13. Paediatric Dentistry

Question 1

Trauma 1

1. 2 aims of trauma management in primary dentition
2. 2 aims of trauma management in permanent dentition
3. 8 components of trauma stamp
4. 5 factors that prognosis of injury depends on

Answer 1

1. Preserve integrity of permanent successor and preserve primary tooth where possible
2. Preserve vitality of tooth to allow root maturation and restore crown to prevent occlusal problems
3. Sinus/tender in sulcus, TTP, colour, mobility, displacement, EPT, thermal test (ECl), percussion note, radiographs
4. Root development stage, injury type, presence of infection, time delay between injury and seeking treatment, PDL damage, age of child, degree of displacement, associated injuries

Question 2

Paeds trauma treatment planning

1. 3 types of immediate treatment
2. 2 types of initial treatment
3. 3 types of permanent treatment
4. When to review paeds trauma

Answer 2

1. Adhesive dentine bandage, treat pulp exposure, remove pain, suture lacerations, reduce teeth
2. Pulp treatment, ortho requirements, temporary restoration
3. Apexogenesis/apexification, root filling, coronal restorations
4. 1wk, 1mth, 3mths, 6mths, 12mths, 18mths, 2yrs,

Question 3

Crown fractures

1. 3 types
2. Management of E#
3. Management of ED#
4. 4 things management of EDP# depends on
5. 4 management options for EDP#

Answer 3

1. E#, ED#, EDP#
2. Selective grinding or acid etch tip (AET) replacement with composite
3. Account for fragment, bond fragment (composite bandage), radiographs, sensibility testing, FU and definitive restoration (6-8wks)
4. Size of exposure, delay in seeking treatment, stage of root development, other associated injuries
5. Direct pulp cap, partial (Cvek) pulotomy, full coronal pulpotomy, pulpectomy, conventional RCT, extraction

Question 4

EDP# management

1. 3 indications for direct pulp cap
2. 3 indications for partial pulotomy
3. Stages in partial pulpotomy
4. 3 indications for full coronal pulpotomy
5. Stages in pulpectomy
6. 2 management options for EDP# in non-vital tooth (and indications for each)

Answer 4

1. Vital tooth, open apex, exposure <1mm, injury <24hrs
2. Vital tooth, larger exposure (>1mm), injury >24hrs
3. LA, dam, enlarge access at exposure site, amputate pulp 2-4mm into healthy pulp tissue, arrest bleeding with saline-soaked cotton wool, evaluate haemostasis, nsCaOH, GIC/composite
4. Open apex, exposure >1mm, exposure >24hrs, contaminated exposure, impaired vascularity
5. LA, dam, enlarge access at exposure site, remove roof of pulp chamber, extirpate coronal pulp, extirpate radicular pulp (2-3mm short of EWL), irrigation and shaping (CHX not NaOCl), obturation (ZOE, nsCaOH, iodoform paste), GIC, ssPMC
6. Conventional RCT, pulpctomy ± apical barrier formation/apexification (MTA), extraction

Question 5

Root #

1. 3 types
2. 2 factors prognosis depends on
3. Management of coronal third root #
4. Management of middle third root #
5. Management of apical third root #
6. Management of vertical root #
7. 4 root fracture outcomes

Answer 5

1. Coronal third, middle third, apical third
2. Position of fracture, communication of fracture line with gingival crevice
3. Irrigate and reposition, 12wk flex splint. Often requires RCT/extraction (if obvious communication)
4. Irrigate and reposition, 4wk flex splint. Often requires RCT to fracture line
5. Irrigate, reposition, 4wk flex splint
6. Often XLA
7. Favourable - calcified tissue union across fracture line, CT union across fracture line, calcified and CT union
   Unfavourable - granulation tissue, usually associated with loss of vitality

Question 6

CR#

1. 5 management options for CR# in permanent teeth
2. How should CR# of primary tooth be managed

Answer 6

1. Remove fragment and restore, ortho extrusion of apical portion, surgical extrusion, decoronation, extraction
2. Remove coronal fragments and obvious apical fragments (apical fragment can be left to resorb)

Question 7

Primary trauma associated injuries

Describe how you would manage the following in the primary dentition:

1. Concussion
2. Subluxation
3. Lateral luxation
4. Extrusion
5. Intrusion
6. Avulsion
7. Alveolar bone fracture

Answer 7

1. Observe only
2. Observe only
3. Extract if occlusal interference; allow to reposition spontaneously if no occlusal interference
4. Extract
5. Parallax - if towards developing permanent tooth (lingual) then extract; if not (buccal) then leave to re-erupt. If no progress after 6/12, XLA
6. Radiograph to confirm, do not replants
7. Reposition, 4wk flex splint

