OSCE Revision Flashcards
transfer lines for pros and why we note them
high smile line - can get idea of how much tooth will show when smiling
centre line - midline of teeth matches midline of ptx face
canine line - dictates size of tooth to be used
residual alveolar line - so teeth are set in such a way above the lower residual ridges that the contacts are on this line
alveolar contour line - if teeth are set at slope then the denture may be displaced during function
rim profile - to ensure adequate lip support
mouthwash F- content and when to give
225ppmF
can give over 6/7 years; only when they have the capacity to spit
what is a toxic dose of fluoride
32-54mg/kg i.e. 5-10g of toothpaste in a 75kg individual
what is a potentially toxic dose of fluoride
5mg/kg - give milk & observe
5-15mg/kg - milk & hospital
15mg/kg+ - hospital & IV calcium gluconate
max dose of F- safely tolerated
1mg/kg
toothpaste for different ages
1000ppmF = 6m-6y unless high risk (smear for <2 & pea sized >2)
1450ppmF = >6y low risk & >3y high risk
2800ppmF = >10y high risk
225ppmF or 0.05% daily mouthwash = >6y high risk
***toothpaste now 1500ppm for everyone of all ages in scotland
what the different radiographic film holders are for
red = bitewing for coronal of posterior teeth
yellow = posterior periapical image of complete tooth including the root
blue = anterior periapical image for complete anterior tooth including root
green = endo for identifying working lengths
what size of film the radiographic holders take
BW = 2 for permanent teeth & 0 for deciduous
anterior PA & endo = 0
posterior PA & endo = 2
how to complete diet diary
3 days including 1 weekend day
write down everything eaten and time it is eaten
difference in ortho wire for springs & for retentive components
0.5mm for springs
0.7mm for retentive components
what are the dimensions of the bite plane
OJ + 3mm
INR
international normalised ratio
what should the INR be for an XLA
<4
ARAB
A - active component
R - retention
A - anchorage
B - baseplate
drug interactions of warfarin
inhibiting - alcohol, epilepsy drugs
potentiating - NSAIDs, ACE inhibitors, antibiotics
tx of ANUG
ultrasonic debridement
CHX
OHI
400mg metronidazole TID 3 days if necessary
standard drug tx of ANUG
metronidazole 400mg 3 TID for 3 days
alternative is amoxicillin 250mg 3 TID for 3-5 days
3 predisposing factors to ANUG
smoking
stress
poor OHI
endo materials - irrigants
- EDTA solution 15% - removes smear layer
- sodium hypochlorite 3% - disinfects & dissolves pulpal remnants, disrupts organic portion of smear layer
- chlorhexidine 0.2% - disinfects canal
endo materials - paper points
to ensure canal is dry before medicating or obturating
endo materials - medicaments
- ultracal/hypocal - NS calcium hydroxide; inter-visit medication to prevent infection
- ledermix - corticosteroid & antibiotic mixture; inter-visit medication for hot, infected pulps to reduce inflammation
endo materials - obturation
- GP points - cold lateral compaction or thermafill, requires AH+ sealant
- resilon - resin based, requires epiphany sealant
lignocaine interaction
2.2ml lignocaine 2% with 1:80,000 adrenaline not advised in ptx with sensitivity to adrenaline or latex, uncontrolled cardiovascular disease, taking MAOIs, tricyclics or beta blockers
citanest 3% with octapressin given as an alternative
post op painkiller - what groups to be wary of
warfarin or pregnant give no NSAIDs (ibuprofen/aspirin)
liver / kidney disease reduce dose
cocodamol
contains paracetamol with 8g or 30g of codeine
ibuprofen dose
200mg or 400mg tablets
take 1.2-1.8g daily in 3-4 doses spread out
preferably after food
do not take more than 2.4g in 24hrs
precaution prescribing ibuprofen to
- elderly ; reduced drug metabolism
- peptic ulceration / GORD; may exacerbate
- pregnant or lactating ; cannot give NSAIDs
- renal / hepatic / cardiac impairment
- asthmatics - don’t give unless they have had before
- history of NSAID hypersensitivity
- taking other NSAIDs
- on long term steroids ; susceptible to gastric ulcers
dose of paracetamol
500mg tablets
1-2 every 4 hrs
no more than 8 tablets a day i.e. 4g in 24hrs
