case pres

Question 1

what is the American association of endodontists definition of previously treated

Answer 1

a clinical diagnosis indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials other than intra canal medicaments
the tooth typically does not respond to thermal or electric pulp testing

Question 2

what is the American association of endodontists definition of symptomatic apical periodontitis

Answer 2

represents inflammation, usually of the apical periodontium, producing clinical symptoms involving a painful response to biting/ percussion/palpation
this may or may not be accompanied by radiographic changes (depending on the stage of disease there may be normal PDL width, or a peri apical radiolucency)
severe pain to percussion or palpation is highly indicative of a degenerating pulp and root canal treatment is needed

Question 3

what is the function of potassium nitrate in sensitive toothpastes

Answer 3

blocks transmission of nerve pain from tooth to brain
usually 5%

Question 4

what is the function of strontium chloride in sensitive toothpastes

Answer 4

strontium ions block fluid flow in dentine tubules

Question 5

what is the function of novamin in sensitive toothpastes

Answer 5

calcium formulation in sensodyne that builds a protective layer over enamel/dentine

Question 6

what is the function of stannous fluoride in sensitive toothpastes

Answer 6

provides a shield that occludes dentine tubules

Question 7

how does exposure to cold stimulus lead to tooth sensitivity

Answer 7

the cold stimulus decreases the hydrostatic pressure of the fluid within the dentine tubules, this causes an outward fluid flow away from the pulp which stretches the nerve terminal within the tubule and leads to action potentials firing in A-beta and A-delta nerves (large and small myelinated fibres that cause sharp pain in response to touch, and pain/temperature respectively)

Question 8

how does the rate of fluid flow within dentine cause sensitivity

Answer 8

nerve endings from the pulp extend into the dentine tubules
the stimulus increases the rate of the fluid flow in the tubules which generates action potential in the nerves, leading to pain
works by a hydrodynamic mechanism

Question 9

what are the risk factors for hypertension

Answer 9

stress
high caffeine intake
smoking tobacco
alcohol
high salt intake
genetics (family history of heart disease)

Question 10

explain the blood pressure reading of 164/102 mmHg

Answer 10

stage two hypertension (>160/>100) requires multiple medications and lifestyle changes

the top number (systolic pressure) is the force the heart pumps blood around the body
the bottom number (diastolic) is the resistance to blood flow in blood vessels between heart beats

important to treat as it puts the patient at risk of heart attack, strokes, renal failure

Question 11

how is hypertension treated

Answer 11

aim to get BP to <120/90 mmHg
single daily drug dose (ACE inhibitors, B blockers, Ca channel blockers, diuretics)
modify risk factors (lower salt intake, exercise, lower caffeine, stop smoking, reduce alcohol)

Question 12

how does hypertension relate to the patient’s dental care

Answer 12

MI risk (keep dental environment as stress free as possible)
possible link to periodontal disease
dentist can reinforce diet, alcohol, smoking advice
medications have side effects (dry mouth, gingival hyperplasia)

Question 13

what are the risk factors for malignant melanoma

Answer 13

UV light (UVB causes melanoma) and repeated sunburns
immunosuppression (steroids, diabetes)
age
pale skin
previous radiotherapy

this patient worked in the Middle East for many years without sunscreen

Question 14

how is malignant melanoma diagnosed

Answer 14

ABCDE checklist: asymmetric, borders (ragged), colours (2 or more ie brown/red/grey), diameter (>6mm), enlarged or elevated

new mole that is getting bigger and changing shape or colour and bleeding/itchy/crusty

commonly on the back in males, and legs in women

excision biopsy
MRI
CT scan

Question 15

what is a sentinel lymph node biopsy

Answer 15

determines microscopic melanoma that has spread to lymph nodes
done at same time as excisional biopsy of stage 1B-2C skin cancer
blue dye injected into where the mole was removed from and follows the path the melanoma has spread to
the first lymph node the dye reaches is the sentinel lymph node - if not affected then very unlikely to have spread to other nodes

