PCPC Flashcards
1
Q
What are some of the challenges in endodontic diagnosis?
A
- Reffered pain
- Lack of propriceptor in the pulp
This makes it difficult to identify the pronlem and undretsand the clinical status of the pulp.
There are no reliable test rather multiple test can be performed to come to a reliable diagnosis
2
Q
What are some of the general medical health conditions that may be mistaken as endodontic pain?
A
- Referred musculoskeletal pain disorders
- Neuropathic pain disorders
- Headache disorders presenting in the dentoalveolar region
- A pathological process outside immediate dentoalveolar region
3
Q
What does COLDSPA stand for?
A
Character
Onset
Location
Duration
Severitty
Pattern
Associated factors
4
Q
What are some of the extra oral features of the edodogenic complications?
A
- External facial asymmetries
- TMJ and masticaroy muscle problems
- Lymphadenopathy
5
Q
What framework can you use to describe soft tissue lesions?
A
CCCTE
6
Q
Why do we need to use periodontal probing for endodontic health?
A
In some cases, isolated vertical bone loss often indicates a fracture
7
Q
What are two major categories of comparative tests?
A
- Peripradicular - percussion, palpation, biting test
- Pulpal - thermal tests, eletric pulp tests, diagnostic anaesthetic tests, test cavity
REMEBER TO ASSESS OTHER TEETH FIRST BEFORE THE TOOTH YOU SUSPECT
8
Q
What fibres are responsible for sharp response to the hot and cold in the pulp?
A
The A - delta fibres that run close to the pulpal horns - the pain last for a short period of time
9
Q
What fibres are responsible for the dull, gnawing prologned pain to heat?
A
C-fibres that are deep within the pulp
10
Q
What is the status of the pulp if the pulp sensebility test came back with no response?
A
No response = non-vital pulp or false- negaitve
11
Q
What is the status of the pulp if the sensibility test came back with a mild response?
A
Mild response = normal pulpal health
12
Q
What is the status of the pulp if the sensibility test came back with a strong bu brief response?
A
Strong but brief response = reversible pulpitis
13
Q
What is the status of the pulp if the sensibility test came back with a strong but lingering response?
A
Strong but lingering = irreversible pulpitis
14
Q
What are some of the causes of false negatives during pulpal sensibility testing?
A
- Calcified canals
- Immature apex
- trauma
- Premedication of the patient
15
Q
What are some of the causes of false positives during pulpal sensibility testing?
A
- Reading from multi-rooted posterior teeth with partially vital pulps maybe misleading
16
Q
When would you do a pulp test?
A
- Prior to restorative dental treatment
- Prior to root canal therapy
- Following trauma to teeth
- Prior to other dental treatment
17
Q
What do pulpal sensibility testing do?
A
They replicate the conditions that cause the pain the patient reports
18
Q
What is DPR?
A
DPR or Dental Panoramic Tomography - a body section imaging technique that results in a wide, curved image layer depicting the maxillary and mandibular dental arches and their supporting structures
19
Q
What are some of the advantages of DPR imaging?
A
- All teeth and supporting structures are shown in one mage
- Allows comparison of left and right sides to assess for symmetry
- Image is easy for patient to understand
- Reasonably comfortable
- Minimal infection control procedures
20
Q
What are the disadvantages of the DPR technique?
A
- Reduced resolution/detail compared to intraoral films
- Superimpositions - of all soft tissue and hard tissue
- May not be suitable for children under 5 or those unable to stand still
- Wheelchair access may be difficult
- Anatomical variation can make imaging difficult
- Equipment is relatively expensive
21
Q
When should you use an OPG?
A
It is recommended that DPR is used only when “The Dentists expects that the additional diagnostic information will affect patient care”
22
Q
What codes are need for SADS for every examination of panoramic x-ray?
A
- 037_ordered
- 037_viewed
- 037_report
23
Q
What is a full mouth survey?
A
It is a process where you take a whole bunch of bitewings and PA in order to have a more clear view of each of the tooth
24
Q
How to maintain patient safety with OPG?
A
- Avoid repeats
- Read and follow manufacturers instructions specific to the machine you are using
- Staff need to receive proper training
- Clinically justifies each image
25
How to maintain staff safety during the OPG?
1. Distance
2. Position
3. SHielding
26
Who should push the button on the DPR?
