Preventative dentistry Flashcards
What are the factors in the development of caries?
Bacteria, susceptible surface, time, sugar
What are risk factors which make up the caries risk assessment?
Saliva flow and quality past dental history - previous restorations family dental history social deprivation fluoride exposure medical history diet analysis
how frequently should you recall a patient?
low caries risk - 6-12 months, can be up to 24
high caries risk - 3 months
What are the pre-eruptive effects of fluoride
improve crystallinity and increase crystal size, rounded cusps, shallower fissures, can lead to fluorosis (dose dependant)
what are the post eruptive effects of fluoride
inhibit demineralisation, increase re-mineralisation. disrupt bacteria extracellular polysaccharide formation, affects pellicle formation
Safe dose, potentially lethal and certainly lethal dose of fluoride
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
When should you provide fissure sealants for children?
All 6s if child has impairments, extensive caries (dmfs 2+)
all susceptible permanent teeth
What are the types of fissure sealant?
resin based, light cure (Bis GMA) or GI
How do you provide a fissure sealant?
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
What can you say to patients for diet advice?
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
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?
- 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
What is the clinical and radiographic presentation of AI?
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
What are the restorative options for AI
prevention, comp veneers, FS, metal onlays, SSC, ortho, implants
What are the restorative options for DI
prevention, comp veneers, overdentures, removable pros, SSC
What are reasons for tooth fracture during removal and turn into a surgical XLA?
inappropriate force/action/instruments
curved roots, heavily restored/carious crown, large roots, close to nerve, ankylosed, alignment of tooth, thick cortical bone, hypercementosis
When would you leave a retained root?
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
what are the options for retained root?
leave, monitor
endo?
remove
refer to MOS-T/specialist/maxfacs
What patient warnings do you give for surgical extraction?
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
?What are general surgical principles?
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
What can be used to retract soft tissues?
Howarths periosteal elevator or bowdler-henry rake retractor
Ash
minnesota
What can you look for which would suggest an OAC?
infection in the 6s etc close lying roots to sinus if last standing molar in quadrant older pt previously had OAC
