BDS3 Clinic GIL

Congratulations! Welcome to BDS3 Clinic!

Scope:
Semester One
- General restorative dentistry
- One pt per session
- Periodontal therapy
Semester Two - Oral Pathology detection
- Mx of non-complex MHx
- Two pts per session - Impressions

Tutor dependent: Complex cons

Pre-Clinic Prep
BE PREPARED: Build good habits and good foundation knowledge this year so
you don’t die in BDS4

- Check your pt’s Hx → MHx, Past Tx/Chart, Imaging, Waitlist, (H), Notes
- Place order forms early, think ahead
- Run Sheets
- Put up the following websites: Therapeutic Guidelines, AMH/MIMS
- Arrive early so that you can calm down and think clearly
Types of COC
Yellow Red Referred Pts

- General CoC - Limited CoC - Your tutor usually

- Pt has waited 2 years - Pt has not waited 2 wants you to still
- You can do what you years perform an exam
want, refer to who you - Sometimes it and new MHx
want means pt has - Usually do only
come from OD, you what is asked of
can do everything you
within your scope - Tutor dependent
- No referrals
allowed
Presentation to Tutor
SYSTEMATIC

1. Introduce Dr, introduce pt

2. Pt details: Pt name, age, report you’ve checked 3Cs
3. MHx: For now list everything and important follow up questions you’ve asked,
later you can list the important ones
4. Pt’s CC
5. Report that you’ve gained consent and Report what you’re doing today
6. “May I please continue?”
Presentation to Tutor
Presentation of Exam Findings to Tutor

- Better to write on piece of paper rather than read off of titanium

- Before you present radiographs, analyse it systematically yourself first
- Before presenting the last item of your full oral exam, have a Tx plan in mind
MHx
- Helps if you know the order off by heart
→ Can maintain eye contact
- Know your follow up questions

Tips

- Pregnancy: ~12yo - 65yo/Menopause

- Last hospitalisations: Last 5 years or any
life threatening hospitalisations or any
lasting complications
MHx - Important ETG things
- Pregnancy: Work in the 2nd trimester
- Beware Triple Whammy: AND → ACE inhibitors/Angiotensin Receptor
Blocker, NSAIDs, Diuretics
- MAOI = NO vasoconstrictor
- Heart attack? Wait 6 months
- Beware bisphosphonates and monoclonal antibodies
- Uncontrolled asthma → No vasoconstrictor
- Uncontrolled BP → No vasoconstrictor
MHx Useful Tips
HBP meds

- ABCD Classes = Ace Inhibitors/Agiotensin Receptor Blockers, Beta Blocker,

Ca Channel Inhibitor, Diuretics
- Gen rules:
- -sartan = ARBs
- - pril = ACE inhibitor
- -olol = Beta blocker

Have AMH, ETG guidelines up on your internet explorer ready to go

https://tgldcdp-tg-org-au.proxy.library.adelaide.edu.au/topicTeaser?guidelinePage=
Oral+and+Dental&etgAccess=true
How to use AMH
Demonstration
Full Oral Exam Cons
As per BDS3 Clinics - certain aspects - Fill out Simple Cons chit for DA
may be more important (case/tutor - Revise procedure, burs required,
dependent) dental materials
- Manage your time (don’t start
- E/O exam
something you can’t complete)
- TMJ assessment
- Check occlusion (articulating
- Occlusal assessment
paper)
- IO ST exam
- Fill out cons log!
- HT exam
- Perio Exam
- Radiographs
- Dx + Tx Plan Remember to close your COCs!
(TREAT_COMPLETE)
*Do SHx and DHx when waiting for tutor
LA
- Knowledge of indications/contraindications
- Ask patient about their previous experiences with LA

Technique

- Using the width and flare of Ramus → Demonstration

- Ensure adequate retraction (tissues taut) + stable finger rests
- Prepare cup of water for patient to rinse
- Safe disposal of needle in yellow sharps bin
- New needle required for each entry into tissue

Prepare copy/paste Titanium entry:

