Dental survival guide Draft 2

CLINIC SURVIVAL GUIDE. 2016 MIDWESTERN UNIVERSITY ASDA

" IF

WE

weren’t loving what we already do, we would try doing what we love. " Brandon Le, ASDA Golden Crown’s Representative

Prescriptions Dr Kramer, Dr Taylor, DrAntione, Dr Hagan Antibiotics

Pain Medication

Penicillin V Potassium

Aspirin 325mg (OTC)

500mg take 1 tablet 4 times per day. Disp 40 tablets.

1-2 tablets every 4 to 6 hours (max adult dose: 4,000mg/24 hours)

Amoxicillin

Ibuprofen 200mg (OTC)

500mg take one tablet 3 times per day.

Disp 30 tablets. For Pedo; Infants >3 months and children <40kg: 20 to 100 mg/ kg/day in divided doses every 8 hours.

Clindamycin 300mg take one capsule 3 times per day.

Disp 40 tablets * May cause pseudomembranous colitis. For Pedo; 10 to 20 mg/kg/day divided in 3 to 4 equally divided doses; maximum daily dose 1,800 mg/day.

Azithromycin ( Z-Pak) (Zithromax)- 1pack (6X250mg tablets), take 2 tablets on day 1 and 1 tablet on days 2-5.Disp 1 pack. *May cause arrhythmias careful with patients who have had cardiovascular events. For Pedo; 12mg/ kg/day (maximum dose:500 mg/day) once daily for 5 days.

1 to 2 tablets every 4 to 6 hours (prescription max adult dose: 3,200mg/24 hours). For Pedo < 50 kg: 40 to 10 mg/kg/dose every 6 to 8 hours; maximum single dose: 400mg; maximum daily dose: 40 mg/ kg/ 24 hours.

Aleve (OTC) Naproxen Sodium 220mg/tablet Take 2 tablets to start, then take 1 tablet every 8 to 12 hours up to 3 tablets (660mg) per day.

Acetaminophen 325mg (OTC) Take 1 to 2 tablets every 4 to 6 hours. For Pedo 10 to 15 mg/kg/dose every 4 to 6 hours as needed; do not eceed 5 doses (2.6) in 24 hours.

Hydrocodone Acetaminophen 5/325 (Vicodin) (Norco)- Take 1 to 2 tablets 4 times/day as needed for pain(not to exceed 4,000mg acetaminophen/ day) Hydrocodone 5mg, Acetaminophen* 300mg.

Disp 16 tablets Moderate Pain

Tylenol #3 Acetaminophen* 300mg; Codeine 30mg. Take one tablet every 4 to 6 hours as needed for pain. Disp 16 tablets Moderate pain.

Antifungal

misc

Nystatin Oral Suspension

Cortab

Use 1 teaspoonful for 2 minutes 4 times per day and expectorate. 300ml * High risk of dental decay with prolonged use (>3months)

Mycelex Troches

Caries Control Chlorhexidine Gluconate Oral Rinse 0.12% Floss and brush teeth, completely rinse toothpaste from mouth and swish 15ml(one capful) undiluted oral rinse around in mouth for 30 seconds, then expectorate. Caution patient not to swallow the medicine and instruct not to eat for 2 to 3 hours after treatment (cap on bottle measure 15ml) Disp 3x16 oz.(473 ml)

Prevident Toothpaste (Neutral Sodium Flouride Gel/ Toothpaste 1.1(5,000ppm)) Brush on teeth if paste or place 1 teaspoonful of gel in fluoride tray and apply to teeth 3 to 5 minutes or while you are in the shower, once per day. Disp 2oz.

Stannous Fluoride 0.4% (OMNI Gel), Gel - Kam Gel(Colgate), PerioMed(3M), Stop Gel OralB). 1,500ppm- Brush on teeth or place 1 teaspoon in fluoride tray and apply to teeth 3 to 5 minutes once per day. Disp 4oz.

Magic Mouthwash use every 4-6 hours, hold in mouth for 1-2 minutes, the expectorate. Shake well before using and do not eat 30 minutes after use.

Contains; Viscous Lidocaine 150ml, Diphenhydramine 12.5mg/5ml 20ml,Hydrocortisone 100mg, Tetracycline 2g, Nystatin suspension 20ml.