precaution prescribing paracetamol to
hepatic / renal impairment
alcohol dependent
post op instructions
- take it easy, avoid strenuous activity i.e. exercise for 24hrs
- expect pain; take painkillers before anaesthetic wears off & keep taking for as long as required; ibuprofen gold standard
- may experience swelling, bruising, tenderness in other teeth, stiffness of jaw
- take care when eating & drinking until LA wears off & avoid hard or very hot foods for a few days
- don’t was mouth out for 6hrs but can still brush teeth at night just be gentle
- eat on opposite side of mouth & leave site alone; don’t explore with finger, tongue, toothbrush
- if bleeding occurs at home bite down on damp gauze for 20-30mins
- avoid smoking for as long as possible and don’t drink alcohol for 24hrs
- starting next day gently swirl warm salty mouthwash around mouth 3-4 times a day until healed
- give written instructions
- come back if any problems / if needing sutures removed
smoking cessation advice
ASK - if they are a smoker, how may per day, how long have they been smoking, what do they smoke, do they want to stop, interested in quitting in near future & do they want help doing so
ADVISE - aware of health benefits of quitting, single most effective way of improving health status, past failures will improve chance this time, acknowledge difficulty in quitting, oral & lung cancer, heart disease, gun disease, stained teeth
ASSESS - desire to stop smoking, help must be offered
ASSIST - negotiate a stop date, review previous failed attempts, anticipate what problems they may encounter, suggest enlisting family & friends, inform of NRT availability, and NHS stop smoking service 1-2-1 or group
ARRANGE - follow up NHS SSS referral, give helpline, monitor, support, encourage at future dental appointments
remember to record in notes you had the conversation & the outcome and revisit
special tests to diagnose sjogrens
blood tests - checking for anti-la antibody principally, also anti-ro and ANA
histopathology assessment of labial secondary salivary gland biopsy
radionucleotide assessment into salivary duct
imaging
complications of ptx with sjogrens
dry mouth
difficulty with speech & swallowing
burning mouth
increased risk of oral infection & caries
difficulty with denture retention
long term risk of salivary lymphoma
maxillary anatomy
primary support = hard palate, maxillary tuberosities
2ndary support = alveolar ridge, rugae area, buccal shelves
- post dam along vibrating line, in front of palatine fovea and through hamular notches
- incisive papilla & palatine torus must be relieved
- labial & buccal fraena are muscle attachments which must not be encroached upon
mandibular anatomy
primary support = buccal shelf, pear shaped pad
2ndary support = buccal & lingual slopes of alveolar ridge
- lingual pouch utilised for retention
- floor of mouth is mylohyoid muscle
- lingual, buccal, labial fraena must be accounted for
splinting times primary teeth
only for dento-alveolar fracture resposition and splint for 3-4wks
splinting times in permanent teeth
- concussion = none
- subluxation = 2wks flexible
- intrusive & extrusive luxation = reposition & 2wks flexible
- avulsion = replantation & 2wks flexible
- lateral luxation = reposition & 4wks flexible
- apical & 2/3 root # = replantation & 4wks flexible
- coronal 1/3 root # = replantation & 4mths flexible
- dento alveolar # = reposition & 4wks rigid
principles of AWI 2000
- must benefit ptx
- minimum intervention
- take into account wishes of ptx
- consultation with relevant others
- encourage residual capacity
name the emergency drugs
oxygen
salbutamol
midazolam
adrenaline
GTN spray
aspirin
glucagon
emergency oxygen
15L/min
emergency salbutamol
2 x 100mg actuations
in severe asthma up to 10
not given if foreign body in airway
emergency midazolam
10mg into buccal sulcus
adrenaline
1/2 ampule of 1:1000 parts adrenaline (0.5mg) given as an IM injection using Z plasty admin route disruption technique
if worsening the same can be given in the other leg
emergency aspirin
300mg crushed and under tongue or chewed for anyone having an MI
