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Clinical knowledge II > Manifestations of disease > Flashcards

Manifestations of disease Flashcards

1
Q

What determines a caries risk assessment?

A

Frequency of sugar.
Fluoride exposure.
Oral hygiene.
Medical conditions
Caries experience.
Medications
Family caries experience.

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2
Q

What clinical findings place someone in the high risk caries category?

A

White spot lesions.
Presence of active decay.
Amount of lesions.
Previous restorations/caries experience.
The extent of the carious lesions.
The presence of plaque.
Extractions.
Orthodontic appliances.

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3
Q

What parts of a person’s social history may affect their caries risk?

A

Social deprivation.
Caries in family.
Lack of knowledge surrounding dental disease.
Education.
Alcohol intake.
Diet.
Low dental aspirations

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4
Q

What systemic diseases cause xerostomia?

A

Diabetes
Rheumatoid arthritis
Sjrogren’s syndrome
HIV
Scleroderma
Lupus
Sleep apnoea.

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5
Q

What can cause acidic dental erosion?

A

GORD.
Alcohol.
Carbonated drinks.
Sugary drinks.
Bulimia.
Fruit juices.
Xerostomia due to lost buffering capapcity.

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6
Q

What advice would you give to someone with NCTSL?

A

Referral to a specialist if bulimia or GORD is suspected.
Saliva promoting gels, spray or tablets.
Diet advice to reduce acidic drinks.
Alcohol cessation.
Brush with 1350ppm-1500ppm fluoride toothpaste.
TBI - not brushing after eating/sick.

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7
Q

What makes a person high perio risk?

A

Presence of PRF.
Poorly controlled diabetes.
Smoking.
Smokeless tobacco use.
Family history of periodontitis.
Ethnicity.
Socio-economic status.
Plaque biofilm.
Occlusion

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8
Q

What are the clinical findings that make a patient high perio risk?

A

More than 30% BoP
More than 20% plaque
Plaque retentive factors.
BPE.
Recession
Bone loss on radiographs
Tooth mobility
Tooth loss.

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9
Q

What are the clinical presentation of a smoker?

A

Staining
Halitosis
Hairy black tongue.
Candidiasis.
Mobility
Tooth loss
Lack of BoP due to vasoconstrictor in nicotine.
Stomatitis
Gingival recession.

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10
Q

What makes a person high risk for developing oral cancer?

A

Tobacco and alcohol use.
HPV-16
Gender
Excess body weight.
Age.
Sun exposure
Poor nutrition.
Genetics.

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11
Q

How ca coeliac disease present orally?

A

Glossitis
Angular cheilitis
RAS
Enamel Hypoplasia

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12
Q

How can Crohn’s disease present orally?

A

Swelling of the lips
Mucosal tags
Oral Ulceration
Angular cheilitis
Lip fissures
Perioral erythema
Full width gingivitis

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13
Q

How can ulcerative colitis present orally?

A

Apthous ulcers
Angular cheilitis.

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14
Q

How does GORD present oraly?

A

Dental erosion on palatal aspects.
Antacids

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15
Q

How does hepatic disease present orally?

A

Intra-oral jaundice.
Impaired haemostasis.
Prolonged bleeding

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16
Q

Hoe does anaemia present orally?

A

Pallor
Glossitis
Oral candidosis
Axacerabtion of RAU.
Plummer-Vinson syndrome.

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17
Q

How can leukaemia present orally?

A

Gingival swelling
Oral ulceration
Leukaemic deposits.
Oral purpura.
Candida

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18
Q

How can platelet disorders present orally?

A

Purpura.
Petechial haemorrhages
Blood filled blisters on the oral mucosa.

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19
Q

What causes platelet disorders?

A

Idiopathic thrombocytopaenia
Connective tissue diseases
Acute leukaemias.
Drug associated
HIV

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20
Q

What should be avoided in patients with bleeding disorders?

A

IDB
Aspirin
NSAIDs

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21
Q

What are the oral manifestations of lupus?

A

Lichenoid.
Purpura
xerostomia

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22
Q

What are the oral associations with Rheumatoid arthritis?

A

Sjogren’s Syndrome
Limited opening
crepitus
Stiffness
Pain

23
Q

How may Sjogren’s syndorme present clinically?

A

Parchment like mucosa.
Lobulated depapillated tongue.

24
Q

What is the clinical presentation of scleroderma?

A

Restricted opening
Dysphagia
Widening of the periodontal ligament
Trismus

25
Q

Why is COPD relevant to Treatment?

A

Periodontal susceptibility.
Trigger airway problems
Best treated upright
Difficult for rubber dam.
Smoking cessation

26
Q

What is lichen planus?

A

Bilateral white striations, papules or plaques on the buccal mucosa.

27
Q

What type of lichen planus is the most common?

A

Reticular.

28
Q

What type of lichen planus is the most symptomatic?

A

Erosive.

29
Q

What are the 4 types of epulides?

A

Pregnancy
Fibrous
Giant cell
Carcinomas

30
Q

How would you manage a pregnancy epulis?

A

OHI
May regress after delivery.
May need exision.

31
Q

How do you assess the risk of pain or sepsis before exfoliation?

