Paeds and Trauma Flashcards
1
Q
What is the treatment for reversible pulpitis?
A
Restore or place a dressing and restore later
2
Q
What is a rigid splint?
A
Rigid splint is when there are two uninjured teeth on either side of the trauma
3
Q
How long is the splint time for root fractures in the coronal third?
A
4 months
4
Q
What are the two main management options for amelogenesis imperfecta?
A
- composite restorations on anteriors (bonding may be an issue)
- full coverage restorations (particularly for posterior dentition)
5
Q
What age can you prescribe 5000ppm fluoride toothpaste?
A
16 + years old
6
Q
When will deciduous maxillary centrals erupt?
A
8-12months
7
Q
What teeth do you expect to see in a 3year old?
A
All deciduous teeth
8
Q
When will deciduous mandibular laterals erupt?
A
10-16months
9
Q
What are the four different types of supernumerary teeth?
A
- mesiodens (midline)
- supplemental (look like normal tooth
- conical
- tuberculate (more than one cusp)
10
Q
What teeth are most likely to be affected by macrodontia?
A
maxillary centrals then mandibular 5s
11
Q
What is the treatment for intrusive luxation in mature teeth with less than 3mm displacement?
A
● allow re-eruption without intervention for 8 weeks
- If no movement, reposition surgically
- flexible splint for 4 WEEKS
● Pulp almost always becomes necrotic, appropriate RCT 2 weeks after injury
12
Q
When do the permanent maxillary 4s erupt?
A
9-11years
13
Q
What teeth would you expect to be present in a 12 month old?
A
As, Bs upper and lower
14
Q
How can you manage sensitivity caused by MIH?
A
- 5% sodium fluoride varnish
- Sensitive toothpastes
- 0.4% stannous fluoride gels
- CPP-ACP (tooth mousse)
15
Q
What is lateral luxation?
A
When there is displacement of a tooth in an apical direction into the alveolar bone
16
Q
What is the treatment for this lesion in permanent dentition?
A
Site specific prevention or seal
17
Q
What are the benefits of tooth mousse?
A
good for use of white spot lesions in ortho; reduces sensitivity; and supposedly increases mineralisation
18
Q
When would you splint for subluxation and how long for?
A
A flexible splint may be used to stabilise the tooth for up to 2 WEEKS but only if there is excessive mobility or tenderness on biting
19
Q
What is tooth mousse and why might some people prefer it?
A
CPP-ACP: a calcium phosphate topical cream - it does not contain fluoride
20
Q
Why do you have to be extra careful when treating talon cusp teeth?
A
The extra cusp may have their own pulp so don’t go and smooth it down with a high speed
21
Q
How long do you wait for a contralateral tooth to erupt before you get concerned?
A
6 months
22
Q
What is molar-incisor hypomineralisation?
A
A qualitative defect of the enamel due to lack of mineralisation during development
23
Q
What is the colour of dentinogenesis imperfecta in permanent teeth?
A
grey/translucent
24
Q
When will deciduous maxillary canines erupt?
A
16-24months
25
How does turners tooth happen?
It affects successional teeth (often second premolars) from infection around the interradicular area of the preceding deciduous tooth
26
What is a talon cusp?
An extra cusp that arises on an anterior tooth
27
When do the permanent maxillary 6s erupt?
6-7years
28
What is the treatment for this lesion in primary dentition?
Site specific prevention (preferred) or sealant/infiltration
29
How many canals do maxillary Es have?
3
30
When do the permanent mandibular 5s erupt?
11-12years
31
What are the stages if there is an unerupted central incisor?
1. Monitor
2. Radiograph
3. Refer
4. See if supernumerary erupts
5. Maintain the space
6. Extract supernumerary (probably under GA)
- then wait for eruption or gold chain
32
What is this dental anomaly?
Dentinogenesis imperfecta
33
What is the treatment for this lesion in permanent dentition?
Stepwise caries removal and restore
34
What is this dental anomaly?
Dentinogenesis imperfecta
35
What is avulsion?
Complete loss of a tooth as a result of trauma
36
What is an unsafe dose of fluoride? (requires hospital admission)
5mg/kg of body weight
37
What is the treatment for root fractures in the apical or middle third?
