Paediatric dentistry Flashcards

Question

What can make a pt high caries risk?

Answer 1

1. Medical history: disabled, xerostomia (could be due to polypharmacy), medically compromised, cariogenic medicine. 2. Dietary habits: frequency and volume of sugar intake 3. Clinical evidence: development of new carious lesions 4. Plaque control: oral hygiene (grubby score) 5. Use of fluoride: no toothpaste, fluoride varnish, chlorhexidine use. 6. Social history: low SES, parental caries, mixed home living situation, parental risk factors, poor attendance, low motivation, pain driven attendance.

Answer 2

1. Plaque control 2. Diet 3. Fluoride 4. Fissure sealants

Answer 3

1. Diet modification 2. OH and dental health education 3. Fissure sealants 4. Sugar free medicine 5. Chewing gum contain xylitol 6. Chlorhexidine

Answer 4

1. Translucent zone 2. Dark zone 3. Body of lesion 4. Surface zone

Answer 5

1. Zone of sclerosis (vital reaction of odontoblasts to irritation) 2. Zone of demineralisation 3. Zone of bacterial invasion 4. Zone of destruction

Answer 6

Medically compromised Physical disability Xerostomia Long-term cariogenic medication

Answer 7

Frequent sugar intake Frequent between-meal snacking

Answer 8

- New carious lesions - Premature extractions - Anterior caries/restoration - Multiple restorations - No fissure sealants - Fixed orthodontic appliance

Answer 9

- Infrequent and/or inefficient cleaning - Poor manual control

Answer 10

- Drinking water not fluoridated - No/low fluoride toothpaste - No fluoride supplements

Answer 11

1. Social deprivation 2. High caries in siblings/parents 3. Low knowledge of dental disease 4. Irregular attendance 5. Readily available snacks 6. Low dental aspirations

Answer 12

Reduction in extrinsic sugar intake, both in frequency and volume. Especially non-milk extrinsic sugars. COMA report 1989. Committee on medical aspects of food policy. They conclude that caries is positively related to frequency and amount of NME (non-milk extrinsic) sugar consumption - Frequency and amount of sugar should be reduced and restricted to mealtimes only - Limit consumption of foods and drinks with added sugar to max 4x day (Vipeholm) - Sugars should provide <10% of total energy in the diet or <60g per day - Drink only water and milk outside mealtimes - Snack on sugar free foods (cheese and carrot sticks etc) - Nothing to eat or drink after brushing

Answer 13

1. Vipeholm Study of Diet and Dental Caries 2. Dental Caries Experience on the Children of Hopewood House

Answer 14

Sugar content labelling not always clear Access to healthy food Sugar industry resources for marketing are vast Few families stick to the 3 square meals day trend and tend to graze throughout

Answer 15

Little evidence to support tooth brushing prevents caries but fluoride toothpaste is of benefit. - Plaque forms on uncleaned tooth surfaces and is apparent after 2-3 days of no brushing - Tooth brushing 2x day with 1000ppm fluoride paste - Spit toothpaste out and do not rinse with water - Children <2 should use a smear of toothpaste - Children aged 2-7 should use small pea sized quantity of toothpaste (1350-1500ppm)

Answer 16

Material placed in the pits and fissures of teeth to prevent caries development on occlusal surfaces of permanent molars. Should be placed on all child patients despite the state of caries risk (in accordance to SDCEP 2018)

Answer 17

Should be placed on all child patients despite the state of caries risk (in accordance to SDCEP 2018) Patient selection = children and young people with impairments and or caries in primary teeth Tooth selection - Deep fissures susceptible to caries - Erupted sufficiently - Adequate moisture control achievable - One permanent tooth has occlusal caries then all other permanent molars should be sealed - First permanent molars - Palatal pits of permanent lateral incisors.

Answer 18

1. Investigate a stained fissure before sealing (radiograph and visual inspection), and then isolate. 2. Etch with 30-40% phosphoric acid for 20-40 seconds. 3. Wash and dry the tooth 4. Place the fissure sealants and cure for 20 seconds.

Answer 19

Resin GIC, useful in high caries individual as temp sealant and partially erupted teeth where isolation is an issue (Fuji Triage - no isolation, no bonding required, high F- released (6x more than normal GIC, released F- up to 24 months), there is a conditioner and coating which can be used after application of Fuji Triage) Compomer Fluoride containing sealants

Answer 20

Clinicians should prescribe sugar-free medicines whenever possible and should recommend the use of sugar-free forms of non-prescription medicines

Answer 21

Chewing gum containing xylitol and sorbitol have anti-caries properties through salivary stimulation. Xylitol: studies have demonstrated that substitution of xylitol for sugar in the diet results in much lower caries increments. Dietary advice to patients should encourage use of non-sugar sweeteners. Note: Sugar-free does mean calories free. There is a calorific value which needs to be taken into consideration. Xylitol is a form of polyols, it doesn’t get metabolised by the oral bacteria but also does not get break down in the GIT, hence excessive consumption can lead to laxative effect.

Answer 22

Chlorhexidine prophylaxis in the form of a rinse, gel or paste can achieve on average 46% reduction in caries. Careful! Anaphylaxis and staining!

Answer 23

Low concentration of F in saliva, creating fluorapatite crystals. Critical pH 5.54 Resistant to acid dissolution, decreasing the rate of demineralisation "Fluorapatite is more resistant to acid than hydroxyapatite, with a critical pH of 4.5 compared to 5.5 for hydroxyapatite." "Fluoride can protect teeth from acid erosion by replacing some of the carbonate and hydroxide in enamel with fluoride ions. This makes the enamel surface partially fluorapatite, which is more resistant to acid."

Answer 24

Toothpaste Mouthwash Varnish (22 600 ppm)

Answer 25

As soon as teeth erupt: - Smear of toothpaste - containing at least 1000ppm fluoride - twice a day - last thing at night and on one other occasion

Answer 26

Brushed by parent or carer/assisted when get older: - pea sized amount with toothpaste - containing at least 1,000 ppm fluoride - spit out after brush - 2xday (last thing at night and on at least one other occasion) Apply fluoride varnish (2.26% NaF) to teeth 2 times a year

Answer 27

Use toothpaste containing 1,350 to 1,500 ppm fluoride Apply fluoride varnish (2.26 NaF) to teeth 2 or more times a year

Answer 28

Toothpaste 1,350 to 1,500 ppm. Apply fluoride varnish to teeth 2 times a year (2.26% NaF)

Answer 29

From age 8: Prescribe fluoride mouth rinse (0.05% NaF; 230 ppmF) at a different time to brushing until dental caries risk is reduced. From age 10: Prescribe 2800 ppm fluoride toothpaste until caries risk is reduced. From age 16: Prescribe 2,800 or 5,000 ppm fluoride toothpaste until dental caries risk is reduced. Apply fluoride varnish to teeth 2 or more times a year (2.26%)

Answer 30

0-4 years, child at risk of fluorosis on permanent incisors and first molars (15-30 months is susceptibility window) 4-6 years, premolars and second permanent molars are calcifying and maturing, less aesthetic risk of mottling 6+ years, risk for enamel mottling is negligible, with exception of third molars.

Answer 31

Ulcerative gingivitis Stomatitis Allergic responses

Answer 32

Acute overdose Fluorosis Toxic dose GI upset approx: 1mg F/kg Lethal poisoning 32-64 F/kg Too much F causes cell metabolism to be blocked, calcium metabolism to be interfered and reductions in nerve-impulse and conduction. Symptoms of toxic dose of Fluoride: - Nausea, vomiting and diarrhoea - Excess salivation, tears, mucus and sweat (endocrine production increased) - Headache - General weakness and malaise

Answer 33

<5mg/kg, give milk and monitor for 4 hours 5-15 mg/kg, send to A&E, observe vital signs, gastric lavage given and milk >15mg/kg, send to A&E immediately, calcium gluconate IV, with activated charcoal 1g/kg every 4 hours, as well as gastric lavage and cardiac monitoring.

Answer 34

Mild: diffuse flecks and patches Moderate: mottling, striations and yellow-brown appearance Severe: enamel hypoplasia

Answer 35

- Primary dentition: Up to 0.25 mL of varnish per application - Mixed dentition: Up to 0.40 mL of varnish per application - Permanent dentition: Up to 0.75 mL of varnish per application

Answer 36

Presence of one or more decayed, missing or filled tooth surface in any primary tooth in a child 71 months or younger.

Answer 37

1. Frequent bottle feeding = tooth decay in the upper anterior dentition 2. Long exposure to cariogenic substrate (e.g. bottle at night) 3. Low salivary flow rate at night 4. Parental history of active untreated caries.

Answer 38

Reduce saliva sharing activities due to transmission of S.mutans, cariogenic bacteria. Oral hygiene measures. Avoid high frequency sugar consumption. Infants drink from a cup by 1 year.

Answer 39

Cessation of habits causing ECC Diet modifiecation Fluoride application via smear of 1,000 ppm F (1350 > 3yo) and duraphat XGA where required Restorations where required

Answer 40

Eliminate disease Restore health Prevent pain and infection Preserve space Maintain function Positive attitude

Answer 41

If not treated can cause pain, sepsis, functional problems and issues with schooling.

Answer 42

Crown morphology: Narrow occlusal table mean B-L width of cavity needs to be reduced. Broad flat interproximal areas cause issues diagnosing caries (10% caries in 10-year old is interproximal) Thin enamel and dentine layers mean caries progresses to pulp rapidly. Large pulp horn (MB) pulp horn means risk of pulp exposure greater.

Answer 43

- Child's ability to cope with treatment - Family support for prevention - Presence of infection - Number and size of lesions - Time to exfoliation of the primary teeth

Answer 44

1. Patient factors - caries status, general health, parafuntion, age, diet and cooperation. 2. Tooth factors - location, cavity design, if pulpal involvement, dentition, occlusal load and tooth quality 3. Operator factors - material properties, quality of finish, moisture control, expertise and anaesthesia

Answer 45

Amalgam is not used in paediatrics due to worries over toxicity, safety and aesthetics. Composite is favoured under rubber dam RMGIC and compomers are used regularly is no rubber dam available.

Answer 46

Indication: used for most inter-proximal cavities with 2 or more carious surfaces. Contraindications: non-vital tooth, irreversible pulptitis, not enough tissue structure to retain crown, patient risk of bacterial endocarditis, small occlusal cavities, teeth close to exfoliation and aesthetics concerns, uncooperative child, pathological mobility, buccal sinus, dental abscess.