A

Extent of the lesion
Site of the lesions
Activity of the lesions
Time until exfoliation
Number of other lesions present
Anticipated co-operation from the child.
Anticipated co-operation from the parent.
The range of procedures the clinician is able to provide.
Medical status of the child.

32
Q

What medical information would you gather to risk assess a child?

A

Medications
Medical Conditions
Allergies
hospitalisation

33
Q

What social information would you gather to risk assess a child?

A

Siblings
School
Distance travelled
Attitude to dental health

34
Q

What dental health information would you gather to risk assess a child?

A

Attendance
Previous treatment (GA)
Brushing habits
Fluoride exposure
Complaints
Diet

35
Q

What factors would influence your decision in a paediatric patient?

A

If the child is in pain.
The extent of the lesion.
Which tooth the lesion is present.
Co-operation
Time to exfoliation.
IF the parent is there to consent.

36
Q

In which order should treatment be carried out?

A

Pain prevention.
Prevention
Intervention

37
Q

What is the significance of a BPE code 2?

A

The the black band is visible - less than 3.5mm.
Sub/supra gingival plaque or calculus present.
A screening tool that along with clinical examination will help to diagnose.
BSP outlines treatment for code 2 as OHI, plaque and bleeding charts, PMPR, review at next appointment in 3-6 months.

38
Q

How would you manage periodontal treatment with a patient who is nervous and has cerebral palsy?

A

Acclimatisation with short appointments.
Starting with prevention unless the patient is in pain.
NCTSL, periodontal disease, caries, drooling, xerostomia are common in patients with cerebral palsy.
- Gaining appropriate consent.
- Treatment modifications. (wheelchairs/hoists/stability aids/carer.)
- Different motor skills determine OHI modifications.
- Sedation or GA referral depending on patient anxiety for restorations.

39
Q

How would you carry out treatment to a patient with cerebral palsy?

A

OHI – Brushing twice a day with a modified toothbrush, carers help, make sure to give advice to carer also. Using NaF toothpaste (prescription from dentist for NaF 5000ppm, 0.05% NaF MW to be used during the day).
Plaque and bleeding indices.
PMPR – May hand scale due to patient being nervous to gradually integrate them into the dental practice
Longer appointments.
Treating xerostomia with saliva promoting tablets.
Fluoride varnish (2.26%) application twice a year.
Diet advice – Limiting sugar to meal-times, nothing just before bed. Sugar free medication
Restorations – Do one at a time, GI restorations. Maybe sedation or GA depending on co-operation.

40
Q

What are the factors that increase risk caries prevalence amongst the aging population?

A

Xerostomia
Polypharmacy
Previous periodontal disease (Recession).
Diet
Lack of fluoride (less than 1350ppm)
Root morphology
Living in a residential home.
Social deprivation
Cariogenic medicines.
Physical disability.

41
Q

How would you manage a vaso-vagal syncope?

A

Prevention: -
Raise patients legs above head.
Management if they become unconscious: -
Lay patient supine.
Monitor pulse.
Give oxygen if necessary.

Once recovered may give glucose drink.

42
Q

What would you find in the medical emergency kit?

A

Glyceryl trinitrate (GTN) spray (400micrograms)
Salbutamol aerosol inhaler (100micrograms)
Adrenaline injection (1:1000, 1mg/ml)
Aspirin dispersible (300mg)
Glucagon injection 1mg
Oral glucose solution
Midazolam 5mg/ml buccal
Oxygen
Oxygen face mask & tubing
Basic set of oropharyngeal airways.
Pocket mask with oxygen port
Self-inflating bag and mask.
Variety of well fitting adult and child facemasks.
Portable suction
Single use sterile syringes and needles
Automated blood glucose measurement device
NIBP / Pulse Oximeter
Automated External Defibrillator

43
Q

What is a dentoalveolar infection?

A

A pus producing infection associated with the teeth and supporting structures.

44
Q

When are antimicrobials recommended?

A

As an adjunct to definitive treatment where there is an elevated temperature, evidence of systemic spread and local lymph involvement.

45
Q

What is a periapical abscess?

A

An acute infection that are associated with the apex of the tooth. This can cause systemic effects.

46
Q

What is deciduous pulpal involvement?

A

The soft irreversible dentine extends into the pulp causing irreversible changes before pulpl exposure.

47
Q

What is a periodontal abscess?

A

Usually from trauma at the opening of the gingival pocket.

48
Q

What is ANUG?

A

It is associated with poor oh, smoking and stress. Halitosis, ulceration, malaise. Treatment with PMPR.

49
Q

What is periocoronitis?

A

Inflammation associated with the crown of a partially erupted tooth.

50
Q

What is the herpes simplex virus?

A

Infectious until the crusting is complete. Advice aciclovir.

51
Q

What are the predisposing factors to candida?

A

Age
Pregnancy
Trauma
Diet
Asthma
Diabetes
Malignancy
AIDs/HIV
Xerostomia
Antibiotics
Smoking

52
Q

What are the differential diagnosis’ to candida?

A

Geographical tongue
Leukoplakia.
Hairy tongue.
Lichen planus
HIV infection
Oral cancers.

53
Q

What are the clinical presentations of a squamous cell carcinoma?

A

White or red patch
Non healing ulcer
Earache
Mostly Painless
Dysphasia
Enlarged lymph
Lower lip

Clinical knowledge II (18 decks)

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