OSCE prep Flashcards
(108 cards)
1
Q
Name four uses of elevators
A
-to provide a point of application for forceps -to loosen teeth prior to using forceps -to extract a tooth without the use of forceps -removal of multiple root stumps -removal of retained roots -removal of root apices
2
Q
What are the modes of action of elevators?
A
-Wheel and axle (rotation) -wedge -lever (up and down)
3
Q
What are the different warrick james elevators, and what are their uses?
A
-Warrick James are available in straight, right and left -they have a rounded tip -used to lever fragments of tooth from the socket
4
Q
What are the function and uses of couplands elevators?
A
-used to luxate and elevate fractured roots of maxillary anterior teeth at the crest level by wedging action alongside the root -elevates and lifts the tooth -elevates the free gingiva around the tooth prior to forcep use -separates the tooth from the periodontal membrane making the tooth loose in the socket and easier to extract with forceps -these tear the PDL -increase in number = increase in tip size
5
Q
What are the functions of Cryers elevators?
A
-lifting up roots -pointed tip levers fragment of root out of the socker -principle action is wheel and axle -introduced through the empty socket of one root of multi rooted mandibular molar teeth to engage and remove inter-septal bone and remaining roots
6
Q
What is a periotome?
A
-can be single or double ended -An instrument that facilitates the removal of teeth with minimal damage to the surrounding alveolar bone -it is used to sever the PDL from the surface of the tooth
7
Q
What is the ideal operator position when carrying out an extraction?
A
Right handed; operator stands in front of the patient and to their right for lower right extractions, operator stands behind patient and to their right
8
Q
In smoking cessation, what are the five A’s?
A
-ASK the patient about smoking habits, stopping smoking and past experiences -ADVISE the patient on the oral and general health effects and the personal benefits from stopping smoking -ASSESS whether the patient would like to quit, is thinking about quitting or doesn’t want to quit and record this in their notes -ASSIST by referring to smoking cessation services or give further information if undecided on quitting or not -ARRANGE follow up to review patient
9
Q
Name some nicotine replacement therapy drugs
A
-gum -lozenges -patches -inhaler -micro tabs -oral strips
10
Q
What drugs can be used in smoking cessation?
A
Champix (varenicline)
11
Q
what is the most successful method of quitting smoking?
A
With support via a smoking cessation service, 30% more likely to quit successfully
12
Q
What special tests are used to diagnose Sjorgens syndrome?
A
-dry eyes/mouth -autoantibody ANA , Ro and La -imaging findings -Radio nucleotide assessment -Histopathology findings four or more positive criteria for diagnosis
13
Q
What oral complications are associated with Sjorgens disease?
A
-oral infection risk is increased -increased caries risk -loss/decrease in functional swallowing -problems retaining dentures -salivary lymphoma -secondary to other connective tissue diseases (rheumatoid arthritis, systemic lupus erythametosis
14
Q
(Paeds) What 7 factors associated with dental caries should be recorded in risk assessment?
A
-clinical evidence of previous disease -dietary habits, especially frequency of sugary food and drink consumption -social history, especially socioeconomic status -use of fluoride -plaque control -saliva quantity and quality -medical history
15
Q
(Paeds) What volume and concentration of toothpaste is recommended for a child under 3 years of age?
A
A smear of toothpaste. Standard prevention = 1000-1500ppm Enhanced prevention = 1350-1500ppm
16
Q
(Paeds) What volume and concentration of toothpaste is recommended for a child over 3 years of age?
A
A pea sized amount of toothpaste Standard prevention = 1000-1500ppm Enhanced prevention = 1350-1500ppm Consider Duraphat 2800ppm for children over 10
17
Q
(Paeds) What advice should be given to parents on limiting foods and drinks containing sugar
A
Confine sugar containing foods and drinks to meal times. Grazing on sugar containing foods and drinks between meal times should be avoided
18
Q
(Paeds) If a mouthwash is recommended for a child, what fluoride content should be used?
