Reflective Clinical Practice

Week 1:

I have recalled all risk factor of dental diseases including Periodontal gingivitis, Periodontitis, Dental caries, ECC risk factors, NCTL assessment.

Review aetiologic factors:

Generalized Gingivitis
Aetiologic factors
Oral Hygiene Inadequate plaque removal, high bacterial load

Independent/unsupervised brushing (generalised soft deposits mainly gingival margins and buccal surfaces)
Age/ behavioural aspect Lack of parental supervision/ Low dental IQ and

Low socioeconomic factors
Saliva Buffer, viscosity, resting flow, pH
Mouth breather Check Lip competency

 

Early Caries Childhood Caries
Aetiologic factors
Age Contributing factors include low dexterity, primary dentition
Behavioral aspects Lack of parental supervision/ low dental IQ and low socioeconomic
Oral hygiene Inadequate plaque removal, high bacterial load, independent brushing (generalised soft deposits mainly gingival margins and buccal surfaces)
Diet High cariogenic diet consisting of carbohydrates, sugars and acidic foods, high frequency consumption and low water intake
Susceptible teeth/ surfaces Primary, dentition, deep fissures
Dental History No prior examinations, presence of active caries

 

Non carious tooth loss
Aetiologic factor
Age/ behavioural aspects Low socioeconomic factors/ stress/ bruxism
Diet High cariogenic diet – acidic foods and drinks
OHI Brushing technique, abrasive toothpaste

 

Mobility
AETIOLOGIC FACTOR
Periodontal disease
Occlusion
Trauma
Impaction
Advance exfoliation

Periodontal risk assessment:

Caries risk assessment – Cambra

NCLT risk assessment

Week 2:

Reflection: deciduous teeth is much smaller than permanent teeth. The proximal box is smaller. Very be careful when doing cavity prep as the pulp charm is very wide in deciduous teeth. Additionally, the enamel on deciduous teeth is thinner and more prone to decay compared to permanent teeth. It is important to handle these teeth with extra caution during cavity preparation to avoid any damage to the pulp chamber.

Goal: time management. Try to perform more efficiently as when we do with the kids, they don’t have much patient. They can’t stay still for hours for us to do filling.

Week 3:

I have learned how to deal with young people. The caries affected the maxillary teeth first because the eruption, the salivary gland. Canine affected less because of later eruption. Mandibular anterior teeth unaffected. Early childhood caries puts children at a higher lifetime risk for dental caries. Preventing from early childhood caries is very important. No sweetener on dummy, no sleep with bottle, read the food label we surprise how much sugar we serve. Cereal is thought like a healthy food but also contain a lot of sugar.

Encourage the little children brush their teeth early as they can, drink tap water. Start using fluoridated toothpaste at 18 months – 2 years. Start flossing when leeway spaces.

Children with special health needs, kids of mothers with a high caries rate.

When treating, life the lip to check,

Fix the problem: doing the interproximal first and extend to occlusion.

Goad: time management. Doing more nicer interproximal box. Start working on clinical assessment

Facial image: 55,54,53,52,51,61,62,63,64,65. Maxilla arch. Gingival pink, tongue is ok. Caries on 54B, 53,52,51 labial caries

Week 4:

I have learned about ART techniques: treat caries outside of the traditional clinical setting, born in 1980, caries in low middle income countries are not treated restoratively, can threat to general health, can get infection of the neck and the floor of mouth. ART is just need equipment, water, can used where only minimal equipment and resources are limited.

ART: remove soft caries, using GIC. Aim to prevent caries stretch out, leads to fewer extractions, increase quality of life.

Before using carboxylate cement, now we use GIC. GIC contain fluoride to help to remineralise, prevent the progression of caries, material is gentle with dentin, can come in hand-mixed version.

Different between :

Resin modified: need light cure, has composit, more stronger material, to reduce the acid

GIC: glass ionomer

Technique: small open cavities, anxious or fearful patients, pt who are afraid of hadicapped

Contraindications: not used to abscess or swelling teeth because if it closed by the gic, the infection will stretch out and create bigger issue, not use in pulp tissue or caries tissue cannot be reached with hand.

