Paeds Flashcards
1
Q
Patient taken to clinic by mum’s boyfriend, losing sleep due to dental pain, has gross caries, vague medical history, pyrexic (likely acute PA abscess). What would you want to establish prior to examination? What would your short term management be?
A
Who the legal guardian of the patient is
Thorough medical history
Consent- record everything
Short term tx- drainage, analgesia, AB, schedule review
2
Q
What behavioural management techniques can be used to maximise cooperation in children?
A
Tell Show Do
-> Give age appropriate description
-> Show patient in inocuous extra-oral way
-> Start treatment without delay
3
Q
How do you address the issue of a child patient’s non-attendance?
A
Ensure up to date contact details, Record everything in notes, Contact mum by phone or any other guardians, Discuss with mother the necessity of jodi to come (someone else to consent), Inform mum possibility of child protection getting involved if non-compliance, Set the next appointment on the phone (get appropriate escort)
4
Q
What evidence based brushing advice can be given to prevent further dental caries in children?
A
Use smear if <3, pea size if >3
Use 1450ppmF tooth paste
Use electric toothbrush
Spit don’t rinse
Modified base technique- 45 degree angle from gingival margin (listen for Sh)
Disclosing tablets
5
Q
What does BPE score of 3 mean?
A
Probing depth- 3.5-5.5mm
6
Q
What teeth should you prob to obtain BPE?
A
Modified BPE until age 12
-> 16, 11, 26, 36, 31, 46
-> code 0-2 only
7
Q
What is the normal depth from CEJ to bone crest?
A
2mm
8
Q
What condition can result in periodontal disease in children?
A
Diabetes
9
Q
What investigations can you do for a child aged 13 with BPEs of 3?
A
Diet diary
Radiographs
PGI
10
Q
What treatment would you do for a child aged 13 with BPEs of 3?
A
PMPR
Specialist referral
11
Q
What questions would you ask a patient when they have traumatic fracture of a tooth?
A
How did it happen?
When did it happen?
Did you keep hold of missing compment?
12
Q
What factors can affect prognosis of traumatised tooth?
A
Time since it occured
Maturity of tooth- apex closed or open
Type of fracture- is it complicated involving pulp
-> if it is how large is exposure
Vitality of tooth
Mobility
13
Q
What should you inform the patient’s parents of when they have fractured a tooth traumatically?
A
Complications- discolouration, pain, sinus/infection, damage to adjacent teeth
Prognosis of tooth
Treatment options
14
Q
Where may a fractured fragment of tooth end up, how are these managed?
A
Swallowed- send to A+E
Inhaled- send to A+E for chest x-ray
Embedded in soft tissue- remove and consider suture
Into the environment around patient- restore without fragment
15
Q
How would you manage an ED fracture?
A
- Take 2 PAs to rule out root fracture or lunation
- Soft tissue radiographs
- Bond fragment or place composite bandage
- Sensibility testing
- Evaluation of tooth maturity
- Place definitive restoration
16
Q
What questions would you ask a patient about if they have white, brown, yellow stains on their teeth?
A
During pregnancy - natural birth
Prenatal - Severe illness of mum during pregnancy: anaemia, gestational diabetes
Perinatal - Birth trauma/anoxia, Preterm birth
Postnatal - Prolonged breastfeeding, Fever and medications
Childhood infection - measles, rubella, chicken pox
17
Q
What is the condition causing yellow, brown spots on all permanent molars and incisors likely to be?
A
MIH
-> is this genetic
18
Q
What can you ask a patient about in order to rule out Fluorosis?
A
Is water fluoridated in their area
Do they use supplements
Are they using F toothpaste excessively
Is sibling or parent using higher strength toothpaste
Have they swallowed toothpaste as a younger child
19
Q
What are the issues when restoring teeth with MIH?
A
Susceptible to caries
Poor bonding- difficult to restore
Poor long term prognosis
Need for complex/extensive treatment in future
-> may involve orthodontist
20
Q
A co-operative 10 year old patient attends with moderate crowding requesting orthodontic treatment, but has poor oral hygiene and cavitated caries into dentine in the first permanent molars.
