CDS Paediatric Dentistry Flashcards

(180 cards)

1
Q

Before commencing tx for discolouration, it is necessary to have …. (4)

A

An accurate diagnosis of the cause
Specialist led treatment plan
Informed consent
Pre-operative records

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2
Q

To ensure informed consent for tx of discolouration in children

A

Discuss all risks and benefits
Give written information
Discuss with pt and family that it will require maintenance in general practice, at a cost
Child or young person involved or leading, depending on age
Children receiving this tx should be at or nearing age of Gillick competence

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3
Q

Gillick competence

A

Refers to a young person under 16 with the capacity to make any relevant decision, and is used to assess whether a child is mature enough to consent to treatment

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4
Q

Considerations when determining Gillick competence

A

Child’s age, maturity and mental capacity
Their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact
Their understanding of the risks, implications and consequences that may arise from their decicion
How well they understand any advice or information that have been given
Their understanding of any alternative options, if available
Their ability to explain a rationale around their reasoning and decision making

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5
Q

If a young person is being pressured or influenced by someone else

A

Their consent is not valid

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6
Q

Pre-op records for discoloured teeth

A

Standardisation of recording of aesthetic procedures - SHADE sheet
Clinical photos
Shade
Sensibility testing
Check for sensitivity
Diagram of defect - can be drawn on SHADE sheet
Radiographs if clinically indicated
Pt assessment - visual analogue scale etc, pt can tell how they feel discolouration is affecting their teeth

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7
Q

Treatment options for discolouration

A

Enamel microabrasion
Bleaching
Resin infiltration
Localised composite restoration
Veneers
Do nothing

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8
Q

Bleaching for discolouration types

A

Vital - provided in surgery or at home
Non-vital teeth - inside outside technique or walking bleach technique

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9
Q

Direct vs indirect veneers

A

Direct are free hand/putty guide
Indirect are lab made

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10
Q

When would discolouration be left untreated?

A

If pt doesn’t have any concerns then there is little indication to proceed with tx, even under parental pressure

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11
Q

Microabrasion

A

Removal of the surface layer of opaque enamel

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12
Q

Advantages of microabrasion

A

Easily performed
Conservative
Inexpensive
Teeth need minimal subsequent maintenance
Fast acting
Removes yellow/brown, white and multi-coloured stains
Effective
Results are permanent

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13
Q

Disadvantages of microabrasion

A

Removes enamel
Sensitivity
Teeth may become more susceptible to staining
HCl acid compounds are caustic
Required ppe for pt, dentist, nurse
Prediction of outcome difficult, could appear more yellow as normal dentine colour revealed
Must be done in surgery
Cannot be delegated to another member of dental team

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14
Q

Prior to starting microabrasion clinical technique

A

PPE - patient and team, glasses, bibs etc
Clean teeth with pumice and water
Protect soft tissue - petroleum jelly, rubber dam
Rubber dam - essential to isolate anterior teeth
Sodium bicarbonate guard for gingival protection

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15
Q

Maximum microabrasion

A

10 x 5 second bursts

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16
Q

Why is it important to review repeatedly during microabrasion?

A

Check shade
Check shape - stop if tooth starts looking flattened or if desired colour achieved

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17
Q

Tx following microabrasion

A

Follow with fluoride varnish to help with remineralisation
Important to use a white FV such as profluorid or clinpro
Polish with finest sandpaper disc
Polish with toothpaste

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18
Q

Why is duraphat unsuitable after microabrasion?

A

May introduce a yellow stain

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19
Q

Why do we polish with fine sandpaper disc after microabrasion?

A

Polishing changes the optical properties of the enamel so that areas of intrinsic discolouration become less perceptible
Makes it less obvious where the defect was