Question 16

how was this patient’s malignant melanoma treated

Answer 16

stage 2C (melanoma thicker than 4mm and the outermost layer of skin is ulcerated) was treated with surgery (wide local incision to remove the melanoma and a small area of unaffected tissue around it)

he had a sentinel lymph node biopsy that showed no spread

he is monitored every 4 months for new melanoma/return of original melanoma/ lymph node spread

Question 17

how may malignant melanoma manifest in the oral cavity

Answer 17

very rarely in the mouth but if it is there it is aggressive

brown/red/grey swelling

risk factors = HPV, alcohol, smoking, genetics, poorly fitting denture

differential diagnosis = melanotic macule, mole, amalgam tattoo, Addison’s

if treated with radiotherapy to the head and neck it puts the patient at risk of osteoradionecrosis of the jaw (bone dies as the lumen of blood vessels shrinks in response to irritation from the radiation and there is no blood flow to bone) and radiation caries (xerostomia from destroyed salivary glands)

Question 18

what is osteoarthitis

Answer 18

degenerative joint disease affecting weight bearing joints
cartilage repair dysfunction means that the cartilage in joints becomes thinner and bones rub together, leading to pain

not wear and tear

commonly in weight bearing joints like hips and knees

Question 19

what are the signs and symptoms of osteoarthritis

Answer 19

joint pain that improves with rest
loss of funciton
immobility
radiographic changes (loss of joint space and subchondral sclerosis)
crepitus
swelling
MRI shows loss of cartilage

Question 20

how is osteoarthritis treated

Answer 20

nothing alters the disease progression so treat symptoms rather than cause

joint replacement when function is impacted

treat pain with NSAIDs, weight loss to reduce weight on bones, increase muscle strength around joint, walking aids

Question 21

how might osteoarthritis affect a patient’s dental care

Answer 21

access/mobility
manual dexterity
chronic NSAID use can cause oral ulcers and bleeding (anti-platelet)
can affect TMJ - flattening of condylar head and subchondral sclerosis

Question 22

what is Felodipine’s mechanism of action

Answer 22

Ca channel blocker that is used to treat hypertension and angina

Question 23

what are the side effects of felodipine

Answer 23

dizziness, headache
gingival hyperplasia (tough swelling of the gums caused by increased fluid retention and fibrocytes causing inconsistent growth and gingival bleeding)

grapefruit can worsen side effects as it blocks the enzyme that breaks down (metabolises) the drug so more enters the blood

can interact with erythromycin and clarithromycin (second line antibiotics) and fluconazole and miconazole - increased exposure to felodipine
can interact with GTN spray and nitrous oxide - risk of hypotension

Question 24

what is naproxen’s mechanism of action

Answer 24

NSAID that treats pain and inflammation associated with rheumatic disease by decreasing prostaglandin synthesis (by blocking COX1 and COX2), increasing prostacyclin and decreasing thromboxane A2
inhibits platelet aggregation so can increase patient’s bleeding risk

Question 25

what are the side effects of naproxen

Answer 25

bleeding risk (up to 1h - factor in to appointment time) due to inhibiting platelet aggregation stomach ulcer risk, especially with prolonged use agranulocytosis (severely low WBC) when taken with excessive alcohol use there is an increased risk of GI haemorrhage treat without interrupting medication; use local haemostat measures; limit treatment area (1 XLA at a time); effect lasts 7 days after last dose as the platelet is affected for the lifespan of the platelet

Question 26

what is omeprazole's mechanism of action

Answer 26

proton pump inhibitor prevents the release of gastric acid from parietal cells in the stomach used to treat H pylori infection/ gastric ulcers (prophylaxis for patients with prolonged NSAID use)/ GORD

Question 27

what are the side effects of omeprazole

Answer 27

dry mouth bone fracture with prolonged use - gastric acid secretion increases calcium absorption so reduced gastric acid secretion means there is low calcium absorption, leading to low bone density and possible osteoporosis tell patients to increase their calcium and vitamin B12 to prevent this