Describe your management of the case:
A
History- find out if patient in pain, ask patient if they have any concerns
CRA- diet, F exposure, socio-economic status, OH, medicine, saliva quality, MH
Take OPT/bitewings- assess for caries, review dental development
Prevention- 4 x FV per year, 2800ppmF toothpaste, OHI, fissure sealants
Treatment required before ortho can be carried out- restorations, extractions
-> preferred method of anaesthesia
Discuss orthodontic treatment
-> find out patient concerns
-> Risks and benefits
Discuss reason why ortho isn’t possible at moment
-> OH must be improved- motivate patient
Assess child protection and neglect
21
Q
What are the risks of ortho?
A
Root resorption
Relapse
Recession
Decalcification
Other- wear, failed treatment, ST trauma, loss of perio support
22
Q
What are the risks of extracting 6s?
A
Mesial tipping of 7
Distal migration of 5
-> extract at time of buccal bifurcation of 7 forming to optimise space
23
Q
What are the treatment options for impacted first molars?
A
If not severe- consider extraction of E
Disimpact 6- place ortho separator/brass wire for a week (check for signs of eruption)
Use appliance to push 6 back- difficult as it is partially erupted
-> bond fixed appliance component to 6 to distalise it using PFS
Distal discing of Es- give more space for eruption (can result in a bit of crowding)
Consider pre-molar extractions to alleviate crowding
24
Q
What features of the permanent dentition allow for replacement of primary teeth without crowding?
A
- Leeway space- 3, 4, 5 take up less space than primary c, d, e
-> 1.5mm each side in upper/2.5mm in lower
Growth of maxilla/mandible
25
What materials would you use for splinting an extruded tooth?
Flexible stainless steel wire
Cemented with composite resin shields (acid etch tooth with 37% phosphoric acid)
26
How long is a splint places for extrusion?
2 weeks
27
What tests (apart from radiographs) would you do for an extrusion?
Sensibility testing- EPT/ECL
Mobility
TTP
Assess colour
Look for related sinus
28
What are some of the radiographic features you may see in a tooth which has had a traumatic extrusion?
Widened PDL
Loss of lamina dura
Inflammatory root resorption- ext, int
Altered root development
PA pathology
29
What advice is given for an avulsion over the phone?
Do not handle by root
Do not reimplant primary tooth
Gently rinse under cold running water for 10 secs
If permanent tooth- reimplant and bite on tissue
-> or store in saliva/buccal sulcus>milk>saline
Get to GDP ASAP
30
What checks should be done when patient has avulsed tooth?
Tetanus status
How and where incident occured
Time elapsed since incident- EADT/EAT
Was the patient unconscious- A+E
Account for tooth fragments
31
What splint is used in an avulsion?
If <60 mins EAT- 2 weeks flexible
If >60 mins EAT- 4 weeks flexible
32
What are the common outcomes following avulsion?
Perio outcomes
-> regeneration
-> PDL cement healing
-> ankylosis
-> uncontrolled infection
Pulpal outcomes
-> Regeneration (esp if open apices)
-> Uncontrolled infection/necrosis
Root resorption
Discolouration
Mobility
33
What are the signs of Dentinogenesis Imperfecta/OI?
Wheel chair bound
Multiple bone fractures
Bulbous crowns (amber translucent- grey)
Blue sclera
Pulp obliteration (difficult to RCT)
34
What are the radiographic signs of DI?
Appear like primary teeth with normal root formation
Large pulps- become obliterated
Occult abscess formation (no demonstrable clinical disease)
35
How is DI managed?
Prevention
Composite veneers
Overdentures
Removable prostheses
Stainless steel crowns- lack of tissue to bond to
36
What are extra oral signs of Down's syndrome?
Cataracts
Small mid face
Oblique palpebral fissures
Short/thick neck
Small ears
37
What are intra-oral signs of Downs syndrome?
Periodontal disease
AOB
Tongue thrust
Macroglossia
Class III jaw relationship
Spacing
Hypodontia
Microdontia
38
What are the restorative options for patient with Down's?
