What is the definition of early childhood caries
The presence of one or more decayed, missing or filled tooth surfaces in any primarytooth in a child under 6 years old.
What is the most durable restoration in primary molars?
Stainless Steel Crowns
What is the pre-emptive analgesia dose for children prior to dental appts
One off dose of:
- 30mg/kg paracetamol, 30 to 60 minutes prior to appt.
What timeframe prior to exfoliation are primary teeth not worth restoring
If its due to exfoliate in 6-12 months, not worth restoring.
Instead, extract or temporarily dress.
How do you judge time to exfoliation of teeth?
Levels of resorption
Why is dental amalgam an indirect threat to human health?
When released into the environment, can undergo conversion to methylmercury by aquative microbes, and get concentrated in the human food chain
What is the NZDA stance on restorations and pregnant women:
- precaution - during pregnancy, where clinically reasonable, to avoid elective dental procedures, including the placement or removal of ANY filling material
Trace amounts of what are released from dental resins thoruh salivary enzymatic hydrolysis?
What is the health implication?
Bisphenol A
Estrogenic.
SSC are recommended for:
- Primary tooth lesions greater than 2 surfaces
- Pulp tx teeth
Hall technique contra-indications
- Dental anxious children
- Advanced carious lesions (non vital teeth)
- Accessible single surface lesions
- Pre-existing open bite
- Time limitations
- Inter-radicular radiolucency
Why is it important to re-erupt an intruded tooth immediately
It will ankylose and become unvital.
Will an intruded tooth erupt on its own?
No as will ankylose
What is the optimum range for community water fluoridation
0.8 to 1.2 ppm
Who might be recommended fluoride tablets?
People aged 3+ at high caries risk
In NZ fluoride rinses are contra-indicated for:
- Children under 6
- People over 6 who are low risk
What amount of fluoride is in fluoride gels/foams
2%
What is the amount of fluoride in duraphat
22600 ppm
Who can have duraphat?
People over 12 months old at high caries risk
Except for ……….there is no valid reason to place a restoration at the time a lesion is detected
- Frank cavitation
- Radiolucency extending more than 1/3 into dentine
Evidence says proximal infiltration of lesions is significantly more effective than fluoride
True or false
True
Method for preventing fluorosis at home -
Use recommended amount of TP
What is the difference between ICDAS 5 and 6?
ICDAS 5 is a distinct cavity with visible dentine.
ICDAS 6 is an extensive cavity with visible dentine.
Approximal lesions who radiolucencies are confined to the outer half of the dentine, are likely to be cavitated.
True or false
FALSE. so they’re good candidates for remineralisation therapy.
LIst 5 difference between the crowns of primary and permanent teeth
- Smaller and whiter
- Thinner enamel and dentine
- Broad contact areas
- Narrower occlusal table
- Bulbous crowns/cervical constriction
List 3 differences between the pulp of primary and permanent teeth
- Larger pulp chamber
- Prominent pulp horns
- Curved chamber floor
3 Differences between the roots of primary and permanent teeth
- Flared
- Longer and slender
- Narrow (mesial-distal)
*
In the primary dentition what is used instead of angles molar classification
Terminal planes
Newly erupted teeth are less caries susceptible.
True or false
FALSE!
They are porous so more susceptible, until the enamel matures
Why is it better to have dry enamel for detection of caries?
Larger refractive index between air/enamel vs water/enamel
What number do P lesions go up to?
P5 - radiolucency extends to inner half of dentine
What number do ICDAS codes go up to?
6
What % of enamel is inorganic?
96%
Which is qualitative?
a) Hypomineralization
b) Hypoplasia
Hypomineralisation
Which is quantitative?
a) Hypomineralization
b) Hypoplasia
b) Hypoplasia
What are the 5 judgement criteria used in the diagnosis of MIH?
- Demarcated opacity
- Post eruptive enamel breakdown
- Atypical restoration
- Extracted molar due to MIH
- Unerupted teeth
Demarcated opacities associated with MIH can be what colour?
White, yellow or brown
What is the global prevalence of MIH
14.2%
What condiiton appears to be associated with MIH
Fever or other early childhood illness
Amoxicillin may cause MIH
True or false
False
What teeth are used in MIH diagnosis?