ONLY THE STAFF THAT IS TRAINED
27
What are the components of a panoramic X-ray machine?
1. Control panel
2. X-ray tube head
3. Collimator
4. Detector
5. Detector/cassette carrier
6. Positioning devices
28
What are the detector types used in DPR?
1. Cassette carrier - film and psp storage plate
2. Solid-state sensor
29
What is the key difference between a DPR and BW/PA beam?
DPR beam is slit like and the BW/PA beam starts of round and than travels a rectangular collimator
30
What is the key difference between a DPR and BW/PA beam?
DPR beam is slit like and the BW/PA beam starts of round and than travels a rectangular collimator
31
What is the basic mechanism of DPR rotation?
1. The beam and the detector travel together around the patient with a similar speed using a complex pattern of movement
2. This results in a single image of facial structures
32
What is the centre of rotation?
It is the axis around which the cassette carrier/detector and x-ray tube rotate. DPR machines could have up to 3 centres of rotation in order to account for the specific shape of the dental arches.
33
What is the focal trough?
It is a 3-D curved volume in space within the panoramic machines, designed to fit the avergae form of the midface and lower face. CORRECT PATIENT POSITIONING IS NEEDED TO FOLLOW IT.
34
What is the clinical importance of the focal trough?
1. Structures within the trough are relativley well defined int he final image
2. The closer a structure is to the centre of the trough the more sharply defined is the final image. The further, the blurrier.
35
What happens to the structures that lie buccaly to the trough?
There is a reduction in horizontal plain is reduced - making the object less wide
36
What happens to the structures that lie lingually to the trough?
There is a magnification in the horizontal plain - making the objects more wide
37
What will happen if the patient rotates their head during taking of the DPR?
You will experience both distortions - meaning that one of the sides will appear wider than usuall and the other slimmer than usual
38
What are primary and secondary images?
1. Primary - real images
2. Secondary - ghost images
Primary - occur when the structure lies between the centre of rotation and the detector - objects in front of the centre of rotation - rather further from the tube
Secondary - occur when the structure lies between tube head and centre of rotation - object is behind the centre of rotation - rather closer to the tube
39
How do we identify secondary images?
1. They are blurred and put of focus
2. They have the same orientation as the primary image
3. They are larger than primary image
4. They are higher up and on the opposite side
40
What are some of the accessories that you will need to remove during DPR taking?
1. Jewlerry, tongue rings, pins in hair
2. Partial dentures
3. Hearing aids
41
What should we advise the patient while the DPR procedure is taking place?
1. That the machine will move around them
2. To remain still
3. To push the tongue to the roof of the mouth and seal their lips
42
What is the procedure of positioning the patient for an DPR?
1. Raise the chin rest of the machine to maximum height
2. Ask the patient ot enter unit
3. Adjust height of unit to patient
4. Ask the patient to stand up straight, grip the lower handles on each side, rest chin on bite block and bite into prepared bite block
5. Position feet slightly forward
6. Relax their shoulders
7. Turn on mid-sagital and horizontal positioning beams
8. Align FH and mid-sagittal planes
9. Immobilise head with supporta
10. Ask patient to: Close eyes, stay still, swallow, place tongue to roof of mouth and keep it there, breathe through nose
43
How to examine the entire panoramic images?
1. Examine for quality of the image first - check image sharpness, contrast and density
2. Examine the image for patient preperation and positioning
3. Examine the image fro diagnostic purposes - are structure examined well displayed?
44
What are the zones of the panoramic imaging assessment?
Zone 1 - Nose and sinuses
Zone 2 - Md Body
Zone 3 - Articular Eminence, Condyle, Mx Tuberosities, Pterygo Mx
Fissures, EAM, Cervical Spine
Zone 4 - Epiglottis
Zone 5 - Md Ramus and Spine
Zone 6 - Dentition
45
How would you describe any radiographic finding on a DPR?
1. Multipel or solitary
2. Monostotic (affecting single bone) or polyostotic (affecting multiple bones
3. Locaiton
4. Unileral or bilaterla
5. Size
6. Shape
7. Border
8. Density
9. Impact on adjacent structure
46
Why is bisecting angles technique not ideal?
It is not ideal because it is susceptible to errors
47
Why would you use a bisecting angles technique?
