Module 8 > Paeds > Flashcards

Paeds Flashcards

(62 cards)

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1
Q

How is breastfeeding related to caries risk?

A

Breastfeeding up to 1 year is associated with lower childhood caries.

After this, can contribute to an increased caries risk (i.e. if its on demand during the night).

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2
Q

What does the heel prick test done to a baby test for?

A

Sickle cell
Cystic fibrosis
Congenital hypothyroidism
Inherited metabolic diseases

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3
Q

Vaccination schedule for a child 8, 12 and 16 weeks?

A

8 weeks - 6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus, influenza, hepatitis B), MenB

12 weeks - 6 in 1 2nd dose

16 weeks - 6 in 1 3rd, MenB 2nd dose

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4
Q

Vaccination schedule 1 year and 3 years 4 months?

A

1 year - Hib/MenC, MMR (measles, mumps, rubella), MenB 3rd dose, Pneumococcal 2nd dose

3 years 4 months - MMR 2nd dose, 4 in 1 pre-school booster (diphtheria, polio, tetanus, whooping cough)

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5
Q

Childhood vaccinations 12-13 and 14?

A

12-13 - HPV

14 - 3in1 teenage booster (tetanus, diphtheria, polio), MenACWY (meningitis and septicaemia)

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6
Q

What constitutes a premature child?

A

birth before 37 weeks

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7
Q

What causes congenital cardiac defects?

A

Genetic, maternal exposure to TORCH (various infectious diseases), maternal drug use, maternal systemic disease

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8
Q

Tetralogy of Fallot

A
  1. Ventricular septal defect
  2. Pulmonary stenosis
  3. Right ventricular hypertrophy
  4. Overriding aorta
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9
Q

What are some effects of patients that have tetralogy of fallot?

A
  1. Descreased neurological function (due to chronic hypoxia)
  2. Higher clotting risk due to hypercoagulabilty and thrombosis from polycythaemia (high RBCs in the blood)
  3. higher incidence of systemic infection due to shunting of blood
  4. Blueish tint on patients (cyanosis)
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10
Q

What is the most common congenital heart defect?

A

Mitral Valve prolapse

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11
Q
A
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12
Q

A dacron patch

A

A biocompatible patch used to repair cardiac tissues (this can be a future risk of endocarditis).

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13
Q

Do congenital heart defects cause an increase in caries in children?

A

There are no scientific links to suggest this however there is a loose link more suggestive of a behavioural phenomenon of parents overcompensating and trying to make kids feel better by giving them more high sugar food.

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14
Q

How would you alter dental treatment for a cardiac defect patient?

A

More aggressive treatment (avoiding things such as hall crowns or “waiting to see if caries resolves”) Keeping them complete caries free.

Enhanced caries prevention = high fluoride toothpaste, FS, FV.

Liaise with cardiologist regarding infective endocarditis risk.

Assess medications (anticoagulants etc)

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15
Q

Which cardiac patients would you prescribe antibiotics as they are at an increased risk of infective endocarditis?

A
  1. Prosthetic valve
  2. Previous infective endocarditis
  3. Congenital heart disease
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16
Q

What would you prescribe as a prophylactic antibiotic for a patient with increased risk of infective endocarditis?

A

30mg amoxicillin 1 hour before

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17
Q

How does infective endocarditis present?

A

Flu-like symptoms, high temperature etc, haemorrhagic splinters (nails), osler nodes

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18
Q

Most common type of child cancer?

A

Acute lymphoblastic leukaemia

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19
Q

Basics of acute lymphoblastic leukaemia

A

Induction - reduce as many leukaemia cells as possible (chemo, steroids etc)

Consolidation - lower the amount of any residual leukaemia (methotrexate)

Maintenance - lasts roughly 2 years (to prevent relapse)

Stem cell transplant

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20
Q

What are the key side effects of child patients with cancer?

A
  1. Infection
  2. Anaemia
  3. Mucositis
  4. taste changes
  5. hair loss
  6. High caries risk
  7. Bleeding risk
  8. stunted tooth development !!!
  9. hypodontia
  10. microdontia
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21
Q
A
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22
Q

Dental treatment considerations for patients with bleeding disorders?

A
  1. Avoid regional blocks (risk of hematoma)
  2. Enhanced prevention
  3. XLAs ONLY in hospital setting — maybe better to plan these when not needed to avoid emergency
  4. Avoid NSAIDs (already have an anticoagulant effect so would increase the bleeding risk!!)
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23
Q

What could you prescribe for patients with bleeding disorders to aid treatment?

A
  1. Desmopressin (DDAVP) - stimulates the release of von Willebrand factor and factor VII to aid clotting.
  2. Tranexamic acid (inhibits fibrinolysis - helps stabilise clots)
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24
Q

What sedation can patients with sickle cell disease not have?

