Paeds

Question 1

name 7 parts to caries risk assessment

Answer 1

clinical evidence
social history
medical history
diet
fluoride exposure
plaque control
saliva flow

Question 2

name 8 parts to prevent + give examples for high risk

Answer 2

radiographs - 6 months
fluoride varnish - 4x yearly
fluoride toothpaste - 1450ppm until 10
fluoride supplement
toothbrushing - supervised, spit dont rinse, last thing before bed and 1 other time
diet - cheese, biscuits, fruit, water between meals
medication - sugar free
fissure sealants - on all FPM

Question 3

pictures of nursing bottle caries - what questions do you ask mum

Answer 3

brief pain history - keeping awake at night, any analgesia
do they get a bottle going to bed
what is in the bottle

Question 4

explain nursing bottle caries

Answer 4

when child drinks milk throughout night, saliva flow is low so it allows milk to sit on teeth, high sugar content in milk which causes teeth to decay
resting on top teeth - so worse effected but lower incisors are protected by the tongue

Question 5

give advice to mum about nursing bottle caries

Answer 5

give bottle before brushing teeth, after brushed teeth - only water after and should wait at least 20 minutes to allow fluoride to rest on teeth
should drink from free flow cup
no sweetened milk or soy milk
and general diet advice

Question 6

child presents with primary herpetic gingivostomatitis, explain what this is to parent

Answer 6

these are small ulcers around your childs mouth that are caused by the herpes simplex virus, the same virus that causes cold sores. When a child is first exposed to this, this is a common reaction to the virus

Question 7

what are common symptoms of primary herpetic gingivostomatitis

Answer 7

sore throat, sore mouth, ulcers around mouth, enlarged lymph nodes

Question 8

what advice do you give patient with PHG

Answer 8

plenty of fluids, bed rest, good oral hygiene + CHX MW 2x daily, analgesia, should pass in 7-10 days

Question 9

when to prescribe and what to prescribe for PHG

Answer 9

when - if immunocompromised or severe infection
what - acyclovir 200mg, 1 tablet 5x daily for 5 days

Question 10

key signs of neglect

Answer 10

has an impact on child - not sleeping or eating
obvious dental disease to lay person
not attending appointments despite help given

Question 11

what are the 3 stages in dealing with dental neglect

Answer 11

dental team management
multi team management
referral

Question 12

describe the first stage when dealing with dental neglect

Answer 12

preventative dental team management - ask about barriers to coming to appointments, try to over come them, make appointments at time that suits, explain importance of attending, make sure parent knows concerns

Question 13

describe second stage in dealing with dental neglect

Answer 13

preventative multi agency management - liase with other health care professionals, if under 5, health visitor, school nurse, doctor and share concerns - work together to provide care for child

Question 14

describe third stage of dealing with dental neglect

Answer 14

child protection referral - contact social services, by phone then follow up in writing, good to let family know you are going to do this

Question 15

what questions should be asked to determine cause of discolouration

Answer 15

for fluorosis - have you ever lived anywhere other than scotland? do you remember swallowing toothpaste as a child? did you take any fluoride supplements?
for amelogenesis - is there a family history of discolouration?
for MIH - questions about pregnancy - gestational diabetes, pre-eclampsia, traumatic birth, time in special baby unit, any infections in first year of life

Question 16

what treatment options can be given for discolouration

Answer 16

microabrasion - using acid to lift the stain from tooth, wont all be white, doesnt always work
external bleaching - can make more sensitive
addition of composite - might make more bulky but will reduce sensitivity and improve aesthetics, not destructive
when older - composite veneer, need gum to be stable so need to be at least 18

Question 17

list the order a treatment plan should be carried out in a child

Answer 17

pain management
fluoride varnish - acclimitisation
fissure sealant
small rest not requiring LA
larger rest with LA
XLA

Question 18

explain to parent why SSC being used

Answer 18

evidence shows these crowns are really effective at sealing the decay in, it needs substrate to continue so effectively this stops bacteria growing, it also is less traumatic for the child - no LA required, no drilling required and when tooth comes out, comes out with crown on - shows these last longer than normal fillings in children

Question 19

what are the indications for GA

Answer 19

pre-cooperative
unable to co operate due to MH
treatment is complex
prev failed attempts at treatment under LA and sedation