Answer 47

Thin uniform enamel thickness (1mm) Smaller crowns with marked constriction Narrow occlusal table Broad contact areas Large pulp and large mesio-buccal pulp horn Thin pulpal floor Early radicular pulp involvement

Answer 48

- Rapid caries progression. - Short clinical crown makes matrix bands and isolation difficult. - Need to restore broad contact points. - Thin enamel with less tooth structure protecting the pulp, can be difficult to restore without pulpal involvement. - Easy to expose mesio-buccal pulp horn, requires use of shouldered or round diamond bur when investigating fissure present. - Pulpectomy difficult due to long, flared roots. Primary teeth can be restored effectively if anatomy is considered when choosing the material and technique

Answer 49

Intra-oral radiography is the first choice for young children in deciduous and mixed dentition. Increase of 1.5-8 for number of carious lesions detected on radiograph compared to just visual examination when all risk groups are considered. Oblique laterals or dental panoramic radiographs (DPT) - <10 years of age multiplication factor for risk x3 compared to a 30-year-old adult.

Answer 50

<10 years of age multiplication factor for risk x3 compared to a 30-year-old adult Risk of harm due to ionising radiation is greater in children since their tissues are more radiosensitive and their life spans are longer ALARP principle should be employed

Answer 51

- Radiographs should be preceded by a clinical exam to be justified - Assignment of caries risk should be prior to radiograph - Obtain any previous radiographs - Referral to specialist treatment should be alongside radiographs - Bitewings have significant diagnostic yield even in absence of clinically detectable decay

Answer 52

High caries risk = 6-month intervals, or until no new or progressing lesions are evident. Moderate caries risk = posterior bitewings at one-year intervals Low caries risk = 12-18 month intervals in primary dentition, 2-year intervals in mixed and permanent dentition.

Answer 53

Tx planning for children requiring GA should be comprehensive to avoid the risk of repeat anaesthesia, radiographic assessment must be completed for this. If no radiograph is taken before GA then this can cause smaller, restorable cavities that my have been undiagnosed pre-referral and consequently: - more teeth were extracted - GA was delayed facilitating further restorations.

Answer 54

- Detection of caries in primary, mixed and permanent dentition with approximal contacts - Dental trauma - Disturbances in tooth development and growth - Examination of pathological conditions

Answer 55

- Age and cooperation limitations - Anatomical difficulties (narrow arch and shallow palate) - Occlusal caries may not be visible - May have overlap

Answer 56

- Use size 0 film or phosphor plate with a tab for children aged 4-7 - Use size 0 film or phosphor plate with a holder for children aged 7--10 years - Use size 2 film or phosphor plate with a holder for children in the mixed dentition age 10-11 and when the second molars have erupted aged 12

Answer 57

Pit and fissure lesions account for 85% of all new lesions in adolescents, fluoride has helped in smooth surface lesion.

Answer 58

- Early permanent dentition still calcifying and mineralising more at risk. - First year post eruption - Partially erupted and difficult to access teeth, hard to clean - Deep fissures - Enamel hypoplasia or hypo calcification

Answer 59

Resin sealant - Better retention - Technique sensitive - Longer time to apply - Acts as barrier for bacteria GIC sealant (Chemfil superior or Fuji Triage) - Poorer retention - Easier application - Short time to apply - Release of fluoride

Answer 60

> Occlusal fissure and enamel caries = fissure sealant and prevention > Occlusal D1 caries = preventive resin restoration > Occlusal D3 caries = composite resin > Interproximal caries = composite or amalgam > Incisal edge caries = composite > Cervical caries = composite, RMGIC

Answer 61

Conservative removal of existing carious tissue from the fissure, whilst preventing further decay. - Requires LA, rubber dam and a clean occlusal surface. - Fissure is investigated using a small high-speed diamond bur - Caries identified and removed from ADJ, no other extension into unaffected fissures is carried out - Place thin layer of bonding resin, then restore cavity with composite - Fissure sealants placed on all occlusal surface - Occlusion checked

Answer 62

Glass ionomer cement used to replace dentine Rationale = improved chemical bond and fluoride leaching prevents further decay

Answer 63

Secondary caries Fracture Marginal deficiencies Wear Post-operative wear and sensitivity

Answer 64

Crowding = ortho, applies to both painful and non-painful lesions No crowding and pain > Pulpitis = pulpotomy > Non-vital = RCT No crowding and no pain = indirect pulp cap with coronal seal (Cvek)

Answer 65

Stepwise technique - you leave caries behind, seal on top, wait about 6 months, go back in and remove the rest of caries. This this is a temporary measure.

Answer 66

1. Definitively negative = refusing treatment, forceful crying, fearful 2. Negative = reluctance to accept treatment, evidence of negative attitude 3. Positive = accepting treatment, cautious, willing to comply, reservations, follows instructions 4. Definitely positive = good rapport with dentist, interest in procedure, laughter and enjoyment

Answer 67

Lacking cooperative ability, very young or with specific disabilities Potentially cooperative Cooperative

Answer 68

Crying 1. screaming 2. continuous crying 3. mild, intermittent crying 4. no crying Cooperation 1. violently resists/disrupts treatment 2. movement makes treatment difficult 3. minor movement/intermittent 4. no movement - Apprehension 1. Hysterical/disobeys all instructions 2. Extremely anxious/disobeys some instructions/delays treatment 3. Mildly anxious, complies with support 4. Calm/relaxed/follows instruction Sleep 1. Fully awake 2. Drowsy 3. Asleep/intermittent 4. Sound asleep

Answer 69

Tell-show-do Voice control Modelling (learn through observation) Enhance the child's control, give them the option for a stop signal and choose which tooth to seal first. Distraction techniques Negative reinforcement, strengthening behaviour by removing a stimulus perceived to be unpleasant. Positive reinforcement Desensitisation Clinical holding Restraint Hypnosis Snoezelen environment for people with autism, dementia, brain injury and learning disabilities.

Answer 70

Sedation, such as oral, inhalation and IV General anaesthesia

Answer 71

Child centred approach Positive attitude Work as a team Organisation Honesty Flexibility

Answer 72

Hypomineralisation of systemic origin of the permanent first molars, as well as affected incisors. - Affects one of more of the first permanent molars and/or incisorsW

Answer 73

Affects one or more of the first permanent molars and/or incisors. Demarcated patches White-brown or cream colour Causes post-eruptive breakdown If treated will be missing their 6s or heavily restored, abnormal restorations with excessive calculus deposits.

Answer 74

Fluorosis Amelogenesis imperfecta Turner teeth Idiopathic hypomineralisation

Answer 75

Disruption in secretory phase, causing qualitative defects. Early development Small pits and grooves form on the surface, with gross enamel surface defects.

Answer 76

Disruption to the maturation phase causing poor matrix mineralisation Later in development Causes white and brown opacities, normal thickness but dubious enamel quality

Answer 77

Altered Ca/P ratio Less distinct enamel rods Bacterial penetration and lower hardness of enamel

Answer 78

Multiple putative factors, such as timing of insult, pyrexia, hypocalcaemia and hypoxia. - Exposure to chemicals - Peri-natal problems (time of conception to 1 year after birth) - Neonatal problems - Childhood illness and medically compromised children between the ages 0-1 (crown complete of 6s finishes at 3 yo)

Answer 79

- Aesthetic factors - Sensitivity to treatment, greater innervation in sub odontoblastic and pulp horn regions. - Porous enamel --> porous dentine and increase vascularity - Activation of A6 and C-fibres more easily (difficult to anaesthetise) - Behaviour management (present young 6,7,8)

Answer 80

Good longevity Easy to fit Separators Occlusal dimension settles Gingival health not compromised and allows proper eruption of 7s

Answer 81

Balance = extraction of a tooth from the opposite side of the same arch, designed to minimise centreline shift

Answer 82

Extraction of a tooth from the opposing quadrant to the enforced extraction. Designed to minimise occlusal interference by allowing teeth to maintain occlusal relationships as they drift.

Answer 83

Class I molars = compensate (balance if crowding present) Class II molars = > minimum crowding: extract U6 if likely to over erupt; remove before or after 7s erupted; no balancing > Crowding: compensate if U6 likely to over erupt; remove before or after 7s erupted; no balancing Class III: orthodontic advice to be sought; avoid balancing and compensating CHECK ACTUAL GUIDELINES FOR THIS!!!

Answer 84

- Micro abrasion for management of MIH affected incisors - Etch-bleach-seal - Bleaching - Composite use, both for prevention and aesthetic demands of patients.

Answer 85

Provoked by stimuli, pain disappears with removal of the stimulus. Short duration of pain Relieved by analgesics Sharp pain

Answer 86

Spontaneous and constant pain Long duration and dull throbbing pain Sleep disruption Not relieved by analgesia

Answer 87

Sinus formation Swelling (intra and extra-oral) Extent of caries Grey colour tooth

Answer 88

Vitality testing NOT BENEFIT in primary teeth Mobility TTT Colour Sinus formation Radiograph: caries extent, inter-radicular radiolucency, resorption

Answer 89

Bleeding disorders e.g. von Willebrands, Haemophilia Pt risk under GA

Answer 90

Immunocompromised (oncology, uncontrolled diabetes) Cardiac disorders (risk of IE)

Answer 91

Compliance related to age and complexity of treatment Dental awareness Motivation Pattern of attendance Age, how long till the tooth exfoliates

Answer 92

Gross dental neglect Restorability of dentition Acute infection present Time to exfoliation and amount of root resorption > Due to exfoliate <1 year and advanced root resorption - extract? > Due to remain in function >1 year and minimal root resorption - restore? Hypodontia Effect of developing dentition and value of tooth Avoiding potential future crowding Pulp status

Answer 93

Pulp capping - indirect (direct not successful in primary teeth) Pulpotomy Restorable crown, extent of caries Need to have only reversible pulpitis, absence of sinus and abscess and no spontaneous pain or signs of irreversible pulpitis No radiographic pulp resorption or inter-radicular bone loss.

Answer 94

Pulpectomy or Extraction

Answer 95

Maintains vitality of pulp by placing a dressing either directly on to exposed pulp or onto residual dentine left over a nearly exposed pulp. Aiming to promote pulp healing.

Answer 96

Promote dentine bridge formation over exposure and preserve vitality Ca(OH)2 medicament used. NOT RECOMMENDED IN PRIMARY DENTITION DUE TO POOR SUCCESS RATE.

Answer 97

Arrest caries by removal of active caries. Allow formation of reactionary dentine and promote pulp healing. Preserve vitality: - Used for symptoms free primary teeth with large occlusal lesions - Used for symptom free primary teeth with moderate approximal lesions - Deep carious lesions with no pulpal pathology Requires coronal seal (SSC)

Answer 98

Removal of coronal part of pulp tissue only Assuming its irreversibly inflamed Intention to maintain vitality of radicular pulp For vital, asymptomatic or transient pain patients with no radiographic pathology. Remove coronal pulp --> ferric sulphate (to arrest bleeding) --> ZOE --> Cement restoration --> SSC

Answer 99

1. Ferric sulphate - haemostatic agent, agglutinates blood proteins, forming a barrier 2. Formocresol (not used any more) 3. Calcium hydroxide 4. MTA

Answer 100

Zince oxide eugenol (ZOE) = temp filling or cement material used close to the pulp chamber, as it sedates the pulp.