Enhanced prevention- F supplements, high dose F toothpaste, double sided brush, 2 brush technique
If good cooperation- treat as normally as possible
If placing fissure sealants- consider GI if issue with moisture control
If uncooperative- may require GA
39
What are the types of healing following root fracture?
Calcified tissue union across fracture line
connective tissue
calcified + connective tissue
Osseous healing
40
What is considered as non-healing root fracture ?
Granulation tissue formation
41
How are root fractures managed?
Clean area with water then saline/CHX
If undisplaced- monitor
if displaced- reposition tooth with digital pressure (+/- LA)
Splint for 4 weeks
Review- 6-8 weeks, 6 months, 1 year, 5 years
42
How would you managed non-vital root fractures?
Extirpate to fracture line
Dress with non-setting CaOH then MTA/biodentine to fracture line
Obturate with GP to fracture line
OR XLA
43
What are the signs of Fluorosis?
Varies with severity:
White spots/flecks
Brown spots
Mottling/pitting
44
What are the vehicles for F delivery?
Toothpaste
Fluoride Varnish
Mouthwashes
Supplement tablets
Water
Milk
Salt
45
How is Fluorosis managed?
Accept
Microabrasion
Composite veneers
Porcelain veneers (over 18)
Tooth whitening- may make white spots whiter
46
What are the advantages of NV bleaching?
* Simple
* Tooth conserving- original tooth morphology
* Gingival tissues not irritated by restoration
* Adolescent gingival level not a restorative consideration
* No laboratory assistance for ‘walking bleach’
47
What are the disadvantages of NV bleaching?
* External cervical resorption
* Spillage of bleaching agents
* Failure to bleach
* Over bleaching
* Brittleness of tooth crown (when no coronal filling present)
* Not suitable for amalgam, tetracycline or fluorosis staining
48
What are the steps in the walking bleach technique?
1. Remove root filling to level below CEJ
2. Clean out tooth with ultrasonic
3. Place CWP covered in bleaching agent (10% CP)
4. Place dry CWP on top
5. Seal with GIC/RMGIC
Renew within 2 weeks (can be done 6-10 times)
-> if no change after 3-4 renewals then stop
-> when happy place final restoration
49
What is the only splint used for primary teeth?
Flexible 4 week splint if alveolar bone fracture
50
What is the difference between a flexible and rigid splint?
Flexible- passive, so no tooth movement
Rigid- active, can put force on teeth causing movement
51
How is an avulsed tooth with EADT <60 mins managed?
If open apex- replant/splint for 2 weeks and monitor as it may revascularise
If closed apex
-> Splint 2 weeks
-> pulp extirpation 0-10 days
-> Place AB steroid paste for 2 weeks
-> Place NS CaOH
-> Obturate within 6-8 weeks
52
What is the management of an avulsed tooth with EADT >60mins?
Scrub root clean of dead PDL cells
EO endo (or extirpate at 7-10 days, place CaOH for 4 weeks and obturate)
Replant tooth under LA
Splint 4 weeks- flexible
Consider AB
53
What should dentist ask a patient's mother who is worried about them swallowing F toothpaste?
What quantity toothpaste was swallowed?
What strength of toothpaste?
What age is the child?
What weight is the child?
54
What advice should the dentist give if the patient has swallowed the toxic dose?
Go to hospital
Give calcium orally- milk
55
What are the toxic doses of Fluoride and the action?
5mg/kg body weight = give milk and observe
5-15mg/kg = give child milk and admit to hospital
> 15mg/kg = immediate hospital admission for cardiac monitoring, life support and IV calcium gluconate
56
What is the most common causes of Fluorosis in UK?
Fluoride in water supply
57
What is the first line of treatment for Fluorosis?
Microabrasion
58
What F supplements can be given to a 1 year old?
0.25mg drops
59
What fluoride supplements can be give to a 4 year old?
0.5mg chewable table
60
What F supplementation can be given to a 7 year old?