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20
Q

Enamel loss when using prophy with toothpaste

A

5-10 microns

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21
Q

Enamel loss using prophy with pumice

A

5-50 microns

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22
Q

Enamel loss ortho bracket bonding/debonding

A

5-50 microns

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23
Q

Enamel loss acid etch

A

10 microns

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24
Q

Enamel loss 10 x 5 second HCl pumice miroabrasion

A

100 microns

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25
Opalustre by Ultradent
Purple syringes of 6.6% HCl and silicon carbide particles in water soluble paste, comes with specialised rubber cups with bristles
26
Prema kit
10% HCl in a preparation of fine grit silicon carbide particles in water soluble paste
27
Advice after microabrasion
Teeth are dehydrated Warn pt to avoid highly coloured food and drinks for at least 24hr, recommend up to a week "Anything that would stain a white t shirt"
28
Review for microabrasion
Review pt 4-6 weeks after and take post op photographs
29
How many cycles of microabrasion can be done?
A second can be offered but only if some improvement is seen from the first
30
GDC 2014 guidance on bleaching in children
Products containing or releasing between 0.1% and 6% hydrogen peroxide can not be used on under 18s except where intended wholly for the treatment or prevention of disease This includes discolouration due to hypomineralisation, trauma, fluorosis
31
Vital bleaching options
Chairside - power bleaching Night guard vital bleaching at home
32
Non-vital bleaching options
Inside outside technique Walking bleach technique
33
Bleaching only externally on a non vital tooth
Not very effective
34
Important thing to tell potential bleaching pts
Results are not permanent
35
Chemical for chairside bleaching
Unstable, rapidly reacting hydrogen peroxide Usually 15-38% (equivalent to 75% carbamide peroxide) This has greater risk to soft tissues and eyes Greater risk of sensitivity and this is more expensive
36
Chemical for nightguard vital bleaching
10% carbamide peroxide
37
Where would you cute windows in trays for nightguard vital bleaching?
Teeth you don't wish to bleach
38
Which teeth would you want to avoid bleaching in nightguard vital bleaching?
Veneers Teeth with caries
39
Why is important to have no gingival coverage in night guards for bleaching?
To avoid damage to gingivae and soft tissue
40
Instructions to pt given with night guard vital bleaching
Give written leaflet Brush teeth thoroughly Apply a little gel to tray Set over teeth and press down Remove excess Rinse gently, do not swallow Wear overnight (or at least 2 hours) Remove, brush with toothpaste and rinse with cold water Sensitive toothpaste may be required, or tooth mousse for more severe sensitivity
41
Advice for sensitivity
Sensitive toothpaste - can apply topically Tooth mousse
42
Timescale for night guard vital bleaching
3-6 weeks Keep going until acceptable colour
43
When should composite restorative work be done in relation to bleaching?
Leave for 2 weeks after bleaching to allow shade to settle before shade matching
44
Side effects of tooth bleaching
Tooth sensitivity is common - 15-65% Gingival irritation - more common in higher concentrations
45
Tooth sensitivity and bleaching
Common in adults 15-65% Sensitivity is related to the easy passage of hydrogen peroxide through intact enamel and dentine, reaching pulp in 5 to 15 min Tooth sensitivity considered relatively minor in adolescents than in adults This sensitivity is usually manageable
46
Why is sensitivity thought to be less of a problem for adolescent pts than in adults?
Could be due to increased enamel quality and quantity of the adolescent teeth and to larger pulp complexes allowing faster recovery from the acute inflammation experienced during a sensitivity episode
47
Carbamide peroxide bleach reaction
10% carbamide peroxide converts to 3% hydrogen peroxide, 7% urea, then becomes water, ammonia and CO2
48
Important information for pts with white lesions considering bleaching
White areas could get whiter
49
Advantages of non vital bleaching
Simple Tooth conserving - compared with crown/veneer Original tooth morphology maintained Gingival tissues not irritated by restoration Adolescent gingival level is not mature until around age 17, so may in future affect any restorations No lab assistance required for walking bleach
50
Tooth selection for non-vital bleaching
Adequate root filling - assess with PA - No clinical disease - No radiological disease Anterior teeth without large restorationes Not amalgam or intrinsic discolouration Not fluorosis or tetracycline discolouratione