Answer 101

When open the primary tooth pulp chamber and remove the coronal pulp, apply ferric sulphate for 15seconds. If bleeding hasn’t stopped, apply it once again and if unsuccessful, proceed to pulpectomy

Answer 102

Extirpation of soft tissue content from the coronal pulp chamber and canals. Followed by placement of resorbable dressing (ZOE, iodoform, Ledermix, Ca(OH)2) Indicated with irreversible pulpitis, pulp necrosis and hyperaemic pulp

Answer 103

Clinically: Success = absence of signs/symptoms of pathology Failure = pain, swelling, sinus, mobility Radiolucency: Failure = radiolucency in bone, pathologic resorption.

Answer 104

>50% of children aged >11 have caries affecting FPMs - Normally due them being hypoplastic - Requires a comprehensive clinical and radiographic examination Options for tx = extract, retain and restore

Answer 105

Malocclusion - affects timing for removal Hypodontia Orthodontic input - elective extraction of other 6s

Answer 106

Extent of crowding Presenting malocclusion Stage of dental development (patient age) Maxillary or mandibular molar

Answer 107

1. Immediate resolution of symptoms or infection 2. One off procedure, cost effective 3. Space created to be used for orthodontic 4. Time right extractions allows 7s to move into their space

Answer 108

1. Loss of permanent tooth 2. May require sedation of GA 3. Consequences of early/late extraction 4. Ortho treatment time and complexity might increase

Answer 109

Root bifuration of the 7s forming, usually 8-10 years.

Answer 110

Eruption of 5s to migrate distally

Answer 111

Too late can cause 7s to remain fixed and not migrate mesial

Answer 112

1. Immature roots and open apices present 2. Poor long-term prognosis 3. Lifelong maintenance of compromised 6.

Answer 113

Direct trauma - anterior teeth Indirect trauma - posterior teeth

Answer 114

18% of all preschool injuries are orofacial. Trauma to primary dentition: 31-40% of boys, and 16-30% of girls aged 5 Trauma to the permanent dentition at age 12: 12-33% boys, 4-19% of girls.

Answer 115

Primary = luxation injury Permanent = crown #

Answer 116

Class II div 1 malocclusion - teeth further forward with a lack of soft tissue coverage - Greater the overjet, the greater the frequency of trauma to upper incisors - Overjet >6mm 3x frequency Medical and physical impairments - cerebral palsy - autism - epilepsy Accident prone children

Answer 117

High velocity impact tends to cause crown fractures with less damage to PDL. Low velocity impact tend to cause damage to the supporting structures, the PDL.

Answer 118

Sharp objects give clean fractures with little luxation. Blunt objects have forces spread over a wider area, so tend to cause luxation injuries.

Answer 119

How did it happen? – indicated type and extent of injury that may have occurred. Direct/indirect trauma, High/low velocity, Sharp/blunt object. Where? – Potential contamination of wound. Medico legal reasons. When? – Critical for avulsion injuries and pulpal exposures as the prognosis of the tooth becomes much worse over time. Luxated teeth are harder to move after 24 hours. Delayed presentation could indicate NAI. Loss of conc – headache, amnesia, nausea? – Head injury? Previous injury – may explain RG findings like PCO. Disturbed occlusion – may indicate condylar fracture, jaw fracture, alveolar fracture or tooth luxation. Thermal reactions – thermal sensitivity implies dentine has been exposed and indicates need for dentinal coverage.

Answer 120

> Survey for injuries outside the head and neck region > Look for asymmetry (best observed from behind) > Palpate the facial skeleton for fractures > clean up any debris and dried blood with wet gauze > TMJ (deviation and asymmetry) > Facial injuries: laceration, contusion, swelling, abrasions

Answer 121

Soft tissues: > Lacerations (with potential embedded foreign body/tooth fragment) > Abrasions > Contusion (bruising) > Degloving injury (need to lift lips to look at mucogingival fold) Hard tissues: > missing, fractured, displaced, mobile teeth Occlusion: > any changes to the occlusion

Answer 122

Colour - yellow PCO, grey necrosis Mobility - luxation TTP = apical pathology and damage to PDL Percussion = tone and damage to PDL Cold/EPT vitality test Sinus - pulp necrosis Radiographs - radiolucencies such as apical pathology of # Photos/drawings may also be useful

Answer 123

of the alveolar process

Answer 124

Root fracture or tooth displacement of a luxation injury?

Answer 125

No unless you want to listen to tone (if doubt of concomitant luxation etc.)

Answer 126

Blood supply to the pulp Vitality or sensibility test measures nerve impulses. Not an indicator for if pulp will necrose or recover.

Answer 127

Yes, particularly following luxation injuries.

Answer 128

Teeth may exhibit little or no reaction.

Answer 129

Radiographs provide valuable information and form an important record of the condition and status of affected teeth at baseline. Increasingly there is a medico-legal requirement to obtain baseline radiographs > Some # won’t appear radiographically at first presentation so need something to back you up.

Answer 130

Decrease in response after trauma is very common. Teeth may not exhibit a reaction if root development is incomplete. Teeth being moved orthodontically will have higher excitation thresholds. Little value in testing primary teeth

Answer 131

Crown infraction = Uncomplicated crown # = Complicated crown # = Uncomplicated crown/root # = Complicated crown/root # = Root # =

Answer 132

= An enamel crack, without loss of tooth structure.

Answer 133

A fracture with loss of tissue confined to enamel/enamel and dentine only, without pulp exposure.

Answer 134

= A fracture confined to the enamel and dentine with pulp exposure.

Answer 135

Uncomplicated crown/root # = A fracture involving enamel, dentine and cementum, with no pulp involvement.

Answer 136

Complicated crown/root # = A fracture involving enamel, dentine, cementum and the pulp.

Answer 137

= A fracture of the root involving dentine, cementum and pulp. Fracture lines may be horizontal, oblique or a combination of both.

Answer 138

1. Concussion 2. Subluxation 3. Extrusive luxation 4. Intrusive luxation 5. Lateral luxation 6. Avulsion

Answer 139

= No mobility or displacement of the tooth but TTP.

Answer 140

= An injury to the tooth-supporting structures with abnormal loosening, but without displacement of the tooth.

Answer 141

= Displacement of the tooth in an apical direction into the alveolar bone.

Answer 142

= Displacement of the tooth out of its socket in an incisal/axial direction.

Answer 143

= Displacement of the tooth in any lateral direction, (usually associated with a fracture or compression of the alveolar socket wall or facial cortical bone.)

Answer 144

= Complete tooth displacement out of the socket.

Answer 145

1. Socket wall # 2. Alveolar process # 3. Maxilla # 4. Mandible #

Answer 146

1. Laceration 2. Contusion 3. Abrasion 4. Degloving

Answer 147

Tear or cut of the soft tissues (usually sharp object)

Answer 148

Bruise with no mucosal break (usually blunt object)

Answer 149

Superficial wound from rubbing or scraping mucosa

Answer 150

When top layers of skin and tissue are torn away from the underlying muscle, connective tissue or bone.

Answer 151

- Sensibility testing refers to tests (cold test and electric pulp test) used to determine the condition of the pulp. - Sensibility testing assesses neural activity and not vascular supply. - Testing might be unreliable due to a transient lack of neural response or undifferentiation of A-delta nerve fibers in young teeth. - The temporary loss of sensibility is a frequent finding during post-traumatic pulp healing, especially after luxation injuries. - Thus, the lack of a response to pulp sensibility testing is not conclusive for pulp necrosis in traumatized teeth. Despite this limitation, pulp sensibility testing should be performed initially and at each follow-up appointment in order to determine if changes occur over time. It is generally accepted that pulp sensibility testing should be done as soon as practical to establish a baseline for future comparison testing and follow up. Initial testing is also a good predictor for the long-term prognosis of the pulp.

Answer 152

A delta fibers, or Aδ fibers, are a type of sensory fiber. They respond to stimuli such as cold and pressure, and as nociceptors stimulation of them is interpreted as fast/first pain information. They are thinly myelinated, thus they send impulses faster than unmyelinated C fibers, but more slowly than other, more thickly myelinated "A" class fibers They are thin (2 to 5 μm in diameter), myelinated axons with a moderate conduction velocity, or speed of travel of a nerve signal (2 to 30 m/s). These nerve fibers are associated with acute (sharp) pain and therefore constitute the afferent portion of the reflex arc that results in "pulling away" from noxious stimuli (e.g., retracting your hand away from a hot stove). A certain proportion of Aδ fibers are also associated with sensations of temperature (also known as 'cold receptors) and pressure. Slowly conducting, unmyelinated C fibers, carry slow, burning pain.

Answer 153

There is limited evidence for the use of systemic antibiotics in the emergency management of luxation injuries and no evidence that antibiotics improve the outcomes for root-fractured teeth.

Answer 154

- Meticulous OHI, use soft brush - Use of anti-bacterial agents 0.12% Chlorhexidine topically as mouthrinse on the affected area 2 x day for one week, to reduce bacteria load, plaque and food debris - Soft food for 10 days - Restriction in use of intra-oral pacifier - Advise the parents of potential complications - No participations in contact sports Exercise care when eating as not to further traumatise the injured tooth while encouraging a return to normal function as soon as possible. Encourage gingival healing and prevent plaque accumulation by parents cleaning the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 week.

Answer 155

Parents and caregivers should be advised about possible complications that may occur, such as swelling, increased mobility, or a sinus tract. Children may not complain about pain, but infection may be present. Parents or caregivers should watch for signs of infection such as swelling of the gums. If present they should take the child to a dentist for tx. - Pulp necrosis and infection - Pulp space obliteration - Root resorption - Breakdown of marginal gingiva and bone - Sinus tract - Tooth mobility - Swelling

Answer 156

Allow continued root development and apex formation

Answer 157

No! potential damage to permanent successor.

Answer 158

Delayed eruption Dilaceration of permanent successor tooth Hypoplasia yellow-brown-white opacity) caused by distrubance in matrix formation; characterised by pitted, grooved, or thin enamel, tooth more susceptible to decay, sensitivity. Partial or incomplete malformation of permanent tooth Sequestration of permanent tooth Turner tooth (term used to describe the affect of a disturbance of enamel and dentine formation by an INFECTION from overlying primary tooth; tx as for hypoplasia)

Answer 159

Intrusive luxation

Answer 160

> White or yellow-brown hypomineralisation, injury at 2-7 yo > Crown dilaceration, injury at 2-7 yo > Root duplication, injury 2-5 yo

Answer 161

An abrupt deviation along the long axis of a crown or root portion of tooth/tooth with distorted crown or root. There are two types: developmental and traumatic (caused by primary incisor intrusion resulting in the developing permanent tooth germ displacement).