You would use it if you need to overcome problems encountered with paralleling technique and related to anatomy
48
What is the technique in taking bisected angle radiograps?
Detector positioning
1. Dot to slot
2. Angle the film to capture the full lenght of the tooth
3. Paralller to the palatal/lingual surface of tooth being images
4. Tooth in the center of the detector
5. Hold in position by thumb/haemostats/holder
6. Held gently, detector remains flat not bent or curved
Horizontal beam angulation:
1. Allign central beam at right angles to tooth
Verticall beam angulation
1. Mentallly bisect angle created by tooth & detector at 90 degrees
49
What are the advantages of bisected angle technique?
1. Increased atient comfort
2. Detector positioning is quick and easy
3. When done correctly - appropriate clinical image cna be created
50
What are the disadvantages of bisected angle technique?
1. Success very dependent on skill of operator
2. High risk of destortion
3. Overlapping
4. Bone level not accuratley demonstrated
5. Not reproducible
6. Cone cutting
51
What does localisation require?
Localisation required two views from different angle with their central rays either:
1. At 90 degrees
2. At less than 90 degrees
Example: Getting a panoramic view of an abnormalitie and a lateral ceph in order to determine on which side of the jaw the abnormalities is
52
What is parallax?
It is the difference in the apparent position of an object, caused by a change in the observer's point of view
53
What is an occlusal view?
It is an intra-oral radiographic image where detector is placed in the occlusal plane. It is a type of bisected angle periapical
54
What is CBCT?
Cone beam - is a complex 3D rendering of the jaw
55
When does the student need to ask consent from tutor?
1. Bringing patient into the clinic
2. Begin examination after check of medical history
3, Take diagnostic tests
4, Dismiss patient from clinic
5. Leave the clinic during a session
56
When does a student need to ask consent from a patient?
1. To commence an examination
2. For proposed treatment plan
57
How do you gain a patient's consent for a procedure?
1. Verbal discussion
2. Written consent form for certain procedures like implant or a full mouth clearance
3. Ensure the patient is well informed
4. Ask the patient if they have any questions
58
How do you record consent on titanium?
Use #CONSENT:
1. When you take initial consent for an examination
2. On the date that the patient agrees to the proposed treatment plan
3. If during the Course of Care, your initial treatment plan is altered
59
What is a base chart?
It is a baseline of what has happened in the patient's past. It will give an indication of the patient's previous level of disease/treatment.
60
What is an all chart?
It is a detailed report of the patient's current alteration from health
61
What type of framework are you going to use to access hard tissue or soft tissue abnormalities?
L - location
C Countour
T - Texture
C - colour
S - Size
62
What is an important part of base charting?
Gathering the information by asking the patient about their previous experiences
63
What are some clinical sings that might alert you to the fact that the tooth had previous root canal treatment?
1. Discoloration of the tooth
2. Radio-opacity in the are of the root canals or pulp chamber
3. No response to pulp sensibility testing
4. Potential access hole
64
What are the two levels of demonostration of your clinical knowledge when it comes to staining?
1. Recognition that the staining is present
2. Identification of what caused it
65
What is abrasion?
It is a loss of tooth structure due to contact with an exogenous item. It is characterised by a specific pattern - a good example is a cervical lesion
66
What is erosion?
Loss of tooth structure due to a strong acidic sources. Characterised by scooping pattern and exposed dentine. Hard to restore due to loss of dentinal collagens
67
What is attrition?
Loss of tooth structure due to tooth-tooth contact
68
What is a type of quantitative enamel defect?
Hypoplasia - which occurs during tooth formation stagte
69
What is a type of qualitative enamel defect?
1. Hypomineralisation - which occurs during tooth mineralisation stage. Coud be localised vs generalised
2. Demineralisation - which of course occurs post-eruptively
70
What is important to keep in mind when assessing a demineralised lesion?
ALWAYS DRY THE SURFACE
71
What are some of the other defects that are worth charting?
1. Tooth fracture
2. Restoration fractures
72
What is an important factor to keep in mind when constructing a treatment plan for an individual?
It is important to focus on ensuring patient are offered a treatment plan that addresses all of their oral health needs, even if it is out of our scope of practice.
73
What is dental alginate?