51
Walking bleach method
Oxidising process allowed to proceed gradually over days Access cavity GP removed at least to CEJ Clean out with ultrasonic Bleaching agent placed on cotton pellet into the cavity Covered with a dry cotton pellet Seal with GIC/RMGIC Renew bleach - ideally no more than 2 weeks between appts If no change after 3-4 renewals, stop 6-10 changes total
52
Inside outside bleaching process
Access cavity Do not necessarily need GI lining, can be helpful Custom made mouthguard with windows cut of teeth not to be bleached Pt applies bleaching agent to back of tooth and tray Pt keeps access cavity clean, replacing gel, removing food debris 10% carbamide peroxide Worn all the time except cleaning and eating Gel changed every 2 hours except during the night Stop when tooth shade same as those around it, usually 3-4 days, or 48 hours before next appt, contact dentist if shade not correct at this time
53
Restoration of the pulp chamber of discoloured tooth after bleaching
Non setting CaOH paste placed for 2 weeks, sealed in with GIC then either 1. White GP and composite resin, facility to re-bleach 2. Incrementally cured composite - no re-bleaching but stronger tooth If regression - veneer or crown prep
54
Potential complications of non-vital bleaching
External cervical resorption Spillage of bleaching agents Failure to bleach Over bleach Brittleness of tooth crown
55
Prevention of external cervical resorption when non-vital bleaching
Layer of cement over GP - prevents bleaching agent from getting to external surface of root (not for inside outside technique), can prevent adequate bleaching of cervical area Non-setting CaOH in tooth for 2 week before final restoration - reverses any acidity that might have occurred if above had happened
56
Effects of bleach on soft tissue - short term vs long term exposure
Short term Minor ulceration/irritation Plaque reduction Aids wound healing Long term ?Delayed wound healing ? Periodontal harm ?Mutagenic potential
57
Tooth mousse used as an adjunct to microabrasion
After microabrasion for 4 weeks home application (pea sized amount before bed) helps improve lesion but also with sensitivity Evidence not great
58
Tooth mousse as adjunct to bleaching
2 weeks home application, rub on or in trays Poorly demarcated hypomineralised lesions, mild to moderate fluorosis Evidence not great
59
Medical history consideration for tooth mousse
Recaldent CPP-ACP (casein phosphopeptide - amorphous calcium phosphate) milk derived protein, careful if allergic
60
Resin infiltration
Infiltration of enamel lesions with low viscosity light curing resins Surface layer is eroded, lesion desiccated and resin infiltrant applied Resin penetrates the lesion, driven by capillary forces Infiltrated lesions lose their discoloured appearance and look similar to sound enamel
61
Step by step ICON resin infiltration
1 Pretreatment - rinse and clean teeth 2 Apply etch 3 Rub in etch gel to surfaces of the teeth 4 Let it act for 2 min 5 Rinse 6 Apply icon-dry and let act 30 seconds 7 Visual inspection - is lesion accessible If no repeat steps 2-7 If yes - apply icon-infiltrant to tooth surface and let act 3 min Remove excess material Light cure 40 secs Second infiltration to compensate for polymerisation shrinkage Polis
62
To reduce enamel or not for veneers - considerations
Aesthetics Relative tooth position - in line? out of line of the arch? Masking dark stain - may require thicker composite Age Psyche Plaque removal
63
Enamel reduction for veneers
If tooth is overcontoured by build up of lots of composite - increases plaque retention and stagnation at the gingival margin, especially those with poor OH Bond strength of composite resin to enamel is significantly increased after partial removal of buccal enamel
64
Dental anomalies can affect (4)
Number Size and shape Structure - hard tissue defects Eruption and exfoliation
65
Hypodontia
Less than normal number of teeth
66
Most common missing teeth
3rd molars 9-37% of population have more than one 3rd molar missing Mandibular premolars - 1.2-2.5% Maxillary lateral incisors 1-2%
67
More common dentition for hypodontia
Permanent 3.5-6.5% (primary 0.1-0.9%)
68
Teeth least likely to be missing
First permanent molars and upper central incisors Canines not commonly missing
69
What does Celtic canines refer to?
More common missing canines in Ireland and West of Scotland than the rest of the world
70
Pattern of teeth more likely to be missing
Last in its series eg. third molar, second premolar EXCEPT lower centrals more than lower laterals, as they are genetically coded after
71
Conditions associated with hypodontia
Ectodermal dysplasia Down syndrome Hurler's syndrome Cleft palate Incontinentia pigmentii
72
Tx for hypodontia
