Paediatric Dentistry Flashcards
(288 cards)
1
Q
What developmental indicators can give you information about your patient?
A
Social skills
Cognitive skills
Language skills
2
Q
What developmental descriptors can give you information on your patient?
A
Ego
Animism
Symbolism
Moral realism
3
Q
Describe Piaget’s theory of sensory motor? and What age it develops at?
A
- Acquire knowledge through sensory experiences and manipulating objects
- Understanding that objects still exist even when can’t be seen
- 0-2 years old
4
Q
Describe Piaget’s theory of pre operational? and What age it develops at?
A
- Learn through pretend play but struggle with logic and taking other points of view
- Struggle with understanding the ideal of constancy
- 2-6 years old
5
Q
Describe Piaget’s theory of period of concrete operation? and What age it develops at?
A
- Think more logically, but can be rigid thinking
- Struggle with abstract and hypothetical concepts
- Less egocentric and begin to think about how other people perceive them
- 7-11 years old
6
Q
Describe Piaget’s theory of period of formal operations? and What age it develops at?
A
- increase in logic, the ability to use deductive reasoning and understanding abstract ideas
- See multiple potential solutions to problems and think more scientifically
7
Q
What are the 3 stages of child mind development?
A
- Assimilation
- Accommodation
- Equilibration
8
Q
Name the 3 most important factors to think about when speaking to a child?
A
- Tone
- Nonverbal
- Verbal
Child should be centre of communication
9
Q
How to use tone to aid in child communication?
A
- Children mainly hear tone
- A soft and reassuring voice works best
- Relaxed and friendly
10
Q
How to use non-verbal cues to aid in child communcation?
A
- Face, eyes, gestures and posture
- Be on their level
11
Q
How to adjust speech to aid in child communication?
A
- Age appropriate
- Avoid jargon
- Avoid dear stimulators
12
Q
What is a key technique to teach a child how to behave at the dentist?
A
Positive reinforcement
13
Q
How to implement and show positive reinforcement?
A
- Small steps
- Positive feedback
- Give immediately after good behaviour
- Age appropriate
- Facial expression
- positive tones
- verbal praise
Avoid negative reinforcement (ignore bad behaviour)
14
Q
What does the abbreviation TSD stand for? And how does it help?
A
Tell, Show and Do
- most useful with low anxiety patients
- reduces anticipatory anxiety for new patients
15
Q
Explain the process of TSD?
A
Tell: - age appropriate explanation Show: - demonstrate and let patient feel and touch instrument - avoid fear stimulators Do: - perform action - use positive reinforcement and allow them to control the procedure
16
Q
What can be useful when presented with an anxious child?
A
Modelling:
- less anxious sibling
- uncomplicated treatment
- watch and help
17
Q
What technique can be used to get a patient to relax?
A
Abdominal breathing (+ inhalation sedation)
18
Q
Explain the process of needle desensitisation for an already anxious patient? ***
A
- Instruction on muscle relaxation and / or abdominal breathing
Explanation of the components of the syringe –needle, anaesthetic, handle - Show assembled syringe
- Explanation of topical
- Placement of topical
- Hold syringe on patients hand cap on
- Hold syringe by patients face cap on
- Hold syringe inside patients mouth cap on
- Hold syringe next to site of infiltration cap on
- Hold syringe next to site of infiltration and apply pressure cap on
- Hold syringe on patients hand cap off
- Hold syringe by patients face cap off
- Hold syringe inside patients mouth cap off
- Hold syringe next to site of infiltration cap off
- (Hold syringe next to site of infiltration and apply pressure cap on)
- Hold syringe next to site of infiltration and apply pressure cap off
- Tension/ rub mucosa infiltrate small amount of LA
- Deliver half a cartridge of LA over about 30 seconds
19
Q
Translate these words into child-friendly dentalese:
High and slow speed, needle, injection, rubber dam, filling, crown, excavator and caries?
A
High speed: - buzzy bee Slow speed: - sleepy bee Needle: - sword Injection: - a pinch/scratch Rubber dam: - umbrella or superhero mask Filling: - superhero material Crown: - superhero crown Excavator: - digger Caries: - germs
20
Q
When do Maxillary As erupt?
A
8-12 months
21
Q
When do Maxillary Bs erupt?
A
9-13 months
22
Q
When do Maxillary Cs erupt?
A
16-22 months
23
Q
When do Maxillary Ds erupt?
A
13-19 months
24
Q
When do Maxillary Es erupt?
A
25-33 months
25
When do Mandibular As erupt?
6-10 months
26
When do Mandibular Bs erupt?
10-16 months
27
When do Mandibular Cs erupt?
17-23 months
28
When do Mandibular Ds erupt?
14-18 months
29
When do Mandibular Es erupt?
23-31 months
30
How long a deviation can teeth erupt?
6 Months
31
What are some key defining features of primary dentition?
- Incisor spacing
- Anthropoid spaces (Upper BC and Lower CD)
- Incisors tendency to present Class III (edge to edge)
- Possible buccal crossbite
32
What occlusal defect can thumb sucking lead to?
- Open bite
33
What unique feature do the upper and lower Es present in primary dentition? and its clinical name?
- Class I MB cusp in upper E in buccal groove in lower E
- Flush distal plane
- Allows the first permanent molars to be in correct position
34
When do Mandibular 1s erupt?
6-7 y
35
When do Mandibular 2s erupt?
6-8 y
36
When do Mandibular 3s erupt?
9-11 y
37
When do Mandibular 4s erupt?
9-11 y
38
When do Mandibular 5s erupt?
10-12 y
39
When do Mandibular 6s erupt?
6-7 y
40
When do Maxillary 1s erupt?
6-8 y
41
When do Maxillary 2s erupt?
7-8 y
42
When do Maxillary 3s erupt?
10-12 y
43
When do Maxillary 4s erupt?
9-11 y
44
When do Maxillary 5s erupt?
10-11 y
45
When do Maxillary 6s erupt?
6-7 y
46
When do Maxillary 7s erupt?
11-13 y
47
When do Maxillary 8s erupt?
17-18 y
48
When do Mandibular 7s erupt?
12 y
49
When do Mandibular 8s erupt?
17-21 y
50
Name some key defining features of a mixed dentition?
- Spaced incisors
- Proclined central incors
- Distally inclined lateral incisors
51
Describe and explain the meaning of the leeway space? and the size?
Space is needed as the successors of EDC are larger
- Upper arch: 1.5mm
- Lower arch 2.5mm
- Allows first permanent molars to drift mesially and adopt a class I occlusion
52
Name the 9 main differences between the primary and permanent dentition?
