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1 - BDS4 finals - big topics > Paediatric Dentistry > Flashcards

Paediatric Dentistry Flashcards

(103 cards)

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1
Q

Patient attends clinic after experiencing dental trauma. what special investigations should you undertake?

A

mobility
colour
TTP
sinus
Percussion note
Radiograph
EPT
Ethyl chloride

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2
Q

what advice would you give to the patient/parent following emergency treatment of dental trauma?

A

analgesia
soft diet for 10-14 days
brush teeth with soft toothbrush after every meal
chlorhexidine 0.12% mouthwash 2x daily for one week
warning regarding infection

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3
Q

14 year old child attends your practice following an enamel-dentine fracture of tooth 21. how would you treat?

A

cover all exposed dentine with glass ionomer or composite
- either restore lost tooth structure immediately or at a later visit

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4
Q

How would you restore a root fracture where the coronal fragment has been displaced and is excessively mobile?

A

either
- extract loose coronal fragment
- reposition the loose coronal fragment and splint for 4 weeks

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5
Q

Patient attends clinic for a trauma review after previously experiencing trauma to the 11 a few months ago. they are worried about the colour of the tooth in question, as it is now an opaque yellow colour. the tooth is asymptomatic and there are no signs of necrosis or infection. what would be the most likely reason for this discolouration?

A

pulp canal obliteration
vital pulp response
pulp lays down tertiary dentine as a response to trauma
- leads rot narrowing of the canal walls

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6
Q

Possible consequences of trauma to the primary tooth (how can the primary tooth be affceted)

A

discolouration
infection
- tooth can become non-vital
- sinus
- increased mobility
- radiographic evidence of periapical pathology
delayed eruption

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7
Q

Potential complications of trauma in primary dentition to the permanent successor

A

enamel defects
abnormal crown/root morphology
- e.g. dilaceration
delayed eruption
ectopic tooth position
complete failure of tooth to form
odontome formation

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8
Q

indicators of dental neglect

A

obvious dental disease
- practical care has been offered yet child has not returned for treatment

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9
Q

examples of dental neglect

A

after dental problems have been pointed out:
- irregular attendance, related failed appointments or late cancellations
- failure to complete treatment
- returning in pain at repeated intervals
- repeated GA for extractions

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10
Q

extra-oral signs of physical abuse

A

bruising of face
abrasions and lacerations
burns and bites
choke marks on neck
eye injuries
hair pulling
fractures
- nose
- mandible
- zygoma

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11
Q

intra oral signs of physical abuse

A

contusions
bruises
abrasions and lacerations
burns
tooth trauma
frenal injuries

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12
Q

Physical abuse checklist questions

A

could the injury have been caused accidentally and if so how?
does explanation for injury fit age and clinical findings?
if there has been delay in seeking advice, has there been good reasons for this?

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13
Q

What is expected of the dental team in suspected cases of abuse?

A

observe
record
communicate
refer
NOT expected to diagnose

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14
Q

treatment options for discoloured teeth

A

enamel micro abrasion
bleaching
- vital
- non vital
resin infiltration
localised composite restoration
veneers
- composite

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15
Q

pre-operative records required for all discoloured teeth

A

clinical photos
shade
sensibility testing
diagram of defect
radiographs if clinically indicated
patient assessment

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16
Q

Enamel micro abrasion - steps that must be taken prior to applying HCL

A

PPE worn
patient must be wearing glasses and bib
clean teeth with pumice and water
apply petroleum jelly to gingivae
place rubber dam
place sodium bicarbonate guard
have more sodium bicarbonate available

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17
Q

micro abrasion technique - steps

A

HCL pumice slurry in slowly rotating rubber cup for 5 seconds
- maximum 10 x 5 second applications
wash directly into aspirator after every application
apply fluoride varnish
- e.g. Profluorid (not Duraphat)
polish with finest sandpaper disc
final polish with toothpaste

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18
Q

suitable cases for microsbrasion

A

post orthodontic demineralisation
fluorosis
trauma to primary incisors

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19
Q

advantages of microabrasion

A

easily performed
conservative
inexpensive
teeth need minimal subsequent maintenence
fast acting
effective
results are permanent
can be used before or after bleaching
removes yellow-brown, white and multi-coloured stains

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20
Q

disadvantages of microabrasion

A

removes enamel
HCL acid = caustic
requires protective apparatus for patient, dentist and dental nurse
prediction of treatment outcome is difficult
must be done in dental surgery

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21
Q

post op instructions following microabrasion

A

warn patient to avoid highly coloured food and drinks for at least 24 hours

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22
Q

when would you review a patient following microabrasion? what must you do on review appointment

A

within 4-6 weeks after treatment
and take post op photographs

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23
Q

what are the 2 methods of non-vital bleaching?