Dentures, overdentures or bridges, depending on age of the pt
73
Problem associated with hypodontia in the upper arch
Over eruption of lower canines
74
Another common dental feature associated with hypodontia
Small teeth
75
Premature exfoliation causes
Trauma Following pulpotomy Hypophosphatasia Immunological deficiency e.g. cyclic neutropenia Chediak-Higashi syndrome Histiocytosis X
76
Delayed exfoliation causes
Infra-occlusion 1-9%, usually first primary molar, common if congenital absence of premolar, majority exfoliate by age 11-12 Double primary teeth Hypodontia Ectopic permanent syccessor Following trauma
77
Why would natal/neonatal teeth be extracted?
Inhalation risk Problems feeding
78
Chronology of dental management of hypodontia
Diagnosed - small children Removeable prosthesis - waiting to do something more definitive, mixed dentition Bridgework for missing laterals, orthodontics, composite build ups - teen years Composite veneers - early 20s (gum margins reach settled level) Crowns and conventional bridges, implants - adulthood Enhanced prevention is necessary throughout life, if a pt does not have as many teeth as normal, it is important that they don't lose any to caries, perio etc
79
Problems with occlusion associated with hypodontia
Deep overbites and reduced lower face height
80
Hyperdontia/supernumerary
Increased number of teeth 1.5-3.5% Males:females 2:1 Higher frequency in Japanese More common in maxilla Higher frequency in cleidocranial dysplasia
81
Types of supernumerary
Conical Tuberculate Supplemental Odontome
82
Conical supernumerary
Cone shaped Most common
83
Tuberculate supernumerary
Barrel shaped Has tubercles
84
Supplemental supernumerary
Looks like tooth of normal series, will be slightly smaller and look a bit less like the contralateral, get rid of the one in a worse orthodontic position
85
Odontome
Irregular mass of dental hard tissue, compound or complex
86
Most common cause of delayed eruption of permanent incisors
Supernumerary
87
Premature eruption - associated factors
High birth weight Precocious puberty natal/neonatal teeth (1:2000-3000 births)
88
Delayed eruption associated factors
Pre-term and low birth weight Malnutrition Associated general conditions - downs, hypothyroidism, hypopituitarism, cleidocranial dysplasia Gingival hyperplasia/overgrowth - not so much delayed eruption as delayed appearance
89
Cleidocranial dysplasia
Hypoplasia of cellular component of cementum
90
Hypophosphatasia
Hypoplasia or aplasia of cementum, early loss of primary teeth
91
Anomalies of cementum
Cleidocranial dysplasia Hypophosphatasia
92
Microdont
Teeth that are smaller than normal 2.5% of population F>M e.g. peg laterals
93
Macrodontia
Teeth larger than normal Rare <1% for single teeth and 0.1% in generalised form in Caucasians
94
Double teeth
Gemination - one tooth splits into two Fusion - two teeth join to form one
95
Taurodontism
Flame shaped pulp 6.3% in UK
96
Dens in dente
Invagination on the palatal surface Tooth within a tooth Pulp system of their own Important to seal invaginations to prevent caries
97
Short root anomaly
Most common in permanent maxillary incisors 2.5% incidence 15% of these children also have short roots on canines and premolars Danger point for ortho tx
98
Usual causes for short root anomaly
Radiotherapy Dentine dysplasia Accessory roots
99
Anomalies of enamel
Amelogenesis imperfecta Environmental enamel hypoplasia Localised enamel hypoplasia
100
Amelogenesis imperfecta examples
Hypoplastic Hypocalcified Hypomaturational Mixed forms + hundreds of less common forms
101
Environmental enamel hypoplasia types
Systemic - due to systemic disease such as liver/kidney failure Nutritional - if poor nutrition during development of enamel Metabolic - e.g. Rhesus incompatibility, liver disease Infection - e.g. measles
102
Localised enamel hypoplasia causes
Trauma to primary teeth Infection of primary teeth
103
Hypomineralised enamel
Teeth completely normal shape but with marks on them, white, brown, yellow patches
104
Enamel hypoplasia
Chunks of enamel missing
105
Generalised hard tissue defects can be either ____ or _____
Environmental Hereditary
106
Treatment options for generalised fluorosis
Microabrasion/veneers/vital bleaching
107
MIH
Generalised environmental defect Associated with childhood illness such as kidney or liver failure Chronological pattern can be seen depending on the tooth development occurring during the time of illness
108
Prenatal causes of generalised environmental enamel defects
Rubella Congenital syphilis Thalidomide Fluoride Maternal anxiety and depression Cardiac and kidney disease
109
Neonatal causes of generalised environmental enamel defects
Prematurity Meningitis
110
Postnatal causes of generalised environmental enamel defects
