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BDS5 OSCE Revision > Paediatric Dentistry - Operative > Flashcards

Paediatric Dentistry - Operative Flashcards

(103 cards)

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1
Q

how would you stop an enamel caries lesions progressing and promote remineralisation s

A

show parent the lesion and explain treatment and why it is successful
demonstrate effective brushing of the lesion
give dietary advice
apply fluoride varnish to the lesion 4x yearly
keep record of site and extent of lesion

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2
Q

when would you review an enamel caries lesion to see if arrested or not

A

if after 3 months the active lesions are not arrested consider alternative strategy

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3
Q

when is the hall technique useful

A

a primary tooth with advanced lesions in occlusal or proximal surface

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4
Q

when is the hall crown technique only suitable

A

when there is clear unaffected dentine between the lesion and the pulp

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5
Q

list the steps in the hall technique

A

ensure child is sitting upright
assess whether separators are required - requires 2nd visit 3-5 days later to remove them and fit the crown
ensure airway is protected (gauze)
select correct size of PMC
ensure PMC is well filled with GIC
seat PMC over the tooth - get child to bite down
ask child to open - check crown is seated evenly
remove excess cement and clear contacts with floss
avoid excess cement reaching tongue

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6
Q

what is Icon technique

A

the tooth is isolated, etched using ethanol to dry out the pores that have been created and then unfilled, low viscosity resin is flowed into pores blocking them

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7
Q

what is ART and what is it suitable for

A

atraumatic restorative technique - using hand instruments to prepare cavity and restored using GIC
suitable for primary teeth with single surface lesions

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8
Q

what is the stepwise caries removal technique

A

place LA and gain access
remove all caries on cavity walls
over the pulp - selectively remove caries as to not expose the pulp
use temp restoration - one thats different colour
wait 6-12 months and place LA and remove temp restorations
remove any remaining carious tissue until hard dentine reached
place permanent restoration

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9
Q

how to make a lesion cleansable

A

no LA unless subgingival
using high speed or hand instruments remove undermined enamel to make lesion accessible to toothbrushing
resulting cavity depends on extent of the lesion

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10
Q

what is the technique for conventional crown placement in primary teeth

A

give LA
protect airway
remove caries - if pulpal exposure is a risk place indirect pulp cap
occlusal reduction
cut mesial and distal slices
select correct size of crown
cement in place with GIC and clear contacts

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11
Q

what are contraindications of pulp therapy in deciduous teeth

A

teeth that are close to exfoliation
children who are pre-cooperative or immunocompromised

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12
Q

what is the technique for a pulpotomy

A

give LA
cut access cavity making sure entire roof of pulp chamber is clear and consider rubber dam
remove contents of pulp chamber with slowspeed or hand excavator
irrigate pulp chamber with saline
identify entrances to canals
if still bleeding place cotton wool dampened in ferric sulphate (deciduous only)
if bleeding cannot be controlled progress to pulpectomy
remove cotton wool and place MTA or ZOE cement
fill cavity with ZOE cement and then place PMC

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13
Q

when is balancing extractions indicated in primary dentition

A

one C is to be extracted
one C has exfoliated prematurely
centre line shift developing after extracting one D

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14
Q

when are balancing extractions not usually indicated in primary dentition

A

loss of primary incisors
loss of Ds unless centre line shift develops
loss of Es

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15
Q

at what age is extraction of 6s most favourable

A

8-10 years

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16
Q

what factors influence optimal outcomes of extracting first permanent molars

A

bifurcation of 7s is seen to be forming on OPT
second premolars and third molars are all on OPT
mild buccal segment crowding
class I incisor relationship present

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17
Q

name the order of severity of MIH from best outcome to worst outcome

A

white/cream
yellow
brown

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18
Q

what three time periods should you ask a parent with a child with MIH about

A

prenatal - pre-eclampsia or gesgational diabetes
perinatal - birth trauma/ anoxia
post natal - prolonged breast feeding, illness in first 2 years

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19
Q

treatment options for MIH molars

A

composite/ GIC restorations
stainless steel crowns
adhesively retained copings
timed extractions (correct time for XLA of 6s)