emergency glucagon
1mg IM
will reduce all glucose stores from the liver
as soon as consciousness restored should be given sugar in a quickly absorbable form
7 elements of caries risk assessment
- medical history
- social history
- diet
- plaque control
- fluoride
- saliva
- clinical evidence
impression trays & materials
boxed tray = partially dentate
non boxed = edentulous
materials:
polyether -> impregum
irreversible hydrocolloid -> alginate
reversible hydrocolloid -> agar
polyvinylsiloxane (addition silicone) -> extrude
non elastic -> impression compound
paeds moisture control (6)
- dental dam
- cotton wool rolls
- parotid shield (dryguard)
- tongue retractor
- aspirator
- saliva ejector
stages for a complete denture
stage 1 - primary impressions in alginate or impression compound
LC - please pour in 50:50 plaster stone, construct upper and lower custom trays in light cured PMMA non perforated with upper 2mm spacing and lower 1mm spacing (close fitting), intraoral handles and finger stops
stage 2 - master impressions in silicone or polyether
LC - please pour in 100% dental stone and construct wax rims for jaw reg & return rims on casts
stage 3 - jaw reg
LC - please mount casts in registration provided and set teeth for wax trial, return wax trial dentures on mounted casts
stage 4 - tooth trial
LC - ask for retrial if required or please finish in heat cured PMMA and return on casts
stage 5 - delivery
pain history
SOCRATES
site onset character radiation associated features time exacerbating / relieving factors and severity
angina
chest pain due to ischaemia of heart muscle
characterised by retrosternal chest pain or discomfort that may radiate to arms, shoulders, neck
stable v unstable angina
stable = occurs with activity or stress and is relieved by rest
unstable = lack of blood flow and oxygen that may lead to heart attack (MI); is spontaneous and can happen at any time
MI
heart attack occurs when blood flow to part of your heart is blocked for long enough that part of the heart muscle is damaged / dies
differs from angina as pain is more severe and persistent
not relived by rest
tx for MI
stop treatment, sit up, oxygen 15L/min via non re breathing mask
GTN sublingually if pulse 70 or above
300mg aspirin crushed or chewed
call ambulance
reversible pulpitis
mild inflammation
tooth may respond more than normal to certain stimuli such as heat & sweet
sharp pain (A delta) that resolves within 5-10secs after removal
once cause of inflammation i.e. caries has been removed the pulp-dentine complex will return to normal
irreversible pulpitis
dull aching pain (C fibres) that can last for mins - hrs
worse at night or when lying down due to increase in intra pulpal pressure
symptoms may be initiated by temp changes
removal of causal factor does not lead to pulpal regeneration and if untreated becomes necrotic
tx = RCT/XLA
LA when high BP/heart problems
want adrenaline free
prilocaine with felypressin
don’t use lidocaine without adrenaline as it doesn’t have enough vasoconstrictor so effects would not last long enough
max 3 doses of lidocaine with adrenaline for any heart problems but want to use other
LA if ptx on beta blockers
adrenaline free or limit quantity
LA if ptx on tricyclic anti depressants
limit dose to max 2 cartridges of adrenaline
LA if ptx has latex allergy
citanest (prilocaine with felypressin)
max dose of lidocaine
2.2ml 2% HCl lidocaine 1:80,000 adrenaline
max dose = 4.4mg/kg so 7 cartridges
metabolised in liver & excreted in kidney
amide LA
44mg in a cartridge
max dose prilocaine
2.2ml prilocaine HCl 3% with (1.2mg) fely/octapressin
amide LA
max dose = 8mg/kg so 8 cartridges
66mg in a cartridge
max dose articaine
2.2ml articiane HCl 4% with either
1:100,000
1:200,000
1:400,000 adrenaline
metabolised in liver excreted in kidney
more potent and more rapid onset than lidocaine
max dose = 7mg/kg so 5 cartridges
88mgs in a cartridge
local complications of LA
failure to achieve anaesthesia
prolonged anaesthesia
pain during or after injection
trismus
haematoma
broken needle
soft tissue damage
facial paresis
intravascular injection
