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5 OSCE > Paeds > Flashcards

Paeds Flashcards

1
Q

When is acyclovir prescribed for primary heretic gingivostomatitis?

A

Immunocompromised
Severe infection in the non-immunocompromised

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2
Q

What is primary hermetic gingivostomatitis and what are the symptoms?

A

Primary response to the herpes simplex virus
Sore mouth and throat, enlarged LNs
Also malaise and fever - systemic symptoms
Happens once or twice depending on type - commonly found in children
Lasts 7-10 days

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3
Q

What is the aciclovir prescription for primary herpetic gingivostomatitis?

A

200mg tablets or oral suspension (2000mg/5mg or 100mg/5ml)
25 tablets
1 tablet 5x daily
5x200mg for >2yo, 5x100mg for <2yo

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4
Q

What should be asked in a history for nursing bottle caries?

A

Pain history
Any analgesia and what - check within limits
Does the child have feeding bottle to bed
What is in the feeding bottle

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5
Q

What is the usual pattern for decay in nursing bottle caries?

A

Usually upper incisors, Ds and lower canines (lower incisors protected by tongue)

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6
Q

What advice should be given in nursing bottle caries?

A

Feeder cup replacing bottle from 6 months
No feeding at night (lactose in milk - decreased salivary flow and held in mouth)
No on-demand breastfeeding
No sweetened milk, soy milk (unless medically advised)
Milk and water only between mealtimes
Sugarfree variations of drinks/foods/medicines
Safe snacks include cheese, breadsticks, fruit

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7
Q

What toothbrushing instruction should be given to parents?

A

Assist the child until 7yo
Brush in the morning and last thing at night
No food/drink except water after brushing
Spit don’t rinse

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8
Q

What are the management options for nursing bottle caries?

A

Extraction of carious teeth under GA as in pain - discuss GA risks and benefits
GIC remaining teeth and review (acclimitisation)
Fluoride (supplements and varnish)

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9
Q

What questions should be asked in a PHG history?

A

No days symptoms
Does the child have a fever
Is child less active than normal
Analgesia used - did it work

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10
Q

What are the signs of PHG?

A

Lymphadenopathy
Malaise
Pyrexia
Erythematous gingivae
Ulceration

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11
Q

What are the symptoms of PHG?

A

Sore mouth and throat
Fever
Enlarged LNs

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12
Q

How can you explain PHG to pts?

A

Often has blisters on the tongue, cheeks, gums lips and roof of mouth
After the blisters pop ulcers will form
Other symptoms include high fever, difficulty swallowing, drooling and swelling
Because the sores make it difficult to eat and drink, dehydration can occur
Child may or may not develop cold sores in the future

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13
Q

How is PHG managed?

A

Fluid intake
Analgesia to control fever/pain
Bed rest, take it easy
Clean teeth with dam cotton roll or cotton cloth to rub around gums
Can use dilute CHX to swab gums
Only aciclovir if systemic infection or immunocompromised

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14
Q

When are Paeds radiographs taken?

A

Under 3 only for trauma, high CRA or delayed development
Bitewings high risk 6 monthly, low risk 12-18 monthly

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15
Q

What are the fluoride toothaste strengths?

A

1000 for up to 3 (smear)
1,450 4-16 years (pea)
2800 high risk 10+
5000 high risk 16+

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16
Q

What fluoride supplementation can be used for children?

A

Mouthwash 225pm children over 7
Fluoride varnish 3-4x yearly 22,600m

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17
Q

What should be covered under prevention advice?

A

Radiographs
Toothbrushing instruction
Strength of toothpaste
Fluoride supplementation
Dietary advice
Fissure sealants
Sugar free medicines

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18
Q

What are the non-accidental E/O signs of trauma?

A

Bruising of face
Bruising of ears
Abrasions and lacerations
Burns and bites
Neck - choke or cord marks
Eye injuries
Hair culling
Fractures - nose, mandible, zygoma

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19
Q

What are the I/O signs of non accidental trauma?

A

Contusions
Bruises
Abrasions and lacerations
Burns
Tooth trauma
Frenal injuries

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20
Q

What is in the index of suspicion for non-accidental trauma?

