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OSCE COMMUNICATION SETS

Set One (Purple Set) Set Two (Red Set)

Set Three (Brown Set) Set Four (Pink Set)

White lesion - lichenplanus / lichenoidreaction

Perio - replacementOptions

MIH, amelogenesisimperfecta

ANUG

Gingival enlargement

Consent to do endo 16

Case 35 /

Case 4 /

Case 9 /

Case 5 /

Case 41 /

Case 3 /

Aphthous ulcer

Missing canine

Chronic periodontitis(ADC Handbook Case)

ANUG

Erosion (16 years old)

Crown broke duringextraction

Case 6 / Case 31 /

Case 13 /

Case 5 /

Case 45 / Case 24 /

Acute herpeticgingivostomatitis

Bisphosphonate + steroid(prednisolone)

Xerostomia

Angry patient with RCTtooth broken

Mesioangular impaction

7-year-old boy withdecayed tooth

Case 44 /

Case 23 /

Case 11 /

Case 16 /

Case 26 /

Case 34 /

Ulcer on lateral tongue

Missing lateral

Perio abscess

Irreversible pulpitis(patient going interstate)

RCT done 3 days ago byanother dentist

Consent for extraction

Case 7 / Case 32 / Case 12 /

Case 37 /

Case 38 /

Case 27 /

https://e-denta.com.au/




Set Five (Green Set) Set Six (Orange Set)

Set Seven (Yellow Set) Set Eight (Blue Set)

Dry socket

Ulcer (minor patient)

Trauma (3 years old)

Amalgam replacement

Exo consent (antibioticprophylaxis)

Peri-implantitis

Case 30 /

Case 14 /

Case 21 /

Case 40 /

Case 2 /

Case 22 /

Bluish swelling

Patient wants implants

Cellulitis

4 years old(uncooperative child)

Cellulitis (16/18, asthma,allergic to penicillin)

Amalgam filling bycolleague

Case 18 /

Case 4 /

Case 17 /

Case 34 /

Case 47 /

Case 19 /

Ortho patient wantsbraces

Caries risk assessment (8years old)

Denture stomatitis

Bisphosphonate (pt ondenosumab & warfarin)

Crown broke duringextraction

Replacement options

Case 10 /

Case 33 /

Case 1 /

Case 23 /

Case 43 /

Case 24 /

Vague pain on the leftside with food impaction

Drug addict

Geographic tongue

Perio abscess

Trauma (11 years old)

Oroantralcommunication

Case 15 /

Case 20 /

Case 46 /

Case 7 / Case 36 /

Case 28 /





Set Nine (Silver Set) Set Ten (Gold Set)

5 years old with toothdecay

Pain on biting on 46tooth with largeamalgam

Vertical fracture

Fluorosis

Post op instruction forpatient on anticoagulant

Diabetic patient withperio and missing teeth

Case 54 /

Case 50 /

Case 49 /

Case 51 /

Case 55 /

Case 52 /

Diazepam patient

5 years old with drainingsinus

Hematoma

Chronic moderate tosevere perio seeing aspecialist

Erosion (28-year-oldmarathon runner)

Torre islander nurseconcerned about OAC

Case 58 /

Case 56 / Case 57 /

Case 48 /

Case 59 /

Case 60 /

Set Eleven (Black Set)

-

-

-

-

-

Case 63 /

Case 62 /

Case 61 /

Case 64 /

Case 65 /


Case ONE

TOPIC: CLUSTER:

PeriodonticsClinical Information Gathering Cluster

CASE DISCUSSION: I Don't Like My Smile



Case ONE

SUGGESTED READING MATERIALS: TG ver. 3

Chapter: Periodontal and Peri-Implant DiseaseGingivitisPeriodontitisPeri-Implant Disease

Odell Cases (4th Edition)Case 38Case 52

i.ii.

iii.




STANDARD TEMPLATE(EXAMPLE)

Introduction

Chief Complaint /Reason for Visit

I want a referral for ortho

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionHave you been tested for diabetes?

Medication History -either prescribed or OTC

Social History Smoking historyAlcohol historyHistory of using recreational drugsIf female - pregnancy or pill?

Dental History Do you have a dentist that you normally see?When was your last dental visit and what was itfor?How many times do you brush a day?What type of toothbrush?How do you brush?How long do you brush for?Have you been shown how to brush?Have you got a dye painted on your teeth before?Flossing or use anything to clean in between?How often do you visit your dentist?When was your last visit?What was it for?




CPITN Score

Diagnosis Generalised Chronic Periodontitis

Explain Diagnosis It’s a long-standing disease that is affecting all theteeth. It is an irreversible condition that may progressif not controlled now by intervention.

Specialist Referral

Investigations Take measurements around the gums

Frequently AskedQuestions

Need referral for orthodontics

Since the score is more than 4 (generalised) -specialist referral

Risk Factors SmokingPoor oral hygieneStressFamily history

Management Short term - improve oral hygiene, control stress,go to the GP to test for diabetesLong term - maintain oral hygiene, regular recall

Recall First for a few months - till everything is stable - 3months, then 6 monthly visits

Questions / CheckUnderstanding

Reading Material Rubric - handbook





Case TWO

TOPIC: CLUSTER:

Periodontics and ImplantsClinical Treatment and Evaluation Cluster

CASE DISCUSSION: My Gums are Bleeding, That's All



Case TWO




Odell Cases (4th Edition)Case 35Case 38Case 75

i.ii.

iii.




Introduction

Chief Complaint Bleeding gums and redness

Medical History History of hospitalisation in the past two years /since the last I saw you (If it’s an old patient)Allergies?Adverse reactions?

Diabetes - for how many years?What are your sugar levels?Would you say it is well controlled?

(Depending on the scenario)


Female patients - pills

Social History Smoking- since when? 5 A’sHow many per day?Have you considered quitting?History of using recreational drugs?Alcohol intake?OccupationLiving condition

Dental History When were the implants placed?Have you visited your dentist since?How do you normally keep the implant areaclean?Have you been told how to floss around theimplants / how to maintain your implants?

Diagnosis Peri-implantitis (was given)




Diagnosis (continuation) Inflammation around the implant causingsignificant bone loss.If it progresses can also lead to the loss of thedental implants.

Specific Risk Factors Smoking - explain the 5 A’sStress managementDiabetes (uncontrolled diabetes- risk factor) orimmunocompromisedGum diseaseInadequate oral hygiene

Management Short term - Specialist referralneed special instruments to clean around thatarea which are plastic, carbon or Teflon coated

Both conservative and surgical treatment plansare available- the specialist can best decide thatBest to go to the dentist who did the surgery- sothat he could manage it appropriately by cleaningaround the dental implants and he could alsocheck the bite (if there’s any excess load on thoseteeth- causing the loss of bone)Long term -maintenance and recall

Check Understanding

Specialist Referral


Why do my front teeth feel so loose/ wobbly?Are they going to fall out?He had no idea he had to look after it?How do I keep that area clean?Did my dentist do a bad job?




Further Reading https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612185/https://head-face-med.biomedcentral.com/articles/10.1186/1746-160X-10-34


Case THREE

TOPIC: CLUSTER:

PeriodonticsClinical Treatment and Evaluation Cluster

CASE DISCUSSION: What is Happening to My Gums



Case THREE




i.ii.

iii.




Introduction

Chief Complaint

Details of the ChiefComplaint


Changes in any medicine recentlyHow longAnything changed

Immunosuppressants (cyclosporine)Calcium channel blockers (nifedipine)Anticonvulsants (phenytoin)

Most common drugs causing gingival enlargement:

Dental History

Explain Diagnosis Drug-induced gingivitis

Medical History ConfirmHistory of hospitalisationAllergiesAdverse reaction

Social History

Management Short term:OH, chlorhex mouthwashCleaning either by me or specialistRecall




Management(continuation)

Reference Carranza 13th Edition - page 1182


Why do my gums appear swollen?What has caused this to happen?What can you do to help me?

