1
Q
What nerves must be anaesthetised to remove tooth 48 safely
A
Inferior Alveolar Nerve
Lingual nerve
Long buccal nerve
2
Q
What are two different ways to assess anaesthesia has been achieved?
A
- Probe around the tooth and ask the patient if they feel anything sharp
- ask if the patients lips and tongue feel numb
3
Q
What is the dental terminology for pins and needle feeling or partial loss of sensation ?
A
Parasthesia
4
Q
What is the dental terminology for painful, unpleasant sensation lasting for a fraction of a second ?
A
dysesthesia
5
Q
What is the dental terminology for total loss of sensation?
A
Anaesthesia
6
Q
What are 3 clinical reasons that could account for neurological-sensory deficits?
A
- crushing injury
- cutting/shredding injury
- transection of the nerve
- damage due to LA
7
Q
What is the correct terminology for dry socket?
A
localised alveolar osteitis
8
Q
What are predisposing factors of dry socket?
A
- smoking
- excessive mouth rinsing after extraction
- excessive trauma during extraction
- previous dry socket
- more common in mandibular extractions
- More common in posterior extractions
- More common in females
- Oral contraceptive pill
9
Q
What are signs and symptoms of sry socket ?
A
pain disturbing the patients sleep
pain radiating to the ear
dull aching pain
bad breath (halitosis)
bad taste in the mouth
exposed bone that may be sensitive
10
Q
What is the management for dry socket?
A
- reassure and support the patient
- debridement to remove the old clot and encourage new clot formation
- irrigate the socket with warm saline
- may give systemic analgesia
- antiseptic pack (BIP)
- advice patient on analgesia and hot salty mouthwash
11
Q
What are risk factors of oral cancer ?
A
- smoking
- Alcohol intake
- HPV
- sunlight
- nutritional deficiencies
- candida infections
12
Q
What radiation dose increases the risk of osteoradionecrosis?
A
doses over 60 Gy
13
Q
What are oral complications of radiotherapy?
A
- osteoradionecrosis
- radiation caries
- hypogeusia - loss of taste due to radiation affecting taste buds
- xerostomia - may be due to damage of salivary glands
- difficulty wearing dentures
- more prone to fungal infections
- trismus may occur due to replacement fibrosis of muscles of mastication
14
Q
what sites of the teeth are affected by radiation caries?
A
- gingival margins and incisor edges
15
Q
what are causes of radiation caries?
A
- dry mouth
- loss of taste
- change in diet
- hypersensitivity of teeth makes OH difficult
16
Q
What do you need to know about patients who have had radiotherapy?
A
- what dose of radiation was given
- what area of the body was exposed to the radiation
- duration of treatment
17
Q
What are preventative measures used for patients who have had radiotherapy?
A
- OHI
- higher concentration of fluoride toothpaste
- fluoride varnish
18
Q
how do you treat osteoradionecrosis?
A
- irrigation of necrotic debris
- remove loose sequestra
19
Q
What methods help prevent risk of osteoradionecrosis?
A
- scale teeth near extraction site and use chlorohexidine mouthwash
- careful extraction technique
- antibiotics, chlorhexidine mouthwash and review
- hyperbaric oxygen before and after extraction to increase local tissue oxygenation
- close soft tissues
19
Q
What methods help prevent risk of osteoradionecrosis?
A
- scale teeth near extraction site and use chlorohexidine mouthwash
- careful extraction technique
- antibiotics, chlorhexidine mouthwash and review
- hyperbaric oxygen before and after extraction to increase local tissue oxygenation
- close soft tissues
20
Q
What is the most common cause of facial trauma in a female patients?
A
Domestic Abuse
21
Q
What are the forms of abuse that may be involved in domestic abuse?
A
- Physical violence
- Verbal abuse
- Emotional abuse
- Sexual abuse
- Financial Abuse
22
Q
What process should you follow to ask about the possibility of domestic abuse
A
AVDR
Ask - ask about abuse in a private setting
Validate - show you are concerned about them
Document - be specific and detailed, use patients own words and describe injuries in as much detail as possible
Refer - signpost to appropriate services
23
Q
What are physical signs you may see in domestic abuse ?