F Mouthwash- 225pm
1mg tablet
61
What is the likely diagnosis for a patient who is 3 and has blisters on her gums?
Primary Herpetic Gingivostomatitis
62
How do blisters appear in PHG?
As vesicles which disrupt giving round fibrin covered ulcers
63
What other symptoms may a patient with PHG have?
Fever
Halitosis
Lymphadenopathy
Poor appetite/reluctance to eat
Nausea/malaise
64
What is the cause of PHG?
HSV
65
How do you manage patient with PHG?
Self limiting- support
-> reassure
-> rest
-> fluids
-> encourage eating
-> analgesia
66
What future issues may HSV cause for the patient?
Shingles
Herpes labialis- cold sores
Bells palsy
67
What time frames in the child's life are implicated in MIH? Why are these times important?
Prenatal, Neonatal, Postnatal
-> development of 6s starts before birth
-> enamel matrix of FPM crown is complete by 1 year (incisors by 2)
68
What are the signs and symptoms of MIH?
Well demarcated opacities
Chalky brown, white, yellow patched
High caries rate
Poor bonding
Asymmetrical pattern
69
What are the treatment options for MIH molars?
Composite restoration (bonding issues?)
GIC
Stainless steel crown
Adhesively retained coping- bell glass/gold
Extraction (when dental age 8.5-9.5)
70
What toothpaste would be advised for different age groups?
Age <3
LR = 1000ppm
High risk = 1350-1500ppm
Age 3-9
LR = 1350-1500ppm
High risk = 1350-1500ppm
Age >10
LR = 1350-1500ppm
High risk = 2800ppm (5000ppm if over 16)
71
What are the topical effects of F?
Promotes remineralisation
Formation of Fluoroapetite- helps strengthen tooth structure
Bacteriocidal
72
What are the systemic effects of Fluoride?
Fluorosis
73
What are the effects of primary tooth trauma on primary tooth?
Dicolouration
Infection
Delayed exfoliation
74
What are the effects of primary tooth trauma on permanent tooth?
Enamel defects
Delayed eruption
Dilaceration
Duplication
Ectopic teeth
Arrest in formation
Agenesia
Odontome formation
75
What are the eruption dates for primary dentition?
upper A = 8 months
upper B = 10-13 months
upper C = 1.5-2 years
upper D = 1-1.5 years
upper E = 2.5-3 years
lower A = 6 months
lower B = 10.5 months
lower C = 1.5-2 years
lower D = 1-1.5 years
lower E = 2-2.5 years
76
What are the eruption dates for permanent dentition?
upper centrals = 7
upper laterals = 8
upper canines = 11
upper 1st premolar = 10 (always comes in before the 2nd)
upper 2nd premolar = 11
upper 1st permanent molar = 6
upper 2nd permanent molar = 12
lower centrals = 6
lower laterals = 7
lower canines = 9
lower 1st premolar = 10 (always comes in before the 2nd)
lower 2nd premolar = 11
lower 1st permanent molar = 6
lower 2nd permanent molar = 12
77
When do roots fully form?
Apexogenesis takes 3 years after eruption
78
What are some of the factors in the index of suspicion in injured child?
Delay in seeking help
Vague story
-> account not compatible
Parents mood abnormal
History of family violence
History of previous injuries
Child interaction with parent is abnormal
Child says something contradictory
79
What orofacial injuries are considered suspicious?
Cigarette burns
Hbites
Ear/neck injuries
Brusing not on bony prominence
Grip marks
Slap marks
80
What are the steps in referring a child to child protection services?
Observe
Record- what patient says, take photographs
Communicate
Refer for assessment
Refer to social services by telephone then in writing
81
What are the indications for a pulpotomy?
Good co-operation
Medical history precludes extraction
Missing permanent successor
Over-riding necessity to preserve the tooth
e.g. space maintainer
Child under 9 years of age
82
What are the contraindications for pulpotomy?
Poor co-operation
Poor dental attendance
Cardiac defect
Multiple grossly carious teeth
advanced root resorption
Severe/ recurrent pain or infection
83
How is a pulpotomy carried out in posterior tooth?
