterior open bite
  • Facial asymmetry
  • Deviation of mandible to opposite side
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33
Q

What are the 3 steps in management of a mandible fracture?

very basic steps

A
  • clinical exam
  • Radiographic assessment
  • treatment (control of pain and infection)
  • Two basic principles - reduction and fixation
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34
Q

What radiographs might be taken to assess a fractured mandible?

A
  • OPT and PA mandible
  • Occlusal
  • Lateral oblique
  • Towns view
  • SMV
  • CT
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35
Q

What is observed in an exam following facial trauma?

A

Carried out only after cardiopulmonary and neurological exam deemed satisfactory.
Soft tissue injuries;
- Abraisions
- Lacerations
- Incision
- Wound margins (well defined/clean cut edges, serrated, rounded, necrotic?)
- Size - measure with ruler
- Depth; dermal, fat, muscle or deep to bone
Bruising
- Describe colour; red/pink, bluish, greenish, yellow
- Location;
- Mastoid (Battle sign) may indicate significant brain injury.
- Bilateral peri-orbital, inner canthus, lower border of mandible
- Haematomas; a solid swelling of usually clotted blood within the tissues caused by a break in a vessel wall
- Ear; cauliflowering and any associated bleeding/CSF otorrhoea
Swelling;
- Palpate
Visible deformation
- Eg flattened malar region or zygomatic arch deformity, nasal bone deformity, frontal bone depression. Pupilary level, eye position.
Abnormal movement;
- upon extra-oral palpation
- Malocclusion
- Impared function
- Nerve injury (examine cranial nerves)
Tenderness and pain
Intra-oral;
- sublingual bruising
- Gingival lacerations
- Palatal bruising
- Mandibular deformity
- Missing/fractured teeth
- Occlusion

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36
Q

In the management of mandibular fractures, describe reduction

A

The action by which the fragments of the fractured bone are brought into contact with each other. Open or closed

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37
Q

In the management of mandibular fractures, describe indirect fixation

A

wires, bars and screws to bring maxillary and mandibular teeth together

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38
Q

List four signs of a digit sucking habit

A

*proclined upper incisors *retroclined lower incisors *anterior open bite or incomplete open bite *narrow upper arch *unilateral posterior cross bite

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39
Q

what causes signs of a digit sucking habit?

A

the patients thumb/digits are postitioned in the mouth in such a way that they result in the mandible to drop open. This causes the patients tongue to occupy an area that is not deemed normal. The sucking action initiated by the muscular forces in the cheeks narrows the maxillary arch, causing a unilateral posterior cross bite

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40
Q

List four ways in which a digit sucking habit can be prevented or stopped

A

*URA *behavioural management therapy *sock/gloves on hands *plaster on thumb *foul tasting nail polish/hand cream *the use of a dummy

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41
Q

what does the acronym ARAB stand for?

A

*Active component; induces a force by introducing displacement forces *Retention; resistance to displacement forces *Anchorage; resistance to unwanted tooth movement. Newtons 3rd law (for every action there is an equal and opposite reaction) *Baseplate; to provide anchorage, connector for the retentive components, cohesion, adhesion and stability

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42
Q

list 6 things that can go wrong with the growth and development of teeth ie malocclusions

A

*increased over jet *anterior/posterior cross bite *retained deciduous teeth *ectopic teeth *crowding *trauma *anterior/lateral open bites *ankylosis of deciduous teeth *diastema *dental asymmetries *deep overbit *early loss of deciduous teeth *impacted first molars *spacing *habits *cysts *supernummaries

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43
Q

Name five potential risks of orthodontic treatment

A

*decalcification *relapse *root resorption *pain/discomfort *soft tissue trauma *failure to complete treatment *loss of tooth vitality *inhale or swallow small components *candidal infections

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44
Q

What is the process of obtaining consent and writing a referral for GA?

A

PROCESS
* Discuss GA risks and benefits and all other alternatives
* Need referral to hospital and all other carious teeth will also be extracted to avoid future GA
* GA involves a day in hospital - need to monitor full recovery
* A chaperone is needed throughout

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45
Q

What are the risks of GA?

A

VERY COMMON RISKS
* Headache, nausea, vomiting, drowsiness, sore throat/nose

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46
Q

What are the risks of GA?

A

VERY COMMON RISKS
* Headache, nausea, vomiting, drowsiness, sore throat/nose/nosebleed from intubation
RISKS FROM TX
* Pain, bleeding, swelling, bruising, infection, loss of space, stitches
RARE, MAJOR RISKS
* Brain damage, death (3 in a million. A machine is needed to breathe during op and there is a small risk of being unable to breathe independently on waking
* Upset/anxiety on waking making anxiety worse
* malignant hyperpyrexia (very rare, important to ask about FH)
POTENTIAL CONTRAINDICATIONS
* Sickle cell, diabetes, downs syndrome, malignant hyperpyrexia, CF or severe asthma, bleeding disorders, cardiac/renal conditions, epilepsy, long QT syndrome (fast/chaotic heartbeat)

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47
Q

What should be included on a written referral for a childs GA?

A
  • Pt name
  • Pt address
  • Pt/parent contact numbers (landline and mobile)
  • Full medical history
  • GDP/GMP details
  • Parental responsibility
  • Justification for GA
  • Proposed Tx plan
  • Previous Tx details
  • Radiographs and if none available, state why
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48
Q

What is the purpose of a GA assessment appt?

A
  • For Tx planning only. The plan may change with specialist opinion
  • Gain informed consent which must be written
  • Discuss GA process, side effects, complications
  • Adult escort with no other children
  • Pre op fasting
  • Post op arrangements
  • Post op care and pain control
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49
Q

What is the purpose of a GA assessment appt?

A
  • For Tx planning only. The plan may change with specialist opinion
  • Gain informed consent which must be written
  • Discuss GA process, side effects, complications
  • Adult escort with no other children
  • Pre op fasting
  • Post op arrangements
  • Post op care and pain control
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50
Q

What special investigations should be carried out as part of an orthodontic assessment?

A

*radiographs (OPT, maxillary anterior occlusal, lateral cephalogram) *vitality tests *study models *photographs

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51
Q

When should you refer patient for orthodontic assessment?

A

deciduous dentition - CLP, craniofacial abnormalities (if not under MDT care) early mixed dentition - delayed eruption of perm incisors, impaction/FOE of 6s, poor prognosis of 6s, severe class 3, AXB, ectopic canines, pathology late mixed dentition - growth mod in class 2, hypodontia, other routine problems

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52
Q

What indices are used for assessing orthodontic need

A

IOTN - grade 1 - minor malocclusions grade 2 - minimal need grade 3 - moderate need - use the aesthetic component grade 4 - great need grade 5 - very great grade 4/5 get NHS treatment grade 3 needs aesthetic component of 6+

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53
Q

How do you assess the dental health component?

A

MOCDOO Missing teeth overjet crossbite displacement overbite other

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54
Q

When do you extract FPM?

A

poor prognosis, need calcification of the furcation of the 7s as optimal. if late - little space closure and 7 tilts mesially if early - get crowding

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55
Q

How does a twin block appliance work?

A

retroclination of upper anteriors proclination of lower anteriors mid line palatal screw frequently incorportated to tip posterior teeth to correct PCB re-positions mandible forward reduces muscle action on jaws some skeletal grown from secondary growth centres correcting AOB with posterior bite planes and allows further eruption of anteriors

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56
Q

What are the signs of impacted canines?

A
  • delayed eruption - retained Cs - unable to palpate - distal tipping of 2s loss of vitality or mobility of 1s/2s
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57
Q

How would you assess vertical skeletal relationship?

A

LAFH vs TFH - should be 50% ish FMPA - should meet at the back of the head

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58
Q

Describe the AP class I relationship

A

maxilla 2-3mm in front of mandible

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59
Q

Describe the AP class II relationship

A

maxilla >3mm in front of mandible

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60
Q

What are the average values in class I cephalometrics?

A

*SNA relates maxilla to anterior cranial base

Average value 81o +/- 3o

*SNB relates mandible to anterior cranial base

Average value 78o +/- 3o

*ANB relates mandible to maxilla

Average value 3o +/- 2o

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61
Q

What is the average value of FMPA

A

27o +/- 4o

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62
Q

In terms of cephalometrics, what is the upper and lower anterior face height?

A

*Upper; nasion to anterior nasal spine

*Lower; anterior nasal spine to menton

*average value of LAFH to TAFH 55%

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63
Q

What are the eruption dates for

4’s

3’s + 5’s

7’s

A

4’s - 10yo

3’s + 5’s - 11-12 yo

7’s - 12-13 yo

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64
Q

What are the causes of unerupted central incisors?

A

Supernumeraries preventing eruption. Trauma/dilaceration

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65
Q

What are the treatement options for an unerupted central incisor due to a supernumerary?