Local Anesthesia Dr Van, Dr Schuerman DRUG/COncen

MRG

MG/LB

0.5% Bupivicain

90MG

0.6

MG

e (Marcaine)

1.8ml

Max Cartridge

9MG

10

Cartridge

CANADA

2%Mepivicaine (carbocaine)

400MG

3.0

36MG

11

3% Mepivicaine

400MG

3.0

54MG

7.4

2% Lidocaine

300MG

36MG

13.9

4% Articaine (septocaine)

NOT LISTED

3.2

72MG

6.6

4% Prilocaine (citanest)

600MG

40

72MG

8.3

1/50,000 epi

0.2mg/ 200mcg

36mcg

5,5

1/100,000 epi

0.2mg/ 200mcg

18mcg

11

1/200,000 epi

0.2mg/ 200mcg

9mcg

22

1/20,000 levonordefrin

1mg/ 1000mc

90mcg

11

Epi given to cardiac compromised patient

0.04mg/ 40mcg

levonordefrin given to cardiac compromised patient

1mg/ 1000mcg

3.2 (2.0PEDS)

calculations Anesthetic: % X 10mg/ml X ml Injected

Vasoconstrictor: 1/100,000= 10mcg/ml x ml injected

One Kg =2.2 Lbs

2% solution =36mg/carpule*

3% solution =54mg/carpule

4% solution =72mg/carpule

Recommended Maximum Dosage 2.0 mg/lb, 4.4 mg/Kg

MRD Calculation 32 lbs/2.2 = 14.5kg x 4.4= 63.9mg 63.9mg/36mg = 1.7carpule

Rule of thumb 1 carp / 20 lbs *2%Lidocaine 1:100,000epi* **MWU 2% Lidocaine w/ 1:100,000 epi ONLY**

" ABILITY may get you to the top, but it takes character to keep you there" Stevie Wonder

Anesthetic Drug Interactions/ Drug Drug Interactions Dr Van NON-SELECTIVE BETA BLOCKERS Use plain anesthetic or 2%mepivicaine / 1/20,000 levonordefrin

TRICYCLIC ANTIDEPRESSANTS Use caution with epi, DO NOT USE Levonordefrin (neocobefrin)

METRONIDAZOLE (Flagyl) or Flucanazaole (Diflucan) inhibit Warfarin (Coumadin) Should NOT be COADMINISTERED

NSAIDS Inhibit lithium secretion prescribe acetaminophen or narcotic analgesics

CORTICOSTERIODS Consult MD may need to prescribe loading dose

ANTIDIABETIC AGENTS Consult MD large epi doses increase blood glucose. (>4 cartridges of 1/100,000 epi)

OPIODS May potentiate cardiorespiratory effects of local anesthetics. May provoke bronchospasms in ASTHMA Patients= DO NOT administer opioids especially MEPERIDINE (Demerol)

ACE INHIBITORS & CALCIUM CHANNEL BLOCKERS Limit epi dose to large of dose may induce angina

THROXINE (Levothyroxine) increases cardiac sensitivity to epi =limit epi dose

PHENOTJIAZINE Suppress vasoconstriction actions leading to hypotension. Also potentiates LAâ&#x20AC;&#x2122;s = thus greater depression of BP, HR and Respiratory Rate

COCAINE Potentiates endogenous epi and norepi, additional vasoconstrictors increase likelihood of dysrthythmias including ventricular fibrillation

BENZODIAZEPINES May potentiate cardiorespiratory effects of local anesthetic.

ERYTHROMYOCIN & CLARITHROMYOCIN B ( laxin) Antibiotics and antifungal POSACONAZOLE (Noxafil). All three may cause TORSADES DE POINTES.

PRILOCAINE & BENZOCAINE May cause methemoglobinemia at high doses. Be aware if patient is also taking ACETAMINOPHEN, which also produces an elevation in methemoglobinemia levels.

HISTAMINE 2 ANTAGONISTS

CIMETIDINE (Tagamet), RANITIDINE (Zantac). The biotransformation of amide local anesthetic is inhibited.

Only significant with CHF patients of ASA III or Higher.

Etch enamel and dentin with 37% Phosphoric acid. Place on enamel first, 15 seconds for enamel and 10 for dentin.

Total Etch

Apply Gluma substitute 2 30 seconds scrubbed into dentin lightly air dry until no film visible

Apply Prime and Bond (excitTE F) Scrub for 10 seconds. Gently air thin until no pooling remains. Cure for 9 seconds (3-3 second intervals with valolight on medium setting

Etch enamel only with 37% hosphoric acid for 10-15 seconds. Rinse and dry thouroghly

Apply Gluma substitute 2 30 seconds scrubbed into dentin lightly air dry until no film visible

Apply self etch+ Primer (Adhese 1). Brush n 15 seconds and leave for 15 senonds lightly air dry until no film visible.

