practice questions Flashcards by em doz

Give advice, including diet and toothbrushing instruction to a mother of a 6 month old at their first dental checkup.

By 6 months, lower incisors begin to erupt
- start to bring for 6 monthly checkups.

diet
- continue breastfeeding / formula
- avoid putting baby to bed with a bottle (especially if it contains anything other than water due to increased caries risk)
- only water between meals, try to avoid fruit juices or sugary drinks - keep these to mealtimes.
- at 6 months, start weaning, introducing savoury and sugar free foods, encourage healthy options.

TBI - as soon as first tooth erupts!
- use soft, small baby toothbrush
- SMEAR of 1000ppm toothpaste
- brush twice a day (morning and before bed)
- no rinsing after brushing

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A parent has attended with their 7 year old daughter complaining of discolouration of the front adult teeth and sensitivity to hot and cold.
Outline potential diagnosis and management options.

Take a history (SOCRATES), diet habits, OH.
differential diagnosises:
- MIH (usually around 6-8)
- fluorosis
- enamel hypoplasia
- early caries
mx:
- high fluoride toothpaste (normal adult toothpaste 1350-1500ppm) twice daily.
- fluoride varnish 2-4 times a year
- sensitive toothpaste for symptoms
- diet advice (reducing frequency of sugar attacks, keep to meals)
- OHI, gentle brushing.
- sealants/GIC?
- More permanent restorative options to be considered when older (veneers, crowns, microabrasion)
- regular check ups for monitoring 3 monthly.
reassure - not decay but a developmental issue so will protect and monitor teeth and improve appearance over time.

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On examination, a 3 year old presents with unrestorable caries affecting all Ds and Es and UC-C. Parent mentions previous dentist said outer layer of the teeth may be weaker than normal but other 2 children aren’t affected by this. Child is currently asymptomatic.

Mx and Advice

early childhood caries +/- enamel hypoplasia?
1. ask about brushing and diet (put to bed with bottle / not brushing)
2. explain there are a lot of unrestorable teeth present and so XLA of these teeth may be advisable to prevent future pain (IHS or GA) - requires referral to paeds specialist.
3. TBI - brush x2 a day with smear of 1000ppm toothpaste (BUT adult toothpaste due to high caries risk), to be done by parent.
4. Diet Advice - keep to mealtimes, limit sugar attacks to 4.
5. Monitor at 3 monthly checkups, fissure seal 6s and apply FV 2-4 times a year.
Big focus on prevention and home care to be emphasised.

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A 14 year old attends for a checkup with a 12mm overjet.
- do you refer the pt?
- if so, when?
- urgent or routine?
- would this be a late referral?
- what treatment is likely to be carried out?

Yes, this pt should be referred - 12mm overjet is SEVERE.
- routine referral as soon as possible
- late referral as usually made between 10-12
- late referral means growth modification options are nearly finished (functional appliances rely on growth but fixed appliances can still correct alignment.

(treatment depends on stare of OHI)

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A patient attends your practice who requires the extraction of the UL4. They are taking alendronic acid for osteoporosis and have been for the last 10 years.
Discuss the associated risks and treatment options.

Pt is at a greater risk of MRONJ due to being on bisphosphonates for over 5 years.
- tx options include no tx, endo or xla.
- usual risk factors apply (pain, bleeding, infection etc) but added risk of MRONJ because of the medication she’s on.
- signs to look out for include: non-healing socket with exposed bone (<8 weeks) and bad taste / smell

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A patient is having a lower 8 extraction that they are very nervous about.
Discuss the overall procedure.

acknowledge anxiety - ‘completely normal, I’ll explain everything clearly, what is it you’re anxious about?’
we’ll start by numbing the area with LA so you won’t feel any pain, just pressure and some movement, you’ll be numb for a few hours.
then I’ll wiggle the tooth out to remove it - SOMETIMES MAY REQUIRE A SMALL CUT IN THE GUM but this is normal for lower wisdom teeth.
once tooth is out i’ll clean the area and maybe place a stitch if needed.

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A patient is having a lower 8 extraction that they are very nervous about.
Discuss methods that could be used to help manage their anxiety.

LA only - can place topical gel beforehand for a bit of numbing and then injections to make the area nice and numb.
IHS - breathing in a mix of oxygen and happy gas through a nosepiece. Helps you feel calm but you’ll still be awake.
IV Sedation - given through a small line in your arm, makes you very relaxed and sleepy but you’re still responsive.
GA - last resort when all other options have been explored.

