PIA Flashcards
What are the zones of the panoramic imaging assessment?
Zone 1 - Nose and sinuses
Zone 2 - Md Body
Zone 3 - Articular Eminence, Condyle, Mx Tuberosities, Pterygo Mx
Fissures, EAM, Cervical Spine
Zone 4 - Epiglottis
Zone 5 - Md Ramus and Spine
Zone 6 - Dentition
What are some of the pre-requisites for health according to the Ottawa Charter?
- Peace
- Shelter
- Education
- Food
- Income
- A stable exosystem
- Sustainable resources
- Social justice and equity
What are some of the action areas of health promotion according to Ottawa charter?
- Build healthy public policy - think sugar tax
- Create supportive environments - think ban of sugary foods in schools
- Strengthen community action - support your local dental programs such as the indigenous oral health unit
- Develop personal skills - raising awareness with patients
- Reorient health services - focus on both high risk and popuation approach
How do you write a diagnostic statement for periodontist modified by diabetes?
- Type of periodontal disease
- Disease extent
- Stage
- Grade
- Current disease status
- Risk factor profile
E.g.
Periodontitis: generalized (65%), Stage III (CAL <10 mm), Grade C (HbA1c 8.9%), currently unstable (PPD <8mm, BOP 45%).
Risk factors: uncontrolled diabetes (HbA1c 8.9%), smoking 20 cig/day, high strss levels (change in work)
What are the criteria to assess alginate impresion?
- Alginate mix is homogenous and smooth - is it mixed well, is it too runny
- Tray appropriate size - are all teeth included and past the tuberocity area
- Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal - is it seated on teeth correctly, has it set, has the material flown past the CEJ
- Adequate amount of alginate in tray and the treay has been seated and muscled trimmed correctly - has muscle been trimmed, have the tongue been placed properly
- Tray has been removed correctly
What are the basic drugs and equipment that should be available at every dental practice required by law?
Drugs:
1. Oxygen
2. Adrenaline
3. Glucose
4. Bronchodilator
5. Aspirin
6. Hydrocortisone
Equipment:
1. Blood pressure monitor
2. Glucose monitor
3. Pulse oximeter
4. Automated external defibrillators
5. Laryngeal airways
What is syncope, what’s it’s causes and how do we manage it?
Syncope - transient self-limiting loss of consciousness. The onset is rapid and spontaneous and complete. Has presyncope phase of light-headed, nauseated, anxious and pale.
The underlying mechanism - cerebral hypoperfusion - i.e. low oxygen levels
Causes:
Vasovagal
Orthostatic
Cardiac dysrhythmias
Cardiac disease
Managmenet:
- Stop treatment
- Lie the patient down
- Support airway by removing all object for the mouth
- Measure the patient’s blood pressure and heart rate
- If the patient does not regain consciousness - call 000 begin DRSABCD
What is the protocol of action if you suspect the patient having coronary ischaemia syndromes in chair?
- Stop treatment
- Measure: blood pressure, heart rate and pulse oximetry
- Assess consciousness
- To relieve symptoms use glyceryl as instructed, call the registered nurse
If patient reports pain to be THE WORST EVER DO:
1. Call 000
2. Give glyceryl to a patient with previous history of angina
3. Give aspiring 300 mg orally
4. Measure: blood pressure, heart rate and pulse oximetry
5. Start supplemental oxygen - call registered nurse
6. Provide reassurance
7. If patient loses consciousness - start DRSABCD protocol
What is cardiac arrest, what are signs and causes, what is the management of the patient?
Cardiac arrest is the stop of heart function.
Signs: no pulse, loss of consciousnes and respiration
Causes: ventricular tachycardia, ventricular fibrillation, asystole
Managment:
1. Stop dental treatment
2. Call 000
3. DRSABCD
What is the management of mild or moderate asthma?
- 4 puffs of slabutamol inhaler, 1 puff at a time, shaken before each puff
- Ask the patient to take 4 breaths in and out of the spacer after each puff
- Wait 4 minutes
- If no imporvement - repeate
- If no improvement again - define this as a sever or life-threatening attack
What is the management of sever or life threatening asthma attack?
- Call 000
- Start oxygen and airway support
- Salbutamol - 12 puffs for 6+ years, 6 puffs for less than 6 year olds
- 1 puff at a time, 4 breaths in between
- When waiting for help - perform the protocol every 20 minutes
- If patient is worsening - continuously administer salbutamol
What are the signs of partial airway obstruction?