- Smaller
- Whiter
- Thinner enamel
- Molar more bulbous
- Wider contact points
- More pulp to crown ratio
- Large pulp goms
- More root to crown ratio
- Roots splayed
53
What is the definition of hypodontia? and Which genetic conditions are they associated with?
Lack of teeth
| Cleft, Down's and Ectodermal dysplasia
54
Which teeth are mostly likely to not form?
1. Wisdom
2. Upper lateral incisors (can also be peg)
3. 2nd premolars
55
What does a ectodermal dysplasia patient display, different compared to a healthy patient?
- Hair: fine, dry and sparse
- Skin: dry with perioral pigmentations
- Sweat glands: absent
- Teeth: hypodontia (small and conical)
56
What is the definition of supernumerary teeth?
Extra teeth
57
What signs are presented if supernumerary teeth may be present?
Delayed eruption of the central incisors
58
Name the 4 types of supernumerary teeth?
- Conical
- Tuberculate
- Supplemental
- Odontome
59
Where are conical supernumerary teeth found?
In the midline and are conical
60
Describe the appearance of a tuberculate supernumerary tooth?
Have more than 1 cusp or tubercle
61
What is unique about a supplemental supernumerary tooth?
Duplicate of a tooth:
- lateral incisors
- premolars
- third molars
62
What is an odontome?
Tumours: diffuse mass of cells
63
What problems do supernumerary teeth cause?
- No/delayed eruption
| - Natural tooth is rotated
64
What does microdontia display? and Which teeth are mainly affected?
- Small teeth
- Lateral incisors
- Treatment via crowning
65
What is an accessory cusp? and its treatment?
- Additional cusp to tooth
| - Fissure sealant possible, but needs to identify occlusal relationship (pulpotomy - identify pulp horn)
66
What is the treatment for invagination?
- Fissure sealant
- RCT
- Extraction
67
What does taurodontism display?
Increases pulp size and larger crowns (bull-shaped roots)
68
What does molar incisor hypomineralisation display? and its possible causes? and its treatment?
- Developmental
- Enamel discolouration
- First primary molars and permanent central incisors
- High temp, malabsorption or systemic illness
1s: composite resin
6s: seal or only (possible extraction)
69
What is and what does fluorosis display? and its treatment?
- Over Ingestion of fluoride products
- Whiter spots (mottling) in enamel
- Microabrasion
70
What is and what does amelogenesis imperfecta display?
- Rare genetic disorder
- Hypoplastic or hypomineralized enamel on all teeth
- High caries risk
71
What is and what does dentinogenesis imperfecta display? and its treatment?
- Rare genetic disorder
- Malformation formation of the dentine
- Enamel blue/gray in colour
- Extraction and prevention
72
What is and what does premature eruption display?
- Normal primary teeth but with no root formation
- At around 1-2 months
- Risk of inhalation
- Can develop normally
73
What is and what does delayed eruption display?
- Radiographs essential
- Consider all possible causes (supernumerary, impaction or loss)
- Premature loss of primary is likely to then occur in permanent
74
What is dilaceration?
Trauma to the primary dentition can lead to trauma to the tooth germ
75
What are infraoccluded primary molars?
- Associated with missing permanent premolars
- Primary molars ankylose and faul to alter position
- If permanent successor present leave to exfoliate
76
What is the first thing to achieve when speaking to a new paediatric patient?
Rapport:
| - have a few open questions lined up
77
What are the legal ages for dental consent?
- Over 16 years competent
- Under 12 years not competent and need parent
- Can perform reversible procedures
- If patient between 12-16 y does not want parent to know, you can't tell them
78
Who can consent for the child?
- Natural mother/father
- Step-father if married to Mother before the 4th May 2006
- Registered on the birth certificate after 4th May (father)
- Private agreement
- Sheriff court
79
What are the 6 key points to ensure informed consent has been given?
- Description of the condition
- Available treatment
- Available alternatives
- Risk benefit of the situation
- Time to think
- Answer questions appropriately
80
When is written consent mandatory?
- Sedation
- GA
- Clinical photographs
- Student treatment
81
When seeing a new paediatric patient, what is essential to write in your notes?
- Full name and their preferred name (phonetic)
- Contact details (keep updated)
- CHI number (odd boy and even girl) - even trans
- GP
- School they attend (child protection)
- Whom attended with them
82
What specific details for the medical form about gestation can be essential to know about a paediatric patient?
- How the pregnancy was
- How the birth was
- How was the neonatal care
83
During the medical history questioning, if you have suspicions over learning difficulties what do you do?
- Do they have support in the class
- Do they have help in the school
- Medication for behavioral problems (ADHD)
84
What important questions about social history can be useful to find out with a paediatric patient?
- Who lives with them (rapport)
- Pets
- Interests
Building rapport
85
What important questions about dental history can be useful to find out with a paediatric patient?
- Their attendance, if irregular ask when was last appointment and what for?
- Home (diet)
- Types of toothpaste
- Previous treatment/surgery
- Dental habits like brushing and rinsing
86
What child habits can affect dental development?
- Dummy and finger suckling
- Grinding teeth
- Nail biting
- Pencil biting
87
What questions to ask a child when trying to gauge their anxiety towards attending the dentist?
- How they feel about the dentist?
- Worried about anything in particular?
- Previous experiences?
- Stop Look Listen
- Body language is key
88
Explain the process of an extra-oral examination for a paediatric patient?
1. Skin
2. Hair
3. Skeletal pattern
4. Facial profile (occlusal classification)
5. Facial symmetry
6. TMJ (click or deviation)
7. Nodes (tenderness)
8. Lips (competence or lip trap)
89
Explain the process of an intra-oral examination for a paediatric patient/
1. Oral mucosal tissues (unusual, swelling or change colour)
2. Periodontal tissues (pocketing, bleeding or inflamm)
3. Teeth (charting - dry and clean and general health, eruption pattern)
90
Explain the process to a BPE on a paediatric process?
- Oral hygiene
- Score plaque
- First molars and incisors
91
Explain the process of dealing with a carious lesion, in paediatric patients?
- Size 0 films (bitewings)
- Visual check (spread the teeth)
- Describe and record
92
Explain the process of dealing with tooth surface loss, in paediatric patients
- Evidence of attrition, abrasion or erosion
- Aetiology
- Monitor
- Detailed description and record
93
What to record when there is a suspicion of dental abnormality?
- Abnormal eruption pattern and timing
- Delayed eruption and lack of symmetry
- Size
- Shape
- Colour
- Inherited
- Tooth disruption
94
What to include for a possible trauma checklist?
