What is a regular dental check-up?

Dental check-up frequency depends on a patient’s general oral health. For example if a patient is a
high caries risk or high periodontal risk will be around 3 months. Medium caries/periodontal - risk 6
months. Low caries/periodontal risk – 9 months. A dental check-up allows the dentist to check the
oral health/problems and oral hygiene. So a dental check-up tends to include:

1. Examine the teeth, gums and mouth (in general)

2. General health (diet, smoking, teeth-cleaning routine and alcohol use) and problems with
teeth, mouth and gums since last visit
3. Updates on medical history
4. Any dental problems?
5. Any treatments required

Diet change at university?

Those is university tend have a lower budget, so they would often go for cheaper foods such as
ready meals, crisps, chocolates, fizzy drinks – in comparison, at home the food would usually be
bought and made by parents who buy better foods. These examples are low in nutrients and
vitamins which are vital, and make up for this in sugars, complex carbohydrates and fats. Also
students tend to party and drink a lot of alcohol, compare to when they were living at home. The
average student gains two stones. There is less regular tooth brushing and more carbohydrates are
eaten. Carbohydrates dissolve in the mouth to form simple sugars, so more caries.

Access to dentists by university students, and by general public?

The general public can find dentists by NHS websites, leaflets or looking out for one close to their
place of residence – they can then register with the desired dentist from then on. University
students have a dental practice allocated to them, as result it is easier for them to register with a
dentist. Those who are disabled, have a low income or certain religious routines may find it difficult
to see a dentist or access a dentist as easily.

How often medical history gets checked?

A patient’s medical history should be checked and updated at every treatment visit (even if it is just
a check-up). It is good policy to take a full medical history very time a patient is examined, as
something in the medical history could have changed between appointments. They usually check if
the patient is pregnant, have any allergies, blood disorders, had any medical treatment or blood
disorders (e.g. HIV, Hepatitis B and C)

What are the eruption dates for permanent teeth?

6-7 years Upper AND Lower FIRST MOLAR (6s)

Lower CENTRAL INCISORS (1s)
7-8 years Upper CENTRAL INCISORS (1s)
Lower LATERAL INCISORS (2s)
8-9 years Upper LATERAL INCISORS (2s)
9-10 years Lower CANINES (3s)
10-11 years Upper FIRST PREMOLARS (4s)
10-12 years Lower FIRST PREMOLARS (4s)
 Upper SECOND PREMOLARS (5s)
11-12 years Upper CANINES (3s)
Lower SECOND PREMOLARS (5s)
11-13 years Lower SECOND MOLARS (7s)
12-13 years Upper SECOND MOLARS (7s)
17-21 years Upper AND Lower WISDOM TEETH (8s)

What is the role of the dental nurse?

A dental nurse works to assist a dentist/hygienist/therapist in their daily work and routine. This
would include setting up the equipment required for each patient and procedure, mixing materials
(e.g. for impressions) and general patient comfort. They also assist in taking note for the dental
clinician (e.g. Dental records, teeth notations, etc.) as well as tidying the surgery and sterilising the
instruments used. They keep the surgery running smoothly, as well as carrying out audits and
radiographs. They are usually a patient’s first port-of-call, because they are seen as easier to speak
to.

What is a fit and healthy 18 year old? Male/female

Stippled (like an orange peel), non-inflamed and non-bleeding gingiva, that is tightly shaped around
the front-edge of the tooth. There might be a possible eruption of the wisdom tooth. Maybe some
light staining on the teeth (due acid, tea or coffee). They may have some restorations in their mouth,
e.g. fissure sealant.

What makes up good communication skills?

 Be prepared for patient before they enter a room

 Be appropriately dress, in correct uniform (tunic, bare below the elbows)
 Show interest and sympathy when a patient is talking about their problems and pain
 Wash hands in front of patients
 Smile and be polite
 Soothingly touch shoulder of an anxious patient ( maybe ask if they would like you to hold
their hand)
 Inform them on what is going to happen and why
 If you have a deaf patient, take of mask and look at them when you are speaking to them

How to greet patients

 Open the door and welcome the patient into the clinic. This may include the shaking of
hands, however this depends on religion.
 You can ask them to remove jacket to help them feel more comfortable
 Pay attention to the patient when talking
 Address them by title, if they have not given you permission to call them of first name basis

What is the difference between soap and gel when hand washing?

Liquid (dispensable) soap usually contains antimicrobial agent (e.g. chlorhexidine), which requires
water to wash off afterwards – hot water is used to wash the soap off, as it kills the bacteria as well
as dissolve natural oils on the hands. It is used to remove any physical debris found on the hands.
These are used at the in between patients or when non-clinical activities have happened using the
hands (e.g. having lunch, smoking, etc). However, alcohol-based hand gels can be used when
working with the same patient, when there is no physical debris on the hands and/or gloves. These
gels contain alcohol and biocides (chlorhexidine, triclosan or quaternary compounds), which have
been found to be more efficient and faster acting than antiseptic soaps. However, alcohol gels do
have disadvantages: use of paper towels or tissues to dry hands may lead to recontamination of
hands, there may be a build-up of sticky residue after several uses of the gel (therefore it has been
advised to alternate between the gel and soap to remove the residue), repeated use of the gel can
lead to drying of the skin (some soaps have moisturising products to counteract this).