A
225ppm F for children over 6 years
19
Q
What doses of fluoride tablets can be prescribed for children?
A
-6 months to 3 years = 0.25mg per day -3-6 years = 0.5mg per day 6 years and over = 1mg per day
20
Q
What are the toxic volumes of toothpaste for children?
A
-2 years = 3 tubes -4 years = 4 tubes -6 years = 5 tubes
21
Q
What precautions should be taken in case of fluoride overdose in children?
A
- <5mg/kg = oral calcium (milk) and observe - 5-15mg/kg = oral calcium (milk or calcium gluconate) and take to hospital ->15mg/kg = admit to hospital immediately for IV calcium gluconate and cardiac monitoring
22
Q
What acronym should be used when taking a pain history?
A
SOCRATES
23
Q
What does SOCRATES stand for?
A
-Site -Onset -Character -Radiates -Time -Exacerbating -Severity
24
Q
What is angina?
A
Reversible ischemia of the heart muscle; narrowing of one or more coronary arteries. Results from atherosclerotic plaques in the coronary arteries that restrict the blood flow and oxygen supply to the heart
25
Name some symptoms of angina
-no pain at rest -pain with certain level of exertion (can be worse in cold weather, or brought on by stress) -pain can feel tight, dull/heavy, and may spread to left arm, neck, jaw, back -breathlessness -pain relieved at rest -patient lives within their limitations -gradual deterioration
26
If you suspect a patient has angina what should you do?
Ask the patient if they have a diagnosis, if not, refer urgently to their GP
27
In taking a history from a patient, what should be the first question asked?
What is the patient c/o. ie what is the presenting issue and their reason for attending.
28
What is HPC in medical history taking?
History of the presenting complaint. Take notes in the patients own words and ask appropriate questions surrounding their complaint. ie if the patient fell, did they fall or trip, was there loss of consciousness, were they dizzy etc
29
What is the acronym SOCRATES used for?
Taking a pain history
30
What do the components of SOCRATES stand for?
Site (where is the pain) Onset (what were you doing at the time) Character (describe the pain; sharp, dull, radiating) Radiating (does the pain travel anywhere else) Associated symptoms (otherwise unwell, fever etc) Time (when did the pain start, how long does it last) Exacerbating (does anything make the pain better or worse) Severity (of pain from 1 - 10)
31
What is an inappropriate and appropriate method of taking a medical history
It is not enough to ask a patient 'do you have any medical conditions'. A medical history should be taken in a systematic approach.
32
How should a medical history be taken systematically?
-cardiovascular system (High/low BP, stroke, heart attack, angina. Medication, surgeries) -Respiratory system (Pneumonia, asthma, COPD, bronchitis, sleep apnea) -GI system (acid reflus, chrons, ulcerative colitis, cirrhosis, liver disease) -Endocrine (diabetes) -Musculoskeletal -Neurological -Blood disorders -Other medical conditions, surgeries or hospital admissions
33
Endodontics Describe a normal pulp
-symptom free and normally responsive to pulp testing -pulp may not be histologically normal -clinically normal pulp results in a mild or transient response to thermal cold testing lasting no more than a few seconds
34
Describe reversible pulpitis
(pulpal diagnosis)
-inflammation should resolve following appropriate management of the aetiology -discomfort is experiences when a stimulus applied lasting only a few seconds -occurs with exposed dentine, caries or deep restorations -no significant radiographic changes in the periapical region of the suspect tooth -pain is not spontaneous
35
Describe symptomatic irreversible pulpitis
(pulpal diagnosis)
-vital inflammed pulp incapable of healing and RCT indicated -characteristics may include sharp pain upon thermal stimulus, lingering pain, spontaneity and referred pain -pain may be accentuated by postural changes such as lying down or bending over -over the counter analgesics typically ineffective -common aetiologies may include deep caries, extensive restorations or fractures exposing pulpal tissue -may be difficult to diagnose as inflammation has not yet reached periapical tissues, thus not TTP -dental history and thermal tests are the primary tool for assessing pulpal status
