Past Paper Document Flashcards
what do you ask for smoking cessation
do you smoke
what do you smoke
how long have you smoked for
how many cigarettes daily
how quickly do you like up in morning
why do you smoke
does anyone in family smoke
do you have any kids in the house
what are the 3 As of smoking cessation
ask
advise
assess
what do you advise people of for smoking cessation
harmful to general health - CVS and resp problems
detrimental to oral health - tooth loss, reduced healing, staining, perio disease, oral cancer
personal reasons - money and bad breath
how do you assess motivation to quit smoking
ask if interested to quit now
ask about motivations to quit
ask about previous quit attempts (why were you not successful/what worked)
how much more likely does using NRT make the successfulness of quitting smoking
4x
what are the available NRT products
patches
gum
lozenges
sprays
e-cigs
what do we tell people about e-cigs
new to market so unsure of side effects
no long term health data
less harmful than tobacco
dont vape around children
what smoking cessation services are available
pharmacy
GP
Quit Your Way NHS service
how do you examine a zygoma fracture extra-orally
palpation of zygoma, orbital rim
assessment of nasal bleeding
limitation of mandibular movement
examination of eye - ecchymosis, subconjunctival haemorrhage, double vision, eyeball mobility
examination of sensation of infra-orbital region (superior labial, lateral nasal and lower eyelid)
what are the intra oral features of a zygomatic fracture
tenderness of buttress of zygoma
bruising/swelling/haematoma
occlusal derangement
anaesthesia/paraesthesia of teeth in upper left quadrant
what are the further investigations for zygomatic fracture
occipitomental views
CBCT
CT
what are the next steps are identifying a zygomatic fracture and how is the fracture fixed
urgent phone referral to OMFS unit or A&E
ORIF
what are the handpiece safety checks
back cap doesnt spin
bur is secure
bur does not move laterally
bur can roll
check coupling is secure
run for 5secs or more to listen to sound
what does SDCEP guidance say about when to check INR levels
within 24hrs but 72hrs if stable
what defines a stable INR value
less than 4 for the last 3 months
consistent readings
if you cannot extract a tooth due to bleeding risk and the patient is in pain, what other options are there
analgesia advice
pulp extirpation
sedative dressing
what do you need to discuss with the recipient of a sharps injury
explain nature of injury sustained
explanation of risks of BBV
explanation of standard procedure for sharps injury (blood sample)
explain no pressure for patient to provide a sample
review medical history
gain consent from patient to proceed with sample
what is the aim of a pulpotomy in terms that a patient would understand
to keep undamaged tissue alive so that the tooth can stay alive and continue to grow
how do you explain sensibility testing to a patient
test needed to see how the nerve in the injured tooth responds
helps with long term monitoring of the tooth
how do you explain why dental dam is needed to the patient
say it is a rubber sheet that acts like a mask
gives us good moisture control for better treatment outcome
protects the airway
what questions do you ask to assess pain
SOCRATES but also
- relieving factors/stimulants
- if kept awake at night
what goes onto the pathology form
patient sticker with details
hospital department
date
time
consultant
requested by
phone number
provisional diagnosis
specimen details including site
what is the lab investigation once you have sent a pus aspirate
culture and sensitivity testing
what is the mode of action of bisphosphonates
reduce turnover of bone
accumulate in sites of high bone turnover like the jaw
what is the relevance of bisphosphonates to dentistry
risk of poor wound healing following extraction
need to remove any teeth of poor prognosis prior to beginning drug therapy
important to do everything possible to prevent further tooth loss
reduced bone turnover and vascularity can lead to MRONJ
how do you explain fluoride varnish process to a patient
minimally invasive, involves drying the teeth and painting a gel on the tooth
who is fluoride varnish contraindicated for
severe uncontrolled asthma (hospitalised in last 12 months)
allergy to colophony (sticking plasters)
what are the benefits of fluoride varnish
promotes remineralisation of the tooth
instructions are fluoride varnish application
dont eat/drink for 1 hour
soft diet rest of day
no dark coloured foods
avoid fluoride supplements today
what to do if child ingests 5mg/kg of fluoride
drink milk
what to do if child ingests 5-15mg/kg of fluoride
milk, send to hospital
what to do if child ingests >15mg/kg of fluoride
hospital
what is the structure for breaking bad news
setting
perception
information
knowledge
empathy
summary and close
what should the setting be like for breaking bad news
private room, sitting down at same level as them
did they bring someone with them
how have they been since you last saw them
what do you ask about patients perceptions when breaking bad news
are you aware of what we’re here to discuss
do you know what the purpose of your biopsy was
could you explain to me your understanding of things up till now
what do you do in information stage of breaking bad news
inform patient that you have the results of the biopsy
ask them if they would like you to go through them
what do you say in the knowledge part of breaking bad news
give them knowledge of what you know (the test has shown)
let the information sink in and they can dictate the conversation from here
how do you show empathy when breaking bad news
say you are sorry
ask if they have any questions
ask if they want a relative with them
how do you summarise and close a breaking bad news appointment
summarise what you’ve told them and plan for going forward with treatment
offer them follow up appointment or phone number for questions
give written material if available
what antimicrobials can you use if the patient is on warfarin
nystatin
chlorhexidine
NO AZOLES
what do you check on the cast when you get a crown back
rocking, M/D contact points, marginal integrity, aesthetics
