Paeds Flashcards
1
Q
When do we become concerned about bilateral asymmetry (eruption)?
A
after 6 months
2
Q
How long after eruption do teeth normally reach full length but still have large canals?
A
around 3 years after eruption
3
Q
What is hypodontia?
A
missing teeth as a result of them failing to develop
4
Q
What is anodontia?
A
total lack of teeth in one or both dentitions
5
Q
What is oligodontia?
A
rare condition where more than 6 primary or permanent teeth are absent
6
Q
What is the prevalence of hypodontia?
A
- primary dentition <1%
- permanent dentition 3-6%
- F:M, 4:1
7
Q
Which teeth are most commonly missing in hypodontia?
A
- 8s, lower 5s, upper 2s and then upper 5s
8
Q
What is the relationship between missing primary teeth and missing permanent teeth?
A
around 50% of patients with missing primary teeth have missing permanent teeth
9
Q
What is the aetiology of hypodontia?
A
- unknown/unclear
- likely genetic - autosomal dominant inheritance pattern in families, mutatuions in MSX1 gene on chromosome 4
- occasionally environmental insult or combination of both
- linked to single-gene disorders
- associated with certain syndromes - trisomy 21 (down syndrome), ectodermal dysplasia
10
Q
What is ectodermal dysplasia and what are the signs/symptoms?
A
group of inherited conditions
- males (X-linked)
- abnormal development of teeth, nails, skin, thin sparse hair and absence of sweat glands
- difficulty regulating temperature
- early identification crucial
- microdontia (peg laterals especially)
- multiple missing teeth
11
Q
What are the treatment options for missing upper laterals?
A
- space closure - bring canine into lateral position
- space opening - placement of prosthesis
planning based on eruption of canine and patient’s wishes
12
Q
Where is the most common site for supernumary teeth?
A
anterior maxilla
13
Q
What is the prevalence of supernumary teeth in permanent and primary dentitions?
A
permanent = 1.5-3.5%
primary = 0.2-0.8%
14
Q
What percentage of patients with cleft lip and palate develop supernumaries?
A
40%
15
Q
What are mesiodens?
A
extra tooth in midline, usually peg or conical shaped
16
Q
What is a supplemental tooth?
A
extra tooth that looks like a normal tooth
17
Q
How is a conical supernumary tooth managed?
A
- if not inverted, good chance of eruption
- if not impeding other teeth, can be monitored until eruption then extracted
- if inverted, may migrate superiorly towards nose
18
Q
What are the issues with tuberculate supernumaries and what do they look like?
A
don’t tend to migrate but do impede eruption of adjacent teeth
more than one cusp or tubercle (barrel shaped)
19
Q
How are supplemental teeth managed?
A
usually based around extraction/monitoring spontaneous alignment and use of ortho where necessary
20
Q
What is cleidocranial dystosis and what are the skeletal and dental features of it?
A
- rare autosomal dominant
- skeletal features - hypoplasia/aplasia of clavicles, delayed closure of fontanelles, underdevelopment of bones/joints
- dental features - delayed loss of primary dentition, delayed/failed eruption, supernumary teeth
21
Q
When taking a radiograph to locate a supernumary, if it travels with the X-ray tube where is it placed?
A
palatally placed
22
Q
When taking a radiograph to locate a supernumary, if it travels away from the X-ray tube where is it placed?
A
buccally placed
23
Q
What is the prevalence of microdontia?
A
0.?-0.5% in primary teeth
2.5% in permanent teeth
F>M
24
Q
Which teeth are most commonly affected by microdontia?
A
lateral incisors, e.g. peg shaped teeth
25
What are three examples of types of macrodontia?
- double teeth
- dens in dente (dens invaginatus)
- talon cusps (evaginatus)
26
What does fusion mean when referring to a double tooth?
abnormal shaped tooth resulting from fusion of two separate tooth germs
27
What does gemination mean when referring to a double tooth?
