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Donetsk National Medical University of Maxim Gorky practice activity guidelines




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Donetsk National Medical University of Maxim Gorky


PRACTICE ACTIVITY GUIDELINES


DISCIPLINE: CLINIC, DIAGNOSIS AND TREATMENT OF ODONTOGENIC INFLAMMATTORY JAW CYSTS IN CHILDREN|вспыльчивые,зажигательные,пылкие|


INTENDED AUDIENCE: 4th-year students


FACULTY: Faculty of Medicine for International Students


FACULTY DEPARTMENT: Department of Pediatric Dentistry


Donetsk, Ukraine

2008


PRACTICE № 6

SUBJECT: CLINIC, DIAGNOSIS AND TREATMENT OF ODONTOGENIC INFLAMMATTORY JAW CYSTS IN CHILDREN|вспыльчивые,зажигательные,пылкие|

Importance of the Subject. The problem of inflammation processes has always been considered to be one of the most important in pediatric dentistry. The fact that inflammatory diseases often have complications can threaten child’s life. When occurred in a child's organism the inflammation processes of a jaw bone system develop into different forms and have specific signs and course. The lack of knowledge in this particular field leads to the treatment based only on dentist's experience and intuition.

It is the most common mistake of a doctor to apply the same therapy course and methods of treatment both for adults and children.

Awareness of the distinctive features appropriate to the childhood allow dentist to judge properly on child’s condition in every particular case. This also helps to diagnose an inflammation process on the initial stage of its development, better understand the course of a disease and its dependence on the age peculiarities, and as a result to perform effective prophylaxis and treatment. Thus, the importance of the problem is beyond any doubt.

^ Key Goal - to develop skills in making of tentative diagnosis and proving of principles of treatment of inflammatory jaw cysts in children.


To achieve the above goals, the following skills must be mastered by the students, based on the prerequisite knowledge and skills also given below.


^ Concrete Objectives


Prior-to Practice Knowledge and Skills

  1. To choose data from the patient's complaints and his case history which point to the presence of inflammatory jaw cysts in children.




  1. To choose data from the patient's complaints and his case history which point to the presence of inflammatory jaw cysts in adults (as explained in the Operative Dentistry course)




  1. Identify indications of inflammatory jaw cysts in children during objective examination.




  1. Identify indications of inflammatory jaw cysts in children during objective examination. (as explained in the Operative Dentistry course)




  1. Distinguish dominant symptoms and signs of inflammatory jaw cysts in children.




  1. Distinguish dominant symptoms and signs of inflammatory jaw cysts in adults. (as explained in the Operative Dentistry course)




  1. To make an individual chart of procedures to diagnose most important disease manifestations and interpret the results of target examination to be performed additionally in children with inflammatory jaw cysts.




  1. To make an individual chart of procedures to diagnose most important disease manifestations and interpret the results of target examination to be performed additionally in adults with inflammatory jaw cysts. (as explained in the Operative Dentistry course)




  1. To make a differential diagnosis of inflammatory jaw cysts in children.




  1. To make a differential diagnosis of inflammatory jaw cysts in children. (as explained in the Operative Dentistry course)




  1. To make tentative diagnosis of inflammatory jaw cysts in children




  1. To make tentative diagnosis of inflammatory jaw cysts in adults (as explained in the Operative Dentistry course)




  1. To determine principles of treatment of inflammatory jaw cysts in children.

  1. To determine principles of treatment of inflammatory jaw cysts in adults (as explained in the Operative Dentistry course)





To find out whether your prerequisite knowledge and skills meet the required level we suggest to fulfill the tasks given below (Consult the Key Answers)


Questions for Self-Assessment of Prerequisite Knowledge and Skills


Q- 1. A 23-year-old patient complains of abnormal asymmetry of the face that gradually becomes more and more visible. Anamnesis: 2 years ago chronic periodontitis of tooth 46 was diagnosed, but the patient refused to undergo any treatment. One year ago he noticed extrusion on the lower jaw just in the place of the tooth 46. Sometimes the patient feels pain in tooth 46 during mastication, but after gargling the pain calms down. Tentative diagnosis: radicular cyst of the right part of the lower jaw. Which historic data points to the radicular cyst in this case?