check contact points on adjacent teeth on cast to ensure not damaged
occlusal interference on excursions
check that natural teeth can contact
remove crown from cast and check preparation and if teeth can occlude naturally
how do you avoid having the issue of the crown being too thick when sent back from lab
measure temp crown thickness before cementing
use sectioned putty index with prepping
if the crown comes back from the lab and it is too thick and interfering with the occlusion, how can you manage this
either drop the incisal pin on articular and calculate difference needed to fix occlusion and trim the crown and cement but only if this will not make the crown too thin
re do prep and send back to lab
what special investigations would you conduct if a patient appears with a swelling around the teeth and an 8mm pocket on the distal aspect of the tooth as well as suppuration
PA radiograph
sensibility testing
if a tooth has a swelling, pocket with pus and bone loss from the radiograph but responds positively to sensibility testing, what is the diagnosis
periodontal abscess
how do you treat a periodontal abscess
irrigate through pocket
debridement
hot salty mouthwash
how do you diagnose an OAC
radiographic position of roots in relation to antrum
bone at trifurcation of roots
bubbling of blood
nose holding test
good light and suction
what would chronic OAF patients complain of
fluid from nose
speech and singing of nasal quality
problems with wind instruments
problems smoking or using straw
bad taste/odour, halitosis, pus discharge
pain/sinusitis type symptoms
how do you manage an OAC
inform patient
if small or sinus intact then encourage clot, suture margins, ABX and post op
if large or lining torn then buccal advancement flap, ABX, nose blowing instructions
what are the post operative instructions for an OAC
refrain from blowing nose or stifling a sneeze by pinching nose
steam or menthol inhalations
avoid using a straw
refrain from smoking
what are the antibiotics for bacterial sinusitis
phenoxymethylpenicillin 500mg 4x a day for 5 days
doxycycline 100mg, 2 capsules first day then 1 daily for 7 days
if a child presents with red bumps and ulceration in mouth what questions should you ask
how long
fever?
analgesia?
less active than normal?
what are the signs of PHG
lymphadenopathy, malaise, pyrexia, erythematous gingiva, ulceration
what are the symptoms of PHG
sore mouth and throat
fever
enlarged lymph nodes
what information do you give the parents of a child with primary herpetic gingivostomatitis about the illness itself
primary infection caused by herpes simplex virus
high carriage rate in population
common
most infections are subclinical but can present like this
self limiting and disappears in 7-10 days
child may or may not develop cold sores in future
what is the management of PHG
fluids
analgesia for pain and fever
bed rest
good diet
use CHX to swab gums
can give benzydamine spray for symptoms
what is the prescription for antiviral medication
aciclovir tablets 200mg
25 tablets
1 tablet 5 times a day for 5 days
at what age can you give the adult dose of aciclovir
2yrs old
why would you reline a denture
if the fit surface is not supportive/stable/retentive/underextended but otherwise the denture is fine
why would you rebase a denture
if you want to keep the occlusal surface but change fitting and polished surface
how do you reline a denture
remove undercuts from fit surface with acrylic bur
add greenstick if underextended
take functional impression (bite down whilst impression taking) in light body PVS
pour impression, mount and create self cure PMMA reline to change fit surface
what is a functional impression
getting patient to bite down as impression is being taken
what would you do if a patient came in with complete upper denture and the anterior flange is missing
remove undercuts, build flange with greenstick and reline
what would you do if a denture is underextended at the tuberosities
reline if functionally good and is only problem
remake if everything is bad
what would you do if the baseplate of a denture is too thin and is fracture prone
remake/rebase
what do you do if a denture has too many posterior teeth over the tuberosities
remake
remove posterior teeth
what do you check at a tooth trial appointment and what do you have to do to the cast
check denture extension, support, retention
stability, occlusion
speech, aesthetics (mould, shade)
MARK POST DAM ON CAST
what are the stages of treatment planning
immediate
initial
re-evaluation
re-constructive
maintenance
what would fall under immediate treatment
pain
what would fall under initial treatment
PMPR and patient education
removal of teeth of poor prognosis
NCTSL management (prevention)
caries management
endodontic treatment
what would fall under re-evaluation treatment
periodontal reviews
NCTSL
replacing restorations
what would come under re-constructive phase of treatment
dentures
bridgework
crowns
implants
what would come under the maintenance phase of treatment
periodontal treatment
NCTSL continual review
OHI and prevention
what medication is used for hypoglycaemia
1mg IM glucagon if unconscious
oral glucose/sugary drink if conscious
how does glucagon work
increases concentration of glucose in the blood by promoting gluconeogenesis and glycogenolysis to convert glycogen to glucose
what is the normal level of blood sugar in mmol
5-7mmol
what is the level of blood sugar at which a hypoglycaemic coma occurs
<3mmol
signs of hypoglycaemia
pale, shaky, sweaty, clammy, dizzy, hungry, confusion, blurred vision, LOC
describe the IM injection technique for glucagon injection for hypoglycaemia
inject diluting solution in vial with glucagon powder
swirl to mix
draw solution up
use z-track technique to inject into thigh
reassess ABCDE
what is the z-track technique for IM injection
spread skin
advance needle into skin at 90 degrees
aspirate
inject for 30s
pull out and release tension
what medication is used for epileptic seizures
10mg buccal midazolam
how does midazolam work
short acting benzodiazepine
enhances effect of GABA on GABA receptors resulting in neural inhibition
what are the signs of epileptic seizures
