Osce q's batch 2 1-3 Flashcards

Question

In an osce station you suspect a periodontal abscess, how should this be approached?

Answer 1

If pain history is given, no need to take a new one. Explain what is seen intraorally (ie, swelling, abscess, very deep pocket etc) Request special investigations - pulp testing and radiograph. Pulp will respond to testing and there will be no PAP

Answer 2

- Carry out careful sub-gingival instrumentation short of perio pocket to avoid iatrogenic damage (+/- LA) - If pus is present, drain via pocket or incision - Recommend analgesia - No ABs unless spreading infection or systemic involvement - Recommenduse 0.2% chlorhexidine mw - Review and carry out definitive perio tx - If systemic, pen v first line (250mg 2 tabs 4 x daily for 5 days.) - Amox 500mg 1 3 x daily 5 days - Metro 400mg 1 3 x daily 5 days - ABs only used in conjunction with mechanical Tx

Answer 3

- Early detection through soft tissue exam - Photos - Referral - Pre-treatment assessment

Answer 4

- Stidor (noisy breathing) urgent referral - Persistent unexplained H+N lumps >3 weeks - Ulceration or unexplained swelling of oral mucosa persisting > 3 weeks - All red or mixed red/white patches of oral mucosa > 3 weeks - Persistent hoarseness lasting > 3 weeks (request chest xray at same time) - Dysphagia or odynophagia (pain on swallowing) > 3 weeks - Persistent pain in throat > 3 weeks

Answer 5

- New pt assessment OMFS - Biopsy to confirm diagnosis - CT scan to investigate extent - Lymph node biopsy - CT scan to investigate metastasis - Staging and gradin

Answer 6

- full exam - OPT and PAs are a must - Detailed OHI, TBI, ID cleaning - Fluoride - topical, duraphat TP, MW - Tooth mousse - Dietary advice - PMPR - Consider CHX mw/gel - Restore carious teeth - Removal of trauma; sharp edges on teeth/dentures - Imps for fluoride trays/soft splint - XLA or poor prognosis teeth no less than ten days before cancer tx begins

Answer 7

- Surgical tumour resection can produce alterations to normal anatomy - H+N cancer tx can have adverse effects on respiration, mastication, swallowing, speech, taste, salivary gland function, mouth opening and outward appearance.

Answer 8

- Pain, swelling, limitation of function - Occlusal derangement - Numbness of lower lip - Loose or mobile teeth - Bleeding - Anterior open bite - Facial asymmetry - Deviation of mandible to opposite side

Answer 9

- clinical exam - Radiographic assessment - treatment (control of pain and infection) - Two basic principles - reduction and fixation

Answer 10

- OPT and PA mandible - Occlusal - Lateral oblique - Towns view - SMV - CT

Answer 11

Carried out only after cardiopulmonary and neurological exam deemed satisfactory. Soft tissue injuries; - Abraisions - Lacerations - Incision - Wound margins (well defined/clean cut edges, serrated, rounded, necrotic?) - Size - measure with ruler - Depth; dermal, fat, muscle or deep to bone Bruising - Describe colour; red/pink, bluish, greenish, yellow - Location; - Mastoid (Battle sign) may indicate significant brain injury. - Bilateral peri-orbital, inner canthus, lower border of mandible - Haematomas; a solid swelling of usually clotted blood within the tissues caused by a break in a vessel wall - Ear; cauliflowering and any associated bleeding/CSF otorrhoea Swelling; - Palpate Visible deformation - Eg flattened malar region or zygomatic arch deformity, nasal bone deformity, frontal bone depression. Pupilary level, eye position. Abnormal movement; - upon extra-oral palpation - Malocclusion - Impared function - Nerve injury (examine cranial nerves) Tenderness and pain Intra-oral; - sublingual bruising - Gingival lacerations - Palatal bruising - Mandibular deformity - Missing/fractured teeth - Occlusion

Answer 12

The action by which the fragments of the fractured bone are brought into contact with each other. Open or closed

Answer 13

wires, bars and screws to bring maxillary and mandibular teeth together

Answer 14

\*proclined upper incisors \*retroclined lower incisors \*anterior open bite or incomplete open bite \*narrow upper arch \*unilateral posterior cross bite

Answer 15

the patients thumb/digits are postitioned in the mouth in such a way that they result in the mandible to drop open. This causes the patients tongue to occupy an area that is not deemed normal. The sucking action initiated by the muscular forces in the cheeks narrows the maxillary arch, causing a unilateral posterior cross bite

Answer 16

\*URA \*behavioural management therapy \*sock/gloves on hands \*plaster on thumb \*foul tasting nail polish/hand cream \*the use of a dummy

Answer 17

\*Active component; induces a force by introducing displacement forces \*Retention; resistance to displacement forces \*Anchorage; resistance to unwanted tooth movement. Newtons 3rd law (for every action there is an equal and opposite reaction) \*Baseplate; to provide anchorage, connector for the retentive components, cohesion, adhesion and stability

Answer 18

\*increased over jet \*anterior/posterior cross bite \*retained deciduous teeth \*ectopic teeth \*crowding \*trauma \*anterior/lateral open bites \*ankylosis of deciduous teeth \*diastema \*dental asymmetries \*deep overbit \*early loss of deciduous teeth \*impacted first molars \*spacing \*habits \*cysts \*supernummaries

Answer 19

\*decalcification \*relapse \*root resorption \*pain/discomfort \*soft tissue trauma \*failure to complete treatment \*loss of tooth vitality \*inhale or swallow small components \*candidal infections

Answer 20

PROCESS * Discuss GA risks and benefits and all other alternatives * Need referral to hospital and all other carious teeth will also be extracted to avoid future GA * GA involves a day in hospital - need to monitor full recovery * A chaperone is needed throughout

Answer 21

VERY COMMON RISKS * Headache, nausea, vomiting, drowsiness, sore throat/nose

Answer 22

VERY COMMON RISKS * Headache, nausea, vomiting, drowsiness, sore throat/nose/nosebleed from intubation RISKS FROM TX * Pain, bleeding, swelling, bruising, infection, loss of space, stitches RARE, MAJOR RISKS * Brain damage, death (3 in a million. A machine is needed to breathe during op and there is a small risk of being unable to breathe independently on waking * Upset/anxiety on waking making anxiety worse * malignant hyperpyrexia (very rare, important to ask about FH) POTENTIAL CONTRAINDICATIONS * Sickle cell, diabetes, downs syndrome, malignant hyperpyrexia, CF or severe asthma, bleeding disorders, cardiac/renal conditions, epilepsy, long QT syndrome (fast/chaotic heartbeat)

Answer 23

* Pt name * Pt address * Pt/parent contact numbers (landline and mobile) * Full medical history * GDP/GMP details * Parental responsibility * Justification for GA * Proposed Tx plan * Previous Tx details * Radiographs and if none available, state why

Answer 24

* For Tx planning only. The plan may change with specialist opinion * Gain informed consent which must be written * Discuss GA process, side effects, complications * Adult escort with no other children * Pre op fasting * Post op arrangements * Post op care and pain control

Answer 25

* For Tx planning only. The plan may change with specialist opinion * Gain informed consent which must be written * Discuss GA process, side effects, complications * Adult escort with no other children * Pre op fasting * Post op arrangements * Post op care and pain control

Answer 26

\*radiographs (OPT, maxillary anterior occlusal, lateral cephalogram) \*vitality tests \*study models \*photographs

Answer 27

deciduous dentition - CLP, craniofacial abnormalities (if not under MDT care) early mixed dentition - delayed eruption of perm incisors, impaction/FOE of 6s, poor prognosis of 6s, severe class 3, AXB, ectopic canines, pathology late mixed dentition - growth mod in class 2, hypodontia, other routine problems