36
Describe asymptomatic irreversible pulpitis
(pulpal diagnosis)
-vital inflammed pulp is incapable of healing, RCT indicated -no clinical symptoms and usually responds normally to thermal testing. May have had trauma or deep caries that would result in exposure
37
Describe pulpal necrosis
(pulpal diagnosis)
-diagnostic category indicating death of the pulp, necessitating RCT -non responsive to pulp testing and is asymptomatic -could be non responsive due to calcification, recent trauma or an unknown reason -does not by itself cause apical periodontitis -TTP or radiographic evidence of osseous breakdown
38
Describe previously initiated RCT
-tooth has been previously treated by partial endodontic therapy such as pulpotomy/pulpectomy -depending on the level of therapy, the tooth may or may not respond to pulp testing modalities
39
Describe normal apical tissues
-not TTP -radiographically, the lamina dura surrounding the root is intact and the PDL space is uniform -comparitive testing for percussion should always begin with normal teeth as a baseline
40
Describe symptomatic apical periodontitis
(apical diagnosis)
-represents inflammation, usually of the apical periodontium -painful response to biting and or percussion -may or may not be accompanied by radiographic changes depending on the stage of disease -severe TTP is highly indicative of a degenerating pulp, RCT needed
41
Describe asymptomatic apical periodontitis
(apical diagnosis)
-inlammation and destruction of the apical periodontium that is of pulpal origin -appears as an apical radiolucency and does not present clinical symptoms
No TTP or palpation
42
Describe a chonic apical abscess
-inflammatory reaction to pulpal infection and necrosis -characterised by gradual onset, little or no discomfort and an intermittent discharge of pus through and associated sinus tract -radiographically, signs of osseous distruction (apical radiolucency) -sinus tract tracing possible
43
Describe an acute apical abscess
(apical diagnosis)
-inflammatory reaction to pulpal infection and necrosis -characterised by rapid onset, spontaneous pain, extreme TTP, pus formation and swelling of associated tissues -may be no radiographic signs of destruction and the patient often experiences malaise, fever and lymphadenopathy
44
Describe condensing osteitis
(apical diagnosis)
diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of the tooth
This causes more bone production rather than bone destruction
45
what range should new equipment operate within?
60 - 70 kV
46
what is the advantage of rectangular collimation?
it reduces the exposure to the patient by 30% in comparison to circular collimation
47
what is the ideal focus to skin distance (fsd)?
at least 20cm
48
What do luxators look like and how are they used?
Fan shaped tips
Used to break/tear the PDL
49
What do elevators do and what do they look like?
Square shaped tip
Used to wedge between tooth and bone to lift tooth from socket
50
What do Cryers look like and how are they used?
Left and right pointed end used to elevate single roots, break the sequestrum between multirooted teeth
51
what acronym is used to remember the steps in BLS?
DRS ABCD
52
What does DRS ABCD stand for? Elaborate on each
Danger - check for danger, ensure area around patient is safe Response - check if the patient is responsive. Ask 'can you hear me?', agitate shoulders Shout - shout for someone near by who can help Airway - head tilt, chin lift. Check patients airways are clear from obstruction Breathing - Look, listen and feel for no longer than ten seconds Circulation - check simultaneously for carotid pulse while monitoring for breathing Defibrilation
53
How should an airway assessment be carried out?
Open airway using head tilt, chin lift and assess patency of airway. If foreign body is present and within reach attempt single finger sweep
54
How should breathing be assessed?
Ignore agonal breaths. Look, listen and feel for breathing
55
How is circulation assessed?
Palpate carotid pulse simultaneously with breathing for no longer than ten seconds
56
How should help be sought for a patient who has collapsed?
Shout for help from someone who may be nearby who can assist with CPR and call an ambulance.
57
What information needs to be given when phoning for an ambulance?