Question 8

Primary trauma sequelae

1. List 4 post-trauma complications that can occur after primary trauma that affects primary teeth
2. List 7 post-trauma complications that can occur after primary trauma that affects the permanent successor

Answer 8

1. Discolouration, discolouration and infection, discolouration associated loss of vitality, delayed exfoliation
2. Enamel defects, delayed eruption, odontome formation, abnormal tooth/root morphology, ectopic tooth position, arrest of tooth formation, complete failure to form

Question 9

Permanent trauma associated injuries

Describe how you would manage the following in the primary dentition:

1. Concussion
2. Subluxation
3. Lateral luxation
4. Extrusion
5. Intrusion
6. Avulsion
7. Alveolar bone fracture
8. What does repositioning for intrusion injuries depend upon
9. Give 2 prevention methods for dental trauma
10. Describe first aid advice for an avulsed tooth

Answer 9

1. Monitor and review
2. 2wk flex splint
3. Reposition, 4wk flex splint
4. Reposition, 2wk flex splint
5. If open apex - <7mm allow to reposition spontaneously; >7mm - surgical/ortho alignment
   If closed apex - <3mm allow to reposition spontaneously; 3-7mm ortho/surgical alignment; >7mm - surgical alignment
6. Replant where possible, 2 or 4wk flex splint
7. Reposition, 4wk flex splint
8. Stage of root development (maturity of tooth)
9. Interceptive ortho if OJ >9mm, mouthguard for contact sports
10. Ask if primary/permanent (age of child, what tooth) - if primary then leave; if permanent, handle by crown only, wash off obvious debris, replant immediately and bite on cotton wool/tissue or store in saliva/milk/saline/buccal sulcus if can’t replant, seek immediate dental treatment

Question 10

Replantation

1. Give 3 key features that replantation in cases of avulsion depends upon
2. Give 4 contraindications for replantation after avulsion
3. What do EAT and EADT mean and what should they be if considering replantation
4. Give 4 types of periodontal healing outcomes post-replantation
5. Give 3 types of pulpal healing outcomes post-replantation

Answer 10

1. EAT, EADT, storage medium, pulp viability, time delay in seeking treatment
2. Very immature tooth with EAT >90mins, immunocompromised child, immature lower incisors, other more serious/concerning injuries that required treatment
3. Extra-alveolar time - time out of socket - ideally <60mins
   Extra-alveolar dry time - time out of mouth - ideally <30mins
4. Regeneration, PDL/cemental healing, bony healing (ankylosis), uncontrolled infection
5. Regeneration, controlled necrosis, uncontrolled infection

Question 11

Resorption

1. List 4 types of resorption and describe them

Answer 11

1. External surface - non-progressive. Due to damage to PDL which heals
   External inflammatory - progressive. Initial damage to PDL, maintained by necrotic pulp. RCT required
   External replacement - ankylosis. Initiated by severe PDL and cementum damage, normal repair doensn’t occur. Progressive, bone fuses to dentine
   Internal inflammatory - progressive, initiated by non-vital pulp. Extirpation and nsCaOH required

Question 12

Growth and Development

1. Give 3 dental features at birth
2. Briefly describe the normal feeding development
3. Describe how to perform a knee-to-knee exam

Answer 12

1. Class II, few/no teeth, tongue resting on lower gum pad in contact with lower lip, widely separated gum pads (upper rounded, lower horseshoe)
2. 0-3mths - liquid diet, rhythmic sucking
   4-6mths - munching, more suck/swallow control
   7-9mths - semi-solid diet, mashed, bite, upper lip involvement, chewing, bolus formation
   10-12mths - solid diet, active lip closure, cup drinking, sustained bite
   24mths - mature and integrated feeding pattern
3. Sit opposite parent, knee-to-knee, baby faces parent, lowered onto dentist knee, dentist takes control of head, parent controls arms and legs

Question 13

Tooth Development

1. Give 4 morphological features of primary teeth that distinguishes them from permanent teeth
2. Describe the eruption pattern and eruption dates of primary teeth
3. What is the Leeway space and what is the ideal Leeway space
4. What is the definition of the mixed dentition
5. Describe the eruption pattern and eruption dates of permanent teeth