Answer 28

IOTN - grade 1 - minor malocclusions grade 2 - minimal need grade 3 - moderate need - use the aesthetic component grade 4 - great need grade 5 - very great grade 4/5 get NHS treatment grade 3 needs aesthetic component of 6+

Answer 29

MOCDOO Missing teeth overjet crossbite displacement overbite other

Answer 30

poor prognosis, need calcification of the furcation of the 7s as optimal. if late - little space closure and 7 tilts mesially if early - get crowding

Answer 31

retroclination of upper anteriors proclination of lower anteriors mid line palatal screw frequently incorportated to tip posterior teeth to correct PCB re-positions mandible forward reduces muscle action on jaws some skeletal grown from secondary growth centres correcting AOB with posterior bite planes and allows further eruption of anteriors

Answer 32

- delayed eruption - retained Cs - unable to palpate - distal tipping of 2s loss of vitality or mobility of 1s/2s

Answer 33

LAFH vs TFH - should be 50% ish FMPA - should meet at the back of the head

Answer 34

maxilla 2-3mm in front of mandible

Answer 35

maxilla \>3mm in front of mandible

Answer 36

\*SNA relates maxilla to anterior cranial base Average value 81o +/- 3o \*SNB relates mandible to anterior cranial base Average value 78o +/- 3o \*ANB relates mandible to maxilla Average value 3o +/- 2o

Answer 37

27o +/- 4o

Answer 38

\*Upper; nasion to anterior nasal spine \*Lower; anterior nasal spine to menton \*average value of LAFH to TAFH 55%

Answer 39

4's - 10yo 3's + 5's - 11-12 yo 7's - 12-13 yo

Answer 40

Supernumeraries preventing eruption. Trauma/dilaceration

Answer 41

Remove deciduous and supernumerary. Expose unerupted tooth (potentially bond gold chain). Create space. Monitor for up to 18 months

Answer 42

- Plan around the lower arch (angularion of lower labial segment is stable) - Decide on treatment in lower (ext or no ext) - Build upper arch around lower. Aim for class i incisor and canine relationship - Decide on molar relationship. Class i or full unit class ii

Answer 43

- Mild (0-4mm) stripping or ext of 5s - Moderated 5-8mm - extract 5s or 4s - Severe \>8mm - extract 4s

Answer 44

Inspect pupils Inspect visual fields Assess blind spots

Answer 45

Ptosis (drooping of eyelid) Eye movements Light reflex

Answer 46

Assess patients feeling to touch of forehead, cheek, chin, examine MoM

Answer 47

Changes to sense of taste or hearing. Inspect for facial asymmetry at rest Assess facial movement when patient performs different expressions

Answer 48

Test patients hearing

Answer 49

Exam tongue for hypotrophy or deviation on protrusion

Answer 50

Staging is based on severity. Stage 1 - Early/mild. Interproximal bone loss less than 15% or 2mm Stage 2 - Moderate. Coronal third of root involved. Stage 3 - Severe (potential for additional tooth loss), mid third of root involved. Stage 4 - very severe (posential for loss of dentition) Apical third of root involved

Answer 51

Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss is greater than the buccal attachment loss.

Answer 52

The extracoronal ir intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth

Answer 53

Component which connects the pontic to the retainer(s)

Answer 54

This type of bridge has a retainer at each end with a pontic in the middle joined by rigid connectors. Advantages; robust design, maximum retention and strength, abutment teeth splinted together, can be used in longer spans, lab construction straight forward. Disadvantages; Preparation difficult (parallel tooth prep), minimal taper, common path of insertion for abutments, more tooth tissue removal

Answer 55

This type of bridge provides support for the pontic at one end only by a conventional crown retainer or a resin retained metal wing. Advantages; more conservative than fixed fixed. Lab construction straight forward. No need to ensure multiple tooth preps parallel. Disadvantages; short span only, rigid to avoid distortion, mesial cantilever preferred

Answer 56

length of tooth coronal to alveolar crest compared to length of root embedded in bone. Optimum 2:3, minimum 1:1

Answer 57

\*All metal; gold, nickel/colbals chromium. \*Metal ceramic \*All ceramic; zirconia (lava), lithium disilicate (e-max) \*ceromeric (BellGlass)

Answer 58

- Introduce yourself (name and BDS5) - Explain clinical findings, using props to demo - Radiographic report - caries, bone loss, impacted teeth, crowding etc - Discuss Tx including different options (RCT vs ext, comp vs amalgam etc) - Give perio diagnosis and explain - Offer smoking/alcohol advice - Offer OH, diet advice - Identify if there is toothwear and offer Tx options. - Make sure the pt understands

Answer 59

IMMEDIATE - Address pain (per-coronitis, TA, perio abscess, PAP) - INITIAL - OHI, PGI, 6PPC, supra/sub gingival PMPR. - Diet advice - Any relavent referrals - Smoking/alcohol advice - Impacted teeth - NCTSL - find cause. Tx - restore/splint - Caries management - Endo RE-EVALUATE - Perio 12/52 - NCTSL photos/study mods RECONSTRUCTIVE - dentures/bridges MAINTENANCE

Answer 60

- Fill pt details (sticker on each page) - Practice/practitioner details - Date/time of imp - Date required - What work required INSTRUCTIONS - please pour imps in 100% improved stone, mount on Denar ii semi-adjustable articulator using facebow/wax bite provided. - Construct metal ceramic conventional mesial cantilever bridge to replace tooth xx, use xx as abutment and xx as pontic (- ridge lap for posteriors. - modified ridge lap for upper ants. - dome lower incisior/premolar/upper molar if low smile line. - ovate. - wash through for lower molars) - Please construct in canine guidance and ensure pontic is free of excursive movements. - Please return cast with bridge

Answer 61

- State the type of xray - Diagnostically acceptable/unacceptable - dentition; - teeth - erupted/unerupted/permanent/primary/missing/supernumerary/impacted/ectopic - restorations (heavily/minimally restored) overhangs, poor margins - trauma - Disease; - Caries (primary/secondary) Supra/subgingival calculus, PAP - Perio- bone levels, local/generalised - Endo - well/poorly condensed, distance from apex, separated instruments etc - TMJ - Any other pathologies - Give diagnosis summary

Answer 62

IATROGENIC - RCT - fractured file, perforation, ledging, GP over/under fill, extruded sealer, missed canal - Restorations - overhangs, fractures, poor margins, post w/o RCT, perforated post. - External inflammatory/surface/replacement resorption, cervical root resorption DEVELOPMENTAL - Cysts - dentigerous, redicular, eruption, keratocyst - Unerupted, ectopic, impacted teeth - Dentigenesis imperfecta (bulbous crown, abscess, pulpal obliteration - TMD TRAUMA - Bone #, tooth #, displacement

Answer 63

- Give kennedy classification - Give craddock classification - Identify saddle areas to be restored. Identify and show clearly mesh etc - Indicate occlusal/cingulum rests - Indicate major connector - Indicate retention - clasps - written prescription must match design.

Answer 64

- Explain nature of injury to the nurse to the patient. Risks are to the nurse and not the patient. - Explain risk of BBV to nurse. Risk of transmission of HIV/Hep C etc. Low risk based on injury type (1:300 for HIV) - Explain standard procedure for managing sharps injury. This is applied to all patients. Blood sample needed, this would be asked of any patient. - Approach request of sample professionally and sensitively. - Make it clear that there is no pressure on the patient to agree. - Review MH; have you ever been diagnosed with BBV? Have you ever injected drugs or slept with anyone that has? Have you ever had sex with another man? Have you had sex with someone from another country? Have you ever had a blood transfusion? when/where? Have you ever had dental treatment in anther country? Have you ever had a tattoo/piercing by an unlicenced artist? Answering yes to any of these puts pt at high risk. - Consent - establish patient understands options. Give opportunity to ask questions. Confirm patients decision.