A

Delay in seeking help
Story vague, lacking in details, varying
Account not compatible with injury
Parents mode abnormal, preoccupied
Parents behaviour gives cause for concern
Child’s appearance and interaction with parents is abnormal
Child says something contradictory
History of previous injury
History of violence within the family

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21
Q

How should you take action against non-accidental trauma?

A

Provide any urgent dental tx
Tell parents - unless puts the child at risk
Explain concerns honestly - inform of intentions to refer, ‘these types of injuries have to be reported’
Seek parents consent to share info
Record incident and conversation
Refer to social services - be specific about reasons
Confirm referral acted upon
Arrange dental follow up
Be prepared for reporting in case of court
Always discuss with colleague

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22
Q

What are the causes of staining in children?

A

MIH
Fluorosis
Decal
Tetracycline
Trauma
Dentinogenesis/amelogenesis imperfecta

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23
Q

What are the tx options for staining?

A

Microabrasion
Vital external bleaching
Localised composite addition
Com/porcelain veneer
MCC - destructive

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24
Q

What are the pros and cons of microabrasion?

A

Easy to be done
Effective
Removal of tooth structure
Use of acid

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25
What are the cons of vital external bleaching?
May not work Gingival recession Sensitivity Will not bleach restorations Release Overbleaching
26
What are the risks of localised composite addition?
Adds bulk to the tooth May not mask totally
27
What are the pros and cons of comp/porcelain veneers?
Good aesthetic Tooth prep needed Need to wait until 18 for stable gingival level
28
What are the causes of missing teeth?
Hypodontia Trauma causing arrested tooth formation Ectopic Dilaceration Supernumerary
29
What are the tx options for missing teeth?
RBB Essix retainer RPD Implant if above 18 Ortho space closure
30
What is the procedure for removing a mucocele?
LA around site of swelling Cut in gum Removal in entirety Sutures
31
What are the risks of mucocele removal?
Pain Swelling Bleeding Bruising Infection Numbness Sutures
32
What are the problems with hypodontia?
Space Drifting Overeruption Aesthetics Functional problems
33
When should children with hypodontia be referred to an orthodontist?
6-7 years or when further noticed
34
What are the tx options for hypodontia?
Nothing Restorative only - composite, veneers, RBB, RPD Ortho only Restorative + ortho - space closure and reshape teeth to camouflage
35
What can you say to parents who are looking at making a complaint against a past dentist?
I cant comment as i dont know the full story I can only offer this treatment at this present time Whatever was offered previously will not change what tx is needed now Only tell the practice will have a complaints procedure if the parent asks to complain If will be unhelpful for me to be involved as i wasnt there and dont know the background or what treatment was and wasnt dont I dont feel comfortable speculating on it
36
37
How do you carry out a knee to knee exam?
Introduce self and BDS5 student Reassure parent Explain what you intend to do Sit across from parent with your knees touching theirs Bring your knees together and ask parent to do the same Ask parent to sit the child with their legs around the parents waist Lower the child down into your knees and ask the parent to hold the child’s arms
38
What is included in a trauma stamp?
Mobility Colour TTP Presence of a sinus Percussion note Radiograph Ethyl chloride Electric pulp test
39
What are the signs of subluxation?
TTP Mobility Bleeding from gum No displacement
40
What is the tx for subluxation?
No tx needed Can clean tooth with saline or CHX with gauze wipe due to age
41
What is the home care for subluxation?
Soft food for 1 week Important to keep area clean and plaque free for good healing OHI - brush with soft brush after every meal CHX - 0.2% with cotton swab to area 2x daily for 1 week
42
What are the possible complications to the primary tooth after subluxation?
Pain Swelling Dark discolouration Increased mobility Delayed exfoliation Infection Child may not complain of pain - parent should watch for signs of swelling on gum however as infection may be present
43
What are the possible consequences of subluxation on the permanent tooth?
