OSCE Questions Flashcards
This 50 year old man attends your practice complaining of painful gums, along with a metallic taste. On examination, he has poor OH with yellow ulcers in particular on the interdental papilla. What is the diagnosis + management
- Diagnosis: NUG/NUP (no xray to assess for bone loss)
- Management: good history to detect any underlying causes. Explain condition and importance of OH. Treatment starts with ultrasonic debridement and prescription of chlorhexidine mouthwash to aid OH over the coming days. Provide smoking cessation advice, recommend use of supplements and refer to GMP where there is concerns regarding immunosuppression. Get patient back for definitive periodontal treatment
- Antibiotics not indicated unless no response to mechanical therapy, immunosuppressed patient or systemic signs and symptoms
Give this patient OH advice
- Brush twice a day using a fluoride toothpaste
- Use electric brush where possible, where not possible, carry out modified bass technique
- Use floss where contact points are tight and use ID brushes were spaces are larger and floss would not be effective
- Spit don’t rinse
This patient presents with pain in the lower right second premolar. Radiograph show a periapical radiolucency and loss of bone height. How do we determine if it is a periodontal or periapical lesion
- History – periodontal lesions are often not preceded by toothache whereas endodontic ones are
- TTP – periodontal lesions are often tender to lateral pressure whereas endondotic ones are th vertical pressure
- Probing – periodontal pockets present in periodontal lesions
- Sinus – periodontal lesion will usually discharge through the pocket
- Swelling – gingiva is usually swollen in periodontal lesions
- Vitality test – periodontal infection tooth is always vital
A patient presents with grade 1 mobility of the lower right first permanent molar. There is clinical evidence of furcation involvement
A) How would you classify the furcation involvement
- Grade 1 furcation = initial furcation involvement. The furcation opening can be felt on probing but the involvement is less than one third of the tooth width
- Grade 2 = partial furcation involvement. Loss of support exceeds one third of the tooth width but does not include the total width of furcation
- Grade 3 = through and through involvement. The probe can pass through the furcation
A patient presents with grade 1 mobility of the lower right first permanent molar. There is clinical evidence of furcation involvement
B) What treatment is available for this condition
- For early furcation involvement – scaling and root debridement may be enough but the patient has to be able to keep the area clean post treatment
- Furcationplasty is a surgical procedure involving a mucoperiosteal flap that allows root planning and scaling followed by removal of tooth structure in the furcation area which allows access for cleaning but there is a risk for sensitivity and caries
- Tunnel preparation – buccal and lingual flaps are raised, the entire furcation area is exposed and the flaps are approximated with interradicular sutures leaving a large exposed furcation. There is a risk of sensitivity caries and pulp exposure
- Root resection – this involves the amputation of one or more roots of a multirooted tooth leaving the crown and root stump. The root to be retained needs endo treatment
- Hemisection – this involves sectioning of a two rooted tooth to give two smaller units each with a single root. RCT is necessary pre-operatively and restoration of the crown post-operatively
- Guided tissue regeneration – encourages new connective tissue attachment
- Extraction
This 24 year old woman presents at the practice complaining of bleeding gums, she is in her second trimester of pregnancy and is otherwise fit and healthy.
A) How would you manage this problem
Explain to the patient that gingival inflammation is initiated by plaque and is exacerbated by hormonal changes in pregnancy, especially during the second and third trimesters
Can give patient OHI to encourage good plaque control which will help stop the bleeding. Explain that we prefer not to carry out any dental treatment in first or third trimester. Can see if the patient would like some PMPR during second trimester
Question 6:
A patient attends your practice and requires scaling. She has previously only ever experienced hand scalers and wants to know why you are using an ultrasonic. Explain to her the benefits and disadvantages of it
Pros
* Quicker
* User friendly
* Cavitation of bubbles produces oxygen which can upset the anaerobic bacteria
* Several mechanisms of action – fluid lavage, cavitation, acoustic
* Smaller tip size than hand
* Light pressure can be used for calculus removal
Cons
* Water may make px feel sensitive
A 50 year old man presents to your practice with a bridge extending from upper right 4 to upper left 4. The abutment teeth are mobile as are the remaining molar teeth. Patient has a strong gag reflex and has diabetes. He wants to know whether he could have implants and what factors would influence its success. Discuss this with him and discuss the pros and cons of having an impant retained bridge
- Previous periodontitis can impact the success of implants – a lot of the same bacteria is implicated
- Requires good OH
- Diabetes can impact wound healing which may mean unsuccessful healing after implant placement
- Implant retained bridge may be more beneficial than denture due to gag reflex + would lower risk of thrush which is higher in diabetic patients
- Quite a long span bridge for 2 implants – probably not ideal
Explain NUG to a patient
What is NUG?
- It is a bacterial infection of the gums which commonly affects young adults, often with risk factors
What are the symptoms?
- Gum pain (can be severe)
- Bad breath
- Red, bleeding and swollen gums
- A grey film of bacteria on the gums
- Ulcers on the gums between your teeth
- Bad taste
- Swollen neck glands
- Fever
Who is at risk?
- Ineffective cleaning of your teth
- Smoking
- Stress
- Vitamin deficiencies
- Problems with your immune system
What treatment will you get today
- Explanation will be given on how to look after your mouth in the coming days
- We wil give a gentle and professional clean to your mouth
- We will get you back in to have a detailed gum assessment and management of any risk factors
Explain to a patient why antibiotics are not useful in management of periodontal disease
- Periodontal disease is a biofilm disease
- The bacteria that causes it are protected by the biofilm, almost like they have a roof over their heads which means the antibiotics cannot get to them to kill them
- To allow the antibiotic to reach these bacteria, we have to mechanically disrupt them, effectively creating holes in their roof which allows the antibiotic to reach them
- The other reason that AB are not useful is that they aer systemic, the antibiotic has to go through the stomach, through the GI tract, through the liver before becoming available in the blood. The antibiotic has a long way to go before it can reach where its required
- There is not one specific bacteria that is implicated meaning that broad-spectrum AB are often required and these have more systemic effects e.g GI upset
