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BDS4 CDS > Paediatrics > Flashcards

Paediatrics Flashcards

(73 cards)

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1
Q

What are treatment options for discoloured teeth?

A

Microabrasion, bleaching, resin infiltration, local comp rest., veneers - direct and indirect, do nothing

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2
Q

what should be recorded in the pre-op sheet for discoloured teeth

A

clinical photos, sensibility testing, shade, diagram of defect, radiographs, patient assessment

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3
Q

what is micro abrasion

A

the removal of the surface layer of opaque enamel

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4
Q

what are some advantages of micro abrasion

A

removes brown/yellow stain, effective, conservative, inexpensive, can be used before bleaching, easily performed, permanent results

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5
Q

what are some disadvantages of micro abrasion

A

removal of enamel - destructive, senstivity, may get more staining
need protective wear for patient, dentist and nurse
HCl is caustic
results are unpredictable - may appear more yellow
must be done by dentist

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6
Q

what is the clinical technique for micro abrasion

A

protect soft tissues with dental dam
place sodium bicarbonate guard behind teeth
slurry of HCl for 5 seconds on tooth - can repeat 10 times but wash off and review colour and shape after each one
once happy - place fluoride varnish - clinpro is more white in colour
polish with sandpaper - the finer/smoother prisms look less stained
polish with toothpaste

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7
Q

how much enamel is lost with micro abrasion and compare this to enamel etching

A

100 microns are lost with micro abrasion - 10 are lost with etching so losing 10x the amount

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8
Q

when and why must micro abrasion be reviewed

A

review 4-6 weeks after, advise patient not to drink or eat highly coloured foods as teeth are dehydrated and will stain. Review as can offer a second cycle but only if some improvement has been seen with first lot, if not the second wont work either. Can only do 2 rounds. Must take pre and post op photographs

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9
Q

what bleaching techniques are available for a vital tooth

A

external bleaching only. Chairside power bleaching or at home night guard bleaching

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10
Q

what bleaching techniques are available for a non-vital tooth

A

internal bleaching - inside outside technique, walking bleach technique

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11
Q

why is chairside bleaching not normally recommended

A

it uses rapidly reactive, unstable hydrogen peroxide - damage to soft tissue and eyes - causes sensitvity and more expensive

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12
Q

what instructions are given to patients for night guard at home bleaching

A

brush teeth with toothpaste
place gel in mouth guard
put in over teeth and seat - remove excess from gums
rinse gently and dont swallow
wear over night or for at least 2 hours
brush teeth and rinse with cold water
sensitive toothpaste may be required

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13
Q

what are advantages of non-vital tooth bleaching

A

conservative, good results, gingival level of adolescents is unstable for fixed restoration so this is good in mean time, simple, no irritation to gingiva

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14
Q

what are important factors when deciding if a non-vital tooth is appropriate for internal bleaching

A

good root filling - to length and condensed, no pathology
anterior teeth without large restorations
not amalgam discolouration
not fluorosis or tetracycline discolouration

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15
Q

what is the clinical technique of walking bleach - non vital internal bleaching

A

access cavity, remove GP to ECJ, place bleaching agent on cotton wool ball and place in access, place dry cotton wool ball on top and then GI over this. 2 weeks later, remove GI and replace balls - can do this up 6-10 times. Regression of 50% at 2-6 years

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16
Q

what is the clinical technique of inside out bleaching

A

access cavity, custom mouthguard made. Patient puts bleaching agent in back of tooth and mouth guard. replaces the gel every 2 hours except through the night. wear guard all the time except when eating and cleaning. 10% carbamide peroxide used

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17
Q

what are potential complications with non vital bleaching

A

over bleaching, brittleness, external cervical resorption, failure to bleach, spilling of bleaching agents

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18
Q

how can external cervical resorption be prevented

A

layer of GI cement above GP cone - but can prevent adequate bleaching
non setting calcium hydroxide placed for 2 weeks before final restoration - neutralises any acidity in PL

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19
Q

what is resin infiltration

A

infiltration of enamel lesions with low-viscosity resin and cured. surface layer is eroded with etch, lesion becomes desicated and gives access - resin placed and can infiltrate through. causes lesions to lose discolouration and appear similar to sound enamel

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20
Q

what are the parts to caries risk assessment

A

clinical evidence, diet, plaque control, fluoride exposure, medical history, social history, saliva