- Wheeze
- Stridor (noisy inspiration
- Laboured breathing
- Coughing spasms
- Cyanosis
What are the signs of complete obstruction of the airways?
- Inability to breath, speak, cry or cough
- Agitation, gripping of the throat
- Cyanosis
- Bulging of the neck veins
- rapid development of respiratory failure
- Loss of consciousness
What are the steps of management if the patient is conscious with signs of airway obstruction?
- Call 000
- Reassure the patient and ask them to relax, breete deeply and try to dislodge the object by coughing
- If coughing is ineffective - give upto 5 back blows between the shoulder blades - check between each hit
- If the back blows dont work, do 5 chest thrust similar to CPR
- Continue until assistance arrives
What are the steps of management if the patient is unconscious with signs of airway obstruction?
- Call 000
- Inspect the back of the throat for foreign object
- Start DRSABCD
- Consider performing cricothyroidotomy
- DO NOT DO THE HEIMLICH MANOEURVE
What is the management of seizures?
If history of epilepsy or seisures is present - please use a bite block on the patient
- Stop dental treatment
- Ensure patient is not in danger
- Turn the patient to the side
- Avoid restrainning
- Wait until seizure stops
- Maintain airways
- Assess the patient
- If still unconscious, call 000 and maintain airways
What to do if you given the patient a partial paralysis of priocular muscles because of the injection intro the parotid plexus?
- Stop administratioe patchn of local anaesthetic
- Explain what happened
- Tell the patient to not rub their eye
- Close the eye with an eye patch
- Keep the patient under observation until the ability to blink starts to return
- Advise patient not to drive
- Phone the patient in 12 hours and make sure the issue resolved - if not refer for extra medical care
How to manage a person with hypoglycaemia?
- Stop dental treatment
- Give 15 g of glucose or a similar drink or food
- Measure blood glucose - if does not return to normal - repeat the dose
- If after 3 doses normal blood sugar not returned - call for help
- If unconscious call 000 than DRSABCD
How to manage a person with hyperglycaemia?
Call 000
When does an addisonian crisis occur and how to manage it?
Usually occurs in patient with hyperthyroidism or use of corticosteroids 6-12 hours after surgica; stress
Managment:
1. Call 000
2. Give hydrocortisone 200 mg
3. Think about GIVING MORE STEROID BEFORE PROCEDURES
What is step by step management of mild urticaria or angiodema?
- Stop dental treatment
- Remove or stop administration of the allergen
- Recommend oral anti-histamine
What is the step by step management of a patient with anaphylaxis?
- Stop dental treatment
- Remove or stop administration of the allergen
- Lie patient flat
- Give an intramuscular injection of adrenaline
- Call 000
- Start supplemental oxygen and airway support if needed
- DRABCD
- Repeat adrenaline every 5 minutes
What are some of the important information that needs to be considered when treating a patient with ischaemic heart disease (myocardial infraction)?
- Need to reduce the stress and anxiety
- Patient taking none selective beta blockers - need to consider the amount of epinephrine injected
- Patient taking aspirin may have excessive bleeding
- Patient who had coronary artery bypass graft may require antibiotics
- Patient may have some degree of heart failure
- If patient has a pacemaker, some dental equipment may potentially cause electromagnetic interference
Remember of having INR of less than 3.5 and speak to the cardiologist
What are some of the important information that needs to be considered when treating a patient with COPD?
- Avoid treating if upper respiratory infection is present
- Treat in upright chair position
- Avoid rubber dam in sever disease
- Use pulse oximetry in severe disease
- Avoid nitrous oxide/oxygen inhalation sedation with sever COPD - in order to not reduce the respiratory drive
- Avoid using narcoticts - in order to not reduce the respiratory drive
- Consider using steroids before the appoitment
What medicament would you use for a child’s pulpotomy in student clinic?
Ferric sulphate
What are 2 factors affecting reduced vaccination in low-income countries?
-lack of access,funding and opportunity
-low education,distrust of authority and discrimimation towards minority groups
-virus> more mutations + variants in low income countries
-reduced efficacy of vaccines
What is the role of sodium alginate in alginate material?
Sodium alginate forms a hydrogel former
What is the role of calcium sulphate dihydrate in alginate material?
It provide clcium ions
What is the role of sodium phosphate in alginate material?
It controls working time - acts as a retarder of the rapid use of calcium within the reaction
What is the cartilage theory of craniofacial growth?
