CASE PRESENTATION STUDY Flashcards
(98 cards)
1
Q
What is hypertension?
A
High blood pressure
2
Q
What are some known risk factors for development of hypertension?
A
- age (older)
- obesity
- family history
- tobacco
- poor diet
- alcohol
- genetics
3
Q
How is hypertension graded?
A
Graded using the NICE definition
- Stage 1 (mild)
- Stage 2 (moderate)
- Stage 3 (severe)
4
Q
What are the measurements that classify “mild” hypertension?
A
Systolic = 140-159mmHg
Diastolic = 90-99mmHg
5
Q
What are the measurements that classify “moderate” hypertension?
A
Systolic = 160-179mmHg
Diastolic = 100-109mmHg
6
Q
What are the measurements that classify “severe” hypertension?
A
Systolic = 180mmHg or higher
Diastolic = 110mmHg or higher
7
Q
What readings would be considered hypertensive crisis?
A
Systolic = 180mmHg+
Diastolic = 120mmHg+
8
Q
How severe is your patients hypertension?
A
Mild according to pt
9
Q
What are the symptoms of hypertension?
A
- Often none
- Headache (especially in the morning)
- Nosebleeds
- Blurred vision
- Shortness of breath
10
Q
What medications can be used to treat hypertension?
A
- beta blockers
- ACE inhibitors
- diuretics
- calcium channel blockers
- ARB (angiotensin II receptor blocker)
10
Q
What type of drug is Candesartan?
A
Angiotensin II receptor blocker
11
Q
How does Candesartan work?
A
- Blocks angiotensin II type 1 receptors (located on blood vessels)
- blocks the effects of Angiotensin II such as vasoconstriction and aldosterone secretion (hormone that promotes salt & water retention)
- Both of these lead to reduced blood pressure
12
Q
What are potential side effects of Candesartan?
A
- Dizziness and lightheaded
- Postural hypotension
- Fatigue
- Nausea
- Diarrhoea
13
Q
Why is cataract surgery indicated?
A
Clouding of the eye causing visual impairment. Occurs due to:
- aging
- genetics
- trauma
- medical conditions (eg diabetes)
- long term use of corticosteroids
14
Q
What is a detached retina?
A
the retina (light sensitive layer of tissue at back of eye) becomes separated from underlying connective tissues
- leads to severe visual impairment
15
Q
How might a detached retina affect his dental history?
A
Poor central vision in right eye =
- difficulty with OH
- progressive loss of vision
16
Q
What is the mechanism of action of statins?
A
Used to lower cholesterol levels in the body
- inhibits the HMG-CoA reductase enzyme
- this enzyme plays a crucial role in the synthesis pathway of cholesterol in the liver
- therefor a reduction in liver production of cholesterol
- liver increases expression of LDL receptors, so LDL cholesterol is cleared from bloodstream quicker
17
Q
What are the clinical benefits associated with statins?
A
reduction in production of atherosclerotic plaques therefor reduced CV risk
18
Q
Common statins:
A
- atorvastatin
- simvastatin
19
Q
Side effects of statins:
A
- liver function changes
- increased blood sugar [risk of developing type 2 diabetes] in some individuals
- drug interactions
20
Q
Statin effects on dental tx?
A
- Liver function changes so be careful when using LA metabolised in liver if this is the case (eg Lidocaine)
- Xerostomia leading to higher caries risk
- Interactions with Azole antifungals so need to be careful
21
Q
What medications do statins interfere with?
A
- “Azole” antifungals
- Clarithromycin
- Phenytoin
- Warfarin (mess up the INR level)
22
Q
How can cadasartan interfere with dental tx?
A
- Orthostatic/postural hypotension due to low BP
- Xerostomia
- Interaction with NSAIDs [they reduce the effect of Candesartan]
23
Q
What allergy does your patient suffer from?
A
Allergy to ibuprofen
24
Discuss ibuprofen allergy:
Drug hypersensitivity reaction
25
What are symptoms of ibuprofen allergy?
- Skin reactions = hives, itching, redness
- Respiratory = shortness of breath, wheezing coughing
- Angioedema = lip/face/throat swelling
- GI = vomiting, nausea, diarrhoea, abdominal pain
26
How might an ibuprofen allergy be diagnosed?
- Skin testing/patch testing
- Drug challenge test
27
What type of hypersensitivity reaction is an ibuprofen allergy?
Can be:
- Type I (immediate hypersensitivity) *** most common
- Type III (immune complex)
- Type IV (delayed hypersensitivity)
28
What is the mechanism of Type I hypersensitivity reaction?
- mediated by immunoglobin IgE antibodies
- when exposed to the allergen (ibuprofen), IgE binds to mast cells and basophils
- leads to the release of histamine and inflammatory products
29
What are the clinical presentations of a Type I hypersensitivity reaction?
