SAP BDS 2

What must be done between each patient in the appointment?

Remova all instruments

Wipe down surfaces with disinfectant

Chain of infection (6)

1. Infectious agent

2. Leaves reservoir/ host

3. Through portal of exit

4. Mode of transmission

5. Portal of entry

6. Infects susceptible host

Decontaminate instruments

HTM 01-05

1. Clean

2. Disinfect

3. Inspect

4. Steam sterilise 134 degrees for 3 mins

When to wash your hands (6)

After removing gloves

After contact with contaminated items/ bodily fluid/

Before and after handling food/ breaks

After using toilet

Before and after line manipulation

When can you use alcohol rub

Visibly clean hands on entering/ leaving clinical areas

Donning PPE

1. Clinical handwashing

2. Apron/ gown

3. Mask

4. Goggles

5. Gloves

Removing PPE

1. Gloves

2. Hand hygiene

3. Gown

4. Goggles

5. Mask

6. Hand hygiene

Preventing sharps injuries (4)

Don’t resheath needles

Remove burs from hand pieces/ scaler tips after use

Be careful with matrix bands

Keep bur stand covered

Protocol following needle-stick injury

1. Immediate first aid- stop work, encourage bleeding and clean with warm water and soap

2. Report ncident

3. Assess infection risk

4. Medical evaluation- initial blood work

5. Follow-up at 6 weeks; 3 months and 6 months

6. Prevent future incidents- incident review of safety protocols

Alginate making safety risks (3)

Airway/ eye irritation from alginate powder

Choking hazard

Infection risk to/ from lab

Restorative materials safety risk (3)

Allergy/ irritation

Acid etch burns

Eye irritation from light curing

Rubber dam safety risks (3)

Choking hazard from clamp

Eye injury from frame

Allergy/ irritation to latex

Gingival trauma from clamp

Hand scaling safety risks

Eye injuries

Hand fatigue

Puncture wounds from scalers

Mechanical scaling safety risks

Aerosol generated

Cardiac pacemaker risk

Soft tissue trauma—> bleeding/ bruising/ pain

Communication dos (5)

Face patient with eye contact

Open

Affirmation and Reassuring language

Active and reflective listening

Summarise

Communication dont’s (3)

Dental jargon

Arrogance/ disinterest

Start doing other things

Socrates

Site

Onset

Character

Radiation

Assoiating factors

Time

Exacerbating factors

Severity

Smoking risks

Periodontal disease

Oral cancer

Delayed healing post-trauma/ operation

Diet risks

Sugar: Caries

Vit C/D deficiency: Gingival bleeding/ enamel hyperplasia

Acidic foods: erosion

What is a risk assessment?

Systematic approach to identifying factors that may contribute to oral disease/ compromise treatment outcomes

Diabetes impaired glucose metabolism risks

Periodontal disease

Peri-implant mucositis/ peri-implantitis

Caries

Candidiasis

Bi-directional relationship between periodontal disease and diabetes

Infection risk- impaired immune response

Delayed wound healing (collagen production reduced)

Periodontal tissue breakdown (increased AGEs)

Increased inflammatory response (unregulated cytokines IL-6)

Importance of comprehensive risk profiles

Standardise quantifiable data

Encourage patient participation

Early detection and timely interventions

Data for studying trends

Low risk of caries (4)

Good oral hygiene

No active caries/ restorations

Regular fluoride intake

Minimal sugar intake

Medium risk of caries (3)

Caries history BUT no active caries

Sub-optimal fluoride exposure

Occasional high sugar diet

High caries risk (5)

Multiple active carious lesions

History of frequent restorations

Poor oral hygiene

Frequent sugar intake

Xerostomia

Bitewing

• proximal caries

• Periodontal attachment

• Coronal restorations

Periapical

• perispical pathology e.g. cysts

• Roots/ surrounding bone assessment

• Periodontal bone loss

• Post-endodontic treatment evaluation

OPG

• orthodontics- multiple teeth missing/ impacted (esp. 3rd molar)

• Extensive periodontal disease and bone loss

• Jaw cysts/ tumours

Sectional DPT

• impacted teeth

• Complex root morphology for endodontics

D1

• outer enamel can be remineralised

D2

• can be remineralised

D3

• outer dentine

D4

Inner dentin

D5 pulpal involvement

Root surface caries

• spreads faster below contact point

Recurrent caries

Primary teeth compared to adult teeth

Whiter, bulbous crowns

Softer, thinner enamel

Narrower occlusal table

Shallower fissures

Broader/ flatter contact areas

More splayed roots

Analgesic

Reduced sensibility to pain without loss of consciousness/ sense of touch being affected

Mechanism of action of analgesics

Reversible blocks sodium ion channels

Prevents sodium ion increase

Reversible inhibits neurone depolarisation

Amino esters

• examples

• Metabolised in…

Procaine

Novacaine

• blood plasma= shorter duration

Amino-amides

• examples

• Metabolised in…

Lidocaine

Mepivicaine

Prilocaine

Articaine?