Answer 13

1. Thinner enamel, larger pulp horns, broad contact points/areas, bulbous crowns, cervical constriction

2. A, B, D, C, E
Central incisor - 4-6mths
Lateral incisor - 7-16mths
First primary molar - 13-19mths
Canine - 16-22mths
Second primary molar 15-33mths

3. The extra mesio-distal space occupied by primary molars which are wider than the permanent premolars that will replace them. Ideally 1.5mm upper and 2.5mm lower
4. From when the first permanent tooth erupts until the last primary tooth exfoliates

5. 6, 1, 2, 4, 5, 3, 7, (8)
Central incisor - 6-7yrs old
Lateral incisor - 7-8yrs old
Canine - 9-11yrs old
First premolar - 10-11yrs old
Second premolar - 10-12yrs old
First molar - 6-7yrs old
Second molar - 12-13yrs old

Question 14

Caries Management 1

1. What are 3 aims of paeds dentistry
2. Give 4 methods of caries detection
3. Give 8 classifications of caries

Answer 14

1. Develop and maintain an intact healthy, functional and aesthetic primary and permanent dentition (as few restored teeth as possible), free from pain and infection (no active caries), positive attitude towards future dental care
2. Direct vision (good light, dry tooth), BW radiographs, FOTI, temporary tooth separation (orthodontic separators)
3. Decalcification, pit and fissure, smooth surface, approximate, ECC, recurrent/secondary, arrested, rampant/widespread gross

Question 15

Caries Management 2

1. List the components involved in caries risk assessment
2. List the components involved in caries risk prevention
3. Define and describe the features of early childhood caries

Answer 15

1. CRA - clinical evidence, dietary habits, social history, fluoride use, plaque control, saliva, medical history
2. CRP - radiographs, FV, F toothpaste, TBI/OHI, diet advice, F supplements, fissure sealants, SF medicines
3. Nursing bottle caries. Due to frequent sugar intake and/or reduced saliva flow. Common reasons include prolonged breastfeeding, overnight use of drinking cups (milk/juice), regular use of sugar-containing medication. Common pattern of attack - upper incisors, first primary molars. Lower incisors are protected by the tongue and saliva. Prevention - DHE regarding breastfeeding, drinking cup use, TBI as well as use of SF meds where possible

Question 16

Early Paeds

1. Give 4 key features of OHI for paeds
2. What are natal teeth and how should they be managed
3. Give 4 methods of fluoride application

Answer 16

1. Smear if <3yrs old, pea-sized if >3yrs old TP on dry brush; start brushing as soon as first tooth erupts; brush twice a day for 2 mins; spit don’t rinse; parent-assisted until 8yrs old; F- MW (225ppmF) where appropriate at another time of the day for children over 7yrs old
2. Usually members of primary dentition, rather than supernumeraries. Should be retained as long as possible. Often mobile and if they interfere with breastfeeding/they are inhalation risk, should be removed (XLA)
3. TP, FV, F- MW, F- supplements,

Question 17

Fluoride

1. What are the different concentrations of fluoride toothpaste and when should they be used
2. What are the different concentrations of fluoride supplements and when should they be used
3. What is the potentially lethal dose of fluoride ingestion
4. What is the probable lethal dose of fluoride ingestion
5. How should fluoride overdose be managed
6. What is fluorosis and how does it appear clinically
7. Give 2 methods for managing fluorosis

Answer 17

1. 1000ppmF (<3yrs old for low risk children)
   1350-1500ppmF (<3yrs old for high risk children; all kids >4yrs old)
   2800ppmF (0.619% NaF TP - high risk kids >10yrs)
   5000ppmF (1.1% NaF TP - high risk individuals >16yrs. Not suitable for kids)
2. 0.25mg/day for kids 0.5-3yrs old
3. 5mg/day for kids 3-6yrs
4. 0mg/day for kids 6yrs +
5. 5mg/kg
6. 15mg/kg
7. <5mg/kg ingested - oral calcium (milk) and observe for a few hrs; >5mg/kg - oral calcium, admit to hospital
8. Long-term excessive consumption of fluoride. Mottled, variable appearance (faint white opacity to severe pitting and discolouration)
9. Micro-abrasion, composite masking, composite veneers

Question 18

Treatment planning

1. Describe a sensible/logical treatment sequence for a new paediatric patient

Answer 18

1. FV, FS, preventive restorations, simple restorations, restorations with LA (not into pulp; uppers before lowers), pulp therapies (uppers before lowers), extractions

