Podcast
Questions and Answers
Which of the following is a 'red flag' symptom in dental disorders that warrants careful attention?
Which of the following is a 'red flag' symptom in dental disorders that warrants careful attention?
- Sudden malocclusion (correct)
- Consistent halitosis without other symptoms
- Slight morning bad breath
- Mild tooth sensitivity to cold
Why is it important to consider halitosis as more than just a benign condition?
Why is it important to consider halitosis as more than just a benign condition?
- It primarily affects social interactions but has no health implications.
- It's directly linked to oral cancer development.
- It always indicates severe periodontal disease.
- It might be a warning sign for other underlying systemic diseases. (correct)
A patient complains of consistent bad breath, a white coating on their tongue, and a bitter taste. Which focused history question would be most relevant?
A patient complains of consistent bad breath, a white coating on their tongue, and a bitter taste. Which focused history question would be most relevant?
- History of cardiovascular disease
- Use of strongly flavored food/drink (correct)
- Past instances of bone fractures
- Family history of autoimmune disorders
During a physical exam for halitosis, which of the following would be considered a red flag?
During a physical exam for halitosis, which of the following would be considered a red flag?
A patient presents with halitosis. After taking a history, you suspect a possible dental infection. Which additional symptom would most strongly support your suspicion?
A patient presents with halitosis. After taking a history, you suspect a possible dental infection. Which additional symptom would most strongly support your suspicion?
Which of the following self-care recommendations is LEAST likely to be useful for a patient concerned about halitosis?
Which of the following self-care recommendations is LEAST likely to be useful for a patient concerned about halitosis?
What underlying condition can GERD contribute to, potentially worsening tooth abrasion and erosion?
What underlying condition can GERD contribute to, potentially worsening tooth abrasion and erosion?
When assessing a patient for bruxism, which aspect of the physical exam would provide the MOST direct evidence of the condition?
When assessing a patient for bruxism, which aspect of the physical exam would provide the MOST direct evidence of the condition?
A patient with suspected bruxism reports headaches, jaw pain, and earaches. What differential diagnosis should be considered alongside bruxism?
A patient with suspected bruxism reports headaches, jaw pain, and earaches. What differential diagnosis should be considered alongside bruxism?
What is a cost-effective initial approach to managing bruxism?
What is a cost-effective initial approach to managing bruxism?
Which of the following recommendations is MOST appropriate for a patient looking to manage their bruxism?
Which of the following recommendations is MOST appropriate for a patient looking to manage their bruxism?
A bruxism patient has already tried OTC orthotics and stress reduction techniques without much relief. What should the NEXT step entail?
A bruxism patient has already tried OTC orthotics and stress reduction techniques without much relief. What should the NEXT step entail?
What is the primary mechanism behind a toothache caused by dental caries?
What is the primary mechanism behind a toothache caused by dental caries?
During the evaluation of a patient with a toothache, which of the following symptoms would particularly raise suspicion of a more complex dental issue?
During the evaluation of a patient with a toothache, which of the following symptoms would particularly raise suspicion of a more complex dental issue?
A patient presents with a toothache. They have a history of recent dental work. What characteristic of the pain would be MOST important to note?
A patient presents with a toothache. They have a history of recent dental work. What characteristic of the pain would be MOST important to note?
A patient presents with a toothache. During the oral exam, what finding would MOST strongly suggest the toothache is caries-related?
A patient presents with a toothache. During the oral exam, what finding would MOST strongly suggest the toothache is caries-related?
In managing a patient's toothache, when is it MOST appropriate to consider covering the affected area with IRM or Fuji 9 GI cement?
In managing a patient's toothache, when is it MOST appropriate to consider covering the affected area with IRM or Fuji 9 GI cement?
If a patient presents with a toothache and signs of cellulitis, initial management should include:
If a patient presents with a toothache and signs of cellulitis, initial management should include:
Which of the following patient education points is MOST appropriate for toothache management?
Which of the following patient education points is MOST appropriate for toothache management?
What would be a reason to move a patient to EVAC or transfer?
What would be a reason to move a patient to EVAC or transfer?
According to the Ellis Classification, what type of tooth fracture only affects the enamel?
According to the Ellis Classification, what type of tooth fracture only affects the enamel?
Which symptom indicates that a tooth fracture has exposed the pulp?
Which symptom indicates that a tooth fracture has exposed the pulp?
When managing a fractured tooth with exposed dentin, what treatment is MOST appropriate?
When managing a fractured tooth with exposed dentin, what treatment is MOST appropriate?
