Paeds Flashcards
(171 cards)
1
Q
Give 5 members of paeds haemophilia team
A
GDP, paediatric dentist haematologist haem specialist nurse social workers
2
Q
How is severity of haemophilia assessed
A
% of clotting factors
mild/mod/severe
6-40%/ 2-5%, <1%
3
Q
How would you treat a patient with moderate haemophilia?
A
enhanced preventative care and rx with GDP/CDS
all tx in hospital setting w/ specialist
4
Q
Two clinical manifestations of van Willebrands disease
difference between type I and type II vWb disease?
A
mucocutaneous haemotoma
gingival bleeding
post XLA bleeding
type I: quantitative effect on van Willebrand’s factor - loss to 20-50%.
type II: qualitative effect on vW factor
both autosomal dominant
type III: also quantitative effect- autosomal recessive
5
Q
4 dental procedures that require no augmentation to coagulation factors
A
examination
flouride varnish
small occlusal restorations
supragingival scaling
6
Q
4 management strategies for patients requiring augmentation of coagulation factors
A
coagulation factor replacement
DDAVP - desmopressin
antifibrinolytics- e.g tranexamic acid
local haemostatic measures
7
Q
Give 1 possible complication of recombinant clotting factor therapy
A
antibody resistance
8
Q
3 side effects of desmopressin use
A
hyponatraemia - low serum sodium levels
nausea
diarrhoea
headaches
tachycardia
desmopressin is man made vasopressin (Antidiuretic hormone) used for diabetes, bed wetting, haemophilia A and vWD
9
Q
Risk of nerve blocks in patients with bleeding disorders
Give one alternative to nerve block
A
muscular haemotoma
- blood could flow into sublingual, submandibular, pterygoid spaces
alternative: articaine infiltration
10
Q
Max INR for safely treating paediatric patients
A
2.5
11
Q
When should you prescribe prophylactic antibiotics
A
immunocompromised hypertrophic cardiomyopathy previous infective endocarditis valve replacement cardiac stent adjunct to tx
12
Q
6 extra oral features of Down Syndrome
A
rounded skull small midface atlantoaxial instability dysplastic ears brushfield spots short, broad neck dry lips
13
Q
6 intra oral features of Down Syndrome
A
macroglossia AOB microdontia hypodontia fissured tongue delayed eruption class III occlusion bifid uvula
14
Q
4 medical conditions related to Down syndrome
A
cardiovascular defects esp. VSD cleft lip and palate deafness hypothyroidism mental retardation acute lymphoblastic leukaemia
15
Q
Restorative options for pt with Down Syndrome
A
GI restorations- difficult to achieve moisture control
CHX gel or MW
LA if able. GA risk due to atlanto axial instability
16
Q
What percentage of paediatric patients suffer from asthma?
A
7-19% in the UK
17
Q
What is asthma?
A
reversible airway obstruction caused by: - smooth muscle contraction - inflammation in respiratory mucosa - excess mucous secretion
18
Q
Give 4 signs/symptoms a patient with asthma might display
A
shortness of breath
wheezing
rash
coughing
19
Q
What medications would you expect a patient with asthma to be taking?
A
corticosteroid inhaler - brown- beclomethasone - preventer
beta 2 agonist inhaler - blue - salbutamol - reliever
20
Q
How do asthma medications contribute to tooth wear
A
- xerostomia - .:. sugary/acidic drinks used to aid
- relaxed lower oesphageal sphincter- gastric reflux
- inhaler is acidic
21
Q
What are the dental effects of inhalers and what advice should be given
A
- candidosis
- erosion - from intrinsic (GORD) and extrinsic (acidic medication and sugary drinks)
- xerostomia
advice:
try to rinse with water after every inhaler use,
use spacer is possible
22
Q
What other considerations should be given to asthma patients?
A
- –pt will have increased atopy (genetic tendency for allergic reactions) .:. increased chance of allergic reactions - COLOPHONY in fluoride varnish
- –increased risk of adrenal suppression - from inhaled corticosteroids inhaler
- –med emergencies risk
- –SEDATION risk
23
Q
How is asthma severity established?
A
last hospitalisation
clinical symptoms
measurements- peak expiratory flow, forced resp volume, oxygen saturation
24
Q
What is cystic fibrosis?
incidence?
