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