Answer 65

- Introduce yourself - Explain alendrontic acid is a bisphosphonate drug - Explain action of bisphosphonate drugs; they reduce the turnover of bone. They accumulate in sites of high bone turnover such as the jaw. - Relevance of bisphosphonate drugs in dentistry; risk of poor wound healing following extraction. Need to remove teeth of poor prognosis before therapy. Important to do everything possible to prevent further tooth loss in future. - Reduced turnover of bone and reduced vascularity can lead to death of bone - osteonecrosis. - Specifically name MRONJ - Risk of MRONJ in osteoperosis is low - Make and explain any clinical diagnosis; perio, caries, PAP - Discuss Tx options and risks.

Answer 66

- Explain nature of injury - Explain Tx (pulpotomy) as this is a large exposure, Tx of choice is pulpotomy. - Partial removal of pulp. Explain aim is to keep undamaged tooth tissue alive. Explain this keeps the tooth alive so it continues to grow. - Baseline sensibility tests (shows how the injured tooth and adjacent teeth respond. Gives baseline for future monitoring.) - LA required (give description and why its required) - Describe use of dental dam. Rubber sheet to isolate and protect tooth and airways. - Describe use of handpiece to remove damaged pulp - Pulp will be dressed with setting CaOH and MTA - Tooth coloured filling to restore aesthetics

Answer 67

- Make sure patient details are correctly entered onto form (sticker with CHI, hosp number, name, sex, address, DOB) Hospital dept, date, time, consultant, requested by, phone number - Clinical details to be entered on form; pain, swelling etc. MH, provisional diagnosis ie dentoalveolar abscess. - Specimen details include; type of sample (pus aspirate), details of site ie buccal mucosa of 26 - Investigation - culture and sensitivity testing, bacterial/viral - Wear appropriate PPE when handling specimen. ie gloves - Remove needle from syringe with sheath intact. Dispose of needle in yellow sharps. - Seal syringe for transport with red cap - Label syringe with pt details, place in plastic bag attached to request form

Answer 68

SPIKES SETTING sit down at same level as patient. Is anyone with you today? How have you been since last time? PERCEPTION. Do you know why you're here today? Do you know the purpose of the biopsy? Can you explain your understanding of things up until now? INFORMATION Tell patient you have biopsy results. Ask patient if they'd like you to go over the results. KNOWLEDGE Give a warning shot. 'I wish I had better news. I'm afraid the results aren't good. The test has shown that there are abnormalitits in the cells. I'm afraid the results confirm that you have mouth cancer.' Pause and let it sink in, let paient dictate pace of conversation EMPATHY I understand you'll have lots of questions, does anything come to mind just now? Would you like your partner to come in? Summaise. Repeat news, summarise plan going forward , The good news is we've acted quickly. Treatment will begin asap, I will speak to the surgeons and then with you to discuss treatment.' Offer follow up appt, offer phone number and any written material

Answer 69

- Introduce self - Brief history, ackowledge diabetes and ask about control. Ask if dentures are worn at night. Ask about denture hygiene. - Explain findings - denture induced stomatitis - a yeast/fungal infection, can be a particular problem with diabetics as blood sugars can encourage growth. - Management - palate brushing daily. Denture cleaning advice; clean after meals and soak in CHX or NaOH 15 mins 1-2 x daily. Leave denture out overnight and as often as possible. Check denture fit - may need to be adjusted or replaced. - Offer smoking advice if necessary. Offer diet advice/sugar control - Confirm patient understands. - Antimicrobials? None or CHX. Nystatin 2nd line drug. Pt cannot use azole antifungals due to interaction with warfarin.

Answer 70

- Correct choice of instruments - kilner needle holders and gillie toothed tissue forceps. - Mount needle 1/3rd from end - Correct grasp of needle holder, hold in dominant hand - Correct grasp for tissue forceps - hold in pen grip - Atraumatic handling of flap with tissue forceps - Insert needle at right angle to wound edge and perpendicular to the surface - Insert needle at appropriate distance from wound edge, 2-5mm - Pass needle through flap and retrieve it with instrument - Remount needle with instrument - Take a full bite on 2nd side and retrieve with instrument. Attempt to reinsert at same depth in opposite side of wound and emerge out of tissue at same distance from wound edge as insertion - Demo adequate pronation and supination of hand - Ensure needle is secrew when tying of knot - 1st throw - two turns, grasp suture at free end, approximate edges - 2nd throw - 1 turn in opposite direction, grasp suture at free end and tighten - 3rd throw in opposite direction again - Cut suture to length suitable for wound site. - Knot to side of wound - Final apposition of wound enture wound ends close together but no tension and secrure knot - Dispose or clip needle

Answer 71

Alendronic acid, risedronate sodium. Denosumab. Bevacizumab

Answer 72

Chronic OAF pt may complain of; - Fluids coming out of nose - Nasal sounding speech - Problems playing wind instruments - Problems using a straw - Bad taste/odour, pus discharge - pain/sinusitis type symptoms - An OAC is an acute communication of the air sinus with the oral cavity - In your case the communication hasn't closed over and instead has healed forming a little skin lined communication between the air sinus and the mouth - This is something that should be managed as it makes you more prone to developing sinus infections Management; - Excise sinus tract/fistula, removing epitheliym + buccal advancement flap - ABs (amoxicillin 500mg 7 days, 1 3 x daily. Doxycycine 100mg 7 days, 1 x daily, 2 on day 1) Post op; - Refrain from blowing nose/stifling sneeze - Use steam or menthol inhalators - Avoid straws - Avoid smoking

Answer 73

Features; - Pt generally fit and well. - Associated with familial history of aggresive perio - Rapid LoA not proportional to plaque levels Pattern; - Localised if 6s and incisors (and < 2 other teeth on pt < 30yo) - Generalised if 3 teeth other than 6s/1s/2s on pt >30) - Convincing evidence of a genetic predisposition ot perio, in particular aggressive - Other risk factors such as smoking and OH have an impact - Important to screen and monitor siblings and children of pts with severe perio due to greater risk Be careful as pt can feel hopeless and give up - emphasise it is still treatable Treatment; - meticulous self care - Professional instrumentation (non surgical/surgical if necessary) 6PPC, NSHPT, removal of plaque retentive factors - 2 week course of CHX mw - No ABs routinely but may be appropriate as adjuncts from specialist (no first line of Tx) - Metronidazole or amoxicillin - Benefits of ABs - good results - Risks of ABs - dont treat the cause, low proportion reaches sites, doesn't disrupt biofilm, AB side effects - Pt should be referred to specialist if no changes

Answer 74

Reasoning; Relines - when fitting surface is inadequate but denture is otherwise ok, ie occlusal planes, OVD, profile are acceptable but fitting surface underextended, not supportive/stable or retentive. Rebase - when you want to keep the occlusal surface but change fitting and polished surfaces. Method; - Check all occlusal relationships are acceptable and appropriate. - Remove undercuts from fitting surface with acrylic trimming bur - Adjust border with under/over extension with green stick - Apply adhesive to fitting surface of denture to be relined - Insert imp material (light body PVS) into fitting surface and seat denture - Functional imp (ask pt to bite together so the imp is taken in OVD) - Take opposing imp with denture in situ - Take bite reg if OVD not obvious - When set, remove imp, disinfect and sent dent to lab for reline Prescription; please pour imp in 100% dental stone using denture imp provided. Please mount upper/lower cast and create a self cure PMMA reline to change fitting surface