A
chromosomal abnormality affected chr7
production of xs thick mucous affecting lungs, pancreas and salivary glands
affects 1 in 2500
25
Signs and symptoms cystic fibrosis
```
recurrent respiratory infections
low weight
cough
wheeze
shortness of breath
thickened saliva
```
26
4 intraoral manifestations of cystic fibrosis
thickened saliva
ENAMEL DEFECTS
delayed eruption
increased calculus
27
dental considerations of cystic fibrosis
sedation contraindicated
diet advice - high cal, probably sugary diet due to nutritional deficiency
ohi - carry toothbrush everywhere
antibiotic resistance and prescribing- recurrent infections
diabetes and liver disease
28
why is inhalation sedation contraindicated in cystic fibrosis
high oxygen supplementation causes decreased respiratory rate
.:. ability to clear secretions reduces in long sedated periods
29
incidence of cancer in u15 y/o
1/600
30
list 5 most commmon childhood cancers
```
leukaemia
lymphoma
brain tumour
wilm's tumour (kidneys)
neuroblastoma
```
31
3 tx modalities cancer
chemo
radio
surgery
32
4 acute intra oral complications cancer tx
infections
haemorrhage
xerostomia
mucositis
33
what is mucositis?
ulceration of all mucosa types in oropharynx/ digestive tract usually as a result of chemotherapy
34
grading of mucositis?
0 none
1 soreness, erythema
2 ulceration, erythema - solid foods tolerated
3 ulceration, erythema - liquid foods only
4 oral alimentation impossible - life threatening
35
mgmt strategies mucositis?
- general- avoid spicey foods, no strong MW
- smooth cusps/ sharp edges on restorations
- low level laser light therapy - stimulate collagen production
- analgesia in form of lignocaine 2% solution
- enhanced oh
36
a paediatric patient undergoing chemo for leukaemia presents with bleeding gums. why would this be?
what ohi to help?
give 3 local and 1 systemic haemostatic options
platelets levels low - <20-30 x10(9)/L
avoid toothbrushing. use CHX on swab to clean
local: pressure & gauze, ice, topical thrombin
systemic: platelet infusion
37
minimum platelet count for injections/xla/scaling
>80 (40-100) x10(9)/L
38
give 3 ways chemotherapy renders patients more susceptible to infection
- inhibits antibody response
- abolition of delayed hypersensitivity
- neutropenia
39
suppurating pocket assoc w/ 16. how to decide tx?
culture
| sensibility testing
40
What is aplastic anaemia?
disease of bone marrow and the hematopoietic cells residing within - causes pancytopenia.
41
4 intra oral signs of aplastic anaemia?
ulceration
haemorrhage
infection
mucosal pallor
42
4 factors to consider before tx of aplastic anaemic?
increased infection risk
haemorrhage
increased risk of SCCa
anaemia
43
what is GVHD?
4 intra oral signs
Graft Versus Host Disease
where immune cells from graft tissue recognise host as foreign.
a frequent and serious complication following hematopoietic stem cell transplantation (HSCT)
lichenoid tissue reaction - can be reticular or erosive
xerostomia - due to salivary glands affected .:> increased caries rate
limited mouth opening
ulceration - can appear as canker sores
mucoceles
erythema
44
how might a child with renal failure appear at presentation? (3)
underweight - failure to thrive
pallid
fatigued
45
give 6 intraoral features of a child with renal failure?
GGEEPP
```
gingivitis
gingival hyperplasia
enamel hypoplasia
excess plaque accumulation
petechiae
pulp obliteration
```
46
when should dental tx be carried out for children with renal failure?
day after dialysis
47
implications of organ transplant for dental tx? (4)
cyclosporin immune suppressant -> gingival hyperplasia
corticosteroids -> pulp obliteration
bleeding disorders -> platelet dysfunction. care with la- haematoma likely in pterygoid region
long term immunosuppression -> poorly controlled infections
osseous lesions in jaw
48
5 early clinical features of diabetes
```
polyuria
acetone breath
irritability
weight change
thirst
fatigue
```
49
5 late clinical features of diabetes
```
dehydration
renal dysfunction
hypovolaemic shock
nausea
vomiting
```
50
5 oral manifestations of diabetes
```
xerostomia
progressive periodontitis
caries
candida infection
oral neuropathies
```
51
3 features of a hypoglycaemic attack
```
strong, bounding pulse
clammy skin
confusion
hunger
nausea
```
52
3 features of hyperglycaemic attack
```
weak pulse
dry skin
acetone breath
frequent urination
rapid breathing
```
53
prevalence of epilepsy in children
1/250
| ~0.5%
54
3 intraoral signs of epilepsy
trauma to teeth
soft tissue trauma
gingival hyperplasia (phenytoin)
recurrent oral ulceration
55
what is haemolytic anaemia?
type of anaemia with lysis of erythrocytes (RBCs)
| can be intravascular/extravascular
56
how can haemolytic anaemics be diagnosed?
peripheral blood smear
57
3 categories of haemolytic anaemia and eg of each
membrane defects - spherocytosis
enzymatic defects - G6PD
structural defects - Sickle cell disease, thalassaemia
58
how might a patient with haemolytic anaemia present? (6)
```
pallid
fatigued
ascites
underweight
oedema of legs
jaundiced
shortness of breath
FTT failure to thrive
```
59
6 oral related signs of sickle cell disease
```
anaemia
ulceration
smooth tongue
jaw joint pain
impaired growth
hypercementosis
skeletal deformities
osteoporosis of jaw
```
60
4 dental implications of sickle cell disease
poor infection control
post op antibiotics
prevention
inhalation risk
61
6 orofacial manifestations of thalassaemia?
