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BDS3 Intro to Clinics > special investigations and presenting pts > Flashcards

special investigations and presenting pts Flashcards

1
Q

aim of special investigations

A
  • To analyse teeth and oral tissues to aid diagnosis and treatment planning
    • Reach definitive diagnosis from a differential/provisional diagnosis
      • Cost money to do
      • Fair for the pt? Money and time?
        • Yes, in balance to try to confirm as accurately as possible
          • Limited resources and time and decide what is most important
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2
Q

examples of special investigations

A
  • Radiographs
    • Bitewings
    • Periapicals
    • Occlusal
    • Panoramic DPT
    • CBCT
  • EPT electric pulp test
  • Thermal tests
    • Heat
    • Ethyl chloride (cold)
  • Mobility tests
  • Plaque and bleeding scores
  • Test drill
  • MRI – suspected salivary gland issue
  • Ultrasound – suspected salivary gland issue
  • Sialography – salivary glands (flow, pH)
  • Biopsy
  • Diet diary – more at risk for certain diseases
  • Microbiological tests
  • Oral rinse, Swab take e.g. COVID 19
  • Haematology tests – suspected anaemia
  • Study models – assess occlusion
  • Allergy testing – lichenoid mouth reactions
  • Photographs – esp case presentation, clinic do yourself but in hospital take to dep
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3
Q

common dental radiographs

A

Bitewings

Periapicals

Occlusal

Panoramic DPT

CBCT

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4
Q

vitality tests

A

EPT

thermal tests - heat, ethyl chloride

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5
Q

MRI used in dentistry when

A

suspected salivary gland issue

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6
Q

ultasound used in dentistry when

A

suspected salivary gland issue

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7
Q

sialography used in dentistry to investigate

A

salivary glands (flow, pH)

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8
Q

diet diary used to assess

A

pts who may be more at risk of certain diseases by seeing their habitual eating

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9
Q

types of microbiological tests

A

oral rinse, swab tests

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10
Q

example of use of haematological tests

A

suspected anaemia, bleeding disorder

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11
Q

study models can be used to

A

assess occlusion when pt not present

monitor pt changes

record dentition

help design prosthesis

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12
Q

when may an allergy test be used in dentistry

A

for lichenoid mouth reactions

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13
Q

when may clinical photographs be used in dentistry

A

teaching

monitor pt changes

esp case presentation, clinic do yourself but in hospital take to dep

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14
Q

indications for oral radiographs (8)

A
  • diagnosis
    • bitewings for caries
    • periapical for abscess/ apical disease
    • trauma – fracture
    • periodontal disease – bone loss – horizontal or vertical
    • RCT – working length
    • Before extraction – assess root morphology
    • Assess unerupted teeth (periapical)
    • Swellings – what tooth/area associated with
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15
Q

contra-indications for oral radiographs

A
  • Pregnant – do if need to do in emergency, beam not aiming at foetus but still assess if it can wait
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16
Q

sensibility testing assesses

A

vitality – blood – more reliable, difficult and unpractical Dopler flow;

sensibility – response of nerve fibres

17
Q

3 indications for sensibility tests

A
  • localise pain
    • unsure of source of pain
  • apical issue
  • bone loss with perio - possible perio-endo lesion
18
Q

2 contra-indications for speical test use

A
  • false positives
    • use in context with other tests
  • relaiability issues
    • multi-rooted or traumatised recently

Tooth dried for EPT, ethyl chloride/ EndoIce, heat

19
Q

4 indications for periodontal charting

A
  • BPE scores 3 or 4
  • Mobility – assess if restorable
  • Gingival margin
  • Pocket depth
20
Q

contra-indications to perio charting

A

Probe in pocket will cause bleeding so don’t if they have bleeding issues

21
Q

4 indications for study models

A
  • Orthodontics
  • Planning a complex Tx to assess occlusion (grade)
  • Changed to OVD – increasing vertical dimension of teeth for a reason for occlusion
  • Assess tooth wear – grade or compare to older model

Can do electrical scan and store digitally

22
Q

3 contra-indications to study models

A
  • Gag
  • Allergies to materials
  • If crown is already confirmed occlusion

electrical scan may help resolve gag hurdle

23
Q

what special investigation may be used for bleaching?

A

photographs - have pre-treatment record to assess difference

Prior approval for NHS treatment – only so much can you do before needing approval for extra funding

Need to take photos for documents

24
Q

what is needed for clincal photos?

A

Need consent – specific for what you are using, cannot take full face photos

Can’t use mobile phone

Retractors, dry area and take photo

25
Q

oral medicine lesions

A

take clinical photos to record

  • send by secure email or for records to compare later
26
Q

2 indications for biopsies

A
  • Take when want to investigate further/ suspected malignancy
  • Unsure what something is
27
Q

what is possible if there is a lesion next to an amalgam restorations

A

lichenoid reaction possible

28
Q

types of biopsy and how to take

A

Need consent and need a laboratory to send it to – need to be able to store in proper medium between taking and testing

  • Punch
  • Triangle
  • Free hand

Want abnormal and normal tissue to compare

  • Don’t take all of lesion away

Have accurate drawing/picture/description markers so lesion can be located in mouth

29
Q

3 saliva tests

A

flow

buffering capacity

caries - private, unsure of reliability

30
Q

diet diary

A

3 days, one is a weekend day

all food and drink and times recorded

can assess links between mouth and diet

31
Q

presenting a patient

A
  • An important skill throughout your career – to supervisor, exams
  • Needs to be structured
32
Q

when is a pt presented

A
  • before you start treatment
  • after you have examined the pt
33
Q

reason for presenting pt

A

Discuss with supervisor about proposed Tx before the pt arrives

  • E.g composite filling on upper right 5 (15)
    • Get them to check tooth before commencing any Tx to confirm good to go post examination
34
Q

what to include when presenting a pt (5 components)

A
  • Name*
  • Age if appropriate*
  • Reason for attendance/ Referral*
  • Summary history - CO, HPC, PMH and SH (just relevant)*
  • Charting – ask Qs that you are unsure off, write down what you see even if you are unsure*
35
Q

eg presentation of pt

A

Mrs Robinson
Reason for attendance
A new patient who has just moved into the area and wanted to register with you as an NHS patient
Patient concerns
35 year old female attends saying that she is really struggling to wear a CoCr denture that was provided last year to replace her missing central incisor. She had a post crown but the root split. Initially she had worn an acrylic denture but it was even worse.
PMH, SH and PDH
Medically she is fit and healthy and only taking the contraceptive pill. She is recently divorced, has no children and works full-time in a bank. She has had extensive dental work in the past which she puts down to lots of sweets as a child and being a “bit wild” when she was younger.

BDS3 Intro to Clinics (10 decks)

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