Question 28

what is paracetamol's mechanism of action

Answer 28

painkiller and anti pyretic that inhibits prostaglandin synthesis (lipids found at the side of damage/inflammation) dentists can prescribe at 2x 500mg tablets taken 4x a day for 5 days

Question 29

what are the side effects of paracetamol

Answer 29

thrombocytopenia over dose = >4g in 24h (8 tablets); signs tend to develop 4-6 days later and include vomiting, nausea, right subcostal pain/tenderness

Question 30

what is sertraline's mechanism of action

Answer 30

selective serotonin reuptake inhibitor (SSRI) used to treat depression/OCD/PTSD this patient is prob on sertraline as tricyclic anti depressants such as amitriptyline interact with felodipine (cayuse hypotension)

Question 31

what are the side effects of sertraline

Answer 31

dry mouth bruxism - indirectly lowers dopamine levels (dopamine inhibits jaw clenching) altered taste postural hypotension

Question 32

what is simvastatin's mechanism of action

Answer 32

statins inhibit enzyme-dependent cholesterol synthesis in the liver, leading to reduced total and LDL cholesterol levels

Question 33

what are the side effect of simvastatin

Answer 33

myopathy (muscle weakness/spasms) thrombocytopenia erythromycin/clarithromycin/miconazole/fluconazole all cause increased exposure to simvastatin so risk myopathy nystatin oral suspension is the preferred anti fungal treatment for this patient

Question 34

what causes TMJ clicking

Answer 34

lack of coordinated movement between the condyle and the articular disc the condyle has to overcome the mechanical obstruction before full joint movement can be achieved the disc is initially displaced anteriorly by the condyle during opening until disc reduction occurs - the clicking noise is the disc snapping back into place signs and symptoms include jaw stiffness, mandible deviating to the affected side on opening can progress to osteoarthritis if left untreated

Question 35

what does a facebow measure

Answer 35

the relationship of the maxillary teeth to the terminal hinge axis of rotation (an imaginary horizontal line drawn through the condylar heads) it is used to mount the upper cast on an articulator (the lower cast is mounted based on the occlusal record - done in RCP for this patient) Denar facebows also record the inter condylar distance (used when mounting on semi or fully adjustable articulator)

Question 36

what are the functions of each of the muscles of mastication

Answer 36

masseter - elevates and retracts the mandible temporalis - elevates and retracts the mandible lateral pterygoid - protrudes, depresses and moves the mandible laterally medial pterygoid - elevates, protrudes and moves the mandible laterally

Question 37

what is rotational movement of the mandible

Answer 37

20mm opening of the mandible around the terminal hinge axis the condyle head and articular disc remain in the articular fossa and there is no downward or forward movement of the condyle

Question 38

what is lateral translation of the mandible

Answer 38

lateral pterygoid contracts on the non working side to move the mandible to the working side (ie if the mandible moves to the patient's right their right is the working side) = Bennet movement

Question 39

what is the Bennet angle

Answer 39

Bennet angle is made with the sagittal plane and the path of the non working condyle during lateral translation of the mandible when viewed in a horizontal plane

Question 40

describe the positions in the posset's envelope

Answer 40

RCP = retruded contact position = first tooth contact when the mandible is in the retruded axis position; used in wear cases where there are insufficient index teeth to create a reproducible ICP ICP = intercuspal position = tooth position regardless of condyle position; the best fit of teeth; AKA centric occlusion edge to edge protrusion T = maximum opening = no tooth contact; full translation of the condyle over the articular eminence R = retruded axis position = no tooth contact; most superior anterior position of the condylar head in the fossa

Question 41

what is canine guidance

Answer 41

during lateral movements of the mandible only the canines touch this discludes the posterior teeth and protects them from horizontal forces (mutually protected occlusion)

Question 42

what is group function

Answer 42

there are multiple teeth contacting on the working side during lateral movements (buccal to buccal cusp is preferred) commonly have bilateral group function in wear cases; this means that there are lateral forces on posterior teeth and the muscles don't get a rest

Question 43

why is RCP used in wear cases

Answer 43

there are insufficient index teeth to gain a stable, reproducible ICP

Question 44

what is OVD

Answer 44

the superior-inferior relationship between the maxilla and the mandible when the teeth are in occlusion