Dial 999 Ask for an ambulance State location, phone number and nature of emergency Must state 'cardiac arrest and patient is not breathing'
58
Describe how chest compressions should be carried out
Place hands in the centre of the chest, interlock fingers, lock arms and compress chest by 5-6cm deep at roughly 100-120 times per minute. Continue with as few interruptions as possible
59
How should an automatic external defibrilator be used (EAD)
Place pads in position as illistrated on bare flesh, ensuring good contact without interrupting compressions. Turn on AED and follow prompts If shock advised ensure no one is in contact with the patient by verbal and visual warnings. Deliver shock and immediately commence chest compressions Attempt ventilation with bag, valve, mask connected to 15L of oxygen with ratio of 30 compressions to two ventilations and look for chest movement Continue until paramedics arrive or patient responds
60
What is the ratio of chest compressions to ventilations?
30 compressions to two ventilations
61
What volume of oxygen should be connected to the bag, valve, mask?
15 litres
62
In paediatric BLS, when CPR is indicated, what is the first step?
Five rescue breaths before commencing with compressions
63
In paediatric BLS, how should help be sought?
CPR should be carried out for one minute before going for help if you are on your own
64
In paediatric BLS, what is the ratio of compressions to breaths?
15 compressions to two ventilations
65
During the coronavirus outbreak, what alterations should be made to delivery of CPR?
-Do not get too close to the patient to check breathing - When calling 999, put the operator on speaker phone and follow their instructions - Cover the patients nose and mouth loosely with a towel to reduce the risk of cross contamination -Do not give mouth to mouth, instead proceed with chest compressions -If available, use defibrilator as per instructions and prompts
66
What is the chain of infection?
- Infectious agent (bacteria, viruses, fungi, parasites) - Reservoir (dirty surfaces and equipment, people, animals) - Portal of exit (open wounds, skin, aerosols, splatter of fluids) - Mode of transmission (contact, ingestion, inhalation) - Portal of entry (broken skin/incisions, mucous membranes) - Susceptible host (elderly, any person, immunocompromised)
67
How is the chain of infection broken for contaminated forceps?
- The chain is broken at the reservoir where there are dirty contaminated forceps - You should break the chain by cleaning, disinfecting and sterilising the instrument prior to use
68
What are the differences between stable and unstable angina?
- Stable angina; chest pain or discomfort that often occurs with activity or stress that is relieved by rest
- Unstable angina; lack of blood flow and oxygen that may lead to heart attack
69
How does a heart attack differ from angina?
A heart attack occurs when blood flow is blocked for a long enough period that the the heart muscle is damaged or dies. Differs from angina in that the pain is more severe and persistent. It is not relieved by rest
70
What treatment can be provided in a dental setting for an angina/heart attack?
- Stop any treatment
- Sit patient upright
- 15l oxygen
- GTN spray
- 300mg aspirin chewed or crushed
- If symptoms to not alleviate, phone ambulance
71
Describe the symptoms associated with reversible pulpitis
- Mild inflammation
- The tooth may respond more than normal to certain stimulus such as temperature and sweet
- These stimulus tend to result in a sharp pain (A delta fibres) that resolves 5-10 seconds after being removed
- Once the cause of the inflammation has been removed then the pulp/dentine complex can return to normal
72
Describe the symptoms associated with irreversible pulpitis
- Dull aching pain (C fibres) that can last minutes up to hours
- Often worse at night keeping the patient awake or when lying down
- Symptoms can be brought on by temperature changes
- Removal of the cause of inflammation does not lead to pulpal regeneration and if left untreated can cause necrosis
- Treatment either RCT or ext
73
What are the stages of treatment planning?
- Relief of pain; temp restorations/extractions
- Disease control; restorations, extractions, HPT, smoking cessation
- Re-evaluation; assess if disease is under control
- Reconstructive phase; crowns, RCT, dentures
- Maintenance; check ups etc
74
What emergency drugs should be kept in a dental practice?