A

Remove deciduous and supernumerary. Expose unerupted tooth (potentially bond gold chain). Create space. Monitor for up to 18 months

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66
Q

What are the stages of treatment planning in orthodontics?

A
  • Plan around the lower arch (angularion of lower labial segment is stable)
  • Decide on treatment in lower (ext or no ext)
  • Build upper arch around lower. Aim for class i incisor and canine relationship
  • Decide on molar relationship. Class i or full unit class ii
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67
Q

What are the general principles of space required in the lower arch? ie define crowding

A
  • Mild (0-4mm) stripping or ext of 5s
  • Moderated 5-8mm - extract 5s or 4s
  • Severe >8mm - extract 4s
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68
Q

For CN exam, how do you test CN 2 (Optic?)

A

Inspect pupils
Inspect visual fields
Assess blind spots

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4
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69
Q

For CN exam, how do you test CN 3, 4, 6 (oculomotor, trochlear and abducens)

A

Ptosis (drooping of eyelid)
Eye movements
Light reflex

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70
Q

For CN exam, how do you test CN 5 (trigeminal?)

A

Assess patients feeling to touch of forehead, cheek, chin, examine MoM

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71
Q

For CN exam, how do you test CN 7 (facial?)

A

Changes to sense of taste or hearing.
Inspect for facial asymmetry at rest
Assess facial movement when patient performs different expressions

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72
Q

For CN exam, how do you test CN 8 (vestibulococclear?)

A

Test patients hearing

73
Q

For CN exam, how do you test CN 12 (hypoglossal?)

A

Exam tongue for hypotrophy or deviation on protrusion

74
Q

What is the purpose of staging periodontal disease and what are the four stages?

A

Staging is based on severity.
Stage 1 - Early/mild. Interproximal bone loss less than 15% or 2mm
Stage 2 - Moderate. Coronal third of root involved.
Stage 3 - Severe (potential for additional tooth loss), mid third of root involved.
Stage 4 - very severe (posential for loss of dentition) Apical third of root involved

75
Q

Describe type 3 recession

A

Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss is greater than the buccal attachment loss.

76
Q

In bridgework define retainers

A

The extracoronal ir intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth

77
Q

In bridgework define connectors

A

Component which connects the pontic to the retainer(s)

78
Q

Describe a fixed fixed bridge and its pros and cons

A

This type of bridge has a retainer at each end with a pontic in the middle joined by rigid connectors.

Advantages; robust design, maximum retention and strength, abutment teeth splinted together, can be used in longer spans, lab construction straight forward.

Disadvantages; Preparation difficult (parallel tooth prep), minimal taper, common path of insertion for abutments, more tooth tissue removal

79
Q

Describe a cantilever bridge and some pros and cons

A

This type of bridge provides support for the pontic at one end only by a conventional crown retainer or a resin retained metal wing.

Advantages; more conservative than fixed fixed. Lab construction straight forward. No need to ensure multiple tooth preps parallel.

Disadvantages; short span only, rigid to avoid distortion, mesial cantilever preferred

80
Q

In bridgework, what is the ideal crown to root ratio?

A

length of tooth coronal to alveolar crest compared to length of root embedded in bone. Optimum 2:3, minimum 1:1

81
Q

List some materials used for conventional bridges

A

*All metal; gold, nickel/colbals chromium.

*Metal ceramic

*All ceramic; zirconia (lava), lithium disilicate (e-max)

*ceromeric (BellGlass)

82
Q

Tx planning station with xrays, photos, models. How to approach this

A
  • Introduce yourself (name and BDS5)
  • Explain clinical findings, using props to demo
  • Radiographic report - caries, bone loss, impacted teeth, crowding etc
  • Discuss Tx including different options (RCT vs ext, comp vs amalgam etc)
  • Give perio diagnosis and explain
  • Offer smoking/alcohol advice
  • Offer OH, diet advice
  • Identify if there is toothwear and offer Tx options.
  • Make sure the pt understands
83
Q

How should a Tx plan be prioritised?

A

IMMEDIATE
- Address pain (per-coronitis, TA, perio abscess, PAP)
- INITIAL
- OHI, PGI, 6PPC, supra/sub gingival PMPR.
- Diet advice
- Any relavent referrals
- Smoking/alcohol advice
- Impacted teeth
- NCTSL - find cause. Tx - restore/splint
- Caries management
- Endo
RE-EVALUATE
- Perio 12/52
- NCTSL photos/study mods
RECONSTRUCTIVE
- dentures/bridges
MAINTENANCE

84
Q

What details should be given on a lab prescription for a cantilever bridge?

A
  • Fill pt details (sticker on each page)
  • Practice/practitioner details
  • Date/time of imp
  • Date required
  • What work required
    INSTRUCTIONS
  • please pour imps in 100% improved stone, mount on Denar ii semi-adjustable articulator using facebow/wax bite provided.
  • Construct metal ceramic conventional mesial cantilever bridge to replace tooth xx, use xx as abutment and xx as pontic (- ridge lap for posteriors. - modified ridge lap for upper ants. - dome lower incisior/premolar/upper molar if low smile line. - ovate. - wash through for lower molars)
  • Please construct in canine guidance and ensure pontic is free of excursive movements.
  • Please return cast with bridge
85
Q

How to systematically go through a radiographic report?

A
  • State the type of xray
  • Diagnostically acceptable/unacceptable
  • dentition;
  • teeth - erupted/unerupted/permanent/primary/missing/supernumerary/impacted/ectopic
  • restorations (heavily/minimally restored) overhangs, poor margins
  • trauma
  • Disease;
  • Caries (primary/secondary) Supra/subgingival calculus, PAP
  • Perio- bone levels, local/generalised
  • Endo - well/poorly condensed, distance from apex, separated instruments etc
  • TMJ
  • Any other pathologies
  • Give diagnosis summary
86
Q

What should be looked for/identified when looking at iatrogenic/developmental faults on a radiograph?

A

IATROGENIC
- RCT - fractured file, perforation, ledging, GP over/under fill, extruded sealer, missed canal
- Restorations - overhangs, fractures, poor margins, post w/o RCT, perforated post.
- External inflammatory/surface/replacement resorption, cervical root resorption
DEVELOPMENTAL
- Cysts - dentigerous, redicular, eruption, keratocyst
- Unerupted, ectopic, impacted teeth
- Dentigenesis imperfecta (bulbous crown, abscess, pulpal obliteration
- TMD
TRAUMA
- Bone #, tooth #, displacement

87
Q

How to approach the design of a lower co/cr

A
  • Give kennedy classification
  • Give craddock classification
  • Identify saddle areas to be restored. Identify and show clearly mesh etc
  • Indicate occlusal/cingulum rests
  • Indicate major connector
  • Indicate retention - clasps
  • written prescription must match design.
88
Q

Nurse has a sharps injury following treatment. Explain concern to patient and how you would manage this.

A
  • Explain nature of injury to the nurse to the patient. Risks are to the nurse and not the patient.
  • Explain risk of BBV to nurse. Risk of transmission of HIV/Hep C etc. Low risk based on injury type (1:300 for HIV)
  • Explain standard procedure for managing sharps injury. This is applied to all patients. Blood sample needed, this would be asked of any patient.
  • Approach request of sample professionally and sensitively.
  • Make it clear that there is no pressure on the patient to agree.
  • Review MH; have you ever been diagnosed with BBV? Have you ever injected drugs or slept with anyone that has? Have you ever had sex with another man? Have you had sex with someone from another country? Have you ever had a blood transfusion? when/where? Have you ever had dental treatment in anther country? Have you ever had a tattoo/piercing by an unlicenced artist? Answering yes to any of these puts pt at high risk.
  • Consent - establish patient understands options. Give opportunity to ask questions. Confirm patients decision.
89
Q

How to approach a conversation with a patient about risks of extraction and MRONJ before starting alendrontic acid?

