BDS 2 SAP final

What are the important stages of decontamination and where is it described? *

HTM 01-5

1. Clean to remove debris/ saliva

2. Disinfect to kill microbes

3. Inspect for debris/ damage

4. Steam sterilise for 3 mins at 134 degrees and 2.1 bar

5. Store- up to 1 year if wrapped

What type of pathogen can survive the sterilisation process and what disease might it cause?*

Prion proteins

CJD

What are 3 blood-borne viruses transmitted via sharps injuries and their risk? *

Hep. B= 30%

Hep. C=3%

HIV= 0.03%

How can you reduce the likelihood of sharps injuries? (3)*

• don’t resheath needles

• Immediately dispose of needles and matrix bands after use in sharps bin

• Cover bur packs when not in use

• Remove burs/ scaler tips after use

How to dispose of matrix bands?*

Carefully remove from holder

Dispose in sharps bin

What to do immediately after needle-stick injury?*

1. Wash with warm water and soap; encourage bleeding; dry and apply plaster

2. Report to supervisor

3. Assess risk from vaccine status and patient

4. Medical evaluation- PEP within 1 hour; 3 week, 3 month and 6 month follow up

5. Review safety protocols

When to wash hands?

After

• toilet

• Touching contaminated instruments

• Contact with bodily fluids

Before and after

• patient contact

• Breaks

• Wearing gloves

PPE wearing order

1. Handwashing

2. Apron

3. Mask

4. Goggles

5. Gloves

PPE removal order

1. Gloves

2. Handwashing

3. Apron

4. Goggles

5. Mask

6. Handwashing

Signs of cancer (6)

• lymph nodes- hard, tender, fixed >1cm

• Dysphasia

• Loose teeth

• Unexplained swelling/ weight loss

• Persistent muscle/ TMJ pain

• Ulcers >2 weeks persistent bleeding, increasing in size

Examples of sharps (6)

• carpules

• Needles

• Matrix bands

• Orthodontic wires

• Scalpels/ endodontic file

• Broken mirror

Hazards of Using alginate

Eye/ airway irritant

Choking hazard

Cross contamination

Hazards of using restorative materials

Acid-etch burns

Allergy

Eye irritant from curing

Hazards of using rubber dam

Choking on clamp

Latex allergy

Gingival trauma

Eye trauma from frame

Hazards of hand scaling

Sharps

Eye injury

Tiredness

Hazards of using ultrasonic scalers

Aerosol

Pacemaker

Soft tissue trauma

Hazards of endodontics

Infection from breaking file

Sodium hypochlorite irrigation causing irritation

Cross contaminants

RFA/HPC/PCO pain history*

Site

Onset

Character

Radiation

Associated factors

Time

Exacerbating factors

Severity

MH concerns

Hypertension/ heart disease

Asthma/ COPD

Anaemia

Allergy- penicillin; latex; anaesthetic

What is the effect of anticoagulant medications?

Delayed healing

Excessive bleeding

Empathy meaning

Active listening to understand and offer comfort by getting to root of problem

Why is taking medical history important?

Accurate diagnosis

Safe tremendously

Prevent complications

Tailored care

Legal/ ethical

Special tests to be conducted

Radiographs

Cold/ hot testing with endofrost/ ethyl chloride for pulp vitality

Tender to percussion- PDL/ periapical

Stages of treatment

Emergency- remove pain

Stage 1- disease control/ stabilise

Stage 2- restorative/ definitive

Follow up and maintain

Factors from patients history that predicts their caries risk*

MH: high sugar medications; diabetes/ Sjorden’s reducing saliva flow

DH: previous caries/ restorations; OH

SH: diet; stress; SES;