Question 19

Caries Management 3

1. Name 2 techniques that can be used to treat caries in primary incisors
2. Give 2 risks of early loss of primary teeth
3. Give 2 risks of early loss of permanent 6s
4. Give 3 materials that can be used to restore primary molar teeth

Answer 19

1. Interproximal discing, strip crowns
2. Increased tendency for space loss, increased risk of crowding
3. Rotation and mesial movement of 7s, distal drift of 5s
4. Composite, GIC, RMGIC, compomer, stainless steel crown

Question 20

Fissure Sealants

1. Give 2 management options for stained/suspicious fissures
2. What are fissure sealants and why are they used
3. Give 3 indications for placing fissure sealants
4. What teeth should be fissure sealed
5. Describe the process of applying a fissure sealant
6. Name 2 materials used for fissure sealants
7. From Q6, choose the worst material, give 2 indications and 1 reason why it is second choice

Answer 20

1. FS, PRR, caries removal and monitor
2. Materials that provide an impervious barrier to the fissure system to prevent development of caries. Used to seal fissures and puts and prevent food getting caught in them and causing decay
3. High caries risk children, children with impairments (mental/physical), medically compromised children
4. 4s, 5s, 6s, 7s (rarely cingulum pits of 1s/2s)
5. Clean tooth (prophy paste), isolate and dry (dam, dry guard, cotton wool, saliva ejector), etch tooth for 30s, wash etch off, re-isolate and dry, apply FS (with excavator/microbrush), cure for 30s, check placement (attempt to dislodge with sharp probe)
6. Bis-GMA (resin), GIC
7. GIC - poor moisture control (partially erupted), pre-cooperative child. Poor retention

Question 21

Traditional Stainless Steel Crowns

1. Give 2 indications for using traditional ssPMCs
2. Describe the process of placing a ssPMC using the traditional technique
3. Name and describe 3 common problems with using this method

Answer 21

1. > 2 surfaces affected, pulp therapies, developmental defects, fractured primary molars
2. Occlusal, approximate and peripheral reduction, cement crown with GIC
3. Rocking - cervical margin >1mm beyond max curvature
   Canting - due to uneven occlusal reduction
   Loss of space - due to extensive caries, causing square (not rectangular) prep

Question 22

Hall Technique Crown

1. Describe this technique and why it is useful
2. Give 2 indications for using this technique
3. Describe this procedure
4. Give 4 reasons for failure (2 major, 2 minor) of primary restorations

Answer 22

1. No caries removal and doesn’t require LA or tooth prep. Seals caries in until tooth exfoiliates
2. Asymptomatic, no clinical/radiographic signs of pulpal involvement
3. Place ortho separators (3-5 days before Rx), remove separators, select crown, fit with GIC (partially seat until contact point engaged, ask patient to bite into place - cotton wool on occlusal surface), remove extruded GIC
4. Major - irreversible pulpitis, abscess, interradicular radiolucency, restoration lost and tooth unrestorable
   Minor - secondary caries, restoration lost and requiring intervention, restoration lost and tooth restorable, reversible pulpitis not requiring pulp therapy or extraction

Question 23

Pulp Therapy

1. Give 3 disadvantages of extractions (3 advantages of pulp Rx)
2. Give 4 indications for pulp Rx
3. Give 3 contraindications for pulp Rx
4. Give 3 signs of pulpal involvement
5. Name 3 types of pulp therapy that can be used to restore carious primary teeth

Answer 23

1. Loss of space, reduced function, impeded speech development, trauma from anaesthesia, psychological trauma
2. Good cooperation and motivation, patient appropriate age (<9yrs old, cooperative), good attendance, MH precludes extraction (bleeding disorders), ortho considerations (space maintenance, absent successor)
3. Poor cooperation and motivation, poor attendance, tooth close to exfoliation, MH precludes pulp Rx (immunocompromised, cardiac defect), multiple grossly carious teeth, advanced root resorption, severe/recurrent pain or infection, unrestorable tooth
4. Marginal ridge breakdown, symptomatic (TTP, mobile, buccal swelling/sinus), interradicular radiolucency
5. Indirect pulp treatment, pulpotomy, pulpectomy

Question 24

Indirect Pulp Treatments

1. Give 2 indications for this technique
2. Describe the procedure

Answer 24

1. Asymptomatic vital teeth, no pulpal exposure

2. Remove soft caries (leave hard caries), place setting CaOH, restore tooth (GIC + composite/ssPMC)

Question 25

Pulpotomies 1. What are the 3 aims of pulpotomies 2. Give 3 indications for pulpotomies 3. Describe the technique 4. What are 2 features of a non-inflamed pulp during bleeding evaluation 5. What are 2 features of an inflamed pulp during bleeding evaluation and how should you proceed