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21
Q

what are the parts to preventions

A

fluoride varnish, fluoride toothpaste, fluoride supplement, fissure sealants, radiographs, diet advice, change medication, toothbrushing advice

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22
Q

what guidelines are used for caries risk and prevention

A

sign 138, SDCEP

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23
Q

what toothbrushing advice should be given

A

brush twice a day, including once before bed, fluoride toothpaste, spit dont rinse, should be supervised

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24
Q

what is the indication for fissure sealants

A

for all first permanent molars of all children regardless of risk factor
in high risk children - deciduous molars caries free, and premolars

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25
what are the steps for fissure sealants
patient and tooth selection tooth isolation - rubber dam, cotton wool clean tooth - pumice and slurry etch - 35% phosphoric acid and dry apply resin sealant light cure check retention, remove flash, check for air bubbles
26
what materials are required for fissure sealants
rubber dam or cotton wool roll, dry guard, saliva ejector 35% etch pumice and slow speed resin light cure probe, excavator, microbrush, mirror
27
how can hard tissue defects be divided and give examples
localised - trauma or abscess of primary generalised - environmental or hereditary environmental - fluorosis or MIH hereditary - ameleogenesis imperfecta
28
what is the difference hypomineralisation and hypoplastic
2 phases of enamel development - secretory and mineralisation secretory lays down jelly like shape of tooth, if there is a problem with this - the tooth will be hypoplastic - insufficient bulk/thickness of enamel mineralisation - increasing mineral content and thus hardness - if there is a problem with this, the tooth will be hypomineralised
29
what is AI and how is it diagnosed
AI is an inherited condition in which there is a malfunction with enamel development - either secretory or mineralisation. diagnosis - family history, appearance (affects all teeth, tooth size, colour, shape, yellow/brown or white), radiographic - no difference between enamel and dentine
30
what medical conditions have an enamel defect - not ameleogenesis imperfecta
epidermolysis bullosa, prader-willi, downs
31
how to tell the difference between fluorosis and MIH
MIH - only molars and incisors fluoride - all teeth ask if they lived in fluorodated area
32
what questions are asked to get diagnosis of MIH
pre-natal - problems in last trimester of pregnancy - pre-eclampsia, gestational diabetes, infections natal - premature birth, time special baby unit, traumatic birth post-natal - infections in first year of life, how long they were breast fed for
33
what is the calcification dates of FPMs and incisors
FPMs - 7-8 months after ovluation, crown formed at 1 year of life incisors - start 3-4 months after birth, complete by 3-6 years
34
when would you consider balancing an XLA
XLA of tooth on same arch but condralateral side - prevent midline shift primary canines
35
when would you consider compensating an XLA
XLA of same tooth on opposite arch - opposing tooth prevent over eruption if XLA of lower FPM - XLA upper FPM, over eruption would prevent drifting of 7 and space closure
36
what guidelines are available for planned XLA of FPM
RCS Clinical Effectiveness Committee 2009
37
what is the order of treatment planning
prevention and acclimitisation first - OHI, Diet advice, fluoride varnish - can introduce aspirator, cotton wool rolls, 3n1 fissure sealants - polish with prophy cup to introduce slow speed small restorations with no LA - stabilisation phase larger restorations with LA - start with maxillary pulpotomy and extractions
38
what is fluorosis
defect in mineralisation of enamel due to high levels of systemic fluoride during enamel development, causes white lines in mild form or brown/yellow marks in more severe form
39
what age are children at risk of fluorosis until
until calcification is complete of all crowns - age 8 on SIGN 138 guidelines for cosmetic purposes - until age 3 for anterior crown development
40
what is the recommended fluoride levels for children
until age 8 - 0.1mg/kg/day from age 8 - 10mg/day supplement until age 3 - 0.25mg/day age 3-6 - 0.5mg/day 6+ 1mg/kg/day
41
what are the recommendations for different levels of fluoride ingestion
less than 5mg/kg - give calcium (milk) orally and observe 5-15mg/kg - give calcium (milk or calcium gluconate) and take to hospital for observation more than 15mg/kg - urgent hospital referral, intensive care and cardiac obs - IV cardiac gluconate
42
what are the components fear and anxiety
physiological - breathlessness, perspiration, palpitations cognitive - hypervigilance, loss of concentration, inability to remember behavioural - avoidance, asking questions, missing appts