3 types of handwashing
social - plain/antimicrobial soap and running water / ABHG if hands not visible soiled; used for removing transient organisms
hygienic hand wash - used for removing transient microorganisms & reducing resident microorganisms, liquid soap & water then ABHG, antimicrobial soap or antiseptic hand cleanser
surgical scrub - antiseptic hand cleansers, longer & more thorough, inc lower arms, hibi scrub often used
eruption dates
FPMs 6yrs (6s at 6)
lower incisors 31 41 6yrs
upper incisors 11 21 7 yrs
lower laterals 32 42 7yrs
upper laterals 12 22 8yrs
lower canines 33 43 9yrs
upper & lower 1st premolars 10yrs
upper canines 13 23 11yrs
upper & lower 2nd premolars 11yrs
upper & lower SPM 12yrs
wisdom teeth 18+yrs
elevators & luxators
elevators - loosen tooth
luxators - cut PDL
couplands - spoon shaped, straight end, not sharp
cryers - break bone inbetween roots
warwick james - hold infront and curve points to side of ptx mouth you use it for
lab prescription for primary imps
LOWER - pleasure pour primary imp in 50:50 plaster stone & construct close fitting (1mm spaced) non perforated light cured PMMA tray with intra oral handles
if bony undercuts present then 2mm spacing may be prescribed for use with an appropriate elastomer
UPPER - please pour up primary imp in 50:50 plaster stone and construct a 2mm spaced non perforated light cured PMMA tray with intra oral handles (so they don’t interfere with soft tissues i.e. lips)
lab prescription for 2ndary imps
please pour up master imps in 100% dental stone and construct upper & lower wax occlusal rims on light cured bases
lab prescription for jaw reg
please mount casts on articulator (average value) and set the upper teeth to the wax rim
please set lower teeth to uppers
specify any special features e.g. diastema or imbrications
lab prescription for trial
finish - please wax up for finish and process in heat cured acrylic resin
re trial - remount casts and make specified changes for 2nd trial
ortho prescription for anterior crossbite
A - Z spring 0.5mm HSSW
R - 4/4 6/6 adams clasps 0.7mm HSSW
A - yes
B - self cure PMMA FPBP
ortho prescription for posterior crossbite
A - mid palatal screw 0.5mm HSSW
R - 4/4 6/6 adams clasps 0.7mm HSSW
A - yes
B - self cure PMMA FPBP
ortho prescription for retracting canines
A - 3/3 palatal finger spring + guard 0.5mm HSSW
R - 6/6 adams clasps 0.7mm HSSW & southend clasp on 11/21 in 0.7mm HSSW
A - yes
B - self cure PMMA
*if clasps on primary teeth then 0.6mm HSSW
ortho prescription for moving canines palatally
A - 3/3 buccal canine retractor 0.5mm HSSW + tubing
R - 6/6 adams clasps 0.7mm HSSW, 1/1 southend clasps 0.7mm HSSW
A - yes
B - self cure PMMA
ortho prescription for OB (check this)
A - 13-23 robert’s retractor 0.5mm HSSW
R - 6/6 adams clasps 0.7mm HSSW
A - yes
B - self cure PMMA FABP OJ +3mm
prescription for mounting casts with facebow
please mount upper casts and transfer cast onto average value articulator using facebow registration
articulate lower cast to upper in ICP and fabricate custom incisal table
colombia curette
red
double ended point scaler
2 cutting edges on each blade
for sub gingival & root planing anywhere in mouth but with limited access to deep pockets
4R-4L
mini sickle
red
double ended
2 cutting edges on each blade
buccal & lingual embrasure surfaces supra gingivally and within pocket orifice
gracey curette 1-2
grey
double ended
each blade has single cutting edge
subgingival scaling of upper and lower anteriors
gracey 7-8
green
double ended
each blade has single cutting edge
subgingival of buccal / lingual surfaces of posterior teeth
gracey 11-12
orange
double ended with single cutting edge
sub gingival scaling of mesial surfaces of posterior teeth
gracey 13-14
blue
double ended
each blade has single cutting edge
sub gingival scaling of distal surfaces of posterior teeth
hoe scaler 134-135
yellow
double ended
gross supra and sub gingival scaling of buccal & lingual surfaces
hoe scaler 156-157
red
double ended
gross supra and sub gingival scaling of mesial & distal surfaces
seating positions when scaling
7 o clock = 43-33 labial & lingual