● If displaced, reposition the coronal fragment as soon as possible
● Check positioning radiographically
● Stabilise with a passive flexible splint for 4 WEEKS
● RCT coronal section if pulp necrosis occurs
38
What is this dental anomaly?
Turner's tooth
39
What is this dental anomaly?
Amelogenesis Imperfecta
40
What is the pain diagnosis for these symptoms:
● Spontaneous pain (wakes child up at night)
● Does not resolve on removal or stimulus
● Pain to hot/cold
● Does not resolve with placement of temporary dressing
Irreversible pulpitis
41
What should you give a patient that has had 1-5mg/kg of fluoride?
milk
42
What is the treatment for this lesion in permanent dentition?
Stepwise caries removal and restore
43
What is the treatment for dental abscesses in cooperative children?
Primary teeth: XLA or pulp therapy
Permanent teeth: RCT or XLA
44
What is the treatment for enamel-dentine-pulp fractures in immature teeth?
● Partial pulpotomy
● Pulp capping
45
What are the symptoms of reversible pulpitis?
● Pain to cold/sweet
● Tooth not TTP
● Resolves on removal of stimulus
● Tooth difficult to localise
46
What is the pain diagnosis for these symptoms:
● Spontaneous pain (wakes the child at night)
● Tooth mobile and TTP
● Swelling
● Malaise (general feeling of unwell)
Dental abscess
47
What is this dental anomaly?
Talon cusp
48
What teeth are normally effected by bottle induced caries?
upper As but Ds may also be affected
49
What age can you prescribe 2800ppm fluoride toothpaste?
10 + years old
50
What is this dental anomaly?
Amelogenesis Imperfecta
51
What are the different types of double teeth?
Germination (two crowns, one bud); fusion (two tooth germs form one large crown)
52
How long do you splint for alveolar fractures?
4 Weeks
53
What is the prevalence of MIH?
affects 1 in 4 children worldwide
54
When will deciduous mandibular first molars erupt?
12-16months
55
When do the permanent maxillary lateral incisors erupt?
8-9years
56
What medical condition common in children contraindicates fluoride varnish and why?
Asthmatics (due to potential allergic reaction to colophony)
57
What dentition are most likely to be effected by microdontia?
upper laterals
58
What permanent teeth do you expect to be present in an 11 year old?
upper: 1s, 2s, 3s?, 4s, 5s?, 6s
lower: 1s, 2s, 3s, 4s, 5s?, 6s,
59
When do the permanent maxillary 5s erupt?
10-12years
60
When will deciduous mandibular centrals erupt?
6-10months
61
When do the permanent mandibular 6s erupt?
6-7years
62
What is the treatment for double teeth?
fissure sealants to prevent caries in the abnormal anatomy
63
What is the pain diagnosis for these symptoms:
● Pain to cold/sweet
● Tooth not TTP
● Resolves on removal of stimulus
● Tooth difficult to localise
Reversible pulpitis
64
What length of extraoral dry time for an avulsed tooth do you assume the PDL is non-viable?
30 mins
Kept in a solution = <60mins
65
When is root formation complete for primary teeth?
12-18 months post eruption
66
What is the primary treatment option for bottle induced caries?
advice
67
What is the treatment for enamel-dentine-pulp fractures in mature teeth?
● Conservative pulp treatment (i.e. partial pulpotomy)
● Non-setting calcium hydroxide lining
● If posts are required, RCT is the preferred treatment
● If the tooth fragment is available, it can be bonded back to the tooth (rehydrate the fragment first in either water or saline for 20 minutes)
● In the absence of the fragment, cover the exposed pulp with GI or composite
68
How long is the splint time for root fractures in the apical or middle third?
4 weeks
69
When will deciduous maxillary laterals erupt?
9-13months
70
What is the prevalence of dentinogenesis imperfecta?
1:8k
71
What is the treatment for this lesion in permanent dentition?
Selective or complete caries removal
72
When do the permanent mandibular central incisors erupt?
6-7years
73
When do the permanent maxillary central incisors erupt?
7-8years
74
What is the lethal dose of fluoride?