Answer 162

Short roots Apices are wide and often diverging Dentine walls of the entire tooth are thin and relatively weak Non-vital immature teeth have a higher # risk due to crown-root ratio

Answer 163

1. Direct pulp capping 2. Cvek pulpotomy 3. Cervical pulptomy

Answer 164

1. Non-setting CaOH (hypocal) 2. Mineral trioxide aggregate (MTA) 3. Odontopaste (not actually sure about this) (missed slides after this as unsure)

Answer 165

1. Cervical, middle and apical # 2. Vertical, horizontal and oblique # 3. Displaced and un-displaced #

Answer 166

Apical # are better prognosis, coronal # worse. Most common in middle or apical third of root Coronal fragment often extruded or luxated. End-approximated before a fibrin clot can form Apical fracture difficult for bacteria to penetrate and infect. Initial displacement of the coronal portion of root # most important indicator of prognosis.

Answer 167

Prevent ankylosis

Answer 168

> Cervical root # = placed for 4 months > Middle or apical root # splint applied for 2-4 weeks

Answer 169

Transient Apical Breakdown (TAB), phenomenon in which luxation injuries heal by mimicking apical inflammation

Answer 170

— 0.4mm wire in diameter by using flowable composite (IADN trauma guide) — Wire must sit passively on the teeth, do not bond and then bend — Keep composite and bonding agents away from the gingiva and proximal areas to avoid plaque retention and secondary infection — Cannot use preformed arch wire due to lack of pre-formed natural arches on teeth — Flexible splint = one either side — Rigid splint = two either side 2 X SEA: subluxation, extrusive luxation and avulsion 2wks of splinting 4 x RL: root # and lateral luxation 4wks of splinting 4 months for cervical root # and associated alveolar #

Answer 171

Condition which can occur in teeth where hard tissue is deposited along the internal walls of the root canal and fills most of the pulp system leaving it narrowed and restricted.

Answer 172

> Minimised damage to the PDL - prompt emergency tx - reposition and splint > Maintain vitality - protect exposed dentine > Prevent inflammatory resorption - maintain vitality - OR extirpate necrotic pulp

Answer 173

In case of severe infractions, etching and sealing with bonding resin should be considered to prevent discolouration and bacterial contamination of the infractions. Otherwise, no treatment is necessary. No F/U:

Answer 174

If the tooth fragment is available, it can be bonded back on to the tooth. Alternatively, depending on the extent and location of the fracture, the tooth edges can be smoothed, or a composite resin restoration placed F/U: - 6-8 weeks - after 1 year

Answer 175

If the tooth fragment is available and intact, it can be bonded back on to the tooth. The fragment should be rehydrated by soaking in water or saline for 20 minutes before bonding. Cover the exposed dentine with glass-ionomer or use a bonding agent and composite resin. If the exposed dentine is within 0.5mm of the pulp (pink but no bleeding), place a calcium hydroxide lining and cover with a material such as glass-ionomer. F/U: - 6-8 weeks - 1 year

Answer 176

In patients where teeth have immature roots and open apices, it is very important to preserve the pulp. Partial pulpotomy or pulp capping are recommended in order to promote further tooth development. Conservative pulp treatment (e.g. partial pulpotomy) is also the preferred tx in teeth with completed root development. Non-setting calcium hydroxide or non-staining calcium silicate cements are suitable materials to be placed on the pulp wound. If a post is required for crown retention in a mature tooth with complete root formation, RCT is the preferred treatment. If the tooth fragment is available, it can be bonded back on to the tooth after rehydration and the exposed pulp is treated. In the absence of an intact crown fragment for bonding, cover the exposed dentine with glass-ionomer or use a bonding agent and composite resin. F/U: - 6-8 weeks - 3 months - 6 months - 1 year

Answer 177

- Until a treatment plan is finalized, temporary stabilisation of the loose fragment to the adjacent tooth/teeth or to the non-mobile fragment should be attempted. - If the pulp is not exposed, removal of the coronal or mobile fragment and subsequent restoration should be considered. - Cover the exposed dentine with glass ionomer or use a bonding agent and composite resin. Further treatment options: The treatment plan is dependent, in part, on the patient’s age and anticipated co-operation. Options include: > Orthodontic extrusion of the apical or non-mobile fragment, followed by restoration (may also need periodontal re-contouring surgery after extrusion). > Surgical extrusion > Root canal treatment and restoration if the pulp becomes necrotic and infected. > Root submergence > Intentional replantation with or without rotation of the root. > Extraction > Autotransplantation. F/U: After 1 week After 6-8 weeks After 3 months After 6 months After 1 year Then yearly for at least 5 years.

Answer 178

- Until a treatment plan has been finalized, temporary stabilisation of the loose fragment to adjacent tooth/teeth or to the non-mobile fragment should be attempted. - In IMMATURE teeth with incomplete root formation, it is advantages to preserve the pulp by performing a partial pulpotomy. Rubber dam isolation should be tried. > Non-setting calcium hydroxide or non-staining calcium silicate cements are suitable materials to be placed on the pulp wound. - In mature teeth with complete root development, removal of the pulp is usually indicated. -Cover the exposed dentine with glass-ionomer or use a bonding agent and composite resin. Future treatment options: - (depends on age and co-operation) - Completion of root canal treatment and restoration - Orthodontic extrusion of the apical segment (may also need periodontal re-contouring surgery) - Surgical extrusion - Root submergence - Intentional replantation with or without rotation of the root - Extraction - Autotransplantation F/U: After 1 week After 6-8 weeks After 3 months After 6 months After 1 year Then yearly for at least 5 years

Answer 179

- If displaced, the coronal fragment should be repositioned ASAP. - Check repositioning radiographically. - Stabilise the mobile coronal segment with passive and flexible splint for 4 weeks. If the fracture is located cervically, stabilisation for a longer period of time (up to 4 months) may be needed. - Cervical fractures have the potential to heal. Thus, the coronal fragment especially if not mobile, should not be removed at the emergency visit. - No endodontic treatment should be started at the emergency visit. - It is advisable to monitor healing of the fracture for at least one year. Pulp status should also be monitored. - Pulp necrosis and infection may develop later. It usually occurs in the coronal fragment only. Hence, endodontic treatment of the coronal segment only will be indicated. As root fracture lines are frequently oblique, determination of root canal length may be challenging. An apexification approach may be needed. The apical segment rarely undergoes pathological changes that require treatment. - In mature teeth where the cervical fracture line is located above the alveolar crest and the coronal fragment is very mobile, removal of the coronal fragment, followed by RCT and restoration with a post-retained crown will likely be required. Additional procedures such as orthodontic extrusion of the apical segment, crown lengthening surgery, surgical extrusion or even extraction may be required as future treatment options (similar to those for crown-root fractures outlined above). F/U: after 4weeks S* After 6-8 weeks After 4 months S** After 6 months After 1 year Then yearly for at least 5 years

Answer 180

Reposition any displaced segment. Stabilise the segment by splinting the teeth with a passive and flexible splint for 4 weeks. Suture gingival lacerations if present. Root canal treatment is contraindicated at the emergency visit. Monitor the pulp condition of all teeth involved, both initially and at follow ups, to determine if or when endodontic treatment becomes necessary. F/U: After 4 weeks S* After 6-8 weeks After 4 months After 6 months After 1 year Then yearly for at least 5 years

Answer 181

No treatment is needed. Monitor pulp condition for at least one year, but preferably longer. F/U: After 4 weeks After 1 year

Answer 182

Normally no treatment is needed. A passive and flexible splint for up to 2 weeks may be used but only if there is excessive mobility or tenderness when biting on the tooth. Monitor the pulp condition for at least one year, but preferable longer. Analgesia when required, soft diet, avoid contact sports. Relief of occlusal interference. F/U: After 2 weeks S* After 12 weeks After 6 months After 1 year

Answer 183

- Reposition the tooth by gently pushing it back into the tooth socket under local anaesthesia. - Stabilise the tooth for 2 weeks using a passive and flexible splint. If breakdown/fracture of the marginal bone, splint for an additional 4 weeks. - Monitor the pulp condition with pulp sensibility tests. - If the pulp becomes necrotic and infected, endodontic treatment appropriate to the tooth’s stage of root development is indicated. F/U: After 2 weeks S* After 4 weeks After 8 weeks After 12 weeks After 6 months After 1 year Then yearly for at least 5 years.

Answer 184

- Reposition the tooth digitally by disengaging it from its locked position and gently reposition it into its original location under local anaesthesia. > Method: Palpate the gingiva to feel the apex of the tooth. Use one finger to push downwards over the apical end of the tooth, then use another finger or thumb to push the tooth back into it socket. - Stabilise the tooth for 4 weeks using a passive and flexible wire splint. If breakdown/fracture of the marginal or alveolar socket wall, additional splinting may be required. Monitor the pulp condition with pulp sensibility tests at the follow-up appointments. At about 2 weeks post-injury, make an endodontic evaluation. - Teeth with INCOMPLETE root formation: > Spontaneous revascularisation may occur > If the pulp becomes necrotic and there as signs of inflammatory (infection-related) external resorption, root canal treatment should be started as soon as possible. > Endodontic procedures suitable for immature teeth should be used. Teeth with COMPLETE root formation: > The pulp will likely become necrotic. > RCT should be started, using a corticosteroid-antibiotic or calcium hydroxide as an intra-canal medicament to prevent the development of inflammatory (infection-related) external resorption. F/U: After 2 weeks After 4 weeks S* After 8 weeks After 12 weeks After 6 months After 1 year Then yearly for at least 5 years

Answer 185

- Teeth with INCOMPLETE root formation (immature teeth): > Allow re-eruption without intervention (spontaneous repositioning) for all intruded teeth independent on the degree of intrusion. > If no re-eruption within 4 weeks, initiate orthodontic repositioning. > Monitor the pulp condition. > In teeth with incomplete root formation, spontaneous pulp revascularisation may occur. However, if it is noted that the pulp becomes necrotic and infected of that there are signs of inflammatory (infection-related) external resorption at follow-up appointments, RCT is indicated and should be started asap when the position of the tooth allows. Endo procedures suitable for immature teeth should be used. > Parents must be informed about the necessity of follow-up visits. - Teeth with COMPLETE root formation (mature teeth): > Allow re-eruption without intervention if the tooth is intruded less than 3mm. If no re-eruption within 8 weeks, reposition surgically and splint for 4 weeks with a passive and flexible splint. Alternatively, reposition orthodontically before ankylosis develops. > If the tooth is intruded 3-7mm, reposition surgically (preferably) or orthodontically. > If the tooth is intruded beyond 7mm, reposition surgically. > In teeth with complete root formation, the pulp almost always becomes necrotic. Root canal treatment should be started at 2 weeks or as soon as the position of the tooth allows, using a corticosteroid-antibiotic or calcium hydroxide as an intra-canal medication. The purpose of this treatment is to prevent the development of inflammatory (infect-related) external resorption. F/U: After 2 weeks After 4 weeks S* After 8 weeks After 12 weeks After 6 months After 1 year Then yearly for at least 5 years.