A

walking bleach technique
inside out method

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24
Q

walking bleach technique - steps

A

access cavity opened
root filling removed to just below gingival margin
cotton wool with bleaching agent placed in access cavity
- covered with dry cotton wool
seal with GIC
bleach renewed no more than 2 weeks between appointments
- no more than 3-4 renewals

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25
combination/inside out bleaching method - steps
open access cavity custom made mouthguard made - windows cut in guard of teeth that you don't want to bleach patient applies bleaching agent to back of tooth and tray access cavity must be kept clean - gel changed every 2 hours or so expect at night - changing gel removed food debris mouthguard to be worn at all times except eating and cleaning - 1-2 weeks
26
How would you restore the pulp chamber after inside out bleaching?
non setting calcium hydroxide paste for 2 weeks and seal with GIC then either - white GP and composite resin or incrementally cured composite
27
potential complications of non vital bleaching
external cervical resorption spillage of bleaching agents over bleaching failure to bleach brittleness of tooth
28
hypodontia prevelence in primary dentition
0.1-0.9%
29
conditions associated with hypodontia
ectodermal dysplasia Down syndrome cleft palate Ellis Van Creveld syndrome hurler's syndrome incontinentia pigmentii
30
anomalies of size and shape - give examples
microdontia Microdontia double teeth odontomes - complex or compound taurodontism - 6.3% in uK - flame shaped pulp dilaceration accessory cusps e.g. talon cusps
31
what is ameliogenesis imperfecta? name the types of ameliogenesis imperfecta
genetic enamel anomaly affects all teeth within dentition thin to no enamel, normal dentine and pulp types: hypoplastic hypomaturational hypocalcified mixed forms
32
taurodontism features
vertically elongated pulp chamber and short roots linked to type 4 ameleogenesis imperfecta
33
what is dilaceration?
an abnormal bend in the root usually due to traumatic injury to primary tooth
34
localised enamel hypoplasia - questions to ask patient/parent
- trauma to primary tooth or - infection in primary tooth
35
generalised enamel defects - types
fluorosis MIH
36
MIH cause
associated with childhood illness or chronological hypo-mineralisation e.g liver or kidney failure
37
amelogenesis imperfecta - types
hypoplastic hypocalcified hypomaturational mixed forms
38
dentine dysplasia features
normal crown morphology amber radiolucency short constricted roots pulpal obliteration
39
What is dentinogenesis imperfecta?
a genetic disorder of tooth development affecting dentine
40
features of teeth with dentinogenesis imperfecta
bulbous crowns pulpal obliteration (initially large pulps) - abscess formation short roots
41
dentinogenesis imperfecta problems
aesthetic acid susceptibility spontaneous abscess
42
neo-natal teeth are--
teeth that are present within 8 weeks of birth
43
indications for extracting Neo natal teeth
- poses aspiration risk - causes issues breastfeeding
44
In regards to dental trauma, how would you describe the term 'concussion'?
Tooth is tender to touch but has not been displaced
45
In regards to dental trauma, how would you describe the term 'subluxation'?
Tooth is tender to touch, has increased mobility but has not been displaced
46
What is extrusion?
When the tooth has been partially displaced from its socket
47
what is intrusion?
when the tooth is displaced through the labial bone plate
48
What is avulsion?
When a tooth is completely out of its socket
49
What does a mild grey discolouration following dental trauma indicate?
intra pulpal bleeding - still vital tooth
50
Cvek pulptomy steps
Trauma stamp and radiographic assessment LA and rubber dam clean area with saline then disinfect with sodium hypochlorite remove 2mm of pulp with high speed round bur -place saline soaked cotton wool pellet over exposure until haemostasis achieved apply CaOH then GI or white MTA restore with composite resin
51
partial pulpotomy success rate
97%
52
full coronal pulpotmy succes rate
75%
53
aim of a pulpotomy
keep vital pulp tissue within canal to allow normal root growth
54
indications for Endodontics in child
good co-operation avoid GA medical history precludes extraction - e.g. bleeding disorder ortho considerations - space preservation
55
pulp treatment in children - contraindications
poor co-operation medical history precludes pulp treatment - immunocompromised ortho considerations - space closure desired advanced root resorption pus in pulp chamber gross bone loss
56
eruption sequence of upper permanent teeth
6, 1, 2, 4, 5, 3, 7, 8
57
what is the eruption sequence of lower permanent teeth?
6, 1, 2, 3, 4, 5, 7, 8
58
premolars typically erupt at around age...
10
59
first permanent molars typically erupt at around age...
6
60
second permanent molars typically erupt at around age...
12
61
lower central incisors typically erupt at around age...
6