Permanent first molars, and affected incisors
Enamel of teeth affected with MIH has been found to have a mean % reduction in mineral content and an increase in protein content.
28%
What has been found to potentially enhance bonding of resin adhesives to hypomineralised enamel?
5% NaOCl - Ekambrin 2016
When does a tx plan ‘expire’
6 months
List 3 medication conditions which might result in oligodontia
- Ectodermal dysplasia
- Clefting
- Down syndrome
Term used for supernumerary tooth in the anterior maxilla:
Mesiodens
3 conditions associated with supernumerary teeth:
- Cleidocranial dysplasia
- Cleft lip and palate
- Gardner syndrome
4 problems caused by presence of supernumerary teeth?
- Obstruction of tooth eruption
- Displacement of teeth
- Crowing of teeth
- Cystic change
Ideally get consent for any patients under:
16
What are some key developmental issues you should look for in children:
- No canines palpable by 9
- Hypomin on 6s
- Peg laterals - monitor for canine issues
- No successor
- Ankylosis of over-retained primary
3 options for tx of macrodontia
- Stripping
- build up antimere
- exo and prosthetic
condition which often presents with microdontia:
ectodermal dysplasia
Why do you need to xray double teeth?
Check if roots/pulp chambers are merged
Management of dens in dente or dens invaginatus
Seal to prevent pulp necrosis
If necrosed - RCT if morphology favourable
How to prevent tubercle fracture of a dens evaginatus (occlusal enamel pearl)
- Before it comes into occlusion, support sides of tubercle with composite resin and recontour occlusal surface to produce a central tidge.
- After tooth comes into complete occlusion, grind off, then seal
List 2 systemic causes of delayed tooth eruption, and 4 local causes
- Hypothyroidism
- Hypopituitarism
- Supernumerary
- Hereditary gingival fibromatosis
- Ectopic tooth bud
- Crowding
- Dilacerations
- Early exo of primary
What might cause delayed tooth exfoliation?
- Infraocclusion
- Double primary teeth
- Ectopic permanent tooth
- Trauma
List 7 methods of behavioural management
- Desensitisation
- Tell-show-do
- Positive reinforcement
- Distraction
- Behaviour shaping
- Modelling
- Voice control
Methods of behaviour management where anxieties are dealt with by exposing him/her to a series of dental experiences in order of increasing anxiety
Desensitisation
What is behaviour shaping?
Comination of Tell show do, positive reinforcement and distraction to shape behaviour
What is modelling, as a behavioural management method?
Children develop from observation and imitation of others, eg learned conditioning
NSAIDs should be avoided in children with what common condition
Asthma
What is the likely cause of a child presenting with facial swelling and acute pain tender to touch?
A necrotic pulp. Treat with drainage via tooth or soft tissue, and extract.
If systemic - abs
5 symptoms of teething
- Sleepless
- Increase saliva and dribble
- Flushed cheecks
- Increased urge to bite
- Eruption cyst
2 best management tools for teething
- Teething rings
- Pain relief
- AVOID cariogenic comforters
Management of lip bite -
Chlorhex mouth rinse
Managment for primary gingivostomatitis
- Chlorhex mouthrinse
- Keep up liquids
- Symptomatic care
How long does Primary gingivostomatitis usually last
10 days
In what case would you prescribe a young patient with primary gingivostomatitis to the hospital
Immunocompromised
Upper frenum laceration can be associated with:
Force feeding
4 symptoms of asthma
- Cough (dry and repetitive)
- Wheeze
- Breathlessness
- In attack may have speech difficulty, pulse increase, cyanosis
5 oral manifestations of asthma
- High caries prevalence
- Xerostomia
- Oral candidosis
- Gingivitis
- Malocclusion
What should you do in an asthma attack
- Stop tx, ensure airway is clear
- Give B2 agonist inhaler - two puffs repeatedly
- Call for help
- Oxygen if available
- Maintain calm environment until help arrives
Life long, neuro-developmental disorder that often becomes apparent before age 7. Tx with Ritalin and Adderall.