- two teeth develop from one tooth germ, look abnormally wide, appear similar clinically and radiographically
28
What is the term now used to described "fused" and "geminated" teeth?
double teeth
29
What is dens in dente?
"tooth within a tooth"
- localised area of crown folded inwards
- can result in area of caries, leading to pulpitis and PA infection
- difficult/impossible to endodontically treat
30
What is talon cusp?
an extra cusp on an anterior tooth which arises as a result of evagination on the surface of a crown before calcification has occurred. May have its own bit of pulp and can be mistaken for supernumary when PE
31
What is amelogenesis imperfecta?
spectrum of hereditary defects in the function of ameloblasts and mineralisation of enamel matrix.
that affects the structure and appearance of the enamel of the teeth
32
What are the two main types of amelogenesis imperfecta?
Hypoplastic type - thin but hard enamel, normal bond strength
Hypomineralised type - full thickness enamel but very soft, impaired bond strength
33
What is the type of inheritance involved in amelogenesis imperfecta?
- autosomal dominant
- X-linked
- autosomal recessive
- sporadic inheritance patterns
- sporadic cases
34
What are the associated dental defects in amelogenesis imperfecta?
- pulp calcification
- delayed eruption
- gingival overgrowth
- taurodontism
- skeletal anterior open bite (around 50% of pts)
35
What is the difference between hypoplastic generalised and hypoplastic localised amelogenesis imperfecta?
- generalised = thin, patchy, rough aspect of enamel layer
- localised = same but limited to a part of the crown
36
How does hypoplastic amelogenesis imperfecta present radiographically?
can be difficult to observe
hypoplasia of enamel layer, more pronounced in coronal 2/3
37
What are the two sub-types of hypomineralised amelogenesis imperfecta and what is their clinical appearance?
1) hypocalcified - after eruption enamel persists only on cervical part
2) hypomature - chalky appearance with orange, brown or white colour
38
What is the radiographic appearance of hypocalcified amelogenesis imperfecta?
normal thickness of enamel before eruption, enamel radiolucency similar to dentine
39
What is the radiographic appearance of hypomature amelogenesis imperfecta?
normal thickness of enamel, enamel radiolucency slightly higher than dentine
40
What are the diagnostic criteria for amelogenesis imperfecta?
- involves exclusion of extrinsic environmental or other factors
- correlation with dates of tooth formation to exclude a chronological developmental disturbance
- establishment of likely inheritance pattern
- recognition of phenotype (e.g. hypomature)
41
For a differential diagnosis of amelogenesis imperfecta, what other diagnoses must be excluded?
- extrinsic disorders of tooth formation
- dental fluorosis
- chronological disorders of tooth formation
- GI upset such as coeliac disease
- initiation of anti-leukaemic therapy
- renal disease
- localised disorders of tooth formation
- trauma
- MIH
42
What is dentinogenesis imperfecta?
inherited disorder affecting dentine. Defective dentine formation results in discoloured teeth that are prone to attrition and fracture
43
What type of condition is dentinogenesis imperfecta?
autosomal dominant inherited condition
44
What are the sub-types of dentinogenesis imperfecta?
Type I - associated with OI
Type II - DI on its own
Type III - "Bradywine isolate"
45
If a dentinogenesis imperfecta patient also has osteogenesis imperfecta, what kind of DI do they have?
Type I DI
46
What are the features of type I dentinogenesis imperfecta?
associated with osteogenesis imperfecta
- likelihood of skeletal abnormalities
- >70% class III skeletal pattern
- likelihood of bone fractures
- bisphosphonates routinely used in management
- likelihood of cardiac defects
47
How does dentinogenesis imperfecta present in primary dentition?
- colour = amber
- attrition
- pulp obliteration
- spontaneous abscesses
48
How does dentinogenesis imperfecta present in the permanent dentition?
- colour = grey/translucent
- short roots
- pulp obliteration
- spontaneous abscesses
49
What are the 5 main clinical problems in dentinogenesis imperfecta?