Question 45

what evidence suggests increasing the OVD by 2mm is appropriate in this case

Answer 45

approximately how much tooth height has been lost improved facial aesthetics composite restorations require 1-2mm space to be placed according to the British society of restorative dentistry booklet

Question 46

what are the stages for recording a Denar Slidematic Facebow

Answer 46

apply bite registration paste or softened alminax to bite fork; seat with the locating arm on the patient's right hand side and allow the wax to harden; recheck it can be seated into the correct position in the mouth use a ruler to mark the anterior reference point on the patients face (43mm above the incisal edge of the lateral incisor) assemble the transfer jig to the ear bow and tighten the screw securely position the bite for intra-orally and ask the patient to hold in place (the numbers 1 and 2 should face the operator); insert the bite fork into clamp 2 ask the assistant to gently guide the ear bow into the external auditory meatuses and tighten the anterior connecting screw adjust and position the ear bow vertically until the locating arm is aligned with the anterior reference marked on the patient's face; tighten screw 1 to secure this position tighten screw 2 detach the facebow from the bite fork and transfer jig; disinfect and send to lab ensuring the screws are tightened

Question 47

what is the intercondylar distance on a semi adjustable articulator

Answer 47

110mm Bennet and condylar guidance angles are set by operator

Question 48

what are the set values of an average value articulator

Answer 48

bennet angle set at 15 degrees condylar guidance angle set at 30 degrees; the angle formed by the Frankfort plane at the head of the condyle and the path of the condyle during function

Question 49

name the types of articulator and when each should be used

Answer 49

semi and fully adjustable - require facebow registration and are used in cases with group function that require multiple adjustments simple hinge and average value - used in cases with canine guidance where the posterior teeth disclude during lateral movements arcon

Question 50

how would you explain the radiation of a peri apical radiograph to a patient

Answer 50

daily background radiation is 10uSv, eating a banana is 0.1uSv, getting a peri apical is 0.2uSv, getting an OPT is 10uSv

Question 51

what are some problems with sensibility tests

Answer 51

the tests stimulate nerve fibres which may not directly correlate with blood supply so cannot indicate the state of blood supply; tooth vitality is related to blood supply, not nerve transmission there can also be issues in testing multi rooted teeth peri radicular inflammation occurs before the pulp is totally necrotic laser doppler is needed to assess blood flow

Question 52

how does an electric pulp test work

Answer 52

stimulates sensory A-delta nerve fibres at the pulp-dentine junction unmyelinated C-fibres may or may not respond positive response suggests there is vital pulp tissue in the coronal aspect of the pulp chamber; no indication of reversibility of inflammation; no correlation between pain threshold and pulp condition (measurement of electric voltage/ score is not accurate) negative response indicates pulpectomy is required in 97% of cases EPT is unreliable in young teeth (open apices) or recently traumatised

Question 53

what is the procedure for an electric pulp test

Answer 53

dry teeth - prevents current transferring to adjacent teeth isolate tooth conducting medium (toothpaste) on tip of EPT probe EPT placed adjacent to pulp horn (incisal edge or cusp tip) as most sensory nerves are found here patient completes the circuit by holding the EPT current slowly increased and patient indicates when tingling/heat sensation is felt test tooth in question, then contralateral, then tooth question

Question 54

how do thermal sensibility tests work

Answer 54

hydrodynamic forces cause fluid movement within dentinal tubules in response to thermal stimulus

Question 55

how would you perform a cold sensibility test

Answer 55

cotton pellet sprayed with ethyl chloride/ difluorochloromethane (-500 degrees Celsius)/ endo-ice (-27.2 degrees celsius) placed on dried and isolated tooth, next to pulp horn or isolate tooth with dam and no LA and spray cold water and air on tooth negative response is highly indicative of pulp necrosis

Question 56

why are heated sensibility tests not commonly used

Answer 56

too much heat can cause irreversible pulpitis hot GP cone or green stick are added to tooth