9 o clock =
- 14-18 buccal
- 44-48 buccal
- 34-38 lingual
11 o clock =
- 14-18 palatal
- 44-48 lingual
- 34-38 buccal
- 24-28 buccal & palatal
- 13-23 labial & palatal
post op XLA
- do not rinse out for several hrs ideally wait until next day; don’t rinse vigorously when you do & rinse with warm salty water
- avoid exploring socket with tongue finger toothbrush etc
- avoid hot food on day of XLA & chew on other side of mouth when eating
- avoid excessive exercise for 1-2 days
- avoid smoking / drinking on day of XLA
- brush as normal but take care of where socket is
- if bleeding starts bite down on damp gauze for 20mins
- if it doesn’t stop contact GDHS or A&E
- may have slight discomfort so take analgesia before LA wears off
alkaline hypochlorites for denture cleaning
dont leave CoCr dentures for longer than 10mins as they corrode
superior cleaning properties
effective dissolution of plaque
stain removal properties
bacterial & fungicidal properties
possible bleaching of acrylic resin
residual taste after use
e.g. dentural, milton
effervescent peroxidises for denture cleaning
powder of tablets
rapid in action and simple to use
problems can arise if hot water used with denture, can cause bleaching
additional mechanical cleansing action
bubbles created by release of oxygen which may dislodge debris
materials
ledermix - antibiotic & steroid used on vital pulp
riva - GI used as cavity base
relyx - RMGI to cement MCCs in
calzinol / sedanol - ZOE (used in primary RCT as it is resorbable)
dycal / ultracal - CaOH used for pulp capping if small exposure during cavity prep & used as cavity lining material
vitrebond / vitermer - RMGI used as restorative material in cervical cavities if adequate moisture control cannot be achieved
jaw reg data
OVD
centre line
canine line
high lip line
occlusal plane
arch form width (width-lip support)
setting teeth
profile of upper rim trimmed by dentist is transferred onto occlusal plane guide - provides arch form for setting teeth
centre of lower ridge is transferred onto occlusal guide plane
centre line is transferred onto casts and the occlusal plane guide
canine lines marked at level distal to incisive papilla on cast
contour of occlusal rim is marked to show flat area of ridges where teeth should be placed
what LA can you not use for an IDB
articaine
purpose of beak on molar forceps
to engage root furcation
movement types for XLA
coronal shape:
round = rotation movement
oval = buccal and back
oblong = figure of 8
therefore
lower anterior = buccal & back
lower premolars = rotation
lower molars = fo8
upper anterior = rotation
upper premolars = buccal & back
upper molars = buccal & back (fo8 would snap root)
to identify caries / unrestorable teeth from photographs
look for large overhanging restorations
broken down teeth
discolouration
marginal ridge breakdown
fracture lines
NCTSL
active lesions
arrested lesions
crown prescription lab card
primary imp - please pour impressions in 100% dental stone & construct study models. mount casts with facebow - please mount upper casts on arcon articulator using facebow reg and construct customised incisal table
special trays - please construct non perforated custom trays made of light cure acrylic with 3mm wax spacer, please include extra handles
master imp - please pour master imp in 100% improved stone to construct definitive casts, please mount on articulator with jaw reg, please section tooth for MCC with metal palatal surface with canine guidance & labial aspect in porcelain with interproximal contact
delivery - fit & cementation
polycythaemia
raised Hb
leukocytosis
raised WCC
thrombocythemia
raised PLT
normal values Hb
normal male = 13.5-17.5g/dl so anaemic = <13g/dl
normal female = 12-15.5g/dl so anaemic = <15.5g/dl
normal RCC
male = 4.7-6.1 million cells/mcL
female = 4.2-5.4 million cells/mcL
normal WCC
4.5-10 thousand cells/mcL
normal MCV
87 +/- 5 femtolitres fL
will be normal in bleeding but reduced volume overall
normal HCT
newborn = 60% 0.6
males = 40-52% 0.4-0.52
females = 46% 0.46
normal PLT
150-400x10 to the 9 / mcL
iron deficient anaemia