A

Cannot have nitrous oxide sedation (can cause sickle cell crises or pulmonary issues)

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25
Sickle cell crisis?
Sickle cells end up clumping together, blocking vessels and reducing blood flow and oxygen flow. Can cause pain and ischemia. CAN BE STRESS INDUCED!! i.e. at the dentist
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Oral impact of asthma?
Regular use of steroid inhaler can cause dry mouth and affect oral micro biome, causing oral thrush.
28
Why are asthmatics at higher risk of caries?
Dry mouth due to regular inhaler use
29
Dental implications of a patient with cystic fibrosis?
Delayed dental development and enamel opacities (due to poor nutrition from malabsorption, systemic inflammation from chronic infection) Highly calorific diet GA risk (respiratory distress) Liver cirrhosis (affects clotting factor production and Vit K deficiency - consider impact on XLA)
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Epilepsy key dental considerations
1. Trauma 2. Medications (sugary or causing gingival overgrowth from Phenytoin) 3. Medical emergency management (>5mins = midazolam)
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What is important to remember about cerebral palsy in terms of how to behaviourally manage the patient?
Physical disability NOT a learning disability = communication often doesn’t need to be changes
33
Dental considerations for a cerebral palsy patient
Dexterity effected - OH Salvation - harder for moisture control dental trauma risk
34
Prevalence of down syndrome and gene causing it
1 in 600 births Trisomy 21
35
Associated medical conditions of down syndrome
Congenital heart defects Susceptibility to leukaemia (philadelphia) Sleep apnoea (affects GA) Cervical spine atlantoaxial instability (effects sitting in chair)
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Extra oral features of down syndrome
Class III malocclusion, small sinuses and nasal airways (mouth breathing)
37
Intraoral features of down syndrome
1. High arched palate 2. Enlarged tonsils and adenoids 3. Fissured tongue 4. Big tongue (macro glossia) 5. Hypodontia & microdontia 6. Enamel defects 7. Delayed eruption 8. AOB 9. Periodontal disease susceptibility!!!!
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DiGeorge Syndrome clinical features
C = cardiac defects A = abnormal faces T = thymic aplasia (lack of T cells so higher risk of infection) C = cleft palate H = hypocalcemia 22 = 22q11 deletion Catch 22!
40
Prevalence of cleft lip and/or palate
1.35 in every 1000 live births Mostly unilateral (80%)
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What’s a common missed impact of cleft lip and or palate?
May have issues with hearing vs speech (that’s why their speech may sound funny)
43
What is the aetiology of cleft palate and lip?
Polygenic and multi factorial = genetic and environmental
44
Most of the time cleft lip and palate will present as part of…
A syndrome such as… - Pierre Robin syndrome - Treacher Collins syndrome - Apert’s
45
What are the associated dental anomalies of cleft lip and palate?
1. Class III skeletal/incisors 2. Hypodontia (often laterals) 3. Supernumeraries 4. Size/shape abnormalities 5. Delayed dental eruption/development 6. Hypomineralisation
46
What dental considerations should you have for a diabetic patient?
1. Increased periodontal risk 2. Delayed healing 3. Issues with fasting (consider this for GA) 4. Higher caries risk with snacking etc
47
Considerations for patients with muscular dystrophy i.e. Duchenne MD?
1. Difficulty holding mouth open 2. Risks associated with GAs (malignant hyperthermia - rapid rise in heart rate and temperature can be fatal!) 3. OH dexterity difficulty
48
Dental considerations for patients with ectodermal dysplasia?
1. Hypodontia 2. Conical teeth 3. May face bullying due to aesthetics - may wish to place prosthesis to replace missing teeth (difficult in a growing patient - will need to see regularly) Sparse hair, skin, lack of sweat glands mean they can overheat.
49
What dental condition is associated with osteogenesis imperfecta?
Type 1 dentinogenesis imperfecta (opalescent teeth and blue sclerae) Associated brittle bones = orthodontics aren’t ideal, bisphosphate use Signs of abuse may be masked by typical frequent fractures
50
How many primary 1 children in 2022/23 were at risk of being overweight or obese?
21.9%
51
How much more likely are children in deprived areas to be overweight than those in affluent areas?
twice as likely
52
How many people are affected by ASC and what does it stand for?
autism spectrum condition 1 in 100 Not classified as a learning or mental health condition but simply a neurodivergence.
53
If ASC is not a mental health condition or learning disability then why might it be confused as this?
Because 1/3 of autistic people ALSO have a learning disability And autistic people are more likely to experience mental health problems.
54
Dental considerations for a patient with ASC?
1. Alternative communication 2. Altered OHI; non-flavoured toothpaste (may have sensory issues) 3. May take a laxido due to constipation issues (which could contain sugar) 4. May have specific interests or routines 5. Diet may be specific
55
Different types of ulcers based on size and presentation
major - >1cm minor - <1cm herpetiform - many tiny ulcers that can merge into larger painful areas (not herpes)
56
Neonatal teeth management
57
Angular cheilitis treatment
Miconazole gel (fungal) Sodium Fusidate (bacterial)
58
Recurrent aphthous ulceration
Aetiology - unclear Likely “family + bloods + GI” Stress minor trauma bacterial/viral infection allergic disorder hormonal disturbance
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Management of recurrent aphthous ulceration
1. Manage exacerbating factors - avoid foods/SLS free toothpaste etc 2. Avoid super infection - corsodyl 0.2% mouthwash / salt water rinse 3. Symptomatic relief - Difflam (0.15% benzydamine hydrochloride) 4. Topical steroid medication - beneficial in the initial phase (prodromal) = Betamethasone soluble tablets
61
PFAPA and cyclic neutropenia
Can present very similarly; aphthous stomatitis, fever, malaise, pharyngitis, cervical adenitis PFAPA is an inflammatory disorder where as cyclic neutropenia is a condition of low blood count (can be differentiated by doing a blood count) that makes the patient more prone to infection.
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