paeds Flashcards

Question

Systemic and inherited diseases that can cause periodontitis

Answer 1

papillon-LeFevre syndrome (autosomal recessive) ehlers-danlos syndrome hypophosphatasia chediak-higashi neutropenia leuokycte adhesion deficiency syndrome diabetes

Answer 2

-marginal gingival tissues more vascular (red), fewer connective tissue fibres, thinner epithelia, less keratinization -therefore look redder and often mistaken for inflammation. -Thinner cementum and cortical plates. -PDL less fibrous and more vascular. Bone more vascular and fewer trabeculae. [So perio disease progresses rapidly]

Answer 3

-modified BPE technique used in <18 years -BSP or BSPD -6 index teeth (all 6s, UR1, LL1) -start doing when 6s and incisors have erupted - 7 years -Use codes 0, 1 and 2 for 7 yrs-11yrs -Use full range of codes for 12yrs – 17 yrs. If codes 3 or 4 found = radiographs -Eruption of primary dentition is accompanied by localized bleeding, leading to persistent swollen and rounded papillae and >3mm sulcus depths. due to tooth eruption, can seem more inflamed than it is (and more vascular, less keratnisation, migrating JE) -Eruption of permanent teeth accompanied by migration of JE, leading to large sulcus depth. After full eruption, JE and gingival margin continue to shift. Will get different sulcus depths in BPE. Mistaken for gingival recession

Answer 4

<5 years = ¼ adult dose >5 years= ½ adult dose >10 years = adult dose 225ppm prescription for high risk 8+ who will comply

Answer 5

causes by aspirin and viral illness (esp 5-10 years. Not used in <16 year olds) -Sudden illness and vomiting. Increase in NH3 and H+ in blood, brain swells, liver inflames and fails, all organs affected. -Death if undiagnosed. So instead use paracetamol or ibuprofen for viruses in children

Answer 6

immune overreaction due to infection, causing inflammation, low BP, high RR, organ failure, fever, feels cold to touch, extreme pain, pale/ blue/ blotchy/ mottled skin/ lips/ tongue, confusion, lethargic, high HR, not urinating, low oxygen saturation, convulsion -A purpuric rash, a weak high pitched cry, not responding normally (not interested in feeding or normal activities)

Answer 7

-ulcerated gingiva, won’t want to eat, sore to touch, dehydrated, drooling, rash around mouth, crying, disrupted sleeping. -Treatment includes massage, dry the drool, teething toys/ foods, topical or systemic analgesia (bonjela, paracetamol elixir)

Answer 8

-natal teeth=born with teeth -neonatal= come in within 30 days of birth -underdeveloped, raged edges, hypoplastic, ulcer on tongue which affects feeding, wobbly, could be inhaled. -Only remove if excessively mobile and airway risk, interferes with feeding, ulceration of ventral tongue. As part of normal denititon

Answer 9

-blue area where bleeding in follicle. Will regress when tooth erupts so want it to erupt naturally -Teething toys. May need ellipse of tissue, LA or GA If problematic. Be carful of bleeding as haemostasis can be difficult to achieve. -do not touch as will bleed excessively. Heal on their own. Incise and drain only if symptomatic or interfering with occlusion.

Answer 10

-picking or playing with gingiva causes recession and loss of attachment. Bitten nails can get impacted into gingiva and cause infection. -Can be associated with dermatitis artefacta so consider referring to psychologist. -Treated by removing cause, OHI, manage ulceration with chlorhexidine, soft diet/ fluids, review

Answer 11

-bacterial inflection involving spirochetes. -Interdental papilla destroyed (grey slough), erythema, painful, smell, commonly due to malnourished. -Treatment involves OHI, debridement, smoking cessation, if infection then metronidazole (200mg) 3Xdaily for 3 days

Answer 12

-spirochete and fusobacterium infection due to malnourishment or previous bacterial or viral infection. -Destroys soft and hard tissue, aggressive and gangrenous, due to poor sanitation. Subsaharan Africa. -Treatment includes debridement, nutrition, antibiotics, hydration