causes - chronic blood loss, malabsorption of iron (coeliac), dietary deficiency, increased demand i.e. pregnancy, puberty, low ferritin levels
clinical features - concave nails, itching, angular stomatitis, beefy tongue (painless glossitis)
low Hb, low MCV & MCH
pernicious anaemia
both B12 & folic acid needed for DNA synthesis in maturing erythroblasts so def in either causes erythroblasts to have large nuclei = megoblasts in marrow
B12 absorbed by intrinsic factor in terminal ileum
folate absorbed in duodenum
clinical features - painful glossitis, demyelination of spinal cord, peripheral neuropathy, ataxia
low Hb, high MCV
thalassaemia
normal Hb production
genetic mutation of globin chains (alpha in asian & beta in Mediterranean)
clinical features - chronic anaemia, marrow hyperplasia, splenomegaly, cirrhosis, gallstones
treated with blood transfusions & prevent iron overload
sickle cell anaemia
beta chain substitution
change shape in hypoxic environment (prevents passage of cells through capillaries)
heterozygous = sickle cell trait
homozygous = sickle cell disease
clinical features - vascular occlusion, retinal ischaemia, acute chest syndrome
aplastic anaemia
diminished or absent haemopoietic precursors in bone marrow
present as pancytopenia, macrocytosis (inc MCV) and reticulocytopenia (immature RBCs)
acute leukaemia
neoplastic proliferation of leukocytes, usually disseminated
accumulation of malignant white cells in bone marrow & blood
malignant cells tend to be precursors (blast cells)
2 types - acute myeloid and acute lymphoblastic
lymphoma
neoplastic proliferation of leukocytes, usually a solid tumour
malignant lymphocytes accumulating in lymph nodes
lymphadenopathy, peripheral vasculature even organs
hodgkins & non hodgkins
interactions of penicillin
- bacteriostatic antibiotics i.e. clindamycin, erythromycin, tetracycline = impaired action of penicillin
- methotrexate = reduced efficacy of penicillin
interactions of cephalosporins e.g. ceftaroline fosamil
- warfarin = increased bleeding risk
- bacteriostatic antibiotics i.e. clindamycin, erythromycin, tetracycline = impaired action of cephalosporin
interactions of macrolides i.e. clarithromycin & erythromycin
- benzos = CNS depression
- clindamycin = antagonist
- statins = myotoxic (avoid!)
interactions of metronidazole
- anticoagulants = increased bleeding risk
- barbituates = decreases clinical effect
interactions of tetracyclines i.e. doxycycline, minocycline, tetracycline
- antacids = reduced serum conc of tetracyclics
- oral contraceptive = slight increase in ovulation
- doxycycline with methotrexate = AVOID
interactions of antifungals i.e. metronidazole, fluconazole
- miconazole w warfarin - AVOID potentially life threatening bleeding
- fluconazole w cimetidine = reduced efficacy of fluconazole
interactions of NSAIDs i.e. aspirin
- warfarin = increased bleeding risk
- cyclosporin = nephrotoxicity
- salicylates = increased GI damage with reduced analgesic effect
- ibuprofen with digoxin = increased digoxin levels
- tramadol w SSRI anti depressants = causes serotonin syndrome
interactions of narcotic analgesics i.e. opioids, codeine, meperidine
- opioids w alcohol = CNS depressant
- codeine w cytochrome inhibitors = inhibits activation of codeine
- meperidine w MAOIs = hypertension / hyperpyrexia or coma & hypotension
interactions of LA
- amides w beta blockers / cimetidine = metabolism of lidocaine reduced (liver metabolism)
- esters w anticholinesterases = metabolism of esters reduced
endo files colour
white
yellow
red
blue
green
black
universal K files 2% taper
protaper colours
yellow
red
blue
black
NiTi
access cavity shape
max incisors = triangle
max canines = ovoid
max premolars = elongated oval
max molars = quadrilateral
mandib incisors = triangles
mandib canines = ovoid
mandib premolars = ovoid
mandib molars = trapezium
what to include in radiograph report
type of radiograph
grade of radiograph
teeth present
caries
PDL /lamina dura
periapical
bone loss
for UR / LL PA radiograph
hold bite block in left hand
insert rod from right side
place square side into rod
for UL / LR PA radiograph
hold bite block in left hand
