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SCR Flashcards

1
Q

Identify caries classification

A

Decalcification - white/brown spot lesions

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2
Q

Give 5 signs and symptoms of TMD

A

* Headache. * Ear pain. * Muscle pain. * Joint pain. * Trismus. * Clicking or popping noises. * Crepitus.

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3
Q

Give 5 aspects of causative advice for TMD

A

* Soft diet. * Stop parafunctional habits ie nail biting. * Support mouth upon opening (yawning). * Relaxation. * Chew on both sides. * Cut food into smaller pieces. * Don’t incise food. * Avoid chewing gum. * Avoid over opening.

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4
Q

What information could be elicited from an examination in cases of suspected TMD?

A

* Range of movement. * Clicking/crepitus. * MoM hypertrophy. * Tenderness on palpation. * Reduced intercisal opening distance. * Signs of bruxism. * Scalloped tongue. * Linea alba

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5
Q

What factors could predispose someone to having TMD?

A

* Females more than males. * Age 18-30 years. * Stress. * Habits such as nail biting, chewing gum.

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6
Q

What would first line management of TMD be?

A

* Counselling, reassurance, soft diet, advice on chewing both sides, cut food, stop chewing gum.
* Splint therapy; soft splint, hot water bottle, hard splint, bite raising appliance
* Joint therapy; accupuncture, physio, relaxation.
* Drugs; Ibuprofen, paracetamol, muscle relaxants - tricyclic antidepressants.

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7
Q

What other conditions may present similarly to TMD and how would you exclude them?

A

* Pericoronitis (no clicking)
* Myofascial pain syndrome (no clicking)

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8
Q

You decide to construct a stabilisation splint. Your technician doesn’t know what this is. How would you write your lab sheet?

A

Please pour upper and lower alginates in 50/50 dental stone/plaster. Please provide contrast vacuum form splint in soft acrylic for lower arch, covering all occlusal surfaces while avoiding gingival margin.

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9
Q

What are exostoses/tori?

A

Excessive cortical bone growth

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10
Q

What is Stafne Bone defect?

A

* A radiolucency in posterior mandible below IAC

* Due to lingual concavity

* May appear as cyst but is not a pathology

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12
Q

What are the two broad types of odontogenic cysts?

A

Inflammatory and Developmental

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13
Q

What are the two types of inflammatory odontogenic cysts?

A

Radicular and residual

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14
Q

What are the four types of developmental odontogenic cysts?

A

Keratocyst, eruption cyst, dentigerous cyst, lateral periodontal cyst

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15
Q

What is the aetiology of radicular cysts?

A

* Accounts for 60% of odontogenic cysts

* Associated with a non vital tooth

* Epithelial source; epithelial cell rests of malassez

* Sequential to pulp necrosis in areas of chronic inflammation

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16
Q

What is the radiographic appearance of a radicular cyst?

A

* Well demarcated

* Associated with the apex of a tooth

* Can be apical lateral or residule

* Residule cysts occur when there has been a cyst associated with a tooth which has been extracted, but the cyst remains

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17
Q

List four diagnostic tools in cyst identification?

A

Any four of;

* Sensibility tests

* Radiographic features

* Aspiration

* Protein content

* Biopsy of the cyst lining

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20
Q

What are the radiographic features of a dentigerous cyst?

A

* Central, lateral and circumferential radiolucencys

*Unilocular radiolucent area associated with crown of an unerupted tooth.

* Large cyst - pseudo impression of multilocular bhowever this is because trabecular bone persistently tries to grow through.

* Well defined and often sclerotic border, but an infected cyst may show less defined borders.

* Usually 3-4mm in diameter, if below this diameter likely to be an enlarged dental follicle

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21
Q

What is the relavant histology for radicular cysts?

A

* Uniform layer of squamous cell epithelium

* Epithelium desquamates into the lumen which contains necrotic debris and protein rich fluid

* Epithelium may have Rushton bodies

* Lumen or wall may contain cholesterol cleft, dystrophic calcifications, RBCs and haemosiderin pigmentation

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22
Q

What diagnostic notes are associated with a radicular cyst?

A

* Straw coloured aspirate

* Sensibility tests will show an unresponsive tooth.

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23
Q

What is the aetiology of a dentigerous cyst?

A

* Commonist type of developmental cyst

* Associated with an unerupted tooth

* Epithelial source; reduced enamel epithelium

* Accounts for 18-24% of jaw cysts

* Can lead to displacement and root resorption of other teeth

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25
Q

What are the histological features of a dentigerous cyst?

A

* Connective tissue layer; loosly arranged fibrous wall. Island of inactive epithelial cell rests.

* Epithelial lining; 2-4 layers of cuboidal epithelium. Flat interface connecting the epithelium and connective tissue.