Answer 186

Concussion: OA = 100%, CA = 96% Subluxation: OA = 100%, CA = 85% Extrusive luxation: OA = 95%, CA = 45% Lateral luxation: OA = 95%, CA = 25% Intrusive luxation: OA = 40%, CA = 0% Avulsion: OA = 30%, CA = 0%

Answer 187

1. Keep the patient calm 2. Find the tooth and pick it up by the crown (the white part). Avoid touching the root. Attempt to place it back into the jaw. 3. If the tooth is dirty, rinse it gently in milk, saline or in the patient’s saliva and replant or return it to its original position in the jaw. 4. It is important to encourage the patient/guardian/teacher/other person to replant the tooth immediately at the emergency site. 5. Once the tooth has been returned to its original position in the jaw, the patient should bite on gauze, a handkerchief or a napkin to hold it in place. > If replantation at the accident site is not possible, or for other reasons when replantation of the avulsed tooth is not feasible (e.g. unconscious pt), place the tooth, asap, in a storage or transport medium that is immediately available at the emergency site. This should be done quickly to avoid dehydration of the root surface, which starts to happen in a matter of a few minutes. In descending order of preference, milk, HBSS, saliva (after spitting into a glass), or saline are suitable and convenient storage mediums. Although water is a poor medium, it is better than leaving the tooth to air-dry. 7. The tooth can then be brought with the patient to the emergency clinic. 8. See a dentist or dental professional immediately.

Answer 188

The maturity of the root (open or closed apex) The condition of the periodontal ligament (PDL). This is dependent on: > The time out of the mouth - Minimising the dry time is critical for the survival of the PDL cells. - After and extra-alveolar dry time of 30 minutes, most PDL cells are non-viable. > The storage medium the avulsed tooth was kept in.

Answer 189

- The periodontal ligament of an avulsed tooth often becomes contaminated by bacteria from the oral cavity, the storage medium, or the environment in which the avulsion occurred. Therefore, the use of systemic antibiotics after avulsion and replantation has been recommended to prevent infection-related reactions and to decrease the occurrence of inflammatory root resorption. - Additionally, the pt’s medical status or concomitant injuries may warrant antibiotic coverage. - In all cases, appropriate dosage for the pt’s age and weight should be calculated. - Amoxicillin or penicillin remain the first choices due to their effectiveness on oral flora and low incidence of side effects. Alternative Abx for penicillin allergies. - Tetracycline or doxycycline are generally not recommended for pts under 12, due to risk of discolouration of permanent teeth when administered in young pts

Answer 190

Avulsed teeth always require stabilisation to maintain the replanted tooth in its correct position, provide patient comfort, and improve function. Current evidence supports short-term, passive and flexible splints for stabilisation of replanted teeth. stainless steel wire up to a diameter of 0.016” or 0.4mm or with nylon fishing line (0.13-0.25mm), and bonded to the teeth with composite resin. Replanted permanent teeth should be stabilised for a period of 2 weeks. The wire and composite should be paced on the labial surfaces to avoid occlusal interference and to enable palatal/lingal access for endodontic procedures. Keep the composite and bonding agents away from the marginal gingiva and interproximal areas to avoid plaque retention and secondary infections and to allow relatively easy cleaning by the patient.

Answer 191

1. Avoid participation in contact sports 2. Maintain a soft diet for up to 2 weeks, according to the tolerance of the patient. 3. Brush their teeth with a soft toothbrush after each meal. 4. Use a chlorhexidine (0.12%) mouth rinse twice a day for 2 weeks.

Answer 192

After 2 weeks S* After 4 weeks After 3 months After 6 months After 1 year Then yearly for at least 5 years.

Answer 193

After 2 weeks S* After 1 month After 2 months After 3 months After 6 months After One year Then yearly for at least 5 years.

Answer 194

1. Clean the injured area with water, saline, or chlorhexidine. 2. Verify the correct position of the replanted tooth both clinically and radiographically. 3. Leave the tooth/teeth in place (except where the tooth is malpositioned; the malpositioning needs to be corrected using slight digital pressure). 4. Administer LA, if necessary, and preferable with no vasoconstrictor. 5. If the tooth or teeth were replanted in the wrong socket or rotated, consider repositioning the tooth/teeth into the proper location up to 48 hours after the traumatic incident. 6. Stabilise the tooth for 2 weeks using a passive flexible splint such as wire of diameter up to 0.016” or 0.4mm bonded to the tooth and adjacent teeth. Keep the composite and bonding agents away from the gingival tissues and proximal areas. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left in place for about 4 weeks. 7. Suture gingival lacerations if present. 8. Initiate root canal treatment within 2 weeks after replantation. 9. Administer systemic antibiotics. 10. Check tetanus status. 11. Provide post operative instructions. 12. Follow up: 2 weeks S*, 4 weeks, 3 months, 6 months, one year, yearly for at least 5 years.

Answer 195

1. If there is visible contamination, rinse the root surface with a stream of saline or osmolality-balanced media to remove gross debris. 2. Check the avulsed teeth for surface debris. Remove any debris by gently agitating it in the storage medium. Alternatively, a stream of saline can be used to briefly rinse is surface. 3. Put or leave the tooth in the storage medium while taking a history, examining the patient clinically and radiographically, and preparing the patient for the replantation. 4. Administer local anaesthesia, preferable without a vasoconstrictor. 5. Irrigate the socket with sterile saline. 6. Examinate the alveolar socket. If there is a fracture of the socket wall, reposition the fractured fragment into its original position with a suitable instrument. 7. Removal of the coagulum with a saline stream may allow better repositioning of the tooth. 8. Replant the tooth slowly with slight digital pressure. Excessive force should not be used. 9. Verify the position of the replanted tooth both clinically and radiographically. 10. Stabilise the tooth for 2 weeks using a passive, flexible wire of a diameter up to 0.016” or 0.4mm. Keep the composite and bonding agents away from the gingival tissues and proximal areas. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left in place for about 4 weeks. 11. Suture gingival lacerations if present. 12. Initiate RCT within 2 weeks after replantation. 13. Administer systemic antibiotics. 14. Check tetanus status. 15. Provide post-operative instructions (contact sports, soft diet for 2/52, soft toothbrush after every meal, chlorhexidine gluconate 0.12% MW 2x/day 2/52. 16. Follow up: 2 weeks S*, 4 weeks, 3 months, 6 months, 1 year, then yearly for at least 5 years.

Answer 196

1. Remove loose debris and visible contamination by agitating the tooth in physiologic storage medium, or with gauze soaked in saline. Tooth may be left in storage medium while taking a history, examining the patient clinically and radiographically, and preparing the patient for the replantation. 2. Administer local anaesthesia, preferably without vasoconstrictor. 3. Irrigate the socket with sterile saline. 4. Examine the alveolar socket. Remove coagulum if necessary. If there is a fracture of the socket wall, reposition the fractured fragment with a suitable instrument. 5. Replant the tooth slowly with slight digital pressure. The tooth should not be forced back to place. 6. Verify the correct position of the replanted tooth both clinically and radiographically. 7. Stabilise the tooth for 2 weeks using a passive flexible wire of a diameter up to 0.016” or 0.4mm. Keep the composite and bonding agents away from the gingival tissues and proximal areas. 8. Suture gingival lacerations if present. 9. RCT should be carried out within 2 weeks. 10. Administer systemic antibiotics. 11. Check tetanus status. 12. Provide post-operative instructions (avoid contact sports, soft diet 2/52, soft toothbrush after meals, chlorhexidine gluconate 0.12% 2x/day 2/52. 13. Follow up: 2 weeks S*, 4 weeks, 3 months, 6 months, 1 year, then yearly for at least 5 years.

Answer 197

- The periodontal ligament becomes necrotic and is not expected to regenerate. - The expected outcome is ankylosis-related (replacement) root resorption. - The goal, in these cases is to restore, at least temporarily, aesthetics and function while maintaining alveolar bone contour, width, and height. - Therefore the decision to replant a permanent tooth is almost always the correct decision even if the extra-oral dry time is more than 60 minutes. - Replantation will keep future treatment options open. The tooth can always be extracted, if needed, and at the appropriate point following prompt inter-disciplinary assessment.

Answer 198

- There is the potential for spontaneous healing to occur in the form of new connective tissue with a vascular supply. - This allows continued root development and maturation. - Hence, endodontic treatment should not be initiated unless there as definite signs of pulp necrosis and infection of the root canal system at follow-up appointments.

Answer 199

1. Clean the area with water, saline, or chlorhexidine. 2. Verify the position of the replanted tooth both clinically and radiographically. 3. Leave the tooth in the jaw (except where the tooth is malpositioned; the malpositioning needs to be corrected with slight digital pressure. 4. Administer local anaesthesia, if necessary, and preferable with no vasoconstrictor. 5. If the tooth or teeth were replanted in the wrong socket or rotated, consider repositioning the tooth/teeth into the proper location for up to 48 hours after the trauma. 6. Stabilise the tooth for 2 weeks using a passive and flexible wire of a diameter of 0.016” or 0.4mm. Short immature teeth may require a longer splinting time. Keep the composite and bonding agents away from the gingival tissues and proximal areas. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left in place for 4 weeks. 7. Suture gingival lacerations, if present. 8. Pulp revascularisation which can lead to further root development, is the goal when replanting immature teeth in children. The risk of external infection-related (inflammatory) resorption should be weighted against the chances of revascularisation. Such resorption is very rapid in children. > If spontaneous revascularisation does not occur, apexification, pulp revitalization/revascularisation or root canal treatment should be initiated as soon as pulp necrosis and infection is identified. 9. Administer systemic antibiotics 10. Check tetanus status 11. Provide post-operative instructions (avoid contact sports, soft diet for 2/52, soft toothbrush after meals, chlorhexidine gluconate 0.12% 2x/day 2/52. 12. Follow ups: 2 weeks S*, 1 month, 2 months, 3 months, 6 months, 1 year, and then yearly for at least 5 years.