Open vs closed questions*

Allow patient to respond

Can only be answered with yes/ no

Positive body language (5)*

Eye contact

Open posture- don’t fold arms

Lean slightly forward

Sit at eye level

Mirror and nod

OARS*

• communication model

Open ended questions

Affirmative language

Reflective listening

Summarise

TIPPS*

• behaviour change model

Talk

Instruct

Practice

Plan

Summarise

Preventative instructions (8)*

OH and toothbrushing instructions

Shorter recall

Diet modifications

Contact GP

2600/5000ppm toothpaste

Fluoride/ chlorohexadine mouthwash

26000ppm fluoride varnish 2-4x per year

Fissure sealants on molars

What brushing instructions should be given? *

BASS technique-45 degree towards gum line

2x/ day for 2 mins, once at night

1450ppm toothpaste

Don’t rinse/ use mouthwash after

Instruments used for interdental cleaning and why(5)*

Water flosses- mobility issues

Floss- small gaps

Interdental brushes- large gaps

End-tufted brush- orthodontics/ behind 3rd molar

Denture brush- teeth and base

Constituents of toothpaste and functions (9)*

• anticarious: sodium fluoride

• Anticalculus : zinc citrate

• Antisensitivity: strontium chloride

• Antistaining: hydrogen peroxide

• Abrasive: calcium carbonate

• Detergent (plaque solubility): sodium lauryl sulphate

• Humectant: xylitol

• Thickening agent: synthetic cellulose

• Flavouring: spearmint

Diet sheet recommendations (7)*

• reduce frequency and quantity of free sugars

• Switch to ‘safe’ foods- nuts, cheese, plain yoghurt

• Have larger meals to avoid snacking

• Restrict sugars to meal times

• Switch erosive drinks to milk/ water

• Ensure enough vit. C/D

• 15-20% proteins- decrease oral pH

Eatwell recommendations(5)*

• 5 fruits/ vegetables/day

• 2l of water

• 50-55% carbohydrates

• 30% fats

• 15-20% proteins

Ways to introduce behaviour change (3)*

COM-B

ICES

POLAR training

Strategies for behaviour change (5)*

TOOTHPICKS

If-then plans

Pros/cons motivational interviewing

TIPPS

SMART goals

Communication models (2)*

OARS

CLASS

Effects of smoking (3)*

Reduced gingival flow= root caries

Impaired healing= longer healing post-extraction

Increased inflammatory cytokines= periodontitis with less BOP

Increased risk of cancer

Level of evidence of fissure selants*

Cochrane systematic reviews of RCT- reduce occlusal caries in children/ adolescents; limited evidence for adults

What teeth should get fissure sealants?*

Permanent molars/ premolars

With deep pits/ fissures

At risk of occlusal caries

What happens when fissure sealants placed over occlusal caries?*

Arrests lesion- turns black/ brown

Cutting of nutrients, substrates and oxygen

Best intervention for early occlusal caries? *

Fluoride varnish

2800/5000ppm toothpaste

Best intervention for occlusal dentine caries*

Fissure sealant

Best intervention for enamel buccal lesion *

Minimally invasive resin composite

Effects of smoking withdrawal*

nIcotine cravings

Mood swings

Concentration difficulties

Increased appetite

Sleep disturbance

Constipation

Productive cough

Oral ulcers

Explain the stages of VBA*

Ask- record smoking status

Advise- on most effective way of quitting

Act- on patient response

How to set up 3-in-1 syringe for infection control *

Single-use disposable tip

Plastic sleeve

Run waterlines to flush tubes

Biofilm definition

Complex aggregation of microorganisms encased in highly hydrated matrix of exopolysacchraides secreted by bacteria

What bacteria are responsible for caries? (4)*

Actinomyces

S.Mutans

Fusobacterium

Lactobacilli

Name 6 features responsible for the formation of caries

• bacteria/ plaque

• Time

• Tooth

• Diet

• Saliva

• Fluoride/ AB agents

• Knowledge

Featherstone caries balance

Complex interaction between protective and pathological factors

Pathophysiology of caries

Acidic by-product- lactic acid

Of bacterial metabolism of fermentable carbohydrates

Below critical pH results in diffusion of calcium, carbonate and phosphate out of tooth

Stephan’s curve

Frequent eating/ drinking

Lowers pH below critical pH

• enamel: 5.5

• Dentin: 6.5-7.5

Into danger zone for long time

Caries defintion

Infectious microbial disease

Results in destruction and dissolution of tooth

Episodic- phases of demineralisation as a result of bacterial metabolism, and remineralisation

OCCURING simultaneously within same lesion

Cavity definition

Breach in tooth surface

Ways to classify caries

• progression

• Tissue

• Surfaces involved

• Number of surfaces

Progression of caries classification

• acute- rapid, soft, light

• Chronic- slow, dark, minimal symptoms

• Arrested- non-progressive, dark

Tissue caries classification

• enamel

• Dentine

• Root/ cementum

Surfaces involved caries classification

I- pits/ fissures

II- proximal of posterior

III- proximal of anterior

IV- proximal and incisal of anterior

V- cervical of all

VI- cusp tips/ incisal edge

Number of surfaces caries classification

Simple=1

Compound=2

Complex= 3+

Residual caries definition

Caries left behind

Recurrent caries

New decay beneath restoration

Ways of diagnosing caries (5)*

Visual/ tactile- dry; blunt probe; bright light

Radiographs

Caries detector dye

UV illumination

Fibre-optic transillumination

DIAGNODent; CarieScan

Where to look for caries (5)