A
- repeated injuries
- Bruises at different stages if healing
- dental/maxillofacial injuries
- facial bruising, strangle marks around the neck or fingertip bruising
- TMJ problems
-Orofacial pain
24
What are causes of liver cirrhosis
- Alcohol
- Hepatitis virus
- fatty liver disease
- autoimmune causes:primary billary cirrhosis
- haemochromatosis
- hepatocellular carcinoma
- drug induced
25
what does dentally fit mean
- no active pathology
- consider removing teeth of poor long-term prognosis
- establish preventative plan
26
why should a patient be dentally fit before a transplant
the patient will be immunosuppressed for the rest of their life so must reduce the risk of further dental intervention in the future
27
what teeth can be justified to extract when making a patient dentally fit
teeth with periapical periodontitis or other pathology
teeth with poor prognosis - highly restored and secondary caries
28
what causes thrombocytopenia to occur
splenic sequestration
impaired hepatic synthesis
increased degredation of thrombopoeitin by platelets sequestered in the congested spleen
drug related - alcohol, penecillin based drugs or heparin
29
what platelet level is considered safe to treat in general practise
>100 x 10^9 / L
30
why might patients with advanced alcoholic liver disease have increased risk of bleeding
- thrombocytopenia
- medication induced, patient may be taking heparin
- liver disease may have been caused by hepatitis or HIV which both affect bleeding
- clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
30
why might patients with advanced alcoholic liver disease have increased risk of bleeding
- thrombocytopenia
- medication induced, patient may be taking heparin
- liver disease may have been caused by hepatitis or HIV which both affect bleeding
- clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
31
What are the types of dementia
Alzheimers
Vascular dementia
Dementia with lewy bodies
32
what are early stages of dementia?
Short term memory loss
confusion
Anxiety, agitation or distress
Communication issues - decline in ability to talk or write
33
What are middle stages of dementia
support required for everyday activites e.g. washing, dressing, using the bathroom
Increasing forgetfulness
Distress, aggrression or anger
Risk of wandering
behaving inappropriately e.g. going out in pyjamas and slippers
34
what are end stage
inability to recognise familiar objects, surroundings or people
Increased physical frailty - may shuffle when walk or become confined to a bed or wheelchair
difficulty eating and swallowing
asphagia
35
who can provide section 47 AWI certificate for dental treatment
dentist who has done additional training
general medical practicioners
consultants in-charge of patient care
36
What is the antibiotic and dose given for antibiotic prophylaxis
amoxicillan 3g
clyndamicin 600mg
37
how long before a procedure is AB prophylaxis taken and what guidance is this from
1 hour
SDCEP guidance
38
what are indications of child abuse/neglect?
- irregular attenders - only attend when in pain
- delayed seeking attention/help for injuries
- injuries to the triangle of safety (ears, neck and side of face)
- Injuries to the head and neck
- injuries to both sides of the body
- untreated injuries
39
What would you ask if you suspect child abuse
ask what caused the injury and see if the story matches clinical finding
Has there been a reason for delay in seeking advice
40
who could you discuss concerns with about child abuse
Child protection adviser
Named safeguarding nurse
41
what are the stages in managing child neglect?
Preventative dental team management - raise concerns with the parents, offer support, set targets and monitor progress
Preventative multi-agency management - liase with other professionals (e.g. health visitor, GMP, school nurse) and agree joint plan of action
Child protection referral - follow local guidelines to refer to social services
42
how do you refer to child services?
initially by telephone
follow up referral in writing
43
what is the treatment for dentine enamel fracture
cover all exposed dentine with glass ionomer or composite
44
what would you look for clinically when monitoring this patient
- normal mobility
- no TTP
- discolouration
- Infection
45
what are radiographic signs a tooth is non vital
internal inflammatory resorption
External inflammatory resorption
Periapical abscess
Widened PDL
Loss of lamina dura
46
what appliance might help prevent injury to anterior teeth
splint
47
explain the distribution of decay in nursing bottle caries
lower incisors protected by the tongue
Maxillary incisors are affected worst as they erupt first
Affects molar teeth
if habit continues teeth will be affected in the sequence of eruption
48
what causes nursing bottle caries
going to bed with a bottle of milk or juice
prolonged breastfeeding
baby using bottle as a comforter rather than a dummy
inappropriate use of feeding bottles and cups - should not contain sugar juice or milk
49
fluoride regime for 2 year old with caries
1500 ppmF toothpaste 2x daily
50
fluoride regime for 2 year old with caries
1500 ppmF toothpaste 2x daily
51
What are recommendations to make for toothbrushing
- brush 2x daily with a smear of toothpaste (state concentration)
- Parent should be brushing teeth for the child
- do not rinse mouth after brushing
- use a small headed toothbrush with soft bristles
52
What are local causes of maloclussion
- variation on tooth number
- variation in tooth size or form
- abnomralities of tooth position
- Local abnormalities of soft tissue
- Local pathology
53
what are examples of variation in tooth number
supernumary teeth
hypodontia
Retained primary teeth
early loss of primary teeth
unschedules loss of permanent teeth
54
what are the types of supernumary teeth
conical
tuberculate
supernumary
odontome
55
what are 2 ways to assess AP skeletal pattern
Palpate skeletal bases
visual assessment
56
what are possible non-skeletal factors that can because class 2 div 2 occlusion
- lip trap
- digit sucking
- crowding
57
what appliance can be used to correct class II div 2 malocclusion
functional appliance - twin block
58
how does mandibular growth occur
growth occurs at condylar cartilage
growth occurs by surface remodelling ( resorption and deposition of bone)
results in increase in height of the ramus and increase in the length of the dental arch to accomodate teeth
growth is downwards and forwards
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