GOAL IS TO MAKE IT COMFORTABLE FOR YOU

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Consent LR6 and LR7 RR (close proximity to 8) for XLA

Benefits:
- removal of badly decayed teeth
- prevent future infection
- prevent future pain
- space for prosthetic restoration

Risks
- damage to adjacent teeth
- retention of root fragments
- pain, bleeding, infection
- nerve damage
- potential MOS

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Explain management of LR6 and LL7 retained root (gingival overgrowth).

LA to numb area (IDB long buccal)
aim to luxate and elevate the tooth but there is a high chance the distal root will fracture.
will then aim to extract with elevators / root forceps but LR7 will need MOS.
if LR6 struggles to be delivered then a flap can be made to cover the 67.
some bone will have to be drilled away in order to extract the tooth this way.
stitched up at the end.

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You find a fractured file in the root of an asymptomatic tooth on a PA for a new pt.
How would you explain your findings / tx options?

Show the pt the x-ray and explain that you can see an obstruction in the canal indicative of a fractured RCT file.
Ask if the previous dentist ever mentioned that.
Explain that at the minute, it is good that they are experiencing no symptoms from this tooth so monitor but it could potentially flare up in the future.
if this happens then tx options would include re-RCT (potentially requiring referral to specialist) or XLA +/- with a view to restoring.
if referred then specialist would try to remove / bypass the file to clean and fill the canal again.
options for restoring: no tx, RPD, bridge, implant (depends on bone height).

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You are doing an RCT on a pt but the pt starts to become agitated, has lots of pain and a localised swelling mid way through.
How would you explain and manage what has happened?

Hypochlorite incident?
1. stop
- explain that some of the cleaning solution used to disinfect the tooth may have leaked through the dam.
- solution is effective at disinfecting inside the tooth but can be irritating to surrounding tissues if it escapes.
2. immediate copious irrigation with saline or water for 15 mins
3. ice pack compression for 24 hours followed by warm compress for 24 hours
4. analgesics to manage pain
5. antibiotics to prevent secondary infection (amoxicillin / metronidazole)
6. review

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Pt presents with C/C over 10 years old - clear sings of occlusal wear and pt complains of soreness in the corner of their mouth.
What is the diagnosis and cause?

explain that the soreness in corners of mouth is indicative of angular chelitis
sometimes in denture pts, fungal infection by candida albicans occurs due to inappropriate OH (taking out at night etc) and this can cause cracking and soreness in the corners of the mouth.
in this case it can also be due to the wear causing the mouth to be over closed and corners to fold inwards and remain moist, making the ideal environment for the infection to spread.

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Pt presents with C/C over 10 years old - clear sings of occlusal wear and pt complains of soreness in the corner of their mouth.
Short term management.

Miconazole gel or nystatin cream + denture hygiene advice.
(could check for nutritional deficiencies or consider temporary reline)

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Pt presents with C/C over 10 years old - clear sings of occlusal wear and pt complains of soreness in the corner of their mouth.
Long term management:

Construction of a new set of C/C to correct OVD.

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Management of a lesion suggestive of erythroleukoplakia:

URGENT 2WR
- red component carries high risk of malignancy.
- eliminate any risk factors (smoking, alcohol, chronic trauma)
- full examination; note site, size, shape, texture.
- explain to pt that you have found a lesion that looks different to the rest of the mouth and so you would like to refer them urgently to have it checked.
- ask them if they have had any other associated symptoms: bleeding, growth, ulceration)

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Pt presents with sore, ref palate under the area of their upper partial denture. RMH - lansoprazole, atorvastatin, clopidogrel.
After providing denture hygiene advice, you look to prescribe therapy for the pt.
Write a prescription:

Pt has denture stomatitis, look at RMH!
(usual topical would be miconazole oral gel but clopidogrel effect is increased by this so CONTRAINDICATED)

Nystatin Oral Suspension 100,000 units/ml 30ml bottle
1ml to be used 4 times daily (QDS)
Retain in mouth for as long as possible before swallowing.

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A school teacher has rung your practice after a child has fallen in the playground and avulsed an upper tooth - explain how you would handle the situation.

ask the age / adult or baby tooth - 6+ then likely permanent.

if primary tooth
- do not reimplant
- find the tooth if possible, attend to injuries and attend the practice, ideally with parent.
- ask about loss of consciousness.

if adult tooth
- find tooth and handle by the crown, not root
- rinse with milk / saline / saliva if contaminated and reimplant
- ask child to bite on handkerchief
- if can’t reimplant, store in milk / saliva / buccal sulcus and attend straight away (ideally with parent present)
- when attending practice, check positioning / clean with saline and reimplant, splint for 2 weeks and check tetanus status, prescribe systemic antibiotics.