32-64mg/kg of body weight
75
What are the most common missing teeth (in order)? (4)
in order: 8s, lower 5s, upper 2s, upper 5s
76
When will deciduous maxillary first molars erupt?
12-16months
77
What advice do you give for a child 3-6 years old with normal caries risk?
2x daily supervised brushing
- pea sized (minimum 1350ppm)
- spit don't rinse
78
What is the treatment for this lesion in primary dentition?
Fissure seal or site-specific prevention
79
What is specific about the LA you use when treating alveolar fractures?
You ideally don't want it to be a vasoconstrictor
80
What teeth do you expect to be present in a 13 year old child?
All permanent dentition other than 8s
81
What is the main issue with dens in dente?
can result in an area of caries and is difficult to treat endodontically
82
What is the treatment for this lesion in primary dentition?
Selective caries removal (preferred) or hall crown
83
How long do you splint for lateral luxation?
4 weeks
84
What is dens in dente?
a tooth within a tooth - when a localised area of the crown is folded inwards
85
What is a flexible splint?
Flexible splint is when there is one uninjured tooth on either side of the trauma
86
Ideally within what time frame should an avulsed tooth be replanted?
Within 15 minutes
87
What is this dental anomaly?
MIH
88
What age can you place amalgam in a mouth?
15 years old
89
What is the treatment for enamel-only fractures?
● If the tooth fragment is available, it can be bonded back to the tooth
● If fracture is minor, edges can be smoothed
● Composite resin placed
90
When do the permanent maxillary canines erupt?
11-12years (but begin palpating at 9years)
91
What is the colour of dentinogenesis imperfecta in primary teeth?
amber
92
What type of trauma is this?
Extrusive luxation
93
What is the treatment for irreversible pulpitis in precooperative children?
Primary teeth: refer for XGA of sedation
Permanent teeth: RCT or extraction, refer
94
What do you do if a patient comes in with an avulsed tooth?
1. clean tooth with milk or HBSS, clean socket with saline
2. LA, place and check positioning
3. splint for 2 weeks
4. suture if needed
5. RCT 2 weeks after reimplantation
6. Antibiotics
7. Check tetanus status
95
When is the crown completed for permanent teeth?
3-5 years before eruption
96
What is the treatment for intrusive luxation in mature teeth with 3-7mm displacement?
● Reposition surgically
- Flexible splint for 4 WEEKS
● Pulp almost always becomes necrotic, appropriate RCT 2 weeks after injury
97
What will a patient that has had more than 5mg/kg of fluoride need?
gastric leverage
98
When do the permanent mandibular 7s erupt?
11-13years
99
What is the treatment for alveolar fractures?
● Reposition any displaced segment
● Check reposition radiographically
● Stabilise with flexible splint for 4 WEEKS
100
What are the three types of dentinogenesis imperfecta?
Type I (associated with osteogenesis imperfecta)
Type II (DI on its own)
Type III (Brandywine isolate)
101
How long do you splint for with extrusive luxation?
2 weeks unless there is break down/fracture of the marginal bone - then its 4 weeks
102
Why do you not RCT deciduous dentition?
their roots resorb
103
How long do you splint an avulsed tooth?
2 weeks
If alveolar fractures are involved, 4 weeks
104
What advice do you give a patient after avulsion?
● Avoid contact sports
● Soft diet for 2 weeks
● Brush teeth with soft toothbrush after each meal
● Use chlorhexidine mouthwash (0.12%) twice a day for 2 weeks
105
What is this dental anomaly?
Dental fluorosis
106
What advice do you give for a child under 3 years old with normal caries risk?
Brush teeth 2x daily once erupted with toothpaste
- smear (minimum 1000ppm)
107
What is this dental anomaly?
Microdontia
108
How many canals do maxillary Ds have?
3
109
What is the treatment for enamel-dentine fractures?