Long term:No improvementSpecialist referral for r surgical removal of theenlargement (Carranza 13th Edition, Chapter58, pages 589, 1182)

Possibility of substituting the drug or altering thedose should be discussed with the GP - so a GPreferral is essentialManagement would differ based on the findingseither fibrotic or inflammatoryThrough cleaning and maintaining oral hygieneDrug substitution and recall to assess the gingivalstatusIf no improvement - specialist referralMay indicate surgical removal of the gumovergrowth


Case FOUR

TOPIC: CLUSTER:

Periodontics and ImplantsClinical Information Gathering Cluster

CASE DISCUSSION: I Want Implants



Case FOUR

TOPIC:

CLUSTER:

Replacement Options for A PeriodicallyCompromised PatientClinical Information Gathering Cluster

CASE DISCUSSION: -



Case FOUR




Odell Cases (4th Edition)Case 17Case 35Case 38Case 44Case 54Case 69

i.ii.

iii.




Introduction



Dental History

More Information AboutDental Implants

What are dental implants?A dental implant is a piece of metal thatresembles a screw. It is put into the jaw wherethe missing tooth’s roots were present. Overtime, bone grows around this implant, whichhelps to hold it in place. An artificial tooth or acap is then attached to the metal to fill in thegap left by the missing tooth.It takes about 6-9 months for the entireprocess.

Explain the need for special x-rays and studymodelsSpecialist referral for treatmentAdvantages of dental implantsExplain the surgical treatmentRecovery or healing may be affected with themedication you take and if any medicalconditional if presentSmoking delays and interferes with healing andcan cause failure implants to fall out

Medical History

Social History

Yes




More Information AboutDental Implants

Risk Factors / ModifyingRisk Factors

SmokingPoor oral hygiene

Smoking should be stopped at least 2 week beforethe surgery and 8 weeks after (Reference: ClinicalCases of Prosthodontics)Cost- about $4000-$5000 per implantMaintenance and regular follow up there afterHome care of implantsExplain risk of failure as well

Recall


Reading Material

Specialist Referral

Further Reading https://www.healthdirect.gov.au/dental-implant#targetText=A%20dental%20implant%20is%20a,left%20by%20the%20missing%20tooth.http://www.adi.org.uk/profession/dentist_guide/a-dentists-guide-to-implantology.pdf


Case FIVE

TOPIC: CLUSTER:

PeriodonticsDiagnosis and Management Cluster

CASE DISCUSSION: Please Help!



Case FIVE



Chapter: Periodontal and Peri-Implant DiseaseNecrotizing Periodontal Disease


i.




Introduction

Chief Complaint

Social History

Medical History

Dental History

Details About the ChiefComplaint


Explain Diagnosis Name of diagnosis - ANUG

Modifiable Risk Factors Smoking - 5 A’sStressPoor oral hygiene - leading to gum diseases

Management Numb the areaRemove as much of the plaque and other necroticdebris as immediate management. Irrigate/flushwith either local anesthetic solution, hydrogenperoxide, or chlorhexidineUse mouthwash - for up to 14 daysSmoking cessation counselingRecall in 2-3 days - give further oral hygieneinstructions at that stage most likely the painwould have reduced and I carry out the furtherdeep cleaning





Recall 48-72 hours


Patient using Listerine mouthwashPatient has brought amox, not taken it yetWhat are you going to do for me today?

Specialist referral - if no improvement is seen orpatient is not responding to your treatment, if thepatient seems uncooperativeAntibiotics - fever is generally present as accordingto TG, it’s a painful infection - metronidazole ortinidazole metronidazole 400mg orally, 12 hourlyfor 5 days (remember to inform the patient toavoid alcohol for 24 hours with metronidazole and72 hours with Tinidazole)Analgesic – Ibuprofen 400 mg, every 4 hours (to amaximum for 2400/24 hours) orParacetamol 500 to 1000 mg orally, every 4 hours(to a maximum of 4g/24 hours)Advice to stop smokingControl stressMaintain nutrition and fluid intakeMain oral hygiene and rinse with 0.2% or 0.12%chlorhexidine mouthwash.

Check Understanding

Specialist Referral


Case SIX

TOPIC: CLUSTER:


CASE DISCUSSION: Just a Clean Please



Case SIX




Odell Cases (4th Edition)Case 21Case 38Case 52Case 54

i.ii.

iii.




Introduction


Medical History (alreadytaken)

Dental History (alreadydone)


Social History (alreadydone)

x

Details of the ChiefComplaint (alreadydone)

Since when did you notice it?Is there bleeding present?Do your teeth feel loose?

Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionHave you been tested for diabetes before?

Normal brushing routineHow many times do you brush?What type of toothbrush?How long do you brush for?Do you use anything to clean In between yourteeth?How often do you see your dentist?When was your last dental visit?What was that for?

SmokingWhat do you smoke?How many do you smoke?Since when?Have you considered quitting?




Social History(continuation)

Explain Investigations(already done)

Explain the Diagnosis -with the help of the x-ray

Risk Factors

AlcoholUsage of recreational drugsStress levels

Family History Family history of early tooth loss

ProbingRecessingMobility testingX-rays

Chronic generalised periodontitis - a conditionaffecting the gums and the supporting structuresof the teeth, which is causing the bone to shrink orbone levels are going down which is most likely tocause tooth loss if left untreated. It is an irreversible process although it can bestopped with adequate measures such asimprovement in oral hygiene, controlling stresslevel, stable blood sugar levelsCan cause early tooth loss

Smoking plays a very important factor and can bevery harmfulCondition is worsened with smokingPoor oral hygieneStressFamily historyDiabetes

Modifying Risk Factors Improve oral hygiene (OH advice)Control stressMaintain oral hygiene




Modifying Risk Factors(continuation)

Treatment Plan

Reading Material

Consider quitting smoking, I can help you withthatStress levels

Immediate phase:Do nothing - explain advantages anddisadvantages

Start treatment - immediate treatmentPocket depths, recession, and attachment losscan be measured and sent to the specialistInitial treatment can be done todayOral hygiene instructionsSpecialist referral

Maintenance phase:Recall – 3 monthly recall (oral hygiene will beassessed, x-rays, pocket depth will bereviewed)



Case SEVEN

TOPIC: CLUSTER:


CASE DISCUSSION: What is this Between My Gums



Case SEVEN



Chapter: Periodontal and Peri-Implant DiseasePeriodontal Abscess


i.




Introduction

Chief Complaint

Medical History

Dental History


Social History


PainfulHow long has this bump been present?Food lodgement in that areaFoul taste?

Bump near the front tooth

Investigations (check ifit's done)

Diagnosis Localised periodontal abscess

Treatment /Management

Nothing today - it is a consultation appointment, youcan do the treatment planning


Recall 3 months, 6 months, and a year

Specialist Referral Yes! If no response to my treatment or if you prefergoing to the specialist




Reading Material


Further ReadingReference

Why is the swelling present?Are you going to do anything today?

No, because it’s a consultation appointmentI do visit the dentist - why didn’t he mentionanything about keeping my teeth clean?Do you think he did a bad job?Why only one tooth is affected?Patient said he brushes once and does not useanything to clean in between (OH instructions)No one has told him how to brushHow is it smoking-related and why is it soharmful?If there is pus present there, why shouldn’t I takethe antibiotics?

Therapeutic Guidelines


Case EIGHT

TOPIC: CLUSTER:

Mucosal Lesions / White LesionsClinical Information Gathering Cluster

CASE DISCUSSION: White Lesions Reported by Patient



Case EIGHT



Chapter: Oral Mucosal DiseaseAssessment of Oral Mucosal DiseaseOral CancerOral LeukoplakiaOral ErythroplakiaOral Lichen PlanusOral Lichenoid LesionGeographic TongueOral Candidiasis and Candida-Associated Lesions


i.ii.

iii.iv.v.

vi.vii.

viii.




Introduction

Chief Complaint Patch next to the silver filling


When did you first notice it?Has it happened beforePainfulDo you have skin lesions?SiteSizeShapeSurfaceColourDurationAny changes with medication or toothpaste?

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionDiabetesHypertension- blood pressure


Has any new medicine been introduced?Does of any medicine has been changed?

Dental History Last visitRegular dentistFilling or any recent dental treatment that wasdone or amalgam filling?Habit of check biting/trauma to that area




Social History SmokingAlcoholUse of recreation drugsStress

Investigations Biopsy (NHMRC guidelines)

Differential Diagnosis Could be lichen planus or lichenoid reaction

Specialist Referral Biopsy and confirmation and to carry out the righttreatmentIf it becomes symptomatic

Explain Diagnosis If lichen planus - it is the body’s reaction to anallergenSkin lesion + oral lesionIt has the typical spider web-like appearanceNo treatment is essential generally unless itbecomes painful Lichenoid reaction - happens as a reaction to aparticular drug that you have been taking, or itcould even happen due to a reaction to the silverfilling

Risk Factors SmokingAlcoholStress

Management Refer to the specialist for the biopsy to confirmwhat the patch is and we will treat it accordingly I pain present - the specialist will prescribe somemedication for that





Precautions Avoid smoking and alcoholStressAvoid spicy food Avoid alcohol-containing mouthwash Keep that area clean

Reading Material


What is this white patch inside my cheeks?Is it cancer?When will it go away?Why did it happen?