A
  • Introduce yourself
  • Explain alendrontic acid is a bisphosphonate drug
  • Explain action of bisphosphonate drugs; they reduce the turnover of bone. They accumulate in sites of high bone turnover such as the jaw.
  • Relevance of bisphosphonate drugs in dentistry; risk of poor wound healing following extraction. Need to remove teeth of poor prognosis before therapy. Important to do everything possible to prevent further tooth loss in future.
  • Reduced turnover of bone and reduced vascularity can lead to death of bone - osteonecrosis.
  • Specifically name MRONJ
  • Risk of MRONJ in osteoperosis is low
  • Make and explain any clinical diagnosis; perio, caries, PAP
  • Discuss Tx options and risks.
90
Q

Paes trauma. EDP#
Outline procedure to parent of an anxious child

A
  • Explain nature of injury
  • Explain Tx (pulpotomy) as this is a large exposure, Tx of choice is pulpotomy.
  • Partial removal of pulp. Explain aim is to keep undamaged tooth tissue alive. Explain this keeps the tooth alive so it continues to grow.
  • Baseline sensibility tests (shows how the injured tooth and adjacent teeth respond. Gives baseline for future monitoring.)
  • LA required (give description and why its required)
  • Describe use of dental dam. Rubber sheet to isolate and protect tooth and airways.
  • Describe use of handpiece to remove damaged pulp
  • Pulp will be dressed with setting CaOH and MTA
  • Tooth coloured filling to restore aesthetics
91
Q

Describe how to handle and request testing of pus aspirate of an abscess

A
  • Make sure patient details are correctly entered onto form (sticker with CHI, hosp number, name, sex, address, DOB) Hospital dept, date, time, consultant, requested by, phone number
  • Clinical details to be entered on form; pain, swelling etc. MH, provisional diagnosis ie dentoalveolar abscess.
  • Specimen details include; type of sample (pus aspirate), details of site ie buccal mucosa of 26
  • Investigation - culture and sensitivity testing, bacterial/viral
  • Wear appropriate PPE when handling specimen. ie gloves
  • Remove needle from syringe with sheath intact. Dispose of needle in yellow sharps.
  • Seal syringe for transport with red cap
  • Label syringe with pt details, place in plastic bag attached to request form
92
Q

Breaking bad news. Give results of biopsy confirming oral cancer.

A

SPIKES
SETTING sit down at same level as patient. Is anyone with you today? How have you been since last time?
PERCEPTION. Do you know why you’re here today? Do you know the purpose of the biopsy? Can you explain your understanding of things up until now?
INFORMATION Tell patient you have biopsy results. Ask patient if they’d like you to go over the results.
KNOWLEDGE Give a warning shot. ‘I wish I had better news. I’m afraid the results aren’t good. The test has shown that there are abnormalitits in the cells. I’m afraid the results confirm that you have mouth cancer.’ Pause and let it sink in, let paient dictate pace of conversation
EMPATHY I understand you’ll have lots of questions, does anything come to mind just now? Would you like your partner to come in?

Summaise. Repeat news, summarise plan going forward , The good news is we’ve acted quickly. Treatment will begin asap, I will speak to the surgeons and then with you to discuss treatment.’ Offer follow up appt, offer phone number and any written material

93
Q

Patient has pain from denture and sore palate. Test done confirms denture induced stomatitis affecting palate. MH includes type 2 diabetes, warfarin and atrial fibrilation. Explain findings and offer advice

A
  • Introduce self
  • Brief history, ackowledge diabetes and ask about control. Ask if dentures are worn at night. Ask about denture hygiene.
  • Explain findings - denture induced stomatitis - a yeast/fungal infection, can be a particular problem with diabetics as blood sugars can encourage growth.
  • Management - palate brushing daily. Denture cleaning advice; clean after meals and soak in CHX or NaOH 15 mins 1-2 x daily. Leave denture out overnight and as often as possible. Check denture fit - may need to be adjusted or replaced.
  • Offer smoking advice if necessary. Offer diet advice/sugar control
  • Confirm patient understands.
  • Antimicrobials? None or CHX. Nystatin 2nd line drug. Pt cannot use azole antifungals due to interaction with warfarin.
94
Q

What are the steps for a simple interuppted suture?

A
  • Correct choice of instruments - kilner needle holders and gillie toothed tissue forceps.
  • Mount needle 1/3rd from end
  • Correct grasp of needle holder, hold in dominant hand
  • Correct grasp for tissue forceps - hold in pen grip
  • Atraumatic handling of flap with tissue forceps
  • Insert needle at right angle to wound edge and perpendicular to the surface
  • Insert needle at appropriate distance from wound edge, 2-5mm
  • Pass needle through flap and retrieve it with instrument
  • Remount needle with instrument
  • Take a full bite on 2nd side and retrieve with instrument. Attempt to reinsert at same depth in opposite side of wound and emerge out of tissue at same distance from wound edge as insertion
  • Demo adequate pronation and supination of hand
  • Ensure needle is secrew when tying of knot
  • 1st throw - two turns, grasp suture at free end, approximate edges
  • 2nd throw - 1 turn in opposite direction, grasp suture at free end and tighten
  • 3rd throw in opposite direction again
  • Cut suture to length suitable for wound site.
  • Knot to side of wound
  • Final apposition of wound enture wound ends close together but no tension and secrure knot
  • Dispose or clip needle
95
Q

Name a bisphosponate drug, RANKL inhibitor and Anti-angiogenic

A

Alendronic acid, risedronate sodium. Denosumab. Bevacizumab

96
Q

OAF. Take a history, explain the diagnosis from images/x-rays and history. Explain management and surgical closure

A

Chronic OAF pt may complain of;
- Fluids coming out of nose
- Nasal sounding speech
- Problems playing wind instruments
- Problems using a straw
- Bad taste/odour, pus discharge
- pain/sinusitis type symptoms

  • An OAC is an acute communication of the air sinus with the oral cavity
  • In your case the communication hasn’t closed over and instead has healed forming a little skin lined communication between the air sinus and the mouth
  • This is something that should be managed as it makes you more prone to developing sinus infections

Management;
- Excise sinus tract/fistula, removing epitheliym + buccal advancement flap
- ABs (amoxicillin 500mg 7 days, 1 3 x daily. Doxycycine 100mg 7 days, 1 x daily, 2 on day 1)

Post op;
- Refrain from blowing nose/stifling sneeze
- Use steam or menthol inhalators
- Avoid straws
- Avoid smoking

97
Q

Localised aggressive perio. Diagnose from OPT. Explain diagnosis and management.

A

Features;
- Pt generally fit and well.
- Associated with familial history of aggresive perio
- Rapid LoA not proportional to plaque levels
Pattern;
- Localised if 6s and incisors (and < 2 other teeth on pt < 30yo)
- Generalised if 3 teeth other than 6s/1s/2s on pt >30)

  • Convincing evidence of a genetic predisposition ot perio, in particular aggressive
  • Other risk factors such as smoking and OH have an impact
  • Important to screen and monitor siblings and children of pts with severe perio due to greater risk

Be careful as pt can feel hopeless and give up - emphasise it is still treatable

Treatment;
- meticulous self care
- Professional instrumentation (non surgical/surgical if necessary) 6PPC, NSHPT, removal of plaque retentive factors
- 2 week course of CHX mw
- No ABs routinely but may be appropriate as adjuncts from specialist (no first line of Tx)
- Metronidazole or amoxicillin
- Benefits of ABs - good results
- Risks of ABs - dont treat the cause, low proportion reaches sites, doesn’t disrupt biofilm, AB side effects
- Pt should be referred to specialist if no changes

98
Q

Reline of F/F. Select correct material and write prescription

A

Reasoning; Relines - when fitting surface is inadequate but denture is otherwise ok, ie occlusal planes, OVD, profile are acceptable but fitting surface underextended, not supportive/stable or retentive. Rebase - when you want to keep the occlusal surface but change fitting and polished surfaces.

Method;
- Check all occlusal relationships are acceptable and appropriate.
- Remove undercuts from fitting surface with acrylic trimming bur
- Adjust border with under/over extension with green stick
- Apply adhesive to fitting surface of denture to be relined
- Insert imp material (light body PVS) into fitting surface and seat denture
- Functional imp (ask pt to bite together so the imp is taken in OVD)
- Take opposing imp with denture in situ
- Take bite reg if OVD not obvious
- When set, remove imp, disinfect and sent dent to lab for reline

Prescription; please pour imp in 100% dental stone using denture imp provided. Please mount upper/lower cast and create a self cure PMMA reline to change fitting surface

99
Q

A parent brings their child to clinic, not feeling well and is distressed. Image shows blistering/ulceration of gingivae, inner lips and commisures.
Take history, provide diagnosis to mother, Tx and answer any questions.

A
  • Introduce self and designation
  • Take a history; number of days of symptoms, does the child have a fever? Less active than normal? Analgesia used, and did it work?

Signs and symptoms of primary herpetic gingivostomatitis; lymphadenopathy, malaise, pyresia, erythematout gingivae, ulceration, sore mouth and throat, fever

Diagnosis - primary herpetic gingivostomatitis. Contagious primary infection caused by herpes simplex virus. Self limiting and will disappear in 7-10 days. High carriage rate in population, common.
Most often occurs in young children and is usually the first exposure a child has to herpes virus (responsible for cold sores)
Most initial infections are subclinical but can present as this florid infection. Usually no symptoms. Often will present with blisters on tongue, cheeks, gums, lips, roof of mouth. Once blisters pop, ulcers will form.
Other symptoms to watch out for are high sever, difficulty swallowing, drooling and swelling
Dehydration can occur due to difficulty eating/drinking.
Child may not develop cold sores in future.

Management- push fluid intake. Analgesia to control fever/pain. Bed rest, take it easy. Clean teeth with damp cotton wool or cloth to rub around gums. Can use dilute CHX to swab gums.

As child had had problems for 3 days and is otherwise fit and well antivirals are not recommended.