It is an irreversible hydrocolloid material that is used in dentistry for impressions
74
What is the role of sodium alginate in alginate material?
Sodium alginate forms a hydrogel former
75
What is the role of calcium sulphate dihydrate in alginate material?
It provide clcium ions
76
What is the role of sodium phosphate in alginate material?
It controls working time - acts as a retarder of the rapid use of calcium within the reaction
77
Describe the setting process of alginate.
1. When mixed with water, a cross-link polymer chain is formed, resulting in a three-dimensional network structure
2. Calcium sulphate dihydrate provides the Ca ions for the cross-linking reaction that the sol to a gel
3. In order to decrease the setting time, sodium phosphate is added, which acts as a retarder, decreasing the number of Ca ions available for cross linking
4. When a certain threshold of Ca ions have been achieved, the cross linking reaction fully sets
78
What are the common uses of dental alginate impressions and the resultant study casts?
1. Occlusal analysis
2. Diagnostic tools for treatment planning
3. Fabrication of various dental appliances
79
What are some of the advantages of alginate as a dental material?
1. Easy to manipulate
2. Relatively cheap
3. Comfortable for patient
4. Non-irritant
5. Non-toxic
6. Records most details in the mouth
80
What are the disadvantages of alginate as a dental material?
1. Surface reproducibility not very high
2. Dimensionaly not stable
3. Takes up water
4. Needs to be casted immediatley
81
What is syneresis?
It is the loss of fluid within the alginate gel - this causes shrinkage
82
What is evaporation?
It is the loss of water from the surface of the alginate gel - this causes shrinkage
83
What is imbibition?
It is swelling of the alginate if immersed in water - this causes distortion
84
What are the clinical steps in making an alginate impression?
1. Informing the patient about the procedure
2. Equipment needed selected
3. Assess the oral cavity
4. Tray selection
5. Tray try-in
6. Md Tray try-in
7. Mx Tray try-in
8. Mandibular impression - preparing and mixing alginate
9. Loading the Md tray
10. Making the Md impression
11. Making the Mx impression
12. Checking your working area
13. Laboratory form/instructions
14. Record keeping
85
What are the criteria to assess alginate impresion?
1. Alginate mix is homogenous and smooth
2. Tray appropriate size
3. Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal
4. Adequate amount of alginate in tray and the treay has been seated and muscled trimmed correctly
5. Tray has been removed correctly
86
What are three most common anaesthetics used in the ADH
1. 2% Lignocaine with 1:80000 adrenaline (Lignospan special)
2. 3% Mepivicaine (Scandonest Plain)
3. 4% Articaine with 1:100000 adrenaline (Articadent)
87
What is the purpose of methylparabens in LA solution?
They act as an antibacterial preservative?
88
What is the purpose of bisulphote in LA solution?
They act as an anti-oxidant for the vasoconstrictor
89
What is the purpose for the vasoconstrictors in LA solutions?
1. Decrease blood flow
2. Slow systemic absorption of LA
3. Maintain higher local concentration of LA
4. Prolonge the duration of LA action
5. Reduce bleeding
90
What is a normal process to ensure that the pain control is achieved for the patient?
1. Double check the medical history
2. Double check treatment plan
3. "Safety steps" must be undertaken
4. Don't give LA unnecessarily
91
What are the safety steps for safe LA injecting?
1. Uncap needle
2. Stabilise hand with syringe
3. Retract & finger rest with opposite hand
4. Approach mouth watch needle tip
5. Inject
6. Discard needle
92
What are the important steps to an appropriate infiltrtion?
1. Good retration
2. Clean and dry the area
3. See the depth of the fornix
4. Inject next to root apex 2-3 mm deep ensuring that the bavel point towards the bone
93
What are the three important aspects of performing an appropriate inferior alveolar block?
1. Level - coronoid notch, 1 cm above lower occlusal plane, midway between arches with mouth wide open
2. Angle - opposite premoalrs
3. Entry point - pterygotempora depression - but this may be missing so rely on the palpation of the coronoid notch
94
What are 5 most common reasons for the failure of the LA?
1. Poor technique
2. Insufficient volume
3. Inflammation
4. Age & cortical bone density
5. Anatomical variability
95
What to do in SADS if a patient shows symptoms of syncope?