```
squirrel like appearance
large cheekbones
depressed nasal ridge
class II malocclusion
maxillary protrusion
candidosis
gingivitis
high caries incidence
```
62
6 intraoral manifestations of HIV
```
oral ulceration
salivary gland enlargement
hairy leukoplakia
hepetic stomatitis
recurrent candida infections
kaposi sarcoma
xerostomia
```
63
How is HIV diagnosed
```
ELISA
enzyme -
linked
immuno-
sorbent
assay
```
64
Current management of HIV
HAART
triple therapy
```
highly
active
anti
retroviral
therapy
```
65
most common cause of anaemia in children?
4 intraoral signs of this anaemia
iron deficient anaemia
```
glossitis - inflammation causing sore, smooth looking, depapillated tongue
candida infections
apthous ulceration
pale mucosa
angular cheilitis
```
66
what type of anaemia does i)b12 ii)fe iii) folate deficiency induce in pts
macrocytic
microcytic
macrocytic
67
how does the clinical presentation of the tongue differ from patients suffering from iron and b12 deficient anaemias
iron: large, red, smooth, depapillated
b12: fiery red, atrophic, sore, beefy
68
gi disease presenting with pigmented lesions in oral cavity and on lips
Peutz Jeghers
| brown macules 2-5mm on lips, oral cavity and face
69
```
what is gardner's syndrome
intraoral presentation (3)
```
colonic polyposis
supernumerary teeth
mandibular cysts
70
what is coeliac disease?
| 3 intraoral presentation
lifelong autoimmune condition as reaction to gluten
apthous ulceration
mucosal erythema
chronological hypoplasia
depapillation of tongue
71
what is crohns disease
| 5 intraoral presentation
inflammatory bowel disease (IBD) affecting any part of GI tract
```
full thickness gingivitis
cobblestoned mucosa
mucosal tags
ulceration
fissured tongue
```
72
4 strategies to manage intraoral symptoms of crohns
dietary advice
steroids- topical/ systemic. betamethasone, hydrocortisone pellets 2.5mg
non-cinnamon containing toothpaste
correct anaemic deficiencies
73
child brought in by non-parent. what do you need to establish prior to examination?
thorough history inc medical and drug history
| consent- if carer has consent, situation, where consenting adult is
74
describe a behavioural management technique
name 4 other techniques
tell show do
Tell: tell the patient what you’re going to do, Show: show the patient what you’re going to do, Do: get the patient,
Plan: long term
```
others:
desensitisation
modeling
distraction
parental presence
positive reinforcement
voice control
```
75
How would you address the issue of non attendance of a child?
- ensure contact details are up to date
- explain to parent necessity of attendance of pt and of consenting guardian presence
- inform parent of need for child protection involvement in cases of non- compliance
- arrange next appt on phone
- record everything fully in notes
76
evidence based toothbrushing advice?
2-5 mins / 2 x daily
pea sized amount/ 1450ppm toothpaste
modified bass technique/ 45 degree angle to gingival margin and brushing away from margin
77
What does a BPE score of 3 mean?
probing depth of 3.5-5.5mm
78
pt attends with fracture of 11. history?
account for missing fragment - swallowed/inhaled/embedded in soft tissue
how it happened
when it happened
79
List 4 things that determine prognosis of fractured tooth
- type of fracture
- mobility
- vitality
- maturaturity of tooth - open/closed apex
80
Pt presents with yellow/white/brown stains on teeth. Differential diagnosis?
How would you differentiate?
amelogenesis imperfecta
fluorosis
molar incisor hypomineralisation
AI - affects all teeth, familial aggregation, on radiograph molars can appear taurodont
F- affects all teeth, history of high fluoride in childhood- ingestion/ water. white opacities caries resistant
MIH- affects 1s and 6s only. susceptible to caries. well demarcated opacities
81
What questions would you ask parent of child with white/yellow/brown staining?
- childhood systemic illnesses? - measles, rubella, upper respiratory tract infections
- pregnancy- did mother suffer from any systemic illnesses prenatally?
- premature delivery?
- prolonged breast feeding?
- traumatic birth?