Recall To discuss the biopsy results, next in every 6 months

Further Reading Therapeutic GuidelinesOxford Handbook of Clinical DentistryShafersNeville


Case NINE

TOPIC: CLUSTER:

Mucosal Lesions / White LesionsClinical Information Gathering Cluster

CASE DISCUSSION: White Lesions Reported by You



Case NINE





i.ii.

iii.iv.v.

vi.vii.

viii.




Introduction

Chief Complaint Patch next to the silver filling


When did you first notice it?Has it happened beforePainfulDo you have skin lesions?SiteSizeShapeSurfaceColourDurationAny changes with medication or toothpaste?

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionDiabetesHypertension- blood pressure


Has any new medicine been introduced?Does of any medicine has been changed?

Dental History Last visitRegular dentistFilling or any recent dental treatment that wasdone or amalgam filling?Habit of check biting/trauma to that area





Investigations Biopsy (NHMRC guidelines)

Differential Diagnosis Could be lichen planus or lichenoid reaction

Specialist Referral Biopsy and confirmation and to carry out the righttreatmentIf it becomes symptomatic

Explain Diagnosis If lichen planus - it is the body’s reaction to anallergenSkin lesion + oral lesionIt has the typical spider web-like appearanceNo treatment is essential generally unless itbecomes painful Lichenoid reaction - happens as a reaction to aparticular drug that you have been taking, or itcould even happen due to a reaction to the silverfilling


Management Refer to the specialist for the biopsy to confirmwhat the patch is and we will treat it accordingly I pain present - the specialist will prescribe somemedication for that





Precautions Avoid smoking and alcoholStressAvoid spicy food Avoid alcohol-containing mouthwash Keep that area clean

Reading Material


What is this white patch inside my cheeks?Is it cancer?When will it go away?Why did it happen?

Recall To discuss the biopsy results, next in every 6 months

Further Reading Therapeutic GuidelinesOxford Handbook of Clinical DentistryShafersNeville


Case TEN

TOPIC: CLUSTER:

Mucosal Lesions / Fungal InfectionsDiagnosis and Management Cluster

CASE DISCUSSION: Denture Stomatitis with Angular Cheilitis



Case TEN



Chapter: Oral Mucosal DiseaseAssessment of Oral Mucosal DiseaseOral Candidiasis and Candida-Associated LesionsOral MucositisDry MouthSalivary Gland Infections especially SjogrenSyndrome


i.ii.

iii.iv.v.




Introduction

Chief Complaint Denture feels wobbly and falls during yawning

Medical History Confirm the medical historyHistory of hospitalisationAllergiesAdverse reactionLast blood testLast GP visitDiabetesDry mouth

Medication - eitherprescribed or OTC

Medication history - list of medicationsLong term corticosteroidsInhalers

Dental History When did he lose his teeth?How did he lose his teeth?Do you have a dentist that you normally see? Howoften?When was the last dental visit and what was it for?

Denture History How do you normally keep your dentures clean?Nightwear of denturesWhen was this upper denture made?Lower dentureAre you happy with the dentures?Does it feel wobbly, seem to be getting worse? Orwas it always moving?Were any adjustments made to the currentdenture? Is It pinching anywhere?Can you eat properly with it?




Denture Hygiene

Social History SmokingAlcoholDiet

Diagnosis Denture stomatitisAngular cheilitis (if diagnosis not given already)

Explain Diagnosis

Management Improvement in denture hygiene / denture careDenture care advice - pg 83 of TGExisting dentures should be reviewedWe should consider making a new denture as thevertical (height) is lostGP referral- blood test, swab test for the corners ofthe mouth and to check blood sugar levelsIf the diagnosis of angular cheilitis is given thengive antifungalsMiconazole 2% - apply at the corners of the mouth4 times a day for 14 days (check if the patient is nottaking warfarin- pg 84 of TG)

Specialist Referral If no improvement after making a new denture

Recall


Why is my denture wobbly (or denture feelswobbly) and falls during yawning?What should I do with the corner or the mouth?


Case ELEVEN

TOPIC: CLUSTER:

Periodontics / Mucosal LesionsClinical Information Gathering Cluster

CASE DISCUSSION: Primary Herpetic Gingivostomatitis



Case ELEVEN



Chapter: Herpes Simplex Virus InfectionsPrimary Oral Mucocutaneous HerpesRecurrent Oral Mucocutaneous Herpes

Odell Case (4th Edition)Case 28

i.ii.




Introduction

Chief Complaint

Empathy

He developed these lesions and we went to the GPand the GP gave him antibiotics (he hasn't taken theantibiotics yet). GP said to come see you

Details of ChiefComplaint

Since when does he feel like this?Any other lesions like this?First time?FeverCan he eat and drink properly?Has he come in contact with anyone who issuffering from cold sores or similar condition likethis?

Medical history ConfirmAllergiesAdverse reactionsLast visit to GPConfirmImmunocompromised


Confirm that he hasn't taken the AB yet

Dental History

Social History

Investigations




Differential Diagnosis

Explain Diagnosis Primary herpetic gingiva stomatitis, whish is acondition caused by a virus. It is very common inchildren. Almost all adults have a positive test(serology) for it.

Risk Factors /Recurrence

Happens when individuals are stressedFeverPeriods of stressImmunocompromised

Management RestMaintaining fluid balanceOHI with mouthwashAvoid hot and spicy foodLignocaine gelParacetamolIf he is unable to eat or drink - hospital

Precautions Avoid rubbing of the eyesAvoid sharing utensilsWash clothes separately

Check Understanding

Recall 2 weeks


Reading Materials TGOdell Case 28


Case TWELVE

TOPIC: CLUSTER:

Mucosal Lesions / UlcersClinical Information Gathering Cluster

CASE DISCUSSION: 4-Week-Old Ulcer



Case TWELVE



Chapter: Oral Mucosal DiseaseAssessment of Oral Mucosal DiseaseOral CancerTraumatic Oral UlcersRecurrent Aphthous Ulcerative Disease


i.ii.

iii.iv.




Introduction

Chief Complaint


TraumaWhen did you notice it?Has it happened before?Ulcers anywhere else?Increased in size?Shape?LocationColour changesNumbness in that areaDoes something specific make it better or worse?Did you visit any other doctor/dentist for it before?

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionCheck for diabetesLast GP visitLast blood testAny other ulcers on the body


Dental History Do you have a dentist that you normally see?Sharp tooth or filling?

Social History SmokingAlcohol




Social History(continuation)

Use of recreation drugsStressOccupationLiving conditions

Investigations Check for sharp toothPhotoMeasure the ulcerExamine the ulcerExtra oral examination

Specialist Referral(depending on how longthe ulcer is present - ifmore than one month)

If the ulcer is not healingUncooperative patient

Differential Diagnosis Could be from the traumaInflammatoryDermatologicalSCC Other unknown origins

Management Local factors - round off the sharp tooth. Avoid hotand spicy food, alcohol-containing mouthwashLA gelSmoking, alcoholBlood testControl stressSpecialist referral - if no signs of healing or if abiopsy is needed





Check Understanding /Questions

Recall After 1-2 weeks



Case THIRTEEN

TOPIC: CLUSTER:


CASE DISCUSSION: Recurrent Aphthous Ulcers



Case THIRTEEN





i.ii.

iii.iv.


Case FOURTEEN

TOPIC: CLUSTER:


CASE DISCUSSION: Scenario One: Miner with Painful UlcerScenario Two: Miner with Painless Ulcer



Case FOURTEEN





i.ii.

iii.iv.




Introduction

Chief Complaint Patient said he had a red spot on the lower jaw/wasn’t aware of it for a long time.He had upper and lower denture, he got his toothextracted 2 months ago.He wanted a new denture. He wanted to know ifyou could do the denture in 3 months


Problem/previous experience with the firstdentureHave you noticed this ulcer/red spot?Does that area feel irritated or painful?Numbness in that area?Any other ulcers anywhere else on the body?