1. Stop dental treatment
2. Elevate patient's legs to achieve a position where their head is lower than the heart. If patient is in dental chair, tilt the chair back to a horizontal angulation
3. Allow patient to recover slowly
4. Measure patient's blood pressure & heart rate
96
What are the steps to gingival assessment?
C - colour
C - contour
C - consistency
T - texture
E - exudate
97
What are the steps to ILA?
1. Patient
2. CC
3. MHx
4. SHx
5. DHx
6. Exam
98
What is TRIM?
TRIM is an acronomy for:
Timing
Relevance
Involvment
Method
99
What are the steps to bonding to dentine?
Etching – this will expose collagen – may cause pulpal fluid to flow up which can compromise the bond – etch for a little less
Use a primer – wet or dry – dry: collagen is collapsed which rehydrated – wet: small amount of water remains – creation of hybrid zone
Unfilled resin
Polymerise
Filled resin
Polymerise
100
What are the steps of amalgam placing?
1.Remove caries or remove failed amalgam
2.Consider depth of cavity – at least 2 mm into dentine
3.Remove unsupported enamel
4.Retention - macromechanical retention
5.Liner/base
6.Pack amalgam using a plugger – permite ect amalgam used in sim
7.Burnish
8.Carve using cuspal inclines
9.Articulating paper and adjustment
10.Polish 24 hours later
101
What is the pattern of erosion relating to intrinsic sources?
1.Upper posteriors are affected first
2.Diffuses and affects the upper anterior next
102
What is the pattern of erosion relating to extrinsic sources?
1.Occlusal of lower affected first
2.Palatal of upper anterior
103
How would you assess the teeth on the radiograph?
1. State what radigraph and side you are looking at
2. FDI: notatation with restorations and radioopacities
3. Pathology: radiolucencies, extent and causes
104
How would you identify gingivitis?
1.Localised - 10% - 30% BOP
2.Generalised - >30% BOP
No pain or no clinical attachment loss
105
How would you identify periodontitis?
Proximal clinical attachment loss of equal or above 2 teeth, non-adjacent
OR
Buccal/oral clinical attachment loss of 3mm with 3mm pocketing at 2 teeth or more
106
What are the steps to occlusal analysis?
1.Teeth present/missing
2.Morphology of teeth
3.Wear - mild, moderate, sever
4.Crowding,spacingrotations
5.Axail inclanations
6.Shape of dental arch
7.Cruve of spee and wilsons curve
8.Angle molar classification/canine classification
9.Overbite (%) / overjet (mm)
10.Mediolateral
107
What is the 4A's framework?
Ask, assess, acknowledge and address that can be used to adress a patient with dental anxiety
108
What is ALARA?
It stand for as low as reasonably possible - which is a concept used in radiography in order to reduce radiation exposure for both the operator and patient.
1.Keep your distance
2.Shield
3.Do not take unnecessary radiographs
109
What is the needle stick inury protocol in dental emergencies?
1. Stop
2. Place needle/sharp aside
3. Take off gloves
4. Wash hands with soap and water
5. Dry and cover with non-stick dressing
6. Apply pressure if bleeding
7. Let tutor know
8. Contact SADS registered nurse for risk assessment
9. Write up incident report - SLS
110
Give example of two local and two systemic factor for gingivitis and periodontitis.
Local: calculus and over hangs - more sites for harbouring of bacteria, xerostomia - reduciton in anti-microbial effect of saliva
Systemic: Smoking - reduction in blood flow and immune function - more periodontopathogens arise,; Diabetes - increased formation of Advanced Glyation End Products - increased osteo clast function and oxidative stress - increased tissue destruction
111
What are some of the treatment for perio?
Debridment.
Remember that long axis to the tooth should be parallel to the terminal shank
112
What are the steps to bonding resin to enamel?
1. Prophylaxis
2. Acid treatment – for microporosities – increase of surface area for interlocking in the area and create a macromechenical bond – increase of surface area by 2000 times
3. Wash and dry – stop the demin process and remove moisture
4. Fluid (unfiled) resin – flow into microporosities to create resin tags – chemical bonding
5. Unfilled resin polymerised
6. Composite resin placed
7. Polymerised
113
What are two common needles in SA dental clinics
1.Short, 25 mm length, 27 gauge
2.Long, 40 mm length, 27 gauge
114
What is the location of lingual nerve?