Question 57

how could age impact response to sensibility tests

Answer 57

continued dentine formation reduces pulp size and volume over time dentine has increased fibrous content and calcification dentine has decreased cellular components and number of blood vessels/nerves overall the pulp is less likely to reverse an inflammatory response

Question 58

what are the contra indications to using en electric pulp test

Answer 58

patients with cardiac pace makers as the test may interfere with the electric activity of the tooth teeth with open apices as the relationship between the nerve fibres and the odontoblasts has not fully developed yet so my lead to a false negative reading

Question 59

what may lead to a false negative EPT result

Answer 59

extensive caries high amount of reparative dentine patients heavily medicated with analgesics teeth with open apices recently traumatised teeth improper placement of EPT tip low battery of EPT

Question 60

what may lead to a false positive EPT result

Answer 60

presence of partially necrotic pulp in one root of multi rooted teeth EPT tip contacting any part of the oral mucosa anxious patient pre emptying the sensation improper isolation of tooth

Question 61

what evidence suggests the benefit of using cold pulp test as well as EPT to determine pulp vitality

Answer 61

BMC Oral Health (peer reviewed journal) has an article by Huachao Sui et al published in July 2021 that suggests both EPT and cold pulp tests have "similar reliability in judging pulp vitality and are both superior to hot pulp tests. As pulp sensibility testing is subjective, combining EPT with a thermal pulp test for comprehensive diagnosis and mutual verification is warranted"

Question 62

how can toothwear be measures

Answer 62

tooth wear indices such as BEWE, ACE, TWI 3D scans photos study casts sectional silicone index radiographs

Question 63

discuss the Smith and Knight tooth wear index from 1984

Answer 63

used to measure and diagnose multi factorial tooth wear each surface of the tooth is scored based on the extent of enamel/dentine/colour lost (0 - 4) mostly used or research as time consuming and need a computer programme to account for all the data collected can underestimate pathological tooth wear as the estimations for tooth wear related to age (physiological tooth wear) are high

Question 64

what are the scores for the simplified tooth wear index

Answer 64

0 no wear into dentine 1 dentine just visible (including cupping) or dentine exposed 2 dentine exposure greater than 1/3 of surface 3 exposure of pulp or secondary dentine

Question 65

discuss the use of the BEWE

Answer 65

basic erosive wear examination based on the BPE screening tool to guide management of toothwear simple, easy, reliable, consistent results between clinicians most severely affected surface of each sextant is scored and the cumulative score is added together to dictate risk of progression and management some discrepancy between examiners when scoring enamel lesions

Question 66

what are the sextant scores for BEWE

Answer 66

0 no erosive tooth wear 1 initial loss of surface texture 2 distinct defect, hard tissue loss <50% of the surface area 3 hard tissue loss >50% of the surface area scores 2 and 3 often involve dentine

Question 67

what are the risk levels and guides to clinical management for BEWE

Answer 67

none (2 or less) - routine maintenance and observation; repeat at 3 year intervals low (3-8) - OH and dietary assessment and advice; routine maintenance and observation; repeat at 2 year intervals medium (9-13) - OHI and diet advice; identify the main etiological factor(s) for tissue loss and develop strategies to eliminate respective impacts; consider fluoridation measures to increase the resistance of tooth surfaces; ideally avoid placement of restorations and monitor erosive wear with study casts/photos/silicone index; repeat at 6-12 months high (14 or more) - as for medium; consider special care that may involve restorations in cases of severe progression

Question 68

discuss the Anterior Clinical Erosive (ACE) Classification

Answer 68

developed to be easier than BEWE; score based on most severely affected tooth patients are grouped into 1 of 6 classes based on 5 parameters relevant to treatment and prognosis a treatment plan is suggested for each class only looks at anterior maxillary teeth

Question 69

what are the five parameters of the ACE classification

Answer 69

dentine exposure in contact points preservation of incisal edges length of remaining clinical crown enamel on buccal surfaces pulp