LOC, uncontrollable muscle spasms, drooling, tonic clonic, hypotension, hypoxia, loss of airway tone
what does tonic and clonic mean in relation to seizures
tonic = falls rigid
clonic = sharp jerky movements
what is the management of an epileptic seizure
assess patient
do not restrain convulsive movements
ensure patient not at risk of injury
secure airway
10mg buccal midazolam if seizure lasts more than 5 mins
if someone has an epileptic seizure when do you refer them to hospital
if first seizure
if seizure was atypical
if injury was caused
if difficult to monitor patient
how do you make an apology
be honest
acknowledge offence
explain how it happened
express remorse
ensure amends
what is the NHS complaints procedure
acknowledge complain and provide patient with practice complaint procedure
inform defence organisation if you require advice
inform patient of timescales and stages involved
acknowledge complaint within 3 working days
early resolution within 5 working days for straightforward issues
investigation within 10 working days for higher risk issues
Ombudsman for issues not resolved
treatment options for class 3 occlusion
accept and monitor
intercept with URA - proclines upper incisors
growth modification with reverse twin block or headgear
camouflage with fixed appliances
orthognathic surgery
what steps should you follow when discussing with a nurse about their unprofessionalism
facts - of the situation, ask for their account
issues - explain what the issue is
quote - reference GDC standards
now - what action you have to take right now
advice/ask - seek advice from someone more senior/ask nurse if willing to undergo training on the matter
record - document the conversation
what questions are on the BBV checklist
have you been diagnosed with HIV, hep B or hep C
have you ever injected drugs/had sex with someone who has
have you ever had sex with another man
have you ever had sex with someone from a country outside of the UK, western europe, canada, USA, Australia or New Zealand
have you ever had a blood transfusion in a country not listed above
are you from a country that is not listed above
have you ever had a tattoo/body piercing bone by an unlicensed artist
if you expose the pulp, what do you arrest bleeding with
sterile saline
what are the steps of a direct pulp cap
gain haemostasis
clean cavity with chlorhexidine 0.2%
blot dry with cotton wool
cover exposed pulp with setting CaOH
place RMGI liner (vitrebond)
complete restoration
continually monitor vitality of pulp
when would a pulp cap be required
non-carious exposure
what do you do if there is a carious pulp exposure
extirpate/pulpotomy
discuss XLA or RCT
dress with ledermix
what is the process for an indirect pulp cap
clean cavity with 0.2% chlorhexidine
leave firm stained dentine if place and cover with setting CaOH
place RMGI over this
restore with GI/RMGI and leave for 3 months to monitor condition before placing definitive restoration
if symptomatic then commence RCT
what is the SPIKES formula
setting
perception
invitation
knowledge
empathy
summary and close
for breaking bad news
what are the options for tooth replacement when the tooth has a vertical root fracture and is unrestorable
immediate denture and XLA
long term bridge/denture/implant
what questions do you ask about ulcers
when
how many
size
where
how long they last
any time you’re ulcer free
period between flare ups
do they completely heal
symptomatic?
anything that makes it worse
genital or eye ulcers
what is the aetiology of RAS
trauma
stress
allergy
nutritional deficiency
systemic disease
what systemic conditions can be associated with oral ulceration
crohns
behcets
lupus
anaemia
what are the special investigations for RAS
blood tests - FBC, haematinics
coeliac test
pictures
patch testing for allergies
what is the management of RAS
correcting deficiencies/systemic disease/trauma
3 month exclusion diet
CHX, difflam, topical steroids (beclomethasone/betamethasone)
systemic steroids
how do you explain RAS to a patient
reassure it is common condition
many causes (deficiencies/systemic disease/trauma/smoking/SLS/diet)
explain special investigations needed
explain management
how long does minor and herpetiform RAS take to heal and does it scar
1-2 weeks with no scarring
how long does major RAS take to heal and does it scar
6-12 weeks with scarring
what is kennedy class 1
bilateral free end saddles
what is kennedy class 2
unilateral free end saddles
what is kennedy class 3
unilateral bounded saddles
what is kennedy class 4
anterior bounded saddle only
what is craddock class 1
tooth supported
what is craddock class 2
mucosa supported
what is craddock class 3
tooth and mucosa supported
what do you have to think about when placing rests on a CoCr denture
if there is space in the occlusion
type of saddle (free end or bounded)
how much space is needed for a lingual bar and what makes up this space
8mm
3mm gingiva
4mm bar
1mm depth FOM
causes of a retained primary incisor and unerupted 21
trauma to primary causing ankylosis/arrested development/dilaceration or displacement of 21
lack of permanent successor/hypodontia
ectopic tooth germ
crowding
supernumerary
what type of supernumerary is the most common cause of delayed eruption of permanent incisor
tuberculate
signs of delayed eruption of central incisor
discolouration of primary incisor
retained primary
radiographic signs
lateral erupted before central
management of unerupted central incisor
palpate buccally
take PA and occlusal anterior if dilaceration is present
refer to orthodontist
what do you do if unerupted central incisor and no primary tooth
preserve space with URA
what do you do if unerupted central incisor and primary tooth present
extract primary
expose and align
preserve leeway space for 1.5 years
if a patient has TMD, where can pain often radiate to
neck and shoulders
associated symptoms with TMD
limited mouth opening
joint sounds
tender/swollen MoM
headaches
TMJ locking
difficulty eating
what do you need to ask about social history with TMD patients
occupation
stress
home circumstances
sleeping pattern
recent bereavement
relationships
habits
what is the extra oral exam for TMD
lymph nodes
asymmetry
TMJ and MoM
TMJ tenderness