Answer 25

1. Stop/control bleeding, disinfect tooth, perversive vitality of the apical portion of the radicular pulp 2. Carious/traumatic exposure of bleeding pulp, marginal pulpal inflammation, reversible pulpitis, caries extending >2/3 into dentine radiographically 3. LA, dam, access cavity and caries removal, removal of roof of pulp chamber, amputate coronal pulp (slow speed/excavator), arrest bleeding (saline-soaked cotton wool), apply pledget soaked in ferric sulphate for 20s and assess bleeding, ZOE/CaOH/MTA dressing, restoration (GIC, ssPMC) 4. Good haemostasis, bright red colour 5. Poor haemostasis, deep crimson colour; pulpectomy/XLA. Apply temporary dressing before next appt

Question 26

Pulpectomies 1. What is the aim of pulpectomy 2. Give 2 indications 3. Describe the technique 4. When might a pulpectomy be treated in two steps 5. Give 3 clinical and 2 radiological signs of pulp treatment failure

Answer 26

1. Prevent/control infection by extirpation of radicular pulp, followed by cleaning and obturation of the canals 2. Hyperaemic pulp during pulpotomy haemostasis evaluation, irreversible pulpitis, pulp necrosis and furcation involvement, PA periodontitis, chronic sinus 3. LA, dam, enlarge access at exposure site, remove roof of pulp chamber, extirpate coronal pulp, extirpate radicular pulp (2-3mm short of EWL), irrigation and shaping (CHX not NaOCl), obturation (ZOE, nsCaOH, iodoform paste), GIC, ssPMC 4. Evidence of infection (use nsCaOH as inter-appointment dressing/medicament) 5. Clinical - pathological mobility, fistula/chronic sinus, early exfoliation, pain Radiographic - increased radiolucency, root resorption, furcation bone loss

Question 27

Paediatric Periodontics 1. Describe the simplified BPE, when it would be used and how they would be managed 2. Describe the plaque score

Answer 27

1. Simplified BPE - for children 7-11yrs old 0 - healthy (none) 1 - bleeding on gentle probing (OHI and prevention) 2 - calculus or PRFs (OHI, prevention and removal of PRFs) 2. Used to assess patient's oral hygiene. Measured in each sextant 10/10 - perfectly clean tooth 8/10 - line of plaque around cervical margin 6/10 - plaque covering cervical third of crown 4/10 - plaque covering cervical 2/3s of crown

Question 28

Behaviour Management 1. What is the aim of behaviour management 2. What is the definition of dental fear 3. What is the definition of dental anxiety 4. What is the definition of dental phobia 5. Describe 5 behaviour management strategies 6. Give 3 factors which influence a child's behaviour 7. Give 5 signs of dental fear and anxiety

Answer 28

1. To ease fear and anxiety, improve cooperation and promote understanding of the need for good dental health 2. A normal emotional response to objects/situations perceived as genuinely threatening 3. Occurs without a triggering stimulus present and may be due to unknown danger/previous negative experiences 4. A clinical mental disorder that interferes with daily life. Subjects display persistent/extreme fear of objects and/or situations and may demonstrate avoidance behaviour. 5. Positive reinforcement (praise good behaviour) Tell-show-do (explain what you will be doing, show the child the instruments, etc., perform procedure on child) Shaping (aim to guide and modify child’s responses using selective reinforcement) Acclimatisation (planned, sequential introduction of environment, people, instruments and procedures) Desensitisation (gradual exposure to new stimuli or experiences of increasing intensity) Distraction, role modelling, relaxation/hypnosis/CBT 6. Understanding, emotional development, previous adverse dental/medical experiences, attitudes and previous experiences of family/peers, behaviour of the dental team 7. Thumb-sucking, nail-biting, nose-picking, fidgeting, clumsiness, stuttering, hiding, dizziness, stomach pain, headache, needing toilet, asking questions

Question 29

General Anaesthesia 1. What is the definition of GA 2. What are 3 aims of GA in dentistry 3 What are the stages of GA 4. 5 advantages of GA 5. 5 disadvantages of GA 6. 5 indications for GA 7. 5 contraindications for GA