Question 20

explain process of GA

Answer 20

is in a hospital, in a theatre, would need to be there at 7am or 12 (if am or pm session), would have to fast - no food, need to stay in hospital once treatment has been completed, need a chaperone for rest of day
will need to be assessed prior to this - want to carry out all tx required and avoid another GA - might mean tx will be more extreme

Question 21

explain risks of GA

Answer 21

minor risks - sore throat, sore nose, nausea, headache, disorientation and distress when wake up
major risks - need to lower NS, chance of not waking back up, 3 in 1 million but need to make you aware
risks of tx - pain, bleeding, bruising, swelling, infection

Question 22

explain IS to parent

Answer 22

inhale gas through nose, makes you feel light and fuzzy like a day dream - still awake and can still talk to us but are chilled out

Question 23

what do you need to tell parent about IS for consent

Answer 23

risks - nausea, vommitting, light headedness afterwards, tingling in hands and feet
need to have chaperone for rest of day - chaperone cant be pregnant
if cold and cant nose breathe - rearrange appt
light meal beforehand

Question 24

what is microabrasion and what are advantages

Answer 24

removal of surface layer of opaque enamel
effective, fast, removes stained layer - good for yellow/brown
results are permanent

Question 25

what are disadvantages to microabrasion

Answer 25

removal of enamel - increased sensitivity, more susceptible to staining, can only be done in dental surgery, might appear more yellow as dentine exposed

Question 26

describe microabrasion clinical steps

Answer 26

using acid and pumice to remove top layer of enamel - mouth protected with dental dam, 5 secs on each tooth then assess shade, can do up to 10x
then fluoride varnish placed on teeth to ensure enamel stays strong, smoothed down and final polish with toothpaste

Question 27

what should patients be advised following microabrasion

Answer 27

avoid anything that would stain a white t shirt for up to a week
teeth are dehydrated so appear whiter
will review in 4-6 weeks + take photographs, if improvement seen can repeat

Question 28

what is a subluxation injury

Answer 28

damage to tooth supporting structures, causing increased mobility, TTP, bleeding from gingival crevice but no displacement

Question 29

how should a subluxation injury be treated and what is the follow up

Answer 29

treated with a flexible splint for 2 weeks
follow up - 2 weeks, 3 months, 6 months, 1 year then yearly for 5 years

Question 30

what is pulp survival and resorption chances following subluxation

Answer 30

for open apex 100% pulp survival and 1% root resorption
for closed apex 85% pulp survival and 3% root resorption

Question 31

what is extrusion injury and how is it treated

Answer 31

when tooth is displaced axially out of socket - tooth may appear more elongated, mobile and bleeding
treated with flexible splint for 2 weeks

Question 32

what are chances of pulp survival and root resorption following extrusion injury

Answer 32

for open apex - 95% pulp survival, 5% root resorption
for closed apex - 45% pulp survival, 7% root resorption

Question 33

what is lateral luxation and how is it treated

Answer 33

displacement of the tooth in a direction other than axial. tooth is immobile, has high ankylosis percussion note, likely to have fracture of alveolus
repositioned under LA and treated with flexible splint for 4 weeks

Question 34

what injuries are more likely to cause pulp canal obliteration

Answer 34

intrusion, extrusion, luxation

Question 35

how should a history be taken for trauma

Answer 35

when exactly did it happen
how did it happen
were any fragments of teeth lost
have you had any other symptoms
ask about medical history - important to know if congenital heart defects, immunosupression and rheumatic fever

Question 36

what is included on trauma stamp

Answer 36

colour, sinus, TTP, ETP, ECL, radiograph, mobility, percussion notes

Question 37

what advice do you give patients after trauma

Answer 37

avoid contact sports whilst splint in place
have a soft diet for 2 weeks
brush as normal with soft brush after meals
rinse with CHX 0.1% 10ml 2x daily for 1 week

Question 38

what effect does trauma have on primary dentition

Answer 38

discolouration
delayed exfoliation

Question 39

what effect does trauma have on permanent dentition

Answer 39

delayed eruption
arrest in formation
dilaceration of crown/root
enamel defect
complete failure of tooth to form
ectopic eruption