What is Emphysema?
Dilation of alveoli by the destruction of their walls. This decreases the elastic recoil of the lungs (Part of COPD)
What should you avoid giving an asthmatic patient?
What is a common side effect of inhaled steroids?
Oral candidosis (to avoid, rinse mouth after using the inhaler)
What can cause an asthma attack?
- Allergens (dust mites, pollen, animal hair) Exercise, Stress, Emotion, Drugs like aspirin or beta blockers
What is osteoporosis?
Loss of bone mass (leads to increased risk of fracture). 15% women aged 50 suffer from this and increases to 70% of women aged 80. Less common in men
What would you give a patient for immediate anti-coagulation?
Low molecular weight heparin
What would you give a patient for long term anti-coagulation?
What is scleroderma?
Scleroderma is an auto-immune disease where the skin becomes thickened and bound to underlying structures. Signs and symptoms include a beaked nose and limitation of mouth movements
What pathophysiology is involved in Systemic Lupus Erythematosis?
1. Auto-immune multi-system disease. 2. Unknown aetiology 3. Antibodies against cell nuclear components 4. Widespread vascular complex deposition
How do peptic ulcers occur?
Discrete break in the duodenal or gastric mucosa. Factors for this occuring include: helicobacter pylori infection, increased rate of gastric emptying, stress and drugs which damage the mucosal lining (e.g. NSAID's)
What is coeliac disease?
An auto-immune disease which causes small bowel enteropathy caused by sensitivity to gluten
What is Crohns disease?
Crohns disease is a chronic inflammatory disorder which can effect any part of the G.I. tract from the mouth to the anus
What might a patient with Crohns disease present in a dental examination?
Gingival inflammation, cobblestoning of buccal mucosa, aphthous ulceration, mucosal tags, angular cheilitis and swollen lips
What are the clinical manifestations of ischaemic heart disease?
Angina, heart attacks, heart failure and arrythmias
If a diabetic becomes unconscious during treatment what should you give them?
Either 50ml of 50% glucose I.V. OR 1mg glucagon I.M.
What should you give a patient with acute chest pain?
GTN spray/tablet sublingually, Nitrous oxide and oxygen (50/50), oral aspirin (150-300mg) as an antiplatelet agent
What should be administered to a patient suffering an anaphylactic reaction?
High flow oxygen (10-15l/min), adrenaline I.M. (0.5-1.0mg) repeated every five mins until patioent responds, hydrocortisone (100-200mg I.V.), chlorphenamine (10-20mg in 10-20ml blood/saline)
What is Pagets disease?
Abnormal bone remodelling which causes abundant new bone formation. These new bones are structurally abnormal and prone to fracture.
How would you treat SLE?
NSAID's, Steroids and DMARD's (along with practical support)
What do patients with Coeliac disease present with?
Malabsorption, Malaise, Diarrhoea, Iron and folate deficiency and protein deficiency
Which cells does HIV infect?
Infects immune cells (T cells and macrophages)
What test can be carried out to diagnose HIV?
The Elisa test.
What groups are at risk of Hepatitis?
IV drug users, high risk sexual behaviours, haemophiliacs and people who need multiple blood transfusions
Describe the inflammation in Crohns disease
Transmural (affects the whole wall). The infiltrate consists of lymphocytes, macrophages and plasma cells
What are the symptoms of hyperthyroidism?
Hypercalcaemia, Bone pain, Malaise, Depression, Constipation and Abdominal pains, Kidney stones "Bones, Stones and Abdominal Groans"
What are the signs of Hyperthyroidism?
Warm moist skin, Tachycardia (irregular heart rate), Increased BP, Fine tremor and Goitre
What are the signs and symptoms of SLE?
Nervous system: Fits, paralysis, neuropathy, psychosis Heart: Valve disease and endocarditis Lungs: Effusions Kidney failure
What can cause liver disease?
Alcohol, Hepatitis, Haemochromatosis, Drugs, Auto-immune disease and diabetes
What are bisphosphonates?