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20
Q

what is the treatment options for MIH incisors

A

micro-abrasion
resin infiltration
external bleaching
localised composite placement

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21
Q

what are the pumice microabrasion technique steps

A

HCl 18% used
pt wears glasses and bib
clean teeth with pumice and water
petroleum jelly placed on gums and lips
rubber dam placed
sodium bicarbonate guard placed
HCl pumice slurry in prophy cup
max 10 x 5 second applications
wash directly into aspirator after each 5 second application
apply fluoride varnish (NOT DURAPHAT)
polish with finest soft flex discs

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22
Q

what should patients be warned about after microabrasion

A

teeth are dehydrated - warn pt to avoid highly coloured food and drinks for 24 hours

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23
Q

when should microabrasion be reviewed

A

4-6 weeks and take post op photographs

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24
Q

what is the rules for bleaching teeth in children

A

products containing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for purpose of treating or preventing disease

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25
what are the options for bleaching teeth
vital bleaching (external) - chairside - night guard non-vital (internal) - inside out technique - walking bleach technique
26
what is used with nightguard vital bleaching
10% carbamide peroxide gel cut windows in customised tray over any teeth you do not want to bleach
27
how much 10% carbamide peroxide gel should be applied per tooth for at home whitening trays
half a piece of popcorn kernel per tooth
28
what is the walking bleaching technique
root filling removed to below gingival margin bleaching agent placed on cotton wool and put in access cavity dry cotton wool placed over the top sealed in with GIC
29
what is the inside out method for internal bleaching
access cavity left open on the tooth custom made mouthguard patient applies bleaching agent to back of tooth and tray worn all the time except eating and cleaning gel changed every 2 hours apart from night eventually restore with white GP and composite resin
30
how is concussion injury managed in primary teeth
soft diet
31
how is crown fracture managed in primary dentition
smooth or restore (including RCT where necessary) or XLA depending on extent
32
what is the treatment for root fracture injury in primary dentition
soft diet extract if crown is causing mobility
33
what is the treatment for a luxation injury in the primary dentition
soft diet
34
what is the treatment for intrusion injury in the primary dentition
leave to erupt - may require pulp treatment later XLA if radiograph suggests underlying permanent follicle involved
35
what is the treatment for an extrusion injury in the primary dentition
extract if extruded more than 2mm
36
what is the treatment for avulsion in the primary dentition
leave tooth!!! do not replant
37
what is oral hygiene instruction for parents of kids
brush as soon as first tooth erupts assist brushing until 7 years old work in systematic manner brush for 2 mins morning and night with fluoride toothpaste spit toothpaste out and do not rinse avoid eating and drinking for 30 mins after morning brush do not eat or drink after evening brush
38
what diet advice would you give to parents of kids
less than 4 sugary intakes daily restrict sugary drinks to mealtimes do not give feeding bottles at night water or milk between meals be aware of hidden sugars safe snacks = veg, breadsticks, cheese
39
how would you ask a patient to complete a diet diary
2 x days during the week and 1 during weekend truthful and detailed as possible add timings of meals/ snacks
40
how would nursing caries present
rampant caries on especially maxillary incisors and Ds and lower canines
41
what advice would you give a parent to combat nursing bottle caries
do not allow your child to go to bed with a bottle filled with anything but water after brushing wean your child from the bottle in timely manner begin good OH of gums and mouth have early dental visits for child no on-demand feeding
42
what are tx options for nursing bottle caries
XLA primary teeth causing pain restore teeth consider SDF if pre-cooperative consider GA referral
43
when can children use fluoride mouthwash
from 7 years old - 225ppmF
44
what concentration of fluoride does SDF have
44, 800 ppmF
45
how is SDF used
cover soft tissues in vaseline dry teeth apply SDF for 3 mins
46
what are indications for SDF
non-restorable dentine lesions MIH to reduce sensitivity pre-cooperative children delay in sedation or GA asymptomatic cavitated lesions in primary teeth
47