After replanting an avulsed tooth, in what solution is it MOST appropriate to store the tooth?
After replanting an avulsed tooth, in what solution is it MOST appropriate to store the tooth?
During the management of an avulsed tooth, which step is of LEAST importance?
During the management of an avulsed tooth, which step is of LEAST importance?
What action is MOST appropriate after temporary stabilization?
What action is MOST appropriate after temporary stabilization?
Which phrase describes gingivitis?
Which phrase describes gingivitis?
What accurately describes what gums would indicate gingivitis?
What accurately describes what gums would indicate gingivitis?
You've diagnosed a patient with gingivitis. What is an important topic to discuss?
You've diagnosed a patient with gingivitis. What is an important topic to discuss?
During a physical exam for a patient suspected of gingivitis, which of the following assessment techniques is MOST likely to reveal the condition?
During a physical exam for a patient suspected of gingivitis, which of the following assessment techniques is MOST likely to reveal the condition?
When constructing a treatment plan for your gingivitis patients, what is your first course of action?
When constructing a treatment plan for your gingivitis patients, what is your first course of action?
In managing gingivitis, chlorhexidine gluconate 0.12% (Periogard) twice-daily rinses may be recommended:
In managing gingivitis, chlorhexidine gluconate 0.12% (Periogard) twice-daily rinses may be recommended:
What follow-up action is MOST appropriate for treating gigivitis?
What follow-up action is MOST appropriate for treating gigivitis?
Which of the following is a characteristic sign of ANUG (Acute Necrotizing Ulcerative Gingivitis)?
Which of the following is a characteristic sign of ANUG (Acute Necrotizing Ulcerative Gingivitis)?
Which of these signs and symptoms are associated with ANUG?
Which of these signs and symptoms are associated with ANUG?
Which differential diagnosis should be considered?
Which differential diagnosis should be considered?
Why is adequate hydration and nutrition essential in treating ANUG?
Why is adequate hydration and nutrition essential in treating ANUG?
If a patient presents with swelling, trouble breathing, and difficulty swallowing, what is the right course of action?
If a patient presents with swelling, trouble breathing, and difficulty swallowing, what is the right course of action?
What is an indication that a patient requires EVAC/transfer during a situation of Ludwig's Angina?
What is an indication that a patient requires EVAC/transfer during a situation of Ludwig's Angina?
What oral condition would require a consultation from an oral medicine expert for a biopsy?
What oral condition would require a consultation from an oral medicine expert for a biopsy?
For a patient displaying early signs of oral cancer, what primary lifestyle is most important?
For a patient displaying early signs of oral cancer, what primary lifestyle is most important?
Beyond localized discomfort, what systemic sign when present alongside a toothache, should prompt consideration of a more serious underlying issue?
Beyond localized discomfort, what systemic sign when present alongside a toothache, should prompt consideration of a more serious underlying issue?
Why is it crucial to inquire about recent dental procedures when a patient presents with a toothache?
Why is it crucial to inquire about recent dental procedures when a patient presents with a toothache?
Which finding during an oral examination would be MOST indicative of dental caries as the cause of a toothache?
Which finding during an oral examination would be MOST indicative of dental caries as the cause of a toothache?
What is the MOST relevant next step for a patient presents with signs of cellulitis alongside a toothache?
What is the MOST relevant next step for a patient presents with signs of cellulitis alongside a toothache?
What communication would be MOST important to include in the patient education about a toothache?
What communication would be MOST important to include in the patient education about a toothache?
A patient with a severe toothache and signs of systemic infection requires evacuation or transfer. Which of the following would require immediate EVAC?
A patient with a severe toothache and signs of systemic infection requires evacuation or transfer. Which of the following would require immediate EVAC?
According to the Ellis Classification, a tooth fracture exposing the dentin is classified as which type of fracture?
According to the Ellis Classification, a tooth fracture exposing the dentin is classified as which type of fracture?
Which additional complaint would MOST strongly suggest pulpal involvement in a tooth fracture?
Which additional complaint would MOST strongly suggest pulpal involvement in a tooth fracture?
What immediate treatment step is MOST appropriate for managing a tooth fracture where the dentin is exposed?
What immediate treatment step is MOST appropriate for managing a tooth fracture where the dentin is exposed?
When replanting an avulsed tooth, which storage solution is MOST suitable if Hank's Balanced Salt Solution is unavailable?
When replanting an avulsed tooth, which storage solution is MOST suitable if Hank's Balanced Salt Solution is unavailable?
When managing an avulsed tooth before replanting, which action is of LEAST importance?
When managing an avulsed tooth before replanting, which action is of LEAST importance?
Following temporary stabilization of a replanted avulsed tooth, what is the MOST appropriate immediate next step?
Following temporary stabilization of a replanted avulsed tooth, what is the MOST appropriate immediate next step?
How is gingivitis best characterized by what is visually observed?
How is gingivitis best characterized by what is visually observed?
What indication would the gums have that accurately describes gingivitis?
What indication would the gums have that accurately describes gingivitis?
When a patient is diagnosed with gingivitis what topic regarding dental conditions is important to discuss?
When a patient is diagnosed with gingivitis what topic regarding dental conditions is important to discuss?
What physical assessments is MOST likely to reveal gingivitis?
What physical assessments is MOST likely to reveal gingivitis?
Before constructing a proper treatment plan for your gingivitis patients what is the first immediate action to take?
Before constructing a proper treatment plan for your gingivitis patients what is the first immediate action to take?
In what circumstance would it be acceptable to prescribe chlorhexidine gluconate 0.12% (Periogard) twice-daily rinses in helping manage patient's gingivitis?
In what circumstance would it be acceptable to prescribe chlorhexidine gluconate 0.12% (Periogard) twice-daily rinses in helping manage patient's gingivitis?
What symptoms are characterized with ANUG (Acute Necrotizing Ulcerative Gingivitis)?
What symptoms are characterized with ANUG (Acute Necrotizing Ulcerative Gingivitis)?
Which other health factor should be considered that are associated with ANUG besides physical ones?
Which other health factor should be considered that are associated with ANUG besides physical ones?
During a diagnosis of a patient showing signs of ANUG what consideration is important to also consider?
During a diagnosis of a patient showing signs of ANUG what consideration is important to also consider?
In addressing a patient's ANUG, why do experts say adequate hydration and nutrition are essential?
In addressing a patient's ANUG, why do experts say adequate hydration and nutrition are essential?
During a ANUG episode, what would be the right course of action if a patient cannot breath properly?
During a ANUG episode, what would be the right course of action if a patient cannot breath properly?
What scenario during a Ludwig's Angina situation would require EVAC/transfer?
What scenario during a Ludwig's Angina situation would require EVAC/transfer?
After a patient has a consultation from a oral medicine expert for a biopsy, what oral condition are they looking for?
After a patient has a consultation from a oral medicine expert for a biopsy, what oral condition are they looking for?
What behavioral factor carries more risk than the others when concerning development of oral cancer?
What behavioral factor carries more risk than the others when concerning development of oral cancer?
When deciding on a differential diagnoses for toothaches, what diagnoses would require tooth pulp to cause pain in pressure?
When deciding on a differential diagnoses for toothaches, what diagnoses would require tooth pulp to cause pain in pressure?
Which action is MOST helpful to apply while waiting to have access for transport to the next level of care?
Which action is MOST helpful to apply while waiting to have access for transport to the next level of care?
To address severe jaw movements, what steps would you take with chewing gum as a recommendation?
To address severe jaw movements, what steps would you take with chewing gum as a recommendation?
What direction would you consider if pain continues after weeks of conservative treatment?
What direction would you consider if pain continues after weeks of conservative treatment?
What specific risk factor correlates to plaque control?
What specific risk factor correlates to plaque control?
Which symptom correlates to pain with chewing due to inflammation of the ligament(PDL joint space)?
Which symptom correlates to pain with chewing due to inflammation of the ligament(PDL joint space)?
A goal for replanting tooth is most successful when its replaced in _______ minutes?
A goal for replanting tooth is most successful when its replaced in _______ minutes?
When evaluating soft tissue due to potential lacerations (lip/gingiva/oral mucosa) what action would you also take?
When evaluating soft tissue due to potential lacerations (lip/gingiva/oral mucosa) what action would you also take?
If a tooth has amoxicillin, what also can be given?
If a tooth has amoxicillin, what also can be given?
Which food options would one steer clear from in order to avoid aggitating an avulsed tooth infection?
Which food options would one steer clear from in order to avoid aggitating an avulsed tooth infection?
Swelling, bleeding, paresthesia what are those considered?
Swelling, bleeding, paresthesia what are those considered?
What is the best indication for gums to be healthy?
What is the best indication for gums to be healthy?
If Leukoplakia (white color) appears what should be considered for next steps?
If Leukoplakia (white color) appears what should be considered for next steps?
Which form of oral bacteria can be a byproduct of acid that is food debris from plaque causing it to breakdown?
Which form of oral bacteria can be a byproduct of acid that is food debris from plaque causing it to breakdown?
A patient presents with symptoms potentially indicative of a dental disorder. Which of the following findings during a HEENT exam should heighten suspicion for a systemic cause of halitosis?
A patient presents with symptoms potentially indicative of a dental disorder. Which of the following findings during a HEENT exam should heighten suspicion for a systemic cause of halitosis?
A patient complains of halitosis. After obtaining a thorough history, you suspect the patient's diet may be playing a role. What specific dietary habit is MOST likely contributing to their halitosis?
A patient complains of halitosis. After obtaining a thorough history, you suspect the patient's diet may be playing a role. What specific dietary habit is MOST likely contributing to their halitosis?
A patient with persistent halitosis reports regular heartburn and acid reflux. What underlying condition should the dental provider suspect as a potential contributing factor?
A patient with persistent halitosis reports regular heartburn and acid reflux. What underlying condition should the dental provider suspect as a potential contributing factor?
A patient states they have daytime teeth grinding due to stress from work. What should be your next course of action?
A patient states they have daytime teeth grinding due to stress from work. What should be your next course of action?
A patient displays symptoms of bruxism including jaw pain, headaches, and tooth grinding. The patient also has obstructive sleep apnea. How does the sleep apnea impact the bruxism?
A patient displays symptoms of bruxism including jaw pain, headaches, and tooth grinding. The patient also has obstructive sleep apnea. How does the sleep apnea impact the bruxism?
A person has several signs of tooth decay which are a direct result from ______.
A person has several signs of tooth decay which are a direct result from ______.
A patient has a toothache and the pain is triggered when the patient consumes sweet, hot, and cold foods. During the checkup the patient displays mobility in the tooth. What is the likely cause?
A patient has a toothache and the pain is triggered when the patient consumes sweet, hot, and cold foods. During the checkup the patient displays mobility in the tooth. What is the likely cause?
A patient has pain in a particular tooth. During the physical exam you inspect the patients gumline and notice abrasion and recession. What else should you monitor?
A patient has pain in a particular tooth. During the physical exam you inspect the patients gumline and notice abrasion and recession. What else should you monitor?
When evaluating for differential diagnosis for toothaches, what history may lead to a diagnosis?
When evaluating for differential diagnosis for toothaches, what history may lead to a diagnosis?
When treating a toothache caused by caries, when is it MOST appropriate to consider covering the affected area with IRM or Fuji 9 GI cement while awaiting transport?
When treating a toothache caused by caries, when is it MOST appropriate to consider covering the affected area with IRM or Fuji 9 GI cement while awaiting transport?
A patient has a fractured tooth and complains of pain upon sensitivity of cold temperature. Which classification is the patient suffering from?
A patient has a fractured tooth and complains of pain upon sensitivity of cold temperature. Which classification is the patient suffering from?
After a tooth has been avulsed what action is crucial for the goal of replantation being most successful?
After a tooth has been avulsed what action is crucial for the goal of replantation being most successful?
A patient had a tooth avulsion with lacerations to the gums. What action should you take?
A patient had a tooth avulsion with lacerations to the gums. What action should you take?
When is it MOST appropriate to implement temporary stabalization for a reimplanted avulsed tooth?
When is it MOST appropriate to implement temporary stabalization for a reimplanted avulsed tooth?
When completing patient education, what food choice should the patient avoid?
When completing patient education, what food choice should the patient avoid?
Gingivitis if left untreated can lead to periodontitis. What is the main indication of how to describe gingivitis?
Gingivitis if left untreated can lead to periodontitis. What is the main indication of how to describe gingivitis?
During a physical exam of your oral hygiene patients, you notice red swollen gums during the Extraoral/Intraoral exam. What finding would indicate gingivitis?
During a physical exam of your oral hygiene patients, you notice red swollen gums during the Extraoral/Intraoral exam. What finding would indicate gingivitis?
A patient is complaining of pain with their gums in there mouth. What treatment can be used as a good treatment for this ailment?
A patient is complaining of pain with their gums in there mouth. What treatment can be used as a good treatment for this ailment?
In a situation that requires advanced care due to ANUG indications, it is important ______.
In a situation that requires advanced care due to ANUG indications, it is important ______.
During a assessment of a patient complaining of general malaise, the patient has ulcers along their gums. What step should be taken?
During a assessment of a patient complaining of general malaise, the patient has ulcers along their gums. What step should be taken?
Flashcards
Red flag dental symptoms
Red flag dental symptoms
Swelling, bleeding, malocclusion, new growths, numbness, fever, weight loss and post-extraction complications.
Halitosis
Halitosis
Frequent or persistent unpleasant breath odor.
Signs and symptoms of halitosis
Signs and symptoms of halitosis
Consistent bad breath, tongue coating, plaque buildup, dry mouth, metallic taste, thick saliva.
Halitosis focused history
Halitosis focused history
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Bruxism
Bruxism
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Types of bruxism
Types of bruxism
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Bruxism signs and symptoms
Bruxism signs and symptoms
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Bruxism focused history
Bruxism focused history
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Bruxism physical exam
Bruxism physical exam
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Bruxism physical exam findings
Bruxism physical exam findings
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Bruxism differential diagnosis
Bruxism differential diagnosis
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Bruxism management
Bruxism management
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Stress reduction for bruxism
Stress reduction for bruxism
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Long term Bruxism Treatment
Long term Bruxism Treatment
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Bruxism self-care
Bruxism self-care
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Bruxism follow-up
Bruxism follow-up
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Common toothache causes
Common toothache causes
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Toothache pathophysiology
Toothache pathophysiology
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Toothache signs and symptoms
Toothache signs and symptoms
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Toothache history
Toothache history
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Toothache examination
Toothache examination
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Objective toothache findings
Objective toothache findings
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Toothache differential
Toothache differential
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Toothache Pain management
Toothache Pain management
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Toothache self-care: instructions
Toothache self-care: instructions
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Caries
Caries
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Risks of Caries
Risks of Caries
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Caries S/S
Caries S/S
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Caries exam
Caries exam
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Caries initial tx
Caries initial tx
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Caries pt education
Caries pt education
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Tooth fracture is categorized by
Tooth fracture is categorized by
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Tooth avulation
Tooth avulation
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Tooth fracture: Exposed
Tooth fracture: Exposed
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Management for avulsed tooth
Management for avulsed tooth
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Complication to look out for
Complication to look out for
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Replanted tooth pt education
Replanted tooth pt education
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What's is gingivitis?
What's is gingivitis?
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S/S of gingivitis
S/S of gingivitis
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Key PMHX of gingivitis
Key PMHX of gingivitis
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Most use PX in order to dx gingivitis
Most use PX in order to dx gingivitis
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GINGIVITIS differential
GINGIVITIS differential
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Plan on Tx
Plan on Tx
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what education consideration are there
what education consideration are there
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ANUG?
ANUG?
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Pt present to the office what do they show?
Pt present to the office what do they show?
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During exam what would i see?
During exam what would i see?
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Study Notes
Unit 4: Dental Disorders - Terminal Learning Objective
- Given a patient scenario, accurately identify the exams and questions needed to diagnose and treat common dental disorders.
Enabling Learning Objective:
- Given a patient scenario, accurately identify common signs, symptoms, exam findings, and treatments for specified dental disorders.
- These disorders encompass relevant red flags, halitosis, bruxism, toothache/infection, caries, fractured/avulsed teeth, gingivitis, ANUG, mandibular dislocation, Ludwig's Angina, and oral cancer.
Important Red Flag Symptoms
- Swelling can be a sign of a serious infection or other issue
- Bleeding can often indicate an inflammatory process
- Malocclusion may signal trauma or a developmental abnormality
- New growths can potentially reveal lesions that could be problematic
- Numbness or paresthesia might indicate nerve involvement
- Fever is indicative of a possible infection
- Weight loss can be associated with systemic illnesses or malignancy
- Post-extraction complications like alveolar osteitis or osteonecrosis of the jaw (ONJ) can lead to pain/discomfort
Halitosis
- Halitosis is a persistent, frequent odor from the breath.
- Halitosis is generally benign but can be a warning sign of other diseases, needing a full HEENT (Head, Eyes, Ears, Nose, and Throat) exam.
Signs and Symptoms of Halitosis
- Consistent bad breath is a strong indicator
- The tongue may have a white to brownish coating and there may be plaque buildup on teeth
- Dry mouth, metallic taste, and thick saliva can be present, as well as morning bad breath.
Focused History for Halitosis
- Poor oral health care practices, diabetes, usage of tobacco, alcohol, or drugs including strongly flavored foods or drinks should be considered.
- Systemic diseases may factor in.
Physical Exam for Halitosis
- Complete vital signs and pain scale analysis
- HEENT exam with "Sniff test" of exhaled air
- General oral cause usually results in putrefying, pungent smells.
- Systemic causes frequently result in a more subtle, abnormal odor.
- Red Flags: Fever, purulent nasal discharge/sputum, visible/palpable oral lesion.
Halitosis Differential
- Halitosis may result from dental infection, xerostomia, medication use, sinus disease, dietary factors, or systemic diseases like lung, liver, renal, GERD, diabetes, or Sjögren's.
Halitosis Plan
- Identify the source of the odor and treat it
- Psychogenic halitosis - malodor not detected by others - requires psychiatry consult.
Patient Education for Halitosis
- Improve oral health with brushing/flossing, especially focusing on the tongue
- Using non-alcohol mouth rinses, sugar-free gum, and healthy diet
- Stay hydrated, drinking 6-8 glasses of water daily.
Halitosis Follow-Up Actions
- Return for further evaluation if symptoms don't resolve.
Green Directive
- Routine review by preceptor IAW 44-103.
Bruxism
- Bruxism is teeth grinding/clenching that causes abrasion, wear, fracture, and/or avulsion of dental enamel, and cusps of teeth that is often related to stress.
- Awake and sleep bruxism are the two types of bruxism.
- Sleep bruxism is often more extensive and common.
Signs and Symptoms of Bruxism
- Patients may be aware of grinding and clenching
- Other symptoms are headache, neck, jaw, and/or tooth pain
- Earaches or bed partners complaining about the grinding sound.
- Possible history of GERD and/or obstructive sleep apnea
- Tooth abrasion/erosion can become worse with this history.
Physical Exam for Bruxism
- Full set of vital signs and pain scale analysis, as well as HEENT exam
- Focus on HEENT/oral/teeth examination
- TMJs or associated muscles of mastication may be painful and produce a limited opening.
- Palpate and check for pain radiating to ear/temporal regions, popping of the jaw while opening and closing, and enamel fractures
- May demonstrate multiple habitual clench positions with loose painful teeth.
Differential Diagnosis of Bruxism
- TMJ pain - popping, clicking, crepitus, limited ROM, and locking of jaw
- Referred Pain - radiating to ear, temporal, and posterior of neck
- Tooth Pain or Abscess - tooth pain and pressure sensitivity
- Tooth Fracture - trauma
- Headache - referred to/from jaw
Bruxism Pain Management
- Use NSAIDs PRN for pain and heat moldable device if necessary
- Stress reduction through meditation or referral to BHOP is helpful.
Other Bruxism Treatments
- Avoid caffeine, nicotine, and alcohol, and don't do vigorous exercise before sleep.
- Improve sleep duration and quality and avoid fractured sleep patterns.
- Avoid tooth abrasion and erosion.
- Use the prescribed dental devices and consider NSAIDs.
- Stay hydrated and use a soft diet during the acute phase.
- Refrain from gum chewing extreme jaw movements.
- Perform gentle, slow stretching exercises for mandibular ROM
- Heat/cold application to TMJs 15 minutes on/15 minutes off PRN
Required Follow-Up for Bruxism
- If the condition does not improve within 1-2 weeks, a reevaluation may be needed
- If pain continues after 2 weeks, suggest a dental evaluation.
Green Directive
- Routine review by preceptor IAW 44-103.
Toothache
- Toothaches are caused mostly by dental caries, trauma, and erupting wisdom teeth.
Toothache Pathophysiology
- Oral bacteria break down leftover food around teeth and produce acid, resulting in decay
- Acid slowly breaks down the enamel, allowing bacteria penetrate the dentin and colonize.
- Progression through the dentin into the pulp zone produces inflammation, infection, and pain.
Signs and Symptoms of Toothache
- Pain is the main reason for the visit
- Other signs and symptoms will be connected to the pain or infection, like swelling, bad breath or taste, abscess, purulent drainage, or fever.
- Trauma: restoration, gingival abrasion, chips, fractures, or restoration loss, as well.
Focused History for Toothache
- Patient history needs to include possible recent trauma or dental procedure
- Pain history is valuable: minor, moderate, constant, intermittent, spontaneous
- Check for associated swelling/drainage as indicators.
Physical Exam for Toothaches
- Vital signs for fever and HEENT exam to assess gum lines and check for recession, abrasion, caries, and swelling.
- Check if there is a pain at a particular tooth
- Check for obvious caries, fractures, avulsed cusps, or mobile tooth segments may be visually seen.
- Cold stimuli may cause lingering pain
- Bottom of mouth/neck are palpated for induration or TTP, if possible, conduct dental x-ray.
Toothache - Differential Diagnosis
- Cavities - caused by poor hygiene (plaque and calculus)
- Recent Trauma
- Sinusitis - upper molars and recent URI with sinus TTP is present
- Cavernous Sinus Thrombosis - ocular motor nerve dysfunction, as well, vision problems
- Ludwig’s Angina - bilateral TTP, with swelling in the floor of the mouth.
Toothache - Treatment
- Remove root cause of pain.
- NSAIDs or Tylenol for pain
- If caries are present, cover with IRM or Fuji 9 cement, along with antibiotics
- Note that if a PCN allergy Is present, use Clindamycin rather than Amoxicillin.
- If there is swelling, check for space infection or cellulitis
- If a simple gingival abrasion is present, apply fluoride varnish or Fuji 9 GI cement.
Patient Education for Toothache
- Practice good oral hygiene
- Use analgesics and any prescribed antibiotics as directed.
- Report more fever, pain, swelling, and/or purulent discharge ASAP.
- An exam is required within 24 hours for relief, along with an EVAC transfer, 48 hours after.
Green Directive:
- Routine review by preceptor IAW 44-103
Caries
- Caries are tooth cavities caused by the acids released by bacteria in dental plaque.
- Caries can cause tooth destruction, infection, and the need for extraction if not treated.
- Caries risk factors include plaque control, dental defects, low fluoride, sugary drinks, starch, xerostomia, and tobacco.
Signs and Symptoms of Caries
- Variable pain can be mild, moderate, or severe and also constant
- Pain is frequently associated with hot, cold, or sweet food and drinks. The client may also experience pain with chewing when the tooth pulp is inflamed.
Caries: Focused History
- Take dietary, oral hygiene, and anatomical considerations such as crowded or malposed teeth into account
- Ensure tobacco use and if there is any medication use is considered.
Caries: Physical Exam
- Take their vital signs, focusing on whether there is a fever; take pain into account using a pain scale
- Look at their mouth.
- Tools available include X-rays, which can also be helpful.
Caries: Differential
- Account for the pain and look at the caries using gingival recessions
- Check for history, trauma, recurring caries, and or lesions
Caries: Plan
- Floss the patient's teeth to remove debris. Also use saline irrigation.
- You can also use spoon to remove debris
- Give some NSAIDS for pain
- Routine dental appointment
- Place temporary cover on the carries with IRM or Fuji 9
- Make sure the patient is kept hydrated.
Caries: Non-Acute/Acute Info
- Good dental habits: flossing, brushing, and diet control. For the other stages: soft foods that are easy to chew, ensure there are natural temepratures in the food
- Maintain moisture in mouth and stay hydrated to ensure the patient has a good quality of life
- Minimize sugary foods and liquids
Caries: Additional Treatments
- Minimize tobacco use. Make sure the patient is given resources to help kick the habbot.
- Monitor the patient and provide an evaluation.
Tooth Fracture
- Occurs with a range of depths, including the enamel, dentin, and pulp.
Tooth Avulsion
- Either complete, partial, or with alveolar fracture involved.
Signs and Symptoms for Teeth Fractures
- Check over the patient’s vitals, pain scale, and perform mouth exam
- Ask what trauma has been sustained to the tooth/mouth
- Assess the enamel, dentin, and pulp to correctly diagnose.
Differential Diagnosis For Tooth Fractures
- Base the depth of the tooth injury and make sure that the avulsion has consideration for the injury.
Fractured Teeth Plan
- If just the enamel is affected, then no treatment is required
- If the dentin is exposed, then provide heavy pain medication as well as IRM and Fuji 9
- Check patient's for the possibility of a dentist providing quick analysis.
Fractured Teeth: Continued
- Exposing the patient to narcotics and medication. Make sure to check with the surgeon about how to proceed.
Avulsed Teeth Treatment
- Reimplant the tooth and have them follow up with a dentist or place the tooth inside balanced salt solution
- Immersing the tooth in milk, as well, with a paper towel is a quick solution.
Avulsed Teeth Considerations
- Limit removing the viable PDL
- Provide copious amounts of saline irrigation
- Evaluate for soft tissue injury, as well.
Further Evaluation for Avulsed Teeth
- Consider leaving the tooth or other tooth fragments
- Consider providing the patient with a temporary stabilization
- Provide the patient with oral antibiotics for that reason
- Check with the surgeon on any further directions.
Avulsed Teeth Education
- Try not to manipulate the tooth with Fuji 9
- Good oral hygiene is critical
- Provide details with wound and with a new toothbrush.
- Also focus on the patient by avoiding spicy foods and maintain constant rest.
Follow-up Actions For Avulsed Teeth
- Provide the patient with a path forward so they may return to the clinic
- If a tooth is ever swallowed, that is not a concern. But aspirated is a concern!
Red Directive
- Contact preceptor for extra medical advice.
Gingivitis
- Gingivitis is a very common form of inflammation which involves both gum bleeding and swelling.
Gingivitis - Signs and Symptoms
- Bleeding, red, swollen, tender gums, and painfulness all are signs.
Gingivitis - Focused History
- It can be difficult to take everything into account due to malposed teeth, smoking, or other devices that make it hard to take care of the mouth.
Diagnosis for Gingivitis
- Physical exam with the gums and mouth.
- Complete a mouth exam and scale pain 1-10
Gingivitis - Differential
- Check for any inflammation in the mouth
- If there is more than just inflammation, then take that into account for follow-up.
Gingivitis Treatment - Basic
- You can use Tylenol or NSAIDs on top of the oral hygiene
- Have them rinse after to limit irritation.
Gingivitis: Focused Education
- Maintain the health
- Try to stop any tobacco use
- Make sure patient has path to seek help.
Gingivitis: Follow Up:
- Make sure to reach out to patients within a week.
Green Directive:
- All should be reviewing the directive for dental disorders.
Signs and Symptoms of ANUG
- ANUG is a painful infection that contains bleeding, a foul infection of the mouth
- People who are already weak and in a state of stress are often at a higher risk
- All lead to pain with bacteria forming in the teeth.
Exam for ANUG patients.
- Fever evaluation
- Examine and take note of lymph nodes that are potentially related to the craters.
ANUG - Other Considerations
- Differential - Primary issues
- You need to be able to be mobile for these patients as a priority.
ANUG Treatment
- Mouthwash
- Heavy brushing and overall topical and oral medicine
- If no improvement, the patient needs antibiotics with good hydration
- Monitor them
What Should Be Avoided with An ANUG Follow UP?
- Be sure to make sure they are aware of what is going on and how to treat that on a day to day basis
Is Contact Required for the Medical Directive?
- Yes, it's blue so contact the director!
What is the Major Goal With a Patient in this Stage.
- There is not an immediate close, instead is much more related to general trauma
General Consideration of The Treatment
- Most people just need you to assess the site, determine when it became a problem, and note if it is reoccuring
- Make sure to see this in consideration with the mouth.
Does trauma need to show dislocation?
- Consider any injuries. Try to reduce inflammation
Reduction of The Mouth
- You need to prevent the loss of the mouth first. You can do small reduction, though.
Should Heat/Cold Be Avoided With Injuries in TMJ?
- Always recommended from what the person can handle
If a patient is unable, should you proceed?
- You need to stop and recommend another specialist to continue helping.
Should Follow Up Action Be Daily or Weekly?
- Follow-Up Action Should Be Daily and with care.
Do patients ever just not get pain free?
- YES! Sometimes long dislocations need specialized expertise
Ludwig Angina
- The most common infection that comes to the floor of the mouth through the tongue.
How To Diagnose Ludwig Angina?
- It can lead to more long term effects, and more dangerous situations with patients.
Differential
- Infection, localized pain caused by infection.
Treatment For Ludwig Angina
- Maintain a medical emergency/antibiotics.
What Actions Should a Patient Take For Ludwig Angina?
- They need to maintain air pressure.
Directive
- For this you need a Red Directive, and the director needs contacted.
Oral Cancer
- Sores/ growths inside of the mouth that lead to bad cancer.
Cancer Indications!
- Lesions and trauma that should be assessed for what it is. This cancer also often occurs past 50!
Cancer Risks?
- Often involves dental work.
What Can Be Included With A Physical?
- You can do vitals to make sure of the levels. LymphNodes with lymph nodes may be involved!
Cancer Examinations?
- Must be done fully including attention to the soft palate, base of the cheeks, and everything for the patient!
Differentials: What should you do in a cancerous case?
- Consult specialist (Oral Medicine) ASAP
Treatment/Plan
- The only thing to do is biopsy the area to confirm and analyze the issue.
Modification
- The only thing to modify is for them to stop the problem/issue ( Smoking/Alcohol Use etc.) In long term-routine exams are important!
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