* Inlammation; collagen increase in connective tissue layers. Infiltrate of inflammatory cells. Epithelial hyperplasia. Development of retentions ridges. Squamous features

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26
Q

What is the aetiology of an eruption cyst?

A

* Epithelial source; reduced enamel epithelium. Soft tissue equivalent of a dentigerous cyst

* Produce a round, soft, blue cyst over the gingivae

* They occur when the dental follicle separates from the erupting tooths crown in the soft tissue

* Can relf resolve or require a small excision to drain the fluid and allow the tooth to erupt

* No radiograph is required

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27
Q

What are the histological features of an eruption cyst?

A

The same epithelial lining found in a dentigerous cyst

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28
Q

What is the aetiology of a keratocyst?

A

* Associated with a missing tooth

* Can be linked with inferior alveolar nerve paraesthesia.

* Linked with Gorlin-Goltz syndrome.

* Difficult to enucleate and high recurrence rate due to its thin friable lining

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29
Q

What are the radiological features of a keratocyst?

A

* Well defined radiolucency

* Can be unilocular or multilocular

* Typically found in the posterior of the mandible (thinking logically, the 3rd molars are commonly abscent, hence this is why keratocysts could be most commonly found here)

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30
Q

What are the histological features of a keratocyst?

A

* Thin friable wall meaning they are difficult to enucleate.

* 6-8 uniform layers of stratified squamous epithelium.

* Flat epithelial-connective tissue interface.

* Inconspicuous rete ridges

* Basal palisading evident in the basal layer

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31
Q

Describe the management of cysts

A

* Enulcleatuion involves the complete removal of the cyst.

* Incomplete removal can lead to recurrence.

* Marsupulization can be used if there is a high risk of IAN damage or mandibular fracture. This is where a surgical window is created allowing the contents to drain. This is sutured open and can be maintained with a packing material.

* The enucleation can then take place once the cyst has decreased in size

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32
Q

what is the ideal crown to root ratio when considering fixed prosthodontics?

A

Ideal 1:2

Realistic 2:3

Minimum 1:1

Poor 2:1

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33
Q

When providing a bridge, describe Ante’s law

A

The PDL surface area of the abutment teeth should be equal to or greater than the imaginary PDL surface area of the missing teeth.

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34
Q

What is RCP?

A

The position in which condyles articulate with the thinnest avascular portion of their respective discs in the most anterior-superior position against the articular emineses. Independent of teeth

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35
Q

What is ICP?

A

Complete interdigitation of the teeth.

Independent of condylar position.

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36
Q

Describe RCP vs ICP

A

RCP and ICP coincide in only 10% of the population.

Casts are mounted in ICP when ICP can be maintained (single fixed procedure).

Casts are mounted in RCP when ICP is impossible to maintain (complete dentures, multiple teeth being restored).

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37
Q

Descripe how to use bimanual manipulation to acheive RCP

A

One of the most accurate methods to obtain accurate RCP interocclusal records.

With the patient lying back, support the posterior mandible with fingers and the chin with thumbs.

Deprogram the jaw.

Identify first CCP tooth contact and repeat until you identify a consistent first tooth contact.

Keep anterior teeth slightly apart in RCP with acrylic resin jig.

Take interocclusal record of posterior teeth with PVS.

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38
Q

What is a facebow record?

A

The objective is to duplicate on the articulator the relationship of the maxillary arch to the skull and the mandible to the rotational centre of the TMJs that exists for that particular patient.

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39
Q

What are the bite materials of choice when mounting casts?

A

Casts poured from alginate are more accurately mounted with a wax bite.

Casts poured from elastomeric materials are more accurately mounted with elastomeric materials (PVS)

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40
Q

Describe condylar guidance

A

*Slope of articular eminence

*Represented by horizonal condylar inclination on articulator

*Posterior determinant of occlusion

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41
Q

Describe incisal guidance

A

*Incisal edges of lower incisors against lingual slopes of upper incisors.

*Represented by pin and guide table on articulator.

*Anterior determinant of occlusion.

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42
Q

Describe canine guidance

A

When in lateral movements all posterior teeth are immediately discluded as contact occurs soley between upper and lower canine on the working side.

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43
Q

Describe anterior guidance

A

Refers to both incisal and canine guidance.

During protrusive, incisal and condylar guidance provide clearance for all posterio teeth.

During lateral, canines on working side and condyle on balancing side provide clearance for posterior teeth on balancing side.

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44
Q

In prosthodontics, describe mutual protection

A

Front teeth protect back teeth - front teeth disclude posterio teeth during protrusive and lateral movements.

Back teeth protect front teeth. Back teeth have flat occlusal surfaces and strong roots to help protect anterior teeth from bite forces/

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45
Q

From the photograph, what difficulty may arise with regard to the aesthetics of a prosthesis to replace 22 and 23?