- medications taken?
- natural birth?
82
Signs fluorosis?
aeitology?
how to quantity severity?
tx options?
```
varying severity
white flecks
opaque white lines
pitting
brown spots
```
quantity of fluoride intake, type of intake, renal function, metabolic function.
long term ingestion of high fluoride, fluoridated water of >1ppm
Dean's index
```
micro/macroabrasion
bleaching
composite restorations
veneers
full crowns
```
83
implications of MIH
- increased sensitivity
- increased caries susceptibility
- behavioural problems & amp anxiety
- difficulty achieving anaesthesia
- difficulty restoring lesions
- poor aesthetics
84
5 groups of aeitiologies of MIH
- pre/peri and neonatal problems
- exposure to environmental contaminants
- exposure to fluoride
- common childhood illnesses
- medically compromised children
85
5 tx options impacted first molars
```
Leave and monitor
coronectomy
discing of Es
orthodontic fixed appliance
XLA molar
XLA E
```
86
Features of permanent dentition that allow for replacement of primary teeth without crowding?
- Growth of maxilla
- Primate space- physiological spacing between primary teeth
- proclination of permanent teeth
- Extension of dental arch
- Leeway space-
87
Leeway space
combined mesiodistal width of primary canine, first and second molar is greater than the combined mesiodistal width of the permanent canine, first and second premolars
88
pt suffering from extrusion. tx
extrusion splint
cut and manipulate passive splint (SS)
clean and dry area
acid etch areas to be splinted
fix with composite resin
follow up 2 weeks, 4 weeks, 6-8 weeks, 6 months, 1 year, 5 years
clinical exam and radiographs, sensibility testing, mobility, TTP, check colour and sinus
89
On a follow up visit post- trauma a radiograph reveals an irregular apical structure.
what could be causing this?
what else would you expect to see?
tx?
external inflammatory root resorption
widened pdl
loss of lamina dura
RCT, CaOH dressing
apical surgery
90
avulsion of permanent incisor. pt on phone, what to do.
reassure pt
do not handle by root
rinse under cold running water for 10s
reimplant ASAP (check is definitely not primary tooth)
or store in saliva, milk, Hank's saline and visit GDP
91
pt arrives in practice. reimplanted mature tooth closed apex. what to do
leave tooth in place
clean area w/ water spray
suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact
RCT 7-10 days after reimplant
CaOH placed as intracanal medicament for up to a month before obturation.
OR antibiotic corticosteroid (odontopaste)
92
patient instructions following reimplant of avulsed tooth
avoid contact sports
CHX rinse bid/7days
soft food for up to 2 weeks
brush w soft toothbrush after each meal
93
what to do if pt presents w/ mature avulsed tooth in storage medium
if saliva, milk or Hank's balanced salt solution and EADT extra oral dry time of <60 minutes can reimplant
- clean root surface and apical foramen with stream of saline- remove debris and dead cells
- administer LA
- irrigate socket with saline
- examine socket - if socket wall fracture position this with suitable instrument
- reimplant tooth with digital pressure, no force
then as before---
suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact
RCT 7-10 days after reimplant
CaOH placed as intracanal medicament for up to a month before obturation.
OR antibiotic corticosteroid (odontopaste)
94
If pt presents with mature avulsed tooth and EADT >60 minutes what do you do
can do delayed reimplantation - to restore aesthetics, function and maintain alveolar bone contour
ankylosis expected + root resorption. soaking in sodium fluoride solution thought to help slow down process
-Clean with saline and remove any non-viable soft tissue carefully
-RCT can be carried out extraorally or 7-10 days post reimplantation
-LA
- irrigate socket with saline
- examine socket - if socket wall fracture position this with suitable instrument
- reimplant tooth with digital pressure, no force
-suture gingival lacerations if present
=verify normal positioning of tooth clinically and rads
-apply flexible splint- 4 weeks
-prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
-tetanus booster- if uncertain or immunisation/soil contact
95
If pt presents with avulsed immature tooth reimplanted...
leave tooth in situ
clean area w/ water spray
suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact
GOAL revascularisation at apex
if does not occur need to RCT - if evidence of pulp necrosis
follow up - 2 weeks, 4 weeks, 3 months, 6 months, 1 year , 5 year
96
if pt presents with avulsed immature tooth with extraoral dry time <60 minutes...
need to: weigh up risk of revascularisation versus infection related root resorption
if saliva, milk or Hank's balanced salt solution and EADT extra oral dry time of <60 minutes can reimplant
- clean root surface and apical foramen with stream of saline- remove debris and dead cells
- AT THIS POINT- thought to aid revascularisation if application of topical antibiotics (doxycline soak 1mg per 20ml for 5 minutes prior to reimplantation).
