lds2 dec tp and manikin feedback

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thank you for lds dec candidates

Treatment planning LDS Part 2

First case:

60 yr old lady presents with pain on biting on right since last 24 hrs.

Pain last's only for few seconds, avoids eating on her right side.

Lives in Norwich, is on holiday with friends.

Had RCT 2 yrs ago with her Upper right back tooth, has had no problems

MH- Hypertension, Atrial fibrillation

DH- Atenolol , warfarin, phosmax ( not sure of the spelling, it's

bisphosphonate)

Allergies- Penicillin , comes out with rash

Dental history- brushes bd, uses mouthwash, visits dentist every 6 months., eats

lots of veg and fruits, avoids sweets.

Investigations: IOPA UR6: perfect RCT done, can see fracture line in the crown

of UR6, no periapical changes and normal bone levels.

Tooth Sleuth test +ve, movement of palatal cusp.

Vitality test UR5 & 7 normal, no response of UR6

Clinical picture: large composite filling in UR6 ….Diagnosis: Fractured crown

(cracked tooth)

With this information we had to formulate a treatment plan.

Q's

1. Pt on Warfarin so what test would u perform if you wanted to Ext?

2. Precautions you would take when ext a tooth in a pt on warfarin

3. Precautions you would take when you ext a tooth in a pt on bisphosphonates

4.what is the risk if u ext tooth in bisphosphonates

5. Any 4 reasons why the tooth was susceptible to fracture

Second case:

47 year old male presented with a complain of filling lost in LR region.

2 days ago he lost a filling in his back tooth and after that he had pain when

he would eat or drink, which would last for few sec- mins. So he brought

emergency kit from super market and mixed the cement in it and placed it in the

cavity (temporary filling), there was no pain then. But after a day he lost the

temp filling he had placed and again while eating he had pain which last for few

sec. He has again placed the temp cement in the cavity and has come to see the

dentist.

His other problem was while placing the cement he noticed a red patch on his

tongue. It was asymptomatic, saw the patch 2 days ago.

MH - Diabetes

DH- Glibenzide

Allergies- Seafood, gets a rash

Dental history - brushes twice a day, occasionally uses mouthwash, last visit to

dentist was 10 years ago. Healthy diet

Family history - father and brother were diabetic as well

SH- smokes 20 cigarettes per day for last 18 yrs.

No alcohol

Investigations: clinical picture of the lesion on the tongue was median rhomboid

glossitis.

Radiograph: IOPAof LR7 had a large filling not involving the pulp. LR8 impinging

on the 7. No comunication of LR8 orally. No periapical lesion with LR7.

Vitality test: LR7 +ve with early response

There was one more test that examiners had but I did not ask hence not sure, cud

be TTP

Diagnosis: reversible pulpitis

With this information had to formulate a treatment plan.

Q's

1. If this patient faints in your dental chair, what do you think it could be?

hypoglycemia

2. Difference between type 1 & type 2 diabetes

3. What risks are there if the patient is diabetic & smokes? Perio gets worse

4. Due to smoking, patient would be at risk of type 1 or type2 diabetes.

5. what is the white lesion on the dorsum surface of the tongue?

There were two other questions I cant remember.

For Manikin exercise:

1. MCC on UR6, followed by preparing a temporary crown using either Trim or

Quick temp.

2. Class2 DO on UL5 with lining and Amalgam filling

3. Class 3 on UR1. Cavity involving labial and mesial surface.

4. Update your clinical records.

5. Answer 3 questions: e.g.:

- Why do some dentists prefer using GIC as lining?

Manikin was tough

-In the manikin exercises we were not provided with hand cutting instruments and

had no viva, examiners did not speak to us neither did we