A

* Space is too narrow mesial-distally for two full units but is wider than one single unit

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46
Q

What difficulty may arise with regard to the function of a prosthesis to replace 22 and 23?

A

The canine is likely to be involved in guidance.

The lower canine appears to be over erupted.

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49
Q

Assuming there is no relevant medical history; suggest three general factors which need to be considered before referring a patient for consideration for implants?

A

* Oral health and hygiene.

* Patient understands what is involved and willing to comply

* Smoking satus

* Cost

* Perio history

* Does the patient play contact sports

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50
Q

List 3 factors local to site 22, 23 of the proposed implants, which will be assessed for the implant treatment planning

A

* Bone height

* Bone width

* Root position of 21 and 24

* Soft tissue adequacy

* Smile line

* Local perio health/plaque control

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51
Q

List four factors that could cause a bridge to debond

A

Poor OH

Poor moisture control during cementation

Unfavourable occlusion

Parafunction

Trauma to face

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52
Q

Give two criteria to obtain valid consent

A

Informed

Voluntary

Not manipulated

Not coerced

With capacity

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53
Q

What 6 things should be explained to the patient to obtain consent?

A

The treatment and what it involves

The risk of treatment

The benefits of treatment

The likely outcome of treatment

The risk of no treatment

Alternative treatments

Cost

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54
Q

What are the features of Nayyer core?

A

An amalgam core.

Retention obtained from undercuts in divergent canals and pulp chamber.

2-4mm of GP removed from the canal and replaced with amalgam.

Immediate placement and coronal preparation can be done at same appointment

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55
Q

What is the DAHL technique?

A

Localised appliance or restorations to increase the interocclusal space available for restorations

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56
Q

Describe how the DAHL technique works

A

Composite platforms are added to palatal aspect of upper incisors, left for 3-6 months to allow dentoalveolar compensation, then provide definitive restorations

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57
Q

List four contraindications for use of the DAHL appliance

A

MRONJ

Active periodontal disease

Ankylosis

Implant

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58
Q

You are carrying out root canal preparation of an upper right canine under local anaesthetic. You are irrigating the canal with a dilute solution of sodium hypochlorite when the patient suddenly feels intense pain. Within minutes you notice a marked facial swelling in the area and profuse bleeding into the root canal from the periradicular tissues.
What is the most likely cause for these signs and symptoms and why?

A

Extrusion of sodium hypochlorite through root apex.

Due to high pressure injection, injecting too deep, locking syringe in canal.

Accute inflammatory reaction which can be oedematous and/or haemorrhagic.

Can lead to significant tissue necrosis

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59
Q

What would be your immediate action following a hypochlorite accident?

A

Local anaesthetic for pain relief.

Copious irrigation with physiologic saline

Reassure patient that this is a complication that can be controlled

Dress tooth with non setting calcium hydroxide

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60
Q

After immediate steps taken following a hypochlorite accident, what action should be taken?

A

Priority must be given to pain relief, reduction of swelling, and prevention of secondary infection.

Cold compress during the first few days, warm compresses for resolution of soft tissue swelling and elimination of the haematoma

Analgesics; ibuprofen 400-600mg 4 x daily, paracetamol 1g 4 x daily

Review after 24 hours

Script for ABs case specific

Refer if severe

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61
Q

What is the likely cause of the gingival recession seen in the lower anterior sextant?

A

Traumatic overbite

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63
Q

When would mechanical root surface debridement not be successful in eliminated pocket bacteria?

A

* Difficulty with access (especially in furcation). * Non compliant patient. * Inadequate RSD/inexperience of clinician. * Patient is immunocompromised. * Sites inaccessible to instruments. * Failure to disrupt biofilm

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64
Q

When would antibiotics not be effective in periodontal disease?

A

* Antibiotics resisted by biofilms. * Concentration inadequate and not within the therapeutic range. * May not reach site of disease activity

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65
Q

How would you manage a periodontal abscess with systemic involvement?

A

* Incision and drainage. * Gentle sub-gingival debridement. * HSMW * Extraction of tooth if poor prognosis. * Antibiotics * Follow up HPT

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66
Q

What would be clinical signs of improved periodontal health?

A

* Reduced probing depth (<4mm). * BoP <10%. *Plaque scores <15%

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67
Q

*A photo showing a space between 13 and 14*
What investigations should be carried out and why?

A

* BPE; a screening tool for periodontal health. *PGI to assess plaque and bleeding levels. *6PPC to assess periodontal disease. * Periapicals to assess prognosis of teeth, drifting by periodontal disease. * Study models (offers a point of reference)

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68
Q

What bacteria are involved in ANUG?

A

P. Intermedia and fusobacterium as well as spirochetes such as treponema

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69
Q

What are the clinical signs and symptoms of ANUG?