Trauma history:
- Colour
- Mobility
- Vitality
- Radiographs (percussion)
95
What to record for a paediatric patient's orthodontic status? ***
- Skeletal pattern: classification (I/II/III)
- Lips: competent or struggle to keep together
- Tongue: thrust or abnormally large
- ICP: measure overjet in mm and overbite %
- Centre line (off?)
- Cross bite (present?)
Radio, photo and study models for referral
96
What is the international index of orthodontic treatment need?
IOTN:
- 1-5
Aesthetic component:
- 1-10
97
What are the phases of treatment planning, in a paediatric clinic?
1. Prevention
2. Acclimatisation
3. Stabilisation
4. Reassess
5. Restore
98
What factors must you consider when creating a treatment plan for a paediatric patient?
- Options and discussion
- Be personal
- Allow flexibility (reassess)
- Be holistic
99
Explain the process of LA injection procedure in a paediatric patient?
1. Tell show do
2. Ask if they want to see the needle
3. Emphasise how small it is
4. Apply topical (describe taste and feel, use on dry mucosa with wool for 2 mins)
5. Apply LA (describe taste and feel, ensure it is given slowly and re-ensure the patient)
100
Explain the process of abdominal breathing technique to relax your patient?
1. Explain the technique
2. Hand on tummy
3. Breathe in slowly
4. Push tummy out on breathing in
5. Watch tummy
6. Release your breathe slowly
7. Repeat
101
What does NDIP stand for?
National Dental Inspection Programme
| - ages 5 and 12
102
What was the average % of children across Scotland without visible tooth decay, in 2018?
71%
103
What does DMFT stand for?
Decayed, missing and filled teeth
104
What was the average DMFT for children across Scotland, in 2018?
1.15 per tooth
105
What was the average % of 12 year old children in Scotland with no visible decay, in 2019?
80%
106
Why is it advantageous to diagnose dental caries early?
For targeted prevention:
- arrest enamel lesions
- reducing restoration size
107
Explain the process on how to visually diagnose a carious lesion?
1. Good lighting/magnification
2. Tooth clean and dry (probe to clean)
3. All surfaces checked
4. Record ICDAS
108
What does ICDAS stand for?
International Caries Detection and Assessment System
109
What rules does ICDAS abide by?
1. 2 digit code per tooth
110
ICDAS Caries Code 0?
Sound
111
ICDAS Caries Code 1?
First visual change in enamel
112
ICDAS Caries Code 2?
DIstinct visual change in enamel
113
ICDAS Caries Code 3?
Enamel breakdown; no dentine visible
114
ICDAS Caries Code 4?
Underlying dentinal shadow (not caviatted into dentine)
115
ICDAS Caries Code 5?
Distinct cavity with visible dentine
116
ICDAS Caries Code 6?
Extensive cavitation with visible dentine
117
ICDAS Restoration Code 0?
No restoration
118
ICDAS Restoration Code 1?
Partial sealant
119
ICDAS Restoration Code 2?
Full sealant
120
ICDAS Restoration Code 3?
Tooth coloured restoration
121
ICDAS Restoration Code 4?
Amalgam
122
ICDAS Restoration Code 5?
Stainless steel crown
123
ICDAS Restoration Code 6?
Porcelain, Gold, PFM Crown or Veneer
124
ICDAS Restoration Code 7?
Lost or broken restoration
125
ICDAS Restoration Code 8?
Temp restoration
126
Frequency of radiographs for high caries risk in primary or permanent teeth?
6-12 months
127
Frequency of radiographs for low caries risk for primary teeth?
12-18 months
128
Frequency of radiographs for low caries risk for permanent teeth?
24 months
129
Explain some tips and tricks used to aid in radiographing paediatric patients?
- Tell Show Do
- Explain
- Can be delayed, if problematic
130
If radiographs are problematic, but caries risk is worrying, what can you try instead? review in how many days?
Orthodontic separators:
- create space between suspicious teeth, enabling to see mesial and distal surfaces
- review within 5 days
131
What is a caries risk assessment? and how is it beneficial to your future planning?
A assessment to identify the risk he patient has to caries
- info from diet, siblings and hygiene habits
- socio economic background also
Gives you evidence for radiographic review, prevention techniques and when to recall
132
What are the 4 main elements for prevention of caries in children?
- Toothbrushing with Fl toothpaste
- Dietary advice
- Fissure sealants
- Topical Fl
133
Explain the standard prevention message for toothbrushing? and the F-ppm per age range?
- Twice daily for 2 minutes
- <3 1000-1500 F-ppm and with only a smear amount
- >3 1450-1500 F-ppm and a pea-sized amount
- Spit don't rinse
- Parents brush until 7 (or under supervision)
- Supervision over 7
- Split into sextants
- Altered bass technique (circular motion)
134
Explain the enhanced prevention message for tooth brushing? and the F-ppm per age range?
- Disclosing tablets with tooth brushing charts
- Collaboration with external health providers
- < 3 1450-1500 F-ppm and with smear (caries risk over fluorosis risk
- 3-6 1450-1500 F-ppm and pea-sized
- > 7 1450-1500 or stronger F-ppm with pea-sized
- Flossing after brushing
135
Explain the standard prevention message for dietary advice? and how often the message should be broadcasted?
- At least once a year
- Avoid sugar intake, acceptable during meal times
- Sugar free snacks (breadsticks)
- Water is best
- No food/drink after nightly brush
- Explain and show hidden sugars (sucrose)
136
Explain the enhanced prevention message for dietary advice?
- Diet diary 3 weekdays and 1 weekend
- Discuss possible changes (positive reinforcement)
- Small changes
137
Explain the standard prevention message for topical fluoride? and doses per age range? when to avoid use?
- NaF varnish (226000 ppm F)
- Twice annually
- 2-5 y 0.25ml
- > 5 y 0.4ml
- Avoid for colophony, asthma hospitalisation or plaster allergy
138
Explain the process of application of a topical fluoride?
1. Isolate and dry teeth (if problematic, apply wet)
2. Apply with bendable brush
3. Mainly interproximal areas/stagnation points
4. Avoid food/drink for 30 mins
5. Avoid brushing for 2 hours (or to next morning)
139
Explain the enhanced prevention message for topical fluoride?
Use alcohol-free mouthwash for over 7s at a separate time from brushing
140
Explain the enhanced prevention message for fissure sealants?