Procedure: cotton roll isolation, remove plaque, food form pits and fissure, spoon excavators to widen access, remove caries, soft dentine and unsupported enamel,  be careful with pulp.

Risk: use larger spoon excavator to limit risk, leave affected dentine over the pulpal floor, can also place calcium hydroxide to stimulate caries dentine, protect the pulp, create smear layer to allow bonding ,

Should overfill cavity and apply GIC to all pit and fissure to protect all the caries, apply Vaseline, 10 to 20 seconds, do not try and fix restoration with gloved finger as may create voids, check occlusion with articulating paper, adjust the fillings, ask pt to wait 1 hour to eat.

ART technique is a painless, doesn’t required anaesthetic, less cost, simplifies infection control, it is not a compromised treatment.

Silver fluoride: minimal intervention dentistry (MID) always small prep, just fixing up what we need, diet/ nutrition, oral examination,

MI dental treatment: fs, fissure protection, art, hall, applying silver fluoride (SDF).

Silver: antimicrobial (stop bacteria growing), fluoride: caries prevention, remineralisation. Together arrest caries, prevent new caries and assist with hypersensitivity.

Silver fluoride=40% silver fluoride.

Silver diamine (30-38 silver fluoride): ammonia, more stable then silver fluoride alone, arrest caries. Silver turns caries to black. Black last 2 -4 weeks.

SF in Australia: not approve by TGA, CSDS: detecting stain, Riva start desensitising cervical tooth hypersensitivity.

Formulate 1: 40% silver fluoride, 2: 10% stannous fluoride. 2 to help less back staining present

Benefit: protected caries , 2 a year

Note: unsound tooth structure turn black, temporary brown or white may appear, should disappear within 13 days, not to be applied to erupting teeth can alter the colour, not be applied directly to pulp, only to dentine over pulp. CSU will only use SDF in exceptional circumstances.

Hall technique: MID involves, MID is important.

Issues with restorations: fail over time

Hall crown: not removed, stop oxygen supplied so bacteria cannot stretch wide

Where can place Hall crown hypomineralised teeth, approximal lesion, occlusal caries lesion, cavitated or non-cavitated, anxious or young patients, caries to the dentine but not to the middle third of dentine.

Can put hall crown to 55,54,84. 85:duraphat, tooth mousse, flossing

Cannot do SSC because the caries is beyond middle dentine. Option for deciduous: do nothing, restro, pulpotomy, exo, refer

75 not suit for SSC because caries closed to the pulp charm. Can apply SSC for 74, 75

Week 5:

I have learned about disclosing gel which use to identify areas of plaque on the teeth. This gel is applied to the teeth and any remaining plaque will be stained, making it easier to see and remove. It is a helpful tool in promoting proper oral hygiene and preventing tooth decay in both deciduous and permanent teeth.

Week 5:

This week I have revision about Periodontitis stages and grading.

Periodontitis staging: OPG is the best tool to diagnose periodontitis stage.

Use X-rays:

  1. find the worst tooth in the mouth
  2. find the CEJ, move 1.5-2mm apically
  3. Divide the tooth into 3rd.

In this OPG, the worst tooth has perio pocket is 16. Divide tooth into 3 section to figure out exactly what the bone level sitting. About 15m BONE LOSS. Between stage 1 or stage 2, need to move up to stage 2.

 

Tooth 16 is the worst. Bone loss 50% 60%. Between stage III or stage IV, will put to stage IV.

Staging always first, grading second

Review furcation stage:

Bone loss/age= 60%/51>1- grade C

Always consider pt grade B first before moving to A or C.

Tepe share student programme: interdental cleaning.

Clinical signs of periodontal disease: gum red, swelling, bleeding, recession, halitosis.

The patient think “ no pain- no problem, stops brushing since bleeding gums

Come to latest stage: loss teeth

Usage of interdental cleaning: 20% daily interproximal cleaning, 12%  of adults reported daily interdental cleaning, compliance on daily flossing: 10-30%, only 10% of the population regularly use interdental cleaning devices.