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A 21 y/o pt attends with an intrusive luxation of the UR1.
How would you manage (anything different primary vs permanent)?

exam - tooth pushed apically, no mobility, metallic sound on TTP, PA OPG to assess position.
tx - primary tooth should be monitored for spontaneous re-eruption.
- permanent tooth should be extirpated at 2 weeks.
- mild intrusion can be monitored for 3 weeks and then orthodontontically repositioned
- moderate surgically repositioned OR orthodontically
- severe needs surgical.
- splint for 4 weeks

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At a 2 week review of a reimplanted avulsed tooth, you are going to perform RCT.
How would your management differ between an open and closed apex?

Open
- monitor for revascularisation or necrosis
- in the event of necrosis, apexification needed - GDP should extirpate and dress with CaOH

Closed
- extirpate and dressed with CaOH by 2 weeks
- URGENT REFERRAL TO SPECIALIST

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How to diagnose cracked tooth syndrome.

take history - pain on biting, sensitivity, no spontaneous pain.
visual inspection - may also need transillumination or removal of an old restoration
special investigations - TTP (should be normal), ethyl chloride (exaggerated to cold), periodontal probing (may have an isolated deep pocket if crack extends subgingivally)
radiographs - rules out caries / pathology.

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How to manage cracked tooth syndrome.

explain to the pt
options include: leaving and monitoring
- restore the crack with a temporary restoration to see if resolves and then place definitive when diagnosis confirmed of minimal crack.
if crack approaching pulp - consider onlay / crown.
irreversible pulpitis: RCT and crown.
crack extends subgingivally - unrestorable so XLA.

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How would you assemble an EAL for an EWL of 27mm?

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assemble EAL - put lip clip in.
put lip clip on lip
select 31k file (wl is 27 so others wouldn’t work)
attach EAL and get 3 CONSISTENT readings
put stopper to reference point
measure length with ruler

Put the EAL away and all the relevant equipment in the appropriate waste etc.

equipment includes:
- EAL
- 21/25/31mm k files
- ruler
- lip clip
- sponge

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EAL: wipeable
K files: sharps
ruler: autoclave
lip clip: autoclave
sponge: clinical waste

How would you endodontically manage:

a standard LL6 with caries into the pulp.

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RCT and cuspal coverage restoration.

(if unrestorable, xla)

**How would you endodontically manage:** acute periapical periodontitis.

RCT and cuspal coverage

How would you manage a **hypochlorite incident**?

1. **irrigate canal** with saline (or water if not available) - dilutes remaining hypochlorite in canal. 2. **dress** the tooth with non-setting CaOH and a temp filling. 3. **pain management** - add more local and advise immediate paracetamol or ibuprofen usage not exceeding max doses. 4. **swelling management** - ibuprofen (NSAID), cold compress on FIRST DAY, warm compress on FOLLOWING DAYS. 5. **review** - swelling may peak at 5-7 days. 6. **document in notes**

**How would you endodontically manage:** a trauma injury presenting with necrosis.

RCT and monitor regularly. XLA if experiencing symptoms after RCT.

**How would you endodontically manage:** a sclerosed canal.

1. take CBCT to assess canal. 2. access and use ultrasonic to try remove calcified dentine 3. negotiate with 10k and irrigate (cuspal coverage following RCT if successful)

How would you manage a **supernumerary mesiodens**?

xla supernumerary and monitor eruption - refer?

**What type of referral and management would you do for:** Minor RAS

**routine referral** - do FBC, haematinics, ESR, anti-ttg.

**What type of referral and management would you do for:** Squamous Cell Carcinoma

**urgent** - incisional biopsy.

**What type of referral and management would you do for:** Geographic Tongue.

**no referral** - reassure but could do haematinics to investigate any underlying causes.

**What type of referral and management would you do for:** Fibroepithelial Polyp

**routine** - excisional biopsy.

Consent this pt for XLA of LR6 with extensive caries - **write 2 benefits and 5 risks**.

**benefits** - remove badly decayed teeth - prevent future pain - prevent future infection - allow for orthodontic closure - allow for prosthetic replacement. **risks** - post op pain / bleeding / infection - damage to adjacent teeth - nerve damage - need for MOS

What are 3 things needed for consent to be valid?

**consent must be:** - voluntary - informed - pt must have capacity

A 20 year old smoker attends with yellow ulcers interdentally, painful gums and bad breath/taste. He is currently stressed for exams and has a temperature of 38.8º. **What is the diagnosis and management for this case?**

**Acute Necrotising Ulcerative Gingivitis** - 1. give OHI (use of chlorhexidine for plaque control, brush) 2. smoking cessation 3. supra PMPR 4. **evidence of systemic involvement** - metronidazole 400mg / amoxicillin 500mg.

Write a prescription for ANUG.

