Dental and Oral health

Question 1

What is Dental Caries?

Answer 1

Holes in Teeth

Question 2

When does dental caries occur?

Answer 2

As soon as the teeth erupt

Question 3

Whats the cause for dental caries?

Answer 3

1. Dental plaque adheres to surface of teeth
2. Bacteria (predominantly streptococcus mutans) adhere to plaque
3. Bacteria produces acid which dimineralises tooth structure

Question 4

What occurs when dental caries is left untreated?

Answer 4

Untreated may infect the pulp chamber leading to a spreading infection. This can lead to **fatal **consequences (e.g. Ludwigs Angina)

Question 5

Treatment for dental caries

Answer 5

1. Referral to dentist is required
2. Paracetamol (4g max) and Ibuprofen (2.4g max). Generally 1TDS of each.

Question 6

What is Periodontitis?

Answer 6

Inflammation of the ligaments attaching the tooth to bone leading to bone loss around teeth

Question 7

What causes periodontitis?

Answer 7

1. Foreign body is stuck to teeth
2. Bacterial attachment
3. localised inflammation
4. bone loss

Question 8

Symptoms of Periodontitis

Answer 8

Pain and wobbly teeth

Question 9

People with periodontitis (gum disease) are very likely to have type 2 diabetes and vice versa. True or False

Answer 9

True

Question 10

Treatment for Periodontitis

Answer 10

• Referral to dentist is required
• In the meantime analgesics + chlorhexadine mouthwash TDS (three times a day)

Question 11

What is Gingivitis?

Answer 11

Inflammation of the gums

Question 12

Treatment for Gingivitis

Answer 12

Advise patients to brush twice daily as well as CHX mouthwash (e.g. Savacol) for 2 weeks

Question 13

What is Alveolar Osteitis “Dry Socket”:

Answer 13

• Only occurs following a tooth extraction
• Localised painful inflammation of the bone surrounding extraction socket following premature loss/breakdown of the
  blood clot

Question 14

Treatment for Alveolar Osteitis “Dry Socket”:

Answer 14

Paracetamol (4g max) and Ibuprofen (2.4g max).
Generally 1TDS of each - referal to dentist

Question 15

Causes for Alveolar Osteitis “Dry Socket”

Answer 15

women on the pill, type 2 diabetes, smokers

Question 16

What is MRONJ – Medication Related
Osteonecrosis of the Jaw?

WILL BE IN THE EXAM

Answer 16

Exposed bone in the maxilla or mandible that has been
present for more than 8 weeks following a tooth extraction

Question 17

What causes MRONJ?

Answer 17

People that have osteoporosis will take biphosphonates and mono-clonal antibodies. This will interfere with bone turnover (stop the cells that break bone down from working). This makes bone more dense. Blood supply is not efficient –> difficult to do certain oral procedures (wont heal properly) –> exposed bone in the maxilla following a tooth extraction in an old lady taking biphosponates or mono-clonal antibodies

Question 18

List the 2 groups of medicines that cause MRONJ

Answer 18

1. Bisphosponates and Mono-clonal antibodies
   - Biphosponates (Alendronate, Risedronate, Zoledronic acid)
   - Denosumab (mono-clonal antibody)

Question 19

Outline counselling points for MRONJ

Answer 19

1. If a patient is prescribed a bisphosponate: advise them on speaking to a dentist before you start the medication about any dental work that needs to be done. If dental work is required: needs to be done before taking the bisphosponate

Question 20

What is an ulcer?

Answer 20

Exposure of underlying connective tissue (nerve endings - quite painful)

Question 21

What causes traumatic ulcers?

Answer 21

hot foods, chemical burns, sharp broken teeth

Question 22

Ulcers should only be present for 3 weeks as cells in the mouth lay down new mucosa every 3 weeks. True or False

WILL BE IN EXAM

Answer 22

True

Question 23

If ulcers are present for more than 3 weeks then it signifies that something else may be going on (not an ulcer). Why is this the case?

Answer 23

Usually ulcers should be present for only 3 weeks as at the 3 week mark cells in the mouth lay down new mucosa - ulcer is gone. > 3 weeks need to see the doctor

Question 24

What is infective ulcers?

Answer 24

Ulcers secondary to a bacterial, viral or fungal infection

Question 25

An example of a viral infection that causes infective ulcers

Answer 25

Herpangina - viral illness in children

Question 26

What are cold sores?

Answer 26

1. Recurrent oral mucocutaneous herpes simplex virus (HSV) infection follows latent activation of the virus.

Question 27

Where do cold sores occur?

Answer 27

Usually occur on the lips

Question 28

When do cold sores take place

Answer 28

Lesions are preceded by the **prodromal stage** (lasts several hours to days) : burning, tingling, itching

Question 29

Referral Points for Cold Sores

Answer 29

1. Patients with severe recurrences of herpe (cold sores) 2. Patient with generalized or chronic herpes infection 3. Immunocompromised patient 4. Patients with HIV

Question 30

List the causes of fungal infections of the mouth

Answer 30

Local factors: **Dentures**, salivary gland hypofunction, **corticosteriod inhalers**, poor oral hygiene, smoking Systematic Factors: Immunocompromised patients, drugs

Question 31

. For Pseudomembranous Candidiasis and Angular Chelitis referral is necessary (either dentist or GP). Intra-oral white lesions may be much more sinister and require further investigation. True or False

Answer 31

True

Question 32

What is teething?

Answer 32

Tooth eruption generally accompanied by pain, swelling, drooling, irritability

Question 33

Counselling points for teething

Answer 33

1. Teething gels should not be used because of the lack of evidence of efficacy and the potential for harm 2. What is suitable: cold cucumbers, teething rings, rubbing gums with clean finger

Question 34

Treatment for Dentures

Answer 34

Polident

Question 35

When paracetomal and ibuprofen are taken seperately tend to absorb better. True or False

Answer 35

True

Question 36

List the 2 common medications that pharmacists will give out to patients that present with tooth pain

Answer 36

* Paracetamol 500mg 1TDS (Max dose 4g/24hrs) * Ibuprofen 200mg 1TDS (Max dose 2.4g/24hrs) – Beware of patients with hypertension, heart failure, active peptic ulcer disease or GI bleeding.