Choosing the right interdental cleaning:

-Embrasures

-age of the patient

-Patients’ preference

-Susceptibility to periodontal disease

-Periodontal disease experience

-Manual dexterity

Learn the new floss technique

Flossing for the management of periodontal disease and dental caries in adults:

Who should use floss: Embrasure space type I, a pointed papilla that fills the interdental space, good dexterity and high motivation: regular floss/tape, bad dexterity and low motivation: floss on a handle, such as Tepe GOOD Mini Flosser.

Who should use Easy Pick: Embrasure space type II-III

  • Healthy patients = daily cleaning
  • Patients with gingivitis = daily cleaning
  • Periodontitis = complement or on-the-go. Cleaning with additional products necessary

Water floss: 90-degree angle, medium pressure, 3 sec per site

Tepe Interdental brushes extra soft, Tepe Interdental brushes angle

Sizing options: different sizes

Communication with patients: open questions, encourage patients

Week 6:

I have learned the new technique of restoration sandwich technique and closed sandwich technique:

Help push some of that fluoride over to either stop that mineralisation from happening or remineralised that tooth.

Closed sandwich technique: deep lesion, do need to have a enamel present because we need that bonding of the composite. GIC replaces all the dentine, composite replaces all the enamel.

Open sandwich technique: use when you got extremely thin enamel or no enamel at all, really deep so that proximal area is completely restored with the GIC then the composite goes on top.

It’s the choice comes between how much enamel left as to whether should use composite all the way down for the fluoride, how deep it is, the fluoride exposure, incipient lesion. This technique give the strength for the restoration, potentially more than just composite if you were placing it in either of these situations. If go into 2mm to the dentine, prefer to place GIC on the base because it’s got fluoride, it’s stronger and it’s going to bond to the dentine a lot better.

Mini box or slot box is a class II preparation but without that occlusal extension, it’s only the proximal box that you’re cutting into a tooth, much less invasive, not taking away as much tooth structure either. But with that, there is a high chance of failure because you really need to create quite a retentive prep in a small space for the filling to be strong. The occlusal extension always helps us create retention stability or it helps us remove caries, it’s exclusively as well, we have to be very careful of the type of shapes that we create.

Disadvantage of mini box: if no occlusal extension, when we are putting composite in it, it’s just one solid area of composite, a lot of occlusal pressure going on when pts are biting and eating, the chance of fracturing is a little bit higher. So we often only do there types of preparations in premolar because that they can withstand that pressure. A molar which is bigger, gets more force from our daily habits, it is at a high risk of fracturing with a restoration like this. That why we need that occlusal extension for retention purposes.

Class III: all about anterior. Lesion between anterior teeth, proximal surfaces.

Class IV : lesion into proximally and it’s involving the incisal edge of the teeth or the patient’s had a fracture, which is in most cases what happens with the class IV.

Why do people get carries between their front teeth: it’s often one of the last places a pt will get carries, especially the mandibular teeth, it’s very rare. They’ve got to be an extremely high carries risk to get something like that going on the anterior. Happen when people have vomiting in their history, a terrible with brushing an flossing or have quite significant crowding and the food and plaque sitting caught all the time. They may be more prone to caries between their anterior teeth.

Detection anterior lesions: felling with the probe if there’s any roughness, felling with the floss to see if we’re getting any fraying, x-ray. That’s going to give us a cavitation shadowing. Transillumination: putting a light behind the teeth, use the blue light, it’ll actually transfer through caries’ tissue differently than it does through a normal a tooth structure.

Treatment option:

Enamel only: remineralise, we don’t want to cut into a tooth, require pt to be flossing, increasing their fluoride, making sure their brushing is looking good, their diets, getting them as much change as possible to prevent that lesion from progressing. Warning them, if they don’t do good, the next step is we’re going to need to do a restoration because it’s now into the second layer of the tooth.