Medical History Family historyLast GP visitHospitalisationAny changes in your health overall that you havenoticed? AllergiesAdverse reactionWarning cards





Dental History Do you have a dentist that you normally see?Last dental visitPermission to contact the dentist

Social History Smoking historyAlcoholRecreational drugsStress levels

Specialist Referral 3 weeks

Denture History When was the denture made?Does the lower denture feel comfortable?Can he eat properly with it?Does it move during chewing (function)?Reason for tooth removalDenture hygiene

Investigations BiopsyMeasure the ulcer, take photos for records

Differential Diagnosis Traumatic ulcerUlcers of unknown originSCC Angular cheilitis

Risk Factors




Modifying Risk Factors Maintaining nutritionQuit smoking - 5 A’sAdjusting the denture

Check Understanding

Recall 1-2 weeks

Management Specialist referral for biopsyNew denture – because vertical has collapsed


Do you think it’s cancer (examiners stressing onthis point) because we are sending him to aspecialist?Will you be able to make a denture?


Case FIFTEEN

TOPIC: CLUSTER:

Mucosal Lesions / Geographic TongueDiagnosis and Management Cluster

CASE DISCUSSION: Mixed Lesions of Tongue



Case FIFTEEN




i.ii.

iii.iv.v.

vi.vii.

viii.




Introduction

Chief Complaint

Dental History


Patient is stressed - changed job 2 months agoHe discussed with her brother and he said he hasit tooHas lesions that move around the tongueSore when she eats something spicySiteDurationPainDoes it seem to occur when you eat certain foodor during periods of stress?

Medical History (wasclear in this case)

Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionCheck for diabetesLast GP visitLast blood test






Investigations


Explain Diagnosis Geographic Tongue

Risk Factors StressFamily historyHas an association psoriasis

Modifying Risk Factors /Management

De-stressAvoid spicy foodIf you use mouthwash - avoid alcohol-containingmouthwashIf it becomes painful, contact us

Scrape and check if it is not thrush

Specialist Referral PainfulSecond opinion

Check Understanding

Recall One week to see if you are having any reliefThereafter every 3 months


Could it be thrush? - I checked on Googlecould it be cancer? - I checked on GoogleIs it going to be a life-long thing, or will it heal onits own? (Healing period can be variable - it isassociated generally with periods of stress)

Reading Material Therapeutic GuidelinesOxford


Case SIXTEEN

TOPIC:

CLUSTER:

Xerostomia / Sjogren's Syndrome / SalivaryGland InfectionsDiagnosis and Management Cluster

CASE DISCUSSION: I Can’t Take It Anymore



Case SIXTEEN



Chapter: Oral Mucosal DiseaseAssessment of Oral Mucosal DiseaseOral Candidiasis and Candida-Associated LesionsOral MucositisDry MouthSalivary Gland Infections especially SjogrenSyndrome


i.ii.

iii.iv.v.




Introduction

Chief Complaint


When did you notice it?Painful or discomfort?Other parts of the body feeling dry, such as eyes?Do you normally drink enough water?How much water?Mouth breathing?If she is wearing a denture - specific problemswith itRadiotherapy

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionCheck for diabetesLast GP visitHas she gone to an eye doctor before?


What are the medications that you normally take?Antidepressants, antihistamines, andanticholinergicsHas there been a change in the dose of anymedication or has any new medicine beenintroduced?

Dental History Do you have a dentist that you normally see?Last dental visit?Normal OH habitsNew cavitiesFluoride products




Social History SmokingAlcoholCaffeine intake?Use of recreational drugsStressNormal diet

Investigations GP referral forBlood testUrine test - to assess sugar levelsEye test to check if everything is ok

Measure the amount of saliva produced in themouth

Differential Diagnosis Developmental and inflammatory problems cancause reduced saliva production in your mouthSjogren's syndrome

Explain Diagnosis Dry mouthCauses:

drinking less amount of watersome drugs cause the mouth to becomedryblockage in the flow of the salivaradiation therapydevelopmental problemsconditions that affect the eyes, joints, andthe sal

Risk Factors SmokingAlcoholDiet




Social History SmokingAlcoholCaffeine intake?Use of recreational drugsStressNormal diet

Investigations GP referral forBlood testUrine test - to assess sugar levelsEye test to check if everything is ok

Measure the amount of saliva produced in themouth

Differential Diagnosis Developmental and inflammatory problems cancause reduced saliva production in your mouthSjogren's syndrome

Explain Diagnosis Dry mouthCauses:

drinking less amount of watersome drugs cause the mouth to becomedryblockage in the flow of the salivaradiation therapydevelopmental problemsconditions that affect the eyes, joints, andthe sal

Risk Factors SmokingAlcoholDiet




Modifying Risk Factors Avoid excess alcohol, citrus, and caffeineCarry a bottle of waterAvoid spicy foodSugary food

Management Drink rather than sipping water. Stay hydratedOHIKeep your mouth clean and avoid sugary food thatcan stick to your teeth for a long timeSpray that you can keep with you and apply whenyour mouth feels extremely dry to get short termreliefBiotene mouth sprayLet’s stabilise your mouth and fill teeth that aredecayed and try to maintain the mouth in a goodway to avoid further problemsTooth mouse application at nightBicarbonate mouthwash - ½ tsp bicarbonatepowder to one glass of warm water (TG - pg 89)

Specialist Referral If the condition doesn’t get better Eye doctorGP

Check Understanding

Recall Initially, every 1-2 weeks, then eventually if theimprovement is seen every 3 months. If noimprovement or you are not getting any relief, then aspecialist referral


I have many medical problems?What could I do?I always have to keep a bottle of water with me


Case SEVENTEEN

TOPIC: CLUSTER:

Salivary Gland Infections/Odontogenic InfectionClinical Information Gathering Cluster

CASE DISCUSSION: Salivary Gland Infection or OdontogenicInfection



Case SEVENTEEN



Chapter: ACute Odontogenic InfectionsChapter: Salivary Gland Infections





Introduction

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionCheck for diabetesLast GP visitLast blood test

Chief Complaint / Detailsof Chief Complaint

SocratesSiteSizeShapeSurfaceContourColourConsistencyMobility


Dental History Any treatment done before


Investigations X-raysVitality testPercussionBiopsy




Explain Diagnosis

Differential Diagnosis Infection from one of the teethCyst (mucoepidermoid) coming from the salivarygland because it comes and goes and appearsbluishSuspicious growth of unknown origin

Risk Factors Leaving any tooth ache untreatedSmoking

Modifying Risk Factors

Specialist Referral

Check Understanding

Recall


Why does it come and go?And why does it appear blue?

Reading Material Odell Case 55


Case EIGHTEEN

TOPIC: CLUSTER:

Spreading Odontogenic InfectionsClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Cellulitis Don’t Touch Me



Case EIGHTEEN



Chapter: Acute Odontogenic InfectionsChapter: Dental Management of Patients withMedical ConditionsChapter: Practical Information on Using Drugs inDentistryChapter: Antibiotic Prophylaxis for DentalProcedures





Introduction

Chief Complaint Details about the chief complaintFind out why the patient is refusing treatment

SOCRATESBreathing problem?Does the tongue feel elevated?Swallowing problems?Has it worsened in the last hour?

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reaction - check for NSAID-inducedasthmaHistory of using corticosteroidsCheck if the patient is immunocompromised

Dental History Permission to contact the previous dentist to get anyx-rays he may have


AntibioticsPainkiller - Ibuprofen (if not contraindicated) /paracetamol

Social History SmokingAlcoholUse of recreation drugs

Investigations X-raysVitality testingVital signs, fever





Explain Diagnosis Infection that has spread outside the tooth or intothe jawCan be very dangerous

If left untreated - infection could spread anywhereCan be life-threatening

Treatment Open up the tooth and drain the pus or extract -localised swellingFluctuant - incise and drain

Reading Material

Specialist Referral /Hospital Referral

Cellulitis

Risk Factors

Check Understanding

Recall 3-5 days (DHSV Article), 2-3 days



Case NINETEEN

TOPIC: CLUSTER:

Spreading Odontogenic InfectionDiagnosis and Management Cluster

CASE DISCUSSION: Can’t You Do It (Cellulitis)



Case NINETEEN






Case TWENTY

TOPIC: CLUSTER:

Spreading Odontogenic Infections / Drug SeekerClinical Information Gathering Cluster

CASE DISCUSSION: Don’t Touch Me (Cellulitis)



Case TWENTY







Introduction

Chief Complaint Details of chief complaint - SOCRATESFind out why the patient is refusing treatment

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reactionLast GP visitpermission to contact


Mood stabilisersTreated for depression

Dental History Since when did the pain start?Permission to contact the dentistWas any testing done on that tooth?x-rays


Investigations X-raysThermal testing

Differential Diagnosis Infected nerve / decayed tooth?