insert rod from left side
place non square side into rod
key radiograph dimensions
rectangular collimator = 40x50mm
max beam diameter cannot >60mm
FSD 100mm <60kVp & 200mm for >60kVp
aluminium filter 1.5mm <70kVp & 2.5mm for <120kVp
recall for uncomplicated / complicated crown / root #
6-8wks & 1 yr
recall for root #
4wks, 6-8wks, 6mths, 1yr, yearly for 5yrs
recall for pdl injuries
6-8wks, 6mths, 1yr, yearly for 5yrs
recall for avulsion
open apex = 2wks, 1mth, 2mth, 3mth, 6mth, 1yr, yearly for 5yrs
closed apex = ST, 1mth, 3mth, 6mth, 1yr, yearly for 5yrs
recall for dento alveolar #
1mth, 2mth, 4mth, 6mth, 1yr, yearly for 5yrs
recall for primary tooth trauma
all injuries except intrusion = clinical review 1, 3, 6mth, radiograph every 6mths
intrusion = clinical review every mth & radiograph every 6mths
% pulp necrosis of root # & dento alveolar #
root # = 20%
dento alveolar # = 50%
fluoride varnish mechanism
slows caries progression by stopping demineralisation
increases resistance of enamel to acid attack (fluoroapatite)
antibacterial effect by affecting bacteria H+ ATPase
amount of fluoride varnish to use
sodium fluoride 5% (22600ppmF)
2-5yrs = 0.25ml
>5yrs = 0.4ml
frequency of fluoride varnish
standard risk = 2x yearly
enhanced risk = 4x yearly
post fluoride varnish instructions
avoid eating & drinking for the next 1hr
eat soft food for rest of day
brush teeth as usual that night
do not take fluoride supplements that day
teeth may appear yellow but will disappear with eating & drinking
placement of FS
fissure pattern of FPM & SPM
buccal groove of lower 6
palatal groove of upper 6
cingulum pits
materials for FS
bisGMA
GIC - if moisture control hard to achieve
ortho equipment
no 64 universal pliers
no 65 coil formers
wire cutters
retentive appliance components
adams clasp
south end clasp
labial bows
c clasps
0.7mm HSSW
active components
palatal finger spring
z spring 0.5mm HSSW
midline palatal screw
buccal canine retractor
roberts retractor 0.5mm HSSW with 0.5mm ID tubing
when fitting a URA
- Check appliance for right patient
- Check match prescription
- Check and sharp edges on all surfaces of appliance
- Check integrity of wire (eg areas of work hardening, areas of damage)
- Check active component in passive state (uncoil to activate, EXCEPT for Robert’s retractor = coil to activate)
- Fit into patient mouth. Check for (a) no ST blanching (b) anterior and posterior retention (c) flyover not interfering with occlusion
- if happy, remove & activate components
- show ptx how to insert and remove and ask ptx to demonstrate this back to you
- book review in 4-6wks
ptx instructions for URA
- Appliance feel bulky in mouth à reassure patient that he will get used to it
- Appliance causing patient to speak with a lisp à advice patient to practice reading at home and tongue will adjust
- Appliance causing hypersalivation à reassure patient that this will pass within 24h
- Patient feels mild discomfort à tell patient that this is because appliance is working
- Tell patient to wear 24h, including meal times, except
a. Take out after meal to wash
b. Take out in contact sports
c. Avoid hot food
d. Avoid sticky food
- Non-compliance will significantly increase treatment time
FABP V FPBP
FABP used only to correct overbite
to stop digit sucking
patient & parent education
positive reinforcement
habit reversal; child taught to carry out alternative activity
reframing (turning habit into duty)
bitter flavoured gel / plaster to make digit sucking less appealing
fixed appliance i.e. palatal crib / inverted goal post / beads
hanau’s quint
orientation of occlusal plane
incisor guidance angle
cuspal inclination
sagittal condylar guidance angle
compensating curve
what to check during denture delivery on cast (6)
- smooth borders
- stable on cast
- teeth set on alveolar ridge
- centre line & canine line
- occlusal relationship
- teeth shade & mould
what to check during denture delivery in ptx mouth (4)
- extension, retention, stability
- OVD / FWS
- occlusion
- comfort, speech, aesthetics
clamps used
A / AW K - universal clamp for molars
E / EW - anterior & premolars