1) poor aesthetics
2) chipping and attrition of enamel
3) exposure of dentine
4) poor OH, gingivitis, caries
5) pain and infection, pulpal necrosis
50
What are the treatment objectives for dentinogenesis imperfecta in the primary dentition?
- maintain occlusal face height
- maintain OH
- address sensitivity/infection/abscesses
- preserve function, aesthetics and normal growth
51
What are the treatment objectives for dentinogenesis imperfecta in the permanent dentition?
- address aesthetics
- protect incisors/first permanent molars from wear
- maintain occlusal face height
- maintain OH
- address sensitivity/infection/abscesses
52
What are the treatment options for dentinogenesis imperfecta in the primary dentition?
- monitor wear
- overdenture
- SSCs for posteriors, composite crowns for anteriors
- fluoride applications for sensitivity
- extractions if abscessed
53
What are the treatment options for dentinogenesis imperfecta in the permanent dentition?
- monitor wear
- cast restorations on occlusal surfaces of FPMs (and premolars if needed)
- composite veneers
- concern about enamel shear with fixed orthodontics, however, can be used with care
54
What are 5 examples of non-hereditary disturbances in formation?
1) molar incisor hypomineralisation
2) dental fluorosis
3) Turner's tooth
4) dilaceration of tooth
5) metabolic disturbances
55
What is MIH?
Molar incisor hypomineralisation - developmental defect in enamel structure
altered enamel structure with less mineral content caused by disruption to the maturation/late transitional stage of amelogenesis
56
What teeth are typically affected by MIH?
typically primarily first permanent molars and central incisors
57
How common is MIH?
very common, up to 20% population
58
Which teeth are typically more affected in MIH, molars or incisors?
molars
59
What is the appearance of MIH?
demarcated enamel opacities ranging in colour - creamy white to yellow/brown
can appear hypoplastic, normally as a result of post-eruptive breakdown
60
What do patients with MIH present complaining of?
- breakdown of teeth, sensitivity, aesthetic concerns, failed restorations
61
What is the suspected aetiology of MIH?
- ?environmental factors during late pregnancy or first year of life
- ?genetic component
62
What is hypomineralisation?
qualitative defect that presents as clearly identifiable demarcated defects in the translucency of enamel
63
What is different about the enamel form and composition of teeth with MIH?
- greater carbon incorporation and lower Ca and P concentrations
- different Ca and P ratio compared to normal enamel
64
What does fluorosis occur as a result of and how does it present?
- high F concentrations during amelogenesis
- irregular enamel opacities, stained if severe
- unusual in scotland
65
How is MIH managed?
- early identification
- prevention of caries and post-eruptive breakdown
- desensitisation and remineralisation
- long term treatment plan
- maintenance
66
How is MIH identified early and what should be done?
- when incisors erupt before molars, opacity on incisor is a strong indicator of MIH
- if diagnosed, "high caries risk" prevention protocols should be followed
- consider photography
67
What can be done in prevention of caries and post-eruptive breakdown in MIH?
- may need temporisation with restorative material or SS crown
68
How can desensitisation and remineralisation be carried out on a tooth with MIH?
- repeated application of 5% sodium fluoride varnish
- use of commercially available 'sensitive toothpastes'
- use of 0.4% stannous fluoride gels
- CCP-ACP (topical application containing fluoride)
69
What is the long term treatment plan for a person with MIH?
decide and discuss whether to restore teeth definitively or extract
- long term prognosis of affected molar teeth
- occlusion/malocclusion
- aesthetic impact of anterior lesions
70
Why are MIH affected teeth difficult to restore?
- defects vary greatly in size and shape
- dramatic reduction in hardness of enamel
- enamel fractures under normal occlusal forces
- excessive chipping and wear
- sensitivity and pain = anxiety
- no typical etching patterm
71
What is a compensating extraction?
when a lower first permanent molar is removed, removing the upper molar to prevent its overeruption
72
What is considered a rough guide of planning an extraction of a FPM?
in a class 1, uncrowded occlusion, the FPMs of poor long term prognosis should be extracted when the calcification bifurcation of the second permanent molars can be seen radiographically
73
What is fluorosis?