USE LOCAL ANAESTHETIC and RUBBER DAM
1) Remove roof of pulp chamber
2) Remove coronal pulp with sterile excavator or slow running large round steel bur
3) Place a cotton pledget with ferric sulphate for 20 seconds
4) Place zinc oxide/ eugenol in the pulp chamber and restore using a preformed metal crown with GIC core
84
What are the clinical signs of failure in a pulpotomy?
Pathological mobility
Fistula / chronic sinus
Pain
-> review 6 monthly
85
What are the radiographic signs of failed pulpotomy?
increased radiolucency
external / internal resorption
furcation bone loss
-> review 12-18 monthly
86
What is a partial pulpotomy?
Only remove 2mm until you reach healthy tissue, then place CaOH with vitrebond then composite on top
87
How is a pulpectomy carried out?
If Non-vital / hyperaemic pulp:
1. Open roof of pulp chamber
2. Remove contents of pulp chamber
3. Use files to remove pulpal tissue from canals to 2mm short of EWL (worked out off radiograph only)
4. Irrigate with chlorhexidine and dry with paper points
5. Obturate canals with Vitapex® which is a CaOH and iodoform paste (Alternatively a very thin mix of ZOE)
6. Seal with thick mix of ZOE/GI and restore with a preformed metal crown
88
What are the types of amelogenesis imperfecta?
Hypoplastic- enamel crystals do not grow to the correct length
Hypocalcified- crystallites fail to grow in thickness and width
Hypomaturational- enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation
Mixed forms- assoc. with taurodontism
89
What is the cause of AI?
Mutations involving:
Enamel extracellular matrix molecules
Amelogenin/ Enamelin
Kallikrein 4
90
What issues may occur as a result of AI?
Sensitivity
Caries/ acid susceptibility
Poor aesthetics- brown colour
Poor oral hygiene
Delayed eruption
Anterior open bite
Bonding issues
91
How is AI managed?
Preventive therapy
Composite veneers/ composite wash
Fissure sealants
Metal onlays
Stainless steel crowns
Orthodontics
92
What are examples of other causes of enamel defects?
Epidermolysis bullosa
Incontinenta pigmenti
Down’s
Prader-Willi
Porphyria
Tuberous sclerosis
Pseudohypoparathyroidism
Hurler’s
93
A 4 year old patient presents with gross caries across her anteriors, including the smooth surface. What is your likely diagnosis?
Nursing bottle caries
-> cariogenic drinks given in bottle for child to drink throughout the night
94
How is bottle caries managed?
Tell parent not to give child anything to eat or drink following night time brush
Enhanced prevention- 1450 toothpaste, F tablets, FV 4x yearly
OHI- spit don't rinse, be accompanied by adult
Diet advice- milk and water only between meals, sugar free variations, limit to <4 sugar intakes per day, avoid hidden sugars
Caries removal
-> complete or partial depending on cooperation
-> consider SDF
-> consider GA for extraction
95
What are the different types of dentinogenesis imperfecta?
Type I- osteogenesis imperfecta
Type II- autosomal dominant
Brandywine
96
What are the radiographic features of DI?
Appear like primary teeth with normal root formation
Large pulps- become obliterated
Occult abscess formation (no demonstrable clinical disease)
97
What are the issues associated with DI?
Aesthetics
Caries / acid susceptibility
Spontaneous abscess formation
-> poor prognosis
98
How is DI managed?
Prevention
Composite veneers
Overdentures
Removable prostheses
Stainless steel crowns- lack of tissue to bond to
99
What are the indications for a SSC?
* > 2 surfaces affected
* Extensive 2 surface lesions
* Pulpotomy / pulpectomy
* Developmental defects
* #d primary molars
* XS tooth surface loss
* High caries rate
* Impaired OH
* Space maintainer
100
How is a conventional SSC placed conventionally?