Answer 200

1. Check the avulsed tooth and remove debris from its surface by gently agitating it in the storage medium. Alternatively, a stream of sterile saline or a physiologic medium can be used to rinse its surface. 2. Place or leave the tooth in a storage medium while taking the history, examining the patient clinically and radiographically and preparing the patient for the replantation. 3. Administer local anaesthesia, preferably without vasoconstrictor. 4. Irrigate the socket with sterile saline. 5. Examine the alveolar socket. Remove coagulum if necessary. If there is a fracture of the socket wall, reposition the fractured segment with a suitable instrument. 6. Replant the tooth slowly with slight digital pressure. 7. Verify the correct position of the replanted tooth both clinically and radiographically. 8. Stabilise the tooth for 2 weeks using a passive and flexible wire of a diameter of up to 0.016” or 0.4mm. Keep the composite and bonding agents away from the gingival tissues and proximal areas. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left for about 4 weeks. 9. Suture gingival lacerations if present. 10. Pulp revascularisation which can lead to further root development, is the goal when replanting immature teeth in children. The risk of external infection-related (inflammatory) resorption should be weighted against the chances of revascularisation. Such resorption is very rapid in children. If spontaneous revascularisation does not occur, apexification, pulp revitalization/revascularisation or root canal treatment should be initiated as soon as pulp necrosis and infection is identified. 11. Administer systemic antibiotics 12. Check tetanus status 13. Provide post-operative instructions (avoid contact sports, soft diet for 2/52, soft toothbrush after meals, chlorhexidine gluconate 0.12% 2x/day 2/52. 14. Follow ups: 2 weeks S*, 1 month, 2 months, 3 months, 6 months, 1 year, and then yearly for at least 5 years.

Answer 201

1. Check the avulsed tooth and remove debris from its surface by gently agitating it in the storage medium. Alternatively, a stream of sterile saline can be used to rinse its surface. 2. Place or leave the tooth in a storage medium while taking the history, examining the patient clinically and radiographically and preparing the patient for the replantation. 3. Administer local anaesthesia, preferably without vasoconstrictor. 4. Irrigate the socket with sterile saline. 5. Examine the alveolar socket. Remove coagulum if necessary. If there is a fracture of the socket wall, reposition the fractured segment with a suitable instrument. 6. Replant the tooth slowly with slight digital pressure. 7. Verify the correct position of the replanted tooth both clinically and radiographically. 8. Stabilise the tooth for 2 weeks using a passive and flexible wire of a diameter of up to 0.016” or 0.4mm. Keep the composite and bonding agents away from the gingival tissues and proximal areas. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left for about 4 weeks. 9. Suture gingival lacerations if present. 10. Pulp revascularisation which can lead to further root development, is the goal when replanting immature teeth in children. The risk of external infection-related (inflammatory) resorption should be weighted against the chances of revascularisation. Such resorption is very rapid in children. If spontaneous revascularisation does not occur, apexification, pulp revitalization/revascularisation or root canal treatment should be initiated as soon as pulp necrosis and infection is identified. 11. Administer systemic antibiotics 12. Check tetanus status 13. Provide post-operative instructions (avoid contact sports, soft diet for 2/52, soft toothbrush after meals, chlorhexidine gluconate 0.12% 2x/day 2/52. 14. Follow ups: 2 weeks S*, 1 month, 2 months, 3 months, 6 months, 1 year, and then yearly for at least 5 years.

Answer 202

- An avulsed primary tooth should not be replanted. - Reasons include a significant burden (including replantation, splint placement and removal, root canal treatment) for a young child as well as the potential of causing further damage to the permanent tooth or to its eruption. - The most important reason is to avoid medical emergency resulting from aspiration of the tooth. - Careful follow up is required to monitor the development and eruption of the permanent tooth.

Answer 203

- Smooth any sharp edges - Parent/patient education: - Exercise care when eating not to further traumatise the injured tooth while encouraging a return to normal function asap. - Encourage gingival healing and prevent plaque accumulation by parents cleaning thee affected area with a soft brush/cotton swab combined with an alcohol-free 0.1 to 0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 week. F/U: No clinical or radiographic follow up recommended

Answer 204

- Cover all exposed dentine with glass ionomer or composite. - Lost tooth structure can be restored using composite immediately or at a later appointment. - Patient/parent education: - Exercise care when eating as not to further traumatise the injured tooth while encouraging a return to normal function as soon as possible. - Encourage gingival healing and prevent plaque accumulation by parents cleaning the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 week. F/U: 6-8 weeks

Answer 205

- Preserve the pulp by partial pulpotomy. LA is required. A non-setting calcium hydroxide paste should be applied over the pulp and cover this with GIC or composite. Cervical pulpotomy is indicated for teeth with large pulp exposures. - Treatment depends on the child’s maturity and ability to tolerate procedures. Therefore, discuss different tx options (including pulpotomy) with the parents. Each option is invasive and has the potential to cause long-term dental anxiety. Treatment is best performed by child-oriented team with experience and expertse in the management of pediatric dental injuries. Often no treatment may be the most appropriate option in the emergency situation, but only when there is the potential for rapid referral (within several days) to the child-oriented team. - Patient/parent education: - care eating, cotton swab/soft brush w alcohol-free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 week. F/U: 1 week 6-8 weeks 1 year

Answer 206

- Often no treatment may be the most appropriate option in the emergency situation, but only when there is the potential for rapid referral (within several days) to a child-oriented team. - If treatment is considered at the emergency appointment, LA will be required. -Remove the loose fragment and determine if the crown can be restored. Option A: -> If restorable and no pulp exposed, cover the exposed dentine with GIC. -> If restorable and the pulp is exposed, perform a pulpotomy (see crown fracture with exposed pulp) or RCT, depending on the stage or root development and the level of the fracture. Option B: If unrestorable, extract all loose fragments taking care not to damage the permanent successor tooth and leave any firm root fragment in situ, or extract the entire tooth. Treatment depends on the child’s maturity and ability to tolerate procedures. Parent/pt education:... F/U: 1 week 6-8 weeks 1 year

Answer 207

- If the coronal fragment is not displaced, no treatment is required. - If the coronal fragment is displaced and is not excessively mobile, leave the coronal fragment to spontaneously reposition even if there is some occlusal interference. - If the coronal fragment is displaced, excessively mobile and interfering with occlusion, two options are available, both of which require local anaesthesia. Option A: > Extract only the loose coronal fragment. The apical fragment should be left in place to be resorbed. Option B: > Gently reposition the loose coronal fragment. If the fragment is unstable in its new position, stabilise the fragment with a flexible splint attached to the adjacent uninjured teeth. Leave the splint in place for 4 weeks. Treatment depends on the child’s maturity and ability to tolerate procedures Parent/pt education: ... F/U: Where there is no displacement of coronal fragment, clinical examination after: 1 week 6-8 weeks 1 year and where there are clinical concerns that an unfavorable is likely. If the coronal fragment has repositioned and splinted, clinical examination after: 1 week 4 weeks for splint removal 8 weeks 1 year

Answer 208

- Reposition (under local anaesthetic) any displaced segment which is mobile and/or causing occlusal interference. - Stabilise with a flexible splint to the adjacent uninjured teeth for 4 weeks. - Treatment should be performed by a child-oriented team with experience and expertise in the management of pediatric dental injuries. - Parent/patient education: > Exercise care when eating as not to further traumatise the injured teeth while encouraging a return to normal function as soon as possible. > To encourage gingival healing and prevent plaque accumulation, parents should clean the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1-0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 week. F/U: 1 week 4 weeks for splint removal 8 weeks 1 year Further follow up at 6 years of age is indicated to monitor eruption of the permanent teeth.

Answer 209

No treatment is needed Observation Parent/patient education: F/U: 1 week 6-8 weeks

Answer 210

No treatment is needed. Observation Patient/parent education: F/U: 1 week 6-8 weeks

Answer 211

- Treatment decisions are based on the degree of displacement, mobility, interference with the occlusion, root formation, and the ability of the child to tolerate the emergency situation. > If the tooth is not interfering with the occlusion – let the tooth spontaneously reposition itself. > If the tooth is excessively mobile or extruded >3mm, then extract under local anaesthesia. - Treatment should be performed by a child-oriented team with experience and expertise in the management of pediatric dental injuries. Extractions have the potential to cause long-term dental anxiety. Parent/patient education: F/U: 1 week 6-8 weeks 1 year

Answer 212

- If there is minimal or no occlusal interference, the tooth should be allowed to spontaneously reposition itself. -> Spontaneous repositioning usually occurs within 6 months. In situations of severe displacement, two options are available, both of which require local anaesthesia: Option A: > Extraction when there is a risk of ingestion or aspiration of the tooth. Option B: > Gently reposition the tooth. If unstable in its new position, splint for 4 weeks using a flexible splint attached to the adjacent uninjured teeth. Treatment should be performed by a child-oriented team with experience and expertise in the management of pediatric dental injuries. Extractions have the potential to cause long-term dental anxiety. Parent/patient education: F/U: Clinical examination after: 1 week 6-8 weeks 6 months 1 year If repositioned and splinted, review after: 1 week 4 weeks S* 8 weeks 6 months 1 year

Answer 213

- The tooth should be allowed to spontaneously reposition itself, irrespective of the direction of displacement. - Spontaneous improvement in the position of the intruded tooth usually occurs within 6 months. In some cases it can take up to 1 year. - A rapid referral (within a couple of days) to a child-oriented team that has experience and expertise in the management of pediatric dental injuries should be arranged. A parent/patient education: F/U: 1 week 6-8 weeks 6 months 1 year

Answer 214

Avulsed primary teeth should not be replanted A parent/patient education: Exercise care when eating as not to further traumatize the injured tooth while encouraging a return to normal function as soon as possible. To encourage gingival healing and prevent plaque accumulation, parents should clean the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1%-0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 week. F/U: 6-8 weeks Further follow up at 6 years of age is indicated to monitor eruption of the permanent tooth.

Answer 215

Red – occur after luxation (bleeding) Yellow – pulp canal obliteration Pink – internal resorption (gingiva/pulp shines through) Dark – pulp necrosis

Answer 216

Due to the venous microcirculation being severed by the tooth movements, releasing blood. When the blood decomposes it can cause the tooth to burn blue/brown.

Answer 217

A tooth turns pink because when there is internal resorption of the tooth, the dentine is replaced by hyperplastic vascular pulp tissues. The pink becomes visible when the pulp nears the external surface of the tooth.

Answer 218

As the tooth is necrosed, over time there is breakdown of pulpal tissue and blood incorporated into dentine.

Answer 219

It is usually late presentation of cervical resorption. When present with pink discoloration at neck of the tooth, it is often well advanced and extraction may be the only possible treatment.

Answer 220

1)Depends on the cause (e.g. necrosis require XLA or extirpation). 2) Does not necessarily need treatment. 3) Need to monitor carefully – clinically and radiographically for signs of infection. 4) The formation of a sinus or swelling indicates infection/pulpal necrosis therefore needs treatment. 5) Monitor for signs of pulpal sclerosis.