- result from ingestion of high F concentrations during amelogenesis
- irregular shaped opacities, stained if severe
- only affects teeth being formed during time of excessive fluoride (chronological)
74
What is Turner's tooth?
affects successional tooth (often 2nd premolars)
- allegedly hypoplastic enamel following infection around the interradicular area of a primary tooth
- Enamel Hypoplasia reduces the tooth's enamel thickness, increases tooth sensitivity, leaves the affected tooth more susceptible to decay
75
Why is carious tissue removed?
bacterially contaminated/demineralised tissues close to the pulp do not need to be removed, to not agitate pulp.
carious tissue is only removed to create conditions for long-lasting restorations
76
What is the average size of hall crown used?
4
if not, most likely 3 or 5
77
What is a D5 hall crown used for?
size 5, tooth D
78
What should a correctly sized hall crown feel like?
do NOT seat on try-in
should cover all cusps with feeling of "spring back"
79
Which way does the writing on a hall crown always face?
buccal
80
How do you place a hall crown?
- dry crown
- fill with GI luting cement (aquasem), ensuring crown well-filled (2/3)
- dry tooth
- place crown over tooth and partially seat
- remove finger and encourage child to bite or fully seat with finger pressure alone
- child open wide and clean excess cement away quickly (bad taste)
- once excess cleaned, but cement still soft, get child to bite down on cotton wool for 1-2mins, more cement will flow out
- clean cement away, allow set, check and floss contact points
- blanching of gingivae follows, indicator of good fit
81
What should you tell the parent/patient about placement of hall crown?
- crown supposed to fit tightly and gum will adjust
- child will get used to feeling within 24hrs
- occlusion tends to adjust within a few weeks
82
What are the requirements for a hall crown?
- band of 'normal' looking dentine visible between pulp chamber and cavity on radiograph
- teeth should be visualised on bitewings
- tooth must be asymptomatic (or at worst reversible pulpitis)
83
What are the contraindications for a hall crown?
- irreversible pulpitis or abscess/infection
- clinical or radiographic caries reached the pulp, pulp exposure or apical pathology
- badly broken down tooth
- no clear band of 'normal' looking dentine
- teeth with arrested caries
84
What is SDF?
silver diamine fluoride
- clear, odourless, metallic-taste liquid that will stain most oxidisable surfaces black upon exposure to light due to formation of silver oxide layer (skin, tissues, carious lesions, clinic surfaces etc)
85
What is the mechanism of action of SDF?
Ag+ - effects on bacteria, hydroxyapatite doping, collagen degradation inhibition
F - mineral formation, collagen degradation inhibition
86
What are the indications for use of SDF?
- pts at high risk of developing caries - xerostomia, severe early childhood caries
- pre-cooperative pt
- treatment challenged by behavioural or medical conditions
- patient with several carious lesions that may not all be treated in one visit
- difficult to treat carious lesions
- patients without access to dental care
87
What are the contraindications for the use of SDF?
- silver allergy
- pain - irreversible pulpitis or PA periodontitis - spontaneous, severe, constant pain or wakening the child at night
- infection - swelling of tissues, abscesses or fistula
- patient refusing treatment or unable to cope
- unable to isolate tooth and maintain control over oral environment
88
How is SDF applied?
- isolation with cotton wool rolls, dry tooth with air
- dispense a minimal amount of SDF into dish
- using microbrush, apply SDF to carious lesion and agitate for 1 min
- remove excess SDF following procedure completion
89
How should you prepare for the placement of SDF?
- ensure pt knows that lesion will go black
- ensure child has safety glasses and apron on
- warn nurse it will stain anything it touches
90
How often should SDF be used on a lesion?
twice per year
91
What concentration of SDF should be used?
38%
92
What can SDF be effective at?
arresting carious lesions