1. Measure crown- mesio-distal length or tooth/space with separators
2. Place LA and rubber dam
3. Break contact area and produce knife edge finish mesially and distally (careful not to damage adjacent tooth)
4. Occlusal reduction 1-2mm
5. Remove any sharp angles buccally and lingually
6. Dry tooth
7. Fill crown with GIC and cement (remove excess with probe)
8. Check contacts and occlusion
101
How else can SSC be placed?
Hall technique
102
What are the features of a failed SSC?
Rocking
Canting
Crown lost
Crown broken
Secondary caries
Abscesses
Radiolucency on radiograph
103
What are the advantages of planned extraction of first permanent molars?
Relief of crowding
Caries free dentition
Reduced orthodontic need
104
What signs indicate suitability for planed removal of 6s?
Bifurcation of 7s forming
8s present
Class 1
Reduced OB
Moderate lower crowding
Mild- moderate upper crowding
105
What are the disadvantages of planned extraction of 6s?
May provoke DFA
May require GA
Anaesthesia may be difficult
106
What is the most common cardiac defect in children?
VSD
107
What condition is congenital heart defects associated with?
Down's
108
What other medical issues are seen in downs?
Epilepsy
Alzheimers
Leukaemia
Periodontal disease
Cataracts
Hypothyroidism
109
What must be considered when treating patients with ASD?
Anticoagulant therapy
Avoid sedation
Consider ABP for invasive procedures
110
What are the parts of a trauma stamp?
TTP
Sinus
Colour
Percussion notes
Mobility
Displacement
EPT
Ethyl Chloride
Radiographs
111
How is external inflammatory resorption managed?
RCT?
112
What are the parts of a caries risk assessment?
Clinical evidence
Diet
Saliva quality
MH
SH
F experience
OH
113
What are the aspects of the prevention plan for caries?
1. OHI
2. Diet advice
3. F toothpaste
4. F varnish
5. F supplements
6. FS
7. Radiographs
8. Sugar free meds
114
How often should you take a bitewing in a high caries risk patient?
Every 6 months
115
What toothpaste strength would you advise for a 7 year old?
1450
116
What is the optimum concentration of fluoride in water?
1ppm
117
What foods and drinks contain Fluoride?
Shell fish
Raisins
Tea
118
What is the cause of external inflammatory root resorption?
Necrotic pulp - bacterial or dental trauma in origin
-> periapical inflammatory lesion precipitates the resorption process
Restorations encroaching on pulp horns
Inflammation from adjacent teeth
119
What are the clinical signs of external inflammatory root resorption?
Possible- sinus, swelling, apical tenderness, TTP
Mobility may be increased
Negative to sensibility testing as pulp is necrotic
120
How does external inflammatory root resorption appear on radiograph?
Radiolucency but you can still see lines of root canal system
-> superimposed
121
How is a tooth with external inflammatory resorption managed?
RCT- CaOH for 3 months then obturate
Extraction
122
What are the indications for microabrasion?
Fluorosis
Ortho decalcification
MIH
Prior to veneering if dark stain
123
What are the advantages of microabrasion?
* Easily performed
* Conservative
* Inexpensive
* Teeth need minimal subsequent maintenance
* Fast acting
* Removes yellow-brown, white and multi-coloured stains
* Results are permanent
* Can use before or after bleaching
* Can be combined with addition of composite
124
What are the disadvantages of microabrasion?
*Removes enamel
-> Sensitivity
-> Teeth may become more susceptible to staining
* HCl acid compounds are caustic
* Requires protective apparatus for patient, dentist and dental nurse
* Teeth can appear more yellow as dentine can shine through
* Must be done in dental surgery
125
What are the steps in carrying out microabrasion?
1. PPE for patient and team
2. Clean with pumice and water
3. Vaseline on soft tissues
4. Place rubber dam (essential)
5. Place sodium bicarbonate guard on gingival
6. Remove enamel with HCL/pumice slurry with slow speed rubber cup- maximum is 10 x 5 sec applications (review shade/shape each time)
7. Apply FV- pro-fluoride
8. Polish with finest sandpaper disc
9. Polish with toothpaste
126
What are the types of resorption you may see on radiograph of traumatised tooth?