62
upper central incisors typically erupt at around age...
7
63
lower lateral incisors typically erupt at around age...
7
64
upper lateral incisors typically erupt at around age...
8
65
upper canines typically erupt at around age...
11
66
lower canines typically erupt at around age...
9
67
following eruption of a permanent tooth, how long does root formation typically take to complete?
around 3 years
68
outline the pain mechanisms of MIH
dentine hypersensitivity - porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate a-delta nerve fibres peripheral sensitisation - underlying pulpal inflammation leads to sensitisation of C-fibres central sensitisation from continued nociceptive input ?
69
MIH aetiology - potential post natal factors
prolonged breast feeding dioxins in breast milk fever and medication (childhood infections) SES rural vs urban
70
childhood infections liked to MIH development
Rubella chicken pox measles
71
MIH clinical problems
loss of tooth substance - breakdown of enamel - tooth wear - secondary caries sensitivity appearance
72
Treatment options for MIH affected molars
Composite/GIC restorations stainless steel crowns adhesively retained copings Extraction - 8.5-9.5 years old
73
treatment options for MIH affected incisors
acid pumice microabrasion resin infiltration external bleaching localised composite placement combination of above full composite veneers
74
What concentration fluoride is durophat varnish?
22600ppm
75
nursing bottle caries pattern
affects - maxillary incisors and molars usually affected - lower incisors usually spared due to tongue
76
nursing bottle caries prevention
- never use feeding bottle as pacifier - try not to put child to bed with bottle - if bottle used, make sure it contains plain water instead of milk, juice or formula
77
how often should bitewings be taken in a high caries risk patient?
every 6-12 months
78
how often should bitewings be taken in a low caries risk patient?
every 2-3 years
79
how often should check-ups be done in a high caries risk patient? What else should be done?
every 3 months fv application every 3 months
80
from what age can you prescribe a child 2800ppm fluoride toothpaste?
10
81
components of a caries risk assessment
clinical evidence of previous disease dietary habits oral hygiene habits exposure to fluoride social history/SES saliva medical history
82
SDF fluoride concentration
44,800ppm
83
How does silver diamine fluoride work?
occludes dentinal tubules silver is antibacterial fluoride encourages remineralisation
84
advantages of SDF
safe simple, easy and quick - 5 mins non AGP non invasive evidence based
85
SDF disadvantages
stains caries black can cause temporary tattoo relatively expensive metalic taste
86
amalgam is contraindicated in what groups of people?
under 15s pregnant women breastfeeding women
87
When would you refer a child to paediatric dental service?
anxiety and phobia GA extractions sedation special needs vulnerable groups
88
conscious sedation indications
child is anxious but co-operative treatment is straight forward treatment is not likely to damage child's attitude toward treatment in the future
89
conscious sedation contraindications
severe dental anxiety where child is not ready or willing to co-operate required treatment is too complex for maturity of the child child too young to understand how to use IS child cannot breathe through their nose
90
general anaesthetic indications
child needs to be fully anaesthetised before dental procedures can be attempted surgeon needs the child fully anaesthetised before dental treatment can be carried out
91
what is intrusion?
when the tooth is displaced through the labial bone plate
92
what is lateral luxation?
When the tooth is displaced in a palatal/lingual or labial direction
93
What is a complicated crown fracture?
A crown fracture that involves the pulp
94
What emergency advice would you give a patient that has an avulsed permanent tooth?
- hold tooth by crown, do not handle root - wash off any debris with cold water - store tooth in milk or saliva until it can be re-planeted
95
Extrusion splinting time
2 weeks
96
intrusion splinting time
4 weeks
97
avulsion splinting time
2 weeks
98
lateral luxation splinting time
4 weeks
99
dento-alveolar fracture splinting time
4 weeks
100
treatment for lateral luxation injury
if minimal or no occlusal interference - allow to reposition spontaneously if displacement severe - extraction - or reposition and splint
101
Treatment for intrusion injury in primary dentition
allow to spontaneously reposition, irrespective of direction of displacement
102
extrusion management
not interfering with occlusion - allow for spontaneous repositioning excessive mobility or extruded >3mmm - extract
103
alveolar fracture treatment
reposition segment stabilise with flexible splint to adjacent uninjured teeth for 4 weeks - teeth must be extracted after alveolar stability has been achieved

1 - BDS4 finals - big topics (17 decks)

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