43
how can you reduce a patients anxiety
acclimitisation giving the patient control - stop signals, rest breaks, providing them information
44
how can cerebral palsy effect dental health
poor manual dexterity - poor OH limb spasms - unable to get dental treatment safely gag reflex regurgitation - acid causing erosion not in control of their diet or OH
45
how can a patient in a wheelchair be treated
transfer board wheelchair recliner hoist
46
what legislation protects children
children and young people act 2014
47
what are types of abuse
sexual, physical, emotional, neglect
48
what is dental neglect defined as
british society of paeds - the persistent failure to meet childs oral health needs likely to result in impairment of childs oral or general health or development
49
what does dental disease put children at risk of
severe infections, teasing, multiple GAs, repeated antibiotics - resistance
50
what is indicators of dental neglect
obvious dental disease apparent to non-dental professional, but no treatment sought after missing multiple appoints despite support given to carer - not returned for treatment impact on child - sleep loss, eating effected, missing school, teasing
51
what guidance should be followed when managing suspected abuse/neglect
british dental association child protection and dental team
52
what are the stages of management of suspected dental neglect/abuse
stage 1 - dental team management stage 2 - preventative multi-agency management stage 3 - child protection referral
53
what medical condition is associated with supernumerary teeth
cleidocranial dysplasia
54
what are some anomalies related to shape of teeth
peg shaped laterals dens in dentine talon cusp dilaceration
55
what is the relevance of osteogenesis imperfecta
often associated with dentinogenesis imperfecta, have multiple fractured bones
56
what are dentine conditions that only effect dentine
dentinogenesis imperfecta type 2 dentine dysplasia
57
what medical conditions are associated with dentine anomalies
osteogenesis imperfecta ehlers-danos syndrome rickets
58
what should be considered when deciding to extract fpm
AGE, skeletal pattern, future ortho needs, quality of teeth
59
what are causes of delayed eruption
medical conditions - downs, hypothyroidism premature, low birth weight malnutrition gingival hyperplasia
60
what are causes of delayed exfoliation
trauma, infra-occlusion, ectopic successor, hypodontia
61
what are causes of premature exfoliation
trauma following pulpotomy immunological deficiency
62
what advice should be given to all patients post trauma
avoid contact sports for 2 weeks soft diet for 2 weeks maintain good oral hygiene - soft brush after every meal and rinse with chlorhexidine 0.12% twice a day
63
what are types of trauma complications
pulpal necrosis and infection root resorption pulp canal obliteration break down of marginal gingiva and bone
64
how does replacement resorption happen and how does it appear
severe damage to PDL, osteoblasts faster at healing than PDL fibroblasts, PDL becomes replaced with bone - dentine fused directly to bone appears - tooth is infraoccluded as included in bone remodelling, no PDL space seen radiographically
65
what is pulp canal obliteration
response of vital pulp - progressive hard tissue formation within pulp chamber - narrowing of pulp chamber and canal
66
what types of trauma is pulp canal obliteration more likely to be seen
luxation, extrusion, intrusion, root fractures
67
why do immature teeth have a better prognosis following trauma
wider apices - more blood vessels - better healing capacity
68
what is subluxation and what are the symptoms
damage to surrounding tooth structures, no displacement but may have mobility symptoms - increased mobility, TTP, bleeding at gingival crevice
69
what is lateral luxation and what are the symptoms
displacement of tooth in a socket in any direction other than axially symptoms - tooth immobile, ankylosis percussion note (metallic), fracture of alveolus, sensibility tests likely to be negative
70
why is RCT initiated in a closed apex tooth following lateral luxation
high chance of pulpal necrosis, doing pulp extirpation early prevents external infection related root resorption
71
how can root fractures be classified and why is this helpful
apical third, mid third, coronal third coronal third fractures have the worst prognosis and must be splinted for 4 months
72
if a tooth has discoloured yellow following trauma, what is this indicative of
pulp canal obliteration - tertiary dentine laid down in pulp chamber, reduces light transmission
73
what are the properties of splints
must be passive and flexible must allow for adequate oral hygiene must allow for clinical monitoring and sensibility tests ease of placement aesthetics

BDS4 CDS (8 decks)

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