- administer LA
- irrigate socket with saline
- examine socket - if socket wall fracture position this with suitable instrument
- reimplant tooth with digital pressure, no force
then as before---
suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact
AVOID RCT UNLESS EVIDENCE OF PULP NECROSIS
97
if pt presents with avulsed tooth immature and eadt >60 minutes
can do delayed reimplantation - to restore aesthetics, function and maintain alveolar bone contour
ankylosis expected + root resorption. soaking in fluoride solution thought to help slow down process
-Clean with saline and remove any non-viable soft tissue (necrotic PDL) carefully
-RCT can be carried out extraorally or 7-10 days post reimplantation
-LA
- irrigate socket with saline
- examine socket - if socket wall fracture position this with suitable instrument
- reimplant tooth with digital pressure, no force
-suture gingival lacerations if present
=verify normal positioning of tooth clinically and rads
-apply flexible splint- 4 weeks
-prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
-tetanus booster- if uncertain or immunisation/soil contact
98
eruption dates permanent teeth
```
6 y/ o - U6s, L6s erupt,
L1s begin to
7 y/o - L2s and U1s
8 y/o - U2s
9 y/o - L3s, palpate for Us
10 y/o - U4s, L4s, U5s
11 y/o - L5s, U3s, L7s
12 y/o - U7s
17+ - U+L8s
```
99
Main difference in splinting times and why?
flexible splint for 2 weeks if EADT <60 mins
| for 4 weeks if EADT >60mins
100
common outcomes of avulsed teeth (5)
```
discolouration
pulp necrosis
ankylosis
mobility
root resorption
```
101
How do osteogenesis imperfecta and dentinogenesis imperfecta relate?
1/2 of patients with osteogenesis imperfecta will suffer from dentinogenesis imperfecta- whilst the other half will have unaffected teeth and just require routine care.
102
What is osteogenesis imperfecta
dental implications
general signs
brittle bone disease!!
lots of different types- range in severity and effects
OI always associated with bone fragility. Can affect growth of the jaws.
OI does have dental implications though -
- class III malocclusion
- anterior open bite
- impacted teeth
- altered dental development
```
general signs:
blue sclera of eye
multiple bone fractures
short height
large head
easy bruising
range of bone deformities- scoliosis
```
103
Mum brings in baby with one erupted tooth gray/blue in colour. What could it be?
Any signs to look for if more teeth present?
DI - can occur alone or with OI. enamel is normal but dentine and DEJ is abnormal. Enamel cracks away from dentine, and dentine can grow into pulp chamber .:.
- discolouration of tooth,
- reduced feeling in tooth
- high caries susceptibility
- bulbous crowns
- slender shorter roots.
- pulp chamber obliteration
- occult abscess (no obvious signs)
104
Difference between flexible and rigid splint?
flexible - 1 tooth either side
| rigid - 2 teeth either side of trauma
105
4 types of healing after root fracture
which type would give most poor prognosis?
interposition of the following can occur at the fracture line:
- of calcified tissue
- of both calcified and connective tissue
- of connective tissue
- of granulation tissue
poor prognosis: granulation tissue would show loss of vitality of tooth and pulpal necrosis/ infection causing an inflammatory response
106
mgmt of root fractures
undisplaced- soft diet and monitor
| displaced- LA, reposition, splint
107
root fracture what is it? classification?
fracture of dentine, pulp and cementum
horizontal
or vertical
horizontal - number, location, position, extent.
e.g simple apical displaced total horizontal root fracture
vertical - separation and position
e.g complete intraosseous vertical root fracture
108
History to take after traumatic event
SI
```
time and place of event
reason for injury
any previous dental injuries
any pain/ spontaneous
any other associated injuries/symptoms- nausea/loss of consciousness/headache
systemic health review
```
SI:
sensibility testing - can be transient loss of pulp vitality
+pulse oximeter
radiographs
109
indicators of positive healing in root fractures (5)
```
assymptomatic
continued positive pulp testing
signs of healing between root fragments
absence of apical periodontitis
continued root development in immature teeth
```
110
if tooth starts to discolour- yellowy after root fracture what is it
v common finding - 2/3 of root fractures will have partial or complete pulp obliteration
coronal pulpal obliteration
caused by revascularisation of pulp
apical pulp obliteration seen in case of interposition of calcified tissue and those with interposition of calcified and connective tissue.
