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BOARDs > Endo OSCE > Flashcards

Endo OSCE Flashcards

1
Q

How do you perio probe

A

Insert probe into sulcus until resistance
* parallel to long axis of tooth
* tip against tooth
* .2-.25N of pressure

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2
Q

What does probing assess?

A

Gingival Health
Cracked Teeth
BOP=Inflammation
Suppuration=neutrophils/infection

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3
Q

How do you test and classify mobility?

A

Miller Classification: Mobility
1. Grade 1: 0.5-1.0 mm (more than normal)
2. Grade 2: 1.0-2.0 mm
3. Grade 3: >2.0 mm Or depressible

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4
Q

What can cause mobility

A

Loss of Periodontium
Occlusal Trauma

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5
Q

Occlusal trauma

A

Primary:
* Greater than normal occlusal forces are placed on teeth

Secondary:
* Normal or excessive occlusal forces placed on perio compromised teeth

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6
Q

Signs of occlusal trauma

A

Fremitus
mobility
Widened PDL

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7
Q

How is occlusion evaluated in endo?

A

Articulating Paper

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8
Q

What is the most important diagnostic aid

A

Listening to pt’s chief complaint

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9
Q

How do you perform vitality testing

A

Cold or EPT

PFM crown
* Can’t be tested accurately
* access prep w/o anesthesia, Vital pulp- surface of restoration or enamel can be penetrated w/o too much discomfort–>if vital=sudden pain w/dentin is reached; Necrotic if no discomfort or pain w/dentin

Cold Test
* Carbon Dioxide snow or refrigerant
* sensitivity=75% (ability to detect pulp necrosis that is verified clinically)
* Specificity=92% (ability to detect normal pulp)

EPT:
* Sensitivty: 92%
* Specificty: 75%

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10
Q

How to perform percussion testing? What does it assess?

A

Tap on tooth either parallel or perpendicular to crown
* painful=periapical iinflammation-might be sharp pain
* Percuss neighboring teeth and contralateral
* Neighboring teeth often show some tenderness-spread of cytokine and neuropeptides=lower pain threshold

If pain on chewing
* Bite test-bite down on cotton swab

Sharp, Brief pain on biting
* Tooth slooth or cotton swab
* reproduce symptom
* apply to different cusps until pt recongnized same type of pain=CRACK
* might be hidden under large occlusal restoration

Normal to occlusal percussion but sensitive to lateral percussion
* cause=occlusal prematurity or wear pattern in lateral excursion

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11
Q

How do you perform palpation? What does it assess?

A

Firm pressure on mucosa over the apex
* how far inflammatory process has extended periapically
* Painful response=Periapical inflammation

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12
Q

What does heat indicate and how is it performed? What are the possible results?

A

Performed:
* Warm gutta percha
* Warm water
* Burlew wheel
* Polishing Point

Not as accurate as cold or EPT

Exaggerated and lingering after hold or cold=Irreversible pulpitis
* No response w/other tests=Pulp Necrosis

Stimulate C fibers

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13
Q

What does cold indicate and how is it performed? What are the possible results?

A

Endo Ice: Tetrafluoethane (- 26 C)
Carbon Dioxide Snow (-98C)

Stimulates A delta fibers

False Negative Response
* happens w/calcific metamorphosis

False Positive:
* cold contacts gingive or transferred to adjacent teeth w/positive pulps

Exaggerated & LIngering reponse=irreversible pulpitis
No response=Pulp Necrosis

CO2 Snow: (-98C)
* Sensitivity=75% (detect pulp necrosis & verified clinically)
* Specificity: 92% (Detect normal pulp)

EPT:
* Sensitivity: 92%
* Specificity: 75%

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14
Q

What does EPT indicated and how is it performed? What are the possible results? What do the numbers mean?

A

Directly stimulate nerve fibers w/a gradually increasing current
* Does not cause tubule fluid movement

Advantage: Calcified canals
Disadvantage: only detects vital or non-vital

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15
Q

What is more informative, Cold or EPT?

