restorative scenarios Flashcards
You are a dentist in general practice seeing a patient who wears an upper partial chrome denture. The patient has denture stomatitis on the palate.
Explain what the problem is and how you would treat the condition.
- Candida Albicans is a common fungus causing infections in the mouth.
- The fungus can colonise on the surface of dentures, especially when left in overnight.
- Reassure that it is not transmissible and is a very common condition.
- Explain that their mucosa needs time to recover overnight and so the dentures should be left out (like sleeping in shoes).
- Antifungal cream can be applied to the fitting surface 4x a day.
- systemic antifungals should only be used if this doesn’t work. - Arrange a review to check this is working.
Explain the advantages and disadvantages of composite restorations.
adv:
- conservative removal of tooth structure.
- less complex cavity prep as undercuts not needed.
- bonds to the tooth structure for good retention.
- low microleakage, increased strength of remaining tooth, repairable.
disadv:
- polymerisation shrinkage causing gap formation.
- more difficult, time consuming and costly.
- technique sensitive.
Explain the advantages and disadvantages of amalgam.
adv:
- easy to use
- high compressive strength and good wear resistance
- lower cost
disadv:
- not aesthetic
- no insulation
- less conservative as retention is needed in the form of undercuts.
- weakens the tooth structure
- initial microleakage
A 24 year old woman presents with discoloured teeth.
List 4 causes of discolouration.
Any of the following:
- Amelogenesis Imperfecta
- Dentinogenesis Imperfecta
- Fluorosis
- Tetracycline Staining
- Trauma
- Chronological Hypoplasia
- Age
- Caries
How would you conduct vitality testing?
- Explain to the pt that you are going to test whether the nerve in the tooth is still alive or not.
- Ethyl Chloride - spray onto a pledger and hold against the tooth in question and adjacent.
- Gutta Percha - dry the tooth and apply vaseline (stops it sticking) and apply to the tooth for a few seconds.
- EPT - dry the tooth and apply vaseline, make the circuit, apply tip to tooth on lowest setting and slowly increase. - Test adjacent teeth.
Name 3 causes of a false positive in pulp vitality testing.
- Multiple root canals containing vital and non-vital pulp at the same time.
- Nervous Patient.
- Pus in the canals.
Name 3 possible causes of false negatives.
- Presence of a large restoration insulating the pulp.
- Vital pulp with a good blood supply but a damaged nerve supply.
- Secondary dentine insulating the stimulus reaching the pulp.
A 35 year old man presents to your surgery with horizontal yellow banding across his teeth.
What is the most likely cause for this appearance?
Most likely cause is enamel hypoplasia, possibly as a result of disturbance during the period of tooth development.
- enamel is reduced in thickness or deficient in structure, presenting as a linear groove defect along the enamel *
What would the potential treatment options for enamel hypoplasia be?
(ref. horizontal banding case)
- Micro-Abrasion - small amount of stained tooth is removed using an abrasive wheel and dilute acid.
- only useful if the problem is superficial. - Bleaching - use of chemicals to lighten darkened/discoloured teeth.
- can make teeth sensitive and isn’t a permanent effect. - Veneers - requires the enamel thickness to be reduced in order to place.
- Crowns - destructive option, need to be replaced every 10 years.
With regards to the 35 year old man c/o horizontal banding, what other aetiologies may be considered?
- think disturbance *
- Hereditary (amelogenesis or dentinogenesis imperfecta)
- Nutritional deficiencies.
- Infections.
- Trauma during development.
- Exposure to chemicals (mouthwashes, tea, coffee, red wine, smoking).