● If fragment is available and intact, you can bond it back to the tooth (rehydrate the fragment first in either water or saline for 20 minutes)
● Cover the exposed dentine with GI or composite
● If the exposed dentine is within 0.5mm of the dental pulp (pink but no bleeding), place a calcium hydroxide lining and cover with a material such as GI
110
Give me the basic steps of a pulpmotomy
1. LA
2. rubberdam
3. access
4. remove contents of pulp chamber
5. wash with 3 in 1 (no air)
6. cotton wool with ferric sulphate (for bleeding)
7. zinc oxide eugenol cement
8. SSC
111
How often do you apply fluoride varnish for a child with a high caries risk?
4x yearly
112
What is this dental anomaly?
Macrodontia
113
what it this type of trauma?
Lateral luxation
114
How many canals do mandibular Ds have?
2 (mesial and distal)
115
What permanent teeth would you expect to see in a 9 year old?
upper: 1s, 2s, 6s
lower: 1s, 2s, 3s?, 6s
116
What are the distinctive dental features of cleidocranial dysostosis? (3)
- delayed loss of primary teeth
- delayed/failed eruption
- supernumerary teeth
117
What is this dental anomaly?
MIH
118
What is stepwise caries removal?
When the carious tissue is first removed until soft dentin is reached and then a temporary restoration is placed. Months later, the restoration and carious tissue are removed until firm dentin is reached and a permanent restoration is then placed
119
Why is interproximal caries common in children but difficult to see clinically?
they have broad, flat contact points
120
What teeth would you expect to see in a 7 year old?
Deciduous: upper B-E; lower C-E
Permanent: upper 1+6s; lower 1+2+6s
121
How often do you apply fluoride varnish for a patient aged 0-6 years old with a standard caries risk?
2x yearly
122
What type of wire are splints made from?
0.4mm stainless steel wire
123
What is extrusive luxation?
when there is displacement of the tooth out of its socket in an incisal/axial direction
124
What are the 7 main caries risks to go over in an assessment?
● Diet
● Oral hygiene/plaque
● Fluoride use
● Social history (especially socio-economic status)
● Medical history
● Saliva
● Previous disease
125
What is the safe dose of fluoride?
1mg/kg of body weight
126
What is the treatment for this lesion in primary dentition?
Hall crown (preferred) or selective caries removal
127
How many canals do mandibular Es have?
2 (mesial and distal)
128
If both Ds and Es are needing hall crowns, which do you do first and why?
Es because they have a much easier morphology and it helps ease the patient into treatment and they are also going to be in the mouth longer
129
At what age are you not to put amalgams in?
anyone 15 years old and under
130
What are the symptoms of irreversible pulpitis?
● Spontaneous pain (wakes child up at night)
● Does not resolve on removal or stimulus
● Pain to hot/cold
● Does not resolve with placement of temporary dressing
131
What is the treatment for irreversible pulpitis in cooperative children?
Primary teeth: XLA or pulp therapy
Permanent teeth: RCT or XLA
132
What is the main treatment for dentinogenesis imperfecta in molars?
Cast restorations on occlusal surfaces as it protects from wear
133
When do the permanent mandibular 4s erupt?
10-12years
134
What BPE measurements do you do on children aged 12-17 years?
codes 0-4 for only 6s and 1s
135
What is lateral luxation?
When there is displacement of the tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall or facial cortical bone
136
What is the treatment for extrusive lucation?
● Reposition the tooth by gently pushing it back into the tooth socket under LA
● Flexible splint for 2 WEEKS
- If there is breakdown/fracture of the marginal bone, splint for 4 weeks
● Monitor the pulp and if it becomes necrotic, RCT
137
What do you do if a patient comes in after an avulsion but the tooth has been replanted prior?
1. clean the area with saline, water or chlorhexidine
2. check and correct the positioning
3. splint for 2 weeks
4. suture if needed
5. RCT 2 weeks after reimplantation
6. Antibiotics
7. Check tetanus status
138
How often should you review a child who is a high caries risk?
3/4monthly
139
What is the treatment for hypodontia?
space closure or space opening (for prosthesis) - refer/discuss with ortho, paeds and restorative specialists
140
When will deciduous mandibular canines erupt?
16-24months
141
What is Turner's tooth?
an underdevelopment in enamel from a disturbance in the enamel and dentine formation (allegedly infection around deciduous tooth and effects successional tooth)
142
What is concussion in regards to periodontal injuries?