Answer 75

- Introduce self and designation - Take a history; number of days of symptoms, does the child have a fever? Less active than normal? Analgesia used, and did it work? Signs and symptoms of primary herpetic gingivostomatitis; lymphadenopathy, malaise, pyresia, erythematout gingivae, ulceration, sore mouth and throat, fever Diagnosis - primary herpetic gingivostomatitis. Contagious primary infection caused by herpes simplex virus. Self limiting and will disappear in 7-10 days. High carriage rate in population, common. Most often occurs in young children and is usually the first exposure a child has to herpes virus (responsible for cold sores) Most initial infections are subclinical but can present as this florid infection. Usually no symptoms. Often will present with blisters on tongue, cheeks, gums, lips, roof of mouth. Once blisters pop, ulcers will form. Other symptoms to watch out for are high sever, difficulty swallowing, drooling and swelling Dehydration can occur due to difficulty eating/drinking. Child may not develop cold sores in future. Management- push fluid intake. Analgesia to control fever/pain. Bed rest, take it easy. Clean teeth with damp cotton wool or cloth to rub around gums. Can use dilute CHX to swab gums. As child had had problems for 3 days and is otherwise fit and well antivirals are not recommended. If severe case or immunocompromised script for aciclovir 200mg 1 tab 5 x daily for 5 days. Refer to hosp if immunocompromised

Answer 76

Pre-cementation checks - is the restoration as asked for? - Check on cast; rocking, m/d contact points, marginal integrety, adjacent teeth (can be damaged when prepped tooth sawn off cast) - Check for occlusal interference on excursions. Check adequate reduction - Check occlusion with crown on cast Remove crown from cast Check if natural teeth occlude properly Check if tooth is under prepped. Measure crown thickness with calipers. Min 0.5mm circumferential, 1.5mm functional cusps/1mm non functional cusps Management - check amount of interference and if able to reduce crown without making it too thin then adjust and cement. - Otherwise re-do prep and send back to lab. - Follow crown prep principles; ideal taper 6 degrees, retentive grooves/slots, bevel functional cusps, two plane buccal reduction, smooth prep margin at gingival margin. Avoiding fault in future; measure temp crown thickness before cementing. Use sectioned putty index when prepping

Answer 77

- Take concerns seriously, answer questions as able to. 'Hi, what seems to be the problem?' 'Can I offer some assistance?' - Ackowledge anger 'I can see that you're upset and I'm sorry you feel that way' - Try to offer practical help. - Offer investigation with receptionist and provide feeback to pt - Offer another appt 'do you still have time to be seen today?' - 'what would you like to do?' - How can we work around this?' - Make an apology; be honest. Acknowledge the offense. Explain how it happened. Express remorse. - Ensure amends - is there anything we can do? If formal complaint requested, advise on NHS complaints procedure. If required - a local resolution. If satisfactory - complaint closed. If unsatisfactory - healthcare commision or health service ombudsman. NHS complaints procedure; 1. Acknowledge the complaint and provide pt with the practice complaint procedure. 2. Inform the dental defence organisation if you require advice. 3. Inform the patient of the timescales and stages involved 4. Acknowledge the complaint in writing, by email or by phone as soon as you recieve it. 3 working days max but ideally 24 hours 5. Early resolution 5 working days for issues that are straight forward, easily resolved, requiring little or no investigation 6. Investigation 20 working days for issues that have not been resolved at the early resolution stage or that are complex, serious or 'high risk' 7. Independent external review ombudsman for issues that have not been resolved.

Answer 78

Medication given is glucagon. It increases the concentration of glucose in the blood by promoting gluconeogenesis and glycogenolysis to convert glycogen to glucose. Type 1 diabetic hypoglycaemic coma. normal 5-7mmol, unconscious <3mmol. - Assess ABCDE - Signs; pale, shaky, sweaty, clammy, dizzy, hungry, confusion, blurred vision, loss of consciousness (must mention this as it defines treatment) - If conscious and cooperative administer oral glucose 10-20g or sugary drink - If unconscious or uncooperative 1mg IM glucagon injection adn oral glucose when consciousness regained. - If consciouness not regained in 15 minutes, give 2nd dose IM injection technique; - Inject diluting solution into vial with glucagon powder. - Swirl to mix, don't shake - Draw solution back into syringe - Spread skin, advance needle in skin at 90 degrees, aspirate, inject 30s, pull out, release tension. Inject in thigh, hip, deltoid or buttock. Normally would prepare/change needle, remove clothing, alcohol wipe etc but not going to as this is life threatening and saves time Reassess ABCDE. Assess effect of meds, more oral glucose required?

Answer 79

Medication given is midazolam. A short acting benzodiaepine. It enhances the effect of the neurotransmitter GABA on the GABA receptors resulting in neural inhibition. Signs; loss of consciousness, uncontrolable muscle spasms, drooling, ridgidity, sharp jerky movements, decreased BP, hypoxia Assess ABCDE Do not restrain Make sure area is safe Admin 100% oxygen at 15l/min Set timer, if >5 mins give 2ml oromucosal midazolam. Repeat after 5 minutes if not worked. Check expiry date and make sure it's the form of midazolam administered buccally. Choose appropriate dose for age. Recovery position, check airway, monitor. Refer to hosp if first seizure, atypical, injury caused or prolonged

Answer 80

- Build up and diagnosis. Are you aware of what you're here to discuss? You were here a few weeks ago c/o pain/ulceration and we took bloods. Would you like me to run through results? Nothing sinister or to worry about. Results show you have a type of anaemia called microcytic anaemia caused by an iron deficiency. Iron deficiency anaemia is a condition where lack of iron in body leads to reduction in RBC. Iron used to produce RBC which help store and carry O2 in blood and around the body. If you have fewer than normal RBC, your organs and tissues won't get as much O2 as normal. Many people with iron deficiency only have some symptoms; tiredness/lethargy, SoB, palpitations, pale complection, feeling cold. and in some cases oral ulceration. - Aetiology - lack of iron in diet, heavy periods, history of stomach ulcers. - Management - iron supplements, increased iron in diet. This should resolve ulceration in 1-2 weeks. GP can prescribe and may do further tests to pinpoint cause. Advise increase in iron through diet (dark green leafy, iron fortified cereal, pulses, beans, nuts, seeds, meat, fish, tofu, eggs, dried fruit. Avoid spicy food if painful. If unable to eat script for benzydamine mw 0.15%. 300ml, 15ml every 90 mins as required. no more than 7 days. Vit C helps absorption. Caffiene inhibits absorption. Reassure pt. Should resolve within 2 weeks with no scarring. Any Qs?

Answer 81

CAUSES OF RETAINED A/ UE1 - trauma causing damage to 1. Complications include ankylosis, arrested permanent tooth formation, dilaceration (curve/bend in root or crown), displacement. - Lack of permanent successor/hypodontia - Ectopic tooth germ - Crowding SIGNS - Discolouration of A. Retained A -Radiographic - Lateral erupted before central INVESTIGATION- - Radiographic localisation for ortho Tx; another PA /ant occlusal, or opt and occlusal or CBCT MANAGEMENT - always palpate, usually upper 1 is buccal and central OPTIONS -leave and KUO. Inform of possible cyst formation or resorption - Extract retained A (leave 1) and space maintain (warn of cyst formation risk) - Surgical removal of both and space maintain - Refer for ortho opinion/Tx, warn of risks/benefits of ortho -Auto-transplantation - Other options are XLA and hope for eruption, or expose and bond/traction but both unlikely with dilaceration

Answer 82

Remove undercuts, build flange with greenstick and reline. Rebase or remake if this is not possible

Answer 83

Replica denture, ask lab to close diastema at try in stage. Putty imp with vaseline, wax replica for functional imp and bite reg. Otherwise remake. Ask lab to provide try in stage with diastema corrected

Answer 84

If patient is happy with denture otherwise, imp and reline. If unacceptable - remake

Answer 85

Remake with replica technique with cuspless teeth or grind teeth with acrylic trimming bur

Answer 86

Rebase with a thicker plate or high impact resin. Remake denture

Answer 87

Remove posterior teeth with bur or remake

Answer 88

Reline - replacement of denture fitting surface. Relining is satisfactory for lower dentures but increases thickness of upper dentures making it heavier and less retentive. The thickness is directly related to the choice of the impression material, use low viscocity (light body PVS) Rebase - replacement of the whole denture base. Reline lower denture, rebase upper denture. Adjust the periphery of denture as necessary to correct over/under extension. Add greenstick and take imp.