Pits/ fissures

Smooth surfaces

Approximal areas

Under restorations

Exposed roots

How to remove caries (5)*

Burs- fast/ slow handpiece

Laser

Ultrasonic scaler/ chemo-mechanical

Excavator

Air abrasion

Link between saliva and caries *

Reduced saliva= less to wash away plaque; less ions to buffer acid

Mouth pH below critical pH in danger zone for long periods of time increases caries risk

Factor best determining caries risk*

OH

Previous caries/ restorations

Caries low risk

Good oral hygiene

Regular use of fluoride

Minimal sugar intake

No active caries/ restorations

Caries medium risk

History of caries but no active lesions

Suboptimal fluoride exposure

Occasional high sugar diet

Caries high risk

Multiple active carious lesions

History of frequent restorations

Poor OH

Frequent sugar intake

Xerostomia

When to take radiographs for each caries risk

Low= 12-24 months

Medium=6-12 months

High=3 months

What to check on radiographs *

Radiolucency

Bone loss

Caries

Calculus

Overhanging restorations

Recession

What is a radiolucency in the Interproximal region on radiographs?*

Cervical burnout

Implication of enamel having a different critical pH to dentin*

Caries reaching dentin spreads rapidly

Cavity preparation definition

Cutting remaining tooth to receive restoration

Tooth preparation definition

Mechanical alteration of diseased/ defective/ injured tooth so placement of restorative material restablishes form and function including aesthetics

Line angle definition

Junction of 2 tooth surfaces

Point angle definition

Junction of 3 tooth surfaces at single point

Axial wall

Internal vertical surface perpendicular to pulpal floor

Cavosurface angle definition*

Angle between cavity wall and external tooth surface

Conservation definition

Repair tooth from caries/ trauma

Whilst preserving pulp vitality

Extension for prevention definition

All pits and fissures included

Outline form definition

Place preparation margins they will occupy in final preparation except for finishing enamel tooth walls

Outline form principles (5)

Include all faults

Remove all unsupported enamel (0.2-0.5 pulpally of DEJ/ 0.8mm from root surface)

Place margins so restoration can be finished- pierce cus and marginal ridge strength

Connect <0.5mm defects

Minimise dentin extensions

Resistance form definition

Placement of walls to best enable the remaining tooth/ restoration to withstand occlusal forces in long axis of tooth

Resistance form principles (5)

Box with horizontal flat floor

Rounded internal line angles

Min. Depth of material

Minimise extensions into external walls- Cap cusps if necessary

Bond to tooth structure

Retention form definition

Placement of margins to prevent displacement of restoration by lifting/ tipping forces for non-bonded restorations

Convenience form definition

Placement of walls to allow adequate observation, access, and ease of operation for restoration/ preparation

When to remove dentin from lesion

Infected

• sticky, brown, soft

When to remove old restorations (5)

Impacts aesthetics

Reduces retention

Recurrent decay on radiographs

Pre-op pulpal pain

Periphery not intact

Secondary retention/ resistance features

Grooves

Slots/ pins/ steps

Etch and prime

Bevel

Extend

Finnish external walls definition

Further development of cavosurface design and degree of smoothness/ roughness desired

For maximum effectiveness of restorative material

How to choose a restorative material?

Cost

Aesthetics

Extent of lesion

Moisture control

Amount of enamel to bond to

What restorative material should be used for

• Subgingival cavity

Amalgam

• Stringer when depth >1.5mm

What restorative material should be used for

• Patients allergic to resin composite

Amalgam- no resin component

Categories of restoration failures*

• restorative material

• Tooth related

• Operator

Examples of restorative material failures

Marginal failure- ditching/ chipping

Surface degradation- corrosion/ staining

Complete failure- loss/ fracture

Tooth related factors leading to restoration failure

Pulpit is- caries/ fractures

Periodontal- incorrect occlusal contact

Tooth fracture

Secondary Caries

Operator factors leading to restoration failure

Inadequate removal of all caries

Pulpal exposure

Incorrect restoration placement

Poorly contoured/ overhangs