- For deep pits and fissures
- Caries in primary teeth
- Newly erupted permanent molar teeth
- 6s and 7s
- possible palatal of upper 2s, Es, 4s and 5s
- GIC for partial eruption
- In high risk patients you should also consider sealing palatal pits on upper lateral incisors and occlusal surfaces of primary molars
141
How to effectively manage a fissure sealant, in a paediatric patient?
- Always check at every recall
- Can be topped up
- Probe to see any stagnation points
- Refurbish don't Remove
142
Explain the process to manage a suspicious fissure, in a paediatric patient? and the appearance of a possible suspicious fissure?
1. Clean
2. Dry
3. Light
4. Good quality radiograph
5. Describe and record in notes (place a watch on it)
Appearance:
- microcavitation
- shadow around fissure pattern
- treat with PRR and check with radiographs
- compare to opposite tooth
143
What to consider if I seal an early caries lesion in a sealant or PRR?
- Monitor radiographically
- Monitor sealant integrity
- If sealant intact, progression is unlikely
144
What are the golden rules for paediatric patient diagnosis and assessment?
Employ a holistic multi-system approach:
- as more than one problem may exist
- and more than one system may be involved
Change tactics dependent on age:
- approach during history taking and examination
- common pathologies differ
- conditions manifest differently and different ages
Consider common differential for the presenting problem
145
How can play be useful for paediatric patients?
- Create rapport
- Relax patient
- Distract
146
What can a good history enable you to achieve more easily?
- Aid diagnosis
- Gather important information
- Rule out significant pathologies
- Aids targeted examination
- Stay calm and empathetic
- Show an interest
- Facilitate dealing with concerns an anxiety
147
What must you consider when taking a paediatric patient's medical history?
- Consider age and developmental stage
- Consider language and intellectual skills
- Questions can be directed to child and parent
- Gather both perspectives (such as pain)
- Pre-verbal children communicate (non-verbal)
- Older children can be quiet
148
Describe and explain the 12 key stages of a history taking for a paediatric patient? ***
```
Intro:
- introduce self and identify everyone
- generate rapport with child
- record 'examination' observations
Presenting complaint:
- what is already known
- ask child if appropriate
- gain as much information as possible
History of presenting complaint:
- onset, progression, variation, effects and observations
- chronological stages of where they've been (GP/A&E)
- systems enquiry (to identify which system it could be)
Birth history:
- details depend on age and presentation (gestation, late or early, any complications?)
- features may be very relevant years later
Past medical history:
- admission or other problems
Immunisations:
- missed or additional
Development:
- what can they do? any concerns?
- Basc enquiry essential (walking, words and support level)
Drug and Allergies:
- regular treatment or specialised treatment
Family and social history:
- recent or related health issues
- parent/sibling ages and health
- where they fit into the family (youngest, middle or oldest)
- people at home?
School and nursery:
- where? show interest into their school life
- point of rapport
- insight into development
Parental social history:
- smoking
- alcohol
- stress
- occupational health
Addressing concerns and give closure:
- ensure parental concerns have been discussed
- allow questions to be asked
- ensure understanding of the situation
- SUMMARISE
- Record everything that happened in the appointment
```
149
What are the 6 recognised stages of childhood? and their age ranges?
1. Neonate <4w
2. Infant <1y
3. Toddler 1-2y
4. Pre-school 2-5y
5. School age
6. Teenage/adolescent
150
What are the main 7 objectives of childhood?
- To grow
- To develop and achieve their potential
- To attain optimal health
- To develop independence
- To be safe
- To be cared for
- To be involved
151
What is the definition of functional child development? and how long does it last?
- Gaining functional skills throughout childhood
| - Before birth to 5 y
152
Describe the process of development within the brain? Use it or lose it?
1. Cell growth
2. Migration
3. Connection
4. Pruning
5. Myelination
Will lose the connections we don't need
153
Name the 5 key developmental fields for a child?
1. Gross motor
2. Fine motor
3. Speech and language
4. Hearing and vision
5. Social and self help
154
What can trends in developmental sequences give information about?
- If developing normally, should continue normally
| - If developing abnormally, may continue abnormally
155
Name the 4 milestones for child development? is their a range?
Social smiling
Sitting
Walking
First words
Yes
156
Why is development as a child important for later life?
- Learning functional skills for later life
- Hone skills in a safe environment
- Allow our brain's genetic potential to be fully realised
- Equip us with tools needed to function as older people
- Many are completely automatic
157
What are the influencing factors on our development?
- Genetics
- Environment
- Positive early childhood experiences
- Developing brain vulnerable to insults (abuse and neglect)
158
What are some examples of adverse antenatal environmental factors?
- Infections (CMV and Rubella)
| - Toxins (Alcohol and smoking)
159
What are some examples of adverse postnatal environmental factors
- Infection (meningitis)
- Toxins (mercury and lead)
- Trauma (head)
- Malnutrition (iron, folate and vit D)
- Metabolic (hypoglycemia, hyper and hyponatremia)
- Maltreatment
- Maternal mental health issues
160
What information can we gain from assessing development?
- Reassurance and showing progress
- Early diagnosis and prevention
- Discuss positive stimulation/parenting strategies
- Provision of information
- improving outcomes
- Genetic counselling
- Coexistent health issues
161
What toys are useful to use when trying to assess development?
Bricks, crayons, balls, tea sets and picture books
162
What 4 key questions should you be thinking about when carrying out a development assessment?
- How do they move their body?
- What do they do with their hands?
- How do they communicate?
- What can they do for themselves?
163
What questions should you think about during a new paediatric patient, in regards to their development and whether they are normal or abnormal?
- Think about each developmental field (specific to one area?)
- The sequence that has come before
- What skills have they achieved
- What have they not achieved
- Is one field falling behind the other
- Are the skills gained age appropriate
164
How does delayed child developmental relate to dentistry?
- Teeth brushing
- Delayed development may adversely impact their dental health by diet (limited diet range)
- Reflux (cerebral palsy)
165
What is Child Health Screening?
- Receive a red book with the content of all medical history (health and development)
- Child Health Programme (Scotland)
Main components:
- health promotion
- developmental screening
- immunisation
- carer can give observations and concerns
Record, advice and refer if necessary
166
What tests do the CHild Health Programme conduct?
1. New-born exam and blood spot screen
2. New-born hearing screening
3. Health visitor first visit
4. 6-8w review
5. 27-30 month review
6. Orthoptist vision screening
Recall, if necessary
167
What health promotion do the Healthy Child Programme ensure for children?
- Smoking
- Alcohol/drugs
- Nutrition
- Hazards and safety
- Dental health
- Support services
- Mental health
168
What is the purpose of a child examination?
