case pres Flashcards

Question

risk factors for candida

Answer 1

long term corticosteroid use immunosuppressive drugs broad spectrum ABs diabetes nutrition dialysis smoking denture wearing anaemia steroid inhaler use

Answer 2

white pronounced plaques wiped away easily to leave bleeding erythematous surface

Answer 3

erythematous - red & angry; either atrophic from HIV or denture stomatitis hyperplastic - white patches, less pronounced & plaque like than pseudomembranous, can't be wiped off, associated with candidal leukoplakia which can be pre malignant angular cheilitis - seen at commissures & angles of mouth

Answer 4

azoles - i.e. fluconazole / miconazole gel. inhibit ergosterol synthesis (fungistatic). c.glabrata resistant. avoid in warfarin / statins. polyenes - i.e. nystatin. binds directly to ergosterol on cell membranes causing pores to open & cell contents to be lost (fungicidal).

Answer 5

nystatin oral suspension 100,000 units / ml send 30ml 1ml after food 4x daily for 7 days

Answer 6

pt request no tablets as doesn't like taking tablets

Answer 7

yeasts in candida can metabolise simple sugars to alcohol & CO2 gas acetaldehyde produced from subsequent alcoholic breakdown is a carcinogen (cancer causing chemical)

Answer 8

phospholipase - degrades lipids, aids host cell penetration haemolysin - degrades RBCs, facilitates hyphal invasion proteinase - degrades protein, aids adhesion to epithelial cells alters target site to prevent azoles from binding changing cell membrane composition to prevent insertion of polyene

Answer 9

pt not seen dentist in 10yrs & only quit smoking 1yr prior could have had candida for a long time and not realised

Answer 10

SDCEP BSP S3 guidelines - S3 format is the highest level of guideline production considering both a systematic appraisal of published evidence & clinical experience

Answer 11

a systems enquiry HEALABLES H - heart E - endocrine A - a musculoskeletal L - lungs A - a joint issue B - bleeding L - liver / kidney E - brain e.g. FFS / epilepsy S - stomach / GI

Answer 12

no need to undergo surgical xla to remove can maintain alveolar bone for prosthodontic purposes

Answer 13

- signed perio consent form is proof pt knows what is going on & what they need to do - pt must know; they have perio, it is not curable, it is in their control to make it better - need to provide them with tx options; do nothing / perio tx / xla / perio surgery - need to discuss what will happen if perio not controlled i.e. inflammation / tooth mobility / tooth loss - need to discuss what will happen if they do control it i.e. less bleeding / less swelling so formation of black triangles / gums going from red to pink / gum recession & lengthening of teeth / sensitivity (recession exposes more root so more sensitive)

Answer 14

subjective & objective findings that vital inflamed pulp is incapable of healing & RCT indicated sharp pain upon thermal stimulus lingering pain (often 30secs or longer following stimulus removal) spontaneity (unprovoked pain) referred pain pain may be accentuated by postural changes such as lying down or bending over OTC analgesics typically ineffective common aetiologies inc deep caries, extensive restorations, fractures exposing pulp tissues can be difficult to diagnose as inflammation has not yet reached the PA tissues thus resulting in no pain or discomfort to percussion

Answer 15

represents inflammation usually of apical periodontium producing clinical symptoms involving a painful response to biting and / or percussion or palpation may or may not be accompanied by radiographic changes i.e. depending on stage of disease there may be normal width of the pdl or there may be PA radiolucency severe pain to percussion and / or palpation is highly indicative of a degenerating pulp & RCT is needed

Answer 16

severe caries unrestorable unable to gain adequate moisture control to place suitable restoration caries nearly subcrestal ? unable to place adequate dam so cannot carry out rct

Answer 17

increased mobility of the crown of the tooth to at the most 1mm in a horizontal direction

Answer 18

physiological wear of teeth due to tooth to tooth contact

Answer 19

polished facet flattening of cusps shortened clinical crown restorations show same wear as tooth substance can see present in pt on lower anterior 3-3; note this could also be due to MCC opposing these teeth pt identified parafunctional habits - grinds teeth at night

Answer 20

tooth wear index pt scored 2 surface - incisal criteria - loss of enamel exposing dentine for less than 1/3 of surface loss of enamel just exposing dentine defect <1mm deep

Answer 21

unaesthetic poor margins

Answer 22

drill off using tungsten carbide / diamond bur

Answer 23

1. no tx, not causing any pain, PA radiolucency present but no symptoms; might require treatment in the future 2. replace 21 and not 11 but this will leave uneven looking crowns 3. can replace but may make it worse, depends on quality of tooth structure remaining underneath crowns, may need RCT but no clear canal visible may not be possible would require referral to specialist with microscope equipment. Possible sensitivity following this & will not last forever.

Answer 24

- cheaper - functional - less tooth tissue removal required - not as good aesthetics - can see metal collar - metal shine through - less destructive than all ceramic

Answer 25

definitely more aesthetic but more expensive and require increased removal of healthy tissue so increased chance of pulp exposure upon prep emax less prep but all ceramic more prep

Answer 26

emax 2mm all the way round ? mcc - 1.3mm labial should and 0.5mm palatal chamfer ?