- Glyceral trinitrate (GTN) spray (400 micrograms)
- Salbutamol aerosol inhaler (100 micrograms)
- Adrenaline injection 1;1000 1mg/ml)
- Dispersible aspirin (300mg)
Glucagon injection (1mg IM injection)
- oral glucose tablets
- Midazolam (10mg/ml)
- oxygen
75
In the emergency drug kit, what is GTN spray used for?
- 400 micrograms; unstable angina
- Give sublingually
- If symptoms continue, give oxygen and phone ambulance
76
In the emergency drug kit, what is salbutamol inhaler used for?
- Asthma or mild breathing difficulties
- If not rapid response, give oxygen and phone ambulance
77
In the emergency drug kit, what is adrenaline injection used for?
- severe anaphylactic reaction
- IM injection
78
In the emergency drug kit, what is dispersible aspirin used for?
- Give immediately if MI suspected
- If possible, give without water as it will be absorbed faster
79
In the emergency drug kit, what is glucagon injection for?
-for hypoglycemia when the patient is unconscious
80
In the emergency drug kit, what is oral glucose tablets for?
hypoglycemia when the patient is conscious
81
In the emergency drug kit, what is midazolam used for?
for recurrant seizures or seizures lasting longer than 5 minutes
82
What is anaphylaxis?
Severe allergic reaction
83
What are some signs and symptoms of anaphylaxis?
- Urticaria; raised areas due to oedema
- Erythmia (red rash)
- Runny nose
- Inflammed eyes
- Difficulty breathing, wheezing, hoarse voice, coughing
- Patient may be pale, clammy, confused, or have an impending sense of doom
- Low BP
- Respiratory/cardiac arrest
84
What is the management of anaphylactic shock?
- Lay patient flat and raise legs
- Oxygen; 15l per minute
- Call ambulance
- Salbutamol can be given if mild
- If severe; give adrenaline 0.5mg IM injection into middle of vastis lateris muscle of thigh
- Repeat every five minutes depending on improvement
- If patient becomes unconscious, commence CPR
85
What is the systematic method of giving a radiographic report?
- Name the x-ray ie bitewing
- Grade the quality of the x-ray (1 = excellent, 2 = diagnostically acceptable, 3 = diagnostically unacceptable)
- Criteria for bitewings; show teeth from mesial of first premolar to distal of last tooth, upper and lower equally. Critical to see the enamel dentine junction. Desirable to have no overlap
- Criteria for periapical; full length of at least one tooth should be seen as well as surrounding anatomical features
- State what teeth can be seen
- List previous treatment ie RCT, PBC
- Bone levels
86
What are the types of systemic antimicrobials?
- Amoxicillin 500mg + metronidozole 400mg - Metronidozole alone - Erythromycin - Doxycyclin - Tetracycline
87
What is necrotising ulcerative gingivitis?
A common, non contagious infection of the gums. Acute necrotising ulcerative gingivitis is the usual course the disease takes. If improperly treated NUG may become chronic and/or recurrent
88
List some of the signs/symptoms that a diagnosis of necrotising periodontal disease is based on
- Ulcerated and necrotic papillae and gingival margin resulting in a characteristic punched out appearance. - The ulcers are covered by a yellowish/white/grey slime made of fibrin, necrotic tissue, leucocytes, erythrocytes and mass of bacteria - Lesions develop quickly -Lesions are very painful - Bleeding readily provoked -The first lesions are most often seen interproximally in the manibular anterior region -Foul smell -Ulceration often associated with deep pockets as gingival necrosis coincides with loss of crestal alveolar bone -Sequestrum formation; necrosis of small or large parts of the alveolar bone. Not only interproximal but also adjacent oral and facial bone - Swelling of lymph nodes
89
What are some risk factors associated with necrotising perio disease (NP)
-malnourished - psychological stress - Sleep deprivation -Poor OH -Smoking -Immunosuppresion
90
Give the four stages of treatment for NP
1). Ultrasonic debridment 2). Pain may prevent patient from brushing, instead 0.2% chlorhexidine mw 2 x daily 3). Patients with malaise, fever and lassitude, lack of response to mechanical therapy and impared immunity; 200mg/400mg metronidazole TID for 3 days 4) Smoking cessation, vitamin supplements, dietary advice
91
Define periodontal disease (gingivitis/periodontitis)
A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque.