  1. Gradual swelling of the face

  2. Extrusion on the lower jaw in the place of the tooth 46.

  3. Pain relevance due to gargling

  4. Chronic periodontitis of tooth 46

  5. Pain in tooth 46 during mastication


Q- 2. A 42-year–old patient complains of destruction of the mandibular tooth and abnormal asymmetry of the face that gradually becomes more and more visible. Objective examination revealed that the face is asymmetric because of the extrusion in the lower jaw. An extrusion is palpated within the limits of the teeth 36, 37 on vestibular surface of the alveolar outgrowth. Parchment crackling is felt during palpation|положительный|. Palpation is painless, and there is no colour change in oral mucosa. There is deep carious cavity in the tooth 36; teeth | 36, 37 painless to percussion. Which historic data points to the radicular cyst in this case?

1. Gradual swelling of the face

2. Parchment crackling

3. The two teeth being painless to percussion |.

4. Extrusion on the lower jaw

5. Carious cavity in the tooth 46


Q-3. A 35-year–old patient complains of high temperature, and toothache. Objective examination: there is swelling of the tissues of the upper lip, and a painful infiltrate on the vestibular surface of the alveolar outgrowth within the limits of 11, 12, 13 teeth. The tooth| 12 is extremely painful to percussion; the teeth 11, 13 are not painful. There is a deep carious cavity in the tooth 12. X-ray image shows a destruction area around the root apex of the tooth 12 with clear outline, 1.5 сm in diameter. Tentative diagnosis: radicular cysts in stage of exacerbation. Which of the following is the leading sign of the desease in this case?

  1. One-sided infiltrate within the limits of the three teeth

  2. Bad general condition, and high temperature |стан|

  3. Destruction area with clear outline, Destruct1.5 cm in diameter

  4. Swelling of soft tissues of the upper jaw

  5. The teeth 11, 12, 13 being tender to percussion.


Q- 4. A 43-year–old patient complains of tooth destruction. Objective examination: the face is asymmetric because of the extrusion in the upper jaw. A painless extrusion is palpated within the limits of the teeth 25, 26, 27 on the vestibular surface of the alveolar outgrowth. The sign of parchment crackling is present|положительный|. There is a deep carious cavity in the tooth 26, and it is tender to percussion. Tentative diagnosis: radicular cyst. Which of the following investigations should be done to prove the diagnosis?

  1. Contact X-ray examination|

  2. Orthopantomographia

  3. Teeth sensitivity to thermal irritants.

  4. Electroodontodiagnostic

  5. Palpation of lymphatic nodes |



Q-|задача| 5. A patient is 25 years old. Objective examination: temperature is 37.5 °C. An infiltrate is palpated on the vestibular surface of the alveolar outgrowth within the limits of the tooth 36. Tooth 36 is tender to percussion. The roots of the tooth 36 are visible. X-ray shows: a destruction area around the roots of the tooth 36, with clear outline |, 1.5 сm in diameter. Tentative diagnosis: exacerbated radicular cysts. Which historic data allows performing differential diagnosis with chronic exacerbated periodontitis|обострения|?

  1. Destruction of the crown of the tooth 36

  2. Infiltrate in the area of the tooth 36

  3. Tooth 36 being tender to percussion.

  4. X-ray examination data

  5. High temperature


Q- 6. A patient is 30 years old. Objective examination: the face is asymmetric because of swelling of the soft tissues of lower jaw. A painful infiltrate on the vestibular surface of the alveolar outgrowth within the limits of 35, 36, 37 teeth is palpated and they are tender to percussion. There is carious cavity in the tooth 36 that communicates with the pulp cavity. Probe is painless. X-ray image shows a destruction area with clear outline around the roots of the tooth 36, 1.2 сm in diameter. Make a tentative diagnosis.