111
tx for root fracture with pulpal necrosis
long term CaOH therapy
followed by conservative RCT within 7-10 days for mature apex
for immature apex apexification to be completed first the RCT
CaOH has weakening effect on tooth .:. MTA can be used for horizontal root fractures for faster healing
112
contributory factors to pulpal necrosis in root fractures
displacement of coronal fragment
use of rigid splints
mature apex at time of fracture
marginal periodontitis
113
aetiology of vertical root fractures
prognosis
extensive restorative tx
endodontic tx
parafunctional habits
can treat
e.g guided tissue regeneration
or fixation and application of MTA
but normally XLA
114
advantages and disadvantages of non vital bleaching
:) easy
safe
conservative
no lab assistance needed (walking bleach technique)
```
:(
brittle teeth
external cervical resorption
relapse
may fail
over-bleaching
```
115
walking bleach technique
pre-op shade
photographs
radiographs to check RCT
```
dam
gain access
remove restoration
GP removed to gingival margin
ensure good coronal seal
10% carbamide peroxide soaked cotton pledget placed in cavity
sealed with GIC
pt to return every 2 weeks for up to 10 replacements/ happy with shade
then nsCaOH placed to reverse acidity
then final restoration
```
116
child ingested toothpaste
| 3 questions to ask pt
conc of toothpaste
amount swallowed
age/weight of child
117
toxic dose fluoride
tx if ingested
potentially toxic 5mg/kg
a&e immediately
oral calcium
118
most common cause of fluorosis in uk
fluoride in water supply
119
family w/3 children aged 1,4,7. live in area with 0.3ppm water supply F-.
what supplementation would you suggest
for 1 y/o - fluoride drops 0.25mg
for 4 y/o - fluoride chewable tablets 0.5mg
for 7 y/o- fluoride MW 225ppm. 1mg needed
120
3 y/o pt presents with blisters on gums. dx?
any other features you'd expect
tx
primary herpetic gingostomatitis
- contagious
- herpes simplex virus type 1
- 6 month - 6 y/o
- most common viral infection of mouth
```
symptoms:
blisters 1-3mm in size
painful, erythematous gingiva
ulcers on gingiva, lips,mucosa
halitosis
malaise
refusal to eat
high fever
headache
irritability
```
tx:
supportive only- reassurance, rest, fluids
appropriate analgesia
OHI - CHX
advise parent of contagious nature- childs eyes
refer if concern re: refusal to eat/
121
issues caused by herpes simplex virus reactivation
herpes labialis - cold sores (15-30%)
| bell's palsy
122
topical effects of fluoride
promotes remineralisation
hydroxyapatite-> fluorapatite
bactericidal
decrease acid production of plaque
123
effects of primary tooth trauma on a primary tooth
discolouration
delayed exfoliation
infection
loss of vitality
124
effects of primary tooth trauma on a permanent tooth
```
delayed eruption
enamel defects
arrested development
ectopic placement
abnormal morphology
```
125
eruption dates primary dentition
Upper: 7, 9, 18, 14, 24 months
Lower: 6, 8, 16, 12, 20 months
126
eruption dates permanent dentition
Upper: 7, 8, 11, 10, 10, 6, 12 years
Lower: 6, 7, 9, 10, 10, 6, 12 years
127
factors that increase index of suspicion of child welfare in injured child
```
delay seeking tx
injuries not matching story
inconsistent story
contradictory info from child
abnormal behaviour/mood child
abnormal behaviour parent
previous history of injury
```
128
orofacial injuries suspicious of mistreatment
cigarette burns
hand/finger marks
bites
ear/neck injuries
129
how to refer pt on if concerned about welfare
A - Assess
H - History
E - Examination
T - Talk to the child and parent about concerns (if you feel safe)
D - Document: everything and in the patients own words
M - multiagency (Contact senior colleague and/or e.g. dental protection for advice.)
48
R - refer: Child protection services for information. Social services for referral. Ensure you follow up within 48hours. If
possible take photographs with permission. Consider contacting police if you feel child is in immediate danger.
130
indications pulpotomy(6)
```
Avoid XLA,
co-operation,
space maintenance,
caries 2/3 into dentine,
exposure >1mm,
marginal ridge destroyed,
avoid GA,
MH precludes XLA,
no permanent successor.
```
131
contraindications pulpotomy (6)
```
congenital heart disease
immunosuppression
suppurating pulp chamber
>2/3 root resorption
severe pain
severe infection
severe bone loss
space management
```
132
Why and how would you carry out pulpotomy?
Indication: exposure of bleeding pulp with no previous symptoms and no clinical/radiological sings of infection.
e.g traumatic exposure
or large iatrogenic exposure
LA and dental dam,
Access → remove caries and unroof pulp chamber,
Amputate coronal pulp w/ excavator/slow
speed,
irrigate and dry pulp,
control haemorrhage (20s ferric sulphate),
assess pulp (→if abnormal bleeding then
pulpectomy),
Restore→ CaOH/MTA at stumps, GIC luting cement, SSC.