This theory was popularized by Scott in 1950s and states that cartilage determines the craniofacial growth. Proponents of this theory state that cartilage is responsible for the growth and bone just replaced it.
What is the functional matrix theory of craniofacial growth?
The functional matrix hypothesis was popularized by Melvin Moss in 1962. This theory said that neither bone nor cartilage is a major determinant of growth but soft tissue is. His view stated that as soft tissues around the jaw and face grow, bone and cartilage follow the growth of these soft tissues.
What type of bones are present in the cranial vault?
Flat membranous bones with suture in between. Osteogenesis occurs in the ossification centres + sutures. The cause of increase area of bones occurs due to brain growth. The out cortical plate usually deposits and inner cortical plate resorts.
What are the factors that facilitate dental arch allignment?
- Use of interdental, primate and leeway spaces
- Increased inter-canine width; mainly due to transverse growth
- Proclined eruption of permanent incisors, forming a wider arch & increases dental arch length
- Appositional growth of alveolar processes in 3 planes
- Appropriate size of apical base and teeth
From which branchial arch does the mandible originate?
1st Branchial arch.
How do we define cases of gingivitis in a reduced periodontium without history of periodontitis?
Localized gingivitis: Probing attachment loss – Yes, Radiographic bone loss – Possible, Probing depth all sites – less than 3mm, BOP score – between 10% to 30%
Generalised gingivitis: Probing attachment loss – Yes, Radiographic bone loss – Possible, Probing depth all sites – less than 3 mm, BOP score – above 30%
How do we right diagnostic statement for gingivitis?
- Extend - localised of generalised
- Disease - gingivitis
- Specification - biofilm induced, mediated by pregnancy or leukaemia
What is the unit of absorbed radiation?
It is called a Gray (Gy) or a Jkg-1
What type of biopsy would you use to confirm an ameloblastoma?
Incisional biopsy
What is the type of biopsy would you use to confirm of radicular cyst?
Fine needle aspiration
What is the H band?
It is a zone of thick filaments that is not actin
What is the I zone?
It is a zone of no myosin fillaments.
What nerve exerts pressure to anterior palate?
Nasopalatine
What nerve innorvates gingiva of mandibular canine?
Incisive branch of IAN
What are the 3 elements of autoclave sterilisation?
Moist hear in the form of saturated steam under pressure in an air tigh vessel.
Heat, steam, pressure and air tight vessel.
What type of cyst can be between 11 and 21?
- Nasopalatine cyst - mostlikely
- Nasolabial cyst
- Pariapical granuloma
- Apical periodontitis
How do you help a pregnant patient with gingivitis?
- Educate the patient about the diagnosis, peform debridmenet and provide OHI
- Use soft bristle tooth brush along gingival margins using modified Bass technique
- Use CHx for 2 weeks
What do you consider before extracting a tooth from a patient with diabetets?
- Pre-operative and post operative moutrinse with CHx to reduce bacteria number to reduce infection post extraction
- Minimise truama during extraction
- Ue longer lasting LA
- Good haemostatic control like cotton pellets
- Prescription of analgesics
- Post operative instructions: don’t drink hot liquids, don’t rinse after extraction, don’t smoke
- NEXT WEEK FOLLOW UP APPOINTMENT
What are some of the systematic considerations for a patient with diabetets?
- Consider multidisciplinery care with GP and oral surgeon
- Stock dental practice and train personal for hypolglycemic/hyperglycemic situations
- Consider oral consequences of diabetes: poor healing, increased infection rate, increase xerostomia
- Risk of periodontitis
- Consider early appoitments
- Remember - these patient are immunosupressed
What is the mechanism of warfarin?
- Competitively inhibits and blocks COX 2 enzymes
- This affects platelet thromboxane A2 activity which inhibits platelet activation
- Thus - reduction in clotting
Why can’t you take codeine and alcohol together?
Codeine can not be taken with alcohol.
Codein acts on the central nervous system together with alcohol.
This increases sedation.
Also alcohol inhibits metabolism of codeine so that increases blood concentration of codeine metabolites to cause overdose.
Who should avoid fluconazole?
- People who take warfarin - due to increased risk of bleeding
- Pregnant ladies - it is a Category C drugs due to risk f foetal damage, decrease growtha dn development of the feutus, potential risk of miscarriage
What is the point of using 20% polyacrylic acid?
To remove smere layer to facilitate ion exchange