Answer 89

* <10mm diameter * Last up to two weeks * Only affect non keratinished mucosa * Heal without scarring * Usually respond well to topical steroids * Ulcer free period is good guide to morbidity * Will never affect attached gingivae or hard palate * Diagnose by history. Exam - yellow/grey base with red margin/halo

Answer 90

* Can last for months * Can affect any part of the oral mucosa keratinised, not or both * May scar when healing * Poorly responsive to topical steroids (intralesional steroids more useful) * Usually >10mm, may also have smaller ulcers, diagnose according to worse ulcer * Diagnose by history

Answer 91

Blood tests (GDP can liase with GMP). Deficiencies - iron, B12, folic acid Coeliac Allergy tests unreliable, better to just avoid common triggers. Benzoate, sorbate, cinnamon, chocolate. For 3 months, if no change, unlikely to be allergy.

Answer 92

* Correct blood deficiencies * Refer for investigations * Avoid dietary triggers (SLS containing TP, sesodyne, pronamel and kingfisher and fine) * Script initially for steroid free Tx (CHX, benzydamine mw) * Topical steroid spray/mw but only effective before ulceration occurs (when pt gets pre breakout tingle)

Answer 93

Usually during a growth spurt. New shoes? Often causes iron deficiency, ask about diet/supplements?

Answer 94

If there are no results from non steroid and steroid treatments Major aphthous ulcers or a child under 12

Answer 95

* Thin, under extended and/or absent flanges. * Previous repairs * Stress concentrators - large frenal notch, midline diastema, foreign particles * Poor fit * Lack of adequate relief * Tooth wear

Answer 96

Inclusion of a metal plate. Use of an alternative denture base material such as high impact acrylic resin for thin under extended flanges

Answer 97

For simple midline # two fragments are secured with sticky wax. Sent to lab and repaired with light cured PMMA. Easier processing but weaker than heat cured. Multiple #; if possible seat larger fragments intraorally and take imp, otherwise remake. fractured teeth - take imp of opposing arch to establish correct occlusal relationship.

Answer 98

Diagnosis - ANUG. Presents as acute form of gum disease. Develops quicker and more severe than normal. Aetiology - can be caused by a variety of reasons but tends to be in people with high levels of stress, smokers, poor OH, poor nutrition, immunocompromised. Symptoms include painful, bleeding gums, painful ulcers, receeding gums in between teeth, bad breath, bad taste. Can cause systemic symptoms, swollen lymph nodes, fever. Management; reassure pt that it can be managed by local measures; OHI NSHPT inc RSD with LA. CHX 0.2%. Smoking cessation, stress management. Systemic involvement; metronidazole 200mg, 1 tab 3 x daily for 3 days. No alcohol. Amoxicillin 500mg 1 tab 3 x daily for 3 days Analgesia advice, register with GDP, review in ten days and refer if no improvement.

Answer 99

* Explain importance of being dentally fit, improving OH and looking after dental health. * Chemo puts a toll on entire body including mouth. * GDP role to reduce complications in chemo regime (avoid unscheduled interruption. Remove potential sources of infection. Avoid exacerbation of mucositis. * Plan prevention and rehabilitatio; FM scaling, remove teeth or poor prognosis or areas of infection. Extractions at least ten days before chemo starts. Tx should be avoided during chemo, if Tx done after there is risk of MRONJ, slower healing and infection. Take imp for splint and smooth sharp teeth. * Pre Tx prevention; OHI, duraphat varnish, duraphat TP 2900 (0.619%) or 5000 (1.1%) Id cleaning. Diet advice, avoid spicy acidic food, fizzy drinks, fruit juice. Smoking and alcohol cessation. * Mid Tx; minimal intervention unless emergency or pathology management. Mucositis; inflammation and ulceration, pain requiring analgesia. Can affect eating and OH. * Topical cooling agents can be used, ice, lignocaine, benzydamine mw (difflam), tea tree oil mw * Thrush - antifungals * Post Tx care; maintenance of oral and dental health. Prevention. Increased frequency of visits. MRONJ, altered taste, dry mouth. * Decreased salivary flow and altered consistency. Recovery over years and may not return to normal. Increased risk of caries, perio, candidiasis, sialadentis, pros difficulties.

Answer 100

* Introduce youself * Wash hands * Don PPE * Ask pt to confirm name, reason for attendance * Position pt and turn on light. * Approach palatally if possible. * Avoid damage to adjacent teeth * # remaining thin layer of enamel with instrument * Ensure cavity margins are clear of contact

Answer 101

* Enter pt details (sticker); CHI, hosp number, name, sex, address, DOB. * Hosp dept, date, time, consultant, requested by, phone # * Clinical details; pain etc, other relevant details (present for 6 mon, gradual increase in size. * MH * Provisional diagnosis ie fibro epithelial polyp * Specimen details - aspirate, excisional biopsy. * Details of site - left dorsum of tonue etc * Investigation required - culture and sensitivity testing (bacterial and fungal). PRC and viral load (viral). Histopathology (tissue biopsies) * Wear appropriate PPE * Label pot with pt details, place in plastic bag and attach to request form

Answer 102

* Use two pieces of floss through ortho separator * Pull tight and move down between contacts but not subgingival, mesial and distal of tooth * Leave in place for 2 - 7 days * Remove with blunt probe * Sit child upright * Protect airway with gauze * Choose crown (smallest size that will seat, use sticky stick. Should cover all cusps and approach contacts with slight springiness - dont fully seat. * Dry crown, fill crown with GIC * Dry tooth (if its caviated fill with GIC first) * Place crown over tooth * Seat fully with finger pressure * Pt can seat by biting gauze * Remove excess cement with CWR, apply pressure for 2/3 mins * Floss between contacts

Answer 103

* ABCDE * Are you choking? * 5 x back slaps between shoulder blades (child can be across knee) * 5 abdominal thrusts * continue to check for object dislodging * ABCDE * BLS if not resolved * 999, refer to hsop and check for rib #

Answer 104

Same Lingual Opposite Buccal Parallax technique One radiograph taken straight on, second taken either mesial or distal to first. If object moves same way as tube head - lingual, if opposite - buccal

Answer 105

OB risk of trauma OJ risk of trauma ectopic - risk of root resorption or cyst formation

Answer 106

* Material * Saddles - identify and add mesh * Support * cingulum/occlusal rests * Retention - clasps (premolar gingivally approaching, molar ring) * Major connector, ring design, bar, full cover

Answer 107

LA needle unshealthed, scalpel, tooth in forceps, endo files, other sharps Sharps box position Messy bracket table Discarded gloves Blood spillage

Answer 108

* Black - household waste * Orange - low risk clinical waste contaminated with blood or saliva * Yellow - high risk such as body parts inc teeth (not on clinic) * Red - specialised/hazardous waste. Amalgam waste, spill leak proof mercury vapor suppressant in lid. For amalgam waste, capsules and amalgam filled teeth. * Blue - sharps including vials with pharmaceuticles remaining * Orange sharps bin; * Always dispose of sharps immediately * Always keep out of reach of children * Always close sharps box between uses * Never retrieve anything from sharps box * Never fill more than 3/4