400mg Metronidazole Tablets Take 1 tablet 3 times a day for 3 days. Send 9 (nine) tablets. Avoid **alcohol**. — CROSS OUT BOTTOM —

What diagnoses to write for a periodontally involved implant:

1. perio diagnosis (Stage, Grade, Unstable/Stable, risks) 2. peri-implantitis or peri-implant mucositis

Write a prescription for a therapist to manage peri-implantitis.

1. OHI, TBI, P&B indices, FV, FPA 2. supra PMPR 3. sub PMPR if indicated - LA prescription: 2% lidocaine 1:80000 epinephrine, dose: 4.4ml/kg - use topical benzocaine if required. 4. review in 8-12 weeks.

What ages are the growth periods for girls /boys?

girls = 10-13 boys = 11-14

Pt attends with mother C/O sensitive and yellow teeth which seem to be crumbling only on the front and back teeth. **What is the most likely diagnosis for this condition?**

Molar Incisor Hypomineralisation

Explain MIH to the mum / child:

- common condition called molar incisor hypomineralisation - means that the outer protective coating of the very front and back teeth didn’t form normally during development. - **this is no one’s fault** and the cause is currently unknown but contributing factors may include traumatic birth / childhood illness. - management will focus heavily on the prevention of these teeth getting worse (FV application, sealing 6s) - any molars that are more extensively broken down may need PMC or XLA depending on severity.

A 4 y/o attends having traumatised his front teeth. His As are infraoccluded and a sinus is present above URA. **What are 3 questions you would ask when taking a history of this incident?**

1. when, where, how did the injury occur? 2. any loss of consciousness? 3. what is the tetanus status of the child (are they up to date with vaccinations?* 4. any other injuries which may require urgent medical attention? 5. have they found the tooth.

The same child later attends when they are 7 with a gap where the central should be. **As a GDP, how would you manage this pt at this time?**

1. reassure - front teeth should erupt age 7-8 so there is still some time for growth. 2. refer routinely 3. monitor 4. review OPT / take more up to date.

A woman attends with pain from the LL5 (has an 8mm pocket distally, responsive to EPT). Pt is feeling well. **Please explain diagnosis and treatment options.**

1. periodontal abscess 2. mx includes incision and drainage / sub PMPR (**no antibiotics indicated at this time as there is no fever or signs of systemic involvement**)

**Please explain the purpose of:** Fox’s Occlusal Plane Guide

**used to check if dentures are balanced on both sides** - landmarks used to assess (alatragal and interpupillary lines).

**Please explain the purpose of:** Hot Plate

Melts the wax of the reg rims so they better fit in the mouth.

**Please explain the purpose of:** Alma Gauge

measures lip support so the dentures have a natural appearance

**Please explain the purpose of:** Willis Bite Gauge

measures the height of the face from under nose to under chin when pt is biting and at rest to make sure there is enough space between dentures to chew and speak comfortably. (*measures the length of the bite*)

**Mum brings her 8 month old to his first knee to knee exam and wants to know how to care for his teeth.** Please give advice and explain where she can find more information.

- check up by 1: good start and continue to bring for regular checkups to get him used to the environment and also spot any anomalies earlier. - start brushing teeth as soon as first one erupts: smear of 1000ppm toothpaste, brush twice a day for 2 mins, brush and supervise until 7. - discourage breast feeding and introduce free flow cup to wean off using bottle. *More info can be found in the Delivering Better Oral Health Toolkit.*

**Pt had his tooth taken out yesterday by a dentist who is currently not in. He says it has not stopped bleeding and is taking medication for AF.** What questions would you ask to manage this over the phone?

1. Ask about medication - ‘*are you currently taking any medication to manage AF?*; **warfarin**. 2. INR - *when was the last time you measured your INR and what was the value?*; **3.5 measured on morning of appt**. 3. How was the XLA - *how did it go? how did the bleeding start and has it been continuous?* 4. Colour and consistency of the blood? 5. Previous XLAs - *have you had any previous XLAs and how did these go?*

**Pt had his tooth taken out yesterday by a dentist who is currently not in. He says it has not stopped bleeding and is taking medication for AF.** What advice would you give to manage this pt over the phone?

1. Did the dentist give you a bite pack / gauze yesterday? - **no**: roll up handkerchief and bite down for 20 mins. 2. Attend the dental practice ASAP 3. Pack with **surgicel** (oxidised cellulose) and suture socket.

What do you use to pack sockets in both dry socket or uncontrolled bleeding?

**SURGICEL** (oxidised cellulose) for **excessive bleeding**. and **ALVOGYL** for **dry socket**.

practice questions Flashcards

(53 cards)