Dentine involment: showing on the x-ray, cavitation.

Preparation: angulation of bur should perpendicular to the end surface at the point of access to avoid overextension, without removing unnecessary enamel, not in 90 degree angle. When one tooth is affected, often the tooth next door is because what ever caused the caries was sitting between both of them. Again, it’s often food or plaque, hydrogenic diet, pH issue, demoralisation, the caries is more a bit sudden. We don’t want to clear the entire contact point, preserving as much enamel around.

Week 7:

Local anesthetic is a part important of clinical dental field. It helps to numb the area being treated, proveding pain relief for the patients. Also I have learned the prescaution and how to prevent them.

Pain on Injection Paraesthesia (prolonged anaesthesia) Needle breakage Trismus
Cause:

Careless technique

Too rapid injection- torn tissue

Subperiosteal injection

Solution is too warm or too cold

Pronounced – needle unintentionally pricks an anatomical structure – electric shock

 

Prevent:

Know your landmarks, good technique, inject SLOWLY.

Bevel facing bone

Make sure LA is room temp

 Burning or tingling

Persistent/ permanent anaesthesia

Tingling or pins: paraesthesia

Increased sensitivity: hyperesthesia

Pain to non- noxious stimuli: dysesthesia

Misconception around Articaine IAN blocks

Trauma to nerve:

+LA from a cartridge contaminated by alcohol or sterilisationà irritationàoedema

+Haemorrgage into nerve sheathàintraneural hematomaàincrease pressure

-give to a previous partially anaesthetised stie

 

Prevent:

Adherence to injection protocol

 

Management:

Duration determined

Speak to pt personally, reassure and advise it is not uncommon after LA administration

Mostly transient and will resolve in 8 weeks

Document

If unresolved after 8 weeksàirreversibleà refer to a neurologist or oral surgeon

 Cause:

Rare

Report needle had been bent first and that needle was inserted in its entire length

Smaller diameter needle (30gauge) are more likely to break

Pt movement

 

Prevent:

Larger gauge needle

Use long needle if inserting >18mm into soft tisse

Don’t insert all way , don’t apply extensive lateral pressure whilst needle is inserted into soft tisse

 

Management:

Remain calm, ask pt to remain still

Visible: remove it

Unvisible: inform pt, document, refer to macillofacial surgeon

Document

 Cause:

Limited opening of the mouth

Arise 1-6 days post injection

Insert needle into muscle (medial pterygoid with IAN block)

Haemorrhage

Bleeding to muscle following injection

Inject directly to muscleà necrosis of exposed muscle fiber

 

Prevent:

Adherence to injection protocol

Avoid repeat injections and multiple insertiong

Use minimum effective volumes of LA

 

Management:

With mild pain: heat, saline rinse, analgesis,

Inform pt, perform daily mouth exercise

Usually disappear in 7-10 days

Document

If severe pain: if last longer, refer maxillofacial surgeon
Paralysis Soft tissue Haematoma
Inject to parotid glandà paralysis of muscle of facial expression

 

 

Prevent:

Adherence to injection protocol

Slight resistance to deposition of LA for an IAN

 

 

Management:

Reassure pt and advise paralysis is normal transient and will last for duration of soft tissue

Remove any contact lenses

Cover eye path

DOCUMENT

 Frequently lip, tongue or cheek bite in younger children, mentally

or physically disabled clients- can lead to swelling and causes

significant pain when the L.A effects resolve

 

 

Prevent:

Select L.A of appropriate duration for the client

◦ Cotton role in mouth

◦ Post Operative

 

 

Management:

Instructions to Pt and Parent- DOCUMENT!!!!

◦ Warning stickers

Analgesics, saline mouth rinse, Vaseline

◦ If severe tissue laceration, or signs of systemic involvement

discuss with DO, who may need to prescribe antibiotics

 Cause

◦ Effusion of blood into an extravascular space, most likely from inadvertently nicking a

blood vessel

◦ Common in

 pterygoid plexus of veins, posterior superior alveolar vessels, inferior alveolar vessels, & the mental vessels

 If occurs in Pterygomandibular space, may lead to swelling in pharyngeal arch and slight trismus

 

Prevent: knowledge of landmark, anatomy.