Explain Diagnosis

Risk Factors If left untreated - the infection can spread and can bevery dangerous




Importance of HavingDental Treatment /Complications

Specialist Referral /Second Opinion

Check Understanding

Recall


Reading Material

After doing some treatment - offer you somepainkillers such as ibuprofen


Case TWENTY-ONE

TOPIC: CLUSTER:

Dry Socket / Pain After ExtractionClinical Information Gathering Cluster

CASE DISCUSSION: -



Case TWENTY-ONE



Chapter: Complications After Oral SurgeryChapter: Orofacial Pain


SUGGESTED READING MATERIALS:




Introduction




Dental History History of any dental extractions?Difficult extractions?Experience of healing after dental extractions

Investigations

Differential Diagnosis(will vary according tothe case)

If pain starts immediately after tooth extraction -retained root piece, fractureIf pain starts 2-3 days after exo - dry socket

Explain Diagnosis /Complications

Dry socketIncomplete removal of the toothDamage to the adjacent teethDamage to the nerveFracture of the bone




Risk Factors SmokingNot following the post-operative instructions

Normal Expectations

Check Understanding /Post-op Instructions

For about half an hour after surgery, you shouldplace pressure on the gauze pad covering theextraction site by biting on it. If bleedingcontinues, apply new gauze and pressure foranother half an hourDo not eat or drink hot foods and beverages aftersurgery.Do not rinse your mouth.Do not use a straw.Do not spit.No exercise on the day after you get your toothremoved.Do not drink carbonated beverages.Do not brush your teeth on the day of the surgery.Then resume normal home care, gently brushingand flossing.Some bruising, swelling, and pain are normal –particularly if you have had a wisdom toothextraction. Take your prescribed medication anduse a cold compress on your face.Plan to eat soft foods, such as soups, milkshakes,fruit juice, and yogurt, for 2-3 days.Do not bite your lips, cheeks, or scrape your gums.

Specialist Referral If healing doesn't occur after 3 weeks

Uneventful extractionModerate amount of pain and swelling for thenext few daysSigns of healing seen within 7 days




Management for DrySocket

Irrigate the socketDressingPainkillersRecall in 2 days to change the dressingThe wound will heal slowly if no signs of healing in3 weeks- review diagnosis and consider specialistrefer for review


Recall After 2 days

Reading Material


Case TWENTY-TWO

TOPIC: CLUSTER:

Prophylactic AntibioticsClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Case TWENTY-TWO



Chapter: Acute Odontogenic InfectionsChapter: Dental Management of Patients withMedical ConditionsChapter: Practical Information on Using Drugs inDentistryChapter: Antibiotic Prophylaxis for DentalProceduresChapter: Complications After Oral SurgeryChapter: Orofacial Pain



Case TWENTY-THREE

TOPIC: CLUSTER:

Dental Management of Medically Complex PatientsClinical Information Gathering Cluster

CASE DISCUSSION: Localised Odontogenic Infection (JustTake It Out)



Case TWENTY-THREE






Case TWENTY-FOUR

TOPIC: CLUSTER:

Complications During or After ExtractionClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Did You Just Break My Tooth!!!



Case TWENTY-FOUR





Case TWENTY-FIVE

TOPIC: CLUSTER:

Consent for ExtractionClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Case TWENTY-FIVE






Case TWENTY-SIX

TOPIC: CLUSTER:

PericoronitisClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Pericoronitis (It’s Killing Me)



Case TWENTY-SIX






Case TWENTY-SEVEN

TOPIC: CLUSTER:

Oro-Central Communication ManagementClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Hello Sinus



Case TWENTY-SEVEN








Introduction


Chief Complaint


Dental History


Investigations Already done



Explain Diagnosis Mobile tooth, the exo seems uncomplicated

Management Numb toothWith the help of my instrument, I’m gently goingto move and rotate the tooth and gently pull it out




Management It seems to be an easy procedureAsk consent

About Antibiotics What are antibiotics?Antibiotics are medicines used to prevent andtreat bacterial infectionsIt is given to people who are at a high risk ofdeveloping an infection

Reason for not prescribing Ab: Resistance: Antibiotic resistance is rising todangerously high levels in all parts of the world Antibiotic resistance is accelerated by themisuse and overuse of antibiotics

In Australia, there are some instances that justifythe use of antibiotics and we have someguidelines that we follow for people who are at ahigher riskOffer second opinionReading material on AbIf still insisting - ask them to sign a consent form ofrefusal

Referral

Check Understanding


Why did my previous dentist give me antibioticsand why don’t you give me? (Concentrate onexplaining the side effects of antibiotics)What if I then get an infection?

Reading Material


Case TWENTY-EIGHT

TOPIC: CLUSTER:

Extraction of an Upper Tooth ConsentClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Case TWENTY-EIGHT







Introduction

Chief Complaint


Since when is present?Pain?First episode?S- siteO- onsetC-characterR-radiatingA-aggravatingT-tempE- effect on sleepS- scale of 1-10Was it sensitive to hot and cold ?

Very mobile 47, salty taste, pimple present

Medical History Confirm medical historyMI- when was it? To see if he is in the safe periodHTN - is it controlled/ uncontrolledHypothyroidism - he’s is more prone to infection,keep appointments shortOsteoporosis - MRONJSince when do you have this?Since when have you been taking this medicine?Is this the first time you have taken this injection?History of hospitalisationAllergiesAdverse reactionCheck for diabetesLast GP visit


When did you take the panadine fort?




Dental History

Investigations X-ray?Temperature testingMeasurements around the gum

OHIHas this pimple in the mouth happened before?

Differential Diagnosis Periodontal abscess – pus is coming from thegumsPeriapical abscess - is it coming from a dead tooth

Explain Diagnosis Most likely it seems to be coming from the gums

Social History

Management GP - to check INR levels, CTX levels (get permissionfrom GP)When did you see your GP last for hypertension? -Is everything ok with that?Talk to your specialistExtract the toothNerve treatmentConsider ABP

Risk Factors Smoking (check)Denosumab - two days ago - high riskWarfarin- INR


Specialist Referral Specialist to give you clearance

Check Understanding




Recall


Antibiotics - most likely you won’t be needingantibiotics because it’s a localised collection ofpusWhy don’t you take the tooth out, it’s very loseIf you want to drain it, from where will you drain itand will you be giving me antibiotics for today

2 weeks8 weeks

Reading Material


Case TWENTY-NINE

TOPIC: CLUSTER:

Dental Trauma / AvulsionDiagnosis and Management Cluster

CASE DISCUSSION: Knocked Down Tooth



Case TWENTY-NINE



Chapter: Dental and Maxillofacial TraumaA Broken Tooth or FillingTooth AvulsionMaxillofacial Trauma

i.ii.

iii.




Introduction

Chief Complaint

Empathy Introduction


Any other injuriesDid the child lose consciousness?

When, where, and how did the trauma occur?Were there any other injuries?What initial treatment was given?Have there been any other dental injuries inthe past?Are current immunizations up-to-date?

Altered or loss of consciousnessBleeding from the head or earsDisorientationProlonged headacheNausea, vomiting, amnesiaAltered vision or unilateral dilated pupilSeizures or convulsionsSpeech difficulties

VomitingDid he find the tooth? Where is it now?Have the parents been informed?TimeHow did the injury happen?