TMJ sounds - clicking/crepitus
range of movement of TMJ (extent/trismus/deviation/inter-incisal opening)
muscle tenderness
facial asymmetry
what is the intra-oral exam for TMD
inter-incisal mouth opening (should be >35mm)
cheek biting/linea alba/tongue scalloping
occlusal NCTSL
ICP/RCP, group function
muscle tenderness (pterygoids)
what are the special investigations for TMD
OPT
blood tests for inflammatory markers (ESR/PC/CRP)
arthrography
MRI
ultrasound
CBCT
what are the causes of TMD
idiopathic
stress
trauma including dental procedures and bruxism
what is the conservative management of TMD
counselling
stabilisation splint
massage
heat therapy
physiotherapy, acupuncture, US therapy, hypnotherapy
medication - analgesia/diazepam/amitriptyline/botox
what is the counselling for TMD
reassurance
soft diet
bilateral mastication
avoid wide opening
no chewing gum
avoid incising foods
cut food into small pieces
stop parafunctional habits
support mouth when yawning
how do you explain TMD to a patient
common condition
explain anatomy of jaw joint in simple terms
muscles get tired if overworked, inflamed and sore
explain management
what is the aetiology of ANUG
poor OHI
stress
smoking
immunocompromised
malnourished
what are the signs/symptoms of ANUG
painful, red, gingiva
halitosis
punched out ulceration of interdental papilla areas
grey necrotic sloughing
what is the management of ANUG
OHI
PMPR
smoking cessation
chlorhexidine 0.2% or 6% hydrogen peroxide mouthwash
if systemic then ABX
analgesia
review within 10 days
what is the antibiotic prescription for ANUG
metronidazole 400mg
1 tablet three times a day for three days
what warning comes with metronidazole
dont drink alcohol
advice for children with nursing bottle caries
feeder cup replacing bottle from 6 months
no feeding at night
no on-demand breastfeeding
no sweetened milk
milk and water only between mealtimes
sugarfree variations of drinks/foods/medicine
safe snacks - cheese, breadsticks, fruit, plain crisps
assist toothbrushing until 7yrs old
management of nursing bottle caries
extraction of carious teeth under GA
GIC remaining teeth and review
fluoride supplements and varnish
what is the process of a GA referral to talk through with parents
discussion of risks/benefits
referral to hospital for specialist to assess
GA will involve day in hospital
need of chaperone throughout
what are the risks of GA
headache, nausea, vomiting, drowsiness
sore throat or sore nose/nose bleed from intubation
brain damage, death, upset when coming round, malignant hyperpyrexia
risks of the actual treatment itself (pain etc)
what paediatric conditions require special care and may contraindicate GA
sickle cell disease
diabetes
downs
malignant hyperpyrexia
CF or severe asthma
bleeding disorders
cardiac or renal conditions
epilepsy
long QT syndrome
what is on the GA referral form
patient details and GP details
parental responsibility
justification for GA
proposed treatment plan
previous treatment details
what happens at the GA assessment appointment
treatment planning only
written informed consent
explain GA process, side affects and complications
pre-operative fasting discussed
post-operative arrangements made
post-operative care and pain control discussed
what issue with the impression surface of a denture could contribute to it being loose
distortion of impression
poor adhesion to tray
warped denture base
lack of post dam
poor denture bearing foundations
flabby ridge
bony prominence
atrophic mandibular ridges
what issues with the occlusal surface of a denture could contribute towards looseness
premature occlusal contact
centric occlusion not coincident
high lower occlusal plane restricting the tongue
what issues on the polished surface of a denture could contribute towards looseness
peripheries overextended/underextended
not placed in neutral zone
cheeks and lips are in equilibrium with those of the tongue
what issues on the denture bearing foundations could contribute towards looseness
atrophic ridges
tori
flabby ridge
frenum
how do you manage an atrophic ridge when making a denture
cuspless teeth
extension
soft liners
how do you manage tori when making a denture
provide area of relief on cast over this before processing
what radiographs would you use in a cancer patient to identify teeth of poor prognosis
OPT, PA
what do you do if your patient is about to undergo cancer treatment and they have teeth of dubious prognosis
XLA
what are the oral side effects of chemotherapy
caries
mucositis
dry mouth
altered taste
what treatment can we do for patients who are about to undergo cancer treatment
impression for soft splint
oral hygiene instruction
high strength fluoride prescription
fluoride trays
fluoride varnish
smooth sharp teeth
diet advice - avoid hot and spicy foods, avoid fizzy drinks, fruit juices and acidic fruit
smoking and alcohol advice
what is the management of mucositis
avoid smoking/spirits/spicy foods/tea/coffee
prescribe topical lidocaine, saline, sodium bicarbonate, benzydamine, gelclair, caphasol, oral cooling (ice)
what type of candidosis is common in cancer patients
pseudomembranous
what post treatment do we give to cancer patients
prevention
monitoring
dry mouth management
MRONJ management
palliative care
what is the pattern of xerostomia like in cancer patients
50-60% reduction in salivary flow in first week
further 20% in next 5-6 weeks
what is saliva consistency and character like in cancer patients
increased viscosity
decreased pH
what are the associated problems with xerostomia in cancer patients
dysphagia
dysarthria
dyspepsia
quality of life reduced
what are you at increased risk of with xerostomia
caries
periodontal disease
candidiasis
sialadenitis
prosthodontics difficulties
if there is smooth surface caries on an anterior tooth, which surface do you approach this from
palatal
how do you place a separator
floss 2 pieces of floss through orthodontic separator
pull tight and move down between contacts of tooth but not subgingival
how long is a separator left in place for
2-7 days
how are separators removed
with BLUNT probe
what cement is used for a hall crown
GI (aquacem)
how do you manage a choking child
ABCDE
are you choking? can you cough?