Answer 109

* Stop what youre doing * Donn appropriate PPE * cover spill with paper towels * Apply NaOH, sodium dichlorosocyanurate liquid/powder 10k ppm * leave for 3-5mins, use scoop to pick up gross contamination, goes in orange waste * Clean rest with detergent wipes

Answer 110

* Possible causes; hereditary, keratosis (smoking, trauma), lichenoid, lupus, pseudomembranous candidosis, carcinoma * Explain to pt there could be a number of causes. Some completely harmess but some can be more serious and possibly cancerous. * FoM is high risk site for oral cancer and as you have other risk factors (smoking, alcohol) it would be best to have this checked out * Biopsy will be taken by OM/Maxfac to send to lab, sutures. * Risk factors - smoking and alcohol cessation. Reduce alcohol, dont mention 14 units, wake up call to quit

Answer 111

Sore for around a week, similar to ulcer. Pain, bleeding, bruising, swelling, infection, altered sensation. Stitches will disolve 1-2 weeks WSMW, soft diet, limit smoking etc Offer review appt and discuss findings

Answer 112

Aciclovir only prescribed if pt is immunocompromised or if infection is severe. * Primary response to herpes simplex virus. * Sore mouth and throat, lymphadonopathy (systemic involvement) * Period of malaise and fever * Happens once or twice and is slef limiting 7-10 days. * Push fluid intake, bed rest, alalgesia/antipyretic, CHX, nutritious diet. * Aciclovir script - 200mg (100mg if under 2 yo), send 25 tabs. 1 5 x daily for 5 days

Answer 113

* mount cast and tripod * Use analysing rod to analyse abutment teeth and soft tissue undercut only * Pencil rod, mark survery line of all abutment teeth and soft tissue undercut * Determine if cast needs to be tilted (if unfavourable undercuts), change path of insertion to highlight undercuts * In common path of displacement, find appropriate location for clasps with undercut guages (buccal upper molars, lingual lower molars) * Mark clasp position with pencil * 0.25mm co/cr, 0.5mm wrought gold, 0.75mm wrought ss

Answer 114

* Give a diagnosis * Initial general history; headache? Loss of consciousness? Nausea or vomitting? Numbness anywhere on face? Police involvement? Examine and record injuries * E/O - pain, lacerations, bleeding, swelling, facial asymmetry, palpation of madible bilaterally, condyle, ramus, body, symphysis * Limitation of mandibular movement? * Deviation? Tenderness over TMJ? * Examine sensation of lower lip/chin (areas supplied by mental nerve) * I/O; lacerations (especially gingivae), bruising, swelling, haematoma, occlusal derrangement and step deformities, loose or broken teeth, anaesthesia/parasthesia of teeth, AOB due to bilateral ramus/sub-condylar fracture * Classifications - simple (no break in skin), compoind (break in skin/gingivae), or communiated (multiple fractures) * Compound fractures require ABs * State if it is single, double or multiple * Name the site - condylar, body, coronoid, angle, ramus, parasymphyseal, alveolar * Unilateral/bilateral * Displaced or not * Favourable/unfavourable * Influences on displacement - pull of attached muscles, angulation and direction of fracture line, opposing occlusion, magnitute of force, mechanism and direction of injury, intact soft tissue * Further investigations; two radiographs (opt and PA mandible), or cbct * Identify relevant radiographic findings * Management - urgent phone call to omfs or a&e for advice and urgent referral * Surgical management - orif. conservative if undisplaces, asymptomatic or patient presents one month or more later

Answer 115

* Decalcification will happen around the periphery of the brackets, it weakens the enamel to caries and leaves unsightly staining * you're at a higher risk if you have history of caries, evidence of decal elsewhere or NCTSL * Give OH advice on small toothbrush head and single tufted around brackets * Advise on use of interdental brushes and superfloss * Brush 2 x daily, spit dont rinse, clean after meals, use of discloving tablets, colgate mw 250ppm F * Diet advice should include limiting sugar amount and frequency (less than 3 x daily) * Avoid snaking between meals * Avoid hard or chewy foods, fizzy drinks, sports drinks, chewing gum * Beware of hidden sugars * Rinse mouth after eating * Fluoride; duraphat 2 x daily, normal TP outwith this. Keep for yourself not other family members, particularly children. 0.619% 2800ppmF 75g * 1.1% 5000ppmF 51g

Answer 116

* Gold standard - cuspal coverage onlay. Gold, composite, porcelain, zirconia. Reduces risk of tooth fracture/catastrophic failure. Less microbial leakage/better seal * Full coverage MCC, GSC, all ceramic, all zirconia. If less tooth structure remaining, in order to cover and protect. * Direct restoration - composite or amalgem. If occlusal cavity only. Not as favourable, leakage, more likely to fracture. * Core build up if necessary. Gold standard would be in composite. Explain tooth has been hollowed out and need to fill space between cavity and crown. * Nayyar core not favourable (comp into canals), metal cast post if necessary but also not favourable

Answer 117

* How to assess caries risk (7things) clinical evidence, diet, MH, SH, saliva, plaque control, fluoride exposure * What does prevention include? 8 things - Radiographs, diet advice, TBI, fluoride tp, fluorise supps, fluoride varnish, FS, sugar free medication Advice * Assist child until able to brush independently, 2 x daily with fluoride TP. Give demo at each check up. Methodical approach. Spit dont rinse * Diet - avoid snacking on surgary foods between meals. Give alternative snack ideas, milk and water only between meals. Bottle/sippy cup advice. No eating or drinking after tooth brushing * Fluoride varnish 4 x yearly >2yo. TP, MW advice >6yo

Answer 118

* Aquacem GIC - metal post, MCC, gold, zirconia * Panavia (anaerobic cure comp) adhesive bridge (RRB) * Nexus NX3 (dual cure comp) - fibre post, composite/porcelain restorations, veneers Precement checks * On cast - is restoration as asked for? Rocking m/d contact points, marginal integrety, aesthetics. Check contact points on adjacent teeth on cast as they can be damaged when sawn off. Occlusion on excursions, natural teetch contact (use articulating paper) Post cement checks * excess cement removed, no space around margins, interproximal contact point exists and is clear. Occlusion checks, cleansible. * Check pt is happy with fit and appearance

Answer 119

* Pt sticker on all 3 sheets - name, age, CHI, sex, DOB, phots or SH * Practice details - name and number * Date and time of imp, date work requested for return * Plan - stage of Tx and any other lab work Instructions - * Please pour imps in 100% dental stone, mount on DENAR ii semi adjustable articulator using facebow/was bite provided. * Construct metal ceramic conventional mesial cantilever bridge to replace tooth xx, using xx as abutment and xx as pontic * Shade * Ridge lap pontic (posterior) * Modified ridge lap pontic (upper ant) * Dome pontic (posterior or lower ant) * Please contruct in canine guidance and ensure pontic is free of excursive movements * Please return bridge with cast * Signature

Answer 120

* Introduce self * Reassure dad and child * What happened, when, loss of consciousness? other injuries? Any pain relief? * Knee to knee exam; explain what you're doing. sit knee to knee, knees toughing and kept together. Ask dad to have childs legs around waist, lower child onto knees and ask dad to hold arms. Trauma Stamp; colour, EPT, ethyl chloride, TTP, percussion note, mobility, displacement, radiograph, sinus Subluxation signs - TTP, mobile, bleeding from gum. No displacement Explain injury; we call this injury a subluxation, it's an injury to the ligaments that support the teeth. This has affected the baby teeth. There is no treatment to be done, KUO. Today we can clean the tooth and mouth with saline, CHX and gauze. At home stick to softer diet for a week. Keep mouth clean and free of plaque to encourage healing. Brush 2 x daily with soft TB. Swab area with CHX 2 x daily for one week. Child may have pain, swelling, discolouration, the tooth becomes more loose, delayed exfoliation, infection. KUO signs of infection, normal to have some pain following trauma. Possible complications in permanent teeth - premature or delayed eruption. Enamel hypoplasia/hypomineralisation, crown/root dilaceration, failure to form or erupt. Odontome formation. Follow up in 1 week and 6 weeks