- Gingivitis does not always progress to periodontitis.
- Periodontitis may progress at different rates at different sites in the mouth and in different people
92
What are some modifying risk factors associated with periodontal disease?
- Smoking
- Systemic diseases (diabetes melitus, leukaemia, HIV, osteoperosis, osteopenia)
- Stress
- Drugs (calcium channel blockers, immunosuppresants, anti-convulsants)
- Nutrition and obesity
- Pregnancy
93
What are some risk determinants of periodontal disease?
- Genetic polymorphism can affect expression levels of genetic products.
- Sex
- Genetic disorders and syndromes
- Socio-economic status
94
What are some local risk factors of periodontal disease?
Plaque retentive factors such as; calculus, restorations, carious cavities, partial dentures, orthodontic appliances, malpositioned teeth
Other factors such as traum from occlusion and insufficient oral hygiene
95
Explain how smoking can have an impact on periodontal health
- Effect on oral microbiota
- Increased activation of the immune system
- Decreased healing capacity (reduced blood flow)
96
What drugs can have an impact on gingival health and how can this present?
- Anti-convulsants such as phenytoin.
- Immunosuppresants (in implant patients)
- Calcium channel blockers (nifedipine, amlodipine)
- Can cause ginigival enlargement = more fibroblasts
- Can cause gingival swelling = more intercellular fluid, increased permeabilisation of the vessels
97
What are the four staging categories of periodontal disease?
1. Early/mild. Interproximal bone loss at worst site \<15% or 2mm
2. Moderate. Bone loss; coronal third of root
3. Severe. Potential for additional tooth loss. Bone loss; mid third of root
4. Very severe. Potential for loss of dentition. Bone loss; apical third of root
\*Use maximum bone loss at worst site. If BWRs are all that's available, measure from CEJ. If known to have lost teeth due to periodontitis - can be assigned stage four
99
What are the three categories of grading periodontal disease?
A. Slow. \<0.5 (max bone loss less than half patients age)
B) Moderate. 0.5-1
C Rapid. \>1.0 (max bone loss more than patients age)
100
How is local and generalised periodontal disease or gingivitis defined?
\< 30% is of teeth/gums affected = localised
\> 30% teeth/gums affected =generalised
101
How do you carry out an assessment of current periodontitis status?
\*Currently stable - BoP \<10%. PPD \<4mm. No BoP at 4mm sites
\*Currently in remission - BoP \>10%. PPD \<4mm. No BoP at 4mm sites
\*Currently unstable - PPD \>5mm or PPD \>4mm and BoP
102
Give the applications of the mini-sickle (red)
Red A point scaler with two cutting edges on each blade. Used on buccal and lingual embrasure surfaces supra gingivally
103
Give the applications of the columbia curette (red)
Red A universal curette with two cutting edges on each blade. Used for sub gingival scaling anywhere in the mouth Limited access to deep pokets
104
Give the applications of the Gracey curette 1-2 (grey)
Grey single cutting edge used for fine/deep sub gingival scaling upper and lower anteriors
105
Give the applications of the Gracey curette 7-8 (green)
Green Single cutting edge Buccal and lingual surfaces of posterior teeth
106
Give the applications of the Gracey curette 11-12 (orange)
Orange mesial surfaces of posterior teeth
107
Give the applications of the Gracey curette 13-14 (blue)
Blue distal surfaces of posterior teeth
108
Give the applications of the hoe scaler 134-135 (yellow)
Yellow Gross supra and sub gingival scaling of buccal and lingual surfaces
109
Give the applications of the hoe scaler 156-157 (red)
Red supra and subgingival scaling mesial and distal surfaces