Answer 13

-HSV1&2=vesicles in and around mouth, generalized gingiva erythema, herpetic gingiva stomatitis, heretic whitlow. Reactivation causes herpes labialis (cold sores) -hand foot and mouth=coxsackie virus, very infectious, vesicles and ulcers (not on gingiva, more likely on palate) -herpangina=coxsackie, Posterior aspect of oropharynx, progress to painful ulceration, sore throat, vomiting, general malaise. not on gingiva Can be misdiagnosed as tonsilitis -HHV3= Runny nose, cold-like symptoms, precedes into skin rash, vesicle, ulcers, scabs – most infectious then. Itchy. Oral lesions can occur but never alone. Reactivation causes shingles which is tingly

Answer 14

Soft diet. Fluids. Analgesics and antipyretics. Benzydamine chloride 0.15% oral spray or rinse every 2 hours (Difflam).

Answer 15

Managed with bed rest, fluids, topical/ systemic analgesia (but not ibuprofen is it allows the virus to get deeper. Use paracetamol instead or lidocaine lollypop), ulcer coverage (orabase alone). -If severe or immunosuppressed use acyclovir tablets, suspension or cream

Answer 16

-ulcers on non-keratanised epithelium. Non-traumatic -crohn’s, diet, stress, hormones, allergies, familial, trauma, deficiency (Fe/ folate/ B12) , Behcet's, drugs -Treat underlying cause, chlorehexidine, difflam spray (benztdamine hydrochloride 0.15%, antibacterial and reduces inflammation) -Cover ulcer and reduce inflammation (adcortyl in orabase, gengigel) minor=2-10mm major ulcers=> 10mm diameter. Last >2 weeks. Heal with scarring

Answer 17

-improve quality of life and wellbeing, aids prognosis, targeted prevention, decision making for treatment planning, allows us to inform the patient which can motivate them to change their behaviours, informs health service planning -Detection requires: well lit, magnification (not essential for children though as want to see what they are doing), clean tooth (use dry brush or cotton wool), dry tooth (allows detection of early WSL by changing refractive index of enamel allowing greater light scattering), wet tooth (to allow detection of dentine shadowing), separators to allow vision of approximal regions (needs leaving on for a couple of days), tactile feel of it

Answer 18

1. Fiber-optic transillumination: Lesion has lower index of light transmission and interrupts light beam so aids visual inspection, but not very specific and no numerical score given. More useful for anterior teeth and interproximal 2. Quantitative light-induced fluorescence: blue light makes teeth green. Demineralisation of enamel reduces natural autofluorescence. 3. DIAGNOdent (Quantitative laser fluoresce): Aids detection of non-cavitated caries. Healthy = little fluorescence. Carious = high value 4. Electrical conductance measurement: intact enamel is a good insulator. Porosities in lesions fill with water and ions from saliva to increase conductance. More useful for pits and fissures and interproximal 5. Ultrasonic caries detector: emits ultrasonic waves and measures echo. Cavities produce different echo than healthy tooth 6. Bioluminescence: protein binds with calcium and camera picks up flash of light to indicate lesion.

Answer 19

Validity= measuring what you intend to measure Reliability= consistently measuring the same thing Sensitivity= getting True positives - detecting caries Specificity= True negatives. Avoiding false alarms Specificity is often higher than sensitivity in visual and radiographic detection - more likely to get false alarms

Answer 20

0= sound, no caries 1=first visual signs when dry, opacity or discolouration. Prisms still shiny and in tact 2=distinct visual change in enamel, early white spot lesion visible when dry. Frosty 3=localised enamel breakdown. Classic white or brown spot lesion, no cavitation, no dentine exposure 4=underlying dentine shadowing, with or without enamel breakdown 5=distinct cavity with visible dentine. Caries past ADJ 6=extensive cavity (>half the surface) with visible dentine 7=unrestorable

Answer 21

0=no radiolucency 1=radiolucency in outer 1/2 of enamel 2=inner 1/2 of enamel 3=outer 1/3 of dentine 4=middle 1/3 dentine 5=inner 1/3 dentine 6=into pulp Initial: in enamel or outer 1/3 dentine Moderate: middle 1/3 dentine Extensive: inner 1/3 dentine or into pulp Only restore when moderate or extensive