- Key step working towards a diagnosis
- Already started during history taking
- Age appropriate techniques
- Be sensitive to child
- Not expected in OSCEs
169
Name the 9 main things you're trying to examine during a paediatric examination?
- ABCDE and baseline observations
- general condition and peripheries
- Respiratory systems
- Cardiovascular systems
- Alimentary systems
- Neurological and musculoskeletal systems
- ENT and skin
- Developmental skills
- Measurements and centile
170
Tips for during a paediatric examination?
- Observe first
- Be friendly and smile
- Speak to child (tone)
- get down to eye level
- Be careful moving them
- Gentle handling and gradual exposure
- Show interest in toys/play
171
What are the 5 main areas to identify each time doing a paediatric assessment?
- Start with a good observation (pre-assessment)
- Think of each system
- Think of each body part
- Think of the method related to age
- Rapport is essential
172
What to observe for during a paediatric assessment per system? (general? CVS? Resp? GI? Neuro? MSK? other?) ***
```
General:
- appearance, play, interaction
Resp:
- effort, noise, rate, recession, o2, nebuliser?
CVS:
- colour, perfusion
GI:
- feeding, vomit, abdominal distension/movement
Neuro:
- alertness, interaction, play, posture
MSK:
- mobility. limb movement, posture, mobility aids
Other:
- bruises, infections, rashes
Other:
- toys
```
173
What to observe when looking at the hands and arms during a paediatric assessment?
- warm, capillary refill, radial/brachial pulses (rate/rhythm)
- clubbing, nail changes, hand skills and pen marks
174
What to observe when looking at the head and face during a paediatric assessment?
- eyes (jaundice), lips (colour and moisture), tongue, nose
| - scalp changes, bruises, rashes and fontanel
175
What to observe when looking at the neck during a paediatric assessment?
- rashes and nodes (easier from front); size, mobility, position, consistency and symmetry
- tracheal tug
176
What to observe when looking at the chest and back during a paediatric assessment?
- Murmurs (timing, pitch, quality, location, radiation)
- Apex beat, thrills, chest expansion
- Breath sounds (all areas, reduced, symmetry, added)
- Percussion (limited in infants, not routine, commonly forgotten with dealing with pneumonia)
- Resonance and fremutrys (pre-school?)
- Rashes and skin marks
- spine alignment, deformity and sacral dimple
177
What to observe when looking at the abdomen and groin during a paediatric assessment?
- Tenderness (watch face and movement)
- Masses (esp stool) and organomegaly (liver, spleen and kidneys) (using thumb)
- Bowel sounds and bruits
- Femoral pulses (essential for infants)
- Hernias (and testis)
- Genital and anal appearance (not appropriate for older children
178
What to observe when looking at the legs and feet during a paediatric assessment?
- Mobility, changing posture, movements and tone
- Reflexes (easy when v. young), plantars, clonus
- Power, coordination, sensory assessment if older
- Pulses, warmth, capillary refill, colour and mottling
- Rashes, bruises and marks
- Deformities and gait
179
How to use play during a paediatric assessment?
- Use play to illustrate what you want to achieve
- Use play as a distractor
- Use play as a clinical tool (power, mobility and fine control)
180
Tips to use during a paediatric assessment?
- Smile and make positive eye contact
- Engage in child's interests
- Recognise common toys and characters
- Soothing words for babies
- Counting fingers (6)
- Observe as much as you can
- Child friendly language
- Be honest
- Leave unpleasant things last
- Play skills
- Document systematically
181
A 6y old boy is undergoing a dental procedure. He is known to have a history of eczema, hay fever and a nut allergy. He suddenly develops an abrupt onset of facial swelling, tight feeling in his throat and is finding it difficult to breathe. He is lethargic, RR 50, HR 170, Sats at 88, he has widespread urticarial rash and a bilateral wheeze.
Diagnosis? Treatment? Discharge advice? Triggers?
```
Diagnosis:
- Anaphylaxis/Type 1 hypersensitivity; resp signs (increased RR), rash, shortness of breath
Management:
- ABCDE approach
- Get help early
- Oxygen 15 L/m
- IM adrenaline (epipen: 0-6 y 150mcg, 6-12y 300mcg and >12 500mcg)
- If possible, IV access and fluid resuscitation
Advice on discharge:
- careful exposure history
- avoid triggers
- see GP if trigger unclear
- Piriton available at future visits
- Epipen available
- Emergency treatment plan
Triggers:
- Latex gloves
- Administered medication
- Anaesthetic agents
- Food before dentist
```
182
A 10y old boy with type 1 diabetes is undergoing a dental procedure. He becomes pale, quiet and anxious. He is sweaty with HR 110 and RR 25.
Diagnosis? Management? Risk assessment?
```
Diagnosis:
- hypoglycaemia (symptoms such as sweating, dizziness, hunger, fatigue, headache)
Treatment:
- use a glucose-only treatment
Management:
- recognise hypo and stop treatment
- test capillary glucose
- give hypo treatment (10-15g of glucose) if <4mmol/L
- re-test after 10-15 min and ensure glucose >4mmol/L
Risk reduction:
- check diabetics before treatment
- staff awareness and training
- small pre appointment snack
```
183
A 4y old girl who is known to have epilepsy is attending a dental review. Whilst in the waiting area the receptionist observes a seizure and urgently summons your attendance.
Diagnosis? Management? Risk reduction?
```
Diagnosis:
- Generalised tonic-clonic seizure
Management:
- life flat but no restraint
- remove hazards
- keep mouth clear
- check if rescue treatment is available
- Administer rescue treatment after 5 mins (buccal midazolam common)
- Call ambulance if seizure is over 10 mins
Risk reduction:
- defer treatment if recent illness
- check if recent seizure
- check if rescue treatment available
- check for treatment protocol
- consider epilepsy training
```
184
A 7y old girl is known to have asthma is undergoing a dental procedure. She complains of her chest feeling tight and shortness of breath. She has an audible wheeze. RR 40, HR 140m Sats 91%. Chest is in drawing under the ribs.
Diagnosis? Management? Risk? Risk reduction?
```
Diagnosis:
- asthma attack
Recognise:
- wheeze and shortness of breath
- anxiety
Management:
- keep calm and clear mouth
- follow emergency protocol
- give oxygen
- 10 puffs of salbutamol (via spacer)
Risk:
- active symptoms?
- frequency of attacks?
- specific triggers (enamel dust, fluoride varnish, methyl methacrylate, LA and drugs)
- current meds
Risk reduction:
- need relieving inhaler
- taken medication today?