Questions to ask:

Signs of closed head injury:



Medical history Vaccination status - tetanusHeart conditions - SABE - do not re-implantBleeding disordersCongenital heart diseasesAllergies


Dental history

Social history

Investigations X-ray - occlusal - upper, lower PA, status of theadjacent teeth

Differential diagnosis

Explain diagnosis Avulsion - tooth has fallen out of the socket

Management Depends on the ageIf primary tooth - do not re-implantIf age is less than 8 years and the apex is openmore than 2mm - RCT only if signs of necrosisdevelop (Cameron)

Time lapse since the tooth has been out of thesocket

Best to re-implant tooth immediatelyBest prognosis within 15 minutes (TG)

Prognosis is poor is re-implanted after 60minutesIf more than 30 minutes have pas - thenrehydrate the tooth by soaking it in sodiumfluoride for 20 minutes





Clean the tooth and the boneRe-implant the tooth, after numbing that areaSplint (wire)Start endo either on the day or within 10 daysBest storage media - milk - tooth can survive up to6 hoursShort term management - clean the tooth, numbthe area, and re-implant the tooth, splint the toothDepending on the root apex status - decide ifnerve treatment is necessary (it is advised forpatients with closed apex with 2-3 weeks)AnalgesicsAntibioticsMaintain soft dietChlorhex mouthwashMaintain oral hygiene

Risk factors Mouth guardNot maintaining the oral hygiene

Complications External resorptionSurface resorptionInflammatory resorptionAnkylosesFailure of nerve treatment

Long term effects Tooth is appearing darkerIt fuses with the boneTooth loosening

Check understanding




Recall Within 2 weeks initially4 weeks6-8 weeks1 yearYearly for 5 years

Specialist referral If you need an expert opinion or if we feel it isgetting a bit more complex

Frequently askedquestions

Reading materials Odell 26Cameron 202IADT GuidelinesSequence of Eruption 519



Case THIRTY

TOPIC:

CLUSTER:

Dental Trauma/Concussion/Discoloration afterTraumaDiagnosis and Management Cluster

CASE DISCUSSION: What’s Wrong With My Son



Case THIRTY





i.ii.

iii.




Introduction

Chief Complaint

Empathy


Loss of consciousnessWhen did he notice the colour change?Pimple associated itVaccination status - tetanusPainMobileWhat surface did he hit?Why was there a delay in the presentation?Any other injuries?

Charlie has a fall last week. Tooth has become black.

Dental History Confirm age, confirm it's a baby tooth

Medical History Vaccination statusAllergiesAdverse reactions

Medication History -either OTC or prescribed

Investigations Clinically and radiograph

Differential Diagnosis Concussion, subluxation (if mobility is seen -subluxation)




Explain Diagnosis /Management

(management willchange depending onthe root status)

Because of the trauma or his fall, this tooth haschanged colour (bruise in the tooth). Sometimesthe colour comes back to normal. If it continues todarken or a pimple develops, then contact me. Wewill have to do some treatment at that stage(nerve treatment or extraction).Continue monitoring it and maintain oral hygiene.

Sequelae of trauma to primary teeth

It is important to discuss with parents the sequelae ofluxated or avulsed primary incisors. Although it maybe difficult to accurately predict the prognosis for theunerupted permanent teeth, parents appreciatehaving an idea of the possible outcomes. In cases thathave been followed up in studies, up to 25% ofchildren are left with some developmentaldisturbance of the permanent tooth.

Damage to the unerupted permanent dentitionoccurs more often with intrusive luxation andavulsion in very young children. It is important towarn parents of possible problems with permanentteeth and also to reassure them that, with modernrestorative materials, minor defects are easilyrepaired.




Explain Diagnosis /Management(continuation)

Direction and displacement of the primary rootapex.Degree f alveolar damage.Stage of formation of the permanent tooth.Treatment provided to the primary tooth.

Necrosis of the pulp of the primary tooth with greydiscolouration and possible infection of the rootcanal system followed by abscess formation.Internal resorption of the primary tooth.Ankylosis of the primary tooth. Commonly,intruded primary teeth will fail to fully erupt butwill exfoliate normally. In rare cases, extractionmay be required just prior to the eruption of thepermanent incisor.Hypoplasia or hypomineralization ofsuccedaneous teeth.

Sequelae in the permanent dentition depend on:

Possible damage to primary and permanent teeth

Complications

Precautions MouthguardKeep an eye on the tooth

Recall / Follow-Up 2 weeks3 months6 monthsyearlyIf the tooth is still tender, then please have a softdiet




Questions Examiner didn't ask much - he's ok. Patient didn'tseem as worried.Is the nerve treatment similar to the nervetreatment in adults?What difference would a specialist (pedodontist)do?Do you put the same material that you put foradults?Why did the colour change happen after oneweek?He has a school photo and concerned with colour

Check Understanding


Case THIRTY-ONE

TOPIC: CLUSTER:

Missing / Delayed Eruption of Permanent TeethClinical Information Gathering Cluster

CASE DISCUSSION: Why Are They That Big



Case THIRTY-ONE


SUGGESTED READING MATERIALS: Odell Cases (4th Edition)

Case 5Case 50




Introduction

Chief Complaint Address concernCheck the age of the patient (prepare the caseaccordingly)Know that the permanent lateral incisors erupt at8-9 years of age (canine erupt - 11 to 12)

Medical History Confirm medical historyHistory of hospitalisationAllergiesAdverse reaction


Dental History Does she have a dentist that she normally see?TraumaRecent x-rayshow long was the baby tooth lost?Has she had a big x-ray taken?

Family History Check

Investigations If the parent concerned - confirming by taking x-ray, otherwise reassuranceGap is more than 8mm - mesiodense

Recall 6 months

Diagnosis Check the age and answer accordingly




Explain the Reasons forthe Late Eruption or ifthe Tooth is Missing

Missing - failure to form, family historyFailure to erupt - history of trauma could havecaused a bend in the rootThick gums / scar tissueCyst formationInadequate space to come outLocked in the boneMesiodense

Developmentally absent, possibly associated withcleft lip or palate or other craniofacial syndromesExtractedAvulsed

Dilaceration and/or displacement as a result oftraumaScar tissue preventing eruptionSupernumerary tooth preventing eruptionInsufficient space as a result of crowdingPathological lesion (e.g. cyst or odontogenictumour) preventing eruption

Missing

Failure to Erupt

Treatment

Recall 6 monthly


(The patient is 10 years in some cases and 7 insome)Examiner was asking, is the canine/lateralmissing?Does she need braces?




Frequently AskedQuestions (continuation)

Patient had read about the ugly duckling stageUpper and lower canines are both missing - age 10Are you sure that the tooth is missing?No bulge in the upper canine region, but therewas a bulge in the lowerWhy have the teeth flared out?

Recall

Further Reading Study the sequence of eruptionUgly duckling stage


Case THIRTY-TWO

TOPIC: CLUSTER:

Delayed Eruption / Congenitally Missing TeethClinical Information Gathering Cluster

CASE DISCUSSION: Are They Ever Going To Come Out?



Case THIRTY-TWO



Case 5Case 50




Introduction

Chief Complaint Address concernCheck the age of the patient (prepare the caseaccordingly)Know that the permanent lateral incisors erupt at8-9 years of age (canine erupt - 11 to 12)



Dental History Does she have a dentist that she normally see?TraumaRecent x-rayshow long was the baby tooth lost?Has she had a big x-ray taken?

Family History Check

Investigations If the parent concerned - confirming by taking x-ray, otherwise reassuranceGap is more than 8mm - mesiodense

Recall 6 months

Diagnosis Check the age and answer accordingly




Explain the Reasons forthe Late Eruption or ifthe Tooth is Missing

Missing - failure to form, family historyFailure to erupt - history of trauma could havecaused a bend in the rootThick gums / scar tissueCyst formationInadequate space to come outLocked in the boneMesiodense

Developmentally absent, possibly associated withcleft lip or palate or other craniofacial syndromesExtractedAvulsed

Dilaceration and/or displacement as a result oftraumaScar tissue preventing eruptionSupernumerary tooth preventing eruptionInsufficient space as a result of crowdingPathological lesion (e.g. cyst or odontogenictumour) preventing eruption

Missing

Failure to Erupt

Treatment

Recall 6 monthly


(The patient is 10 years in some cases and 7 insome)Examiner was asking, is the canine/lateralmissing?Does she need braces?




Frequently AskedQuestions (continuation)

Patient had read about the ugly duckling stageUpper and lower canines are both missing - age 10Are you sure that the tooth is missing?No bulge in the upper canine region, but therewas a bulge in the lowerWhy have the teeth flared out?

Recall

Further Reading Study the sequence of eruptionUgly duckling stage


Case THIRTY-THREE

TOPIC: CLUSTER:

Caries Risk Assessment / Early Childhood CariesClinical Information Gathering Cluster

CASE DISCUSSION: What Is He Eating? / Why Is He EatingLike That?