Answer 221

a. Occurs when there is disruption of the blood supply at the apical foramen = ischaemic necrosis (infarction) b. Infection related liquefactive necrosis. c. Higher incidence in - Traumatised teeth with complete root development are more likely to necrose as the apex is closed so cannot revascularise and in concussion, subluxation and lateral luxation.

Answer 222

Concussion within 3 months Lateral luxation/intrusion – after 2 years

Answer 223

Need to place a composite bandage to seal the dentinal tubules to prevent ingress of bacterial through the dentinal tubules to the pulp. This is to prevent bacterial infiltration and consequent inflammation of the pulp (leading to necrosis). – is an important factor in success of pulp survival.

Answer 224

Diagnosed by AT LEAST 2 SIGNS AND SYMPTOMS: a. Persistent grey colour b. Radiographic signs of periapical inflammation (radiolucency or widened PDL) c. TTP d. Sounds ‘dull’ percussion test as no vital tissues. e. Sinus/swelling f. Mobility g. Suppuration h. Lack of vitality response after 3 months post trauma.

Answer 225

1. Colour of tooth might change and get worse. 2. Might develop pulpal sclerosis or obliteration – this may make RCT impossible at later date as can’t enter root canal, and tooth becomes unrestorable. 3. Draining sinus is a chronic situation, and through may be asymptomatic now, can get acute exacerbation of chronic infection. May result in swelling, pain and spreading infection. 4. Tooth may become symptomatic and unrestorable at later date. 5. Discuss options at each review appointment. – document if still don’t want tx.

Answer 226

It is resorption found within the root canal. If you identify it early as possible you can fill the deficiency with a good obturation system. Tend to refer these patients to specialists in moderate to advanced cases as difficult to clean and fill.

Answer 227

It is located along the root surface. 1. Surface resorption – this is transient and is tooth repair related. It is self-limiting in nature. 2. External inflammatory resorption – associated with infection/necrotic pulp. 3. External replacement resorption – associated with ankylosis following the death of PDL cells. 4. Cervical resorption – manifests at cervical aspect of the tooth and is due to damage to the PDL and sub-epithelial cementum. 5. Transient apical resorption.

Answer 228

1. Mature apex 2. A significant injury e.g. intrusions/avulsions.

Answer 229

Inflammatory – extirpate the pulp Replacement – no successful treatment

Answer 230

Root resorption is normally a result of significant amount of damage to the PDL or pulp due to trauma. Tend to present early – well within 2-3 years of avulsion. Open apices lead to increased occurrence.

Answer 231

Trauma (damage to the PDL or sub-epithelial cementum) or idiopathic. More common in pts who are older at the time of injury. Early detection is key as tend to be asymptomatic until reach the pulp.

Answer 232

1. May be able to repair and may not need RCT. 2. External repair +/- RCT – where MTA/BIODENTINE is used to repair the external defect. – often involves raising a flap to expose area of resorption. 3. Internal repair and RCT – when conducting the RCT will place MTA/biodentine where the resorption defect is. 4. Internal replantation – where you remove the tooth, conduct required treatment then re-implant and accept ankylosis. – will then need RCT. 5. Extraction.

Answer 233

4-24% of traumatised teeth will have some degree of pulpal obliteration. 1. Symptomatic (inflammatory symptoms) or asymptomatic 2. Loss of pulpal space radiographically 3. Yellow discolouration of crown

Answer 234

As there is excessive calcified material within the canal. Very prone to perforations as accessing canal very difficult. – when access may not drop into the canal. Refer to specialist.

Answer 235

If there are no aesthetic issues or symptoms then the tooth can be retained as it is no different to an osseointegrated implant. If resorption is a problem this will need to be addressed. Complications: i. resorption of the tooth may lead to eventual loss of the tooth. ii. Tooth may become discoloured due to necrosis iii. Tooth may become infra occluded and become an aesthetic concern

Answer 236

1. Ankylotic root resorption – replacement resorption. Radiographically diagnosed within the first 2-3 years of avulsion. 2. Associated with infra occlusion where the tooth becomes shorter than other teeth as doesn’t grown. 3. Decoronation – removal of the crown leaving the roots to preserve alveolar bone. Decoronation may be necessary when there is 1+mm of infra position. 4. If a patient has a low smile line then aesthetics tends to be less of a concern. Need to discuss rate at which resorption is occurring and advise appropriately. Could be retain tooth and saving for implant.

Answer 237

1. Survival 2. Pulp canal obliteration > successful re-vascularisation > deposition of hard tissue along pulp canal walls 3. Pulp necrosis > inflammatory resorption

Answer 238

- Initial pulp status - Status of apex > open apex increases chance of survival due to high vascularisation > extent of injury, concomitant damage to PDL - Time since injury - the longer duration increases chance of necrosis - Concurrent injuries - PDL damage increases chance of necrosis

Answer 239

- Necrotic pulp + PDL damage - Luxation + necrosis = inflammatory resorption - Treatable by extirpating pulp in pts to prevent inflammatory resorption Prolonged insult to PDL leading to continued pathology - Due to infection in the pulp causing loss of vitality and necrosis

Answer 240

- Caused by death of PDL cells - More likely to happen in more severe injuries such as Luxation or Avulsion - XGA or Coronectomy - Tooth tissue is resorbed and replaced with bone - Extra-oral dry time is biggest indicator of replacement resorption risk - More likely to happen in re-implantation cases in open apices as more growing potential present, more bony remodeling

Answer 241

- Asymptomatic - Transient apical breakdown - Repair related, undergoes healing and should be monitored only (no Tx) - Self-limiting process, often an incidental radiographic finding - Caused by localised and limited injury to root surface or surrounding tissue - 2—3 weeks of osteoclast activity before healing then occurs - If cementum alone is involved in the resorptive process then complete healing will occur, but if dentine is involved there will be re-contouring

Answer 242

- Related to repair and transient breakdown of the pulp chamber > If pulp becomes necrotic the resorption will cease unless lateral canals present > Internal resorption starts within the pulp chamber of a tooth > Internal resorption can occur only on vital (or partially vital teeth)

Answer 243

> Preservation of vital pulp tissue so that continued root development with natural apical closure can occur in patients with an open apex > Cvek Pulpotomy, removal of all infected and damaged pulp, dressed in CaOH > Cervical pulpotomy > Patient: vital pulp, immature root with an open apex

Answer 244

ability of residual pulp and apical and periodontal stem cells to differentiate???

Answer 245

- Inducing a calcified barrier at the apex of a non-vital tooth (MTA) with incomplete root formation > Need a microscope to place the MTA > To facilitate endodontic obturation in patients with no growth potential

Answer 246

- Has different sound from a normal tooth when it is percussed (often described as cracked china sound) - Lack periodontal membrane space on a radiograph - Has no physiological mobility - May become infraoccluded as the jaw grows around it - Replacement resorption causes considerable damage to the PDL and bone remodeling, resulting in loss of alveolar height

Answer 247

1. Mesiodens = conical shape complete tooth in anterior maxilla, commonly unerupted, normally in midline (75%) 2. Tuberculate = barrel shaped tooth, more than one cusp, incomplete roots, normally palatal to U3s usually paired (12%) 3. Supplemental = resembles normal tooth shape and size, appears as normal tooth, upper lateral incisors and lower premolars (7%) 4. Odontoma = (compound odontoma) hamartoma of odontogenic origin, irregular mass of denticles, anterior maxilla/posterior mandible (6%)

Answer 248

Occur due to budding of dental lamina, either sporadically or because of a syndrome.

Answer 249

Extraction if: - impeding eruption of adjacent teeth - causing displacement - interfere with tx (orthodontics) - associated pathology Otherwise monitor if symptomless or adjacent teeth still forming.

Answer 250

Hypodontia = missing teeth Oligodontia = >6 missing teeth Anodontia = missing all teeth

Answer 251

8s > 5s> 2s> 1s

Answer 252

Caused by obstruction or disruption of dental lamina, with a failure of dental epithelium to initiate or function. - space limitation for tooth germ - environmental factors (teratogen) - genetic - syndromes

Answer 253

No success - look via radiograph

Answer 254

Ectodermal dysplasia: disorder affecting outer layer of tissue of the embryo (ectoderm) Cleft lip and palate, due to abnormal induction and proliferation of the mesenchym

Answer 255

Tooth larger than normal type, usually affects single tooth. Single teeth = unknown cause, due to isolate disturbance of development Generalised = due to hormonal imbalances

Answer 256

Small than normal tooth Usually 8s and 2s. Aetiology unknown, generalised microdontia v rare. Management of microdontia: - build up with composite resin - porcelain veneer - extract and then replace with orthodontics, implant or autotransplantation.

Answer 257

Joining of adjacent tooth germs

Answer 258

Developmental separation of a single tooth germ

Answer 259

Infolding of the dental papilla Mild = deep cingulum pit Severe = abnormal crown enamel often very thin, leading to caries and an increased potential for pulpal necrosis

Answer 260

Enamel covered tubercle on crown of tooth 43% may contain pulpal Mandible > maxilla Commonly on occlusal surface of premolar Treatment to avoid occlusal interferences and any problems associated with this

Answer 261

1. Cusp of carabelli, bilateral maxillary 6s. 2. Talon cusps in the cingulum of permanent incisors Treatment: > Seal groove between accessory cusp and tooth > If occlusion affected, then selective reduction and removal of cusp possible.

Answer 262

Morpho-anatomical change in the shape of a tooth. Enlarged body and pulp chamber seen radiographically. Apical displacement of the pulpal floor Due to failure of the HERS to invaginate properly, causing short roots, enlarged body and enlarged pulp with normal dentine.

Answer 263

Matrix production and initial mineralisation

Answer 264

Increase in mineral content

Answer 265

Reduced QUANTITY of enamel. Secretory phase affected so disturbance in the formation of the matrix of enamel which give rise to pitted and grooved enamel (no normal volume of matrix). Results in irregular shaped teeth, gross enamel deficit. Disturbance occurs during secretory phase.

Answer 266

Reduction in QUALITY of enamel Distrurbance during maturation phase White/brown opacities Normal thickness but dubious quality enamel

Answer 267

condition in which the tooth enamel has an insufficient amount of calcium. Teeth have white opaque and chalky appearance.

Answer 268

1. Infection 2. Idiopathic 3. Trauma 4. Irradiation Infection or trauma that affects a deciduous tooth can result in hypoplasia or hypomineralisation of permanent successors.

Answer 269

Genetics: - Down syndrome - Ectodermal dysplasia - Epidermolysis bullosa - Occulo-dento-osseous dysplasia Environmental - prenatal: rubella and syphilis - neonatal: premature birth, hypocalcaemia, hypoxia - postnatal: measles, chickenpox, vitamin deficiency Chronological Systemic

Answer 270

Generalised enamel defects affecting all or most teeth of the primary and permanent dentition.

