What are two physical signs of anxiety
- Palpitations
- Sweating
- Breathlessness
Outline 2 communication barriers and how to overcome them
- Language difficulties - interpreter
Two cognitive management techniques and examples of each
- ) REDUCE UNCERTAINTY:
- Provide info about the procedure and what you are going to do prior to starting
2.) ENHANCE CONTROL for patient - introduce use of hand signals to stop procedure/raise a concern, stress ball, controlled breathing
SOURCE OF DISTRACTION - music, TV
6 Steps for fissure sealant
- Pumice tooth clean away debris
- Moisture control (cotton wool or dry guard)
- Acid etch 15s
- Dry tooth but don’t desiccate
- Apply fissure seal with probe in the groves and fissures
- Light cure 30 seconds
What is the % survival rate of fissure seal after 4 years? Give paper name, publication date and highest level of evidence
- 48 months 60% caries reduction and 52% retention
- Nunn JH et al., 2000 Journal of paediatric dentistry 1997
- Randomised Control Trial
Alternative ways to protect occlusal surface
- tooth splinting
- Pre-formed metal crown
- Occlusal reduction to get contacts out of lateral excursions
- Fluoride varnish
18 year old hockey player comes in with discoloured UR1. Non-carious dentition and wants it fixed.
What 2 special tests?
Outline 3 treatment modes to address presenting complaint
- Periapical radiograph
- Vitality test - ethyl chloride, EPT
• Venners (porcelain or composite)
• Anterior full coverage crown:
- All ceramic e.g. glass-infiltrated high strength core)
- Resin bonded e.g. feldspathic glasses
Name ceramic crowns but not metal ceramic crowns and advantages and disadvantages
• HIGH STRENGTH CERAMIC CORE: (alumina reinforced feldspar, glass-infiltrated high strength core):
- Has good aesthetics
- High strength
- Destructive preparation
- Opaque core
- Non-adhesive
- Poor marginal fit
(Pure Alumina)
- Good aesthetics
- High stength
- Good marginal fit
• ALL CERAMIC - RESIN BONDED:
(Feldspathic glasses, Leucite reinforced glass ceramics, Lithium disilicate glass-cermaics
- Good aesthetics
- High strength
- Good marginal fit
- Adhesive
- Destructive prep
- semi-translucent core
How are indirect restorations most likely to fail?
- DEBONDING
- FRACTURE:
- Static - segment fractures but remains on tooth, due to excess loading or poly shrinkage
- Cohesive - Within the body of the ceramic and due to excessive functional/parafunctional loading
- Adhesive - Bonding interface has failed due to overloading occlusion
Outline the 4 bonding agent systems
• Type 1:
Etch + Prime + Bond
• Type 2:
(Etch & Prime) + Bond
• Type 3:
Etch + (Prime & Bond)
• Type 4:
(Etch & Prime & Bond)
Phosphoric acid 37%
Problems with free end saddle denture
- Denture can be pulled posteriorly damaging the distal tooth.
- Requires indirect retention due to unbounded distal saddle that can cause tipping around the last tooth in the arch
- Not well tolerated - 50% of free end saddles not worn!
Advantages/Disadvantages of CoCr Denture
- Thinner material so allows for easier adaptation/tolerance for pt.
- More sturdy
- Longer lasting
- More retentive
- Better fit
- More expensive
- Takes longer to make
- Not aesthetic
2 features of dummy sucking
- Increased overbite
* Unilateral crossbite
Mother concerned about long-term effects. What would you advise?
If stopped before 8 years old can realign themselves within a year, if difficult stopping consider using dental/non-dental aids
How does digit sucking differ from dummy sucking
Non-ortho management options
• Retroclination of lower labial aspect and proclination of upper labial aspect, even more pronounced if suck with palm upwards
- Foul tasting nail varnish
- Bandage several digits together
Perio-endo lesion:
What special investigations can be done and how does this affect differential diagnosis
- PA
- Vitality testing
- If pulp vital and no PA abnormalities then no need for RCT (partial pulpotomy, direct capping)
- If true combined lesion then these tests will confirm and therefore also indicate outright RCT or XLA
4 types of posterior crowns
- FGC
- PFM
- 3/4 gold
- All ceramic
list 2 crowns used for RPD abutments
- Milled CAD/CAM crown
- FGC
What info sent to lab when making RPD
- Working impression
- Impression of opposing dentition
- Interocclusal record
- Shade
- Shape
- Surface texture
When fitting a crown and it is too high what are the reasons for this
- Excess cement in crown
- Not enough occlusal reduction
- Not enough trimming of crowns at margins
How to manage temporary restoration that has been lost
- Take impression of diagnostic wax-up and place e.g. protemp to make crown. Spot etch composite if anteriors
4 functions of temporary restoration
- Protect pulp
- Protect preparation
- Prevent drifting of teeth
- Provide good plaque control
- maintain occlusal relationship
- Maintain aesthetics
- Check is prep adequate reduction