133
indication and tx pulpectomy
indication: exposure of non-bleeding or severely hyperaemic pulp, irreversible pulpitis or clinical/radiological signs of
periapical periodontitis or acute abscess.
LA and dental dam,
Access → remove caries and unroof pulp chamber,
Amputate coronal pulp w/ excavator/slow
speed,
remove radicular pulp using barbed broaches. WL from radiograph, file canals 2mm short
of apex (important not to go past apex - tooth germs),
irrigate w/ CHX, dry canals,
obturate with CaOH and iodoform
paste (Vitapex),
restore with GIC and SSC.
vitapex is premixed CaOH and iodoform paste used as temp or permanent root canal filling post pulpectomy
134
WHat is AI
Give 4 types of amelogenesis imperfecta
disorder of tooth development
hypoplastic
hypocalcified
hypomaturational
mixed w/ taurodontism
135
Signs and symptoms AI
teeth that are:
small
discoloured
pits/ grooves
prone to rapid wear/breakage
136
Cause AI
genetic mutation of enamel extracellular matrix molecules e.g amelogenin, enamelin
137
Mgmt AI
```
enhanced prevention
composite veneers
fissure sealants
SSC
metal onlay
```
138
Dental implications AI
```
aesthetics
sensitivity
caries/acid susceptibility
delayed eruption
AOB
```
139
4 y/o presents. gross caries across anteriors inc smooth surface
cause
tx
nursing bottle caries
cariogenic drinks left in bottle for child to feed on overnight
```
complete/ partial caries removal +/-. temporisation GIC
or if severe- XGA
Fluoride varnish 4xyear 22600ppm
consider supplements
advice:
```
```
avoid taking bottle to bed
advise against on demand feeding
milk and water only between meals
sugar free swaps of foods
not soya unless on medical grounds
spit dont rinse when toothbrushing, pea sized 1450 w/ parental supervision
```
140
3 types of dentinogenesis imperfecta
1. associated with osteogenesis imperfecta
2. autosomal dominant
3. brandywine
141
Dental implications dentinogenesis imperfecta
```
aesthetics
caries
occult abscess
poor long term prognosis
root fracture
```
142
indications SSC
```
>2 surfaces affected/ broken down
tx for severe MIH defects
post pulpotomy/pulpectomy
space maintainer
marginal ridge breakfdown
```
143
how to place SSC conventionally
- consent
- LA, dam
- tooth prep - 1mm removal occlusal w/flat fissure bur, clear contacts w/ fine taper bur
- crown selection - measure MD, adjust w/ band forming pliers
- isolate and dry tooth
- mix GIC
- seat lingually, snap buccally
- look for gingival blanching
- remove XS cement w/ probe
- check contacts and occlusion
144
how does hall technique differ to conventional crown placement
no LA
no toothprep
no caries removal
145
how would you judge a crown has failed
```
secondary caries
pulpitis
crown lost
crown rocking
abscess
```
146
advantages of planned extraction of FPMs
indications of suitability for planned extractions of FPMs
spontaneous space closure
reduction in possible ortho need
caries free dentition
bifurcation of 7s forming
class I incisors
mild buccal crowding
147
2 disadvantages of planned XLA
bad experience
GA if goes wrong
difficult achieveing anaesthsia
148
most common cardiac defect in children?
which condition is this highly associated with
mgmt of these pt
ventricular septal defect
-where connection between two ventricles
assoc/w/ down syndrome
mgmt: prevention to avoid tx. OHI to minimise endocarditis risk. xla rather than pulptx. consult with cardiologist. avoid sedation
refer to specialist care.
149
mgmt of external inflammatory resorption
Extirpate the pulp and carry out chemomechanical disinfection. Place non setting CaOH dressing. Reassess to see if
resorption has stopped. If yes, complete endo, if not continue w/dressing and plan replacement.
150
7 factors making up prevention plan
1. OHI/ tooth brushing instruction
2. Diet Advice
3. Fluoride toothpaste
4. F varnish
5. F supplements
6. Fissure
sealants
7. Radiographs
8. Sugar free medication.
151
fluoride supplementation in areas of <0.3ppm F-
1mg/day fluoride tablets
152
name 3 sources of fluoride found in food and drink
beer
tea
cucumber
bony fish
153
clinical trauma review (trauma stamp) (8)
```
colour,
displacement (ONLY AT 1st VISIT),
mobility,
sinus/tender in sulcus,
EPT,
Ethyl chloride,
TTP,
Radiographs.