Answer 22

-to maintain primary tooth until exfoliation, if caries close proximity to pulp, maintain an intact arch, avoids physiological and psychological trauma of extraction, xtn may be medically contraindicated, no permanent successor, space maintenance (mixed dentition), co-operative child and carers -Contraindications: uncooperative, risk of infection, neglected dentition (>3 pulpotomies required), severe acute infection, unrestorable crown, root caries, >2/3 root resorbed so near to exfoliation, pathology

Answer 23

-Non vital pulp = pulpectomy. When pulp is necrotic (no blood) Or if bleeding difficult to stop -Vital pulp = Indirect pulp therapy (hall technique) =Single visit Pulpotomy =Desensitizing pulpotomy (lerdamix) =Pulpectomy =(Direct pulp cap – never used for caries exposure, only if child happens to bite on bur causing clean pulp exposure)

Answer 24

-protects a tooth that has no pulp exposure, pulp is vital, caries is deep into dentine -a thin layer of dentine is left in place to reduce pulp exposure risk . selective caries removal where only infected is removed and affected is left to remineralise -protective dressing is placed on top on remaining dentine - calcium silicate cement (eg. biodentine or GIC) Then restored and a preformed metal crown placed. Reactionary dentine will be produced

Answer 25

-Excising affected pulp tissue. Cut back to healthy pulp -Disinfect pulp with formaldehyde -Ferrous sulphate (15.5%) applied for 15s to arrest bleeding, dry with cotton wool -Place Calcium silicate cement over pulp stumps to create dentine bridge -Then ZOE lining -Then restore, doing preformed metal crown -Partial – 1-2mm of superficial pulp -Full – clear full pulp chamber

Answer 26

-Direct pulp cap materials after exposures -calcium hydroxide= -stimulates calcific barriers. Irritates pulp to create dentine bridge. Doesn’t work well with inflamed pulp so needs removing. Alkaline -Mineral trioxide aggregate(MTA)= (Silicates, aluminates, calcium sulphate, bismuth oxide) Stimulates cytokine release from pulpal fibroblasts stimulating hard tissue formation

Answer 27

2 applications of ferric sulphate or pulpectomy if doesn't stop bleeding

Answer 28

temporary dressing with Ledermix Then in next visit ferric sulphate pulpotomy

Answer 29

-if necrotic pulp (bloodless carious exposure) - 1 stage pulpectomy =remove coronal and radicular pulp staying 2mm from apices, clean, don't shape, irrigate with chlorhexidine or saline as hypochlorite risks damaging the successor, dress and seal with PMFC -if necrotic with PAP= 2 stage pulpectomy (use calcium hydroxide dressing in between to get rid of infection) Only do this for 2nd primary molars only

Answer 30

-use composites mainly -compomers (poly acid modified composite resin) -Pre-formed metal crowns popular (extra-coronal) for multi surface tooth -composite strip crowns-preload crown with composite and fit onto tooth, fiddly, useful for amelogenesis imperfecta -GIC- not as common, temporary. For single surface occlusal restoration

Answer 31

adhesive, aestheitcly pleasing, fluoride leaching, useful in caries control, no need for moisture control BUT long setting time, more brittle than composite so more likely to fail so not routinely used for multi-surface restoration, susceptible to erosion and wear, radiolucent, command set

Answer 32

Adhesive, very good aesthetic, command set BUT technique sensitive, needs rubber dam and therefore LA, expensive, need good co-operation and low caries risk

Answer 33

gold standard. Quick to use, results in more durable restorations, no ditching (unlike with amalgam), no moisture control Risk of them pinging off if cement gets weak or if picked one too big Use the OAP technique or Hall technique.