It is medial and anteriorly to the inferior alveolar nerve and in close proximity to the lateral surface of medial pterygoid muscle.
115
How to perform anaesthesia of buccal nerve?
1. Inject just medial to anterior border of mandible, distal buccal to the last molar tooth around the level of the lower occlusal plane
2. Hold the syringe parallel with the occlusal plane on the same side
3. Advance the neddle until the needles gently touches the mucp[eriosteum/bone, then slightly withdraw and then inject
116
What nerve innovate the upper molars?
The posterior superior alveolar nerve
117
What nerve innovates the upper premolars?
The middle superior alveolar nerve
118
What nerve innovates the anterior upper teeth?
The anterior superior alveolar nerve
119
During odontogenic infection, what is the path of least resistance in the mandible?
1. If above the mylohyoid line, the infection would progress lingually, eroding the lingual cortical plate and entering the sublingual space. This will elevate the tongue and create diffuculties with breathing
2. If below the mylohyoid line, the infection would progress down into the submandibular space. This may causes swelling near the angle of the ,and able to potentially causing trismus and therefore diffuculties chewing..
120
What does informed consent include?
1. Alternatives and all options for treatment
2. Information surrouding the nature and what the treatment involves
3. Risks of treatment
4. Pros and Cons of treatment and No intervention
5. Cost of treatment
121
What does PICO stand for?
Patient
Intervention
Comparison
Outcome
122
What are contra indications for use of lignospan special?
It should not be used with patients with epilepsy, bradycardia, sever shock or heart block
123
What are contra indications for use of Septanest?
It should not be used on patients with allergy to articane or epilepsy
124
What are contra indications for use of Scandanest?
No major contraindications, good for people with sulfite
125
What is gingivitis?
Gingivitis is generally regarded as a site-specific inflammatory condition initiated by dental biofilm accumulation and characterized by gingival redness and oedema and the absence of periodontal attachment loss.
126
What are signs of gingivitis?
1. Bleeding on probing
2. Erythema
3. Oedema
4. Halitosis
5. Presence of biofilm
6. Discomfort on probing
7. NO EVIDENCE OF RADIOGRAPHIC BONE LOSS
127
What are symptoms of of gingivitis?
1. Bleeding on brushing or flossing
2. Red gums
3. Swollen gums
4. Bad taste, bade breath
5. Soreness
6. Usually not painful
7. Difficulty eating, altered taste
128
What does it mean by reduced periodontium?
In certain situttion there are no evidence of previous periodontal disease, but the periodontium is reduced due to other factors such as genetical factors, injury or trauma or other. In this case, we can state that the healthy gingiva on a reduced periodontium.
129
How to write a diagnostic statement for gingivitis?
1. Extend - localised or generalised depending on the BOP
2. Disease - gingivitis
3. Specification - biofilm induced, mediated by pregnancy or leukemia
130
What is DIGO?
Drug Induced Gingival Overgrowth.
131
What can cause DIGO?
Calcium channel blockers that are used in treatment of cradiovascular disease, immunosuppressants or anticonvulsants
132
What are some treatments for DIGO?
1. Meticulous biofilm control can not prevent development of lesions but may reduce their extent and severity by preventing a secondary infection
2. In sever cases surgcal excision and/or drug substitution may be required
133
What are signs of necrotising gingivitis?
1. Central necrosis of interdental papilla
2. Large amounts of bleeeding on probing
3. Pain on probing
4. Halitosis
5. Lymphodenopathy - swelling of lymph nodes
134
What are the symptoms of necrotising gingivitis?
1. Pain
2. Bleeding of gums
3. Gums appear different
4. Bad taste, bad breath
5. Malaise
6. Fever
135
How do we treat necrotising gingivitis?
1. Debridment under LA (removal of biofilm, calculus and necrotic tissues)
2. Local irrigation with chlorhexidine 0.2%
3. Antibiotic therapy - Metronidazole 400 mg orally, 12-hourly, 3-5days
4. Review and reffer when needed
136
How do we identify biofilm and calculus?
1. Using GC tri Plaque ID Gel
2. Using a dry field of view with use of probes both the periodontal and 11/12 probe
3. Radiographs
137
How do you measure recession?