```
154
cause of external inflammatory root resorption?
clinical signs?
mgmt?
infected/necrotic pulp release bacterial toxins, which travel up dentinal tubules and stimulate osteoclasts to resorb the root .:. cementum and bone resorption.
mobility, negative sensibility testing, may be TTP
moth eaten appearance of PDL and root on RADS
RCT, dress with CaOH and review every 3 months. if progressing continue with CaOH. if abating obturate ad monitor
155
indications for microabrasion
```
fluorosis
ortho decal
trauma
pre-veneer to mask staining
MIH - with predominantly brown lesions- little affect otherwise
```
up to 100ym removed
156
benefits and negatives microabrasion
```
:) easy
permanent
conservative
effective
easy after care
```
:( caustic acid
in surgery only
enamel removal
unpredictable
157
describe process of microabrasion
pre op photos/diagrams/ shade guide/ sensibility/ rads if indicated
ppe
prepare solutions- pumice, 18% hydrochloric w/ pumice and sodium bicarbonate. labelled well.
clean teeth w/ pumice
vaseline applied to gingiva
dental dam positioned
sodium bicarbonate barrier applied to gingiva
acid+pumice rubbed onto affected surface 5 seconds with wooden stick
washed thoroughly
repeated up to 10 times, 100 microns removal if 10
thoroughly clean
apply flouride TP
soft flex disc used to remove prism-less layer
fluoride varnish applied
review 4-6 weeks
post op rads/photos
advice: no coloured foods for 24 hours. anything that would stain a white tshirt.
158
3 conditions assoc/ w/ hypoplasia
ectodermal dysplasia
down's syndrome
cleft lip and palate
ED- two or more of ectodermal develop abnormally - skin hair teeth nails sweat glands mucous membranes
159
percentage incidence of primary and permanent hypodontia?
primary 0.9%
| permanent ~6%
160
bleaching product components
10% carbamide peroxide
=
3.3% h202
6.6% urea
161
Why could a child be anxious before the dentist?
```
'infection' from parents
negative experience previously
expectation of pain/uncomfort
friends negative/ unusual experiences
media
uneducated on modern analgesic techniques
```
162
How do you measure childhood anxiety?
MCDAS
modified child dental anxiety scale
pictures of faces for numbers
163
8 behavioural management techniques
```
modeling
acclimitisation
desensitisation
tell show do
distraction
positive reinforcement
progressive muscle relaxation
hypnotherapy
```
164
6 y/o haemophilia A pt attends practice with buccal swelling and grossly carious 85.
What is haemophilia A?
dx?
tx?
genetic disorder caused by deficiency in factor VIII clotting protein
periapical abscess assoc/w/85
avoid XLA due to clotting issues
atraumatic pulpotomy if poss.
antibiotics given if needing to refer
XLA -> DDAVP - desmopressin - manufactured factor VIII available for mild-mod haemophilia A
atraumatic XLA
infiltration LA if possible
ensure clot, suture socket
oral tranexamic acid given post op, may be required pre-op
165
name 3 local haemostatic agents
```
LA w/ vasoconstrictor
tranexamic acid
thombin, fibrin
surgicel
ferric sulfate
gelfoam
```
166
triad of impairment in autism?
social impairment in :
- interaction
- imagination
- communication
167
features of autism? (6)
```
hypersensitivity
hyposensitivity
obsessive
learning difficulties
tubular sclerosis
epilepsy
```
168
mgmt of autistic patients dental visits
plan visit: info leaflets, social story, acclimitisation visit
timing: first appt of day or first after lunch, child can wait in car
environment: quiet surgery, no radio, no interruptions, taste of FV
communication: makaton, learning boards, avoid casual chit chat, literal speech
extra: oranurse unflavoured toothpaste
169
indications for fissure sealants?
materials used
```
medically compromised
caries in primary dentition
high caries risk
learning difficulties
mental&physical handicap
```
bisGMA resin, GIC
170
describe technique for fissure sealant placement
isolate tooth, saliva ejector, cotton wool or dam
clean tooth thoroughly - toothbrush/prophy
rinse 20 seconds
etch 20 seconds 37% phosphoric acid, wash, dry thoroughly, replace cotton wool, check for frosted appearance
apply thin fissure sealant in fissures and pits,
inc. buccal palatal extension if app.
cure 30 secs
check with sharp probe
check for excess
review
if GIC do not need as good moisture control and do not need to etch
171
4 types of cerebral palsy
How could it be further classified?
spastic
ataxic
athetoid
mixed
types based on how severely brain damage has affect muscle tone- strength and tension of muscles
could be hypo or hypertonia.
hypo- low muscle tone, loss of strength and firmness.
hypertonia- high muscle tone, causes rigidity and spasmodic movement,
monoplegia, - one limb
Hemiplegia, - one side of body
diplegia, triplegia, quadriplegia, -2,3,4 limbs respectively