A

* Blunting of interdental papilla. * Halitosis. * Grey slough that wipes off to reveal ulcerative tissue. * crater like ulcers. * Reverse gingival architecture

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70
Q

List 5 risk factors for ANUG

A

* Age (young) *Stress *Poor OH *Immunocompromised (HIV) *Smoking

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71
Q

Briefly outline management of ANUG

A

* Ultrasonic debridement *Oxygenating MW (hydrogen peroxide 3%) *OHI modified for patient *Consider Chlorhexidine *Smoking cessation if needed * ABs if systemic or immunocompromised (Metronidozole 200mg 3 x daily for 3 days)

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72
Q

Patient is obese and a reformed smoker, history of ischemic heart disease. Despite excellent OH he still has pockets of 6/7mm that BoP. You elect to undertake open flap curretage. What do you discuss with the patient to get informed consent?

A

* Risks; gingival recession, infection, pain, bleeding, swelling, bruising. *Benefits; effectively debride area with direct vision *Outcomes; possible reduction of pocket depths *Other treatment options; Repeat NSPT *Risks of no treatment; increase in pocket depth, increase in mobility, increased risk of tooth loss

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73
Q

A patient has just completed surgical periodontal therapy, when should the patient be reviewed and what is the rationale?

A

8 weeks to allow sufficient time for healing.

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74
Q

What are the clinical signs of improved health following HPT?

A

* Pocket depths <4mm *BoP <10% * Plaque score <15%

75
Q

Why might antibiotics not work for chronic periodontal disease?

A

* Biofilms resistant to antibiotics. * Antibiotic resistance. * Antibiotics inactivated by first pass metabolism. * Poor patient adherence to regime

76
Q

Describe how a modified plaque score is recorded

A

* Recorded for every patient

* 16, 21, 24, 36, 41, 44 (Ramfjords teeth)

* Each tooth is split into buccal/lingual.interproximal surfaces

* 2 = visible plaque

1 = Plaque revealed with probe

0 = no plaque

77
Q

Describe how a modified bleeding score is recorded

A

* Recorded for every patient

* Measures marginal bleeding rather than BoP

* Each Ramfjords tooth has a perio probe run gently at 45 degrees around the gingival sulcus in a continuous sweepl For up to 30 seconds after probing, check for the presence or absence of bleeding.

* mesial, distal, buccal, lingual

* Score of 1 or 0

78
Q

What are the four stages of periodontal disease?

A

Worst site of bone loss is used

Stage 1; (early/mild) <15% or <2mm from CEJ

Stage 2; (moderate) Coronal third of root

Stage 3; (severe) Mid third of root

Stage 4; (very severe) Apical third of root

79
Q

How is periodontal disease graded?

A

% of bone loss divided by patients age

Grade A slow rate of progression, <0.5

Grade B Moderate rate of progression, 0.5-1

Grade C Rapid rate of progression >1

80
Q

How do you rate the assessment of current periodontal status?

A

Currently stable; BoP <10%, PPD = 4mm, No BoP at 4mm sites

Currently in remission; BOP >/= 10%, PPD = 4mm, no BoP at 4mm sites

Currently unstable; PPD >/= 5mm

PPD >/= 4mm and BoP

81
Q

What clinical and lab investigations can be carried out to help aid a periodontal diagnosis? (3marks)

A

* Thorough history including family history.

* Periodontal pocket chart

* Microbiological analysis of swab of crevicular fluid

82
Q

In a patient with periodontal disease, how would you decide the prognosis for individual teeth? (3)

A

* Loss of attachment

* Mobility

* Furcation involvement

83
Q

What are some proposed biofilm resistance mechanisms?

A

*Antimicrobials may fail to penetrate beyond the surface layers of the biofilm

*Antimicrobials may be trapped and destroyed by enzymes.

*Antimicrobials may not be active against non-growing microorganisms

*Expression of biofilm specific resistance genes (eg efflux pumps)

*Stress response to hostile environment conditions

84
Q

Besides the lower anterior sextant, where else might you expect to see signs of a traumatic overbite?

A

Palatal gingivae of upper anteriors

85
Q

Having completed a history, examined the soft tissues, charted the teeth and restorations present and examined the occlusion, list 5 other investigations you would perform.

A

* BPE

* Full periodontal chart as indicated

* Clinical photographs

* Plaque and bleeding indices

* Radiographs

* Study models

* Mobility scores

* Sensibility testing

86
Q

List two generatl approaches to this patients initial treatment

A

* Hygiene phase therapy

* A bite raising appliance

87
Q

Give 3 features of apical periodontitis

A

*Chronic poly-microbial infection

*Stimulation of host response

*Connective tissue destruction

91
Q

At a re-evaluation appointment there are no deep pockets and the patients oral hygiene is excellent. But the lower incisors are still mobile and causing the patient concern, what further treatment would you offer to manage the mobility?

