Paediatrics

Question 1

caries in the following teeth
54 52 51 | 61 62 64
84 | 74
what is the name of the caries distribution

Answer 1

early childhood caries
nursing bottle caries

Question 1

why are the specific teeth affected in early childhood/nursing bottle caries

Answer 1

the tongue protects lower incisors
upper anteriors are the first to erupt
upper incisors are the first in contact with the milk/substance in the baby bottle
canines are not yet erupted

Question 2

causes of early childhood/nursing bottle caries

Answer 2

prolonged bottle feeding
bottles at night
bottles used as a pacifier
poor OH
high sugar/acidic within bottle
transmission of strep

Question 3

what fluoride regime for 2y/o with early childhood/nursing caries

Answer 3

1350-1500ppm fluoride toothpaste
fluoride varnish applied 4x year

Question 4

recommendations regarding toothbrushing regime for high risk 2y/o

Answer 4

brush 2x day
fluoride toothpaste, use a smear
spit not rinse
supervised
brush for 2 mins
demonstrate to the dentist

Question 5

deciding order of treatment

Answer 5

1. OHI and diet advice
2. fluoride varnish
3. fissure seal
4. small occlusal with no LA
5. occlusal on upper with LA
6. interprox on lower molar LA
7. lower molar for pulp therapy
8. XLA upper molar

Question 6

aspects of a child’s behaviour confirming they are anxious

Answer 6

fidgeting, refusal to open mouth, crying, clinging to parent, not sitting in chair, complaining
perspiration, feelings of unease, breathlessness

Question 7

signs of abuse/neglect

Answer 7

severe untreated pain, bruising/cuts on face, sleep loss, contusions, burns, tooth trauma

Question 8

further questions to ask when investigating suspicion of abuse/neglect

Answer 8

how did they get the bruise/cut
have they been in an accident
how long ago
history of previous injuries

Question 9

sign 83 guideline on toothbrushing

Answer 9

toothbrushing 2x daily
supervised toothbrushing
brush before age of one or when first tooth comes in

Question 10

how long should a diet diary be kept

Answer 10

3 days

Question 11

child has carious teeth and parent fails to bring them back for 2 appts
what next

Answer 11

document in notes
safeguard nurse, child protection adviser, social services

Question 12

what 3 courses of action may take place as a result of onward discussion to social services when suspicious of abuse/neglect

Answer 12

investigation, initial assessment, discussion, gathering of information
no action
immediate danger = child protection by sherrif officer for child to be removed by police

Question 13

emergency tx of dentine/enamel fracture of tooth 11

Answer 13

temporary filling of GI to cover exposed area

Question 14

signs/symptoms to look for in dentine/enamel fracture in longitudinal monitoring

Answer 14

colour of tooth, pain of tooth, mobility of tooth, sensitivity of tooth, misalignment of tooth or ones beside

Question 15

radiographic signs which may be present if dentine/enamel fracture tooth 11 becomes non-vital

Answer 15

external root resorption, periapical radiolucency, empty pulp chamber/root canal, widening of PDL
pulp canal obliteration
loss of lamina dura

Question 16

prevention of further injury of dentine/enamel fracture 11

Answer 16

mouth guard, special fit from lab

Question 17

reasons for a child to be dentally anxious

Answer 17

media coverage, prior dental experience, family experience/opinion, poor knowledge of tx, expectation of pain

Question 18

how to treat an anxious child

Answer 18

acclimation, work quickly, calm, empathy, give them stop signals, explain

Question 19

behavioural management methods of dentally anxious child

Answer 19

positive reinforcement, tell-show-do, desensitisation, distraction, relaxation techniques, stop signalsvoice control
enhanced control
behaviour shaping

Question 20

what is EADT and EAT

Answer 20

EADT = extra alveolar dry time = time before tooth is placed in storage medium or reimplanted

EAT = extra alveolar time = total time tooth has been avulsed and in storage medium

Question 21

storage mediums for an avulsed tooth

Answer 21

saliva, milk, saline, HBSS

Question 22

what information would you give to someone on the phone about an avulsion

Answer 22

handle the tooth by the crown, not the root
place in storage medium
wash of any debris
reimplant
get to dentist ASAP

Question 23

what type of splint is used for subluxation and for how long

Answer 23

flexible splint, 1 tooth each side
2 weeks

Question 24

fluoride regime for a high risk 4y/o

Answer 24

pea sized 1350-1500ppm fluoride toothpaste
apply fluoride varnish 4x year
0.5mg fluoride supplements

Question 25

at what age can you give fluoride mouthwash

Answer 25

7 y/o

Question 26

what is the toxic fluoride dose and how to treat this

Answer 26

> 5mg/kg
give calcium orally, activated charcoal, calcium glugonate
15mg hospitalised

Question 27

what drug counteracts benzodiazepine sedation

Answer 27

flumazenil

Question 28

how can dental trauma impact primary and permanent dentition

Answer 28

disruption of normal eruption, ankylosis, speech development, ability to chew/speech, movement of permanent tooth germ, fractures/crack, pulp exposure, root resorption, aesthetics, infraocclusion

ectopic tooth position
arrested tooth development
odontome formation
enamel hypoplasia
delayed eruption

Question 29

advantages of first molar extractions at the correct stage of developmet

Answer 29

caries free dentition
allows spontaneous eruption of 7 therefore relieving need for ortho tx

Question 30

when is the best time to remove carious 6s

Answer 30

when 5’s present
bifurcation of 7

Question 31

disadvantages of removing 6s under GA

Answer 31

loss of tooth, chewing/speech problems, scared of dentist