A

Cold
* can indicate pulp condition

EPT:
* Only indicate vital or necrotic

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16
Q

What is the rationale for using a control tooth?

A

Reference

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17
Q

What is transillumination? What does it test? What is a positive transillumination? What instrument is used to perform this test?

A

Identifies longitudinal crown fractures
* Fracture does not transmit light

Mandibular 2nd molar=most commonly cracked tooth

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18
Q

What is the tooth slooth and what is it used for?

A

Bite test

When pt presents with sharp, brief pain on biting
* Tooth slooth or cotton swab to reproduce
* =Crack

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19
Q

Abnormal Palpation results, percusion results, or bite tests results in what diagnosis

A

Symptomatic apical periodontitis

Acute apical abscess=swelling present

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20
Q

What is Vista Blue and what is it used for?

A

Vista Blue
* Detect fractures and hard to find root canal orifices
* unit dose packaging-limit risk of staining
* individual brush tip-used for 1 pt and no sterilization/Throw away

Methylene blue due
* superior pooling and visibility
* preferred over caries indicator dyes for identifying extra and intra-coronal cracks
* Apply w/disposable applicator tip
* Will stain clothing and countertops

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21
Q

Describe the indication for antibiotic use

A

Pt has:
1. systemic involvement
* fever, malaise, cellulitis, trismus, dysphagia, lymphadenopathy, immunocompromised

  1. Acute apical abscess w/no drainage
    * can also do I&D
22
Q

Strategies for post-op pain control

A

Penicillin:
* 1g loading
* 500 mg q6h 3-7 days

Amoxicillin:
* 1g loading
* 500 mg q8h 3-7 days

Clindamycin (for endo)
* 600 mg loading
* 300 mg q6h x7 days

MILD PAIN
Ibuprofen
* up to 800 mg q6h

MODERATE PAIN:
Tylenol 500 mg q6h

SEVERE PAIN (impacted teeth, perio surgery, complex implant placement)
Hydrocodone q6h

23
Q

What are pulpal diagnosis

A

Normal
* Inflamed
* Reversible Pulpitis
* Symptomatic Irreversible pulpitis
* Asympatomatic Irreversible Pulpitis
* Necrotic
* Previously initiated tx
* Previously treated

24
Q

Normal Pulp

A

No Symptoms
normal response to pulp testing
* mild or transient response to cold test
* does not last more than 1 or 2 secs

25
Q

Reversible Pulpitis

A

inflammed vital Pulp-> Can heal to NORMAL

Discomfort w/cold or sweet
* goes away w/in a couple of seconds

Causes:
* Exposed dentin
* careis or deep restorations

No spontaneous pain

26
Q

Symptomatic Irreversible Pulpitis

A

Vital inflammed pulp=can’t heal
TX=RCT

Characteristics:
* Sharp pain to thermal stimulus
* Lingering pain (30 secs or longer)
* Spontaneous-wakes patient up at night
* Sometimes sensitive to heat
* Referred pain
* Postural changes-analgesics don’t work

Causes:
* Deep caries
* extensive restorations
* fractures exposing pulp

27
Q

Asymptomatic Irreversible pulpitis

A

Vital inflamed pulp can NOT heal
TX=RCT

No symptoms:
* respond normal to thermal

causes:
* trauma
* Deep caries–> pulp exposure

28
Q

Pulp Necrosis

A

Pulp Death
* No response to thermal testing-> can be due to calcified canal, recent hx of trauma, or just not responding
* asymptomatic

Does not cause apical periodontitist by itself unless canal is infected

29
Q

Previously Treated Pulp

A

Endo treated tooth
* Canals are obturated but not intracanal medicaments
* no response to cold or EPT

30
Q

Previously Initiated Pulp therapy

A

partial endo treated tooth
* Pulpotomy or pulpectomy
* may not repsond to endo testing