Answer 271

Autosomal dominant: 50% chance of passing AI Autosomal recessive X-linked: M more severely affected and uniformly affected, F have vertical ridges and grooves Sporadic cases

Answer 272

Phenotype used to described way it looks. Hypoplasia (type 1) Hypomaturation (type 2) Hypocalcification (type 3) Hypomaturation-hypoplasia with taurodontism (type 4)

Answer 273

Clinical hypomineralisation of systemic origin affecting one or more of the four first permanent molars and any incisors. — Demarcated patches — White-brown, cream or yellow colour — Aetiology: peri-natal and neo-natal problems and common childhood illnesses mainly — Management: recognition, review, desensitisation, temporisation and then restoration

Answer 274

1. Prevention > Fl > Desensitising toothpaste > CPP-ACP products > Fissure sealants > Oral hygiene 2. Temporisation > GIC > Fill in deficit > Stainless steel crown (SSC) 3. Definitive tx - molars - composite, SSC, gold or cobalt chrome onlays, XLA - incisors - > microabrasion - pumice (abrasion) + 18% HCL (erosion) - pumice (abrasion) + 37% phosphoric acid (erosion) > etch-bleach-seal* - 60s etch --> NaOCl 5% (5-10 mins) --> re-etch --> fisure sealant > Bleach > Bleach and composite * GDC (May, 2014) - use of hydrogen peroxide (0.1-5%) not permitted under the age of 18 except for the purpose of treating or preventing disease.

Answer 275

An autosomal dominant condition affecting formation of dentine. Dentine consists of a reduced number of wide irregular tubules, with areas of atubular dentine. Loss of scalloping at ADJ. Teeth have opalescent bluish appearance. Teeth wear rapidly as enamel is lost. Translucent, discoloured greyish brown teeth with a glassy appearance. Often associated with significant tooth wear (attrition).

Answer 276

Type I associated with osteogenesis imperfecta (blue sclera, increased bony fractures, long limbs). Type II is similar to type I but no osteogenesis imperfecta. Type III has marked attrition and pulp exposures (often called shell teeth due to radiographic appearance).

Answer 277

Radiographically, teeth can have bulbous crowns, short roots and/or pulp obliteration in many teeth.

Answer 278

Autosomal dominant, both dentitions affected Normal enamel but atypical dentine with abnormal pulp pathology Type I: radicular type, with short roots and barely any pulp Type II: coronal type, with enlarged pulps

Answer 279

Local trauma may affect dentine formation Infection Nutritional deficiencies Cytotoxic drugs or tetracycline

Answer 280

Primary dentine > formed before eruption of tooth > mainly consist of circumpulpal dentine Secondary dentine > physiological type of dentine after full length of root has formed > regular dentine that is formed during the life of the tooth and laid down in the floor and ceiling of the pulp chamber Tertiary dentine - two types dentine formed as a result of noxious stimuli --> reactionary dentine - dentine laid down in response to mild stimuli --> reparative dentine - irregular dentine laid down directly beneath the path of injury as a response to strong stimuli >

Answer 281

Hypercementosis - periapical inflammation - mechanical stimulation Hypocementosis - cleidocranial dysplasia - hypophosphatasia

Answer 282

Abnormality of all dental tissues, due to arrested development of the tooth germ

Answer 283

Autism spectrum disorder (ASD) is a neurological and developmental disorder 1. Social communication > may have unusual, delayed or lack of spoken language > difficulty understanding non-verbal communication > take language literally > use of makaton sign language to communicate 2. Social interaction > decreased interest in others and wider world > difficulties recognising and understand other people's emotions and feelings > difficulties expressing their own emotions 3. Restrictive and repetitive behaviours > may have obsessive type behaviours > intense and highly focused interest > resistant to change > enjoy routine

Answer 284

A form of autism spectrum disorder Do not have delay in language and cognitive development Find social communication and interpretation difficult

Answer 285

Child Protection Act 1989 Biological fathers that have parental control (if on birth certificate) Parental responsibility can be given to grandparents and step-parents by court order Gillick competence can be applied Any child can consent for a check-up as is non-invasive

Answer 286

- November 2003, law changed that allowed parents unmarried to jointly be on the birth certificate - Prior to Nov 2003 both parents had to be married to have joint parental responsibility - Same sex relationships are the same with regards to civil partnerships and marriage - Surrogates have parental responsibility until the child is adopted

Answer 287

People aged 16-17 are technically able to consent for treatment - If not acting prudently or rationally consent cannot be given - Patient must have clarity of thought before consenting and fully understand the complications and benefits of treatment

Answer 288

Adenomatoid Odontognic tumour (AOT) Ameloblastic fibroma

Answer 289

Herpes Simplex Virus 1

Answer 290

Herpes simplex virus 1 > Occurs in labial area > Presents as a vesicular lesion that ruptures and produces crusting > Reactivation of HSV-1 (which is the primary infection PHG)

Answer 291

Bilateral enlargement of the parotid glands with flu-like symptoms

Answer 292

Intra-oral manifestation are Kolpik's spots on the buccal mucosa, alongside malaise

Answer 293

Cocksackie virus Child febrile, irritable, loss of appetite, with general malaise Vesicles in tonsillar region with cervical lymph node enlargement Lesions do not coalesce

Answer 294

Cocksackie virus Maculopapular rash affecting tongue and oral mucosa, as well as fingers and toes. Vesicles rupture and produce painful ulceration Condition lasts 10-14 days

Answer 295

Varicella Zoster virus Vesicular rash on the skin Intraoral lesions resemble primary herpetic infection Highly contagious

Answer 296

Herpes Zoster Vesicular lesions develop within periphery of trigeminal nerve. High contagious

Answer 297

Infections (herpes) or drugs (sulphonamides) Causes macules to blister in anterior mouth, blood stained and crusted lips Lesions of squamous epithelium happen concurrently

Answer 298

Acute pseudomembranous candidiasis New-borns, immunocompromised and long-term antibiotics Candida Albicans causative Large white plaques on buccal, labial and gingival mucosa If white plaque removed results in raw, bleeding, underlying mucosa. Where normal oral flora has been altered.

Answer 299

Pyrexia Red, swollen face Anxious and distressed Unwell child

Answer 300

Sinus present Mobility Halitosis Discolouration

Answer 301

Fluctuant, fluid cyst that appears 2-3 weeks prior to eruption of a tooth As eruption takes place the cyst may be blood filled and purple in colour Usually asymptomatic and resolve Shouldn't incise lesion as to avoid infection

Answer 302

Present at birth, may develop with the infant but regresses over time. Often completely disappear No treatment required, monitor

Answer 303

Ipsilateral facial haemangioma and meninges calcification. Contralateral focal epileptiform seizures with paralysis Mental retardation Red wine skin appearance

Answer 304

Minor salivary gland trauma normally located on lower lip Bluish swelling with keratinised surface Mucous retention cyst, similar appearance but lined by epithelium Most common non-infective cause of salivary gland swelling in children

Answer 305

Bluish swelling on the floor of the mouth Arises from sublingual salivary gland

Answer 306

New-born lesions Small white or grey lesions Gingival cysts arise from remnants of the dental lamina Dental lamina grows into ectomesenchyme Located within connective tissue between crown of developing tooth and oral mucosa Cyst lined by keratinised stratified squamous epithelium Present in 80% of neonates > Epstein Pearls = hard palate raphe > Bohns nodules = alveolar ridge

Answer 307

New born lesion (80% female) Soft round, exophytic swelling on upper alveolar ridge. Surgically drained to maange.

Answer 308

Occurs in anterior maxilla gingiva Reaction to chronic trauma, normally from subgingival calculus.

Answer 309

- Biphasic neoplasm of neuroblast and melanin producing epithelioid cells of neural crest origin - 60% anterior maxilla Rapid growth and locally aggressive

Answer 310

Benign condition Small pedunculated cauliflower like growths, white or pink in colour Caused by HPV

Answer 311

Found inside the cheeks/lips/tongue Very common, firm, pink, painless swelling found mostly in the cheeks, no discharge, doesn't grow in size with time. Caused by trauma Sharp teeth Cheek/lip biting habits Treatment: can be left but normally are surgically removed under LA/GA. Tend to recur

Answer 312

Well defined Sessile Next to tooth with pathology (plaque/caries) Treatment Remove the cause Remove epulis by excision and send for analysis Improve pt OH

Answer 313

Phenytoin Cyclosporin Nifedipine (Ca channel blockers)

Answer 314

Ventral surface of the tongue caused by rubbing of the tongue on the newly erupted sharp incisal edges of mandibular anterior teeth. Management: requires smoothing the incisal edges High incidence in children with familial dysautonomia and cerebral palsy

Answer 315

New-born pathology whereby the lingual frenum has a short attachment to the floor of the mouth. Surgically corrected if presenting an eating or speech problem.

Answer 316

- Erythema multiforme - Stevens-Johnson syndrome - Bechet's syndrome - Epidermolysis bullosa - Lupus erythematosus - Neutropenic ulceration

Answer 317

Acute myeloid leukaemia Neutropenia Thrombocytopenia Down syndrome Ehler-Danlos syndrome

Answer 318

Dental erosion has no critical pH as it depends on saturation of the solution.

Answer 319

pH 7 Bicarbonate: The primary buffer in activated saliva Phosphate: The primary buffer in non-stimulated saliva ??

Answer 320

Extrinsic acids > Dietary acids: frequency more important than quantity Intrinsic acids > Chronic regurgitation of gastic acid (GORD) > Eating disorders: anorexia and bulimia nervosa, linked with psychiatric problems > Rumination syndrome: repetitive regurgitation of recently ingested food

Answer 321

a. Loss of surface features b. teeth become smooth and shiny c. incisal edges become more translucent.

Answer 322

a. thinning and chipping of incisal edges b. darkening of teeth c. dentine sensitivity d. cupping of occlusal surfaces (perimolysis) e. dentine exposure f. proud restorations

Answer 323

a. Teeth shorten b. Exposure of pulp c. Periapical pathology and abscess formation

Answer 324

Enamel and dentine thinner in primary dentition, erosion able to progress rapidly

Answer 325

1. Resolve sensitivity 2. Restore missing tooth surface 3. Prevent further tooth tissue loss 4. Maintain balanced occlusion Primary dentition - Asymptomatic, minimaI TSL- restorative treatment not indicated - Small areas of exposed dentine causing sensitivity- cover with composite/GIC - Larger areas of exposed dentine- composite crowns (anterior) or SSC (posterior) - Exposed pulps- pulp therapy/extract

Answer 326

Mainly inhalation sedation with local anaesthesia. Only for children with complex oral needs or who cannot be managed with either: - behaviour managment - local anaesthesia and midazolam (no midazolam for children <12)

Answer 327

Cause paradoxical reactions and have narrow therapeutic index

Answer 328

In patients <16

Paediatric dentistry Flashcards

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