History and Examination Flashcards
What aspects of the child’s history would you want to know?
C/O
HPC
MH- medical conditions, recent hospital admissions, under investigation for anything, medication.
SH- who is at home, parental responsibility, siblings, caries experience in siblings, what school, smoking/vaping.
DH- brushing habits, who brushes the child’s teeth, fluoride toothpaste, how often, previous dental experience.
Diet
What would you do at the first appointment?
Introduce yourself, build rapport.
History
Examination- E/O and I/O
Plaque score
BPE (if 7 or over)
Occlusion
Caries risk assessment
What are the seven components of the caries risk assessment?
Clinical evidence
Saliva
Plaque control
Fluorid exposure
Diet
Medical history
Social history
In a very young child, what can you do to aid the examination?
Have the child sit on the parents lap facing them and then lean them backwards so their head is on your lap.
Parent holds their hands throughout.
Explain this to the child and the parent.
Reward the child afterwards.
What is the best way to assess caries in a paediatric patient?
Visual inspection on clean, dry teeth, with good lighting and magnification.
Radiographs can supplement this.
How does carious enamel present?
White, chalky, opalescent appearance.
How does carious dentine present?
If caveatted- may present as a hole in the tooth with a dark centre, surrounded by a chalky white halo.
If enamel is still intact- enamel may look fine but has a darker underlying tone- suggests carious dentine.
Stained pit/fissures with chalky white halo suggests dentine involvement.
What signs would make you think the caries is only in enamel?
Dark stained pit or fissure with no chalky white enamel surrounding it.
No radiographic evidence of caries.
How would you determine if a carious lesion is active or arrested?
Run probe along intact enamel- if it is smooth, it is arrested. If it feels rough, then it is active.
Carious dentine appears soft- if it is hard then it is sound.
Colour is not a good indicator of disease activity.
When determining the extent of caries radiographically, how would you do this?
Outer third of dentine
Middle third of dentine
Inner third of dentine
Must determine if there is a clear brand of dentine between the pulp and the carious lesion.
When should you start taking bitewing radiographs?
4 years old.
How often should bitewing radiographs be taken in a child?
High caries risk- 6-12 months
All other children- 2 years.
What factors influence caries management strategies?
Where the caries is within the tooth
Extent of carious lesion
Co-operation of child
Age of the child- if the tooth is close to exfoliation
How long you need the tooth to last for
Activity of lesion- active or arrested?
Number of other lesions in the mouth
Child’s medical status
Anticipated co-operation of child and parent with preventative strategies
What are the signs of sepsis in primary teeth?
Inter-radicular radiolucency
Non-physiological tooth mobility
Sinus
TTP in a non-exfoliating tooth
Alveolar tenderness
Pus
Systemic symptoms
What clinical circumstances would make the patient high risk for pain and infection?
Active cavitated caries.
Pulp exposure
Necrotic pulp with several years until exfoliation
