SBA

What is viral sialadenitis?

the inflammation and enlargement of one or several major salivary glands.

It most commonly affects parotid and submandibular glands.

Most commonly caused by Staphylococcus aureus

What is the most common viral cause of sialadenitis?

mumps

What are the symptoms of sialadenitis?

Enlargement and discolouration of the glands
Fever
Decreased saliva
Pain while eating
Dry mouth
Swelling in your cheek and neck region

Treatment of Sialadenitis

good oral hygiene
increasing fluid intake
massaging over the affected gland
applying a warm compress
using foods which increase saliva (such as lemon drops)

Secondary prevention of periodontitis

early detection and management pathways: BPE

In children aged 7-11, what BPE should be used and what are the codes

0, 1 and 2

At what age should normal BPE codes be used?

from 12 years old

What teeth are examined in a BPE for children aged 7-17

UR6 UR1 UL6

LR6 LL1 LL6

Class I mobility

<1mm movement horizontally

Class II mobility

>1mm movement horizontally

Class III mobility

>1mm movement horizontally and vertically

What are the two forms of necrotising periodontal disease?

Necrotising gingivitis (ANUG)
Necrotising Periodontitis

What are the symptoms of necrotising periodontal disease?

Pain
Bleeding
Halitosis

What is necrotising stomatitis?

Extension of necrosis beyond the muco-gingival junction

3 common species of bacteria found in acute necrotising ulcerative gingivitis (ANUG)

Treponema
Fusobacterium
Prevotella intermedia

Treatment of acute necrotising ulcerative gingivitis

PMPR
Oxidising mouthwashes
Chlorhexidine
Antibiotics (metronidazole)

What is a periodontal abscess?

Localised purulent lesion that develops in the soft tissue adjacent to a pre-existing pocket

What is a purulent lesion?

pus filled lesion

What could be the cause of a periodontal abscess?

Trauma to pocket epithelium
Obstruction to pocket entrance
Complication of subgingival instrumentation

Symptoms of a periodontal abscess (3)

Pain on biting/constant
Swelling
Discharge causing possible halitosis

What strain of virus is responsible for cold sores?

herpes simplex virus (HSV-1)

Cold sores

Cold sores should start to heal within 10 days, but are contagious and may be irritating or painful while they heal.

Some people find that certain things trigger a cold sore, such as another illness, sunshine or menstrual periods.

Antiviral treatment for cold sores

acyclovir

Necrotising sialometaplasia

trauma to the palatal salivary glands

Medications that cause gingival hyperplasia?

Phenytoin

Calcium channel blockers

Cyclosporin

ABCDE assessment

Airway
Breathing
Circulation
Disability
Exposure

Key assessment of airway

Can pt talk normally

Opening of the airway

Infant - neutral position
Child - head tilt, chin lift or jaw thrust
Adult - head tilt, chin lift or jaw thrust

Indication for oropharyngeal airway blockage

Unresponsive patient with absent gag reflex

Indication for nasopharyngeal airway blockage

Patient with reduced GCS (consciousness) and an intact gag reflex

Sizing of nasopharyngeal airway

Average male: 7
Average female: 6

How much oxygen should be delivered?

15 litres per minute

ABCDE assessment for an Acute Asthma Attack

A - Can't complete sentence in one breath
B - Tachypnoea (increased respiratory rate)
C - Tachycardia
D - Reduced level of consciousness due to hypoxia
E - Inspect for evidence of anaphylaxis

Treatment for acute asthma attack

Administer high flow oxygen
Administer reliever inhaler - 2 puffs every two minutes up to 10 puffs

Treatment of Type I Hypersensitivity

Antihistamines
Corticosteroids
Adrenaline

ABCDE assessment for Anaphylaxis

A - stridor, swelling to lips & tongue
B - Shortness of breath & increased respiratory rate, wheeze
C - Tachycardia & hypotension, pallor
D - Reduced level of consciousness due to hypoxia, syncope
E - Skin & mucosal changes

Treatment of Anaphylaxis

Oxygen & airway support
Chair position
Adrenaline via IM injection
Salbutamol if severe wheeze

Dose of adrenaline in anaphylaxis for a child less than 6 years

150 mcg
1:1000 adrenaline

Dose of adrenaline in anaphylaxis for a child 6-11 years

300 mcg
1:1000 adrenaline

Dose of adrenaline in anaphylaxis for adults and children over the age of 12

500 mcg
1:1000 adrenaline

Choking protocol

Encourage to cough
If ineffective - 5 back blows
If ineffective - 5 abdominal thrusts

Chocking protocol for infants

Head downwards, prone position
5 back blows with heel of one hand
If ineffective - 5 chests thrusts - 2 fingers, sharp and slow rate

What is clinical governance?

a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

What are 7 pillars of clinical governance?

Clinical Effectiveness
Risk Management
Patient & Public Involvement
Audit
Staff Management
Education & Training
Information

How much CPD does a dentist need?

100 hours every five years

How much CPD do a dental therapist and hygienist need?

75 hours every five years

How much CPD does a dental nurse need?

50 hours every five years

What duct is the most common site for salivary stones?
Why?

submandibular gland , the duct has a tortuous "uphill course"

What is the proposed aetiology of salivary stones?

deposition of calcium salts around a nidus (focus of infection) of debris

Episodic pain / swelling around meal time paired with a firm mass on the FOM would make you suspicious of....

sialolithiasis - salivary gland stones

Histologically, concentric rings of calcium deposits are indicative of

sialolithiasis - salivary gland stones

What causes an extravasation mucocele?

usually damage to or a traumatic severance of a salivary gland duct

mucin is spilled into the connective tissues from a ruptured or traumatised salivary gland duct

What is the most common site for a mucocele?

lower lip - very uncommon on the top lip

Where are 75% of nectrotising sialometaplasia lesions located?

minor salivary glands on the hard palate

Chronic autoimmune disease that is involved in the destruction of the lacrimal and salivary glands is called...

sjogren syndrome

What is secondary sjogrens?

sicca syndrome + another autoimmune disease like lupus, scleroderma, rheumatoid arthritis, or cirrhosis

What kind of caries are associated with sjogrens?

cervical caries

What is the management of sjogren syndrome?

artificial saliva, maintaining good oral hygiene, anti-fungal agents to prevent candidiasis

Medications for sjogrens syndrome

Hydroxychloroquine and methotrexate

Causes of sjogrens syndrome

Triggered by a combination of genetic and environmental factors.

Certain people are born with specific genes that make them more vulnerable to a faulty immune system.

Pulpal protection for deep carious lesions

Dycal (calcium hydroxide)

Biodentine (calcium silicate)

Vitrebond (resin glass ionomer)

When is the use of Dycal indicated?

- direct and indirect pulp capping
- root fractures
- root resorption

!!! DO NOT USE UNDER AMALGAM !!!

When is the use of Biodentine indicated?

- direct and indirect pulp capping
- pulpotomies
- furcation repair
- can be used under amalgam

!!! HIGH COST & LONG SETTING TIME !!!

When is the use of Vitrebond indicated?

- indirect pulp capping ONLY

- base under composite and/or amalgam

!!! WILL ONLY BOND TO DENTINE NOT THE PULP !!!