If severe case or immunocompromised script for aciclovir 200mg 1 tab 5 x daily for 5 days. Refer to hosp if immunocompromised

100
Q

Crown critique. Cold crown fitted onto mounted casts. Assess crown and make decision to fit or remake.

A

Pre-cementation checks
- is the restoration as asked for?
- Check on cast; rocking, m/d contact points, marginal integrety, adjacent teeth (can be damaged when prepped tooth sawn off cast)
- Check for occlusal interference on excursions. Check adequate reduction
- Check occlusion with crown on cast

Remove crown from cast
Check if natural teeth occlude properly
Check if tooth is under prepped.
Measure crown thickness with calipers. Min 0.5mm circumferential, 1.5mm functional cusps/1mm non functional cusps

Management
- check amount of interference and if able to reduce crown without making it too thin then adjust and cement.
- Otherwise re-do prep and send back to lab.
- Follow crown prep principles; ideal taper 6 degrees, retentive grooves/slots, bevel functional cusps, two plane buccal reduction, smooth prep margin at gingival margin.

Avoiding fault in future;
measure temp crown thickness before cementing.
Use sectioned putty index when prepping

101
Q

12 Minute station
Complaints procedure.
Pt annoyed they had to wait an hour and receptionist was rude
How to approach?

A
  • Take concerns seriously, answer questions as able to. ‘Hi, what seems to be the problem?’ ‘Can I offer some assistance?’
  • Ackowledge anger ‘I can see that you’re upset and I’m sorry you feel that way’
  • Try to offer practical help.
  • Offer investigation with receptionist and provide feeback to pt
  • Offer another appt ‘do you still have time to be seen today?’
  • ‘what would you like to do?’
  • How can we work around this?’
  • Make an apology; be honest. Acknowledge the offense. Explain how it happened. Express remorse.
  • Ensure amends - is there anything we can do?

If formal complaint requested, advise on NHS complaints procedure. If required - a local resolution. If satisfactory - complaint closed. If unsatisfactory - healthcare commision or health service ombudsman.

NHS complaints procedure;
1. Acknowledge the complaint and provide pt with the practice complaint procedure.
2. Inform the dental defence organisation if you require advice.
3. Inform the patient of the timescales and stages involved
4. Acknowledge the complaint in writing, by email or by phone as soon as you recieve it. 3 working days max but ideally 24 hours
5. Early resolution 5 working days for issues that are straight forward, easily resolved, requiring little or no investigation
6. Investigation 20 working days for issues that have not been resolved at the early resolution stage or that are complex, serious or ‘high risk’
7. Independent external review ombudsman for issues that have not been resolved.

102
Q

12 minute station
Medical emergencies
Explain hypoglycaemia drugs to nurse

A

Medication given is glucagon. It increases the concentration of glucose in the blood by promoting gluconeogenesis and glycogenolysis to convert glycogen to glucose.
Type 1 diabetic hypoglycaemic coma. normal 5-7mmol, unconscious <3mmol.
- Assess ABCDE
- Signs; pale, shaky, sweaty, clammy, dizzy, hungry, confusion, blurred vision, loss of consciousness (must mention this as it defines treatment)
- If conscious and cooperative administer oral glucose 10-20g or sugary drink
- If unconscious or uncooperative 1mg IM glucagon injection adn oral glucose when consciousness regained.
- If consciouness not regained in 15 minutes, give 2nd dose

IM injection technique;
- Inject diluting solution into vial with glucagon powder.
- Swirl to mix, don’t shake
- Draw solution back into syringe
- Spread skin, advance needle in skin at 90 degrees, aspirate, inject 30s, pull out, release tension. Inject in thigh, hip, deltoid or buttock.

Normally would prepare/change needle, remove clothing, alcohol wipe etc but not going to as this is life threatening and saves time

Reassess ABCDE. Assess effect of meds, more oral glucose required?

103
Q

12 minute station
Medical emergencies
Explain to nurse drugs used for epilepsy

A

Medication given is midazolam. A short acting benzodiaepine. It enhances the effect of the neurotransmitter GABA on the GABA receptors resulting in neural inhibition.

Signs; loss of consciousness, uncontrolable muscle spasms, drooling, ridgidity, sharp jerky movements, decreased BP, hypoxia

Assess ABCDE
Do not restrain
Make sure area is safe
Admin 100% oxygen at 15l/min
Set timer, if >5 mins give 2ml oromucosal midazolam. Repeat after 5 minutes if not worked.
Check expiry date and make sure it’s the form of midazolam administered buccally. Choose appropriate dose for age.
Recovery position, check airway, monitor.
Refer to hosp if first seizure, atypical, injury caused or prolonged

104
Q

Recurrent Aphthous Stomatitis - Recurrent Minor Ulcers (6 mins)
27-year old patient presents with ulcers. The patient’s ulcers are no more than 10mm in size (history provided etc). Using this information and the available lab results (Patient has low iron and folate). Discuss the lab findings, the diagnosis and management options for this condition with the patient. You do not need to gain any more information from the patient.

A
  • Build up and diagnosis. Are you aware of what you’re here to discuss? You were here a few weeks ago c/o pain/ulceration and we took bloods. Would you like me to run through results? Nothing sinister or to worry about. Results show you have a type of anaemia called microcytic anaemia caused by an iron deficiency.
    Iron deficiency anaemia is a condition where lack of iron in body leads to reduction in RBC. Iron used to produce RBC which help store and carry O2 in blood and around the body. If you have fewer than normal RBC, your organs and tissues won’t get as much O2 as normal. Many people with iron deficiency only have some symptoms; tiredness/lethargy, SoB, palpitations, pale complection, feeling cold. and in some cases oral ulceration.
  • Aetiology - lack of iron in diet, heavy periods, history of stomach ulcers.
  • Management - iron supplements, increased iron in diet. This should resolve ulceration in 1-2 weeks. GP can prescribe and may do further tests to pinpoint cause.
    Advise increase in iron through diet (dark green leafy, iron fortified cereal, pulses, beans, nuts, seeds, meat, fish, tofu, eggs, dried fruit.
    Avoid spicy food if painful. If unable to eat script for benzydamine mw 0.15%. 300ml, 15ml every 90 mins as required. no more than 7 days.
    Vit C helps absorption.
    Caffiene inhibits absorption.
    Reassure pt. Should resolve within 2 weeks with no scarring. Any Qs?
105
Q

Ortho - Retained ULA + Unerupted UL1 (6 mins)
Photos of discoloured 61 and labial/buccal segments of an 8 year old. PA of a dilacerated floating 21 that could be anything. Please identify the problem present for this patient and discuss its further investigation/management with your examiner.

A

CAUSES OF RETAINED A/ UE1
- trauma causing damage to 1. Complications include ankylosis, arrested permanent tooth formation, dilaceration (curve/bend in root or crown), displacement.
- Lack of permanent successor/hypodontia
- Ectopic tooth germ
- Crowding
SIGNS
- Discolouration of A. Retained A
-Radiographic
- Lateral erupted before central
INVESTIGATION-
- Radiographic localisation for ortho Tx; another PA /ant occlusal, or opt and occlusal or CBCT
MANAGEMENT
- always palpate, usually upper 1 is buccal and central
OPTIONS
-leave and KUO. Inform of possible cyst formation or resorption
- Extract retained A (leave 1) and space maintain (warn of cyst formation risk)
- Surgical removal of both and space maintain
- Refer for ortho opinion/Tx, warn of risks/benefits of ortho
-Auto-transplantation
- Other options are XLA and hope for eruption, or expose and bond/traction but both unlikely with dilaceration

106
Q

How to approach F/- with anterior flange missing?

A

Remove undercuts, build flange with greenstick and reline. Rebase or remake if this is not possible

107
Q

How to fix # denture with midline diastema?

A

Replica denture, ask lab to close diastema at try in stage. Putty imp with vaseline, wax replica for functional imp and bite reg. Otherwise remake.
Ask lab to provide try in stage with diastema corrected

108
Q

How to correct a denture that is underextended posterior at tuberosities?

A

If patient is happy with denture otherwise, imp and reline. If unacceptable - remake

109
Q

How to correct dentures with locked occlusion?

A

Remake with replica technique with cuspless teeth or grind teeth with acrylic trimming bur

110
Q

How to correct a denture with a thin baseplate?

A

Rebase with a thicker plate or high impact resin. Remake denture

111
Q

How to correct a denture with an occlusal table too long? ie teeth lie over tuberosity

A

Remove posterior teeth with bur or remake

112
Q

Describe a reline vs rebase and the differences

A

Reline - replacement of denture fitting surface. Relining is satisfactory for lower dentures but increases thickness of upper dentures making it heavier and less retentive. The thickness is directly related to the choice of the impression material, use low viscocity (light body PVS)
Rebase - replacement of the whole denture base.
Reline lower denture, rebase upper denture.
Adjust the periphery of denture as necessary to correct over/under extension. Add greenstick and take imp.

