Intra-oral Examination Soft Tissues: . evidence of cheek biting on the left side .

scalloping of right and left side of tongue BPE 3 2 3 3 3 3 O Leary plaque Index 58% Intra-oral appearance . Skeletal Class 1 . Class 1 incisal relationship . Class 1 molar relationship . ICP is not equal to RCP . Premature contact in RCP on UL7 . Group function on right and left lateral excursion . Right working side interferences . Right non-working side interferences

Below are learning objectives to be discussed in your case discussion session . Describe how to perform extra-oral diagnostic testing for temporomandibular joint dysfunction syndrome (TMJDS), including palpation of the muscles of mastication . Describe how to perform intra-oral diagnostic testing for TMJDS. . Discuss the clinical presentation, differential diagnosis, risk factors and management of TMJDS. . Describe the basic principles of occlusion and occlusal analysis. Discuss and be able to record in a patient o Intercuspal position o Centric occlusion o Terminal hinge axis o Retruded contact position o Centric relation o Posterior guidance o Anterior guidance (canine guidance, group function) o Working side and working side interferences o Non-working side and non-working side interferences o Posselt s envelope of border movements of the mandible in the sagittal plane o Bennett s border movements of the mandible in the coronal plane . Discuss the impact of receiving a diagnosis of cancer and the effects on daily living of having cancer. . Discuss the oral complications seen in patients who are receiving chemotherapy or radiotherapy. . Discuss the dental management of patients who are receiving chemotherapy or radiotherapy, and supportive advice that can be offered whilst undergoing these treatments. . Have knowledge of the dental implications of the treatments used to treat cancer. . Discuss the epidemiology, aetiology, classification, risk factors, prognosis and

general management of non-oral cancer. . Discuss the importance of early referral of cancer and have knowledge of the

referral systems for biopsy. . Discuss how to ensure follow-up after a referral. Below are ALL the learning objectives for this case. Some are to be covered during your self-directed learning time, as they are topics that have already been visited during Year 1 and Year 2, although you may wish to broaden and deepen your knowledge. Some are covered during the case discussion sessions, others during workshops, plenaries and student led plenaries. Please use your Group WIKI for collaborative learning. . Understand the epidemiology, aetiology, classification and stages, risk factors, presenting features, diagnosis, complications of, prognosis and general management of non-oral cancer. . Understand the importance of early referral for investigation and biopsy of cancer. . Have knowledge of the treatments of non-oral cancer. . Understand the impact of receiving a diagnosis of cancer and the effects on daily living of having cancer. . Understand the oral complications seen in patients who are receiving chemotherapy or radiotherapy. . Understand the dental management of patients who are receiving chemotherapy or radiotherapy, and supportive advice that can be offered whilst undergoing these treatments. . Have knowledge of the oral manifestations and dental management of patients with non-oral cancer. . Understand the epidemiology, aetiology, risk factors, presenting features, diagnosis, prognosis, general and dental management of TMJDS. . Understand occlusion and occlusal analysis.

MAPPING OF LEARNING OUTCOMES WITH PREPARING FOR PRACTICE DOCUMENT CLINICAL Non-oral cancer . 1.1.4 Identify general and systemic disease and explain their relevance to oral health and their impact on clinical treatment . 1.1.7 Describe relevant physiology and discuss its application to patient management . 1.1.9 Describe the properties of relevant drugs and therapeutic agents and discuss their application to patient management . 1.1.13 Explain, evaluate, and apply to clinical practice psychological and sociological concepts and theoretical frameworks of health, illness, behavioural change and disease . 1.7.2 Identify, explain and manage the impact of medical and psychological conditions on the patient . 1.12.3 Identify all stages of malignancy, the aetiology and development of tumours and the importance of early referral for investigation and biopsy TMJDS . 1.1.3 Identify oral diseases and explain their relevance to prevention, diagnosis and treatment . 1.1.5 Explain aetiology and pathogenesis of oral disease . 1.1.6 Identify relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management

. 1.2.1 Obtain, record and interpret a comprehensive and contemporaneous patient history . 1.2.2 Undertake an appropriate systematic intra and extra-oral clinical examination . 1.4.1 Synthesise the full results of the patient s assessment and make clinical judgments as appropriate . 1.4.2 Formulate a differential diagnosis or diagnoses and from there a definitive diagnosis . 1.10.2 Provide patients with comprehensive and accurate preventative education and instruction in a manner which encourages self-care and motivation . 1.14.2 Recognise and manage temporomandibular joint disorders Occlusion . 1.14.1 Assess and manage caries, occlusion and tooth wear COMMUNICATION . 3.2 Recognise the importance of non-verbal communication, including listening skills and barriers to effective communication. . 3.3 Explain and check patients understanding of treatments, options, costs and informed consent and enable patients to make their choice . 4.1 Communicate appropriately with colleagues from dental and other healthcare professions in relation to: -The direct care if individual patients -Oral health promotion -The day to day working of the clinical department/ practice in which the individual works

-The wider contribution which department/ practice makes to dental and healthcare in the surrounding community -Raising concerns when problems arise . 4.4 Communicate appropriately and effectively in professional discussions and transactions within the health and other sectors PROFESSIONALISM . 6.1 Put patients interests first and act to protect them

. 7.2 Recognise and act upon the legal and ethical responsibilities involved in protecting and promoting the health of individual patients MANAGEMENT and LEADERSHIP . 10.1 Put patients interest first and act to protect them . 11.1 Take a patient-centred approach to working with the dental team . 12.1 Recognise and comply with systems and processes to support safe patient care