Answer 34

-techniques for applying PFMC -OAP= occlusal approximal peripheral bevel. Involves removing tooth tissue all the way around the tooth -Hall technqiue= biologically sealing decay in so don't need to remove caries. No tooth prep or LA needed -Modified Hall technique= clear interproximal area but no occlusal reduction or peripheral bevel. This is used if the crown does not fit perfectly

Answer 35

-normal amount of enamel but poorly mineralised (qualitative defect) - maturation phase of amelogenesis -Abnormal enamel rods mean that when occlusal forces are applied they cause enamel to chip off and breakdown -tips of enamel different shade to base -yellowing of molars -affects all cusps of a tooth -opacities on incisors which can extend from tip to gingival margin

Answer 36

insufficient amount of enamel and occasionally poorly mineralised (quantitative defect) -tooth almost looks concave -thin translucent enamel with dentine visible through

Answer 37

-qualitative defect of 1-4 first permanent molars with or without the permanent incisors. -6s affected in severe cases -contralateral (opposite tooth of arch will be affected) -70% of children with MIH have incisor involvement -Yellowing of molars. Opacities on incisors. Brown areas have higher protein content. -Chalky, brown, motled -occurs in 1 in 8 children -can cause pain, hypersensitivity (dentine less protected), poor aesthetics -can cause post-eruptive breakdown when tooth crumbles away

Answer 38

-Aetiology unknown -trauma. At the point of impact, this will cause hypomineralisation on the permanent tooth -Acute or chronic childhood illness - hypoxic event, fever, long term use of antibiotics (normally amoxicillin), asthma, pneumonia, hypocalcaemia -Amelogenesis/Dentinogenesis imperfecta -Generalised hypomineralisation -Prenatal -maternal obesity, stress, illness, vit D deficiency, smoking, medications -Perinatal -breastfeeding, fever, birthweight, caesarean delivery

Answer 39

enamel crumbling away, after tooth eruption, that has hypomineralisation and/or hypoplasia. Attrition, erosion, abrasion and caries can speed it up

Answer 40

1. Hypoplastic amelogenesis imperfecta – affects all teeth, symmetrical pattern. Primary and permanent. Yellowing. pitting and grooving, thin enamel 2. Fluorosis – chronological and symmetrical pattern. White or brown spots on teeth. Porous enamel. Lacework pattern. Premolars less affected. Don't affect primary

Answer 41

-What did/do the primary teeth look like? -Does anyone else in the family have similar teeth? -Any difficulties during birth? -Any illnesses during late pregnancy? -Any illnesses during baby’s first year of life? -Any injuries or infection affecting primary teeth? -Lived in another country during childhood? -Fluoride supplements? -Excessive consumption of fluoride up to age 3?

Answer 42

-Preventative counselling -Desensitising (fluoride varnish, toothpaste prescription, tooth mousse) -SDF (minimal use in MIH as does not restore structure, just reduced carious activity) -Fissure sealants (resin based. If mild. GIC only if uncooperative) -Direct restorations (but poorer bonding due to hypo mineralised so may fail. Use composite, not GIC) -PFMC (for severe cases. Best option for 2nd molar. Temporary choice until xtn or cast) -Indirect/cast restorations (mild to moderate) -Extraction (if severe) and ortho

Answer 43

-Restore if… mildly/ moderately affected, good cooperation, hypodontia, risk of drifting -minimal tooth reduction, minimises pulp trauma, provides cusp coverage, controls sensitivity -Extract if… symptomatic, severely affected, ortho considerations, poor cooperation. Extract at appropriate time

Answer 44

-Want something minimally invasive to reduce sensitivity, improve aesthetics and maintain tissue 1. Tooth mousse (replenishes Ca, P, F to remineralise) 2. Pumice acid microabrasion (18% HCl acid and gently removing outer layers, but removal of sound tooth tissue) 3. Resin infiltration ( into most porous parts of the teeth, but very expensive) 4. Bleaching (18% carbamide peroxide - 6% hydrogen peroxide – done in close-fitting trays) If <18 normally illegal, however since 2016 can be used by specialists for therapeutic reasons 5. Composite masking (localised composite over the opacity – can leave a shine through, but this avoided by putting fissure sealant after etch and before the composite 6. Composite restorations 7. Composite veneers - last resort as won't be able to do the other less destructive treatments after this