• liver

Vasoconstrictor function

Narrow blood vessel diameter

= slow blood flow

= reduced blood flow; slower metabolism

Adrenaline as a vasoconstrictor

Hormone

• prolonged duration

• Reduced toxicity

• BUF not if unstable angina/ hypertension

Octopressin/ Felypressin as a vasoconstrictor

Synthetic octapeptide

• no unwanted side effects

• BUT not as effective as adrenaline; not for late pregnancy

Potency of LA

Minimum concentration of La agent required to reduce nerve action potential by ½ its amplitude within 5 minutes

Local risks of LA

• contaminated needle= risk of infection spread

• Too fast= pain/ bruising of soft tissue; trismus

• Nerve/ blood vessel laceration= parathesia

• Too far back= facial palsy

• Lip biting; burns

• Fractured needle

General risks of LA

• psychogenic sympathetic response- fainting; palpitations

• Toxicity due to overdose/ hypersensitivity

• Allergy (use amino-amides)

• Drug interactions with non-cardio selective beta blockers/ diuretics/ antihypertensives

Check LA cartridge for

• clear- no contaminants

• No bubbles

• Gold diaphragm not pierced

• Expiry date

Topical LA

20% benzodaine/ 5-10% lidocaine

= 2mm of soft tissue

If cardiac history when doing LA

Limit adrenaline to 0.04mg

Lidocaine with adrenaline

2% conc. in 2.2/1.8ml

7mg/kg

Fast

= SAFEST

Lidocaine without adrenaline

4.5mg/kg

Fast but short duration of action

Articaine with adrenaline

4% in 2.2ml

7mg/kg

Fast

= NOT for ID block

Prilocaine with fellypressin

4% in 2.2ml

6mg/kg

Bupivicaine with adrenaline

0.25/0.5% in 10ml ampulla

Adrenaline- 1:200k

1.3-2mg/kg

Long but lasts 8-10 hours

Infiltrations are preferred method for

• maxilla- diffuses better through less porous bone

• Anterior mandible- lowest density

• Articaine

Buccal infiltrations

• maxilla

Anterior/ middle/ posterior superior alveolar nerve- CN V2

= buccal mucosa + pulp

= fillings/ root canals/ PMPR

Buccal infiltrations

• mandible

Long buccal nerve- CN V3

= buccal mucosa + pulp

= fillings/ rot canals/ PMPR of ANTERIOR teeth only

Buccal infiltrations

Muco-buccal fold

45 degrees

1MM depth

Palatal infiltrations

Nasopalatine/ greater palatine nerves

= palatal mucosa

= extraction; rubber dam

Palatal infiltrations landmarks

Apical to gingival sulcus

Pressure with mirror

1-2mm

Tissue blanches

Lingual infiltration

Lingual nerve

= lingual mucosa

= extraction 1 tooth with id block

Greater palatine block

= greater palatine nerve

= palate + posterior teeth

• extract multiple teeth

Nasopalatine block

Nasopalatine nerve

= palate + anterior teeth

= extraction 1,2,3 on both sides

ID block

Inferior alveolar + lingual nerves

= buccal, lingual mucosa + pulp

= extractions

NOT ARTICAINE

ID Block landmarks

Coronoid notch And Internal oblique ridge

Retromandibular raphe

Across premolars

1cm above occlusal plane

Mental nerve block

Mental nerve

= buccal mucosa 1,2,3,4

• extraction of anterior teeth with lingual infiltration

Long buccal block

Buccal nerve

Buccal of 7/8s

= raising buccal flap

Alternatives to LA If anxious

Cognitive behavioural Therapy

Hypnosis

Conscious sedation

Inhalation sedation

Intravenous sedation

Paracetamol

0.5-1g every 4-6 hours (max 4g/ day)

Inhibit COX in CNS → decrease PG production

OTC/ IV

• overdose

NSAIDS

• ibuprofen

400mg every 4-6 hours (max 2.4g/day)

Non-selective inhibition of COX1/2

OTC/IV

• stomach/ kidney/ heart issues

• Asthma

• Allergies

• Elderly/ pregnant/ <16 yrs

Opioids

• codeine

30-60mg every 4-6 hours

Tablets

• constipation; reduced breathing

Opioids

• morphine

Titration/ oral in hospital only

• respiration issues

• Addiction

Opioids mechanism

Agonist to receptors- activate

• reduced BP

• Sedation

• Reduced itching/ nausea

Rubber dam Advantages

Infection control

Dry field and moisture control= enhanced diagnosis/ restoration longevity

Enhanced patient comfort- reduced pain perception

Enhanced patient safety- no ingestion; soft tissue protection

Improved visual access- soft tissue retraction

Time saving

Rubber dam sheet

15×15cm

Medium 0.2 thickness

Punch and push holes 3-4mm apart

Pronged

= retraction

Prongless

= retention

Winged

= retention

Wingless (W)