Apply Adhesive Resin (Adhesive 2) Coat dentin and enamel and scrub for 10 second slightly air dry until no film visible. Cure for 9 seconds (3-3 second intervals with valolight on medium setting

Self Etch

Intaglio Preparation/ Cementation Dr Cufone, Dr Smith CEMENTED

E max

Non rententeive crown preps

Venners, Inlays and Onlays and Bruxers

BONDED No Sandblasting 20 sec etch/ 60 sec prime

CEMENTED

Good Retention

BONDED

Non Retentive

P FM MWU ASDA

14

Onlays, Inays andVeeners

Non Rentitve preperation

CEMENTED

Z i rcon i a

Sandblasted 60 MDP primer

BONDED

Non Retentive

Gold Onlays and Inlays

CEMENTED Good Retention

Gol d / M ed a l BONDED

Non Retentive

" make

no

judgements where you have no compassion Anne Mccaffrey

title Dr Luk

CAD/CAM Work Flow Dr Wall, Dr Smith By 8:15/1:15 • Restorative kit is set up • Retraction cord/ laser are set up • Anesthesia is set up

By 8:30/1:30 • PAR has received payement • BP taken, start check has been been received • Patient has profound anesthesia • Provisional matrix has been fabricated

By 9:15/2:15 • Crown preperation 100% complete • Retraction cord or soft tissue laser has been used

By 9:45/2:45 • Crown Prepation is scanned, designed and sent to the mill.

If 3:00 has passed finish scan and and start provisional.

• Set Up for cementation

By 10:30/3:30 • Milled Crown anamtomy is refined if needed, sintered/ Glazed.

• If CAD/CAM crown is not finished firing by 3:45 • Start provisional.

By 10:45/3:45 • Crown Adjustments are made • Precemtation radiograph taken (if margins are subgingival) • Crown is polished if neccesary

By 11:00/4:00 • Post cementation radiograph taken • Post cementation adjustments have been made if necessary • Patient escorted by student doctors to waiting room

By 11-11:30/4-4:30 • Student doctor finishes and modifies notes • Faculty approves radiographs and notes

MWU Wave one protocol

Endodontics Dr Johns

01 02

Turn on the e-3 unit, set it to WaveOne Recip/Wave All by toggling the + above the e-3 button, hold hand piece head down and run 30 sec to get rid of oil. Without a file in the hand piece, press the Calibration button and let the hand piece run until it stops (~7 sec).

03

Put EDTA or RC Prep in the chamber. Set the e-3 unit to Dr’s Choice 1 (Vortex 15/.04 setting) by toggling the + by the e-3 button; put a Vortex Blue 15/.04 file into the handpiece. With the handpiece running and the Root ZX hooked to the file, introduce the VB 15/.04 into the orifice of the canal and let it draw down as you do the WaveOne Gold file. Work the VB 15/.04 all the way to the Working Length.

04 05 06 07 08 09 10

Irrigate the canal with EDTA with the EndoActivator for 15 seconds. Rinse and put EDTA or RC Prep in the chamber.

Select the appropriate WaveOne Gold file and put it in the handpiece. Always have the file running while in the canal. Do NOT use a pecking motion, rather get a GOOD FINGER REST and let the file be pulled down into the canal. Go about 1/3rd the way into the tooth. Pull the file out of the canal several times using a brushing motion against the walls of the canal (circumferentially).

Set the e-3 unit to Dr’s Choice 2 (Vortex 15/.06 setting) by pressing the left arrow then toggling the + next to the e-3 button; put a Vortex Blue 15/.06 file into the handpiece. Work the VB 15/.06 Set the e-3 unit to WaveOne Recip/Wave All; put the WaveOne Gold file into the hand piece.

Take the WaveOne file to the working length (WL). Pull the file out of the canal using a brushing motion against the walls of the canal. Wipe the debris from the flutes FREQUENTLY. Rinse with air/water, dry, then rinse the canal(s) with EDTA; leaving the chamber full, irrigate for 1 minute using the EndoActivator, taking the tip down to WL-2mm. Click the time at the bottom right of the monitor’s taskbar for a timer.

Rinse with air/water, dry, then rinse the canal(s) with NaOCl; leaving the chamber full, irrigate for 5 minutes using the EndoActivator, taking the tip down to WL-2mm.

Flush thecanals/chamber with air/water, then dry the canal(s) with paper points...medium, then fine...until canal(s) is (are) dry.

Get patency, then make sure that you can get to the WL with the #30 hand file (blue)...go down ONCE to WL using a wrist-watch motion. In clinic, have your instructor verify the apical fit by performing this step.

11 12 13 14 15 16 17 18 19 20

Fit an appropriate WaveOne gutta percha (GP) point and get MP verification PAX. Have instructor check the fit.

Prepare a small amount of sealer on a mixing pad...cut a piece of the Obtura gutta percha plug in half...you’ll only need that, or less.