Otitis media Measles Chicken pox TB Pneumonia Diphtheria Deficiency of vit A, C&D Heart disease Long term health problems such as organ failure
111
Diagnosis of amelogenesis imperfecta
Family history Generally affects both dentitions, usually worse in permanent Affects all teeth Tooth size, structure and colour Radiographs - no obvious difference in radiolucency between enamel and dentine
112
Hypoplastic amelogenesis imperfecta
Enamel crystals do not grow to the correct length
113
Hypomineralised type amelogenesis imperfecta
Crystallites fail to grow in thickness and width
114
Hypomaturational type amelogenesis imperfecta
Enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation
115
Problems associated with amelogenesis imperfecta
Sensitivity Poor OH due to sensitivity Caries/acid susceptibility Poor aesthetics Delayed eruption Anterior open bite
116
Treatment for amelogenesis imperfecta symptoms
Preventative therapy Composite veneers/composite wash - helps aesthetics and sensitivity Fissure sealants Metal onlays Stainless steel crowns Orthodontics (Restorative and ortho have trouble as the tooth surface is so different that lots of bonding mechanisms will not work)
117
Why can orthodontics be difficult for amelogenesis imperfecta?
Tooth surface is so different that lots of bonding mechanisms will not work
118
Systemic disorders associated with enamel defects (not with amelogenesis imperfecta)
Epidermolysis bullosa Incontinent pigmentii Down's Prader-willi Porphyria Tuberous sclerosis Pseudohypoparathyroidism Hurler's
119
Most common anomaly of dentine
Dentinogenesis imperfecta
120
Types of dentinogenesis imperfecta
Type I - associated with osteogenesis imperfecta Type II - autosomal dominant, tend to have no other medical conditions Brandywine
121
Anomalies of dentine
Dentinogenesis imperfecta - 3 types Dentine dysplasia Odontodysplasia
122
Dentine dysplasia
Normal crown morphology, amber radiolucency, pulp obliteration, short constricted roots
123
Odontoplasia
Localised arrest un tooth development, thin layers of enamel and dentine, large pulp chambers, 'ghost teeth' on radiographs
124
Diagnosis of dentinogenesis imperfecta
Appearance Family history Associated with osteogenesis imperfecta Both dentitions affected Radiography - bulbous crowns, initially very large, then obliterated pulps (I and II) Enamel loss
125
Problems associated with dentinogenesis imperfecta
Aesthetics Caries/acid susceptibility Spontaneous abscess Poor prognosis
126
Solutions for symptoms of dentinogenesis imperfecta
Prevention Composite veneers Overdentures Removeable prostheses Stainless steel crowns
127
What must be named on the consent form for non-vital tooth bleaching for children?
The justification for treatment - the specific dental problem
128
Active ingredient for vital bleaching
Hydrogen peroxide
129
When can under 18s have tooth bleaching?
For the purpose of treating or preventing disease
130
How is the fact that tooth whitening is a conservative method, explained to pts and parents?
No tooth tissue is removed
131
Risks of non vital tooth bleaching described in consent form
Gum sensitivity/irritation Composite restorations can't be whitened, may need replaced following treatment Teeth are more vulnerable to breaking as they must be left hollow with no dressing in place, we advise to avoid high contact sports and chewy foods on the teeth being treated This treatment may not achieve satisfactory results and further treatment may be required Not suitable if pregnant or breastfeeding Not suitable if pt has acatalasaemia. glucose-6-phosphate dehydrogenase deficiency
132
Who must sign consent form for childhood non vital bleaching?
Parent or guardian
133
What two places are pts advised to apply bleaching gel to, for at home bleaching?
The tray in the area of the toot being treated Into the hollow tooth
134
How often should pts change the bleaching gel for inside outside technique?
Every 2 hours except during the night
135
When should patients doing inside outside bleaching stop?
When the shade looks the same colour as the teeth on either side OR 48 hours before the next dental appt, if not whitened sufficiently at this time you must call the dentist
136
How often does inside outside technique usually take to bleach the teeth?
3-4 days
137
Can pts eat or drink with inside outside bleaching trays in the mouth?
No
138
Why is it important that inside outside bleaching is finished 48 hours before the next dental appt?
To allow the shade to settle before shade match of the definitive composite restoration
139
Advise for pts if bleaching gel gets onto soft tissues
Remove with a tissue
140
Where should bleaching gel be stored for at home whitening?
In the fridge
141
What should patients avoid during at home whitening treatment?