Answer 121

* Assess cavity - make sure margins not at contact area. Avoid damage to adjacent teeth * State dam would have been placed * Line cavity floor with vitrebond * Check occlusion and for overhangs * Give POI

Answer 122

Airway constriction, bronchoconstriction, increased breathing rate, wheeze, pt clutches at chest, flushed. ABCDE Salbutamol 10 puffs in spacer, repeat as necessary (short acting beta2 agonist, relaxes smooth muscle causing bronchodialation O2 15l Call 999

Answer 123

Discuss Tx * Confirm tooth to be removed under LA * LA means you will be awake, numb lower lip, tongue. Cannot take away feeling of pressure but no pain * A cut will be made in the gum to expose the top of the tooth, may need to remove some bone around the tooth, similar sensation to having fillings. * The tooth itself may need to be sectioned * Area will be cleaned with saline and some dissolving stitches placed * Some unpleasant sounds, squelchy, cracking etc as the tooth is close to your ear * Complications; pain, bleeding, swelling, bruising, infection, dry socket, stiff/achy jaw, damage to adjacent tooth/filling. Temporary/permanent damage to nerve. Sensory nerve so no change in appearance/function. Altered sensation or taste. * <10% temp, <1% permanent * Describe coronectomy if suitable * Eat before appt. Don't need a chaperone. Day off work sensible. Take it easy

Answer 124

N steriliser - non-vacuum, passive air removal, unwrapped solid products, non hollow and non lumened. B sterilisers - vacuum, active air removal, packaged instruments. Lumened, hollow or porous instruments

Answer 125

Stages - air removal, sterilising, drying, cooling 134-137o 2-2.3 bar for minimum holding 3 mins water used - reverse osmosis, distilled, sterile, deionised

Answer 126

Daily - wipe clean, change water, automatic control test, steam penetration test (Bowie Dick, Helix) Weekly - ACT, steam penetration, vacuum leak test, automatic air detector function test Quarterly - validation report - data collection to determine effectiveness of steriliser Annual report carried out by insurance company for safety (pressure release valves) Need signature to know it's valid

Answer 127

* Shouln't be overlapping and hinged instruments open * Check if there is a reciept print out * Check if there is colour change on the packaged instruments (brown to pink or yellow to blue) * If unsure, go through the process again

Answer 128

Preauricular, parotid, submandibular, submental, occipital, postauricular, jugulo digastric, jugulo-omohyoid, deep cervical, supraclavicular Brief history, have you been aware of this lesion? How long for? Pain? Problems when eating or swallowing? Hoarse voice? Relevant MH. Smoke/drink? Regular attender? MW? Discuss lesion; has a number of possible causes, some are harmless but some more sinister and as this is a high risk site and you have risk factors, I'd like to refer for biopsy. I'll send an urgent referral to maxfax where a biopsy will be taken and sent to a lab for testing. What to expect - LA, small amount of tissue removed and dissolving stitches. Post op advice Offer review appt Management of risk factors

Answer 129

* Demographics - type of xray, age, date etc * Quality - acceptable/unacceptable * dentition - permanent/primary/mixed, teeth erupted and unerupted, missing teeth, supernumerary, impacted, ectopic. Restorations - heavily/moderately/minimally restored, overhangs, fractures, poor margins, trauma. * Disease - Caries; primary/econdary, supra/subgingival, PAP. Perio - localised/generalised, supra/subgingival calculus. Endo - well compacted, material, mm from apex, seperated instruments etc. TMJ. Other pathologies (cysts etc) * Diagnosis

Answer 130

Metronidazole AB of choice, can write script but state pt is alcoholic to pharmacist. Otherwise script for amoxicillin. Correct pt name, address in full, CHI number. Amoxicillin 500mg, send 9 capsules, take 3 x daily for 3 days. Sign and date

Answer 131

* leave KUO - risk of pain, infection, abcsess, tooth breakdown, catastrophic root # * Remove crown and remove caries, attempt new crown. Removes risk of post removal, doesn't resolve problem of no endo, infection risk * Remove post and core, RCT and replace - risk of removing post and core (root #/core/post#), RCT involves cleaning out the tooth and filling - several appts * Risk of tooth being unrestorable - XLA required. Replacement options

Answer 132

* z-spring encased in acrylic * Fault with adams clasp flyover * Fault with adams clasp arrowhead * Adams clasp on wrong tooth * FABP instead of PBP or vice versa * Remake appliance

Answer 133

Date Where seen (i.e. OSCC / OSTA) Covering Consultant Ref From (and why) – Complaining of – (C/O) History of Presenting Complaint - (HPC) Medical history (MH) If Medical History Questionnaire has been completed note that you have checked it and summarise the key areas. CVS – Coronary Heart Disease / Blood Pressure / murmur / valve RS – Bronchitis / Asthma / COPD / other Bones / Joints – arthritis, osteoporosis Liver / Hepatitis / Jaundice GIT (bowels) GUT (waterworks) Diabetes Epilepsy Blood/bleeding issues Hospital / specialists Operations / GAs and any problems with GA (including family history) Pregnancy status Meds - List medications within the notes. Allergies – list these Social History (SH) occupation - home situation - travel arrangements - smoking - alcohol - OE – Extra Oral Examination of the Head and Neck Lymph nodes Lymphadenopathy? - where TMJ exam FROJM (free range of jaw movement) MoM (muscles of mastication) Sounds – What and during what movement? swelling / asymmetry / skeletal / facial bones? Skin Lips IO – Soft Tissue Exam (ST) lips commisures BM (buccal mucosa) Tongue FOM (Floor of mouth) HP/SP/Fauces Hard Tissue exam (HT) pertinent tooth and periodontal examination Investigations: Radiographs - Justification / grade of image (1, 2, 3) / report of image Sensibility testing if appropriate Provisional Diagnosis Discussed with / Seen with member of Staff Options given to patient: 1) do nothing 2) 3) Discussion re: Surgery – e.g. LA, incision, bone removal, tooth division, sutures Discussion re: anxiety control (LA / IV / GA) Discussion re: SIGN/NICE/SDCEP guidelines (if appropriate) Discussion re: complications: (example for third molars) Pain, swelling, jaw stiffness/limited mouth opening, bleeding/bruising, infection, stitches, damage to adjacent teeth, altered sensation to lip/chin/tongue (temporary 10-20% / permanent usually under 1% although some studies say up to 5%) to include anaesthesia / paraesthesia / dysaesthesia +/- taste disturbance). Information sheet given? Plan – What is planned for next appointment, and where this is booked for / When? Student signature Student Print Name BDS 2/3/4/5 Staff Signature Staff Print Name Grade

Answer 134

* Resorbable - sutrures lose most of their tensile strength early on and will be fully absorbed by the tissues. These are normally used in areas where the suture requires to be buried, or is difficult to remove. Used for most intraoral wounds. * Non-resorbable - sutures retain tensile strength and remain in the tissues until they are removed. they are often used in areas where high tensile strength is required for alonger period of time, such as OAC, skin closure, or to hold dressings when exposing canines. * Monofilament - sutures are made from a single strand. They are less likely to facilitate an infection because it is more difficult for bacteria to colonize a single strand. * Polyfilament - sutures are made from several smaller strands twisted together and can be easier to handle. Often contraindicated in contaminated wounds. Examples * Polyfilament resorbable - vicryl, velosorb, polysorb * Monofilament resorbable - monocryl * Monofilament non-resorbable - nylon, prolene * Polyfilament non resorbable - silk