- reduce anxiety
- prompt treatment of exacerbation
- delay treatment with symptoms
```
185
A 3y old boy is undergoing a tooth extraction. The tooth falls into back of mouth and he begins to cough and choke. The cough becomes quieter and is colour becomes more pale.
Diagnosis? Management? Risk reduction?
```
Diagnosis:
- Choking (coughing effectively or ineffectively)
Treatment:
- Back blow or abdominal thrusts
Risk reduction:
- care with small items
- minimise sudden movements
- parental care
- age appropriate toys
- training
- emergency protocol
```
186
A 13 y old girl is attending for a dental procedure. As the LA is being drawn up she becomes very pale, feels dizzy and loses consciousness for 10s. She is plae, unresponsive HR 60 but recovers quickly on awakening.
Diagnosis? Management? Risk reduction?
```
Diagnosis:
- vasovagal syncope
Management
- help
- lie flat and clear mouth
- sit up slowly
- defer treatment
- observe until well
- see GP for ECG
Risk reduction:
- triggers (pain, stress, anxiety, hunger)
- recognise early signs (pale, sweating, tachycardia
- fluid intake
- leg strengthening exercises
```
187
A 7y old boy attends for a dental assessment. He's missed his last 2 appointments due to asthma. His mum says he has had asthma for 3 years he uses 2 types of puffer and takes a tablet. He recently had a cold.
What is the problem?
What is the significance?
What are you going to do?
```
Problem:
- asthma
Significance:
- he has a stronger form of asthma
Treatment:
- blue inhaler
- other inhalers
- last need blue inhaler
- wheezing increased
- defer treatment
```
188
What is the presentation and triggers of asthma?
```
Presentation:
- Wheeze, cough and shortness of breathe
Triggers:
- URTI
- Exercise
- Allergy
- Cold weather
- Anxiety
```
189
What are the steps for treatment of asthma?
1. Inhaled beta agonist (blue)
2. Inhaled corticosteroids (brown)
3. Increase brown/Long acting beta agonists (green)/leukotriene receptor antagonist (tablet)
4. High dose ICS (purple)
5. Oral steroids
190
Oral health changes found in asthma patient and reasons for why they occur?
```
Increased rate of caries development:
- reduced saliva
- increased strep mutans
- mouth breathers
Dental erosion:
- reflux
Oral mucosa changes:
- inhaled meds in oropharynx
- oropharyngeal candidiasis
Gingivitis:
- linked to inhaled steroids
- increased calculus
```
191
What to adjust in treatment towards an asthmatic patient?
- Increase frequency of review
- Brush twice a day
- Use a spacer
- Avoid rinsing mouth after medication
192
A 3y old boy attends for a dental procedure. There is no fever or other systemic features (no cough, diarrhoea or vomiting rash or colour change). Find discolouration of the ear (bruising)
Diagnosis? Management? Next steps?
```
Diagnosis:
- non-accidental injury (ear is usually protected from injury)
- BE CAREFUL WITH LANGUAGE
Role:
- document clearly (examination, question parent)
- further examination (identify any further abuse)
- discuss with seniors
- refer to child protection
Further steps:
- skeletal survey
- CT
- Bloods
- Ophthalmology review
- police and social work investigation
- case conference and placement decision
```
193
A 5y old girl attends for dental procedure. Her parents mention she has had 3 weeks of lethargy, pallor, recurring fever and bruises. You find blisters on her gingival mucosa.
Diagnosis? investigation? management?
```
Diagnosis:
- acute leukaemia (likely ALL)
Management:
- admit to hospital
- urgent referral to paediatric oncologist
- FBC and film to confirm
- bloods
- specialist oncologist advice and treatment
- professional photos
```
194
What 4 factors should you consider when deciding on the type of restoration material to use, for a paediatric patient?
Lesion
Time left time exfoliation
Cooperation
Your ability
195
Describe the decision-making tree for restorability? and the 4 outcomes?
```
Restorable:
- YES
- NO
Manage caries
Prevention and review
Extraction
Pulpal therapy
```
196
Name the 3 outcomes for caries removal?
Complete
Partial
None
197
Describe the pros and cons for complete caries removal, in a paediatric patient?
```
Pros:
- evidence based and gives best result
Cons:
- difficult, LA, isolation and drilling necessary
- pulp exposure risk high
- expensive
```
198
Describe the pros and cons for partial caries removal, in a paediatric patient? and what material is used
```
Pros:
- evidence based
- reduced need for LA, prep time and pulp exposure
Cons:
- marginal seals need to be perfect
- monitoring essential
Mainly composite (water control)
```
199
Describe the pros and cons for no caries removal and sealing the tooth, in paediatric patients? and what material is used?
```
Pros:
- No LA or prep
Cons:
- quality of seal is v. important
- weak evidence
- monitoring is essential
GIC with vaseline
```
200
Describe the pros and cons for no caries removal with a preformed metal crown, in paediatric patients?
```
Pros:
- no LA, prep, iatrogenic damage and best preference for all parties
- evidence based
Cons:
- partial fitting can lead to leakage
- aesthetics
```
201
Describe the process of fitting a preformed metal crown using the Hall technique?
```
Assess tooth shape and contacts:
- preOP radiographs (for spacing aid)
- ortho separators
- assess marginal ridge breakdown
- adjust PMC shape
- prepare the tooth
Occlusion:
- PMC will sit slightly higher than normal tooth
- cause an anterior open bite
- Measure incisor relationship after fitting crown
- over time occlusal forces, using the Cal effect with bend the PMC into place
- Asses bucall relationship to opposing tooth
Patient preparation:
- explain procedure
- jazz up the tooth (crown for tooth)
- bite hard on cotton wool rolls
- explain taste
Selection:
- smallest PMC
- trial fit
- well fitted crown should spring back
Airway protection:
- gause parachute with gauze tape
Cement loading:
- GIC luting cement
- 1 scoop per 2 drops of liquid
- runny
- working time 1-2 mins
- crown filled 3/4 full
First stage seating:
- squeeze crown over tooth, with pressure from thumb (from lingual to palatal)
- patient to bite hard on dry cotton wool roll
- crown should squeeze between contacts
- cotton wool rolls to remove excess cement
- if not seated correctly remove with excavator
Final seating:
- if happy, patient should apply pressure on cotton roll, holding for 2-3 mins
- excess cement removed
- contacts and occlusion checked
```
202
Describe the pros and cons for no caries removal with prevention,in paediatric patients?