 

 

 

Management:

Immediate

 Apply direct pressure until bleeding stops

◦ Subsequent

 Advise pt about possible soreness

 Apply ice intermittently for first 4-6 hours (no heat)

 Expect discoloration and wait for the reduction in swelling &/or bruise.

Week 8:

It is important to understand when patients need antibiotic before dental treatment to prevent the infection that can affect their health issue. However, minimum of antibiotic used is preferred to reduce the risk of antibiotic resistance.

When is antibiotic prophylaxis required?

Cardiovascular conditions:

  • Prosthetic heart valve
  • History of endocarditis
  • Heart transplant with valvulopathy/ valve dysfunction
  • Congenital heart problems

Compromised immunity:

  • Organ transplant
  • Neutropenia
  • Cancer therapy

When is Antibiotic prophylaxis NOT required?

  • Cardiovascular pacemaker
  • Rheumatic fever without valvular dysfunction
  • Mitral valves prolapse without valvular regurgitation
  • Simple restoration, impression do not need antibiotic.

Scripts for infective endocarditis prophylaxis

  • First choice: Amoxicillin 2g, 1 hr before tx
  • Children, first choice: Amoxicillin 50mg/kg, 1 hr before tx
  • PCN allergy: Clindamycin 600mg, 1 hr before tx
  • Children PCN allergy: Clindamycin 20mg/kg, 1 hr before tx
  • Non-oral (IV or IM): ampicillin 2g, 30 min before tx
  • Children, non-oral: Ampicillin 50mg/kg, 30min before tx

For Prosthetic Joint Prophylaxis

  • First choice: Keflex 2g, 1hr before tx

Week 9:

Review medical disease condition

Diabetes Mellitus Diabetes Insipidus
Metabolic disease that leads to high blood glucose

Body can’t produce or react to insulin properly

Polydipsia (thirsty), polyphagia (hungry)m polyuria

 Kidneys are unable to retain water

Body can’t produce or react to ADH properly

Polydipsia and polyuria.
Type I Type II Gestational diabetes
Children onset

Insulin dependent, deficiency.

The body does not make enough insulin.

Ketosis to Ketoacidosis (more severe)

Genetic, can’t prevent.

Require insulin injection.

 

 85 to 90%

Adult onset

Result of obesity poor diet, lack of physical activity.

Non-insulin dependent

Insulin resistance: less insulin production or blood the target cells are no longer sensitive to insulin.

Most cases can be prevented

Late stage need insulin injection

 

 Pregnant women onset

Combine type 1 (insulin deficiency) and type 2 (insulin resistant)

Resolves after baby is delivered.

 

Oral Manifestations of Diabetes

  • Periodontal Disease
  • Not an issue if diabetes well controlled
  • Reciprocal relationship
  • Diabetes modifies host response to plaque,

periodontal disease modifies ability to control blood sugar levels

  • Periodontal abscess’s
  • Dental Caries: Minimal evidence for association- but patient may

be at increased caries risk pending diet and

saliva/quality quantity

  • Increased susceptibility to Oral Infections if poorly controlled
  • Evidence of increased association with Oral

Candidiasis infections

  • Limited evidence to support increased associations with Lichen planus & Recurrent Aphthous Stomatitis
  • Salivary Dysfunction/Dry Mouth
  • Taste disturbances & other neurosensory disorders

Dental Management- Well controlled

patient

  • Same as non-diabetic for most routine procedures
  • History Taking: Are they IDD or NIDD? Changes?
  • Adherence to management and monitoring of blood

glucose levels

  • Appointments
  • Short
  • Relatively stress free
  • Early appointments, or appointments after

breakfast/lunch to avoid hypoglycaemic episode

  • Local Anaesthesia
  • LA with a vasoconstrictor for profound anaesthesia if required
  • Avoid excessive amounts of adrenaline to prevent elevation of blood glucose levels
  • Importance of optimal OHI behaviours
  • Frequent Maintenance
  • Will dental treatment impact their ability to eat?