Answer 45

-Microinvasive treatment, without necessity for tooth tissue removal -Unfilled, low viscosity resin flows into porous enamel -Can penetrate between 5 to 25 micrometres -Rubber dam -2 mins etching (15% HCl), thorough drying, infiltration of resin and then light curing Commercialised under the brand name ICON -microbrasion can be done first to open up the surface

Answer 46

8.5-10 years olds - usually 9.5 years -until 7 has bifurcated, which will then naturally drift into place of 6. [7 crown completion at 8 years, bifurcation at 8.5] -Ideally need to have 8s -Good angulation of 5s to prevent it tipping distally -(6s first permanents to erupt so likely to be carious and hypominerlaised)

Answer 47

-hypoplastic (rough or smooth) - pitted, thin enamel -hypocalcified/hypomineralised= opaque, yellow, soft - hypo mature= diffuse white opacities. snowcapped -inherited enamel disorder. Genetic -affects primary and permanent teeth can cause rapid attrition, sensitive, increased calculus, elongated root, post-eruptive breakdown

Answer 48

-Hereditary defect in dentine -May be associated with osteogenesis imperfecta (associated with Type 1) – other bone fractures -Rapid tooth loss – treat before vertical tooth loss -Put preformed metal crowns on primary teeth -appearance= even grey-brown colour with altered translucency. bulbous. Thin roots. Gradual pulp obliteration by dentine. Enamel fractures and severe wear follow shortly after eruption -more severe in primary teeth

Answer 49

-Extrinsic (direct)= coffee, tomato sauce, wine smoking, poor OH, iron supplements, post orthodontic treatment -Extrinsic (indirect)= CHX -Intrinsic (enamel staining)= trauma or infection from primary predecessor, caries, internal resorption, amelogenesis imperfecta, fluorosis, illness.infection/radiation/deficiency during tooth formation, tetracycline, idiopathic -Intrisnic (dentine staining)= necrotic pulp, metallic restorations, caries, dentinogenesis imperfecta, tetracycline, congenital porphyria, excess bilirubin, idiopathic, RCT

Answer 50

1. Enamel microabrasion - brown patches 2. Resin infiltration (ICON) 2. Tooth whitening – vital or non-vital 3. Veneers – composite or porcelain (porcelain less likely in child as they grow and cannot add to it) 4. Crowns

Answer 51

-uses acid to remove intrinsic brown opacities and diffuse white opacities in outer 1/3 of enamel. -Not suitable for non-vital teeth or tetracycline stains -for fluorosis, idiopathic speckling, turner teeth, post-ortho demineralisation, Removes surface enamel to improve discolouration -Prior to veneers Lesions on enamel [-brown fluorosis stains easier to remove than white as less deep]

Answer 52

1. Clean teeth with pumice and water, wash and dry 2. Isolate teeth with rubber dam 3. Don’t tuck the dam into margin, instead seal edge of dam with Copalite varnish 4. Place sodium bicarbonate and water paste around the dam to neutralise any splashes of acid. Also cover patients neck 5. Mix 18% HCl and pumice to a slurry and apply a small amount to tooth on a rubber cup (or a wooden stick). The cup should be rotating slowly and in contact with the tooth for 5 seconds 6. Wash for 5 seconds directly into the aspirator tip 7. Repeat up to a max of 10 applications, until achieved what you want to achieve 8. Apply fluoride varnish for 3 minutes to reminieralise. NOT Duraphat as it is yellow! 9. Polish with finest Soflex discs 10. Warn not to eat highly coloured foods for 24 hours 11. Review in 1 month.