- hives
- angioedema
- respiratory symptoms
- anaphylaxis
30
What is anaphylaxis?
severe and life-threatening allergy condition
31
How many sugar intakes per day makes someone high caries risk?
3+ sugar intakes per day at separate times
32
What effect does smoking have on general health?
Smoking can lead to:
- respiratory diseases (COPD, cancer)
- CV disease (atherosclerosis, stroke, heart attack)
- cancer (lung, throat, oral, stomach)
- reduced immune function
- lowered reproductive health
33
What effect does smoking have on oral health?
Increased risk of
- Periodontal disease
- Oral cancer
- Delayed healing
- Halitosis and tooth staining
- Chronic hyperplastic candidosis
-
34
How does smoking increase periodontal disease risk?
- Vasoconstriction of gingival tissues (reduction in oxygen & nutrients to gingiva)
- Impaired chemotaxis of neutrophils/macrophages to fight off periodontal causing bacteria
- Increased osteoclast activity leading to bone resorption
- Impaired wound healing & collagen production
35
What bacteria are involved in periodontal disease?
- P. gingivalis
- Prevotella intermedia
36
How much more likely are you to develop oral cancer if you smoke? (no alc)
2x more likely (increases with frequency and consumption)
37
How much more likely are you to develop oral cancer if you drink alcohol?
2x more likely
38
How much more likely are you to develop oral cancer if you smoke AND drink alcohol?
5x more likely (synergistic effect)
39
Risk factors for oral cancer development?
- Smoking
- Alcohol
- HPV infection
- UV
- Stress
- Age (60+)
- Gender (male)
40
What is the significance of pack years?
Higher pack year value = increased risk of developing negative effects associated with smoking
41
Explain the synergistic effect of smoking and alcohol consumption on development of oral squamous cell carcinoma:
- Alcohol compromises the mucosal barrier, allowing easier passage of smoking carcinogens into the body
- Both impair the immune system
- Increased risk of OSCC development
42
What is the recommended max limit of alcohol intake per week?
14 units per week, spread over 3 days with at least 2 alc free days
43
How many units in a pint of beer? (approx)
2 units
44
How many units in a pint of guinness?
2.4 units
45
What is geographical tongue?
Benign condition that causes patchy atrophic areas on the tongue "map like pattern"
46
What are the causes of geographical tongue?
- Genetics
- Idiopathic
- Zinc deficiency
- Hormonal fluctuations (eg pregnancy)
- Associated with other autoimmune/inflammatory conditions eg psoriasis
47
Symptoms of geographical tongue?
- Often none
- Burning/stinging sensation when eating acidic or spicy foods
48
What is the clinical presentation of geographical tongue?
- smooth, irregularly shaped red patches on the tongue with white margins
- migratory nature (tends to change a lot)
- lack of filiform papillae in affected area
49
What does TTP suggest?
- periapical involvement/infection/periodontitis
- pulpitis
- cracked tooth syndrome
- occlusal trauma
50
What is the purpose of a BPE?
Screening tool for periodontal disease detection, does not DIAGNOSE
51
What does sensibility testing involve?
- Ethyl Chloride
- EPT
52
What does 6PPC record?
- Gingival level
- Pocket depth
- LOA
- Mobility
- BoP
- Furcation
53
What is meant by loss of attachment?
Loss of attachment is the distance from the CEJ, to the base of the periodontal pocket
- indicates the cumulative loss of supporting periodontal tissues, including gum, periodontal ligament, and alveolar bone.
54
What dosage is a PA radiograph?
4uSv
55
What dosage is an OPT radiograph?
20uSv
56
What is condensing osteitis?
localised area of increased bone density associated with chronic low grade inflammatory stimulus (lack of PA radiolucency)
57
Causes of condensing osteitis:
- chronic pulpal inflammation
- non-vital teeth
58
What is attrition?
The physiological wearing away of tooth structure as a result of tooth to tooth contact
59
What is erosion?
The loss of tooth tissue as a result of a chemical process that does not involve bacteria
60
What types of toothwear exist?
- Erosion
- Attrition
- Abfraction
- Abrasion
61
What is meant by generalised periodontitis?
>30% of teeth are affected
62
What is meant by stage III periodontitis?
Bone loss extending to the mid-third of the root
63
What is meant by grade B periodontitis?
Rate of progression number is between 0.5-1.0 (moderate rate of progression)
64
What is meant by "currently unstable" in a periodontal diagnosis?
BoP (inflammation is currently present)
65
Aside from smoking, what other risk factors play a role in periodontal disease?
- Diabetes
- Pregnancy
- Stress
66
Why are defective bridge and crown margins a problem?
- Marginal leakage leading to secondary caries
- Periodontal problems (irritation to surrounding gingiva)
- Poor retention & stability
- Poor aesthetics
- Difficult to keep clean
- Compromised RCT coronal seal
67
Ideal post dimensions?
- Parellel
- Non-threaded
- Cement retained
68
Why is a parallel post preferred?