What are the seven steps of hand washing?

Alternative hand-washing techniques to avoid Dermatitis

1. Don’t keep hands in water for too long

2. Use an antimicrobial mild cleanser, that is less harsh on the skin compared to other soaps, to
wash hands
3. Dry hands thoroughly after washing
4. Use lots of moisturisers and apply frequently

What is used to stop cross infection/disinfection of surgery?

All clinical members of staff (and sometimes patients) must where personal protective equipment
(PPE). Things like gloves, should be worn when handling equipment, treating patients, setting up all
procedures, clearing away after a procedure and during cleaning – always dispose after one use.
However, things like eye visors and disposable aprons should be worn only during the treatment of
patients. Also all surfaces (including the patient chair) should be disinfected with antimicrobial
disinfectants. On top of this, all equipment should be cleaned, sterilise, packaged and dated. Dental
practices should reduce the risk of needle stick injury e.g. use butterfly-wings on needles, or use long
brushes when manually cleaning a sharp instrument.

What is extra- oral examination and what does it check for (look in detail)

This is the examination of the head and neck soft tissue. They may check for asymmetries in the
areas around the jaw. To examine the lymph nodes (normal lymph nodes are less than 1cm,
however they can remain relatively large after infection, they should be non-tender and mobile) in
the head and neck region, the clinician would feel (palpate) the area gently to look for tenderness or
enlargements – this examination may include feeling around the neck, ear, base of skull, under the
jaw and chin area. The clinician may ask the patient to swallow or open and close their mouths.

What is an intra-oral examination?

This is an inspection of the teeth and the surrounding hard and soft tissue in the oral cavity. The
clinician usually performs this using an instrument with a sharp point (e.g. a probe), to check for
damage in the teeth (e.g. caries and calculus) as well as the gums (e.g. periodontitis or gingivitis) –
this may include checking the depth of each sulcus to check for this as well as root defect. The
examination also includes the inspection of the floor of the mouth, the surface of the tongue, lymph
nodes, salivary gland and ducts. The may also check to see how the patient’s bite is like.

What abnormalities might you see in extra-oral and intra-oral examination?

In extra-oral examinations, the clinician may feel abnormally large and/or tender lymph nodes and
this can be an indication of inflammation or that drainage of an infection had occurred. A non-tender
enlarged lymph node may indicate cancer or lymphoma. During intraoral examinations
abnormalities such as abscesses, oral cancer and ulcerations can be discovered, along with gingivitis,
calculus and caries.
What is a healthy oral-mucosa / alveolar mucosa? Look at cell layer

Healthy oral mucosa is usually pink/red (due to its vascular nature), it is smooth with large amounts
of moisture due to the high saliva content.

Fibroblasts are cells that give rise to/ secrete most extracellular matrix proteins (which are used for
connective tissue) – which is the in the Lamina Propria.

ECM = extracellular matrix proteins

What is gingivitis?

This is the inflammation of the gingiva, most commonly due to the accumulation of dental plaque at
the gingival margins.

Other causes of gingivitis include:

 Some medications e.g. Calcium channel blockers, cyclosporine, phenytoin

 Poorly controlled Diabetes – poorer immune defence system – reaction to infection is more
severe than in a non-diabetic. High glucose levels allow the bacteria to thrive and proliferate.
High blood sugar levels lead to damage blood vessels which reduces the supply of oxygen
and nourishment to the gums – making infections of the gums and bones more likely.
 Smoking – masks any symptoms of gingivitis and weakens body’s defence (as it may alter the
host response in neutralising infection). Smoking creates an anaerobic environment, which
promotes the growth of Gram-negative bacteria
 Hormones and Stress
 Immunosuppressed patients

Signs/Symptoms:

 Red swollen gingiva (especially interdentally)

 Bleeding gums
  Halitosis
 Sometimes tenderness gingivally
 Spongy gingiva and loss of detail

Treatment:

 Promotion of good oral hygiene

 Non-surgical hygiene treatment (scale and polish)
 If non-surgical treatment does not work then surgery (e.g. open flap) may be required

What is difference between a normal gingiva vs. abnormal gingiva?

The colour of normal gingiva varies between ethnicities, in darker pigmented people, the attached
gingiva tends to be darker purple than the mucogingival junction (which is pale pink). However, in
fair skinned people the gingiva is paler than the mucogingival junction (pink in colour). The gingiva
covers all of the root of the teeth, which makes the teeth secure and anchored. However, abnormal
gums (e.g. if a patient has periodontitis or gingivitis), the gums would be inflamed, very red and
bleeding, sometimes the gingiva could have receded to leave more teeth or even root exposed.
Sometimes the gingiva could be enlarged or sometimes have dark patches (that are not normal to a
race), which could be an indication of something pathological.

What is a Basic Periodontal Examination and how do you take it?

What can we do to reduce plaque deposits?

Usually brushing thoroughly twice-a-day and flossing removes plaque, however if the plaque is
particularly hardened (calculus) then a hygienist can scale and polish to allow the teeth to return to
its normal state.