Case THIRTY-THREE



Chapter: Dental CariesChapter: Practical Information on Using Drugs inDentistry

Mouthwashes and Other Topical FormulationsUsed in Dentistry


i.





Introduction

Chief Complaint


Examiner - I have noticed a lot of black holes inmy daughter's teeth

Is she complaining of pain?Has she seen a dentist before for this problem?


Medication regularly - syrup

Diet History What is normal diet?Drink fizzy, drink water insteadDoes she normally consume a lot of sugary food?Snacking between meals?Sticky food, lollies or sticky chocolate barsWhat sort of snacks does he prefer?Frequency of consuming sugar?Time of sugar consumption

Diet Advice Dietary advice should include an explanation of theeffect of between-meals eating and sugary drinks. Itmust also be personal, practical, and positive! Thesuggestion that a child should select crisps whenfriends are buying sweets is more likely to be followedthan total abstinence.




Diet Advice(continuation) Save sweets to be eaten on 1 day, e.g. Saturday

dinnertime, or to be eaten at the end of a meal.All-in-one chocolate bars are preferable to packetsof individual sets.Foods that increase salivary flow (e.g. cheese,sugar-free chewing gum) can help to reverse thepH drop due to sugar if eaten afterward.Treacle, honey, and fruit (especially fruit juice) arecariogenic.Artificial sweeteners should be avoided in pre-school children.Fibrous foods, e.g. apples, are preferable to asucrose snack, but they can still cause decay andthere is no evidence that they can clean teeth.

Diet chat - 4 days

Some helpful hints:

Dental History Do you have a dentist that you normally see?Would you say the condition has worsenedrecently?OH and flossFluoride?Does he brush by himself?Tank or tap water or bottled water?What type of toothbrush?Has he shown how to brush?Dye painted teeth

Social History Did he grow up locally?Primary carer




Investigations X-rayDisclosing teeth

Management Ask who is the primary carer?Health care card – CDBS $1000/ 2 yearInform about the infection passing to thepermanent toothEmergency phase - restore teeth that have deepdecay, close to the nerveStabilization phase- remove all the decay from therest of the teeth, pit, and fissure sealants Preventive - diet advice, high fluoride-containingtoothpaste - for adults and children for more than10 years of age. If less than 10 years of age- toothmousse - TG pg 52Maintenance phase - recall, regular fluorideapplication

Diagnosis Rampant caries

Explain DiagnosisA term with no specific definition, but often usedto describe extensive, rapidly progressing cariesaffecting many teeth in the primary and/orpermanent dentition.

Rampant caries

Risk Factors Sugar containing foodInadequate brushing

Modifying Risk Factors Reduce sugarChoose healthy food and drink




Specialist Referral

Recall

Check Understanding


He’s spending time with his grandparentsThey don’t have time – careless parentThey seem to be coming from a low socio-economic class (was asking if they have to pay forthe specialist treatment) I like drinking coke and I give him also

Diet chart was given (in another case) no access totap water. The child was very uncooperative evenwhile examined. The parent was concerned abouthow you would be able to treat him?Because there’s so much to be done- is it going tobe very expensive?

Another variation:

Reading Material TG - Caries Risk AssessmentOdell Case 1Evan's Article - Caries Risk Assessment


Case THIRTY-FOUR

TOPIC:

CLUSTER:

Early Childhood Caries / BehaviouralManagementDiagnosis and Management Cluster

CASE DISCUSSION: Sugar, Holes & Uncooperative (TheLethal Combination)



Case THIRTY-FOUR






i.





Introduction

Chief Complaint


Examiner - I have noticed a lot of black holes inmy daughter's teeth

Is she complaining of pain?Has she seen a dentist before for this problem?


Medication regularly - syrup

Diet History What is normal diet?Drink fizzy, drink water insteadDoes she normally consume a lot of sugary food?Snacking between meals?Sticky food, lollies or sticky chocolate barsWhat sort of snacks does he prefer?Frequency of consuming sugar?Time of sugar consumption

Diet Advice Dietary advice should include an explanation of theeffect of between-meals eating and sugary drinks. Itmust also be personal, practical, and positive! Thesuggestion that a child should select crisps whenfriends are buying sweets is more likely to be followedthan total abstinence.




Diet Advice(continuation) Save sweets to be eaten on 1 day, e.g. Saturday

dinnertime, or to be eaten at the end of a meal.All-in-one chocolate bars are preferable to packetsof individual sets.Foods that increase salivary flow (e.g. cheese,sugar-free chewing gum) can help to reverse thepH drop due to sugar if eaten afterward.Treacle, honey, and fruit (especially fruit juice) arecariogenic.Artificial sweeteners should be avoided in pre-school children.Fibrous foods, e.g. apples, are preferable to asucrose snack, but they can still cause decay andthere is no evidence that they can clean teeth.

Diet chat - 4 days

Some helpful hints:

Dental History Do you have a dentist that you normally see?Would you say the condition has worsenedrecently?OH and flossFluoride?Does he brush by himself?Tank or tap water or bottled water?What type of toothbrush?Has he shown how to brush?Dye painted teeth

Social History Did he grow up locally?Primary carer




Investigations X-rayDisclosing teeth

Management Ask who is the primary carer?Health care card – CDBS $1000/ 2 yearInform about the infection passing to thepermanent toothEmergency phase - restore teeth that have deepdecay, close to the nerveStabilization phase- remove all the decay from therest of the teeth, pit, and fissure sealants Preventive - diet advice, high fluoride-containingtoothpaste - for adults and children for more than10 years of age. If less than 10 years of age- toothmousse - TG pg 52Maintenance phase - recall, regular fluorideapplication

Diagnosis Rampant caries

Explain DiagnosisA term with no specific definition, but often usedto describe extensive, rapidly progressing cariesaffecting many teeth in the primary and/orpermanent dentition.

Rampant caries

Risk Factors Sugar containing foodInadequate brushing

Modifying Risk Factors Reduce sugarChoose healthy food and drink




Specialist Referral

Recall

Check Understanding


He’s spending time with his grandparentsThey don’t have time – careless parentThey seem to be coming from a low socio-economic class (was asking if they have to pay forthe specialist treatment) I like drinking coke and I give him also

Diet chart was given (in another case) no access totap water. The child was very uncooperative evenwhile examined. The parent was concerned abouthow you would be able to treat him?Because there’s so much to be done- is it going tobe very expensive?

Another variation:

Reading Material TG - Caries Risk AssessmentOdell Case 1Evan's Article - Caries Risk Assessment


Case THIRTY-FIVE

TOPIC:

CLUSTER:

Dental Anomalies / Molar IncisorHypomineralisationClinical Treatment and Evaluation Cluster

CASE DISCUSSION: It's Not Your Fault or Is It?



Case THIRTY-FIVE





i.




Introduction

Chief Complaint


When did you first notice it?Were the baby teeth affected?Painful?Family history

Medical History Maternal vitamin D deficiencyIntubation as a babyHistory of jaundicePreterm babyHistory of any IllnessAllergies Adverse reaction


Dental History Pain?Can she brush normally?Dentist?Last x-rays?Diet - diet advice

Social History

Investigations X-rays - if not given

Syrups

Primary Carer

Differential Diagnosis A.ID.IMolar incisal hypoplasia




Differential Diagnosis(continuation)

Explain Diagnosis Based on the history

Risk Factors Sugar?Poor Oral Hygiene


Management Exo or restoCrown - SS

Reading Material

Diet advice, OH - care and maintenance

Odell Case 56Odell Case 1Evan's Article

Chronologically affected defectsIdiopathic

Specialist Referral

Check Understanding

Recall 3 months initially, and then 6 months, and then yearly



Case THIRTY-SIX

TOPIC: CLUSTER:

Dental Trauma / Luxation and IntrusionClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Pull It Back Please, Hurry!!



Case THIRTY-SIX





i.ii.

iii.




Introduction

Chief Complaint

Empathy


Same as above

My tooth has been pushed into the socket

Medical History ConfirmAllergiesAdverse reactionsBleeding tendenciesHeart conditionsVaccination status - tetanusChest x-ray


Dental History Does he have a dentist that he normally sees?Last dental x-ray

Social History

Investigations X-ray - occlusal and lower PASoft tissue injuries

Diagnosis

Explain Diagnosis Tooth has been pushed into the bone. It seems tobe pushed intact about 7-8mm inside the bone.Enamel chip on the adjacent tooth 2.1




Management

Allow eruption without intervention.If no movement within a few weeks, initiateorthodontic repositioning.