Answer 135

Orofacial graulomatosis is skin condition causing swelling to lips, cheeks, face. Related to crohns. Crohns is chronic inflammation of bowel, affects the whole tract. Inappropriate response against gut flora Symptoms include diarrhoea, abdominal pain, fatigue, weight loss, malaise, fever, cobble stoning of mucosa, ulcers. Managed with lifestyle, topical, oral, IV steroids, surgery

Answer 136

Treated with proton pump inhibitors (can alter taste). Histamine receptor antagonists used for Tx can cause dry mouth. GORD can cause dental erosion particularly palatal of upper anteriors

Answer 137

Unpredictable flare ups - may need to be flexible with appts. Pt may be taking corticosteroids - supressed adrenal function affecting ability to withstand stress. May be taking anti-inflammatories (caution with nsaids), immunosuppresents = increased infection risk. Beware of some ABs (clydamicin = increased risk of colitis) Oral aphthous ulceration during flare up, pustules on red base on labial mucosa, gingiva and palate. Crohns can present atypical oral ulceration, OFG, cobblestone appearance of buccal mucosa, mucosal tags.

Answer 138

Enamel defects (discolouration, hypoplasia, hypomineralisation). Aphthous ulcers, angular stomatitis, dry mouth.

Answer 139

May change choice of ABs depending what pt has taken recently for ulcers. Antiacids reduce absorption of tetracylcine and erythrocycline so stagger doses. Avoid nsaids Cimitidine may decrease metabolism of some drugs. Decrease dose of lidocaine and diazepam. Good OH to reduce H.pylori, ABs can result in fungal infections, proton pump inhibitors can affect taste, dry mouth?

Answer 140

* caused by injection into the parotid gland affecting facial nerve. * Diagnose by testing branches of facial nerve * Generalised weakness of the ipsilateral side of the face, inablility to close eyelid, obliteration of the nasolabial fold, drooping of the corner of the mouth, deviation of the mouth to the unaffected side. * Confirmed by the temporal branch being affected - if it was a stroke the pt would still be able to wrinkle their forehead * Manage by reassuring the patient, cover the eye with a pad until blink reflex returns.

Answer 141

* Select edentulous tray * take imp in alginate and use green stick around posterior border * Stand in front of patient * lab slip - please pour imps in 50/50 stone/plaster and construct special tray in light cure pmma with 2mm spacer (alginate), non perforated, finger rests and intraoral handle. please return models with try. thansk

Answer 142

Causes - MIH, fluorosis, decalcification, tetracycline, trauma, dentinogenesis, ameliogenesis imperfecta Treatment; * microabraision - easy, effective, removal of tooth tissue and uses acid * vital external bleaching - may not work, gingival recession, sensitivity, no effect on restorations, relapse/overbleach * Localised composite addition - can make tooth bulky, may not mask completely * composite/porcelain veneer - good aesthetics, tooth prep needed, wait until 18 for stable gingival level * MCC most destructive

Answer 143

Causes - hypodontia, trauma causing arrested tooth formation, ectopic, dilaceration, supernumerary, early ext Options- * RRB, essix retainer, RPD, implant if over 18, ortho space closure

Answer 144

* Metal frame work casting; co/cr bubbles making surface rough - airbubbles trapped in wax when investing. * errors in design - too close to gingival margin, undercuts not blocked out * faults with scrips between drawing and writing; SUPPORT - rests are missing, no posterior stop RETENTION - ring clasp round wrong way. CONNECTOR wrong connector * No labial relief as asked

Answer 145

* PPE * Seating position * Position chair and turn light on * take 2 putty index, 1 for temp, one for reduction (section this one) * 0.5mm prep in two planes with chamfer bur * reduce incisal edge 0.75-1.5mm * Use finishing bur to smooth prep

Answer 146

* Missing teeth - identify causes * Gingival margin, from ACJ, recession * Probing depths - indicator of Tx difficulty * LOA, indicater of disease severity * Bleeding on probing - indication of disease activity * Furcation involvement, indication of Tx difficulty * Mobility - gives rise to symptoms, poorer prognosis Reasons for failure; * smoker * Non compliant - poor oh * Inability of pt to maintain good oh (hard to reach areas such as furcations or stand alone teeth), poor manual dexterity * Systemic factors; stress, diabetes, pregnancy, malnutrition/poor diet * Inadequate debridement * overhangs/poor margins

Answer 147

Overfilled, underfilled, under condensed, missed canal, missed accessory canal, inadequet prep, extrusion, perforation, vertical root fracture, fractured file, blockage/obstruction of canal, poor coronal seal, poor restoration. Options; leave and monitor. No active Tx but may flare up. retreatment peri redicular surgery xla

Answer 148

History; how is dry mouth affecting pt? Need to sip water, need water to eat/swallow, affecting speech, causing discomfort? What medications is pt taking. Drinking? Smoking? MH - diabetes, epilepsy, anxiety, stroke, sjogrens? Features; difficulty swallowing, clicking speech, discomfort, altered taste, cervical caries, halitosis, candidal infections. Management; treat cause, address dehydration, chew gum, modify drugs, reduce caffiene, quit smoking/drinking. Prevention advice. Saliva substitutes Can contact GMP

Answer 149

White patches in mouth. Can occur on skin anywhere but in some cases presents in the mouth. Most common condition seen in oral med dept. Caused by extra keratin deposits. Keratin is a protein found all around your body and in the skin, it can be stimulated by trauma to form a callous. It can be a type of allergic reaction, most commonly to medications or silver amalagm fillings. Very small chance of developing into something more sinister. Around 1% of cases in ten years. Treated by removing obvious cause. Avoid SLS toothpaste, stop mw use, avoid bezoates. Difflam/corticosteroids if symptomatic KUO Any questions

Answer 150

Hep B 1 in 3 Hep C 1 in 30 HIV 1 in 300

Answer 151

* Encourage the wound to bleed, gently squeeze puncture wound * Gently wash with liquid soap (non antimicrobial) and warm water, rinse and dry * cover the wound with waterproof dressing * ensure the item that caused the injury is disposed of properly * Report incident to senior staff * follow local occupational or BBV exposure prone injury protocol for advice on when to attend occupational health/A&E * Document incident

Answer 152

AB prophylaxis not routinely recommended. Special consideration given; * pts with prosthetic valve * pts with previous episode of IE * pts with congenital heart disease * discuss with cardiologist

Answer 153

* Lidocaine 2%. 1;80k adrenaline. 7mg/kg * Articaine 3%. 1;100k adrenaline. 6mg/kg * Prilocaine with felypressin 8mg/kg Remember to check expiry date and that bung is on correctly. Side effects; allergic reaction, seizure, cardiac arrest, nausea, vomitting, diziness, headache, twitching muscles, nerve damage, continued numbness check for anaesthesia

Answer 154

* Fungal infection of the cheek/mouth * potentially malignant - can progress to cancer * Risk factors; OH, steroid inhaler, diet, diabetes, deficiency, dry mouth, antibiotics, immunosuppresion * Management - refer to OM (incisional biopsy). OHI, reduce carbohydrate intake, rinse mouth after inhaler. correct deficiencies, control diabetes, stop smoking, improve denture, * systemic antifungal - fluconazole 50mg send 7 tablets, one to be taken daily for 7 days, then reveiw

Osce q's batch 2 1-3 Flashcards

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