Question 70

what are the benefits of a lower soft splint

Answer 70

easy to manufacture easy for patient to get used to won't wear down restorations - best suited for patients with cosmetic restorations paper by Sameh and Khaled published by the Saudi Dental Journal in 2015 showed that both soft and hard splints improved TMD symptoms in patients with internal derangement or myofacial pain after 4 months; however soft splints exhibited superior results (dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening)

Question 71

explain how you recorded the modified plaque and bleeding scores

Answer 71

ramfjord's teeth (16, 21, 24, 36, 41, 44) are used in order to best reflect the condition of the whole mouth plaque - interproximal/buccal/lingual surfaces scored 0 (no plaque)/ 1 (plaque on probe when skimmed across gingival margin)/ 2 (visible plaque); scores added together and divided by 36 (or 30 if one tooth missing like in this patient) then x100 to get percentage bleeding - mesial/buccal/distal/lingual surfaces scored 0 (no marginal bleeding)/ 1 (bleeding up to 30s after probe swept around the gingival sulcus); scores are added together and divided by 24 (or 20 if one tooth missing like in this patient) then x100 to get percentage

Question 72

describe the process of making immediate dentures

Answer 72

take upper and lower alginate impressions and medium body PVS bite registration request perforated special trays and wax occlusal rims take master impressions, perform jaw reg, take a shade request wax try in denture perform wax try in and ask lab to process, noting which teeth are being replaced (can request a socket-fitting denture to control bleeding and allow for gingival contouring) extract on the same day as denture delivery; ensure haemostasis achieved before denture fitted; remove any sharp or rough areas give denture advice replace in 2 weeks then 6 months once the bone has remodelled and they are used to the new OVD

Question 73

what denture advice would you give to this patient

Answer 73

wear the temporary's for 24 hours to protect the formed blood clot; thereafter remove at night and store in water clean after eating with warm soapy water and a soft toothbrush if using denture cleaners then follow manufacturer's instructions if rubbing then take out and only wear when you need to; wear for the 48h up to the review appointment so we can see where the rubbing is practice reading aloud to get used to wearing them

Question 74

describe the process of designing the CoCr denture

Answer 74

identify saddle areas (Kennedy and Craddock classification) support - rest seats (tooth borne) and mucosal coverage clasps - CoCr need to be 15mm (flexibility) and engage in 0.25mm undercuts reciprocation - resistance to tooth movement on insertion/removal of the denture; given by denture base/ reciprocal arm indirect retention - resistance to rotational displacement of the denture; placed at 90 degrees to clasp axis; rests/base plate/ minor or major connectors select connector simplify design

Question 75

what are the benefits of lingual bar

Answer 75

well tolerated by patients gingival clearance prevents gingival stripping and food packing easy to maintain good OH need 8mm (3mm from gingival margin, 4mm width of bar, 1mm from floor of mouth)

Question 76

what are the properties of a ring connector

Answer 76

rigid, minimal soft tissue coverage can annoy the tongue, poor support not suitable in those with high vaulted palates or palatine tori

Question 77

how does saliva buffer the acidic oral environment

Answer 77

carbonate (pH6.3), phosphate (pH7.2) and amylase/albumin/IgA protein (

Question 78

what is attrition

Answer 78

tooth wear caused by friction of contacting surfaces of teeth can be physiological (by age) or pathological (clenching/grinding) presents as flattened cusp tips and incisal edges lack of posterior support exacerbates attrition

Question 79

what is erosion

Answer 79

chemical process that doesn't involve bacteria action bilateral concave lesions with translucent incisal edges severity depends on type and frequency of acid (titratability means that something may be more acidic by neutralised quicker so causes less damage)

Question 80

how could GORD contribute to erosion

Answer 80

intrinsic source of acid with a pH 1 instruct patient to rinse with bicarb or water after reflux and wait 30m to brush teeth

Question 81

how is stomach acid produced

Answer 81

parietal cells in the stomach respond to acetylcholine, histamine and gastrin to produce and pump out acid all three of these must be blocked to prevent acid transport