113
Q

Describe minor aphthous ulcers

A
  • <10mm diameter
  • Last up to two weeks
  • Only affect non keratinished mucosa
  • Heal without scarring
  • Usually respond well to topical steroids
  • Ulcer free period is good guide to morbidity
  • Will never affect attached gingivae or hard palate
  • Diagnose by history. Exam - yellow/grey base with red margin/halo
114
Q

Describe major aphthous ulcers

A
  • Can last for months
  • Can affect any part of the oral mucosa keratinised, not or both
  • May scar when healing
  • Poorly responsive to topical steroids (intralesional steroids more useful)
  • Usually >10mm, may also have smaller ulcers, diagnose according to worse ulcer
  • Diagnose by history
115
Q

What tests are available for recurrent ulcers?

A

Blood tests (GDP can liase with GMP). Deficiencies - iron, B12, folic acid
Coeliac
Allergy tests unreliable, better to just avoid common triggers. Benzoate, sorbate, cinnamon, chocolate. For 3 months, if no change, unlikely to be allergy.

116
Q

What treatment is available to recurrent ulcers?

A
  • Correct blood deficiencies
  • Refer for investigations
  • Avoid dietary triggers (SLS containing TP, sesodyne, pronamel and kingfisher and fine)
  • Script initially for steroid free Tx (CHX, benzydamine mw)
  • Topical steroid spray/mw but only effective before ulceration occurs (when pt gets pre breakout tingle)
117
Q

When do aphthous ulcers tend to occur in children?

A

Usually during a growth spurt. New shoes? Often causes iron deficiency, ask about diet/supplements?

118
Q

When should a patient be referred for aphthous ulcers?

A

If there are no results from non steroid and steroid treatments
Major aphthous ulcers or a child under 12

119
Q

What are some fracture prone features of a denture?

A
  • Thin, under extended and/or absent flanges.
  • Previous repairs
  • Stress concentrators - large frenal notch, midline diastema, foreign particles
  • Poor fit
  • Lack of adequate relief
  • Tooth wear
120
Q

How can denture fractures be prevented?

A

Inclusion of a metal plate. Use of an alternative denture base material such as high impact acrylic resin for thin under extended flanges

121
Q

How to approach a fractured denture repair?

A

For simple midline # two fragments are secured with sticky wax. Sent to lab and repaired with light cured PMMA. Easier processing but weaker than heat cured.
Multiple #; if possible seat larger fragments intraorally and take imp, otherwise remake.
fractured teeth - take imp of opposing arch to establish correct occlusal relationship.

122
Q

30 yo unregistered patient c/o signs of ANUG.
Smoker and cervical lymphadenopathy. Discuss diagnosis and proposed management.

A

Diagnosis - ANUG. Presents as acute form of gum disease. Develops quicker and more severe than normal.
Aetiology - can be caused by a variety of reasons but tends to be in people with high levels of stress, smokers, poor OH, poor nutrition, immunocompromised.
Symptoms include painful, bleeding gums, painful ulcers, receeding gums in between teeth, bad breath, bad taste. Can cause systemic symptoms, swollen lymph nodes, fever.
Management; reassure pt that it can be managed by local measures; OHI NSHPT inc RSD with LA. CHX 0.2%. Smoking cessation, stress management.
Systemic involvement; metronidazole 200mg, 1 tab 3 x daily for 3 days. No alcohol.
Amoxicillin 500mg 1 tab 3 x daily for 3 days
Analgesia advice, register with GDP, review in ten days and refer if no improvement.

123
Q

Pt is referred to you by oncologist for exam as they are about to start chemo. Pt doesn’t know why. Has caries and PAP. Explain relevance of DH for cancer, Tx, side effects.

A
  • Explain importance of being dentally fit, improving OH and looking after dental health.
  • Chemo puts a toll on entire body including mouth.
  • GDP role to reduce complications in chemo regime (avoid unscheduled interruption. Remove potential sources of infection. Avoid exacerbation of mucositis.
  • Plan prevention and rehabilitatio; FM scaling, remove teeth or poor prognosis or areas of infection. Extractions at least ten days before chemo starts. Tx should be avoided during chemo, if Tx done after there is risk of MRONJ, slower healing and infection. Take imp for splint and smooth sharp teeth.
  • Pre Tx prevention; OHI, duraphat varnish, duraphat TP 2900 (0.619%) or 5000 (1.1%) Id cleaning. Diet advice, avoid spicy acidic food, fizzy drinks, fruit juice. Smoking and alcohol cessation.
  • Mid Tx; minimal intervention unless emergency or pathology management. Mucositis; inflammation and ulceration, pain requiring analgesia. Can affect eating and OH.
  • Topical cooling agents can be used, ice, lignocaine, benzydamine mw (difflam), tea tree oil mw
  • Thrush - antifungals
  • Post Tx care; maintenance of oral and dental health. Prevention. Increased frequency of visits. MRONJ, altered taste, dry mouth.
  • Decreased salivary flow and altered consistency. Recovery over years and may not return to normal. Increased risk of caries, perio, candidiasis, sialadentis, pros difficulties.
124
Q

Describe your approach for a cavity prep 11D

A
  • Introduce youself
  • Wash hands
  • Don PPE
  • Ask pt to confirm name, reason for attendance
  • Position pt and turn on light.
  • Approach palatally if possible.
  • Avoid damage to adjacent teeth
  • # remaining thin layer of enamel with instrument
  • Ensure cavity margins are clear of contact
125
Q

How to complete a histopathology form using patient details and clinical data provided.

A
  • Enter pt details (sticker); CHI, hosp number, name, sex, address, DOB.
  • Hosp dept, date, time, consultant, requested by, phone #
  • Clinical details; pain etc, other relevant details (present for 6 mon, gradual increase in size.
  • MH
  • Provisional diagnosis ie fibro epithelial polyp
  • Specimen details - aspirate, excisional biopsy.
  • Details of site - left dorsum of tonue etc
  • Investigation required - culture and sensitivity testing (bacterial and fungal). PRC and viral load (viral). Histopathology (tissue biopsies)
  • Wear appropriate PPE
  • Label pot with pt details, place in plastic bag and attach to request form
126
Q

Phantom head child. Place separator, remove pre placed separator, size hall crown and select correct cement

A
  • Use two pieces of floss through ortho separator
  • Pull tight and move down between contacts but not subgingival, mesial and distal of tooth
  • Leave in place for 2 - 7 days
  • Remove with blunt probe
  • Sit child upright
  • Protect airway with gauze
  • Choose crown (smallest size that will seat, use sticky stick. Should cover all cusps and approach contacts with slight springiness - dont fully seat.
  • Dry crown, fill crown with GIC
  • Dry tooth (if its caviated fill with GIC first)
  • Place crown over tooth
  • Seat fully with finger pressure
  • Pt can seat by biting gauze
  • Remove excess cement with CWR, apply pressure for 2/3 mins
  • Floss between contacts
127
Q

When trying in a hall crown, child chokes, how to deal with emergency?

A
  • ABCDE
  • Are you choking?
  • 5 x back slaps between shoulder blades (child can be across knee)
  • 5 abdominal thrusts
  • continue to check for object dislodging
  • ABCDE
  • BLS if not resolved
  • 999, refer to hsop and check for rib #
128
Q

Describe the SLOB technique

A

Same Lingual Opposite Buccal
Parallax technique
One radiograph taken straight on, second taken either mesial or distal to first. If object moves same way as tube head - lingual, if opposite - buccal

129
Q

What are the dental health implications of increased OJ, OB, ectopic canine?

A

OB risk of trauma
OJ risk of trauma
ectopic - risk of root resorption or cyst formation

130
Q

How to work through a denture design

A
  • Material
  • Saddles - identify and add mesh
  • Support
  • cingulum/occlusal rests
  • Retention - clasps (premolar gingivally approaching, molar ring)
  • Major connector, ring design, bar, full cover
131
Q

Identify potential dangers in a bay

A

LA needle unshealthed, scalpel, tooth in forceps, endo files, other sharps
Sharps box position
Messy bracket table
Discarded gloves
Blood spillage

132
Q

What are the different waste streams?

A
  • Black - household waste
  • Orange - low risk clinical waste contaminated with blood or saliva
  • Yellow - high risk such as body parts inc teeth (not on clinic)
  • Red - specialised/hazardous waste. Amalgam waste, spill leak proof mercury vapor suppressant in lid. For amalgam waste, capsules and amalgam filled teeth.
  • Blue - sharps including vials with pharmaceuticles remaining
  • Orange sharps bin;
  • Always dispose of sharps immediately
  • Always keep out of reach of children
  • Always close sharps box between uses
  • Never retrieve anything from sharps box
  • Never fill more than 3/4
133
Q

How to address a blood spillage?