A

A lingual bonded splint. This would only be indicated if the patients oral hygiene is very good as in this case

92
Q

Give four indications for the use of chlorhexidine mouthwash?

A

Pre surgery

Post surgery

Denture induced stomatitis

Medically impared (case selective)

Acute necrotising ulcerative gingivitis

Treatment in dry socket

Endo irrigant

High caries risk (individual dependent)

93
Q

What 3 features on a PA would lead you to a diagnosis of Generalised Aggressive Periodontitis?

A

* Bone loss affecting at least 3 teeth

* Age of the patient

* Patient otherwise fit and well

* Vertical bony defects

* Rapid progression of bone loss

94
Q

What clinical and lab investigations could you carry out for a pt with periodontitis?

A

Thorough history inc family history

Periodontal pocket chart

Microbiological analysis of sample (swab of crevicular fluid)

95
Q

In a patient with periodontal disease, how would you decide the prognosis of each tooth?

A

Loss of attachment

Mobility

Furcation involvement

96
Q

In what ways would you provide post perio surgery advice for a patient, and what would you like them to know to avoid post op complications?

A

* Verbal and written

* Avoid smoking for one week if possible

* Avoid rinsing for that day, can rinse from the following day

* Avoid strenuous exercise

* Rinse with CHX mw 2 x daily 0.2% 10ml

97
Q

How do you manage a perio abscess with sytemic involvement?

A

* May require LA

* Achieve drainage via pocket or incision

* Gentle RSI short of the base of the pocket to avoid trauma

* Advise on analgesic use

* Give OHI including use of CHX mw until acute symptoms subside

* Provide antibiotics due to systemic involvement 500mg amoxicillin or 400mg metronidazole both 3 x daily for 5 days

* Review in ten days

98
Q

What is a periodontal abscess?

A

Acute exacerbation of an existing periodontal pocket eg trauma or obstruction. Caused by food packing or inadequate RSD

99
Q

What are some signs and symptoms of a periodontal abscess?

A

Pain on biting or spontaneously

TTP

Swelling

Pus

Pocketing at swelling

Mobility

100
Q

How is a periodontal abscess differentiated from a periapical abscess?

A

Sensibility testing vital vs non vital

Also consider perio status of the rest of the mouth

101
Q

How do you manage occlusal trauma in a patient with periodontal disease?

A

Address the cause; ease high restorations, address parafunction

Bit raising appliance for night time wear

HPT

102
Q

What factors can influence localised mobility?

A

* Existing periodontal disease

* Occlusal trauma causing widening of PDL

* Morphology and length of roots

* Alveolar bone loss

* Resorption/trauma

103
Q

When might splinting be advised in a periodontitis patient?

A

Mobility due to advanced loss of attachment

Mobility is causing discomfort or difficulty eating

To facilitate RSD

104
Q

Why is there a decease in mobility following perio treatment?

A

Increased tissue tone and long junctional epithelial attachment

105
Q

What can be done if the PDL is still widened after successful treatment?

A

Reduce occlusal contacts

106
Q

Diagnose

A

Angular bone loss

107
Q

How are localised and generalised aggressive periodontitis different?

A

Local - localised LOA, 6s, incisors, initially occurs around puberty, robust antibody response

General - Generalised LOA 6s, incisors and 3 + other teeth Onset usually under 30 years Poor serum antibody response

Episodic nature

108
Q

What bacteria is involved in aggressive periodontitis?

A

AA

Porphymonas gingivalis

109
Q

How is aggressive periodontitis initially managed?

A

Non surgical sub gingival PMPR.

2 weeks CHX mw and spray

ABs (amoxicillin or metronidazole)

Refer to specialise within 6-8 weeks

110
Q

In periodontitis, what features would indicate a tooth had poor prognosis and why?

A

Mobility - reduced bone support

Furcation involvement - more difficult to keep clean

LOA - less supporting structures for tooth

Loss of vitality

112
Q

Besides clinically and radiographic, what other two pieces of information are needed before determining prognosis of teeth?

A

Smoking history

Drug history

Systemic disease

113
Q

How is localised angular periodontitis caused?

A

When pathway of inflammation travels directly into PDL space, localised plaque retentive facors

114
Q

How does a healthy periodontium react to occlusal trauma?

A

PDL widening - mobility

No LOA or inflammation

Will resolve when occlusion addressed

115
Q

What category of drug is chlorhexidine?

A

Bisbiguanide antiseptic

116
Q

What is the substantivity of CHX

A

12 hours

117
Q

Give two commonly prescribed doses of chlorhexidine

A
  1. 2% 10ml/ 20mg 2 x daily
  2. 12% 15ml/18mg 2 x daily
118
Q

Name four side effects of CHX

A

Staining

Taste disturbance

Salivary gland enlargement

Anaphylaxis

Interacts with SLS

119
Q

List 8 uses for chlorhexidine

A

Surgical pre op rinse

120
Q

What is TIPPS?