5 back slaps between shoulder blades (lying on thigh or across knees)
5 abdominal thrusts between belly button and sternum
always check for object dislodging
re-evaluate ABCDE
BLS if still not resolved
call 999 to check for rib fracture and tell parents
how long does PHG take to resolve
7-10 days
what is bracing in terms of dentures
resistance to lateral movements
what is the black waste stream for
household waste
what is orange waste stream for
low risk clinical waste
what is yellow waste stream for (we do not have this on clinic)
high risk clinical waste
- body parts and teeth
what is the red waste stream for
specialist waste
- amalgam (white box, red lid)
what is blue waste stream for
sharps with vials of medication
what are the rules of the sharps box
always dispose of sharps in box immediately after use
always keep out of reach of children
always close box between use with temporary closing mechanism
never retrieve anything from box
never fill more than 3/4 full
place sharps box at waist height on flat surface
how do you deal with a blood spillage
stop what we are doing
apply appropriate PPE
cover spill with disposable paper towels
apply sodium hypochlorite/sodium dichloroisocyanurate 10,000ppm
leave for 3-5 minutes then scoop up into orange waste
clean with water and general purpose neutral detergent disinfectant wipes
possible causes of a white patch
hereditary
keratosis
lichenoid
lupus
pseudomembranous or chronic hyperplastic candidiasis
carcinoma/SCC
how would you discuss finding a white patch on the floor of someones mouth to the patient themselves
say it has a number of possible causes, some harmless/benign, some serious
high risk for oral cancer in this site
patient has other risk factors
appropriate to refer for biopsy
urgent referral
what is the guidance for urgent cancer referral
persistent unexplained head and neck lumps for >3 weeks
ulceration or unexplained swelling of oral mucosa > 3 weeks
all red or speckled patches of oral mucosa > 3 weeks
persistent hoarseness > 3 weeks (need chest x-ray too)
dysphagia or odynophagia > 3 weeks
persistent pain in the throat lasting > 3 weeks
who would we prescribe acyclovir to
immunocompromised patients and severe infections in non-immunocompromised
what is the general history you would take for suspected mandible fracture
headache?
LOC?
nausea or vomiting?
numbness of face?
examine and record injuries elsewhere
what are you looking for extraorally with a mandible fracture
lacerations, bleeding, swelling
facial asymmetry
painful?
limitation of mandibular movement?
palpation of mandible bilaterally
mandibular deviation on opening and lateral movement
tenderness of TMJ
examination of sensation of lower lip/chin region
what are you looking for intraorally with a mandible fracture
lacerations, bruising, swelling, haematoma
occlusal derangement and step deformities
loose or broken teeth
anaesthesia/paraesthesia of teeth in lower jaw on side of fracture
AOB - due to bilateral ramus/sub-condylar fracture
what is a simple mandibular fracture
fracture of the bone but soft tissue intact
what is a compound mandibular fracture
fracture of the bone and break in soft tissue
what is a comminuted mandibular fracture
fracture of the bone and multiple soft tissue traumas
what can fractures be classified as
soft tissue involvement
number
site
side
displacement
direction
what factors influence the displacement of mandibular fractures
pull of attached muscle
angulation and direction of fracture line
opposing occlusion
magnitude of force
mechanism and direction of injury
intact soft tissue
what are the further investigations for mandibular fractures
OPT and PA mandible
CBCT commonly used too
what is the management of a mandibular fracture
call maxfacs or A&E for advice
urgent referral
surgical management = ORIF if symptomatic or displaced
conservative management if undisplaced and asymptomatic
what is the OHI for orthodontic decalcification
brush 2x/day minimum with soft brush but also after meals as braces are plaque traps
spit dont rinse, be methodical with brushing (clockwise, 1 at a time, angled)
use single tufted toothbrushes around brackets
interdental brushes and superfloss
use disclosing tablets to see what areas you have missed
diet advice for orthodontic patients
avoid hard, hot, sticky foods, fizzy drinks, sports drinks, lollipops
avoid snacking between meals
limit sugar intake to less than 3x/day
water or milk, crackers, cheese and fruit are good
what is the fluoride prevention for orthodontic patients with decalcification
varnish 4x/year (proflurid)
2800ppm toothpaste
225ppm fluoride mouthwash at other times than brushing
what are the 7 elements of caries risk assessment
clinical evidence
diet
MH
SH
saliva
plaque control
fluoride exposure
what are the 8 elements of prevention
radiographs
diet advice
toothbrushing instruction
strength of fluoride in toothpaste
fluoride supplement
fluoride varnish
fissure sealant
sugar free medicine
what would you ask for on the lab sheet when asking for a conventional cantilever bridge
pour impressions with improved stone
mount on semi-adjustable articulator
construct metal ceramic conventional mesial cantilever bridge to replace tooth …
specify type of pontic (ridge lap etc)
what teeth are dome shaped pontics used for
upper posterior
lower anterior
lower posterior
what teeth are modified ridge lap pontics used for
upper anteriors
what is the gold standard restoration after an endodontic procedure and what materials are available
cuspal coverage onlay
gold, composite, porcelain, zirconia
why would you want to have cuspal coverage after endodontic treatment
less likely for tooth fracture/failure
less microbial leakage/better seal
what materials can you use for a full coverage crown after endodontic treatment
MCC
GSC
all ceramic
zirconia
why is a composite/amalgam restoration alone not as favourable to restore an endodontically treated tooth
more leakage and more likely to fracture
what is panavia used for
adhesive bridges (RBB)
what is aquacem used for
metal posts
MCC
gold restorations
zirconia restorations
what is nexus used for
fibre post
composite/porcelain restorations
veneers
what d you check for on the cast when you get an indirect restoration back from the lab
rocking
contact points
marginal integrity
aesthetics
is the restoration as we asked for
what do you check once you have cemented an indirect restoration
is excess cement removed
is restoration cleansable
check margins, clear interproximally, aesthetics, occlusion
what is the process of surverying
mount
tripod lines
analysing rod to analyse abutments and soft tissue undercuts
