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DS2102 Dentures > Week 6: Diagnoses and Treatment Planning- 1 > Flashcards

Week 6: Diagnoses and Treatment Planning- 1 Flashcards

1
Q

What does evidence based treatment planning require?

A
  • Evidence based treatment planning requires careful assesment of clinically relevant scientific evidence in light of:
  • patient’s oral health
  • dentist’s clinical expertise
  • patient’s treatment needs, preferences and expectations
  • holistic approach in preventions, treatment planning and execution
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2
Q

What consitutes as history in terms of diagnosis and treatment planning?

A
  • cheif complaint and its history
  • relevant dental history including previous treatment, parafunctional habits (e.g. bruxism and clenching)
  • family history of genetic disorders
  • history of periofontal disease
  • patient expectations, motivation, compliance
  • social history (including smoking and alcohol intake)
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3
Q

Which aspects of medical history pertain to dental diagnoses and treatment planning?

A
  • Bone disease, diabetes, bleeding disorders
  • Cardiovascular diseases
  • Mucosal disease, immune system disorders
  • History of cancer and any relvant treatments
  • Drug addiction and psychiatric conditions
  • History of chemotherapy, radio therapy
  • Bisphosphosphonates and antimetabolics medications
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4
Q

Why are bone disease relevant to dental diagnoses and treatment planning?

A

Bone disease lead to problems after extractions- bone resoprtion and deposition (?)

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5
Q

How is diabetes related to dental diagnoses and treatment planning?

A

Healing capacity is affected

??

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6
Q

Discuss Relevant Past Dental History and the relation to diagnoses and treatment planning

A
  • The reasons for missing teeth should be determined
  • Extractions due to caries and advanced periodontal disease
  • Some teeth may be lost due to trauma
  • Teeth can be either unerupted or impaced
  • Teeth may also be congenitally missing
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7
Q

True or False: A scale and clean does not need to be risk assesed in dental treatment planning?

A

FALSE
Everything needs to be risk assesed in dentistry

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8
Q

What are the two subdivisions of risk assesment and dental treatment planning? Discuss the DIFFERENCES of both and provide examples.

A
  • Risk indicators
  • risk indicators are known to be associated with a HIGHER PROBABILITY of the occurance of a particular disease

Example: Diabetes may cause periodontal disease

  • Risk factors
    -risk factors are conditions for which a demonstrable CAUSAL BIOLOGIC LINK between the factor and the disease has been shown to exist

Example: High sugar intake causes dental decay

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9
Q

Which risk categories may be encountered in dentistry?

A
  • Hertiable conditions
  • Systemic disease as a risk indicator for oral health problems
  • Dietary and other behavioural risk indicators
  • Risk indicators related to stress and anxiety
  • Functional or trauma-related conditions
  • Environmental risk indicators
  • Socioeconomic statys and previous disease experience
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10
Q

Describe the process of extraoral examinations

A

In extra-oral examinations (structures should be evaluated in a systemic fashion):
* patients are sitting upright, head unsupported to facilitate observation
* facial form and symmetry
* temporomandibular joint
* eyes, ears, nose
* major salivary glands
* regional lymph nodes and the thyroid gland
* the location and charactersitics of any lesions should be noted in patient records

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11
Q

Describe the process of intraoral examinations

A

In intra-oral examinations:
* soft tissue exam- lips, buccal mucosa and vestibule, tongue, floor of the mouth, salivary glands, hard and soft palate, saliva, and oropharynx
* periodontal examination- Basic Periodontal Examination (BPE), 6-point pocket chart, periodontal indicies, plaque presence, plaque retentive factors, mobility, function, gingival recession
* hard tissue exam- occlusal examination, caries assesment, tooth surface loss, non-carious lesions, examinations of old direct/indirect restorations, bone level assesment utilizing x-rays

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12
Q

What are the further investigations a part of diagnoses and treatment planning?

A
  • Vitality tests
  • Radiographic assesments
  • Study casts and diagnostic wax-up
  • Photographs
  • Occlusal splints
  • Biopsy, medical and microbiological laboratory tests
  • Consultations with General Practioners or Consultants
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13
Q

Describe patient positioning when taking extra-oral and intra oral images

A
  • Ideal position of the patient is seated upright
  • Patients head and the camera axis is perpendicular to midline and parallel to horizon
  • The lens axis is centered at the mesial contact point areas of the maxillary centrals
  • Using facial landmarks, such as the inter-pupillary/inter-commissure lines for orientation, prevents eschewed or incorrect alignment of the incisal plane and/or dental midlines
  • In saggital, the head should not be up, nor down, i.e. parallel to the ala-tragus
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14
Q

Which photos contribute to the essential dental portfolio?