Question 82

what medications can be used to treat GORD

Answer 82

H2 receptor antagonists (ranitidine) - prevent histamine activation of acid production; limited affects as alternative pathways still open PPIs (omeprazole) - stop acid secretion; very effective; steroids and NSAIDs have a side effect of gastric bleeding so PPIs help protect from this antacids - don't stop reflux; turn acids into salt can also be treated by losing weight, avoid triggering activity, stop smoking (improves sphincter)

Question 83

what are the causes of GORD

Answer 83

defective lower oesophageal sphincter impaired lower clearing impaired gastric emptying

Question 84

what are the signs and symptoms of GORD

Answer 84

heartburn epigastric burning (worse lying down) dysphagia GI bleeding severe pain mimics MI - oesophageal muscle spasm can lead to ulceration, inflammation, metaplasia (Barrett's oesophagus where the epithelium changes from simple columnar to stratified squamous - risk of adenocarcinoma or SSC)

Question 85

why is aetiology important when planning treatment for a toothwear patient

Answer 85

attempt to reduce further wear plan for contingencies and failure allow you to be realistic with yourself and the patient identifies wider wellbeing issues that can be signposted prognosis indicator enhances consent aids clinical diagnosis and treatment planning

Question 86

what are the modifying factors for attrition

Answer 86

lack of posterior teeth increases rate of wear on remaining teeth occlusion (edge to edge) restorations (ceramic crowns) combination with erosion (synergistic) stress and anxiety increase the progression of wear

Question 87

what are the modifying factors for erosion

Answer 87

amount and frequency level of control intrinsic = eating disorders, GORD, poorly controlled diabetes extrinsic = fizzy drinks, swimming, inhalers, alcohol, fruits

Question 88

what are the common features of erosion

Answer 88

initially on palatal of upper centrals cupping on lower molars sensitivity interproximal caries polished/ erosion around restorations

Question 89

what is some common preventative advice for toothwear

Answer 89

ensure all advice is individualised high F intake (alcohol free mouthwash and toothpaste) dietary modification (frequency, quantity, method of delivery, elimination and addition) tooth brushing instruction (wait 30 mins after acid intake; spit don't rinse) signposting to CBT or GMP as some aetiology may be outside of scope of GDP

Question 90

why is it important to preserve teeth in bruxism patient

Answer 90

aim to avoid full dentures as bruxism doesnt stop so can lead to fractured dentures, ridge resorption, pain and ulceration under complete denture

Question 91

how can bridgework be used to simplify small saddles

Answer 91

the Pontic is made of ceramic which is inherently stronger than acrylic denture tooth so less likely to break need to ensure that it is not involved in protrusive or excursive movements otherwise it could fail

Question 92

what can be done with the diagnostic wax ups to aid placement of the composite build ups

Answer 92

the diagnostic wax ups are made to the new increased OVD and they are cast into stones that give new working casts that can be used to make stents which act as templates to place the temporary or permanent build ups the stents can be hard acrylic vacuum formed; or made from semi clear silicone (memisil) that can be made on the wax ups so don't need to make the stone working casts and can cure the composites through the memisil

Question 93

what evidence is there for managing tooth wear

Answer 93

direct composites have annual failure rates of 0.7%-26.3% (Hemmings et al 2000) parafunctional activity can result in devastating forces that increase risk of mechanical failure at restoration and tooth level (Hemmings et al 2018) frequent failure of denture components (Hemmings et al 2018) patients need realistic expectations of future reconstruction so they do not attribute failure to inadequate clinical work (Hemmings et a 2018)

Question 94

what are the keys to success when managing failure in tooth wear cases

Answer 94

comprehensive history and exam (information gathering) thorough planning seek advice if needed prevention ! avoid over ambitious treatment ! effective communication ! decision making and treatment planning around basic principles keep plans simple have effective maintenance strategy and regularly reassess the situation

Question 95

how can you ensure effective communication when managing failure

Answer 95

effective listening honesty and transparency taking patients wishes into account addressing difficult issues seeking advice giving patients a reality check documenting discussions being assertive and compassionate time and patience avoiding patient led treatment have a holistic approach to treatment