pencil rod to mark survey line of abutment teeth and tissues
determine whether the cast needs to be tilted to change path of insertion
if needs tilted then remark with red marker in the favourable position tripod lines and survey lines)
what is the distance needed for CoCr clasps
0.25mm
what is the distance needed for gold clasps
0.5mm
what is the distance needed for wrought stainless steel clasps
0.75mm
what is the specifications of the oxygen used during medical emergencies
15L/min 100% O2
risks/complications of lower wisdom tooth surgical removal
pain, swelling, bleeding, bruising, infection, dry socket, jaw stiffness, temporary/permanent numbness, prolonged nerve pain, tingling due to damage to nerve (<1% permanent, 10-20% temporary), damage to adjacent tooth
how do you explain how to do a knee to knee exam
sit across from parent with their knees touching mine
bring knees together and ask parent to do the same
ask parent to sit the child with their legs around the parents waist
lower the child down into your knees and ask the parent to hold the child’s arms
what is on the trauma stamp
EPT, EC, TTP
percussive note
mobility
displacement
radiograph
sinus
what are the signs of subluxation
TTP
mobile
bleeding from gum
no displacement
what is the management of subluxation
explain what the injury is
no treatment required
clean tooth with saline or CHX wipe with gauze
instruct soft food diet for 1 week
brush with soft brush after every meal
what are the possible complications to the primary tooth after subluxation
pain, swelling
dark discolouration
increased mobility
infection (parent watch for signs of swelling)
what are the possible consequences to the permanent tooth after the primary tooth has been subluxated
premature or delayed eruption
enamel hypoplasia/hypomineralisation
crown/root dilaceration
failure to erupt
cease formation
odontome
how often is testing done on the machines in the LDU
daily
weekly
quarterly
annually
specifications of a type N steriliser
non-vacuum
passive air removal
instruments cannot be wrapped, hollowed or lumened
specifications of a type B steriliser
vacuum
active air removal
packaged instruments fine
lumened, cannulated instruments fine
what is the daily test for the steriliser
steam penetration
what is the weekly test for the steriliser
vacuum leak test
air detector function test
what are the 4 types of water that can be used in the steriliser
reverse osmosis
distilled
sterile
de-ionised
what is the sterilising temperature range
134-137 degrees Celsius
what is the steriliser hold time
3 minutes
what are the stages of the WD
flush
wash
rinse
disinfect
dry
what is the daily test for the WD
automatic control test (checking disinfection temperature and hold time)
what are the methods of manual cleaning
immersion or non-immersion
what detergent can be used for manual cleaning and how much of it
pH neutral
30ml to 8l of water
what is the water temperature meant to be for manual cleaning
30-35 degres
what is the management of denture stomatitis
OHI
rinse mouth after inhaler use/use spacer
blood tests if recurrent
lower sugar diet
correct denture fault
stop smoking
denture hygiene instruction
what are the post operative instructions after an extraction
do not rinse for 24hrs, then HSMW 4x/day
careful whilst numb
do not disturb socket with tongue/finger
brush other teeth as normal
avoid hot and hard foods
avoid excessive exercise
eat soft foods on opposite side for a few days
avoid smoking for as long as possible
if bleeding then wet gauze, then phone
painkillers before analgesia wears off (paracetamol and ibuprofen fine)
how do you describe a biopsy procedure to a patient
LA injection around the site of the sample
taking small amount of tissue to send to lab for analysis
suture would be used to close wound - will dissolve
sore for a week after procedure
review appointment to be booked to discuss findings
what are the risks of a post core crown if the tooth has no RCT
infection
abscess
tooth breakdown
root fracture
if someone has a post and core crown with no endodontic treatment at the apex and caries lingually, what are the treatment options
leave/monitor
remove crown and caries
remove post core and replace, re-do RCT
what can acid erosion be explained by
fizzy drinks
fruit juice
alcohol
GORD
bulimia
vomiting
what is attrition related to
parafunction
bruxism
stress
what is abrasion related to
tooth brushing
habits
pipe smoking
nail biting
what are the management options for abrasion
remove foreign object causing wear
change toothpaste
alter brushing habits/technique
change habits (nail biting etc)
GIC/RMGIC on cervical toothbrush abrasion
what are the management options for attrition
resolve parafunctional habit
CBT/hypnosis
splints
what are the management options for erosion
remove causing agent
fluoride toothpaste/mouthwash
desensitising agents
dietary management - straws, avoid sports drinks, chew gum, eat cheese
GMP referral
what percentage of upper first molars have 4 canals
93%
what percentage of upper first molars have 3 canals
7%
what do you check for when fitting a URA
appliance is for the correct patient
appliance is what we asked for
sharp acrylic/protruding wires
wirework integrity
fit appliance
check for blanching/trauma
check posterior retention (flyovers and arrowheads on adams clasps)
when checking that adams clasps are retentive, what order of the components do you check first
flyovers
arrowheads
once you have checked that a URA fits, what do you do next
activate to produce 1mm movement per month
demonstrate to patient about insertion and removal
ask patient to demonstrate insertion and removal
how often do you review a URA
4-6 weekly
what are the 10 post op instructions when delivering a URA
will feel big and bulky
likely to impinge on speech (read a book aloud)
may have mild discomfort but this means it is working
initial saliva increase in 24-48hrs
wear 24hrs/day including meal times
can remove the appliance to clean with soft brush after each meal or when taking part in sports
avoid hard and sticky foods
be cautious with hot food and drinks as base plate acts as insulator
non-compliance lengthens treatment
give emergency contact number
what is the FRAMES counselling approach
feedback - to patient about behaviour
responsibility - for change placed on patient
advice - how to do that change
menu of options - self directed change options
empathetic - warmth, respect and understanding
self efficacy - endangered to encourage change
what questions do you ask about alcohol
how much do you drink
what kind
family concerns?