Recession is measured from the cemento-enamel junction to the gingival margin
138
What are different types of recession?
Type 1 - gingival recession with no loss of inter-proximal attachment
Type 2 - Gingival recession associated with loss of inter-proximal attachment that is lower in the inter-proximal than in true buccal
Type 3 - Gingival recession associated with loss of interporximal attachment that is greater in the inter-proximal than in true buccal
139
How to write a diagnostic statement for periodontitis?
1. Type of periodontal disease - periodontitis
2. Disease extent - generalised or localised
3. Stage - I, II, III, IV
4. Grade - A, B, C
5. Current disease status - stable, remission, unstable
6. Risk profile smoking, diabetes, etc
E.g. Periodontitis; generalised, Stage III, Grade C, currently unstable. Risk factors: smoking 20cig/day
140
What are some of the steps to treatment planning?
1. A comprehensive examination with taking of all histories, extra-intraoral examinations and relevant tests and radiographic images
2. Evaluation, proposing treatment to the patient, patient consent
3. Oral health instructions using TRIM framework
4. Sub/ supra gingival scaling
5. Prophylaxis
6. Diet evaluation
7. Use of extra products
8. Recall depending on patients needs
COMMUNICATING WITH THE PATIENT IS KEY
141
What are the 2 froms of detecrtors available to digital imaging?
1. Solid state (direct) detectors
2. Photostimulable phosphor plate detectors
142
How do we treat hypersensitivity?
1. Block dentinal tubules - using restorations or protective coverings
2. Block nerve activity - stanous fluoride and potassium nitrate
3. Remove the cause - erosion and toothbrushing technique change
143
How do we manage dentine hypersensitivity?
1. Occlude dentinal tubules to reduce impact of stimuli on fluid movement - can be done through chemical occlusion (fluorides) or physical occlusion (sealed resorations)
2. Reduce sensitivity of nerves - using potassium nitrate
144
What are indications for indirect pulp capping?
1. Deep cavity
2. No pulpal exposure
3. Removal of all infected dentine may result in pulpal exposure
4. No signs or symptoms of irreversible pulpits
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What is the most important aspect of indirect pulp capping?
CORONAL SEAL IS VITAL.
146
What happens to the pulp during direct pulp capping?
The varnish that is used is able to neutralise necrotic tissue and cause the deposition of tertiary dentine
147
What are rules in placing a pin?
1. Place in dentine
2. Pin hole parallel to external contour of the tooth
3. 1 pin per cusp
4. Must not be too high
5. Must have access to condense amalgam around pin
6. idially, 2mm of amalgam need to cover the pin
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Why can facial paralysis occur during IANB administration?
Cause: needle was positioned too far posteriorly & LA administered instead in the body of the parotid gland where facial and tympanic nerve run through
Signs + sympotms: Facial paralysis, unilateral, drooping of eyelid and upper lip / corner of mouth
Managment:
1. Tell patient this is temporary
2. Tell patient to not rub their eye
3. Cover the affected eye with eye patch
4. Keep under observation until better
5. No driving back home
6. IF not recovered in 12 hours - will need a medical review
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Why can truisms occur during IANB application?
Causes: Trauma to the muscles or blood vessels, often caused by withdrawing the needle through tissue distension
Signs + symptoms: may present as a prologned spasm of the jaw muscles with limited or complete inability to open the mouth, or pain associated with mouth opening
Managment: Usual improvement within 48-72 hurs with up to 6 weeks for complete recovery. Patient may seek heat therapy, wamr saline rinse, soft diet & jaw exercises.
150
Why can soft tissue damage occur during IANB administration?
Cause: It is usually self-inflicted injury by the aptient themselves; induced trauma or burn
Sings + symptoms: May present as a soft tissue lesion, accompanied by localised pain and swelling. More noticeable once LA has worn off.
Managment: Provide appropriate post-operative insructions. If sever, antibiotics may be prescribed to void infection. Warm saline rinses.
151
Why can temporary blidness occur during the IANB administration?
Cause: Intravascular administaton. Pathway: Inferior alveolar nerve into middle meningeal artery into opthalmic artery causing loss of vision
Signs + Symptoms: Loss of vision a few minutes post IANB administration.
Managment: Stop dental treaatment. Call 000 because patient needs to go to the emergency department. CPR if patient is unconcious.