Premature or delayed eruption Enamel hypoplasia/hypomineralisation Crown/root dilaceration Failure to erupt Failure to form Odontome formation
44
What is the follow up for subluxation?
1 week 6-8 weeks
45
What is involved in a caries risk assessment?
Clinical evidence Diet MH SH Saliva Plaque control Fluoride
46
What are the steps to placing a Hall crown?
Place separators between mesial and distal contacts Floss 2 pieces through separator and pull tight down between contacts (not subgingival) Leave for 2-7 days Remove with blunt probe Sit child upright Place gauze to protect airway Choose crown - aim to fit smallest size that will seat - should be springy Dry crown and fill with GIC (Aquacem) Dry tooth Place crown and seat with finger pressure Can seat by getting child to bite over gauze - second method Remove excess cement with CWR Get pt to bite for 2-3 minutes or finger pressure Make sure all excess cement has been removed Floss between contacts
47
Describe the process of consenting and referral for GA
Discussion of GA risks/benefits and all other alternative options Referral to hospital for specialist to assess - if any other teeth of poor prognosis they will be added to plan to avoid future GA GA will involve day in hospital - need to monitor for full recovery Need of chaperone throughout
48
What are the minor risks of GA?
Headache Nausea Vomiting Drowsiness Sore throat or sore nose/nose bleed from intubation
49
50
What are the risks of GA treatment?
Pain Bleeding Swelling Bruising Infection Loss of space Stitches
51
What are the rare major risks of GA?
Brain damage Death - 3 in a million, need a matching to breathe during o and there is a small risks you will not be able to breathe independently again on waking Upset when coming around Malignant hyperpyrexia - ask for FH, rapid rise in body temp
52
What conditions require special care in GA?
Sickle cell disease Diabetes - can’t fast in same way Down’s syndrome Malignant hyperpyrexia CF or severe asthma Bleeding disorders Cardiac or renal conditions Epilepsy Long QT syndrome
53
What should be included in a GA referral?
Pt name, address Parent contact numbers MH GP details Parental responsibility Justification for GA Proposed tx plan Previous tx details Radiographs, if not then explanation for why
54
What happens at a GA assessment appt?
Written informed consent Explain GA process, side effects and complications Explain adult escort needs to be present with no other children Pre-op fasting Post-op arrangements Post-op care and pain control
55
When is fluoride varnish contraindicated?
Severe uncontrolled asthma (hospitalised in last 12 months) Allergy to colophony (sticking plasters) - can use a colophony free version if needed
56
How can you explain fluoride varnish to a pt?
Fluoride varnish is placed on the tooth and is minimally invasive Promotes remineralisation (hardening of tooth) and prevents demineralisation (softening of the tooth) Involves drying the teeth and painting a gel on the tooth
57
What instructions should be given after fluoride varnish?
Don’t eat/drink for 1 hour Soft diet for rest of the day - no dark coloured foods Avoid fluoride supplements today
58
What is the toxicity of fluoride?
Very small risk and only relevant if small child consumes a quantity of toothpaste 5mg/mg - milk 5-15mg/kg - ipecac syrup, milk, and possible referral >15mg/kg - hospital referral
59
How can you respond if a parent asks why their child needs fluoride varnish?
Clear justification re caries - prevention of tooth decay, additional benefit over and above daily brushing Recommended for all, not just those ar risk Recommended that children get it at least 2x a year Recommendations are evidence based - refer to SDCEP
60
How can you respond if a pt says they’ve heard that too much fluoride can be harmful?
Details know minimal risk with fluoride varnish and twice daily use of fluoride toothpaste Fluoride varnish quantity used if carefully controlled Guidance given re toothpaste quantity and supervised brushing Address fluorosis as a side effect
61
Explain a pulpotomy for an open apex tooth?
Tx of choice if a large exposure Explain that part of the pulp is removed Aim is to keep undamaged pulp tissue alive This is so the tooth stays alive and continues to grow
62
What do you need to explain to a parent that you need to use for an EDP fracture?
Sensibility tests LA - involves injection in gum Dental dam - protects airway, moisture control Drilling - used to remove some pulp tissue Dressing - setting CaOH, MTA Composite restoration - white filling will be placed to regain aesthetics
63

5 OSCE (21 decks)

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