what do you advise about alcohol
general health risks (stroke, cardiac disease)
oral cancer risk
fungal, caries, dry mouth, perio, poor wound healing, dental erosion, bruxism
increased bleeding, less clotting
where do we refer alcoholics to
alcoholics anonymous
what are the guideline surrounding alcohol intake
14 units per week with 2-3 drink free days
what is the definition of bracing in relation to partial CoCr dentures
rigid components of a denture that resist horizontal forces caused by occlusal contact
what is the definition of reciprocation in relation to partial CoCr dentures
rigid components of a denture that resist horizontal forces caused by retentive component during insertion and removal
what are the treatment options when there is a separated file in a root canal
dress and monitor
accept and obturate
bypass
attempt removal
specialist
retrograde endodontic surgery
XLA
how do you remove a fractured file from a canal
if can see then remove with forceps
ultrasonic
how would you bypass a fractured file
using a small file alongside the instrument and EDTA to soften the dentine
what is the order for cleaning the dental chair and surrounding areas
light
control surfaces
full length of all cables
NEW WIPE
dental chair
bracket table
spitoon
NEW WIPE
bench top surfaces
computer keyboard and mouse
what is howarths periosteal elevator used for
raise mucoperiosteal flaps
retraction of flaps
what are cryers elevators used for specifically
elevate roots
remove interradicular bone
what are alice forceps used for
hold soft tissues
pick up teeth
what are bone nibblers/rongeurs used for
trimming bone
remove spicules and septae
what main topics (not questions) must you explain to the patient when explaining about sharps injuries
explain nature of injury
risks
procedure
no pressure to comply
undertake review of MH
patient understands options and can ask questions
confirm patient’s decision
what is the prescription of chlorhexidine for denture stomatitis
chlorhexidine 0.2% solution
300ml
rinse mouth for 1 minute with 10ml twice daily and soak dentures twice daily for 15 minutes
what is the prescription of nystatin for denture stomatitis
nystatin oral suspension 100,000 units/ml
30ml
1ml after food four times daily for 7 days
advise to rinse suspension around mouth and retain near lesion for 5 mins before swallowing
continue to use 48hrs after resolution
what is the second line antibiotic for pericoronitis if the patient is allergic/alcoholic to the first line antibiotic
amoxicillin 500mg
9 capsules
1 capsule 3 times daily for 3 days
what impression materials are suitable for edentulous patients
alginate and impression compound
what is the lab prescription for special trays
please pour casts in 50/50 dental stone/plaster and construct lower special tray in light cured PMMA with 1-2mm spacer, perforated, and extra-oral standard handle
how would you explain OFG to a patient
blocked lymphatic channels causing swelling
autoimmune condition with hypersensitivity to additives
what additives can make OFG worse
benzoates
cinnamon
sorbic acid
chocolate
tomato sauce
what are the symptoms of OFG
lip swelling/cracked
angular cheilitis
buccal cobblestoning
staghorning of FOM
ulceration (linear at the base of the fissure)
lymphoedema
gingivitis
what is included in ,medical history taking when considering OFG
weight loss and bowel problems
what special investigation assists in diagnosis of OFG
patch testing
what is the management of OFG
dietary avoidance
tacrolimus ointment to lip topically
intralesional steroid injections
if a patient gets facial palsy after an IDB, where did you inject into
parotid gland to the facial nerve
what do you test to diagnose a facial palsy
branches of the facial nerve
what are the branches of the facial nerve
temporal
zygomatic
buccal
mandibular
cervical
what are the symptoms of facial palsy
weakness of ipsilateral side of face
inability to close eyelids
obliteration of nasolabial fold
drooping of corner of mouth
deviation of mouth toward unaffected side
how do you confirm that the patient has facial palsy and not a stroke
facial palsy = temporal branch is affected and wont move
stroke = patient can still wrinkle forehead
what is the management of facial palsy
reassurance
cover eye with pad until blink reflex returns
eye patch applied during night time
artificial tears during the days along with sunglasses
what are the causes of stained teeth on a child
MIH
fluorosis
dentinogenesis imperfecta
trauma
amelogensis imperfecta
decalcification
tetracycline staining
what are the treatment options for stained teeth
microabrasion
ICON resin infiltration (dependent on cause of staining/colour)
extrinsic bleaching
non-vital internal bleaching
localised composite addition
composite/porcelain veneer
crown
risks of vital extrinsic bleaching
may not work
gingival recession
sensitivity
will not bleach restorations
relapse
overbleach
what are the causes of missing teeth
hypodontia
trauma causing arrested formation
ectopic
dilaceration
supernumerary
treatment for missing teeth
resin bonded bridge
essix retainer
RPD
implant
ortho to close space
what are the reasons for failure of periodontal treatment
smoking
patient not compliant - OH is poor
inability for patient to practice OH effectively (furcations making tricky or poor manual dexterity)
stress, diabetes, pregnancy, malnutrition, poor diet
difficulty accessing for debridement/inadequate debridement
overhangs, poor margins
what is absolute risk difference
the difference in risk between the groups
what is relative risk ratio
the ratio of the risk in each group