A
  • Stop what youre doing
  • Donn appropriate PPE
  • cover spill with paper towels
  • Apply NaOH, sodium dichlorosocyanurate liquid/powder 10k ppm
  • leave for 3-5mins, use scoop to pick up gross contamination, goes in orange waste
  • Clean rest with detergent wipes
134
Q

white patch on FoM, discuss biopsy and poss oral cancer. Discuss risk factors

A
  • Possible causes; hereditary, keratosis (smoking, trauma), lichenoid, lupus, pseudomembranous candidosis, carcinoma
  • Explain to pt there could be a number of causes. Some completely harmess but some can be more serious and possibly cancerous.
  • FoM is high risk site for oral cancer and as you have other risk factors (smoking, alcohol) it would be best to have this checked out
  • Biopsy will be taken by OM/Maxfac to send to lab, sutures.
  • Risk factors - smoking and alcohol cessation. Reduce alcohol, dont mention 14 units, wake up call to quit
135
Q

What post op advice should be given following biopsy?

A

Sore for around a week, similar to ulcer. Pain, bleeding, bruising, swelling, infection, altered sensation.
Stitches will disolve 1-2 weeks
WSMW, soft diet, limit smoking etc
Offer review appt and discuss findings

136
Q

What are the signs/symptoms and treatment options for a teenager that presents with primary herpetic gingivastomatitis with systemic involvement?

A

Aciclovir only prescribed if pt is immunocompromised or if infection is severe.
* Primary response to herpes simplex virus.
* Sore mouth and throat, lymphadonopathy (systemic involvement)
* Period of malaise and fever
* Happens once or twice and is slef limiting 7-10 days.
* Push fluid intake, bed rest, alalgesia/antipyretic, CHX, nutritious diet.
* Aciclovir script - 200mg (100mg if under 2 yo), send 25 tabs. 1 5 x daily for 5 days

137
Q

Things to remember for a surverying OSCE station

A
  • mount cast and tripod
  • Use analysing rod to analyse abutment teeth and soft tissue undercut only
  • Pencil rod, mark survery line of all abutment teeth and soft tissue undercut
  • Determine if cast needs to be tilted (if unfavourable undercuts), change path of insertion to highlight undercuts
  • In common path of displacement, find appropriate location for clasps with undercut guages (buccal upper molars, lingual lower molars)
  • Mark clasp position with pencil
  • 0.25mm co/cr, 0.5mm wrought gold, 0.75mm wrought ss
138
Q

Mandible fracture. Perform E/O exam to assess pt, sugest further investigations, management if pt presented to you as a GDP

A
  • Give a diagnosis
  • Initial general history; headache? Loss of consciousness? Nausea or vomitting? Numbness anywhere on face? Police involvement? Examine and record injuries
  • E/O - pain, lacerations, bleeding, swelling, facial asymmetry, palpation of madible bilaterally, condyle, ramus, body, symphysis
  • Limitation of mandibular movement?
  • Deviation? Tenderness over TMJ?
  • Examine sensation of lower lip/chin (areas supplied by mental nerve)
  • I/O; lacerations (especially gingivae), bruising, swelling, haematoma, occlusal derrangement and step deformities, loose or broken teeth, anaesthesia/parasthesia of teeth, AOB due to bilateral ramus/sub-condylar fracture
  • Classifications - simple (no break in skin), compoind (break in skin/gingivae), or communiated (multiple fractures)
  • Compound fractures require ABs
  • State if it is single, double or multiple
  • Name the site - condylar, body, coronoid, angle, ramus, parasymphyseal, alveolar
  • Unilateral/bilateral
  • Displaced or not
  • Favourable/unfavourable
  • Influences on displacement - pull of attached muscles, angulation and direction of fracture line, opposing occlusion, magnitute of force, mechanism and direction of injury, intact soft tissue
  • Further investigations; two radiographs (opt and PA mandible), or cbct
  • Identify relevant radiographic findings
  • Management - urgent phone call to omfs or a&e for advice and urgent referral
  • Surgical management - orif. conservative if undisplaces, asymptomatic or patient presents one month or more later
139
Q

A patient with fixed appliances has returned to ask for advice on how to avoid decalcification

A
  • Decalcification will happen around the periphery of the brackets, it weakens the enamel to caries and leaves unsightly staining
  • you’re at a higher risk if you have history of caries, evidence of decal elsewhere or NCTSL
  • Give OH advice on small toothbrush head and single tufted around brackets
  • Advise on use of interdental brushes and superfloss
  • Brush 2 x daily, spit dont rinse, clean after meals, use of discloving tablets, colgate mw 250ppm F
  • Diet advice should include limiting sugar amount and frequency (less than 3 x daily)
  • Avoid snaking between meals
  • Avoid hard or chewy foods, fizzy drinks, sports drinks, chewing gum
  • Beware of hidden sugars
  • Rinse mouth after eating
  • Fluoride; duraphat 2 x daily, normal TP outwith this. Keep for yourself not other family members, particularly children. 0.619% 2800ppmF 75g
  • 1.1% 5000ppmF 51g
140
Q

Pt asks about restoration options for a molar after RCT

A
  • Gold standard - cuspal coverage onlay. Gold, composite, porcelain, zirconia. Reduces risk of tooth fracture/catastrophic failure. Less microbial leakage/better seal
  • Full coverage MCC, GSC, all ceramic, all zirconia. If less tooth structure remaining, in order to cover and protect.
  • Direct restoration - composite or amalgem. If occlusal cavity only. Not as favourable, leakage, more likely to fracture.
  • Core build up if necessary. Gold standard would be in composite. Explain tooth has been hollowed out and need to fill space between cavity and crown.
  • Nayyar core not favourable (comp into canals), metal cast post if necessary but also not favourable
141
Q

How to assess caries risk in a child patient and preventive advice

A
  • How to assess caries risk (7things) clinical evidence, diet, MH, SH, saliva, plaque control, fluoride exposure
  • What does prevention include? 8 things - Radiographs, diet advice, TBI, fluoride tp, fluorise supps, fluoride varnish, FS, sugar free medication

Advice
* Assist child until able to brush independently, 2 x daily with fluoride TP. Give demo at each check up. Methodical approach. Spit dont rinse
* Diet - avoid snacking on surgary foods between meals. Give alternative snack ideas, milk and water only between meals. Bottle/sippy cup advice. No eating or drinking after tooth brushing
* Fluoride varnish 4 x yearly >2yo. TP, MW advice >6yo

142
Q

Identify different crowns/bridges on cast. State cements used and pre/post checks

A
  • Aquacem GIC - metal post, MCC, gold, zirconia
  • Panavia (anaerobic cure comp) adhesive bridge (RRB)
  • Nexus NX3 (dual cure comp) - fibre post, composite/porcelain restorations, veneers

Precement checks
* On cast - is restoration as asked for? Rocking m/d contact points, marginal integrety, aesthetics. Check contact points on adjacent teeth on cast as they can be damaged when sawn off. Occlusion on excursions, natural teetch contact (use articulating paper)
Post cement checks
* excess cement removed, no space around margins, interproximal contact point exists and is clear. Occlusion checks, cleansible.
* Check pt is happy with fit and appearance

143
Q

Write a prescription for a conventional cantelever bridge

A
  • Pt sticker on all 3 sheets - name, age, CHI, sex, DOB, phots or SH
  • Practice details - name and number
  • Date and time of imp, date work requested for return
  • Plan - stage of Tx and any other lab work
    Instructions -
  • Please pour imps in 100% dental stone, mount on DENAR ii semi adjustable articulator using facebow/was bite provided.
  • Construct metal ceramic conventional mesial cantilever bridge to replace tooth xx, using xx as abutment and xx as pontic
  • Shade
  • Ridge lap pontic (posterior)
  • Modified ridge lap pontic (upper ant)
  • Dome pontic (posterior or lower ant)
  • Please contruct in canine guidance and ensure pontic is free of excursive movements
  • Please return bridge with cast
  • Signature
144
Q

Paeds trauma. Supluxation of upper As in 18 month old. Pt brough by dad. Describe knee to knee exam and explain management/consequences to dad

A
  • Introduce self
  • Reassure dad and child
  • What happened, when, loss of consciousness? other injuries? Any pain relief?
  • Knee to knee exam; explain what you’re doing. sit knee to knee, knees toughing and kept together. Ask dad to have childs legs around waist, lower child onto knees and ask dad to hold arms.

Trauma Stamp; colour, EPT, ethyl chloride, TTP, percussion note, mobility, displacement, radiograph, sinus
Subluxation signs - TTP, mobile, bleeding from gum. No displacement
Explain injury; we call this injury a subluxation, it’s an injury to the ligaments that support the teeth. This has affected the baby teeth.
There is no treatment to be done, KUO. Today we can clean the tooth and mouth with saline, CHX and gauze.
At home stick to softer diet for a week. Keep mouth clean and free of plaque to encourage healing. Brush 2 x daily with soft TB. Swab area with CHX 2 x daily for one week.