what are contraindications to SDF
allergy to silver painful gums or mouth ulceration present lesions that involve pulp PA pathology mucositis/ stomatitis
48
what are disadvantages of SDF to warn parents of
permanent discolouration of tooth temporarily stains soft tissue 1-3 weeks
49
what are the effects of SDF
block dentine tubules arrest lesions bacterial death remineralisation inhibition of collagen degradation
50
what is the concentration of duraphat varnish
22, 600 ppmF
51
how much duraphat is used
2-5 years - 0.25ml 5-7 years - 0.4ml do lower arch first
52
what is the aftercare advice for fluoride varnish
avoid eating or drinking for 1 hour eat soft food all day avoid brushing that night only, brush as normal from the next morning avoid fluoride supplements for 2 days
53
what causes fluorosis
excess ingestion of fluoride during development of teeth
54
what is the tx for fluorosis
microabrasion composite veneer spot bonding composite strip crowns
55
what is the tx if child has ingested 5mg/kg body weight fluoride
milk and observe
56
what is the tx if a child has ingested 5-15mg/kg fluoride
give child milk and send to hospital
57
what is the tx for a child ingested more than 15mg/kg fluoride
immediate hospital admission for cardiac monitoring life support and IV calcium gluconate
58
what are signs and symptoms of fluoride overdose
nausea vomiting abdominal pain excess salivation altered taste tremors convulsions shallow respirations
59
what are indications for stainless steel crowns (SSCs)
more than 2 surface lesions extensive 2 surface lesions pulpotomy developmental defects fractured primary molars high caries rate impaired OH
60
what are the placement steps of SSC
measure MD crown width place LA and dam knife edge finish mesial and distal occlusal reduction 1-2mm dry tooth fill crown with GIC and seat removing excess check occlusion and contacts
61
what are the signs of failed SSC
rocking canting crown loss crown broken secondary caries abscesses radiolucency
62
what is the hall technique
no LA or tooth prep ortho spacer for 3-5 days (have pt upright and floss separator under contact point) size crown with BPE probe aim for subgingival fit seal with GIC get patient to bite down or hold for 2-3 mins remove excess and floss contacts POI - reassure about tight fit, occlusion tends to settle within a few weeks
63
when is it indicated for planned removal of 6s
bifurcation of 7s forming class I incisors second and 3rd molars present on OPT moderate lower crowing
64
what are the three main effects of primary tooth trauma to the primary tooth
discolouration infection delayed exfoliation
65
what are the main effects of primary tooth trauma on the permanent tooth
enamel defects delayed eruption dilaceration ectopic teeth arrested development odontome development
66
what are signs and symptoms of MIH
well demarcated opacities chalky brown, yellow and white patches high caries rate poor bonding
67
what are treatments for MIH molars
composite GIC SSC XLA at appropriate times
68
what are treatments for MIH incisors
microabrasion resin infiltration external bleaching composite full composite/ porcelain veneers
69
what questions should be asked re MIH
natural birth severe illness in pregnancy birth trauma pre-term childhood medications childhood infections
70
what are the plaque scores for children
10/10 perfectly clean 8/10 plaque around cervical margin 6/10 plaque cervical third 4/10 middle third covered in plaque
71
what is site specific prevention
demonstrate brushing diet advice FV 4 x yearly alter tx if lesion does not arrest in 3 months
72
what is the process of stepwise caries removal
place local remove carious tissue until cavity walls are cleared to hard dentine selectively remove caries pulpally until enough is removed to place durable restoration restore with pink fuji GIC wait 6-12 months place LA and remove temp remove remaining carious tissue until hard dentine reached place permanent restoration
73
what are indications for GA for a child
required by child/ surgeon medical history complex tx high level of surgical trauma predicted poor cooperation high levels of anxiety
74
what are the stages in GA
induction excitement surgical anaesthesia respiratory paralysis
75
what are risks of GA
death - very rare 1 in 100,000 brain damage headache pain nausea sore throat'
76
how to write a GA referral letter
patient name, address, DOB patient and parent contact patient medical history parental responsibilities GP details justification proposed plan previous treatment radiographs
77
what are POI for GA
analgesia travel home via car or taxi rest and play quietly for rest of day monitoring adult present next day off school or nursery XLA and preventive advice soft diet
78
what is the triangle of safety