Answer 29

1. Any technique (using equipment or drugs) which produces a loss of consciousness and/or abolition of protective reflexes in specific situations associated with medical or surgical interventions 2. Atraumatic induction, completion of comprehensive dental treatment, elimination of pain and infection, establish basis for continued preventive care, short and uncomplicated recovery 3. Induction, excitement, surgical anaesthesia, respiratory paralysis/overdose 4. Patient completely still, improved access and vision, multiple procedures can be undertaken, no response to pain, rapid onset of action 5. Death, brain damage, coma, cost (anaesthetic team, equipment), location (must have immediate access to ICU/PICU), minor risks associated with GA (pain, headache, vomiting, nausea, drowsiness), future outlook to dentistry (does not address DFA), treatment side effects (pain, bleeding, swelling, bruising) 6. Child pre-cooperative, extensive treatment required, patients required to be completely still, severe anxiety levels, surgical drainage of acute infected swelling (abscess), established allergy to LA 7. ASA IV and certain ASA III patients, lack of adequate facilities, lack of adequate equipment, lack of adequately trained personnel and staff, malignant hyperpyrexia

Question 30

Child Protection 1 1. Definition of child protection 2. Definition of safeguarding 3. Definition of child abuse and neglect 4. Child abuse and neglect triad 5. Name 4 types of abuse 6. What are 4 key markers of general neglect 7. Why might neglect of neglect occur

Answer 30

1. Any activity undertaken to protect specific children who are suffering, or at risk of suffering, significant harm 2. Any measure taken to minimise the risks of harm to children 3. Anything which those entrusted with the care of children do, or fail to do, which damages their prospects of safe and healthy development into adulthood 4. Significant harm to child, carer has some responsibility for harm caused, significant connection between carer's responsibility for child and the harm caused to the child 5. Physical, emotional, neglect, sexual, non-organic failure to thrive 6. Failure to thrive, short stature, developmental delay, inappropriate clothing, cold injury, sunburn, ingrained dirt (fingernails), head lice, rampant caries, withdrawn or attention-seeking behaviour 7. Neglect is less incidence-focussed and so there is less shared understanding of what is meant by neglect and how it should be responded to

Question 31

Child Protection 2 1. What is the key piece of legislation associated with child protection and safeguarding in Scotland 2. What are the SHANARRI indicators 3. Give 3 examples of a vulnerable child 4. Give 4 contributing factors in cases of child abuse and neglect 5. Give 3 short-term and 3 long-term consequences of child abuse and neglect

Answer 31

1. Children and Young People's Act (Scotland) 2014 2. Safe, healthy, achieving, nurtured, active, respected, responsible, included 3. <5yrs old, irregular dental attender, medical problems, mental and/or physical disabilities, children in care 4. Drugs, alcohol, poverty, mental illness, domestic abuse, unrealistic expectations, crying, soiling, disability, unwanted, failure to live up to expectations, wrong gender, neighbourhood, housing conditions, intergenerational violence, violence towards pets, social isolation 5. Short-term - physical health, emotional health, social development, cognitive development Long-term - arrest, suicide attempts, major depression, diabetes, heart disease

Question 32

Child Protection 3 1. What are 5 components of the index of suspicion 2. What % of serious head injuries in children <1 are non-accidental 3. What % of abuse-type injuries are to the head and neck 4. What is the definition of dental neglect 5. What is the definition of wilful neglect 6. What are the 3 components to managing dental neglect 7. What are the 4 expectations of the dental team when faced with a case of suspected child abuse 8. Give 3 IO and EO signs of abuse

Answer 32

1. Delay in seeking help/treatment without good reasons, vague story of incident lacking in detail and varying with each telling and person, account not compatible with injury, abnormal parent mood (preoccupied, detached, concerning), abnormal child/parent interaction, child may say something contradictory, history of previous violence and/or violence within the family 2. 95% 3. 60% 4. The persistent failure to meet a child's basic oral health needs, to the extent that this is likely to result in the serious impairment of a child's oral or general health or development 5. Failure to complete treatment after problems/dental neglect is pointed out 6. Preventive dental team management, preventive multi-agency management, child protection referral 7. Observe, record, communicate, refer for assessment 8. IO - contusions, bruises, abrasions, lacerations, burns, tooth trauma, frenal injuries EO - facial bruising (ears, triangle of safety), pinch/slap/punch marks, bilateral injuries, burns and bites, choking marks, eye injuries

Question 33

MIH 1. What is this and what does it affect 2. Give 3 clinical problems associated with MIH 3. Give 3 important periods of enquiry associated with MIH and give 3 questions for each period of enquiry 4. Give 3 treatment options for MIH-affected molars 5. Give 3 treatment options for MIH-affected incisors 6. What is the difference between enamel hypomineralisation and hypoplasia 7. How common is it