A
  • Extra-oral, frontal habitual or ‘rest’ lip position
  • Extra-oral, frontal relaxed smile
  • Extra-oral, frontal laugher
  • Intra-oral, frontal view in maximum intercuspation
  • Intra-oral, frontal view with separated teeth
  • Intra-oral, righter lateral view in maximum intercuspation
  • Intra-oral, left lateral view in maximum intercuspation
  • Intra-oral, occlusal full-arch maxillary view
  • Intra-oral, occlusla full-arch mandibular view
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15
Q

What is the role of wax-up in treatment planning?

A
  • Patient communication tool
  • Visual aid for determination of final aesthetics
  • Template for minimal tooth preparation
  • Guide for occlusal analysis and mock up of projected restorations
  • Fabrication of well-fitting provisionals
  • The wax-up can show the teeth and soft tissue relationship
  • Aids dentist to create a systematic approach for case management
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16
Q

When developing a comprehensive treatment plan, what is required?

A

A comprehensive treatment plan requires:
* Collection/organization of all the relevant information from history and examination
* Establishing the diagnosis and need for any special tests and investigations
* Considering all the treatment options available to the patient
* Formulate the treatment plan in consultation with the patient
* Treatment plan should include an initial emergency/disease control phase prior to the final or definitive phase

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17
Q

What steps comprise the treatment strategy for restorative intervention?

A

STAGE I- Initial Assessment & Emergency Treatment:
* Mange/treat any emergency problems: pain, trauma, acute infection, aesthetic, functional problems

STAGE II- Control of disease and stabilization of structure
* Extractions of teeth with hopeless prognosis
* Periodontal, endodontic and conservative care of teeth to be retained and appropriate preventative care

STAGE III- Evaluation of outcomes- Review effectiveness of treatment & patient’s response to management of disease
* Further disease management and conservative treatment as required
* Consider best management for the replacement of missing teeth: nil, crowns/bridges, implants, removeable partial dentures (ideally chrome-cobalt to gain hard and soft tissue support)*

STAGE IV- Managing the clinical aspects of the work and execution of the treatment plan

STAGE V- Establishing a maintenance programme with a focus on the maintenance of oral health following the provision of complex restorative treatment
* It should be comprehensive and address all aspects of oral health with the prevention of new and recurrent disease

*After extractions, ideally WAIT 6 MONTHS prior to commencing removeable partial denture treatment, especially for chrome-cobalt.

18
Q

What factors influence treatment planning?

A
  • Patient preference, motivation
  • Systemic health and emotional status
  • Financial costs and time allocation
  • Operator’s knowledge, experience and training
  • Laboratory suppoort, dentist-patient rapport
  • Functional and aesthetics technical-demands
  • Patient commitment for long term maintenance
19
Q

What are COMMON dental diagnoses?

A
  • Caries
  • Hyposalivation
  • Periodontal diagnoses
  • Periodontal abscess
  • Periapical abscess
  • Reversible pulpitis
  • Irreversible pulpitis
  • Dentine hypersensitivity
  • Cracked tooth syndrome
  • Periapical/periradicular pain
  • Acute periapical abcess
20
Q

Discuss caries diagnoses (include how to detect and assess caries).

A
  • One of the most controversial diagnosis and decision to intervene in dentistry
  • Visual and tactile examinations (mechanical separators, transillumination)
  • Laser and blue light flurescence examination
  • Chemical examination
  • Radiographic examination
  • ASSESSMENT OF RISK TO DENTAL CARIES: past caries expereince, saliva, diet, oral hygeine
21
Q

Discuss hyposalivation and associated causes

A
  • Caries can be associated with hyposalivation
  • It is caused by many prescription/non-prescription drugs
  • Salivary gland damage/diseases
  • Severe hyposalivaton also may result in:
  • dry, reddened painful oral mucosa, cracked lips, angular cheilitis, atrophy of the tongue’s filiform papillae, gingivitis
  • Candidosis, oesophagitis, heartburn, halitosis (oral malodour)
  • Impaired speech, chewing, swallowing, taste, smell
  • Impaired denture wearing and denture induced stomatitis
22
Q

What are the different periodontal diagnoses?