Turn on System B...lower right switch to “USE”...full power (10) on upper right knob...lower left switch to “Touch”...adjust upper left knob until setting is between 295-300° ...use a F (.06) tip on the hand piece (for the 35 & 45 WaveOne Gold files use the MF (.08) tip). Also, turn on the Obtura unit at this time...it should heat to 200 degrees in about 2 minutes...do NOT put the plunger nor gutta percha plug into the chamber yet...use the size 23 Obtura tip.

Coat the apical end 1/3rd of the gutta percha point with sealer and place in one canal.

Activate the System B by pressing on the spring on the hand piece and engage the tip into the canal orifice, using steady firm apical pressure. Go as far as you can then slightly move the tip side to side while the unit is still on, quickly pull the tip out of the canal then turn off the power by removing your finger from the spring.

Take the smaller end of your condenser (dual ends) and compress the gutta percha firmly in an apical direction. Do not move condenser side to side as it can crack a root.

Fill and condense only 1 canal at a time with the System B.

Important step! After filling all canals with System B, place the #30 file into the canal(s) with the stopper at the WL...it should stick up out of the canal(s) ~3-5mm, indicating you haven’t pulled the GP out of the canal(s)...if you have, then repeat steps 21-23.

With the Obtura tip facing down, put a GP plug in the chamber, then put the plunger into the chamber and activate by squeezing the trigger...gutta percha should express out the tip.

Put the tip of the Obtura into the canal until it touches the gutta percha, hold for 5 seconds, then backfill the canal using steady pressure...the tip should back out of the canal as it fills. Do this in 2-3 increments to avoid getting voids, condensing each increment with the small, then large end of the condenser. Fill to the orifice of the canal. Repeat step for each canal.

pulpAl diagnosis Dr Barnes

Yes

PREVIOUSLY TREATED OR PREVIOUSLY INTIATED THERAPY

Yes

DOES STIMULUS REPRODUCE SYMPTONS

DOES STIMULUS REPRODUCE SYMPTONS

Yes IRREVERSIBLE PULPITUS

No REVERSIBLE PULPITUS

Pulpal Diagnosis HAS TOOTH HAD RCT BEFORE?

Yes

No

DOES TOOTH RESPOND TO HOT/COLD/EPT?

No

No NEOCROTIC PULP

NORMAL PULP

DENTURES Dr Johnson VISIT one

(Prelim impressions)

•

Preliminary impressions

•

Pour up cast module

•

Custom tray capturing all anatomical landmarks with properly angled handle and smooth with no sharp edges

Visit Two

(Final impressions)

•

Custom tray accurately captures anatomy, tray is far enough posterior

•

Border molding

•

Record vibrating line

•

Measure lip line resting and smile lip line

•

Bite gauge to record VDO and VDR

•

Centric tray bite registration

VISIT three

(Wax Rim try In)

• Wax rim try in • Verify lip line, lip support, occlusal and horizontal plane, incisal edge position • Verify phonetics and free way space • Record midline • Use allameter to select anterior teeth width • Record bite registration and bite record • Prescription shade, size and shape of teeth and occlusion

VISIT FOUR

(Wax Denture Try In)

• Verify lip support, lip line, occlusion, palatal seal, phonetics • Confirm with patient the esthetics

VISIT Five

(Insertion)

• Adjust denture base • Adjust over extended areas • Confirm palatal seal • Occlusal adjustment • 24 Hr try in and adjust after

Periodontal Instrumentation “Cheat Sheet” Exploring, Probing + Scaling exploring

11/12

supragingival and subgingival in all 4 posterior sextants.

5/6

supragingival and subgingival in both anterior sextants.

probing Depths recorded at 6 points around every tooth.

UNC

probe: mm increments; 1 ,2, 3, 5, 6, 7, 8, 10, 11, 12mm

CP12

probe: Colored Code; 3, 6, 9, 12mm

Naber’s Probe

to explore furcation involvement in all 4 posterior sextants. 3, 6, 9, 12mm

sca;ling

H5/33

sickle supragingival ONLY in both anterior sextants

204S

sickle supragingival ONLY in all 4 posterior sextants

SC13/14

universal curette supragingival and subgingival in all 4 posterior sextants.

SM13/14

universal curette supragingival and subgingival in all 4 posterior sextants (Same as SC13/14 but larger)

SG5/6

Gracey (area specific) curette supragingival and subgingival in both anterior sextants

SG11/12

Gracey (area-specific) curette supragingival and subgingival on mesial, buccal and lingual surfaces in all 4 posterior quadrants.

SG13/14

Gracey (area-specific) curette supragingival and subgingival on distal surfaces in all 4 posterior quadrants and Mandibular lingual anteriors.

" you

never

know how strong you are until being strong is the only choice you have" Bob Marley

NOTES

NOTES

NOTES