  1. Exacerbated radicular cyst.

  2. Exacerbation of the chronic periodintitis of the tooth 36

  3. Acute osteomyelitis of the left part of the lower jaw.|слева|

  4. Acute serous inflammatory jaw cysts of the lower jaw

  5. Acute purulent inflammatory jaw cysts of the lower jaw


Q- 7. A 46-year–old patient complains of the destruction of the mandibular tooth. Objective examination: there is a deep carious cavity in tooth 46 that is in contact with the pulp cavity. Probe and percussion are painless. Gingiva in the area of the tooth 46 presents hypertrophy of vascular pattern. X-ray shows a destruction area around the roots of the tooth 46 with clear outline, 1.2 cm in diameter around the roots of tooth 46. Diagnosis: radicular cyst of the lower jaw. Decide on the most suitable treatment plan in the above case.

1. Extraction of the tooth 46

2. Operation of cystotomia |

3. Operation of cystectomia

4. Filling of the roots of the tooth 46

5. Filling of the carious cavity of the tooth 46


Key Answers:

№ 1 – 2

№ 2 – 2, 4

Sources of Information

Required Reading:


  1. Lecture materials on Surgical Dentistry


Recommended Reading:

  1. Jimmy R. Pinkham and others. Pediatric Dentistry: Infancy through Adolescence, 4/e. - 2005. – 750 p.

  2. Mitchell L. and Mitchell D.A. Oxford Handbook of Clinical Dentistry. – Oxford, 2003. – 804 p.


Suggested Reading:

  1. Lecture materials.

  2. Graphs of logical structures.



Theory Topics Addressed by the Practice Activities

  1. Historic data of the odontogenic inflammatory jaw cysts in children of different age.

  2. Clinic of odontogenic inflammatory jaw cysts in children.

  3. The main symptoms and signs of odontogenic inflammatory jaw cysts in children.

  4. Additional methods of investigation of odontogenic inflammatory jaw cysts in children.

  5. Differential diagnosis of odontogenic inflammatory jaw cysts in children.

  6. Treatment of odontogenic inflammatory jaw cysts in children.


^ TARGET TRAINING TASKS

For you to master the material do the following tests yourselves using the recommended sequence of activities.


Q-|задача| 1. A 14-year–old patient complains of abnormal asymmetry of the face that gradually becomes more and more visible Anamnesis: 2 years ago chronic periodontitis of tooth 36 was diagnosed, but the patient refused to undergo any treatment. One year ago he noticed extrusion on the lower jaw just in the place of the tooth 36. Sometimes the patient feels pain in tooth 36 during mastication, but after gargling the pain calms down. Tentative diagnosis: radicular cyst of the left part of the lower jaw. Which historic data points to the radicular cyst in this case?

  1. Gradual swelling of the face

  2. Extrusion on the lower jaw in the place of the tooth 36.

  3. Pain relevance due to gargling

  4. Chronic periodontitis of tooth 36

  5. Pain in tooth 36 during mastication


Q- 2. A 12-year–old patient complains of destruction maxillary tooth. Anamnesis: 2 years ago the patient had a trauma of frontal tooth. Objective examination: tooth 11 is gray in colour, percussion is painless, and tooth mobility II is present. An extrusion is palpated within the limits of the tooth 11, and mucous membrane above it has hypertrophic vascular pattern. Tentative diagnosis: radicular cyst of the upper jaw. Which data of objective examination points to the radicular cyst in this case?

  1. Gray color of tooth 11

  2. Tooth 11 being painless to percussion

  3. Tooth mobility II

  4. An extrusion within the limits of the tooth 11

  5. Hypertrophic vascular pattern of the oral mucosa


Q- 3. A 9-year–old patient complains of destruction of mandibular tooth. Objective examination revealed a deep carious cavity in tooth 75 that communicates with the pulp cavity. Tooth 75 is painless to percussion, and there is tooth mobility II. An extrusion is palpated within the limits of the tooth 75, and mucous membrane above it presents hypertrophy of vascular pattern. Tentative diagnosis: radicular cyst of the lower jaw. Which of the following is the main sign of the radicular cyst in this case?