A

Plaque-induced inflammatory periodontal diseases:
* Gingivitis
* Periodontitis
* Chronic periodontitis
* Agressive periodontitis

23
Q

Describe Gingivitis

A

Gingivitis
* inflammatory reactions confined to marginal gingival tissues
* Gingivitis on teeth with reduced periodontal support
* As recession resulting from overvigorous oral hygiene practices
* Previously treated periodontitis

24
Q

Describe Periodontitis

A

Periodontitis: inflammatory conditions that result in loss of attachment and resorption of crestal alveolar bone

25
Q

Describe Chronic Periodontitis

A

Chronic Periodontitis:
* Most prevalent periodontal disease in adults, but may commence in younger patients
* Local factors- plaque, calculus, overhangs
* Subgingival calculus is usually detected at sites of periodontal pockets
* Slow to moderate progression, may have rapid progression, in relation to increased risk
* Modified by risk exposures such as tobaccao smoking, diabetes mellitus

26
Q

What are the manifestations of Chronic Periodontitis?

A

Periodontal attachment loss:
* Periodontal pockets
* Gingival recession
* Furcation invovlements (Classes 1-4, or partial/complete)
* Tooth loss
* Tooth drifting/pathological migration
* Tooth hypermobility (Grade I-III)

27
Q

Describe Aggressive Periodontitis

A

Agressive Periodontitis:
* Rapid periodnotal attachement loss and alveolar bone destruction
* Familal aggregation often discovered
* Periodontal destruction may ot be commensurate with local factors
* May have a specific microbial association and undergo spontaneous remission
* Localized: circumpubertal onset, first molar/incisor attachment loss on at least two teeth, and not more than two teeth other than first molars and incisors
* Generalized: usually patients under 30, but may be older, attachment loss on three or more teeth other than incisors and first molars

28
Q

How is Periodontitis a manifestation of systemic disease?

A

Periodontitis as a manifestation of systemic disease:
* associated with haematological disorders, such as leukemias, acuqired neutropenia (drug induced)
* associated with genetic disorders such as Down Syndrome, familial and cyclic neutropenia, Papillon-Lefèvre syndrome

29
Q

What is the main difference between the new periodontal classification and previous periodontal classification?

A

The new periodontal classification also classifies peri-implant diseases and conditions unlike the previous.

30
Q

What is a periodontal abscess, how can it occur, where is t most commonly seen, what are the potential signs, what may reccurent abscesses indicate, and where are there higher incidences?

A

Periodontal abcess:
* localized collection of pus adjacent to a periodontal pocket
* occurs due to virulent microorganisms, reduced drainage potential, impaction of a forgein body like calculus, tooth pick etc.
* Mostly seen in furcations
* Recurrent abcesses may indicate immunocompromise e.g. poorly controlled diabetes
* There may be swelling, pust, sinus, tender to percussion (ttp), signs of periodontitis and systemic involvement
* periodontal abscesses have a higher incidence amngst patients with pre-existing periodontal pockets

31
Q

Are periodontal abscess a common dental emergency?

A

Yes

32
Q

How can a periodontal abscess be evaluted and what can often be expeceted

A
  • Intra-oral Periapical radiographs (IOPAs or PAs) are critical in evaluating the periodntal hard tissues
  • Widening of the periodontal ligaments and horizontal or vertical bone loss is often expected
  • Insertion of gutta-percha points along a sinus tract or into the periodontal poceket can identify the source of infection
33
Q

Compare and contrast periodontal and periapical abscesses

A

Periapical abscess (usually) has:
* Non-vital (tooth)
* TTP vertically
* May be mbile
* Loss of lamina dura on the x-ray

Peridontal abscess (usually) has:
* Vital (usually the tooth is vital)
* Paini on lateral movements
* Mobile (usually)
* Loss of alveolar crest on the x-ray

34
Q

What are the signs of Reversible Pulpitis and what is the treatment?

A
  • Fleeting sensitivity/pain to hot, cold or sweet with immediate onset
  • Pain is usually sharp and may be difficult to locate
  • Quickly subsides after removal of the stimulus
  • Exaggerated response to pulp testing
  • Carious cavity/leaking restoration is present
  • Tooth not TTP
  • Remove caries, place a sedative dressing/permanent restoration with pulp proctection
35
Q

What are the signs of Irreversible Pulpitis?

A
  • Spontaneous dull, throbbing pain lasts several minutes or hours
  • Usually worse at night
  • Pulsiate in nature
  • Exacerbated by hot and cold
  • A characteristic feature is that the pain remains after the removal of stimulus
  • Periapical tissues become more sensitive to pressure
  • Applicated of heat (e.g. warm gutta-percha) elicits pain
  • Exaggerated/reduced/no respnse to Eletrical Pulp Testing (EPT)
  • May become TTP
36
Q

What is Dentine Hypersensitivity, what are the signs, the prevalane, as well as the involved treatment?

