CDS Paediatric Dentistry Flashcards
(180 cards)
Before commencing tx for discolouration, it is necessary to have …. (4)
An accurate diagnosis of the cause
Specialist led treatment plan
Informed consent
Pre-operative records
To ensure informed consent for tx of discolouration in children
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
Gillick competence
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
Considerations when determining Gillick competence
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
If a young person is being pressured or influenced by someone else
Their consent is not valid
Pre-op records for discoloured teeth
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
Treatment options for discolouration
Enamel microabrasion
Bleaching
Resin infiltration
Localised composite restoration
Veneers
Do nothing
Bleaching for discolouration types
Vital - provided in surgery or at home
Non-vital teeth - inside outside technique or walking bleach technique
Direct vs indirect veneers
Direct are free hand/putty guide
Indirect are lab made
When would discolouration be left untreated?
If pt doesn’t have any concerns then there is little indication to proceed with tx, even under parental pressure
Microabrasion
Removal of the surface layer of opaque enamel
Advantages of microabrasion
Easily performed
Conservative
Inexpensive
Teeth need minimal subsequent maintenance
Fast acting
Removes yellow/brown, white and multi-coloured stains
Effective
Results are permanent
Disadvantages of microabrasion
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
Prior to starting microabrasion clinical technique
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
Maximum microabrasion
10 x 5 second bursts
Why is it important to review repeatedly during microabrasion?
Check shade
Check shape - stop if tooth starts looking flattened or if desired colour achieved
Tx following microabrasion
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
Why is duraphat unsuitable after microabrasion?
May introduce a yellow stain
Why do we polish with fine sandpaper disc after microabrasion?
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
Enamel loss when using prophy with toothpaste
5-10 microns
Enamel loss using prophy with pumice
5-50 microns
Enamel loss ortho bracket bonding/debonding
5-50 microns
Enamel loss acid etch
10 microns
Enamel loss 10 x 5 second HCl pumice miroabrasion
100 microns