Oral risks associated with ADHD
- High caries risk
- Traumatic injuries - falls
Advice for treating ADHD patients
- Book apps 30-60 mins after taking stimulant medication
- Eye to eye contact
- Short clear instructions
- Tell show do
Condition caused by deficiency of clotting factor VIII
Haemophilia A
Condition associated with deficiency of clotting factor IX
Haemophilia B
Congenial bleeding disorder resulting from a quantitative or qualitative deficiency of a plasma glycoprotein which has a function in haemostasis
Von Willebrands disease
Briefly describe normal clotting process
- Bleeding starts
- Vessels constrict
- Platelet plug forms
- Fibrin clot
What is the purpose of platelets?
Provide a surface for blood clotting to occur on
LA containing epinephrine should not be used for patients taking beta blockers.
why?
Can induce hypertension and cardiovascular complication
There is no need to alter or stop anticoagulant therapy before minor oral surgery procedure, if the INR level is below:
4
What procedure is not recommended for children with congenital heart defects
Pulp therapy. Because higher incidence of associated chronic infections.
For pts with congenital heart conditions, when should appts be scheduled
Late morning.
Short and stress free
Oral manifestations of chronic renal disease-
- Bad odor/metallic taste sensation increased
- Concentration of urea in saliva
- Xerostomia
- Paleness of mucosal membrane due to anaemia
- Gingival bleeding from platelet dysfunction
- Enamel hypoplasia
What is the primary tx related concern for patients with chronic renal disease
Bleeding tendency.
Patients with chronic renal disease should be prescribed prophylactic antibiotics.
Why
Immunosuppression
Dentla procedures should ideally be performed on day of dialysis
True or false
False
How long after transplant should patients avoid elective dental tx
6 months
Why is potential for oral infections high in patients after transplanation
They receive immunosuppressive therapy
Oral manifestations of crohns disease:
- Oral ulceration particularly buccal mucosa
- Cobblestone appearance of buccal mucosa
- Oral mucosal tags
- Cracks at the corners of the mouth
- Dental caries
- Gingival bleeding
- Fissured tongue
Oral manifestations of Epilepsy
- Dental trauma
- Drug induced hyperplasia
- RAS like ulcerations
- Root shortening
- Hypercementosis
- Delayed tooth eruption
When should epilepsy patients be scheduled?
Early in morning. Make sure have taken medication.
What MUST you have for patients with epilepsy in the surgery
Dark glasses. Light can trigger seizures.
Methotrexate oral side effect:
Ulcers
Oral manifestations of Juvenile Idiopathic Arthritis
- Gingivitis
- High caries incidence
- Oral ulcerations
- TMJ pain
- Maloccluisons
Oral Manifestations of Diabetes
- Increased caries risk due to xerostomia
- Accelerated tooth eruption with increasing age
- Gingivitis with high risk perio
- Salivary gland dysfunction
- Imparired or delayed wound healing
- Taste dysfunction
- Candidia
Ideal appt time for diabetes patients:
Short, morning appts. Ensure has eaten a meal and taken usual medication prior to tx.
Why is it important for people with diabetes to have a regular recall?
Perio can significantly worsen diabetes and associated cardiac disease.
What should you do in a hypoglycemic episode:
Patient conscious - high dose glucose
Unconscious or unable to swallow - glucagon sub-cut
Oral manifestations of cancer
- Mucosal changes
- dry mouth
- Infection risk
- Caries risk
- Bleeding risk
What are the first baby teeth to erupt?
Lower incisors, and upper incisor
What usually erupts after the primary lower and upper incisors erupt?
The lateral incisors
List the order of tooth eruption of primary teeth
- Central incisors
- Lateral incisors
- First molars
- Canines
- Second molars
What age do lower primary centrals usually erupt?
6-10 months
What age do the primary central incisors usually shed
6-7
What permanent teeth erupt first and when?
Centrals and first molars
6-8 years
What age do wisdom teeth usually erupt
17-21
What age should the permanent canines erupt?
10-12
Primary herpetic gingivostomatitis is seen in children between the ages of 6 months and 6 years. RAS in the herpetiform presentation is mainly seen in people 10-40 years old.
a) Both statements are true
b) Both statements are false
c) Statement one is true, statement two is false
d) Statement one is false, statement two is true
c) Statement one is true, statement two is false.
Which of the following statements regarding pre-emptive analgesia for a child is correct for paracetamol
a) 20mg/kg 45-60 mins before procedure
b) 25mg/kg 60-100 mins before procedure
c) 30mg/kg 45-60 mins before procedure
d) 30mg/kg 60-100 mins before procedure
c)