A

Delivery method of OHI

Talk, instruct, practice, plan, support

121
Q

What 7 things are recorded on a periodontal pocket chart?

A

Missing teeth

Gingival margin

Pocket depth

LOA

Mobility

Furfaction

BOP

122
Q

Give two disadvantages of a pocket chart

A

Assumes all patients have same root length so may appear worse than it is

Pobing depths are subjective/variation between clinicians

123
Q

What are the local factors for gingival recession?

A

Periodontal disease

Habits

Traumatic tooth brushing

Abraisive toothpaste

High frenal attachment

Crowding

Traumatic overbite

Orthodontic treatment

Poor marginal fit restorations

124
Q

How can localised recession be managed?

A

Atraumatic toothbrushing technique

Minimise other risk factors

Monitor

Treat sensitivity

Free/pedicle soft tissue graft

Coronal advancement flap

125
Q

an 8yo child attends with an enamel dentine pulp fracture. You are happy the patient is medically fit with no other injuries.

What two things do you need to know about the injury before you decide whether or not a dirct pulp cap or pulpotomy is the most appropriate treatment?

A

When did the injury occur? Even if pinpoint exposure, if it had been 24hrs plus, high chance of bacterial ingress

Size of the exposure; more than 1mm pulpotomy is best choice

127
Q

Explain the stages of a pulpotomy for tooth 11

A

* Apply dental dam

* Remove pulp tissue at 2-3mm radius around the exposed area

* Assess bleeding - if no bleeding, remove more tissue

* Gain heamorrhage control using CWP and saline (NOT ferric sulphate in a permanent tooth as it stains!)

* If hyperaemic, remove more tissue

* Once normal bleeding has stopped, apply non setting calcium hydroxide

* Seal with GI

* Restore with composite restoration

128
Q

Following a pulpotomy, the patient remains asymptomatic and you are now about to take a 6 month post op radiograph. The pulp has remained vital, what favourable sighs would you expect to see on the radiograph?

A

* Continued root development

* Continued thickening of dentine in the root walls

* No signs of pathology

129
Q

Name 4 fluoride supplements and their doses you would give a patient to prevent decalcification

A

Toothpaste 1450ppmF 2 x daily

Fluoride varnish 22,600ppmF 4 x yearly

Mouthwash 450ppmF 1 x daily

Fluoride tablets, 1mg 1 x daily

130
Q

Name two methods of preventing decalcifications besides fluoride

A

OH and diet advice

Fissure sealants

131
Q

5yo Jodie has been brought in by her mothers boyfriend. She has not been sleeping due to pain. Has never been to dentist before. Facial swelling. Boyfriend vague about MH.

What should you establish prior to examination?

A

Severity of condition. Thorough MH. Consent - record everything that is said and carried out in notes

132
Q

5yo Jodie has been brought in by her mothers boyfriend. She has not been sleeping due to pain. Has never been to dentist before. Facial swelling. Boyfriend vague about MH.

Describe in detail one behavioural management technique to get cooperation

A

Tell. Show. Do

Explain to Jodie what she can expect. Show her the instruments, 3 in 1, medicaments you plan to use. Demonstrate carrying out exam/treatment, get Jodie to help hold mirror etc

133
Q

5yo Jodie has been brought in by her mothers boyfriend. She has not been sleeping due to pain. Has never been to dentist before. Facial swelling. Boyfriend vague about MH.

Jodie has been uncooperative, what would short term management be?

A

Drainage

Pain reliefe

ABs (amoxicillin 500mg 3 x daily 5 days)

Tell parent she must be brought back

134
Q

5 year old child brought to practice with pain and swelling by mums bf. Has never attended dentist before. How would you address previous non attendance?

A

Ensure up to date contact details

Take accurate and detailed notes

Contact mum by phone (or other guardians)

Discuss with mother the necessity of child attending appts

Inform mum of possibility of child protection involvement if non compliant

Set appt over the phone and arrange appropriate escort

135
Q

What evidence based brushing advice would you give for a 5yo to prevent caries?

A

Brush 2 x daily with fluoried TP 1450ppm

Modified bass technique

Brush 2-5 minutes

Use a pea sized amount of toothpaste

Spit dont rinse

136
Q

13yo patient presents with BPE scores of 3s from modified BPE score. What other investigations would you want?

A

PGI.

6PPC

Radiographs

Diet diary

137
Q

13 yo patient presents with BPE scores of 3s. What is your treatment plan?

A

Initial non surgical debridement and HPT. Refer to a specialist

138
Q

List four things that determine the prognosis of a traumatised tooth.

A

Type of fracture (complicated/not complicated)

Maturity of tooth

Open or closed apex

Tooth mobility

Vitality of the pulp

139
Q

Following a traumatic tooth injury in a child, what should be discussed with the parents?

