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