Guest guest Posted November 28, 2011 Report Share Posted November 28, 2011 Hello everyoneI hope we didn't do this case in the near past:-) Mrs DOB; 11/12/1950 Actor Scenario info You have gone to see a new dentist for the following reason; You have suffered from pain on left lower jaw 3, 4 times past years. 1 week ago, you had to go A & E for the pain and swelling and were prescribed a course of antibiotics, which you don’t remember the name of. You were told that your wisdom tooth needs to be taken out. You also had a cap coming off recently. You had an upper denture but broke a year ago. You gagged when you wore it and wondering if there is any solution to it, not keen on another denture. You are very worried and dislike dental treatment. Your dentist retired recently. Medical History Arthritis, osteoporosis for which you take Naproxen 1g daily Alendronic acid 10mg a day Methotrexate 7.5mg once a week Calci-chew No other medical problems. Dental History You only go to the dentist when you feel it is necessary but have had some filling and caps, also a denture made in the past. Still dislike dentists. You brush your teeth twice daily, no other adjuncts. You are not very concerned about the appearance. Social History You are widowed and live on your own. Your children live nearby. Retired. Smoker; Cutters choice rolling tobacco. Alcohol consumption; moderate. About 7-8 units per week as wine. Further Scenario Info for the Actor (Only if asked by the candidate) You have difficulty opening your mouth, no pain but sometimes hear clicking sound from the right side Examiner’s Info Extra-oral exam Slightly swollen on the left cheek. TMJ; click on the right Mouth opening; limited 22mm Intra- oral exam Soft tissue screening; slightly red and inflamed opecurum over LL impacted 8 gagging sensation on the soft palate only Bony tissue screening; nothing significant Tooth charting; Missing 87654 / 5678 6 / 56 Present UR 3 crown missing root stump with temporally dressing No other clinically visible caries nor symptoms BPE; 2/2/1 OH; very little plaque BOP; some 2/2/4 Special Exam and other props Study cast OPG; presenting horizontally impacted LL 8 with very close IDC UR3; root filled. Drug prescription and BNF NB; Pt suffers from “rheumatoid†arthritis, the candidates is supposed to find this out from the fact that pt is taking Methotrexate which he/she can find out from BNF. Postop complications with rheumatoid arthritis need to be mentioned. -increased chance of infection, postop bleeding, also osteonecrosis with the pt on bisphosphonates Kind regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 28, 2011 Report Share Posted November 28, 2011 Actuall, we've discussed the case before. my treatment is: 1) insure the pt that treatment will be as relax as possible 2) explain pericoronitis[Your wisdom tooth is not fully erupted and the part of the gum around this tooth harbour the bacteria,which irritates the gum and it can be easily infected], must removed according to nice guideline. for today do only irrigation with antiseptic solution to clean food debris & abscess. prescribe chlorhexidine mouthwash & Metronidazole 400mg tds for 5 days bec amoxiciline interfer with Methotrexate. refer to omfs for surgical removal, explain procedure & give post-oper complications, particularly damage to IDC which is 1 in 1000 temporarly, 1 in 10000 permanent & risk of osteonecrosis even its less than 1% as its taken by mouth, take advice from GP about drug duration & dose. 3) UR3 do post and core crown. 4) explain gingivitis & perio in LL side, the causes as poor brushing bec of RA & smoking. so scaling + polishing +OHI with electric toothbrush. refer to periodontist for deep pocket cleaning in LL side. 5) advice for quitting smoking as the major risk factor of gum disease. give him NHS help line no. 6) for missing upper back teeth either RPD metal to reduce the chance of gagging, or implant which refer to specialist as might be complicated bec of osteoporosis, also smoking reduce the successful rate. 7) review ,, Ammar > >  Hello everyone > I hope we didn't do this case in the near past:-) > > Mrs > DOB; 11/12/1950 > Actor Scenario info > You have gone to see a new dentist for the following > reason; > You have suffered from pain on left lower jaw 3, 4 > times past years. 1 week ago, you had to > go A & E for the pain and swelling and were prescribed a course of > antibiotics, which you don’t remember the name of. You were told that your wisdom tooth needs to > be taken out. You also had a cap coming > off recently. You had an upper denture > but broke a year ago. You gagged when > you wore it and wondering if there is any solution to it, not keen on another > denture. You are very worried and > dislike dental treatment. Your dentist > retired recently. > Medical History > Arthritis, osteoporosis for which you take > Naproxen 1g daily                                 Alendronic > acid 10mg a day > Methotrexate 7.5mg once a week         Calci-chew > No other medical problems. > Dental History > You only go to the dentist when you feel it is > necessary but have had some filling and caps, also a denture made in the > past. Still dislike dentists. > You brush your teeth twice daily, no other adjuncts. > You are not very concerned about the appearance. > Social History > You are widowed and live on your own. Your children live nearby. > Retired. > Smoker; Cutters choice rolling tobacco. > Alcohol consumption; moderate. About 7-8 units per week as wine. > Further Scenario Info for the Actor (Only if asked by > the candidate) > You have difficulty opening your mouth, no pain but > sometimes hear clicking sound from the right side >  >  >  >  > Examiner’s Info > Extra-oral exam > Slightly swollen on the left cheek. > TMJ; click on the right        Mouth opening; limited 22mm > Intra- oral exam > Soft tissue screening; slightly red and inflamed > opecurum over LL impacted 8                                         \                                                gagging sensation on the soft palate > only                                      \                                         \   > Bony tissue screening; nothing significant                > Tooth charting; Missing 87654  /   5678                                         \                                                                     6      /     56                                       \                 > Present UR > 3 crown missing root stump with temporally dressing                           > No other clinically visible caries nor symptoms > BPE; 2/2/1         OH; very little plaque                    BOP; some                                      2/2/4           > Special Exam and other props > Study cast > OPG; presenting horizontally impacted LL 8 with very > close IDC >          UR3; > root filled. > Drug prescription and BNF > NB; Pt suffers from “rheumatoid†arthritis, the > candidates is supposed to find this out from the fact that pt is taking Methotrexate > which he/she can find out from BNF. > Postop complications with rheumatoid arthritis need to > be mentioned. > -increased chance of infection, postop bleeding, also > osteonecrosis with the pt on bisphosphonates >  >  >  >  > Kind regards > Alena > Ozieva > Quote Link to comment Share on other sites More sharing options...
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