Group of drugs that are helpful in reducing or delaying bone problems in patients with myeloma and some other diseases.
What are the three most common bisphosphonates?
Sodium Clodronate, Pamidronate and Zoledronic acid (last 2 are I.V. and are more potent)
What questions should you ask patients with oral ulceration?
Is the ulceration painful? How many ulcers do you have? How long have you suffered oral ulceration? Which sites in your mouth are affected? Have you suffered from similar ulceration previously?
What haematological investigations would you want in ulcer cases?
Full blood count, Corrected whole blood folate (or red cell folate), Vitamin B12, Ferritin (or serum iron/total iron binding capacity ratio)
How would you manage RAS at the initial visit in general practice?
Full history of complaint, CHX mouthwash, dietary advice to avoid chocolate, crisps and benzoates
What would you do if there had been no improvement in RAS after 4 weeks?
Topical steriods e.g. Hydrocortisone, 2.5mg pellet allowed to disolve adjacent to an ulcer 4 times daily
What are the classic features of trigeminal neuralgia?
Unilateral pain, one division of the trigeminal nerve, Electric shock like pain, Severity of "10 out of 10", trigger factors (e.g. smiling, eating, touching or washing the face)
Which therapeutic agents are often implicated in lichenoid reactions?
Antihypertensives, Gold, Hypoglycaemics and NSAID's
What is balanced articulation?
Simultaneous contacts of the occluding surfaces of the teeth during function.
What is balanced occlusion?
Simultaneous contacts of the occluding surfaces of the teeth in various jaw positions
What is canine guidance?
The guidance provided during the movement of the mandibular canines over the palatal surfaces of the maxillary canines
What is a face bow?
An instrument used to record the relation of the maxillae to the hinge axis of rotation of the mandible. [It enables a similar relation to be established between a maxillary cast and the hinge axis of the articulator.]
What is group function?
Multiple contacts between the maxillary and mandibular teeth on the working side during lateral movements
What are the oral manifestations of Crohns disease?
Aphthous ulceration and cobblestoning of the oral mucosa
Why might a patient be taking oral steroids?
Chronic obstructive pulmonary disease
Inflammatory bowel disease
What are the non-dental side effects of steroids?
Abnormal fat distribution
High blood pressure
Increased risk of infection
Thinning of the skin
How is diabetes diagnosed?
Blood sugar levels
What symptoms may a diabetic experience?
Urinary frequency increased
What are the two main medical emergencies encountered in diabetics?
What are the medical complications of diabetes?
What are the indications for re-root treatment?
- Teeth with symptoms which have been inadequately filled
- Teeth with inadequate root filling when the coronal restoration requires expensive replacement or coronal tissue requires bleaching
What are the signs of a failed RCT?
Clinical symptoms long after completion of RCT
Clinical signs of pathology
Un improving radiographic signs of pathology
A patient has symptoms after RCT, why might this be?
Inadequately cleaned and sealed canals
Vertical root fracture
Is a fractured endo instrument negligence?
This is not regarded as negligence but failure to inform the patient would constitute negligence.
How would you manage extrusion of sodium hypochlorite?
- Inform the patient of the nature of the problem
- Reassure the patient
- Monitor for 30 minutes, there may be bloody discharge so you should irrigate this with saline
- Prescribe analgesics
- Careful follow up on a daily basis until the oedema has resolved
- Prescribe antibiotics if secondary infection occurs
- Apply cold compression pack to relieve swelling
How can you prevent extruding irrigant through the apex of a tooth?
- Obtain a working length radiograph to ensure you are using the correct working length
- Check working length using an apex locator
- Use a 27 gauge leur lock syringe
- Use a slow pumping or passive action when irrigating
- Never wedge the needle into the canal
- Use a stopper on the needle to prevent it going in too far
What might cause extusion of fluid through the apex of a tooth?
- Open apex
- Unnoticed perforation
- External resorption
- Use of excess force during irrigation