- Topical anaesthetic (Ziagel – lidocaine (50mg/g)) applied for __ buccal/palatal infiltration/IANB with short/long needle.
- Administered 2.2mL Lignospan Special (2% Xylocaine with 1:80,000 adrenaline)/Scandonest Plain (3%
Mepivacaine)/Septanest (4% Articaine with 1:100,000 adrenaline)/Citanest (3% Prilocaine with octapressin)
- Pulpal anaesthesia achieved, Pt responded well
- Post op instructions: Patient informed that tooth/lip/soft tissue will be numb for... Advised not to eat/drink hot or very cold foods
or drinks until numbness wears off, and take care not to bite the inside of lip or cheek. Contact clinic if any persistent
numbness (ie. more than 24hrs)
RD
- Use when indicated (allows clear view + easier access to tooth of interest,
moisture control, patient comfort → prevents water/saliva pooling - no DA to
help suction)
- Discuss with tutor
- If they give you the black RD send it back if possible
- Hold down the RD punch and pull around it, the RD punch is blunt af
Cons
- Check occlusion: Know how much space you have to work with and don’t go
over → You’re wasting time
- It’s so much easier than sim clinic… undermined enamel flicks making cavity
prep easier, CR adapts better = flawless margins, CR is all of a sudden
shinier
- Build up your skills: No matrix band protection, use the L10, HS > SS
Periodontal Debridement
- You will learn better techniques as you go → Ask perio support for help
- Have a logical diagnosis before you call perio over to check your exam
- Deep narrow pockets? Mini curettes!
- Half closed mouth > Fully open mouth for those very posterior teeth
- D of 8s and 7s are rarely an excuse now → Learn to rely on tactile sensitivity
and knowledge of tooth morph
Perio Support
- Kaur: Hand scalers > U/S
- Selbach: U/S = Hand scalers
- Perio classification cheat sheet → Perio tutors will expect diagnosis using
new classification
- Provide POI so no surprises re sore gums/mild sensitivity
- Possible sore gums few days after procedure – quite normal. Should settle down within 2-3 days as gums start to heal.
Can rinse with warm salty water 2-3 times/day (1 tspn in cup of warm water) for next few days – help w/ healing and
keeping area clean.
- Brushing and flossing continue as usual, but brush gently as to not further irritate area
- Mild sensitivity to cold foods/drinks due to the removal of the tartar which exposes the tooth surface underneath.
Should settle in week or so. TP for sensitive teeth purchase from supermarket, dab on sensitive areas.
- If the pain persists/any concerns, contact ADH
Tx Planning
Have a Tx plan to present to your tutor before you call them over → You are in charge of the
pt’s care now

- If pt is in pain treat that first, that appointment if possible

- Give pt OHI instruction → Get them to try maintain plaque levels before next
appointment (saves you cleaning their teeth before you treat)
- Fix perio → Nothing worse than doing cons on a bleeding/plaque covered pt
- Cons
- Concurrent referrals

- Pts who hate perio exams: Send them home, tell them to brush their teeth, tell them the
inflammation is their responsibility
What to do if...
- Rampant and Root caries → Find source, something is not right here and it’s
not just OHI → Check medication, xerostomia, radiation, underlying illness
(Diabetes/HIV)
- Pt has fuzzy MHx? → Let tutor know, depending on your Tx plan ask the pt
for permission to call their GP
PCC tips
- Good rapport is EVERYTHING
- Be Confident and low key smooth
- Pre-warn your pt about pain so that they don’t hate you when they’re in pain
- Be understanding: Pt’s already don’t like dentists, often have been in pain for
days, you’re not seeing the best version of their personality → Try to
empathise
- Know when to be firm
- Work with your pt’s depression/anxiety/OCD
- Have the DAs on your side
- Move the patient NOT you
Radiography
Radiography in Clinic
OPG Sessions
- Fill out green laminated request form
- Chill
→ obtain tutor permission → hand to
DA - Bring work to do
- Take patient to x-ray room - Don is a blessing
- Tutor to observe x-ray taking though
may become more lenient as year
progresses
- Wipe down x-ray film for DA to process
- Wipe down machine, chair, tray after
use
- Fill out radiography log book!
Emergency Situations
- Don’t think that it won’t happen to you
- Review common emergency procedures
- Call tutor asap
- Remember to call RN if needed
- Remember to fill out SLS
Assessing Dentures: ONDERASSA - Dr Zi Wei Lim
“On the ass aye” Aesthetics —> check smile properties

Occlusion —> check bite is even and all teeth contacting opposing Stability —> check that there’s no rocking of the denture,
teeth when pt bites down press on LHS/RHS and make sure it doesn’t rock

Neutral Zone —> refers to balance between lips/cheeks vs tongue Speech —> make sure pt doesn’t have issues saying “s” “th”
—> check pt isn’t biting on lips cheeks or tongue sounds, get them to count from 60-70

Design —> you don’t know enough to do this properly but just Age —> age of denture
make sure no clasps are stabbing them in the gum

Extension —> ensure the flanges aren’t stabbing pt in the

sulcus/vestibule/floor of mouth And then in general make sure they’re cleaning the denture
and that it’s not obviously broken
Retention —> Make sure that the denture is able to stay on during
function, make sure it doesn’t come off too easily
What do I do if I get a complex Pt?
1. Let your tutor know
2. Provide Reasoning
3. Refer (019)
4. Go talk to Margot → End of the hall in ADH clinic, swipe your SADS ID, first
door on the LHS
FTAs
- Patients will receive SMS reminder before appointment
- Call patients to gently remind them of their appointment
- If your patient FTAs:
- Call patient
- Bring Nissin models → Headboard
- Assist group members
- Patients with hx of poor attendance:
- 3 cancellations OR 2 FTAs OR FTA letter sent w/ no response within date = PURGE (patient
flow)
If things are going wrong in clinic, ask for help early
Questions?
Kahoot Time
https://create.kahoot.it/share/2020-bds3-clinic-gil/2532d386-c066-4355-8d74-7052
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