```
Pros:
- no prep
Cons:
- habitual tendencies
- cavity shape
- limited evidence
- diet diary
```
203
Describe the pros and cons for extraction, in paediatric patients?
```
Pros:
- remove disease and pain
- nonrestorable or abscess
Cons:
- traumatic
- LA, inhalation sedation and GA
- review
```
204
How to deal with pulpal pain, in paediatric patients?
- dressing
- painkillers
- pulp therapy
- antibiotics
- extraction (refer if possible for IHS/GA)
205
Name the 3 different types of pulpal pain?
Reversible pulpitis
Irreversible pulpitis
Dental abscess
206
Describe the symptoms of reversible pulpitis? and its management?
```
Symptoms:
- Sharp pain
- Transient
- Pain leaves without stimulus
- Stimulus from hot, cold and sweet
- Pain not localised
- tooth not TTP
Management:
- caries removal with LA
- sedative dressing (Kazinol), if cooperation poor
```
207
Describe the symptoms of irreversible pulpitis, in paediatric patients? and its management?
```
Symptoms:
- throbbing
- spontaneous
- intermittent/continuous
- localised/diffuse
- pain to hot and cold
- disturbs sleep
Management:
- depends on cooperation
- perfect would be pulp therapy
- odontopaste with analgesics for pulp therapy (pain control measures)
- Refer for IHS/GA
```
208
Describe the symptoms of dental abscess? and its management? and when to refer?
```
Symptoms:
- severe pain
- swelling
- TTP and mobility (diagnostic factor)
- disturbs sleep
Management:
- depends on cooperation
- pulp therapy may be necessary
- antibiotics and analgesics
- GA/IHS
Refer:
- swelling around canine or over floor and mouth (MaxFac)
```
209
What dose can a 6-11 month old have for amoxycillin?
125mg 3 times a day
210
What dose can a 1-4 y old have for amoxycillin?
250mg 3 times a day
211
What dose can a 5-11 year old have for amoxycillin?
500mg 3 times a day
212
What dose can a 12-17 year old have for amoxycillin?
500mg 3 times a day
213
When should metronidazole be used?
If patient is allergic to penicillin
214
What dose can a 1-2 year old have for metronidazole?
50 mg 2 times a day
215
What dose can a 3-6 year old have for metronidazole?
100 mg twice a day
216
What dose can a 7-9 year old have for metronidazole?
100 mg 3 times a day
217
What dose can a 10-17 year old have for metronidazole?
200mg 3 times a day
218
Describe the pros and cons for pulp therapy, in paediatric patients?
```
Pros:
- evidence based
- avoids extractions
- high success rate
Cons:
- difficult
- LA, isolation, drilling, PMC at same visit
- long
- compliance
```
219
What is the definition of pulpotomy?
- Removal of inflamed coronal tissues
| - Retention of healthy radicular pulp tissue
220
What are the indications and contraindications for pulpotomy?
```
Indications:
- asymptomatic/transient pain
- carious exposure
- traumatic exposure
Contra:
- exfoliation
- unrestorable
- multiple pulp
- poor cooperation
```
221
What is the definition of pulpectomy?
- Removal of irreversibly inflamed coronal and radicular pulp
- filled with zinc oxide eugenol after rinsing the canals
222
What are the indications and contraindications for pulpectomy?
```
Indications:
- irreversible pulpitis
- dental abscess
Contra:
- exfoliation
- unrestorable
- multi pulp
- poor cooperation
```
223
What are the 3 main points to consider when carrying out a trauma assessment to aid achieve the correct diagnosis?
History
Examination
Investigation
224
What to ask when trying to gain information on the paediatric patient history, after trauma?
- When?
- How?
- Where?
- Other injuries?
- Medical history
- Previous trauma?
225
What to asses when carrying out an examination on a paediatric patient, after trauma?
```
Wash patient's face and oral cavity to remove dirt and blood- can uncover further injuries
Extraoral:
- start at the centre (TMJ) and work inwards (facial lacerations)
Intraoral:
- look for any bruising to soft tissues
- foreign bodies
- sepsis
- supporting bone (mobility)
- assess teeth systematically
```
226
What investigations should be carried out on a paediatric patient, after trauma? (also known as a Trauma Stamp) ***
```
Tooth:
- find the tooth affected and the adjacent ones to be safe
TTP:
- tap end of tooth to identify tenderness
Mobility:
- 0 - none
- 1 - horizontal mob < 1mm
- 2 - horizontal mob >1mm
- 3 - axial loosening
Colour:
- colour change - descriptive as possible (darkening)
Electric pulp tester:
- record value of affected tooth, adjacent teeth and a control tooth for comparison
Radiographs:
- check for root fracture/extent of injury (apical)
- take more than one for several POV
Ethyl chloride:
- can patient identify if cold or not
Sinus present:
- which tooth associated with?
P note:
- sounding of when tapping the tooth
- dull, metallic or normal
```
227
What is the definition of a enamel crown fracture?
A fracture confined to the enamel with the loss of tooth surface
228
What visual signs does a enamel crown fracture present?
Visible loss of enamel (no exposed dentine)
229
What results can be expected from a TTP test on a enamel crown fracture?
Should not be tender, but if tenderness is present evaluate for possible luxation or root fracture
230
What results can be expected from a sensibility pulp test for a enamel crown fracture?
Positive, but maybe negative initially indicating transient pulpal damage
231
What is the treatment for a enamel crown fracture?
- Initial radiographs to assess damage (rule out luxation or root damage)
- bond tooth fragment back to tooth
- composite can be used depending on extent and location
- follow up within 6-8 weeks with radiographs
232
What is the definition of a enamel dentine crown fracture?
A fracture confined to enamel and dentine with loss of tooth structure not involving the pulp
233
What visual signs does a enamel dentine crown fracture present?
Visible loss of enamel and dentine, with no visible pulp
234
What results can be expected from a TTP test on a enamel dentine crown fracture?
Should not be tender, but if tenderness is present evaluate for possible luxation or root fracture
235
What results can be expected from a sensibility pulp test for a enamel dentine crown fracture?
Positive, but maybe negative initially indicating transient pulpal damage
236
What is the treatment for a enamel dentine crown fracture?
- Tooth fragment can be bonded back to tooth
- Radiographs to identify extend of damage
- Provisional resto in GIC
- Definitive with composite
- Follow up with 6-8 weeks with radiographs
237
What is the definition of a enamel dentine pulp crown fracture?
A fracture involving the enamel and dentine with loss of tooth structure and pulpal exposure
238
What visual signs does a enamel dentine pulp crown fracture present?