127
How is hypodontia diagnosed?
OPT
128
How can missing anteriors due to hypodontia be replaced?
Cantilever bridge
RPD
129
Who are the members in the MDT for hypodontia?
GDP
Orthodontist
Restorative specialist
130
What conditions are associated with hypodontia?
Anhydrotic ectodermal dysplasia
Down's
CLP
131
What are the incidences of hypodontia in primary and permanent dentitions?
0.9%- primary
6%- permanent
132
What records should be taken before microabrasion?
Photos
Diagrams of marks
Shade recording
Sensibility tests
133
What should you warn patient about after carrying out procedure?
No heavily coloured food or drink for 24 hours
-> Anything that would stain a white tee
134
What type of bleaching at what concentration is commonly used for bleaching in children?
10% carbide peroxide
-> 3.3% H2O2, 6.6% urea
135
How do you work out the aetiology of discolouration of upper central?
Ask about trauma to primary tooth
Ask about childhood medication
Consider what the colour is and link it to diseae
136
What are the reasons that a child may be anxious when attending dentist?
Parental preparation
Fear of unknown
Media
Negative previous experience
Negative medical experience
Pain and discomfort
Fear of needles
137
How is anxiety measured in children?
Faces modified MCDAS
138
What are examples of behavioural management techniques used for children?
Tell show do
Acclimatisation
Role modelling
Desensitisation
Scouting visits
Distraction
Relaxation
Positive reinforcement
Hypnotherapy
139
What is the most likely diagnosis for a 6 year old in pain with gross caries of lower molar and buccal swelling?
Acute apical abscess
140
What are the treatment options for acute apical abscess in children?
XLA (if bleeding disorder- avoid or send to specialist)
Pulptomy/ectomy with SSC
141
What are examples of local haemostatic agents that could be used for child with Haemophilia A?
LA with vasoconstrictor
Surgicel
Transexamic acid
Thrombin powder
Fibrin
Ferric sulphate
142
What is the triad of impairment in autism?
Social communication
Social interaction
Social imagination
143
What are the features of ASD?
Self injurious behaviour
Learning difficulties
Sensory overload
Restricted behaviour patterns
Epilepsy
Sleep disorders
Dyslexia/dyspraxia
144
How are patients with autism managed in dental setting?
Plan the visit: with information leaflets, social story, acclimitisation visit
Timing: first thing in the morning, first thing after lunch, wait in the car beforehand
Environment: quiet surgery, no radio, no interruptions, fluoride varnish taste
Communication: makaton, talking boards, literal speech, avoid casual chit chat
Oranurse toothpaste is helpful if child is sensitive to foaming
145
What are the indications for fissure sealants?
High caries risk- seal molars/premolars on eruption
Medically compromised children- seal all
Children with learning difficulties, physical disabilities, Mental disabilities
-> seal all
146
What materials can be used as fissure sealants?
Bis GMA resin
GIC
147
What are the steps in placing fissure sealants?
1. Isolate with dam/cotton wool and dry guards
2. Clean occlusal surface with pumice and water
3. Etch with 35% phosphoric acid for 20 secs (avoid soft tissue)
4. Wash etch directly into aspirator
5. Dry tooth- check for frosted/chalky appearance
6. Add resin fissure sealant- manipulate and remove excess with micro brush or probe
7. Cure for 30s
8. Check retention by trying to dislodge with probe
148
What are the 4 types of Cerebral Palsy?
Spastic
Ataxic
Athenoid
Mixed
-> further divided into hemi, di, para, quadriplegia
149
What is cystic fibrosis?
Inherited defect on cell chloride channels where excess mucous is produced
-> mostly affects lung and pancreas
-> abnormality of CFTR gene on chromosome 7
150
What are the signs and symptoms of CF?
Cough
Liver dysfunction
OP
Recurrent chest infection
Prolonged diarrhoea
Reduced fertility
Poor weight gain
Diabetic symptoms
151
What are the dental implications of CF?
Thick saliva
Increased calculus
Enamel defects
Long term AB- tetracycline staining
High caries risk
