Preventative dentistry

Question 1

What are the factors in the development of caries?

Answer 1

Bacteria, susceptible surface, time, sugar

Question 2

What are risk factors which make up the caries risk assessment?

Answer 2

Saliva flow and quality
past dental history - previous restorations
family dental history
social deprivation
fluoride exposure
medical history
diet analysis

Question 3

how frequently should you recall a patient?

Answer 3

low caries risk - 6-12 months, can be up to 24

high caries risk - 3 months

Question 4

What are the pre-eruptive effects of fluoride

Answer 4

improve crystallinity and increase crystal size, rounded cusps, shallower fissures, can lead to fluorosis (dose dependant)

Question 5

what are the post eruptive effects of fluoride

Answer 5

inhibit demineralisation, increase re-mineralisation. disrupt bacteria extracellular polysaccharide formation, affects pellicle formation

Question 6

Safe dose, potentially lethal and certainly lethal dose of fluoride

Answer 6

safely tolerated dose: 1mg/kg
potentially lethal dose: 5g/kg
certainly lethal dose: 32-64mg/kg

if child is 19kg, would need to take 63ml of 1450ppm toothpaste to reach PLD

Question 7

When should you provide fissure sealants for children?

Answer 7

All 6s if child has impairments, extensive caries (dmfs 2+)

all susceptible permanent teeth

Question 8

What are the types of fissure sealant?

Answer 8

resin based, light cure (Bis GMA) or GI

Question 9

How do you provide a fissure sealant?

Answer 9

clean the tooth thoroughly with prophy paste
isolate and dry
place 37% phosphoric acid on surface to be sealed for 20 seconds
rinse tooth for same length of time as acid was on
re-isolate and dry thoroughly
apply FS and cure
test the sealant with a sharp probe
monitor and recheck and every appt

Question 10

What can you say to patients for diet advice?

Answer 10

save sweets to one day per week
chocolate is better than packets of sweets
fruit juice has a lot of sugar in
eat cheese or chewing gum after (increases saliva flow)
milk or water between meals
fruit and vegetable`s better for snacks, but still contain sugar

Question 11

a 3 year old child is brought to you, first time they have been to the dentist. how would you address the issue of the previous non-attendance?

Answer 11

• raise concerns with parents
• explain what changes are required
• offer support
• keep everything recorded
• continue to liaise with carers and parents
• monitor
• involve other agencies if it continues

Question 12

What is the clinical and radiographic presentation of AI?

Answer 12

hyperplastic- yellow brown
hypomineralised - yellow brown, soft, rough
hypomaturation - yellow brown and calculus
mixed - taurodonts, brown mottled

all - enamel soft and thin. easily damaged, both dentitions. sensitivity
radiographic - reduced enamel contrast, taurodonts have large pulp

Question 13

What are the restorative options for AI

Answer 13

prevention, comp veneers, FS, metal onlays, SSC, ortho, implants

Question 14

What are the restorative options for DI

Answer 14

prevention, comp veneers, overdentures, removable pros, SSC

Question 15

What are reasons for tooth fracture during removal and turn into a surgical XLA?

Answer 15

inappropriate force/action/instruments
curved roots, heavily restored/carious crown, large roots, close to nerve, ankylosed, alignment of tooth, thick cortical bone, hypercementosis

Question 16

When would you leave a retained root?

Answer 16

covered by soft tissue, sub gingival, no caries or pathology, overdenture/implant in and want to maintain bone height, close association with nerve, medical history contraindicates

must document that you have had conversation with patient

Question 17

what are the options for retained root?

Answer 17

leave, monitor
endo?
remove
refer to MOS-T/specialist/maxfacs

Question 18

What patient warnings do you give for surgical extraction?

Answer 18

explain to patient in their own terms. relate it all to something they understand. might need suction, feeling. stitches - whether dissolving or not. risk of damage to adjacent teeth. post op complications

Question 19

?What are general surgical principles?

Answer 19

larger flaps heal the same as small ones
maximal access with minimal trauma
base>top
use scalpel in one firm continuous stroke
no sharp angles - helps with healing
minimise trauma to papilla
reflect flap down to bone
do not close under tension
close over bone
healing by primary intention

Question 20

What can be used to retract soft tissues?

Answer 20

Howarths periosteal elevator or bowdler-henry rake retractor
Ash
minnesota

Question 21

What can you look for which would suggest an OAC?

Answer 21

infection in the 6s etc 
close lying roots to sinus
if last standing molar in quadrant
older pt
previously had OAC