Visible loss and enamel and dentine with exposed pulp tissue
239
What results can be expected from a TTP test on a enamel dentine pulp crown fracture?
Should not be tender, but if tenderness is present evaluate for possible luxation or root fracture
240
What results can be expected from a sensibility pulp test for a enamel dentine pulp crown fracture?
Usually positive
241
What is the treatment for a enamel dentine pulp crown fracture?
For open apices, pulp capping or partial pulpotomy (to secure root development)
Enables for future root fillings
For closed apices and luxation injury - root treatment is ideal
Follow up 6-8 weeks with radiographs
242
What is the definition of avulsion?
The tooth is completely displaced out of its socket. Socket completely empty
243
How to treat avulsion?
Find tooth
Keep patient calm
Wash under water for 10 seconds before re-implant
Placed in appropriate storage medium
244
Best ways to keep an avulsed tooth viable for reimplantation?
Keep in appropriate storage medium such as patient or parents mouth (avoid extra oral drying over 60 mins)
Are Apexs are open or closed
245
How to reimplant a tooth with a closed apex?
Reimplant
Splint
Initiate RCT 7-10 days after reimplantation
Dress pulp with CaOH for 1 month
246
What is a necessary requirement for a tooth to have, for a preformed metal crown to be placed?
No pulpal necrosis
Adequate tooth structure remaining
No breakdown of marginal ridges
When assessing a primarily molar radiographically,
a clear band of ‘normal’ looking dentine should be present between the carious lesion and the pulp
247
What is the difference between hypomineralised teeth and hypoplastic teeth?
Hypomineralised enamel is a qualitative defect of the enamel with reduced mineralisation. So the enamel is the correct thickness and but its composition is affected.
Hypoplastic enamel describes a quantitative defect so presents as pits and fissures that are also discoloured but thinner
248
Name the diagnosis for: total displacement out of the socket?
Avulsion
249
Name the diagnosis for: displacement, mobility and several tooth movement
Alveolar fracture
250
Name the diagnosis for: displacement, mobility, single tooth with x-ray signs for root fracture?
Root fracture
251
Name the diagnosis for: displacement, mobility, single tooth with no x-ray signs for root fracture?
Extrusion
252
Name the diagnosis for: displacement, no mobility with protrusion/retrusion?
Lateral luxation
253
Name the diagnosis for: displacement, no mobility with intrusion?
Intrusion
254
Name the diagnosis for: no displacement but with loosening?
Subluxation
255
Name the diagnosis for: no displacement, no loosening but +ve TTP
Concussion
256
Name the diagnosis for: no displacement, no loosening but -ve TTP and no fracture?
No trauma
257
Name the diagnosis for: no displacement, no loosening but -ve TTP and fracture below gingival margin?
Crown-root fracture
258
Name the diagnosis for: no displacement, no loosening but -ve TTP and no fracture below gingival margin?
Crown fracture
259
What is the treatment for an enamel dentine fracture?
Seal completely the involved dentine, with GIC to prevent microleakage
In larger fractures, the tooth can be restored with composite
260
What is the treatment for enamel dentine pulp fracture?
Partial pulpotomy
| Place CaOH over the pulp, then covered with a lining such as RMGIC, then restore with composite
261
Follow-up procedure for enamel dentine crown fracture?
3-4 weeks
262
Follow-up procedure for enamel dentine pulp crown fracture?
1 week
6-8 week with radio
1 year with radio
263
What is the treatment for enamel dentine root fracture?
Fragment removal only, if fracture is only small part of root and fragment is large enough allows coronal restoration
Extraction in other cases
264
Follow-up procedure for enamel dentine root fracture?
Fragment removal only:
- 1 week
- 6-8 week with radio
- 1 year
265
What is the treatment for root fracture?
If coronal fragment not displaced no treatment is required
| If coronal fragment displaced, extract the fragment, but apilca fragment left to be resorbed
266
Follow-up procedure for root fracture?
```
No displacement:
- 1 week
- 6-8 week
- 1 year radio
Extraction:
- 1 year radio
```
267
What is the treatment for alveolar fracture?
Reposition any displaced segment and then splint
Stabilise segment for 4 weeks with splint
Monitor
268
Follow-up procedure for alveolar fracture?
1 week
3-4 week radio with splint removal
6-8 week with radio
1 year with radio
269
What is the treatment for concussion?
Observation
270
Follow-up procedure for concussion?
1 week
| 6-8 week
271
What is the treatment for subluxation?
Observation
| Clean with chlorhexidine twice a day for a week
272
Follow-up procedure for subluxation?
1 week
6-8 week
Check for discolouration
273
What is the treatment for extrusive luxation?
Dependent on displacement, mobility, root formation and cooperation
Minor extrusion (<3mm), reposition or leave tooth for spontaneous alignment
Extraction for severe extrusion
274
Follow-up procedure for extrusive luxation?
```
1 week
6-8 week radio
6 month radio
1 year radio
Discolouration may occur
```
275
What is the treatment for lateral luxation?
No occlusal interference allow spontaneous reposition
Minor occlusal interference, slight grinding necessary
Major occlusal interference, needs to be gently repositioned with LA
Severe displacement, extraction is only choice
276
Follow-up procedure for lateral luxation?
1 week
2-3 week
6-8 weeks radio
1 year with radio
277
What is the treatment for intrusive luxation?
If apex displaced towards or through labial bone plate, allow spontaneous reposition
If apex into tooth germ, extract
278
Follow-up procedure for intrusive luxation?
```
1 week
3-4 week with radio
6-8 week
6 month with radio
1 year with radio
```
279
What are the clinical findings for alveolar fracture?
Involves alveolar bone
| Segment mobility and dislocation are common
280
What are the clinical findings for concussion?
Tender to touch
| Normal mobility and no sulcular bleeding
281
What are the clinical findings for subluxation?
Increased mobility but not displaced
| Bleeding from gingival crevice
282
What are the clinical findings for extrusive luxation?
Partial displacement out of socket
| Tooth appears elongated and excessively mobile
283
What are the clinical findings for lateral luxation?
Tooth is displaced palatally/lingually or labillay
| Usually immobile
284
What are the clinical findings for intrusive luxation?
Tooth is displaced through the labial bone plate or impinging on succeeding tooth bud
285
What are the radiographic findings for intrusive luxation?
Apical tip can appear shorter
286
What are the radiographic findings for lateral luxation?
Increases PDL space apically
287
What are the radiographic findings for extrusive luxation?
Increases PDL space apically
288
What are the radiographic findings for alveolar fracture?
Horizontal fracture line to the apices