Answer 53

Wait 30 mins 4 hours soft food

Answer 54

-oxidation process, whereby pigmented carbon ring structures are broken down into colourless structures. -using H2O2 -Non-Vital - for root filled teeth -In surgery 'powerbleaching’ and 'thermocatalytic'. Also Walking bleach. 37% phosphoric acid Vital- for severe extrinsic stains, ageing, fluorosis, tetracyclic stains. -15% carbamide peroxide gel which breaks down to produce H2O2 which causes the whitening. Can also just use max 6% hydrogen peroxide -Over the counter preparations (e.g. toothpaste, boil and form kits) Also Matrix bleaching using trays (Nightguard vital bleaching)

Answer 55

-Not used in under 18s (large pulp chambers), teeth with large/ defective restorations, teeth with apical pathology, fracture, worn, deep surface cracks, pregnancy, unrealistic expectations, sensitive teeth -sensitivity, less likely to brush teeth, bleaching can fade and have to be re-done, soft-tissue burns, potential adverse effects on restorative materials

Answer 56

Illegal to use vital tooth whitening in <18. This is because they have larger pulp chambers, less secondary dentine, possibly poorer plaque control, increased potential for pulpal hyperemia. Need to be qualified as can cause lots of damage. In 2012 GDC allowed the use of H2O2 (<6%) in dentistry for 18+. Must be prescribed by dentists and delivered o supervised by dentist, and consent gained. In 2014, allowed to use it in children for therapeutic reasons. Controversy around this. Cannot whiten at NDH

Answer 57

-Composite veneers (direct technique) -enamel reduction is needed to prevent bulky restorations and bond strength is increased if buccally removed. But over contouring increases plaque retention in gingival margin, and children have large pulp chambers and unstable soft tissue so not as much enamel reduction than in adults -Indications: morphology, diastema, fractures, failed acid pumice, inherited disorder, growing child so porcelain cannot be used. -Porcelain veneers -rarely used in children as growing. Mainly 16+ girls who have stopped growing Indications= discoloration, enamel defects, diastema, malpositioned teeth, malocclusion, poor restorations, ageing, wear patterns, deep pits and ridges Contraindications= unavailable enamel, oral habits (nail biting etc.)

Answer 58

-Abrasion= uncommon (foreign object) -Attrition=common (grinding) -Erosion=most common (intrinsic or extrinsic acid eg. vomitting, GORD, eating disorder, dietary, meds, xerostomia, alcohol) 1/3 of 5 year olds had evidence of TSL on 1+ of buccal surfaces of the primary upper incisors, although only 4% overall had TSL involving dentine or pulp

Answer 59

-silky or glassy appearance -bucco-lingual/ palatal flattening -dished out/ cupping occlusal appearance -dentine exposure -high enamel ridges -pulp wear, loss of vitality -sensitivity -reduction in length of incisors Instrisnic= palatal surfaces. Tongue protects lower teeth Extrisnic= labial incisors and occlusal molars. If stained then inactive as surface is no longer being worn away

Answer 60

-early diagnosis to stop progression -wait and see, if no complaints of pain/sensitivity, function, aesthetics -patient info leaflets -recording the process: study casts, photographs, silicone putty impression, radiographs -diet analysis and counselling -OHI, remineralisation (F toothpaste, varnish. Amorphous calcium phosphate), desensitisation -if teeth sensitive, cover anteriors with composite, or PFMC for posteriors, or extraction -If can see pulpal shine through then teeth should be extracted. Don't want to risk damaging tooth germ so need action -Avoid PFMC if about to erupt -follow up -nocuturnal splint for grinding not ideal due to children growing and poor compliance

Answer 61

Resolve sensitivity Restore missing tooth surface Prevent further tooth tissue loss Maintain a balanced occlusion

Answer 62

Dr Barman’s brush

Answer 63

common in ages 1-3 (as mothers antibodies give protection up to 1 year) -Aggressive gingivitis, fluid filled vesicles on the palate, tongue, and buccal mucosa which burst to leave ulcers -rest etc, Orabase (carboxymehtylcellulose) on ulcers to protect/sooth, topical analgesia (Bongela) -Systemic analgesia + antipyretics, 5% topical Aciclovir every 4 hours, systemic aciclovir 200mg Aciclovir 5Xdaily 5 days (half dose if less than 2)

Answer 64

1) Indirect pulp therapy- setting CaOH or GIC or biodentine OR Pulpotomy- remove coronal pulp, 15.5% ferric sulphate, MTA, CaOH, then PFMC 2) Pulpectomy or XLA

paeds Flashcards

(88 cards)