Allow eruption without intervention if the toothintruded less than 3mm.If no movement after 2-4 weeks, repositionsurgically or orthodontically before ankylosis candevelop. If the tooth is intruded 3-7mm, repositionsurgically or orthodontically.If the tooth is intruded beyond 7mm, repositionsurgically.The pulp will likely become necrotic in teeth withcomplete root formation. Root canal therapy usinga temporary filling with calcium hydroxide isrecommended and treatment should begin 2-3weeks after repositioning.Once an intruded tooth has been repositionedsurgically or orthodontically, stabilize with aflexible splint for 4 weeks.

Short term

Teeth with incomplete root formation:

Teeth with complete root formation:

Address 21 - composite resto




Special Instructions Soft dietOral hygiene especially the wire in onBrushing instruction, mouthwashMouthguardPainkillerMonitor the tooth for colour change

ComplicationsTooth locked in place / ankylotic tone topercussion.Radiographic signs of apical periodontitis.External inflammatory root resorption orreplacement resorption.Endodontic therapy appropriate for stage of rootdevelopments indicated

Unfavourable

Check Understanding

Recall Within 2 weeks initially4 weeks 6-8 weeks 6 months 1 year Yearly for 5 years Watch out for any signs of discolouration andsalty discharge




Reading Materials


Tooth was not as intrudedThe adjacent was fracturedThe girl didn't wear a mouthguard as she said shewasn't in a real game. She was just practicing.The tooth was broken and the teachers couldn'tfind the broken piece.Are you going to reposition the tooth now? She isvery uncomfortable.


Case THIRTY-SEVEN

TOPIC:

CLUSTER:

Pulpal Diagnosis / Factors Affecting Delivery ofTreatmentDiagnosis and Management Cluster

CASE DISCUSSION: I Need It Fixed Now



Case THIRTY-SEVEN



Case 9Case 47Case 62


Case THIRTY-EIGHT

TOPIC: CLUSTER:

Pain After RCT / Complications After RCTClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Is This Normal?



Case THIRTY-EIGHT



Case 1Case 14Case 33Case 53Case 56Case 65


Case THIRTY-NINE

TOPIC: CLUSTER:

Denture InstructionsClinical Treatment and Evaluation Cluster

CASE DISCUSSION: Well Hello Darl



Case FORTY

TOPIC: CLUSTER:

Amalgam ReplacementDiagnosis and Management Cluster

CASE DISCUSSION: Just Change Them All



Case FORTY-ONE

TOPIC: CLUSTER:

Complications During RCTClinical Treatment and Evaluation Cluster

CASE DISCUSSION: You Kidding Me Right?



Case FORTY-ONE


SUGGESTED READING MATERIALS: Odell Case (4th Edition)

Case 48


Case FORTY-TWO

TOPIC: CLUSTER:

RCT ConsentDiagnosis and Management Cluster or ClinicalTreatment and Evaluation Cluster

CASE DISCUSSION: Before We Start



Case FORTY-TWO



Case 47


Case FORTY-THREE

TOPIC: CLUSTER:

Replacement Option for Filling a GapClinical Treatment and Evaluation Cluster

CASE DISCUSSION: What Do You Think About This Gap?



Case FORTY-THREE



Case 5Case 12Case 17Case 35Case 43


Case FORTY-FOUR

TOPIC: CLUSTER:

Complications After RCTDiagnosis and Management Cluster

CASE DISCUSSION: You Broke It, You Fix It



Case FORTY-FIVE

TOPIC: CLUSTER:

Erosion / Attrition / Abrasion / Diet AnalysisDiagnosis and Management Cluster

CASE DISCUSSION: I Need To Stay Awake



Case FORTY-FIVE





Odell Cases (4th Edition)Case 1Case 9Case 27Case 56Case 60Case 61

i.


Case FORTY-SIX

TOPIC: CLUSTER:

Pain Diagnosis / Cracked Tooth SyndromeClinical Information Gathering Cluster

CASE DISCUSSION: I Am So Sorry Doctor



Case FORTY-SIX





Case FORTY-SEVEN

TOPIC: CLUSTER:

Complications After RestorationsClinical Treatment and Evaluation Cluster

CASE DISCUSSION: He Ruined My Tooth



Case FORTY-SEVEN



Case 71


Case FORTY-EIGHT

TOPIC: CLUSTER:

Complications After Local AnesthesiaDiagnosis and Management Cluster

CASE DISCUSSION: I Can't Open My Mouth



Case FORTY-EIGHT



Chapter: TrismusChapter: Local Anaesthetics in Dentistry



Case FORTY-NINE

TOPIC: CLUSTER:

Pain on Biting / Pulpal-Pain DiagnosisClinical Information Gathering Cluster

CASE DISCUSSION: -



Case FORTY-NINE






Case FIFTY

TOPIC: CLUSTER:

Periodontitis / Abscess Infections in ChildrenClinical Information Gathering Cluster

CASE DISCUSSION: There Is A Bump On Her Gum



Case FIFTY






Case FIFTY-ONE

TOPIC: CLUSTER:

Fluorosis / Bleaching in ChildrenDiagnosis and Management Cluster

CASE DISCUSSION: I Need To Look Good



Case FIFTY-ONE



Case 27


Case FIFTY-TWO

TOPIC: CLUSTER:

Extraction of Patient or AnticoagulantClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Case FIFTY-TWO






Case FIFTY-THREE

TOPIC: CLUSTER:

Chronic PeriodontitisClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Case FIFTY-THREE




i.ii.

iii.


Case FIFTY-FOUR

TOPIC: CLUSTER:

Root Vertical FractureDiagnosis and Management Cluster

CASE DISCUSSION: What Are You Talking About?



Case FIFTY-FOUR





Case FIFTY-FIVE

TOPIC: CLUSTER:

Generalised PeriodontitisClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Case FIFTY-FIVE



Case 38Case 52


Case FIFTY-SIX

TOPIC:

CLUSTER:

Periapical Abscess, Lost Space for PermanentDentitionClinical Information Gathering Cluster

CASE DISCUSSION: -



Case FIFTY-SIX



Case 1Case 9Case 33Case 63


Case FIFTY-SEVEN

TOPIC: CLUSTER:

Anxious Patient, Diazepam / AnxiolyticsClinical Information Gathering Cluster


CASE DISCUSSION: -


Case FIFTY-SEVEN

TOPIC: CLUSTER:

Anxious Patient, Diazepam / AnxiolyticsClinical Information Gathering Cluster


CASE DISCUSSION: I Need Something to Relax


Case FIFTY-SEVEN



Case 40


Case FIFTY-EIGHT

TOPIC: CLUSTER:

Treatment of Generalised PeriodontitisDiagnosis and Management Cluster


CASE DISCUSSION: -


Case FIFTY-EIGHT



Case 38Case 52


Case FIFTY-NINE

TOPIC:

CLUSTER:

Indigenous Culture / Statistics, OAC / InfectionControl Protocol for Instrument Processing ofSTD Positive PatientsClinical Treatment and Evaluation Cluster


CASE DISCUSSION: -


Case FIFTY-NINE





Case SIXTY

TOPIC: CLUSTER:

Diet Modification / Erosion / AttritionClinical Treatment and Evaluation Cluster


CASE DISCUSSION: -


Case SIXTY



Case 1Case 9Case 27Case 56Case 60Case 61


Case SIXTY-ONE

TOPIC: CLUSTER:

Developmental Defects and Legal ConsentClinical Information Gathering Cluster

CASE DISCUSSION: -



Case SIXTY-TWO

TOPIC: CLUSTER:

Pain After RCTClinical Information Gathering Cluster

CASE DISCUSSION: -



Case SIXTY-THREE

TOPIC: CLUSTER:

Severe Periodontitis and Replacement Options Diagnosis and Management Cluster

CASE DISCUSSION: -



Case SIXTY-FOUR

TOPIC:

CLUSTER:

Esthetic Concerns and N2O Interactions withDiazepam Diagnosis and Management Cluster

CASE DISCUSSION: -



Case SIXTY-FIVE

TOPIC: CLUSTER:

Dental Trauma / Extrusive LuxationClinical Treatment and Evaluation Cluster

CASE DISCUSSION: -



Documents

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