Child may have pain, swelling, discolouration, the tooth becomes more loose, delayed exfoliation, infection. KUO signs of infection, normal to have some pain following trauma.
Possible complications in permanent teeth - premature or delayed eruption. Enamel hypoplasia/hypomineralisation, crown/root dilaceration, failure to form or erupt. Odontome formation.

Follow up in 1 week and 6 weeks

145
Q

OSCE station with DO cavity to fill with amalgam

A
  • Assess cavity - make sure margins not at contact area. Avoid damage to adjacent teeth
  • State dam would have been placed
  • Line cavity floor with vitrebond
  • Check occlusion and for overhangs
  • Give POI
146
Q

Explain to nurse asthma attack signs and symptoms and Tx

A

Airway constriction, bronchoconstriction, increased breathing rate, wheeze, pt clutches at chest, flushed.
ABCDE
Salbutamol 10 puffs in spacer, repeat as necessary (short acting beta2 agonist, relaxes smooth muscle causing bronchodialation
O2 15l
Call 999

147
Q

Consent process for surgical extraction of lower 8

A

Discuss Tx
* Confirm tooth to be removed under LA
* LA means you will be awake, numb lower lip, tongue. Cannot take away feeling of pressure but no pain
* A cut will be made in the gum to expose the top of the tooth, may need to remove some bone around the tooth, similar sensation to having fillings.
* The tooth itself may need to be sectioned
* Area will be cleaned with saline and some dissolving stitches placed
* Some unpleasant sounds, squelchy, cracking etc as the tooth is close to your ear
* Complications; pain, bleeding, swelling, bruising, infection, dry socket, stiff/achy jaw, damage to adjacent tooth/filling. Temporary/permanent damage to nerve. Sensory nerve so no change in appearance/function. Altered sensation or taste.
* <10% temp, <1% permanent
* Describe coronectomy if suitable
* Eat before appt. Don’t need a chaperone. Day off work sensible. Take it easy

148
Q

What are the differences between N and B sterilisers?

A

N steriliser - non-vacuum, passive air removal, unwrapped solid products, non hollow and non lumened.
B sterilisers - vacuum, active air removal, packaged instruments. Lumened, hollow or porous instruments

149
Q

What are the cycle stages and parameters for type B steriliser?

A

Stages - air removal, sterilising, drying, cooling
134-137o 2-2.3 bar for minimum holding 3 mins
water used - reverse osmosis, distilled, sterile, deionised

150
Q

What are the different steriliser tests?

A

Daily - wipe clean, change water, automatic control test, steam penetration test (Bowie Dick, Helix)
Weekly - ACT, steam penetration, vacuum leak test, automatic air detector function test
Quarterly - validation report - data collection to determine effectiveness of steriliser
Annual report carried out by insurance company for safety (pressure release valves)
Need signature to know it’s valid

151
Q

You find instruments on top of the steriliser. How do you know if they’re clean? What should you do?

A
  • Shouln’t be overlapping and hinged instruments open
  • Check if there is a reciept print out
  • Check if there is colour change on the packaged instruments (brown to pink or yellow to blue)
  • If unsure, go through the process again
152
Q

Lymph node exam - name lymph nodes examined. Suspect cancer FoM so take history and discuss

A

Preauricular, parotid, submandibular, submental, occipital, postauricular, jugulo digastric, jugulo-omohyoid, deep cervical, supraclavicular
Brief history, have you been aware of this lesion? How long for? Pain? Problems when eating or swallowing? Hoarse voice? Relevant MH. Smoke/drink? Regular attender? MW?
Discuss lesion; has a number of possible causes, some are harmless but some more sinister and as this is a high risk site and you have risk factors, I’d like to refer for biopsy.
I’ll send an urgent referral to maxfax where a biopsy will be taken and sent to a lab for testing. What to expect - LA, small amount of tissue removed and dissolving stitches. Post op advice
Offer review appt
Management of risk factors

153
Q

How to report on an OPT

A
  • Demographics - type of xray, age, date etc
  • Quality - acceptable/unacceptable
  • dentition - permanent/primary/mixed, teeth erupted and unerupted, missing teeth, supernumerary, impacted, ectopic. Restorations - heavily/moderately/minimally restored, overhangs, fractures, poor margins, trauma.
  • Disease - Caries; primary/econdary, supra/subgingival, PAP. Perio - localised/generalised, supra/subgingival calculus. Endo - well compacted, material, mm from apex, seperated instruments etc. TMJ. Other pathologies (cysts etc)
  • Diagnosis
154
Q

Pt presents with severe pericoronitis, area has been debrided/irrigated but you feel ABs required. Pt is alcoholic, write script

A

Metronidazole AB of choice, can write script but state pt is alcoholic to pharmacist.
Otherwise script for amoxicillin.
Correct pt name, address in full, CHI number.
Amoxicillin 500mg, send 9 capsules, take 3 x daily for 3 days.
Sign and date

155
Q

Pt presents with post and core crown on tooth with no endo. Lingual caries present, pt does not want Tx. Currently no pain. Discuss options.

A
  • leave KUO - risk of pain, infection, abcsess, tooth breakdown, catastrophic root #
  • Remove crown and remove caries, attempt new crown. Removes risk of post removal, doesn’t resolve problem of no endo, infection risk
  • Remove post and core, RCT and replace - risk of removing post and core (root #/core/post#), RCT involves cleaning out the tooth and filling - several appts
  • Risk of tooth being unrestorable - XLA required. Replacement options
156
Q

List some faults to look out for with a URA

A
  • z-spring encased in acrylic
  • Fault with adams clasp flyover
  • Fault with adams clasp arrowhead
  • Adams clasp on wrong tooth
  • FABP instead of PBP or vice versa
  • Remake appliance
157
Q

What to include on an OS consultation form

A

Date Where seen (i.e. OSCC / OSTA) Covering Consultant
Ref From (and why) –
Complaining of – (C/O)
History of Presenting Complaint - (HPC)
Medical history (MH)
If Medical History Questionnaire has been completed note that you have checked it and
summarise the key areas.
CVS – Coronary Heart Disease / Blood Pressure / murmur / valve
RS – Bronchitis / Asthma / COPD / other
Bones / Joints – arthritis, osteoporosis
Liver / Hepatitis / Jaundice
GIT (bowels)
GUT (waterworks)
Diabetes
Epilepsy
Blood/bleeding issues
Hospital / specialists
Operations / GAs and any problems with GA (including family history)
Pregnancy status
Meds - List medications within the notes.
Allergies – list these
Social History (SH)
occupation -
home situation -
travel arrangements -
smoking -
alcohol -
OE – Extra Oral Examination of the Head and Neck
Lymph nodes
Lymphadenopathy? - where
TMJ exam
FROJM (free range of jaw movement)
MoM (muscles of mastication)
Sounds – What and during what movement?
swelling / asymmetry / skeletal / facial bones?
Skin
Lips
IO – Soft Tissue Exam (ST)
lips
commisures BM
(buccal mucosa)
Tongue
FOM (Floor of mouth)
HP/SP/Fauces
Hard Tissue exam (HT)
pertinent tooth and periodontal examination
Investigations:
Radiographs - Justification / grade of image (1, 2, 3) / report of image
Sensibility testing if appropriate
Provisional Diagnosis
Discussed with / Seen with member of Staff
Options given to patient:
1) do nothing
2)
3)
Discussion re: Surgery – e.g. LA, incision, bone removal, tooth division, sutures
Discussion re: anxiety control (LA / IV / GA)
Discussion re: SIGN/NICE/SDCEP guidelines (if appropriate)
Discussion re: complications: (example for third molars)
Pain, swelling, jaw stiffness/limited mouth opening, bleeding/bruising, infection, stitches, damage
to adjacent teeth, altered sensation to lip/chin/tongue (temporary 10-20% / permanent usually
under 1% although some studies say up to 5%) to include anaesthesia / paraesthesia /
dysaesthesia +/- taste disturbance).
Information sheet given?
Plan – What is planned for next appointment, and where this is booked for / When?
Student signature
Student Print Name
BDS 2/3/4/5
Staff Signature
Staff Print Name
Grade

158
Q

What are the four suture choices and examples?

A
  • Resorbable - sutrures lose most of their tensile strength early on and will be fully absorbed by the tissues. These are normally used in areas where the suture requires to be buried, or is difficult to remove. Used for most intraoral wounds.
  • Non-resorbable - sutures retain tensile strength and remain in the tissues until they are removed. they are often used in areas where high tensile strength is required for alonger period of time, such as OAC, skin closure, or to hold dressings when exposing canines.
  • Monofilament - sutures are made from a single strand. They are less likely to facilitate an infection because it is more difficult for bacteria to colonize a single strand.
  • Polyfilament - sutures are made from several smaller strands twisted together and can be easier to handle. Often contraindicated in contaminated wounds.