Trauma that has caused bruising (normal mobility)
143
What are the symptoms for a dental abscess?
● Spontaneous pain (wakes the child at night)
● Tooth mobile and TTP
● Swelling
● Malaise (general feeling of unwell)
144
What is the treatment for this lesion in permanent dentition?
Selective or complete caries removal and restore
145
What is the prevelance of amelogenesis imperfecta?
1:700-4000
146
When will deciduous maxillary second molars erupt?
24-32months
147
When will deciduous mandibular second molars erupt?
24-32months
148
What is the normal ppm of fluoride varnish?
22600ppm
149
What is the prevelance of hypodontia?
less than 1% in primary dentition and 3-6% in permanent dentition
150
What is the treatment for this lesion in permanent dentition?
Fissure sealants or composite; seal remaining fissures
151
What are the simplest classifications of amelogenesis imperfecta?(2)
hypomineralised (full thickness but weaker - impaired bond strength) and hypoplastic enamel (thin but normal strength enamel)
152
When do the permanent maxillary 7s erupt?
12-13years
153
When extracting 6s, what do you ideal want to wait until?
The bifurcation had formed radiographically on the 7s (boxer short stage)
154
What endodontic anomaly is common in dentinogenesis imperfecta?
pulp canal obliteration
155
What are the main syndromes linked with hypodontia?(3)
- trisomy 21 (down syndrome)
- ectodermal dysplasia
- mutations in the MSX1 gene
156
What is the main treatment for dentinogenesis imperfecta in anteriors?
veneers - aesthetics and protects from wear
157
What teeth would you expect to see present in a 24month old?
Upper and lower: As, Bs, Cs, Ds
(Es may have began to erupt)
158
What is the treatment for root fractures of the coronal 1/3?
● If displaced, reposition the coronal fragment as soon as possible
● Check positioning radiographically
● Stabilise with a passive flexible splint for 4 MONTHS
● RCT coronal section if pulp necrosis occurs
159
When do the permanent mandibular lateral incisors erupt?
7-8years
160
When do the permanent mandibular 3s erupt?
9-10years
161
What pathological issues are common with dentinogenesis imperfecta?
spontaneous abscesses
162
What are the ideal solutions to place an avulsed tooth in?
Starting with best: milk, HBSS, saliva, saline
163
What is the treatment for intrusive luxation in immature teeth?
● Allow for re-eruption without intervention
● If no eruption within 4 weeks, initial orthodontic repositioning
● Monitor pulp condition
164
At what age do you do a BPE as normal?
18+ years
165
What is the treatment for lateral luxation?
● Reposition the tooth gently by disengaging it from its ‘locked’ position under LA
● Flexible splint for 4 WEEKS
● Monitor the pulp and if it becomes necrotic, RCT
166
What is Gillick Competency?
When a young person under 16 has the capacity to make an informed decision and consent to treatment
167
What permanent teeth do you expect to be present in a 10 year old?
Upper: 1s, 2, 4s?, 6s
Lower: 1s, 2s, 3s, 4s?, 6s
168
What is subluxation?
When the tooth is loosened but not displaced
169
What are the main clinical problems associated with dentinogenesis imperfecta?(6)
- aesthetics
- chipping/attrition of enamel
- exposure of dentine
- poor OH
- gingivitis
- caries
170
What BPE measurements do you use for children aged 7-11years old?
codes 0-2 for only 6s and 1s
171
What do patients with MIH usually come in complaining of?
breakdown off teeth, sensitivity, aesthetic concerns or failed restorations
172
What is turners tooth?
Turner's Tooth, also called enamel hypoplasia, is a condition that reduces a tooth's enamel thickness, increases tooth sensitivity, leaves the affected tooth more susceptible to decay, and results in an unsightly appearance
173
When would you consider sealing all 7s on eruption?
if more than one 6 displays caries
174
What is the treatment for dental abscesses in pre-cooperative children?
Primary: refer for XGA or sedation
Permanent RCT or XLA, refer
175
How often do you take bitewings on a child?
Low caries risk = 2 year bitewings
High caries risk = 6 month bitewings
176
What is this dental anomaly?
Dens in dente