Implications of this?

Thyroid Disorders Hyperthyroidism Hypothyroidism
Thyroxine increases metabolic activity 1. Accelerated dental eruption in children

2. Maxillary or mandibular osteoporosis

3. Enlargement of extraglandular thyroid tissue (mainly in the lateral posterior tongue)

4. Increased susceptibility to caries

5. Periodontal disease

6. Burning mouth syndrome

7. Development of connective-tissue diseases like Sjogren’s syndrome or systemic lupus erythematosus

 1. Delayed eruption

2. Enamel hypoplasia in both dentitions, (being less intense in the permanent dentition)

3. Anterior open bite

4. Macroglossia

5. Micrognathia

6. Thick lips

7. Dysgeusia

8. Mouth breathing
Dental Management – Stable patients do not have difficulties with dental care

– Unstable disorder

+ Defer treatment.

+ Consult with physician

+ Avoid adrenaline in LA in unstable hyperthyroidism if need emergency care
Parathyrois Disorders Hyperparathyroidism Hypoparathyroidism
– Parathyroid hormone secreted by the parathyroid

– Function is closely linked with the homeostatic regulation of the calcium ion concentration

 1. Dental abnormalities:

– Widened pulp chambers

– Development defects

– Alterations in dental eruption

– Weak teeth

– Malocclusions

2. Brown tumor

3. Loss of bone density

4. Soft tissue calcifications

 1. Dental abnormalities:

– Enamel hypoplasia in horizontal lines

– Poorly calcified dentin

– Widened pulp chambers

– Dental pulp calcifications

– Shortened roots

– Hypodontia

– Delay or cessation of dental development

2. Mandibular tori

3. Chronic candidiasis

4. Paresthesia of the tongue or lips

5. Alteration in facial muscles
Dental Management – Managed by medication, diet and vitamin D supplementation

– Patients who have hyperparathyroidism may develop osteoporosis

+ Associated medications for this condition may have dental implications
Adrenal Disorders Suppression of Adrenal Function Dental management Considerations for corticosteroids
Most commonly treated with corticosteroids

Corticosteroids often used to:

+Suppress inflammatory response

+ For immune-suppression in the case of autoimmune disorders/ transplant patients

– Corticosteroids can suppress the normal adrenocortical response to stress

 Determine medications and amounts

+ Treatment with prednisolone or prednisone at doses greater than 10mg daily for more than 3 weeks may be sufficient to cause adrenal suppression

+ Could be taking bisphosphonates for steroid-induced osteoporosis.

Consult with medical practitioner and Dentist if believe pt may require alteration to medication/ dose

+ Dose will be increased prior to treatment/ surgery to prevent adrenal crisis.

Dental treatment may be physiologically stressful, particularly tooth extraction, root planning and extended restorative treatment

Treat in the morning to monitor pt; risk for Adrenal Crisis

+ Adrenal crisis can present 6-12 hrs after surgical stress

+ The pt initially feel faint, become confused and collapse

 Increased risk of oral infections

 

Delayed wound healing

 

Risk of secondary infections
Bisphosphonate Dental management
Bone and Calcium Disorders

Osteoporosis is a common health problem

– low bone mass and deterioration of bone

Other bone disorders include Paget’s disease, malignancy, and hypocalcaemia

Bisphosphonates are one of the drug of choice may be used in conjunction with systemic corticosteroids

 

 Usually painful sometimes with draining sinus

Must rule out other conditions:

– malignancy, Hx of Head and Neck radiotherapy

Most common compliant with BRONJ is soft tissue infection, which may be extensive

Commonly follows tooth extraction, but may be associated with poorly fitted denture

 

Before commencing long-term oral or intravenous bisphosphonates in any pts, a comprehensive dental examination should be performed.