A

Inform them of complications; change in colour, loss of vitality, pain, sinus, infection, damage to adjacent teeth. Inform them of prognosis and treatment options

140
Q

How would you treat and enamel dentine fracture?

A

Indirect pulp cap, GI or composite restoration

141
Q

10yo extrudes 11. What materials/splint would you use? How long would you splint for?

A

Flexible ss wire splint for 2 weeks

Flexible ss wire

Acid etch 37%

Composite resin

Water

142
Q

What 4 tests would you do at a check up following trauma besides a radidograph?

A

EPT

Ethyl chloride

TTP

Mobility

Check for displacement

Check for colour change

Check for sinus

143
Q

What advice should be given over the phone following avulsion of a permanent incisor?

A

Reassure the patient

Do not handle tooth by the root

Do not reimplant if it is a primary tooth

Gently rinse under slow running cold water for 10 seconds

Reimplant ASAP or store in saliva, milk, saline

Come to GDP ASAP

144
Q

Pt attends following trauma. What should you check upon arrival?

A

How and where did the incident occur?

Was consciousness lost? Was there any nausea/vomitting? If yes - A&E!

Account for all tooth fragments

Check tetanus status

145
Q

What type of splint is advised following avulsion?

A

EADT <60mins flexible splint for 2 weeks

EADT >60mins flexible splint for 4 weeks

146
Q

What are some common outcomes following avulsion of a permanent incisor?

A

Discolouration

Mobility

Necrosis of the pulp

Ankylosis

Root resorption

147
Q

What are the two modes of action of SDF?

A
  1. Promotes arrest and remineralisation of active carious lesions, dentinal caries and teeth with exposed root surfaces causing hypersensitivity.
  2. Promotes reduced sensitivity in permanent molar teeth with MIH via occlusion of dentinal tubules.
148
Q

What is the patient selection criteria for SDF?

A
  1. Pericooperative children whose behaviour/medical conditions limit invasive treatment.
  2. Need to delay treatment with sedation/GA
  3. High caries risk with compromised MH
  4. Part of biological caries management plan where carious lesions are also brushed twice daily and diet modifications have been made.
149
Q

What are the contraindications for SDF?

A
  1. Signs/symptoms of pulpal involvement.
  2. Radiographic peri-radicular radiolucency
  3. Infection/pain from pulpal origin
  4. Active ulceration
  5. Pregnant/breastfeeding
  6. Undergoing thyroid treatment.
  7. Non compliance with TB/diet
150
Q

What is SDF?

A

Silver diamine fluoride.
A colourless, odourless solution of silver, fluoride and ammonium ions.

151
Q

What is the concentration of SDF?

A

38%, 44,800 ppm fluoride ions

152
Q

Identify caries classification

A

Pit and fissure caries

153
Q

Identify caries classification

A

Decalcification - brown and white spot lesions

154
Q

Identify caries classificaiton

A

Smooth surface caries

155
Q

Identify caries classification

A

Interproximal caries

156
Q

Identify caries classification

A

Early childhood caries. Maxillary incisors, 1st molars, madibular canines. Lower anteriors protected by the tongue

157
Q

Identify caries classification

A

Rampant caries

equal or more than 10 new lesions per year

Lower anteriors affected

158
Q

What can early primary tooth extraction lead to

A

Increased crowding, increased tendancy for space loss.

The earlier primary teeth are removed, the greater the degree of space loss

159
Q

Describe balancing/compensating extractions in the deciduous dentition

A

Balance primary canines to prevent centre line shift

Consider balance of lower first primary molars if arch is crowded

160
Q

What is the result of early loss of the upper first permanent molars?

A

Loss before complete eruption of 7s leads to rotation and mesial movement of 7s and distal drift of 5s

161
Q

What is the result of early loss of lower first permanent molars?

A

Loss after optimum age leads to tilting of 7s

Loss before optimum age leads to mesial drifting and rotation of 5s

162
Q

What are some emergency treatment options for a child patient in pain?

A

Caries excavation and sedative dressing

Pulp therapy, pulpotomy/pulpectomy

Drainage of pus

Extraction with LA +/- IHS. GA?

IV sedation only considered for children over 12

163
Q

In a child patient, what is the sequence of restoration?

A

Fissure sealants

Preventive restorations

Simple fillings eg shallow cervical cavities

Fillings requiring LA but not into pulp (upper arch first)

Pulpotomies/pulpectomies

Extractions

164
Q

Who has parental responsibility for a child?

A

Mother

Adoptive parent

Father if named on the birth certificate

Step parent with parental responsibility agreement

Appointed legal guardian

165
Q

What is the definition of child abuse?

