Patient advice & instruction

Question 1

Can you think of 11 pieces of instruction you would give a patient following an extraction?

Answer 1

 Do not rinse out for several hours, preferably not until the next day. Don’t rinse vigorously when you do rinse out.
 Rinse the next day with hot salty water.
 Avoid trauma. Do not explore the socket with finer/tongue food.
 Avoid hot food day of extraction. When eating try eating on the other side of the mouth
 Avoid excessive exercise
 Avoid smoking/drinking on day of extraction
 Brush as normal
 Advice on bleeding- if bleeds bite on damp gauze and the bleeding should stop
 If bleeding doesn’t stop then contact GDH&S or hospital(A&E)
 May have slight discomfort so take pain killers before the LA wears off. Take whatever pain killers you normally take and continue as instructed on the packet.
 If any problem contact GDH&S

Question 2

Can you think of how you would instruct a patient to maintain denture hygiene?

Answer 2

15. Denture hygiene
     Instructions to patient
    • Insertion and removal
    • Advice re pain
    • Denture cleansing advice
     Alkaline Hypocholorites eg dentural, Milton
    • Don’t leave cobalt chromium dentures for longer than ten mins as they can corrode.
    • Superior cleaning properties
    • Effective dissolution of plaque
    • Stain removal properties
    • Bacterial and fungicidal properties
    • Possible bleaching of acrylic resin
    • Residual taste after use
     Effervesent Peroxides eg Steradent, boots effervesant original
    • Powder of tablets
    • Rapid in action and simple to use
    • Problems can arise if very hot water used with denture, it can cause bleaching
    • Additional mechanical cleansing action
    • Bubbles created by the release of Oxygen which may dislodge debris

Question 3

Can you think of advice you would give a patient getting used to a new denture?

Answer 3

1. Will feel big & bulky – you will get used to it
2. May be mild discomfort – this indicates it is working
3. Will impinge on speech – practise reading out loud
4. You may drool a lot especially first 24 hours
5. Wear all the time – ESP mealtimes
6. Clean after every meal. Remove & store for contact & active sports
7. Non-compliance significantly increases treatment time
8. Avoid hard sticky foods & fizzy drinks
9. Be cautious with hot food & drinks
10. Emergency contact number

Question 4

What checks would you do prior to providing a patient their newly made URA?

Answer 4

1. Right pt; Right appliance
2. Appliance matches prescripton
3. Sharp edges
4. Integrity of wire (CoCr)
5. Fits in mouth w/o blanching
6. Posterior retention
7. Anterior retention
   • Flyovers then arrowheads
   • High flyover – “gum stripper” Arrowheads – wire into gums at undercut
8. Tighten finger springs – Activates active component
   • Always receive active component in passive form
   • 1mm tooth movement per month
9. Demonstrate correct procedure for removing appliance
   • Get patient to do it
10. Book review appointment

Question 5

Can you demonstrate the 5 A’s and the 5 R’s for smoking cessation?

Answer 5

• Ask
o Smoker? How many per day? When first cigarette in day?
o Want to stop for good? Interested in near future? Interested in help?

• Advise
o Aware of health benefits of quitting?
o Single most effective way to improve health status.
o Past failures will improve chances this time round as not easy to do.
o Lung cancer and heart disease, oral cancer, gum disease and stained teeth.

• Assess
o Desire to stop smoking? Help must be offered.

• Assist
o Negotiate a stop date
o Review previous failed attempts and anticipate problems, suggest enlisting family and friends
o Inform of NRT availability and the NHS Stop Smoking Service

• Arrange Follow up
o Arrange NHS SSS referral (one to one or group), monitor, support and encourage at future dental

5Rs
o Relevant benefits Risks Rewards Roadblocks Repeat

Question 6

Can you think of how you would gauge whether a patient had the capacity to give consent, what questions would you need to consider?

Answer 6

• Does the patient have a broad understanding of the procedure, its benefits and risks?
• Do they have knowledge of any alternatives available?
• Are they able to retain this information for a reasonable time?
• Are they able to make a decision and communicate this choice? (Consider residual capacity)
o Note: Capacity fluctuates and is specific to each action/decision.
o Patients may have capacity for some things but not others. It is NOT all or nothing.
• A.W.I.(S.)A. 2000
o Benefit Minimum Intervention Present and Past Wishes
Consultation with Relevant Others Encourage Residual Capacity
• MMSE: Diagose dementia & help assess prognosis & severity 27/30 is normal
o What is the date? Time? PM? 3 things & repeat back