A

Dentine hypersensitivity
* Pain arising from exposed dentine in repsonse to thermal, tactile, or osmotic stimulus
* Dentinal fluid movement stimulate pulpal pani receptors
* Prevalence is ~1:7 adults with a peak in young adults
* Treatment invovles controlling aetiological factors (oral hygeine instructions, possibly including tooth-brushing technqiue, and intrinsic and extrinsic dental erosion)
* Reducing permeablity of dentinal tubules by toothpaste containing strontium/fluoride; placement of varnishes, dentine desensitizers, dentine adhesive systems, resotraiton

37
Q

What is Cracked Tooth Syndrome and how may it be diagnosed?

A

Cracked Tooth Syndrome
* Sharp pain on biting- short duration, few clinical signs and tricky to diagnose
* Tooth often has a large restoratino and crack MAY NOT be apparent
* Transillumination/removal of the restoration may aid visualization
* There is a positive response to vitality (sensibility) testing
* Pain elicitis by biting then releasing on a cotton-wool roll or a ‘Tooth Slooth
* May be assocaited with a bruxing habit
* Direct/indirectio restoration with full occlusal coverage will be needed
* Occasionally Root Canal Treatment (RCT) may be required

38
Q

What is Periapical/Periradicular pain and what are the associated signs for diagnosis?

A

Periapical/Periradicular Pain
* Progression of IRREVERSIBLE PULPITIS leads to PULPAL NECROSIS
* Bacteria by-products lead to inflammatory changes and possibly pain in periapical tissue
* Patient can identify the affected tooth, as the periodontal ligament is inflammed
* Dull ache exacerbated by biting on the tooth, usully no response to sensibility (vitality) testing unless one canal of a multi-rooted tooth is still vital
* The tooth will be TTP
* Radiographically there is loss of lamina dura in the periapical region
* The apical Perioodontal Ligamen (PDL) may be widened or there may be a periapical radiolucency

39
Q

What is an Acute Periapical Abscess, what are the associated signs, and what is the treatment?

A

Acute Periapical Abscess
* Severe pain which will disturb sleep
* Tooth is tender to touch
* Affected tooth is usually extruded, mobile, and TTP
* May be associated with intra-oral/facial swelling/localized intra-oral swelling
* Sensibility testing may be misleading as pus may conduct stimulus to apical tissues
* Radiographic changes can range from a widended PDL to an obvious radiolucency
* It is important to difference this condition from a periodontal abscess
* Drain pus and, if indicated, prepare the canal and place a temporary dressing

40
Q

What is a concern with acute periapical abscesses?

A

LIFE THREATENING (airways can be threatened)- RISKS LUDWIG’S ANGINA

41
Q

What is a prognosis and how are prognoses made? Provide examples

A

Prognosis
* It is a prediction of the patient’s future conditions based on present circumstances
* Generally expressed as “excellent”, “good”, “fair”, “poor”, or “hopeless”
* A prognosis can be made for a tooth, for various treatments or for the patients overall prognosis
* Prognosis is aimed to predict the future course of the disease (progression or regression), both with and wihtout treatment
* For a specific patient, varying pronoses can be determined for multiple disease processes, as well as for recommended treatments
* Although the prognosis for the disease and the treatment may be related, they are not necessairly the same

Examples:

  • A patient with moderate periodontitis may have a “good” prognosis for the control of the disease, but a “poor” prognosis for a long span bridge that is anchored on the invovled teeth
  • A patient with severe periodontits may be described as having a “poor” prognosis for the control of the disease, but a “good” prognosis for a related treatment such as implant-retained removeable partial denture
42
Q

What is flabby ridge, why do patients get flabby ridge?

A

Combination Syndrome (CS) is a condition caused by the presence of mandibular anterior teeth no posterior teeth. This results in significant maxillary anterior alveolar resorption.

Why is this important?

This is important to identify in the first visit because:
- Special tray needs to be designed differently. Extra spacing and pressure relief holes are required in this area
- Use lower viscosity impression material for the impression
- Avoid compressing mucosa in the flabby ridge area when taking impression
- Apply seating pressure in the palatal area only to avoid compressing the flabby ridge area (usually in the anterior section).

*flabby ridge is combination syndrome and combination syndrome is flabby ridge

DS2102 Dentures (11 decks)

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