A

All three elements must be present;

Significant harm to child

Carer has some responsibility for that harm

Significant connection between carers responsibility for child and harm to child

166
Q

Name the Scottish protection agencies

A

National guidance for child protection in Scotland Act 2014 Scottish goverment

Childrens and young peoples Act 2014

Getting it right for every child

167
Q

Name some adult focused, child focused and community focused factors in child abuse

A

Adult; Drugs, alcohol, poverty, unemployment, marital stress, disability, domestic violence, step parents, isolation, abused as a child, unrealistic expectations

Child; Crying, soiling, disability, unwanted pregnancy, failed expectations, wrong gender, product of forced, coercive or commercial sex

Community/environment; Dwelling place and housing conditions, neighbourhood, family violence, dysfunctional family

168
Q

What are some categories of child abuse?

A

Physical

Emotional

Neglect

Sexual

Non organic failure to thrive

169
Q

What are some markers of general neglect?

A

Nutrition; failure to thrive, short stature

Warmth, clothing, shelter; inappropriate clothing, cold injury/sunburn

Hygiene and healthcare; ingrained dirt, head lice, caries

Stimulation and education; developmental delay

Affection; withdrawn

170
Q

What is the definition of dental neglect?

A

The persistent failure to meet a childs basic oral health needs, likely to result in the serious impariment of a childs oral and general health or development

171
Q

What are the three stages of managing dental neglect?

A

STAGE ONE

Preventive dental team management

Raise concerns with parents, offer support, set targets, keep records and monitor progress

STAGE TWO

Preventive multi agency management; liaise with other professionals to see if concerns are shared. A child may be the subject of a Common Assessment Framework at this level. Check if child is subject to a child protection plan. Agree joint plan of action, review at agreed intervals. Letter to health visitor for children under 4 who fail appts and fail to respond to letters

STAGE THREE

Child protection referral; in complex or deteriorating situations. Follow local guidelines. Referral is to social services (phone followed by letter)

172
Q

What factors may raise suspicion of child abuse/neglect? (index of suspicion?)

A

Delay in seeking help

Story vague, lacking in detail, changes person to person

Account not compatible with injury

Parent mood abnormal, pre occupied

Parents behaviour gives cause for concern

Child appearance and interaction with parents is abnormal

Child may say something contradictory

History of previous injury

History of violence within the family

173
Q

How is toothbrushing/plaque control assessed/scored?

A

10/10 Perfectly clean teeth

8/10 Plaque line around the cervical margin

6/10 Cervical third of crown covered

4/10 Middle third of crown covered

174
Q

What factors are included in a caries risk assessment?

A

Clinical evidence of previous disease

Dietry habits, especially frequency of sugary foods/drinks

Social history especially socio economic status

Use of fluoride

Plaque control

Saliva

Medical history

175
Q

Child patient attends with symptoms of pain on stimulus but diagnosis isn’t clear. How to approach?

A

For both primary and permanent teeth, where there are symptoms of pain that may be due to food packing or pulpitis with reversible symptoms but the diagnosis is uncertain, place temporary dressing and review in 3 to 7 days

Resolution of symptoms indicate pulpitis was reversible and a suitable restoration/crown can be placed.

If symptoms do not resolve/worsen or an abcess forms consider appropriate pulp therapy (rct for permanent) or extraction

176
Q

What is the appropriate action to take when a child patient presents with infection?

A

Do not leave untreated

Local measures to bring infection under control

Antibiotics are not recommended unless there are signs of spreading infection of systemic symptoms

If infection is asymptomatic and patient is likely to accept treatment with acclimatisation, then allow up to 3 months for acclimatisation visits. Not suitable for medically compromised patients

177
Q

Outline standard and ENHANCED prevention for children

A

Brush 2 x daily

Use smear of toothpaste under 3y and pea sized amount over 3y

1000-1500ppm F, 1350-1500ppm F ENHANCED. AGE 10+ 2800ppmF

Spit dont rinse

Supervise children until they can brush independently

Demonstrate TB for 3 minutes annually, 3 MINUTES AT EACH RECALL APPT

Use action planning to encourage toothbrushing

PROVIDE DIETARY ADVICE AT EACH RECALL APPT

CONSIDER USE OF FOOD DIARY

UTILISE COMMUNITY SUPPORT, HV, CHILD SMILE

Fissure seal perm molars asap after eruption

FISSURE SEAL PALATAL PITS OF 2S, DS AND ES

Fluoride varnish 2 x per year, 4X PER YEAR 0.25ML 2YO 0.4ML 5YO+

178
Q

What are the principle strategies for managing caries in primary dentition?

A

No caries removal, seal with crown using hall technique

No caries removal, fissure seal

Selective caries removal, and restoration

Pulpotomy

Other options;

Site specific prevention (no caries removal, active prevention)

Non-restorative cavity control (make caviry cleanable and apply fluoride)

Complete caries removal and restore

Extraction

Final Flashcards (13 decks)

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