Answer 33

1. Hypomineralisation of systemic origin. Usually affects 1-4 permanent molars and is frequently associated with affected incisors 2. Sensitivity, poor aesthetics, loss of tooth substance 3. Pre-natal (pre-eclampsia, gestational diabetes, syphilis), natal/neonatal (full-term, birth trauma, prolonged/premature delivery, SCBU/NICU involvement), post-natal (<2yrs - respiratory disease, measles, rubella, varicella, CHD, fluoride intake, nutrition) 4. Composite restorations, SSC, extractions 5. Acid pumice micro abrasion, external bleaching, composite masking, veneers 6. Hypomineralisation - enamel formed is of normal thickness but less mineralised Hypoplasia - enamel formed is thinner but correctly mineralised (true or acquired) 7. 10-20%

Question 34

Hypodontia 1. What is the definition 2. What is the definition of anodontia 3. How common is it in primary dentition 4. How common in permanent dentition 5. What 3 teeth are most commonly affected 6. Give 4 other problems associated with hypodontia 7. Give 3 conditions that hypodontia can be associated with 8. Give 3 management options for hypodontia

Answer 34

1. Developmental absence of one/more teeth 2. Absence of all teeth 3. 3.5-6.5% 4. 0.1-0.9% 5. Third molars, lower 4s, upper 2s 6. Microdontia, peg-shaped upper 2 in absence of contralateral upper 2, abnormal shape and form, spacing, infra-occlusion, deep overbite, reduced LFH 7. Cleft palate, Downs syndrome, ectodermal dysplasia, Hurler's syndrome, incontinentia pigmentii 8. Nothing, space closure (ortho), overdenture, partial denture, composite masking, veneers, fixed pros (bridge, implants)

Question 35

Supernumeraries 1. What is the definition 2. How common are they 3. Where do they commonly occur 4. In the permanent dentition, what are supernumeraries the most common cause of 5. What are 4 types of supernumeraries 6. Give the descriptive term for the 3 positions of supernumeraries 7. Give 2 management options 8. Give 2 conditions supernumeraries may be associated with

Answer 35

1. Extra teeth in addition to the normal series 2. 1.5-3.5% 3. Premaxillary region 4. Delayed eruption of permanent incisors 5. Conical, tuberculate, supplemental, odontome 6. Mesiodens, distomolar, paramolar 7. KUO if not affecting permanent dentition eruption; XLA if erupting/interfering with eruption of permanent teeth 8. Cleft lip and palate, cleidocranial dysostosis (CCD)

Question 36

Anomalies of shape and size 1. Name 6 types of anomalies of shape and size 2. What is microdontia and how common is it 3. What teeth does it commonly affect 4. What is the main complaint with microdontia 5. What is macrodontia and how common is it 6. What is generalised macrodontia associated with 7. How common and double teeth and what are the 2 types 8. Give 1 clinical and 1 radiographic feature of taurodontism 9. What is a dilaceration, what is the most common cause and what tooth is most common affected 10. Give 3 treatment options for dilacerations 11. What is dens in dente and how should it be managed

Answer 36

1. Microdontia, macrodontia, double teeth, odontomes, taurodontism, dilaceration, accessory cusps 2. Tooth that is smaller than normal. 2.5% permanent, <0.5% primary 3. U2, U8 4. Often aesthetics, as spacing will be apparent 5. A tooth that is larger than normal. 1% 6. Hemifacial hypertrophy 7. <0.2%; gemination (one tooth appears to split into 2) and fusion (where 2 teeth appear to fuse into 1) 8. Bull-like appearance, radiographic elongation of pulp chamber 9. Distorted crowns or roots (bend in crown/root). Traumatic intrusion of primary incisor into developing permanent tooth germ. Upper central incisors 10. Crown exposure, ortho alignment, XLA 1. 'Tooth inside a tooth'. Fissure seal ASAP, difficult to root treat so often require extraction

Question 37

Root structure anomalies 1. Give 2 reasons for root structure anomalies

Answer 37

1. Short root anomaly, radiotherapy, dentine dysplasia, accessory roots

Question 38

Enamel structure anomalies 1. What are 3 groups of enamel structure anomalies 2. What are 3 periods of inquiry related to generalised environmental/developmental enamel defects similar to MIH 3. Name 4 systemic diseases associated with enamel defects 4. What is Turner tooth