152
Why can persisten anaesthesia occur when administering IANB?
Cause: Direct sensory nerve damage caused by the needle. Injecting too much LA at high concentrations. Haemorrhage from around/near the neural sheath put pressure on the nerve
Signs + symptoms: paraesthesia will vary depending on structures involved - usually drooling, numbness, pins & needles. If damage to lingual nerve there can be altered taste sensation.
Management: Paraesthesia resolves within approx 8 weeks, if above 8 weeks refer to oral surgeons. Reassure patient and reassess
153
Why can heart palpitations occur during administration of IANB?
Cause: Intravascular injection may cause an excitation of the cardiovascular system
Signs + symptoms: Tachycardia, palpitations and headache
Management: Typically only short in duration. Ensure to stop procedure and monitor the patient.
154
Why can oedema occur during IANB administration?
Cause: May be caused by physical trauma, an allergic response, haemorrhage or irritation
Signs + symptoms: Present as a swelling tissues on the medial side of the ramus after deposition of LA
Managment: Pressure and cold compress applied to the area for 3-5 minutes, acoompanied by warm saline rinse
155
Why can tingly in the trap and throat happen during IANB administration?
Causes: 1) LA travelling down the brachial plexus (unlikely)
2) LA deposited too far back into the fascia surrounding pharyngeal muscles -> anaesthetised supraclavicular branch of cervical plexus that innervates ur traps -> arm numbness (more likely)
Sing + symptoms: Tingling in the throat and trap
Managment: Reassure patient it is temporary. Monitor. If the paraesthesia is persistent, need to get medical care.
156
What is a material risk?
Material riks is a resonable risk depending on a person and procedure. FOr example, fluoride tray is not a risk for an adult but it is for a child
157
What are the steps for periodontal disease management?
1. Treating pain
2. Evaluation of the gingival health
3. Phase I - hygine phase
4. Re-evaluation after 8-12 weeks
158
What framework can be used to assess fissure sealants?
CAMST.
Coverage - is the fissure fully covered
Amount - is there enough FS material
Margins - are the margins sealed & flush
Surface - is the surface smooth
Tooth - at future appts check the tooth
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What is amlogenesis imperfecta?
It is a series of genetic conditions causing change to normal enamel deposition.
It affects all teeth, both deciduous and permanent dentition and occurs due to mutation of enamel proteins.
Results in hypoplastic, hypomineralised and/or hypocalcified enamel.
Symptoms and signs vary between subtypes - include discolouration, sensitivity, increased caries risk, disintegration.
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How would you write a treatment plan?
Using this framework:
1. Completion of all histories
2. Taking consent for additional testing: e.g.tri-plaque gel
or radiographs
3. Diagnosis and treatment plan presentation to the patient + consent for treatment plan
4. Pain management/CC
5. Preventative care: e.g. oral hygine instructions
6. In chair treatment
7. Close date recall with reassessment of ongoing condition changes
8. Transition to regular recall
161
How would you write your statement for LA administration?
1. Put the local anaesthetic : 5% lidocaine Ziagel placed into buccal sulcus near 22
2. Put the technique : Supraperiosteal infiltration
3. Put the anaesthetic and amount and purpose: Lignospan special (2% lignocaine with 1:80000 adrenaline), 1/2 carpule for both soft tissue and pulpal anesthesia
162
What are the 5 important aspects of keeping records
1. Detail
2. Accuracy
3. Legibility
4. Accessibility
5. Retention
163
What is removable prosthodontics?
It is a specialty in dentistry thart focuses ob replacing teeth with removable prosthesis
164
What are abutment teeth?
They are teeth the dentures clasps on
165
What is the general rule when trying to select an appropriate restoration material for a tooth layer?
1. Enamel - composite resin
2. Dentine - GIC
166
What are some of more moderns understanding about the concept of occlusion?
1. occlusion is dynamic
2. Some wear is physiological
3. Continued eruption may occur to compensate for physiological wear
4. Pathological wear is when there is excessive wear for the given age group
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What is the key differene between the Miller technique and Tube shift technique in localisation?
1. Miller technique - two radiographs are taken at right angles to each other - good at determining the position of an impacted tooth
2. Tube shift - a slight shift of the tube is needed after the first radiograph (SLOB) to discern which root is which