ears side of face neck shoulders
79
how do you manage suspected abuse
raise concerns with parents/ offer support set targets liaise with other professionals write letter to health visitor of children who have missed 5 appointments and not responded to letter from practice
80
what is a description of primary herpetic gingivostomatitis
inflammation of gums and lips resulting in painful ulcers and blisters due to infection with herpes simplex takes 10-14 days to resolve
81
what are symptoms of PHG
fever irritability painful mouth ulcers loss of appetite dehydration enlarged lymph nodes
82
what is the tx for PHG
encourage rest encourage fluid intake pain relief clean teeth with chlorhexidine swab if severe or immunocompromised acyclovir 200mg tablets 5 times daily for 5 days
83
what are dental implications of congenital heart defects
higher risk of IE increased bleeding tendency higher risk of death in GA issues with LA containing adrenaline
84
what intra-oral presentations are associated with down's syndrome
AOB macroglossia class III tongue thrust hypodontia microdontia
85
what are treatment options for intrinsic staining (caused by fluorosis, MIH, AI/ DI, tetracycline, trauma)
monitor veneers bleaching microabrasion localised composite restoration ICON resin infiltration
86
what are the steps of micro-abrasion
PPE for pt n team clean with pumice and water vaseline on soft tissues place rubber dam place sodium bicarbonate guard on gingivae remove enamel with HCl/ pumice slurry with slow speed rubber cup max 10 x 5 second applications apply FV- pro-fluoride not duraphat polish with toothpaste avoid anything highly coloured for 24 hours
87
when is bleaching allowed in children
hypo-mineralisation fluorosis trauma
88
what are instructions for night guard bleaching
brush teeth thoroughly apply half grain of rice size gel to tray set over teeth and press down remove excess rinse gently, do not swallow wear overnight remove, brush and rinse after 3-6 week check colour
89
what are the steps for walking bleach technique
remove root filling to level below CEJ clean out tooth with ultrasonic place CWP covered in bleaching agent place dry CW on top seal with GIC/RMGIC renew within 2 weeks and repeat 6-10 times
90
what are the steps to inside-out bleaching technique
access cavity of tooth open produce custom made mouthguard (cut windows in guard of teeth not to be bleached) patient applies bleaching agent to back of tooth and tray patient keeps access cavity clean replacing gel (10% carbamide peroxide) worn at all times except eating and cleaning gel changed every 2 hours except night time
91
what are risks of bleaching
sensitivity failure over bleaching external cervical resorption tooth more brittle damage to soft tissue
92
what is the ICON technique
rinse and clean teeth apply ICON etch and let sit for 2 mins apply ICON dry let sit for 30 seconds do second etch and repeat icon dry when lesions are accessible apply ICON infiltrate for 3 mins remove excess and light cure 40 seconds do second infiltration leave for 1 min polish
93
what are signs of hypodontia
big midline diastema infra-occlusion teeth not erupting/ exfoliating in expected sequence tapered and small teeth
94
what are issues associated with hypodontia
microdontia spacing short root anatomy impaction delayed formation or delayed eruption of other teeth enamel hypoplasia taurodontism maxillary canine/ first premolar transposition
95
how is hypodontia treated
accept restorative alone ortho alone combined ortho and restorative
96
what is combined ortho and restorative tx for hypodontia
open space and place RBB or implant close space plus reshaping of teeth
97
what are the types of amelogenesis imperfecta
hypoplastic - enamel crystals do not glow to correct length hypocalcified - crystallites fail to grow in thickness and width hypomaturational - enamel crystals grow incompletely in thickness and width but normal length
98
what are the issues with amelogenesis imperfecta
sensitivity caries poor aesthetics poor OH delayed eruption bonding issues
99
what are treatment options for amelogenesis imperfecta
preventative therapy composite veneers fissure sealants metal onlays SSCs ortho
100
what classification is used for cleft lip and palate
LASHAL
101
what is the aetiology of CLP
smoking alcohol social deprivation anti-epileptics multi vitamins
102
what are implications of CLP
aesthetic speech issues hypodontia, impaction, crowding, increased caries risk, supernumeraries hearing/ airway issues
103
what are the treatment steps for CLP
3 months - lip closure 1 year - palate closure 8-10 year - alveolar bone graft 12-15 years - definitive ortho 18-20 years - secondary surgery

BDS5 OSCE Revision (16 decks)

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