what is the number needed to treat
number of patients you would need to treat to prevent on patient from developing the risk
what does 95% confidence interval mean
95 times out of 100 the confidence interval will contain the true value in the entire population
what is a null hypothesis
the intervention works only as well as the control
if absolute risk difference overlaps 0 what does this mean
null hypothesis
if relative risk ratio overlaps 1 what does this mean
null hypothesis
what would a narrow confidence interval range mean
the study is more representative of the true population results compared to a broad range
what is it important to ask about studies to make sure they were valid and reliable
blinding
inclusion, exclusion criteria
randomisation
control
were all subjects accounted for at the end
why might root canal treatment fail
overfilled/underfilled
poorly compacted
accessory canals missed
missed canal
inadequately prepared
extrusion of debris
perforation
RCF of incorrect shape
vertical root fracture
endo file fracture
blockage/obstruction of canal
poor coronal seal (failed restoration)
what are the treatment options for failed RCT and give risks of each
leave and monitor - infection/abscess flare up
orthograde treatment - chances of success decreased
periradicular surgery - invasive, expensive, scarring, reduced support
XLA - tooth loss, need replacement, poor aesthetics
what is the normal range for oxygen saturation
97-100
at what oxygen saturation would the alarm on the monitor go off
90
at what oxygen saturation do you start to become hypoxic
85
what do you do if oxygen saturation is starting to drop in sedation
ask patient to breathe
what do you do if oxygen saturation alarm goes off in sedation
give supplemental oxygen (nasal cannulation 2L/min)
reverse with flumazenil (500mcg/5ml)
what are the contraindications for inhalation sedation
common cold
tonsilitis
nasal blockage
severe COPD
MS
pregnancy
claustrophobia
if someone has a dry mouth what questions do you ask them about their presenting complaint
how dry mouth is affecting them
do they need water to swallow
affecting speech?
uncomfortable?
what are the usual features of dry mouth
swallowing difficulty
clicking speech
discomfort
altered taste
cervical caries
halitosis
candidiasis
what do we look out for in the medical history that may indicate dry mouth possible
medications
diabetes/epilepsy/anxiety/stroke/sjogrens/CF/HIV
alcohol/smoking
what is the management of dry mouth
hydration
chew gum
modify drugs (ask GP)
control diabetes/somatoform disorder
reduce caffeine, stop smoking and drinking alcohol
high fluoride toothpaste, treat candida infections
sprays/lozenges, saliva orthana, stimulants, pilocarpine
how do you explain lichen planus to a patient
white patches in the mouth caused by keratin deposition in response to an irritant
irritant can be medication/allergen/amalgam fillings
small chance (1% in 10 years) of developing into cancer
spectrum disease (asymptomatic - cancer)
start by avoiding SLS and benzoates, chlorhexidine and difflam if symptomatic
corticosteroids can be used
takes 3-5 years to resolve sometimes
will take pictures and review every 4-6 months
name the 12 cranial nerves
1 - olfactory
2 - optic
3 - oculomotor
4 - trochlear
5 - trigeminal
6 - abducens
7 - facial
8 - vestibulocochlear
9 - glossopharyngeal
10 - vagus
11 - accessory
12 - hypoglossal
what is the order of protaper retreatment files
D1, D2, D3,
what solvents are used for GP removal
NaOCl
eucalyptus oil
what are the percentages of irrigants used for RCT
NaOCl (3%)
EDTA (17%)
CHX (2%)
what do you do if there are instruments on top of the autoclave and you are unsure if they are sterile or not
start whole procedure again
what is the colour change in a helix/bowie dick
yellow to blue
what are the risk factors for candidal leukoplakia
smoking
OH
steroid inhaler
diet
diabetes
deficiency
dry mouth
antibiotics
immunosuppression
what is the management of candidal leukoplakia
incisional biopsy
OHI
reduce carbohydrate
rinse mouth after inhaler use
correct deficiency
diabetes
correct denture fault
stop smoking
systemic antifungal
review after 7 days
what is the prescription for systemic antifungal for candida
fluconazole 50mg
7 capsules
1 capsule daily
extra-oral signs of non-accidental trauma
bruising of face
bruising of ears
abrasions and lacerations
burns and bites
neck choking marks
eye injuries
hair pulling
fractures
what are the intra-oral signs of non-accidental trauma
contusions
bruises
abrasions and lacerations
burns
tooth trauma
frenal injuries
what makes up the index of suspicion with child abuse
delay seeking help
story is vague/lacking in detail/vary with each telling and person to person
account not compatible with injury
parents mood abnormal/preoccupied
parents behaviour gives cause for concerns
child’s appearance and interaction with parents is abnormal
child may say something contradictory
history of previous injury
history of violence within the family
if you suspect child abuse what action do you take
provide any urgent dental treatment
tell parent unless putting child at risk
seek parents consent to share info
record incident and conversation
refer to social services/police
confirm referral acted upon
arrange dental follow up
be prepared for reporting in case of court
always discuss with colleague
what is the formulation of articaine and max safe dose
4% articaine 1:100,000 adrenaline
7mg/kg
what is the formulation of lidocaine and max safe dose
2% lidocaine 1:80,000 adrenaline
4.4mg/kg
what is the formulation of prilocaine and max safe dose
3% prilocaine with felypressin