Answer 27

18 and 48 are in occlusion replacing 47 with nothing above it is pointless; would be for aesthetic rather than functional purposes same with the 37 as nothing in upper arch opposing this mesially tilted so difficult to get parallel prep for conventional cantilever

Answer 28

protect remaining tooth structure identify where parafunction is worst cheap & easily constructed prior to more definitive hard splint following restorative tx

Answer 29

symptom complex of multifactorial aetiology which almost certainly represents a psychological response to stress that becomes chronic through increasing muscle tension affecting MoM namely masseter, lateral pterygoid, temporalis. muscle hyperactivity can release lactic acid & other components that can cause pain

Answer 30

1. xerostomia - decreased saliva production 2. increased risk of perio - contains toxins & carcinogens that can irritate gum tissue leading to increased inflammation 3. tooth discolouration - adheres to enamel leading to yellow / brown staining 4. oral cancer risk - not as high as tobacco. long term exposure increases risk of OC 5. healing - may impair ability to heal due to reducing blood flow to surgical site & interfering with body's natural healing process

Answer 31

Long term stability of crowns due to lack of posterior support, lot of weight on the front so contributing to attrition of lower anteriors due to parafunction denture would help relieve this pressure provide more function

Answer 32

more aesthetic bonds to tooth

Answer 33

chronic, primary, neurobiological condition influenced by genetic, psychosocial & environmental factors

Answer 34

euphoria slowed thinking & reaction time confusion impaired balance & coordination cough respiratory infection increased HR anxiety addiction

Answer 35

social deprivation poor housing adverse childhood experiences poor role models low educational aspiration lack of opportunities high unemployment

Answer 36

1. potency alteration - cannabis can alter perception of pain & alter sensitivity to pain so could influence effectiveness of LA 2. metabolic interactions - can impact metabolism & clearance of LA from body altering duration of action or potency 3. cardiovascular effects - with adrenaline can prolong acute tachycardia (HR >100bpm) 4. CNS depression - both cannabis & LA depress CNS leading to sedation / drowsiness so combination can increase effect risking excessive sedation / respiratory depression if high doses are used 5. individual variability - some people may experience heightened sensitivity to pain or altered anaesthesia

Answer 37

reversibly binds to sodium channels preventing the entry of sodium into the cells thereby inhibiting the propagation of nerve impulses consequently nociceptive impulses associated with painful stimuli do not reach the brain and pt does not perceive pain note - lidocaine fully metabolised in liver

Answer 38

prevention & monitoring this is tx pts usually in this phase for 6mths advice re TMD & provision of splint

Answer 39

most abused drug in UK with 18.7% of adults aged 16-59yrs reporting having used it in previous yr THC is 1 of 66 cannabinoids within cannabis & is most associated with hallucinogenic / psychoactive effects THC reacts with 2 main receptors: CB1 (mainly found in brain) and CB2 (mainly found in immune cells and GI tract) most common route of admin is smoking through which 50% of THC is inhaled high often felt within mins and lasts 2-3hrs THC accumulates in adipose tissue & slowly released back into the body total elimination can take up to 30 days

Answer 40

- poor OH & perio - reduced salivary flow - appetite enhancing nature of drug - LA containing adrenaline may prolong tachycardia following acute dose of cannabis - chronic use results in increased risk of oral leukoplakia / OSCC / candidiasis / oral infections - cannabis may compound effects of anaesthetic agents thus increasing arterial pressure & HR to possibly life threatening levels - pts should be advised not to use cannabis for at least 72hrs before tx under conscious sedation in order to reduce the likelihood of drug interactions & unpredictable sedation quality

Answer 41

prilocaine & mepivicaine have weak vasodilation properties. both are short acting anaesthetics & good options for children, elderly & pts with contraindications to adrenaline

Answer 42

to act as a vasoconstrictor and delay drug absorption which prolongs duration of LA and reduces toxicity risk

Answer 43

LA base reducing agent (sodium metabisulfide) preservatives fungicide +/- vasoconstrictor

Answer 44

felypressin = less effective vasoconstrictor but is an alternative for hypertensive pts or those wanting adrenaline free LA f - acts on ADH receptors a - acts on adrenoreceptors

Answer 45

prilocaine (citanest) 3% HCl w felypressin (pulp infil = 30-45mins, pulp block = 60mins, soft tissue = 3-6hrs) max dose = 8 cartridges (8mg/kg) mepivicaine 3% HCl plain (pulp infil = 20mins, pulpal block = 40mins, soft tissue = 2hrs) , max dose = 6 cartridges (3mg/kg)

Answer 46

1. control immediate pain 2. lower psychological stress 3. eliminate TMJ damage

Answer 47

rest heat analgesics injections CBT hypnosis psychiatric tx rest masticate bilaterally avoid trauma splint

Answer 48

increase vertical dimension, may reduce joint loading, eliminate faulty occlusal interferences, provide cognitive awareness of damaging oral habits

Answer 49

STRESS - due to caffeine intake, cannabis intake etc

Answer 50

dry mouth can use gel / spray / pastilles to help salivary flow

Answer 51

acrylic - cheaper, better transitional denture, would aim for upper and then discuss provision of lower ask at each appointment highlight positives of getting denture but ensure it is something that pt wants; let pt come to you and ask you for denture would then transition to a chrome denture and then discuss provision of lower RPD if that was something pt was interested in

Answer 52

preserve bone height for future implant placement near vital structures i.e. IAN present for no of yrs with absence of PA pathology can be left & monitored to ensure caries free / no PA pathology

Answer 53

infection risk sitting in soft tissue so straightforward low risk procedure

Answer 54

cheap non toxic / non irritant bulkier less heat transfer quicker to make easier to add to (can add stainless steel clasps to acrylic denture)

Answer 55

stronger thinner more expensive more difficult to add to takes longer to make

Answer 56

1. swab / oral rinse for culture 2. biopsy for hp using PAS stain 3. smear for microscopy

Answer 57

less saliva saliva is antibacterial, acts as a buffer, aids digestion

Answer 58

calcified deposits within canal 2ndary dentine gets laid down an calcified blocking canal system can be idiopathic, age related, trauma related

Answer 59

pink knife edge, no erythema, stippled, no BoP

case pres Flashcards

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