 

Monitor oral health; ill fitting dentures; implants present

 

Bisphosphonates therapy should not be ceased without consulting the pt’s medical practitioner.
Stroke Oral complications Dental management Medications
Modifiable risk factors:

 

+ High BP

+ Smoking

+ Diabetes

+ Cardiovascular disease

+Hypercholesterolaemia

 Slurred speech – communication problems

Weak palate

Difficulty swallowing

May be unilateral paralysis of orofacial muscles

Tongue may be flaccid

R-sided brain damage

+ May neglect left side – food accumulation, lack OH etc.. for left side of mouth

+ May require assistance with OHI

 Dental treatment may need to be modified depending on their medical status and prognosis.

Large handle or powered tooth brushes may improve the effectiveness of oral hygiene

Pt may show some difficulty wearing and cleaning the dentures

Advise and education on risk factors

Motor defects may lead to inability to clean teeth: Powered toothbrushes, large handle toothbrushes or modify handle grip.

Educate carer on hygiene;

Diet modifications if difficulty in swallowing and ‘pooling’

Fluoride

 

 May be taking anticoagulant:

 

Increases bleeding time

Do not cease anticoagulant medication
Epilepsy Oral complications Dental management
A group of chronic neurological conditions characteristics by recurrent unprovoked epileptic seizures.

Well controlled – no issues

Poorly controlled – consult GP

Get good history: type of seizures, age on onset, medications, degree of control, frequency, date of last seizure, precipitating factors, history of seizure related injuries

 Slurred speech – communication problems

Weak palate

Difficulty swallowing

May be unilateral paralysis of orofacial muscles

Tongue may be flaccid

R-sided brain damage

+ May neglect left side – food accumulation, lack OH etc.. for left side of mouth

+ May require assistance with OHI

 Stability of condition; medication; adherence to medication

Short appointments; use of mouth prop to prevent injury if seizure occurs

Medications

+ Gingival hyperplasia secondary to anticonvulsant medication

+ OHI

+ Regular review

Fracture of teeth common during seizure

 
  Status Dental management
Psychological and Psychiatric Disorders 15% of population have a signficant psychological disorder and 2% a major psychiatric disorder Medical Hx: have they disclosed condition? Review medications

LA with adrenaline

+ should be avoided for monoamine oxidase inhibitors MAIOs

+ Dose reduction for other types of antidepressant medications

 
Multiple sclerosis Affects people 20-50 years of age with maximum incidence in young adults

Myelin sheaths around nerves effected impacting nerve conduction

Clinical signs depend on region in CNS effected, may include

Muscle atrophy, visual disturbances, bladder problems, muscle hypertonicity, fatigue, loss of sensations

 Be suspicious if pt complains of abnormal facial pain numbness of an extremity, visual disturbance, muscle weakness, afternoon tiredness, young age

+ refer to neurologist for assessment

Medications can cause burning mouth, bleeding problems, increased risk of infections

Mild: routine Dental care

More severe: difficulty in getting in and out of chair, maintaining OH, short apps

Considerations: Good OHI, maintenance of oral health, ease of accessing dental services (physically, cost etc …)

Week 10:

I have reviewed again: periodontal disease and systemic conditions:

Periodontal diseases–> Inflammation and infection –> systemic effects

Disease association check list:

Biologic plague ability

Strength of Assocaition

Effect of Periodontal treatment on condition

Effect of treatment of condition on periodontitis.

Diabetes: 1.7 million Australians are affected by diabetes: 1.2 million diagnosed, 500k estimated undiagnosed.

Type 1: juvenile or insulin-dependent: failure to produce insula

Gestational diabetes mellitus: during preganancy and resolves

Type 2 diabetes mellitus: adult onset or non- insulin-depen

Biological plausibility: factors accentuating periodontal disease in people with diabete: duration, degree of metabolic control, anglopathy heart disease and stroke, nephropathy (kidney disease), delayed wound healing, neuropathy,

Concurent risk factor: genetics, smoking, nutrition, medications, stress, obesity.

bacteria+diabetes->

– Osteoclasts-> bone resoption.

Week 11: