Dental OSCE quiz 1

1. Gain . Check for allergies, explain to patient the procedure and why we need the rubber raincoat.
2. Select clamp - for primary molars and premolars, for partially erupted molars, for permanent molars.
3. Tie around clamp before application
4. Rubber dam must be pre-. 3 overlapping holes for tooth, 5-6 overlapping holes for
5. Clamp applied without rubber dam
6. Apply rubber dam when clamp is - rock , then .
7. attached to support dam
8. isolation required dam to be stretched to include all required teeth
9. Apply wedget or wedge to aspect of most mesial isolated tooth.

During a TMJ examination, you should stand behind the patient and palpate both joints . The patient should be asked to and close their mouth, and move their jaw . You should note any clicking, (trismus), grinding or grating (), limited , deviation, and pain.

For an ID block you should do the following:
1. Explain what you are going to do; gain . Numbness will last for around or hours and patient should avoid hot drinks and their lip
2. Check for any or contraindications. LA contains and an additive called metabisulphate that could cause a reaction.
3. Check the on the cartridge, check your choice of , check it has no .
4. Dry mucosa and apply anaesthetic - xylonor gel contains .
5. Put the needle together - long needles are coloured and short needles .
6. Check the is orientated correctly!
7. Patient should open their mouth so you can visualise anatomical landmarks. Ensure you have the operating on to visualise tissues for the block.
8. Palpate the with your thumb at the greatest depression - known as the coronoid
9. Slide your thumb until you can palpate the .
10. The syringe is positioned between the on the opposite side and needle inserted at the level of the thumb.
11. The injection site is 1cm above the plane of the molars and medial to the thumb, lateral to the raphe.
12. The needle is advanced around 2.5cm. should be contacted to ensure correct position.
13. When the needle meets the middle section of the rams, withdraw slightly by 1 or 2 mm so that the needle is not
14. Make sure you at this point.
15. Inject - 1.5ml or 2/3rds of a cartridge. This improves patient comfort and you can assess any patient to the solution before you inject too much.
16. The rest of the cartridge is injected as you the needle to block the nerve.
17. Double click the syringe and dispose in the
18. Remove gloves and apply alcohol gel.

You've just given a patient a new set of dentures and are giving them some advice. You advise them:
- Leave dentures in for at least hours initially
- Feeling of compaction and excess will with time
- There may be spots to begin with
- Their lips will with time
- Eat sized pieces of food and eat on sides of mouth
- Avoid foods
- need to be re educated to accommodate dentures
- denture using a soft nylon brush with over the sink. They can use solutions to help them clean.
- Soak dentures overnight in denture cleanser ( solution)
- Clean mouth with warm water daily

Unerupted incisors have several possible causes, these tend to be either or environmental in origin.
Environmental causes include:
1. Trauma - or intrusion of the primary teeth that causes damage to the permanent tooth. This may include the root/crown axis to deviate, known as . The permanent tooth may also become to the bone. In these cases may be required and tooth replacement options considered.
2. primary teeth causing eruption - this may cause a physical to the path of eruption of the permanent tooth. The most straightforward option here would be of the primary tooth if there is no other obstruction and the teeth are close to .

Hereditary causes may include the presence of teeth in the arch, lip or palate, abnormal tooth/tissue ratio or other rarer conditions such as dysostosis.

The other option is that the permanent teeth may be congenitally !

According to the RCS guidelines, we should start monitoring unerupted incisors when:
1. teeth erupted more than 6 months ago
2. Both centrals are unerupted and the lowers erupted more than months ago
3. Deviation in the normal sequence of eruption

During an intra oral examination, you may find that:
- The primary teeth have been retained beyond normal dates (which is or years for upper centrals, or years for upper laterals)
- There may be buccal or palatal on palpation
- Note the space available for incisors - mm for centrals and mm for laterals

You may wish to take some to determine the cause of the unerupted teeth. The technique can locate the position of impacted teeth.

The upper canines usually erupt around or years of age. absent canines is rare 0.3%. of canines is more common, and is usually bilateral. You should be able to maxillary canines around 9 years of age in the buccal .

Causes of impacted maxillary canines may be due to the:
- path of eruption
- rooted or upper lateral incisors ( laterals)
- Crowding
- of primary canine (an indicator rather than a cause!)
- factors. It may run in the .
- It should also be noted that impacted canines is associated with other dental anomolies

You should first assess the child to see if you can tell where the tooth is displaced. If you suspect displacement you may wish to take some .

The radiographs most commonly used for assessing ectopic canines are radiographs, upper radiographs, lateral (for more accurate localisation), computerised tomography, and periodicals (useful for prognosis of retained deciduous canines).

Management depends on wether the teeth are or displaced.
Buccal displacements are usually due to , so relief of is usually the option

Palatal displacements may require surgical with orthodontic , or surgical of the impacted canine.

Occasionally unerupted canines can cause of adjacent lateral incisor roots and possibly the centrals. In this case intervention should be done swiftly.