Examples
* Polyfilament resorbable - vicryl, velosorb, polysorb
* Monofilament resorbable - monocryl
* Monofilament non-resorbable - nylon, prolene
* Polyfilament non resorbable - silk

159
Q

What is OFG, what is crohns?
Symptoms and management

A

Orofacial graulomatosis is skin condition causing swelling to lips, cheeks, face. Related to crohns.
Crohns is chronic inflammation of bowel, affects the whole tract. Inappropriate response against gut flora
Symptoms include diarrhoea, abdominal pain, fatigue, weight loss, malaise, fever, cobble stoning of mucosa, ulcers.
Managed with lifestyle, topical, oral, IV steroids, surgery

160
Q

Dental considerations with GORD

A

Treated with proton pump inhibitors (can alter taste). Histamine receptor antagonists used for Tx can cause dry mouth.
GORD can cause dental erosion particularly palatal of upper anteriors

161
Q

Dental considerations with inflammatory bowel disease.
Includes crohns, ulcerative colitis and pseudomembranous colitis

A

Unpredictable flare ups - may need to be flexible with appts.
Pt may be taking corticosteroids - supressed adrenal function affecting ability to withstand stress. May be taking anti-inflammatories (caution with nsaids), immunosuppresents = increased infection risk. Beware of some ABs (clydamicin = increased risk of colitis)
Oral aphthous ulceration during flare up, pustules on red base on labial mucosa, gingiva and palate. Crohns can present atypical oral ulceration, OFG, cobblestone appearance of buccal mucosa, mucosal tags.

162
Q

Dental considerations with coeliac disease

A

Enamel defects (discolouration, hypoplasia, hypomineralisation). Aphthous ulcers, angular stomatitis, dry mouth.

163
Q

Oral considerations with peptic ulcers

A

May change choice of ABs depending what pt has taken recently for ulcers. Antiacids reduce absorption of tetracylcine and erythrocycline so stagger doses.
Avoid nsaids
Cimitidine may decrease metabolism of some drugs. Decrease dose of lidocaine and diazepam.
Good OH to reduce H.pylori, ABs can result in fungal infections, proton pump inhibitors can affect taste, dry mouth?

164
Q

How to identify and manage a facial palsy following IDB

A
  • caused by injection into the parotid gland affecting facial nerve.
  • Diagnose by testing branches of facial nerve
  • Generalised weakness of the ipsilateral side of the face, inablility to close eyelid, obliteration of the nasolabial fold, drooping of the corner of the mouth, deviation of the mouth to the unaffected side.
  • Confirmed by the temporal branch being affected - if it was a stroke the pt would still be able to wrinkle their forehead
  • Manage by reassuring the patient, cover the eye with a pad until blink reflex returns.
165
Q

Primary imps for -/f - how to take and write lab script for special trays

A
  • Select edentulous tray
  • take imp in alginate and use green stick around posterior border
  • Stand in front of patient
  • lab slip - please pour imps in 50/50 stone/plaster and construct special tray in light cure pmma with 2mm spacer (alginate), non perforated, finger rests and intraoral handle. please return models with try. thansk
166
Q

What are the causes and treatment options for a child with staining?

A

Causes - MIH, fluorosis, decalcification, tetracycline, trauma, dentinogenesis, ameliogenesis imperfecta
Treatment;
* microabraision - easy, effective, removal of tooth tissue and uses acid
* vital external bleaching - may not work, gingival recession, sensitivity, no effect on restorations, relapse/overbleach
* Localised composite addition - can make tooth bulky, may not mask completely
* composite/porcelain veneer - good aesthetics, tooth prep needed, wait until 18 for stable gingival level
* MCC most destructive

167
Q

What are the causes and treatment options for missing teeth in a child

A

Causes - hypodontia, trauma causing arrested tooth formation, ectopic, dilaceration, supernumerary, early ext
Options-
* RRB, essix retainer, RPD, implant if over 18, ortho space closure

168
Q

co/cr partial denture trial on cast - check metal framework against script and find faults

A
  • Metal frame work casting; co/cr bubbles making surface rough - airbubbles trapped in wax when investing.
  • errors in design - too close to gingival margin, undercuts not blocked out
  • faults with scrips between drawing and writing; SUPPORT - rests are missing, no posterior stop RETENTION - ring clasp round wrong way. CONNECTOR wrong connector
  • No labial relief as asked
169
Q

What to remember during a veneer prep station

A
  • PPE
  • Seating position
  • Position chair and turn light on
  • take 2 putty index, 1 for temp, one for reduction (section this one)
  • 0.5mm prep in two planes with chamfer bur
  • reduce incisal edge 0.75-1.5mm
  • Use finishing bur to smooth prep
170
Q

Perio. Compare pre and post treatment pocket charts. Indicate where healing has occured and where it hasn’t. Reasons for failure

A
  • Missing teeth - identify causes
  • Gingival margin, from ACJ, recession
  • Probing depths - indicator of Tx difficulty
  • LOA, indicater of disease severity
  • Bleeding on probing - indication of disease activity
  • Furcation involvement, indication of Tx difficulty
  • Mobility - gives rise to symptoms, poorer prognosis

Reasons for failure;
* smoker
* Non compliant - poor oh
* Inability of pt to maintain good oh (hard to reach areas such as furcations or stand alone teeth), poor manual dexterity
* Systemic factors; stress, diabetes, pregnancy, malnutrition/poor diet
* Inadequate debridement
* overhangs/poor margins

171
Q

Pt has failed RCT, discuss reasons for this and available options

A

Overfilled, underfilled, under condensed, missed canal, missed accessory canal, inadequet prep, extrusion, perforation, vertical root fracture, fractured file, blockage/obstruction of canal, poor coronal seal, poor restoration.

Options; leave and monitor. No active Tx but may flare up.
retreatment
peri redicular surgery
xla

172
Q

Dry mouth, pt is taking amitriptyline. How to establish effects and manage

A

History; how is dry mouth affecting pt? Need to sip water, need water to eat/swallow, affecting speech, causing discomfort?
What medications is pt taking. Drinking? Smoking?
MH - diabetes, epilepsy, anxiety, stroke, sjogrens?
Features; difficulty swallowing, clicking speech, discomfort, altered taste, cervical caries, halitosis, candidal infections.
Management; treat cause, address dehydration, chew gum, modify drugs, reduce caffiene, quit smoking/drinking.
Prevention advice.
Saliva substitutes
Can contact GMP

173
Q

Pt has lichen planus. Explain what it is and what causes it.

A

White patches in mouth. Can occur on skin anywhere but in some cases presents in the mouth. Most common condition seen in oral med dept. Caused by extra keratin deposits. Keratin is a protein found all around your body and in the skin, it can be stimulated by trauma to form a callous. It can be a type of allergic reaction, most commonly to medications or silver amalagm fillings.
Very small chance of developing into something more sinister. Around 1% of cases in ten years. Treated by removing obvious cause. Avoid SLS toothpaste, stop mw use, avoid bezoates.
Difflam/corticosteroids if symptomatic
KUO
Any questions

174
Q

What is the risk of BBV transmission from a sharps?

A

Hep B 1 in 3
Hep C 1 in 30
HIV 1 in 300

175
Q

What steps should be taken in the event of a sharps injury?

A
  • Encourage the wound to bleed, gently squeeze puncture wound
  • Gently wash with liquid soap (non antimicrobial) and warm water, rinse and dry
  • cover the wound with waterproof dressing
  • ensure the item that caused the injury is disposed of properly
  • Report incident to senior staff
  • follow local occupational or BBV exposure prone injury protocol for advice on when to attend occupational health/A&E
  • Document incident
176
Q

when should ABs be used prophylactically

A

AB prophylaxis not routinely recommended.
Special consideration given;
* pts with prosthetic valve
* pts with previous episode of IE
* pts with congenital heart disease
* discuss with cardiologist

177
Q

Local anaesthetic, common formulations and doses. Assembly, side effects, checks

A
  • Lidocaine 2%. 1;80k adrenaline. 7mg/kg
  • Articaine 3%. 1;100k adrenaline. 6mg/kg
  • Prilocaine with felypressin 8mg/kg

Remember to check expiry date and that bung is on correctly.

Side effects; allergic reaction, seizure, cardiac arrest, nausea, vomitting, diziness, headache, twitching muscles, nerve damage, continued numbness

check for anaesthesia

178
Q

Candidal leukoplakia advice and management.

A
  • Fungal infection of the cheek/mouth
  • potentially malignant - can progress to cancer
  • Risk factors; OH, steroid inhaler, diet, diabetes, deficiency, dry mouth, antibiotics, immunosuppresion
  • Management - refer to OM (incisional biopsy). OHI, reduce carbohydrate intake, rinse mouth after inhaler. correct deficiencies, control diabetes, stop smoking, improve denture,
  • systemic antifungal - fluconazole 50mg send 7 tablets, one to be taken daily for 7 days, then reveiw

OSCE 5th year (3 decks)

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