Might still have symptoms

31
Q

Normal Apical Tissue

A

Not sensitive to Percussion/Palpation
* Radiographically-intact PDL/Lamina dura
* Normal Bone

32
Q

Symptomatic Apical Periodontitis

A

Periapical Inflammation
* painful to biting, percusion or palpation

Radiographic:
* Normal
* Widened PDL
* Periapical Radiolucency

33
Q

Asymptomatic Apical Periodontitist

A

Inflammation & Destruction of apical periodontium
* Origin: Pulp

Periapical Radiolucency
* No discomfort to percussion, palpation, biting

34
Q

Chronic Apical Abscess

A

Gradual Onset-little to no discomfort

Asymptomatic
* Sinus tract present-pus
* Periapical Radiolucency
* No discomfort to palpation, percusion, or biting

35
Q

Acute apical abscess

A

Rapid onset
* spontaneous pain
* extreme tenderness to palpation/percussion
* swelling

Might have fever, malaise, lymphadenopathy

Usually has apical radiolucency

36
Q

Condensing Osteitis

A

Diffuse radiopaque lesion at apex
* Long standing apical inflammation

rare

37
Q

Local Anesthesia Strategies

A
38
Q

If there is a periapical lesion of endo origin, the pulp dx is?

A

Necrotic

39
Q

Distinguish b/w various post-op complications (and strategies to prevent them from happening)

A

Pre-op pain decreased by
* 50% after 24 hr
* 90% after 1 week

Sinust tract heals b/w 1-2 weeks

Apical Radiolucency
* 88% show signs of healing b/w 3-12 months post-op

40
Q

What are the 6 specialities represented in IPEC

A

Dentistry
Nursing
Medicine
Osteopathic Medicine
Pharmacy
Public Health

41
Q

What are the 4 topics of interest for competencies

A

Values & Ethics
Roles & Responsibilities
Interprofessional communication
Teams and teamwork

42
Q

Triple Aim

A

Improve pt experience of care
Improve population health
Reduce per capita cost of health care

Implemented in Patient Protection & Affordable Care Act in 2010

43
Q

What other fields should health professional be competent in?

A

Law
Business
Architecture
Urban Planning
Teaching
Engineering

44
Q

Most important outcome of IPEC’s expanded competency model?

A

Providing an enabling framework for
* clinical care providers
* public health practitioners
* professionals from other fields

To collaberate more effectively
* optimize health care across multiple disciplines
* Advance population health

45
Q

How many dental schols required IPE in 2012? 2015?

A

2012: 34%
2015: 69%

46
Q

Commission on Dental Accreditation (CODA) is member of what related to IPE

A

Health Professions Accreditors Collaborative (HPAC)

47
Q

What are the modules & topics of IPEC

A

Modules:
* range from case-based resources, evaluation tooths, & multimedia resources

Primary Topics:
* Communication skills
* curriculum development or evaluation
* health education
* clinical performance evaluation

48
Q

What are the 8 reasons why it is important to agree on a set of core competencies across professions?

A
  1. Create coordinated efffort across health professionals
  2. Foundation for learning continuum in interprofessional competency development
  3. Evaluation & research will strengthen scholarship
  4. Inform professional liscencing of potential testing content for interprofesional collaberative practice
49
Q

Sub-competencies for values & ethics

A

Pt’s & Populations interests at the center of interprofessional health care delivery

Promote health & health equity across life span

Respect the privacy of pts by maintaining confidentiality during team based care

50
Q

Subcompetencies of Roles & Responsibilities

A

Recognize limits in skills, knowledge & abilities

communicate clearly role & responsibility to pts, families, etcs

51
Q

Sub-competencies of interprofessional communication

A

give instructive feedback to others on team
* respond respectfully to feedback from others

use respectful language during difficult situations

52
Q

Sub-competencies: Team & Teamwork

A

Use available evidence to inform effective teamwork and team-based practices

Peform effectively on teams & in different roles

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