Avoid over bleaching Avoid high colourant food and drink during and for 2 weeks following treatment - anything that would stain a white t shirt Avoid hard food, or foods that need chewing or tearing Avoid contact sports
142
What acid is normally used for microabrasion?
18% HCl
143
Acid used in Opalustre microabrasion proprietary kit
6.6% HCl
144
Acid used in Prema proprietary kit for microabrasion
10% HCl
145
What is mixed with HCl in opalustre and prema proprietary kits for microabrasion?
Silicon carbide instead of pumice
146
Congenital
Condition you are born with
147
Guidance for antibiotic prophylaxis
NICE
148
Infective Endocarditis
Infection of the heart lining endocardium, particularly affecting the valves Life threatening
149
What is the concern in those with congenital heart defects when carrying out invasive procedures?
Infective endocarditis
150
High risk for infective endocarditis
Prosthetic valve Previous infective endocarditis Congenital heart disease
151
What are the risks of antibiotic prophylaxis?
Clostridium difficile infection CDI - can lead to colitis and eventually death
152
Clinical features present in a patient with infective endocarditis
Temperature over 38 degrees Sweats or chills Breathlessness Weight loss Tiredness Muscle, joint or back pain
153
Why is caries prevention important in high risk for infective endocarditis patients?
IE is caused by cumulative, low grade bacteremias, therefore exacerbated by poor OH
154
What trauma would this be cassified as?
Intrusive luxation of URA
155
Trauma investigations for intrusive luxation of a primary tooth
Radiographs - review for alveolar bone fracture, primary tooth displacement extent - into adult? for foreign body Sensibility testing
156
When would you extract and intruded primary tooth?
If it has been knocked into the adult
157
What trauma treatment could you do for intrusive luxation?
Allow tooth to spontaneously reposition itself, irrespective of the direction of displacement Spontaneous improvement in the position of the intruded tooth usually occurs within 6mo, but up to a year A rapid referral (within a couple of days) to a child oriented team that has experience and expertise in the management of paediatric dental injuries should be arranged
158
Advice to parents when child has had an intrusive luxation injury
Soft diet, care when eating To encourage gingival healing - clean with a soft brush or cotton swab with chlorhexidine twice a day for one week
159
Follow up timings for intrusive luxation injury
1 week 6-8week 6 Mo 1 year 6 years - if severe
160
What will happen to an adult tooth if the baby tooth gets infection which touches the adult tooth?
Enamel defect - turner teeth
161
What is the use for transexamic acid?
Stop bleeding
162
How long can a tooth be out of the mouth dry and be implanted?
30 mins
163
How long can a tooth be out of the mouth in solution and be reimplanted?
an hour
164
What is the reversal drug for warfarin?
Vitamin K
165
Two types of odontome
Complex Compound
166
Peak age of onset of diabetes
4
167
What is the danger of necrotic pulp in diabetic patients?
Could get infection which will cause blood sugar to spike
168
Which patients should you avoid prescribing anti-fungals?
Warfarin Statins
169
170
Conc 2800 ppm F toothpaste and what is the minimum age?
0.619% 10 years old
171
Conc 5000ppm F toothpaste and what is the minimum age?
1.1% 16 years old
172
How often should bitewings be taken?
Annually, or high risk twice a year
173
Caries risk assessment components
Clinical evidence of previous disease Diet Use of fluoride Plaque control Saliva Medical history Social history/socioeconomic status
174
Complicated fracutre
Enamel-dentine-pulp
175
If an 8 year old child attends with a complicated fracture, what would you want to know about the injury before deciding between pulp cap and pulpotomy?
How long ago did it happen Size of the exposure
176
Process of pulpotomy
LA Dental dam Remove all necrotic pulp 2-3mm radius around the exposed area Assess pulpal bleeding - if no bleeding or hyperaemic remove more Arrest pulpal bleeding with saline soaked cotton wool roll Seal the pulp with GIC Restore tooth with acid etched composite
177
Why could ferric sulphate not be used to arrest pulpal bleeding in a permanent anterior tooth?
Stains the tooth black
178
What would you expect to see at 6 month radiograph after successful pulpotomy in 11 of an 8 year old?
Continued maturation of the roots Normal periapical tissues - no radiolucency or pathology Continued thickening of dentine root walls
179
How to carry out a RCT on a 11 in an 8 year old
Give LA and place dental dam Root access and extirpate the pulp Seal the apex with an MTA plug Place non setting CaOH in the canal and seal with GIC Immediate referral to paediatric dentistry
180