special investigations and presenting pts

Question 1

aim of special investigations

Answer 1

• To analyse teeth and oral tissues to aid diagnosis and treatment planning
  
  • Reach definitive diagnosis from a differential/provisional diagnosis
    
    • Cost money to do
    • Fair for the pt? Money and time?
      
      • Yes, in balance to try to confirm as accurately as possible
        
        • Limited resources and time and decide what is most important

Question 2

examples of special investigations

Answer 2

• Radiographs
  
  • Bitewings
  • Periapicals
  • Occlusal
  • Panoramic DPT
  • CBCT
• EPT electric pulp test
• Thermal tests
  
  • Heat
  • Ethyl chloride (cold)
• Mobility tests
• Plaque and bleeding scores
• Test drill
• MRI – suspected salivary gland issue
• Ultrasound – suspected salivary gland issue
• Sialography – salivary glands (flow, pH)
• Biopsy
• Diet diary – more at risk for certain diseases
• Microbiological tests
• Oral rinse, Swab take e.g. COVID 19
• Haematology tests – suspected anaemia
• Study models – assess occlusion
• Allergy testing – lichenoid mouth reactions
• Photographs – esp case presentation, clinic do yourself but in hospital take to dep

Question 3

common dental radiographs

Answer 3

Bitewings

Periapicals

Occlusal

Panoramic DPT

CBCT

Question 4

vitality tests

Answer 4

EPT

thermal tests - heat, ethyl chloride

Question 5

MRI used in dentistry when

Answer 5

suspected salivary gland issue

Question 6

ultasound used in dentistry when

Answer 6

suspected salivary gland issue

Question 7

sialography used in dentistry to investigate

Answer 7

salivary glands (flow, pH)

Question 8

diet diary used to assess

Answer 8

pts who may be more at risk of certain diseases by seeing their habitual eating

Question 9

types of microbiological tests

Answer 9

oral rinse, swab tests

Question 10

example of use of haematological tests

Answer 10

suspected anaemia, bleeding disorder

Question 11

study models can be used to

Answer 11

assess occlusion when pt not present

monitor pt changes

record dentition

help design prosthesis

Question 12

when may an allergy test be used in dentistry

Answer 12

for lichenoid mouth reactions

Question 13

when may clinical photographs be used in dentistry

Answer 13

teaching

monitor pt changes

esp case presentation, clinic do yourself but in hospital take to dep

Question 14

indications for oral radiographs (8)

Answer 14

• diagnosis
  
  • bitewings for caries
  • periapical for abscess/ apical disease
  • trauma – fracture
  • periodontal disease – bone loss – horizontal or vertical
  • RCT – working length
  • Before extraction – assess root morphology
  • Assess unerupted teeth (periapical)
  • Swellings – what tooth/area associated with

Question 15

contra-indications for oral radiographs

Answer 15

• Pregnant – do if need to do in emergency, beam not aiming at foetus but still assess if it can wait

Question 16

sensibility testing assesses

Answer 16

vitality – blood – more reliable, difficult and unpractical Dopler flow;

sensibility – response of nerve fibres

Question 17

3 indications for sensibility tests

Answer 17

• localise pain
  
  • unsure of source of pain
• apical issue
• bone loss with perio - possible perio-endo lesion

Question 18

2 contra-indications for speical test use

Answer 18

• false positives
  
  • use in context with other tests
• relaiability issues
  
  • multi-rooted or traumatised recently

Tooth dried for EPT, ethyl chloride/ EndoIce, heat

Question 19

4 indications for periodontal charting

Answer 19

• BPE scores 3 or 4
• Mobility – assess if restorable
• Gingival margin
• Pocket depth

Question 20

contra-indications to perio charting

Answer 20

Probe in pocket will cause bleeding so don’t if they have bleeding issues

Question 21

4 indications for study models

Answer 21

• Orthodontics
• Planning a complex Tx to assess occlusion (grade)
• Changed to OVD – increasing vertical dimension of teeth for a reason for occlusion
• Assess tooth wear – grade or compare to older model

Can do electrical scan and store digitally

Question 22

3 contra-indications to study models

Answer 22

• Gag
• Allergies to materials
• If crown is already confirmed occlusion

electrical scan may help resolve gag hurdle

Question 23

what special investigation may be used for bleaching?

Answer 23

photographs - have pre-treatment record to assess difference

Prior approval for NHS treatment – only so much can you do before needing approval for extra funding

Need to take photos for documents

Question 24

what is needed for clincal photos?

Answer 24

Need consent – specific for what you are using, cannot take full face photos

Can’t use mobile phone

Retractors, dry area and take photo

Question 25

oral medicine lesions

Answer 25

take clinical photos to record * send by secure email or for records to compare later

Question 26

2 indications for biopsies

Answer 26

* Take when want to investigate further/ suspected malignancy * Unsure what something is

Question 27

what is possible if there is a lesion next to an amalgam restorations

Answer 27

lichenoid reaction possible

Question 28

types of biopsy and how to take

Answer 28

Need consent and need a laboratory to send it to – need to be able to store in proper medium between taking and testing * Punch * Triangle * Free hand Want abnormal and normal tissue to compare * Don’t take all of lesion away Have accurate drawing/picture/description markers so lesion can be located in mouth

Question 29

3 saliva tests

Answer 29

flow buffering capacity caries - private, unsure of reliability

Question 30

diet diary

Answer 30

3 days, one is a weekend day all food and drink and times recorded can assess links between mouth and diet

Question 31

presenting a patient

Answer 31

* An important skill throughout your career – to supervisor, exams * Needs to be structured

Question 32

when is a pt presented

Answer 32

* before you start treatment * after you have examined the pt

Question 33

reason for presenting pt

Answer 33

Discuss with supervisor about proposed Tx before the pt arrives * E.g composite filling on upper right 5 (15) * Get them to check tooth before commencing any Tx to confirm good to go post examination

Question 34

what to include when presenting a pt (5 components)

Answer 34

* Name* * Age if appropriate* * Reason for attendance/ Referral* * Summary history - CO, HPC, PMH and SH (just relevant)* * Charting – ask Qs that you are unsure off, write down what you see even if you are unsure*

Question 35

eg presentation of pt

Answer 35

***Mrs Robinson Reason for attendance*** *A new patient who has just moved into the area and wanted to register with you as an NHS patient **Patient concerns** 35 year old female attends saying that she is really struggling to wear a CoCr denture that was provided last year to replace her missing central incisor. She had a post crown but the root split. Initially she had worn an acrylic denture but it was even worse**. PMH, SH and PDH** Medically she is fit and healthy and only taking the contraceptive pill. She is recently divorced, has no children and works full-time in a bank. She has had extensive dental work in the past which she puts down to lots of sweets as a child and being a “bit wild” when she was younger.*