- uniform stress distribution
- improved retention
69
Why is a non-threaded post preferred?
- no rotational "screw" stress factors created on placement
- easier removal upon retreatment
70
Why is a cement retained post preferred?
- more reliable retention
- helps distribute occlusal forces down long axis of tooth
71
Are this patients post-restorations ideal?
FAR FROM IT
- 13 = inadequate obturation, post is threaded
- 11 = inadequate obturation, too short from apex
72
Explain the pulp nerves of a tooth with irreversible pulpitis:
A-delta fibres = myelinated fibres that are stimulated via acute stimuli, cause sharp pain
C fibres = unmyelinated fibres located deeper in the pulp that are stimulated by more aggressive or chronic stimuli, cause dull aching pain
Inflammation of pulpal tissues causes pressure to build up which causes pain
73
What is involved in step one of periodontal treatment based on BSP 2017 guidelines?
- Explain periodontal disease, risks/benefits of tx
- OHI
- Control risk factors (eg removal of plaque retentive factors, smoking cessation, diabetes control)
- Supra and some subgingival PMPR
74
What is involved in step two of periodontal treatment based on BSP 2017 guidelines?
- Subgingival PMPR
- Further control of risk factors
- Use of adjunctive antimicrobials
75
What is involved in step three of periodontal treatment based on BSP 2017 guidelines?
- Reinforce OH, behaviour change, risk factors
- Subgingival PMPR on moderate residual pockets (4-5mm)
- Consider surgery for pockets >6mm
76
What type of periodontal surgery exists?
- Flap raising surgery
- Regenerative surgery
- Root resection
-
77
What are the different mobility scores & their meaning?
1 = <1mm movement
2 = 1-2mm movement
3 = >2mm movement and/or rotation/vertical movement
78
What are the different furcation scores & their meaning?
1 = less than 1/3
2 = >1/3
3 = through and through lesion
79
Why are cuspal coverage restorations better?
- Better load distribution down long axis of tooth because cusps are covered
- Prevents crack propagation which can be a problem in direct restorations
- Stronger materials eg Zirconia
- Precision fabrication in laboratory so usually perfect fit to crown of tooth
80
Why did you decide to use composite for these restorations>
- Composite is aesthetic
- Bonds directly to tooth surface
- Patient preference
- Moisture control could be easily achieved
- Minimally invasive, less tooth tissue destruction
81
Explain the steps of caries removal:
- Locate and identify carious enamel and remove to the extent of the ADJ
- Remove peripherally at the ADJ until margins are clear
- Then remove caries circumferentially
- Remove deep caries with a slow speed or excavator
82
What type of bridge does your patient have?
Fixed-fixed conventional design
83
What is a metal ceramic crown?
Consists of:
- metal substructure
- opaceous ceramic layer
- veneering ceramic layer
84
What are the advantages of MCCs?
- Stronger than conventional all ceramic crowns
- Reasonable aesthetics
85
What are the disadvantages of MCCs?
- More extensive tooth prep
- Cost
- Can get metal shine-through
86
Anterior MCC prep values?
- Incisal reduction 2mm
- Labial prep 1.5mm
- Palatal prep 0.5mm-1mm chamfer
87
What luting agent would be used to cement a MCC?
GIC = Aquacem
RMGIC = RelyX
88
What type of pontic does this patient have?
Ridge lap pontic
89
What is SDA?
Loss of most posterior teeth but maintained function and occlusal stability with remaining anterior dentition (requires 3-5 occlusal units minimum)
90
Is this patient suitable for SDA?
Not really due to periodontal involvement and poor prognosis of remaining dentition however pt does not want an RPD so nothing we can do
91
How are posts removed from teeth?
- Ultrasonics
- Sliding hammer
- Masseran
- Heat application to soften cement
92
What risks are associated with leaving a tooth in the mouth with a chronic draining sinus?
Risk of:
- spread of infection
- sepsis risk if infection worsens
- stress on the immune system
- flare ups of swelling and pain
- subsequent tooth loss eventually
93
What are the advantages of creating an immediate denture?
- Restores aesthetics
- May help speech
- Function
- Avoids drifting/tilting/over-eruption of remaining teeth
- Prevents collapse of facial musculature
94
What are the disadvantages of an immediate denture?
- Temporary fit
- Poor adaptation to ridge due to post-extraction resorption
- If pt excessively swells, denture wont fit
95
What instructions do you give to pt after delivery of immediate denture?
Leave in for first 24 hours.
Reviews at:
- 1/2 days
- 1/2 weeks
- 1 month
96
How does caries occur in relation to Stephan curve?
- Fermentable carbohydrates/sugar consumed
- Strep Mutans metabolises it and creates lactic acid
- pH drops below critical threshold 5.5
- demineralisation occurs
- caries formation favourable
- saliva buffers and brings pH back up to 6.5/7
97
What type of luting cement might you use to cement a zirconia crown?
GIC
- Aquacem