1. Deep carious cavity in tooth 75

2. Communication of the carious cavity with the pulp cavity

3. Tooth mobility II

4. An extrusion within the limits of the tooth 75,

5. Tooth 75 being painless to percussion|.


Q- 4. A 9-year–old patient complains of tooth destruction. Objective examination: the face is asymmetric because of the extrusion on the upper jaw. A painless extrusion is palpated within the limits of the teeth 25, 26, 27 on the vestibular surface of the alveolar outgrowth. The sign of parchment crackling is present|положительный|.|положительный|. There is deep carious cavity in the tooth 26, and it is tender to percussion. Tentative diagnosis: radicular cyst. Which of the following investigations should be performed to make the diagnosis?

  1. Contact roentgenogram

  2. Orthopantomographia|

  3. Teeth sensitivity to thermal irritants.

  4. Electroodontodiagnostic

  5. Palpation of lymphatic nodes


Q- 5. A child is 8 years old. Objective examination: temperature is 37, 5 °C. An infiltrate is palpated within the limits of the teeth 74, 75 on the vestibular surface of the alveolar outgrowth. Teeth | 74, 75 are tender to percussion. The roots of the teeth 74 are clearly seen. Tooth 75 is intact. X-ray shows a destruction area around the roots of the tooth 74, 1.2 сm in diameter. Tentative diagnosis: exacerbated radicular cysts.

Which data obtained during investigation allows performing differential diagnosis with acute serous inflammatory jaw cysts of the lower jaw?

1. Destruction of crown of the tooth 74

2. Infiltrate in the area of the teeth 74, 75

3. Teeth 74, 75 being tender to percussion.

4. X-ray examination

5. High temperature


Q- 6. A patient is 14 years old. Objective examination: the face is asymmetric because of swelling of the soft tissues of lower jaw. A painful infiltrate on the vestibular surface of the alveolar outgrowth within the limits of 45, 46, 47 teeth is palpated and they are tender to percussion. There is carious cavity in the tooth 46 that communicates with the pulp cavity. X-ray image shows a destruction area with clear outline around the roots of the tooth 46, 1.2 сm in diameter. What is tentative diagnosis in this case?


  1. Exacerbated radicular cyst of the lower jaw

  2. Exacerbation of the chronic periodintitis of the tooth 46

  3. Acute osteomyelitis of the left part of the lower jaw.|слева|

  4. Acute serous inflammatory jaw cysts of the lower jaw

  5. Acute purulent inflammatory jaw cysts of the lower jaw


Q- 7. A 10-year–old patient complains of the destruction of the mandibular tooth. Objective examination revealed a deep carious cavity in tooth 75 that communicates with the pulp cavity. Probe and percussion are painless. Mucous membrane above the tooth 75 has hypertrophic vascular pattern. X-ray image shows: a destruction area around the roots of the tooth 75 with clear outline, 1.2 cm in diameter. The crown of the follicle of the tooth 35 is inside the destruction area. Diagnosis: radicular cyst of the lower jaw. Decide on the most appropriate treatment plan in the above case.

  1. Extraction of the tooth 75 and operation of cystotomia

  2. Extraction of the tooth 75 and operation of cystectomia

  3. Extraction of the follicle of the tooth 35, and operation of cystotomia |

  4. Extraction of the follicle of the tooth 35, and operation of cystectomia

  5. Extraction of the tooth 75 and of the follicle of the tooth 35, and operation of cystotomia |


Key Answers

№ 1 – 2

№ 2 – 4


Practice Activity Guidelines

The Organizing part being completed the process of making assessments of prior-to-practice knowledge and skills by means of test questions takes place. Then the students complete the Exercises for Self-Assessment Purposes, they get patients with odontogenic jaw cysts to examine, take the historic data themselves, perform objective examination, put the obtained data into the clinic chart, distinguish the dominant signs and symptoms of odontogenic jaw cysts, decide on the methods of examination to be performed additionally and make the evaluation of results, make differential diagnosis and decide on the appropriate treatment plan. After these activities the students’ self-progress is checked and the conclusions on the subject matter are made and the students’ answers are corrected Knowledge on the subject is checked by means of final tests. Then conclusions on the subject matter are made and the introductory instructions on a new subject are given.

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Donetsk National Medical University of Maxim Gorky practice activity guidelines iconDonetsk national medical university named by m. Gorky practice activity guidelines
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