Answer 38

1. AI, environmental enamel hypoplasia (systemic, nutritional, metabolic, infection), localised enamel hypoplasia (trauma, primary tooth infection - Turner tooth) 2. Prenatal (rubella, congenital syphilis, cardiac and kidney disease, gestational diabetes, pre-eclampsia), natal/neonatal (prematurity, meningitis), postnatal (otitis media, measles, varicella, TB, respiratory disease, CHD, vitamin deficiencies) 3. Downs syndrome, Prader-Willi syndrome, epidermolysis bulls, porphyria, Hurler's syndrome, tuberous sclerosis, incontinentia pigmentii, pseudohypoparathyroidism 4. Infection of primary tooth leads to a disturbance in enamel and dentine formation of the permanent tooth

Question 39

AI 1. What are the 4 types of AI 2. How does AI appear radiographically 3. Is AI genetic/environmental/both 4. Name 3 genes associated with AI 5. List 5 problems associated with AI 6. Give 4 management options for AI

Answer 39

1. Hypoplastic, hypocalcified (hypomineralsied), hypomaturational, mixed forms 2. No contrast between dentine and enamel 3. Genetic - familial inheritence 4. AMELX, ENAM, KLK4, MMP20 5. Sensitivity, poor aesthetics, caries susceptibility, poor OH, delayed eruption, AOB 6. Preventive therapy (FS), composite veneers, composite masking, indirect restorations (inlays), SSC, ortho

Question 40

Dentine structure anomalies 1. Name 4 anomalies of dentine structure 2. How many types of dentine dysplasia are there 3. List 3 general disorders that some hereditary dentine defects can be associated with 4. What is odontodysplasia and how do affected teeth appear

Answer 40

1. DI, dentine dysplasia, odontodysplasia, systemic disturbance (nutritional, metabolic, drugs) 2. Type I and type II 3. Osteogenesis imperfecta, Ehlers-Danlos syndrome, vit D resistant rickets, hypophosphatasia, brachio-skeletal genital syndrome 4. Localised arrest in tooth development. Thin layers of enamel and dentine, large pulp chambers - 'ghost teeth'

Question 41

DI 1. What are the 3 types of DI and what are they associated with 2. Give 3 clinical features and 1 radiographic feature of DI 3. Give 3 problems associated with DI 4. Give 3 management options for DI

Answer 41

1. Type I - associated with OI, blue sclera Type II - AD, limited to teeth only Type III - Bradywine 2. Clinical - opalescent blue/brown hie, bulbous crowns, short roots, narrow flame-shaped obliterated pulps, abnormal ADJ Radiographic - pulp chambers almost indistinct, no contrast between dentine and pulp 3. Aesthetics, caries susceptibility, spontaneous abscess, poor prognosis 4. Preventive, composite veneers, overdentures, composite masking, removable prostheses, SSC

Question 42

Cementum structure anomalies 1. What are 2 systemic disorders associated with anomalies of cementum structure 2. Give 3 causes of hypercementosis 3. What is the definition of concrescence

Answer 42

1. Cleidocranial dysplasia, hypophosphatasia 2. Response to inflammation, mechanical stimulation, Paget's disease, idiopathic 3. Uniting of the roots of 2 teeth by cementum

Question 43

Tooth eruption and exfoliation 1. What 3 things is premature tooth eruption associated with 2. What 3 things is delayed tooth eruption associated with 3. Give 4 reasons for premature exfoliation 4. Give 4 reasons for delayed exfoliation 5. What are infra-occluded teeth, how common are they and which tooth is most commonly infra-occluded 6. What is infra-occlusion commonly associated with 7. How should infra-occluded teeth be managed

Answer 43

1. High birth weight, precocious puberty, natal/neonatal teeth 2. Pre-term birth, low birth weight, malnutrition, gingival hyperplasia/overgrowth, associated systemic disorders (downs, hypothyroidism, hypopituitarism, cleidocranial dysplasia) 3. Trauma, primary tooth pulpotomy, hypophosphatasia, immunological deficiency (cyclic neutropenia), histiocytosis, Chediak-Higashi syndrome 4. Infra-occlusion, double primary teeth, hypodontia, ectopic permanent successors, trauma 5. Teeth that become ankylosed (fused) to the bone and appear to sink towards the gingiva (submerging teeth) - they don't grow but everything else grows around them. 1-9%. Commonly L5 6. Congenital absence of the permanent successor 7. Usually exfoliate (around 11-12yrs) but not uncommon for them to be retained into adulthood. Retain as long as possible, extract when 1mm of crown showing supragingivally