Paeds Revision

Question 1

What are the stages of tooth development?

Answer 1

Morphogenesis
Cytodifferentiation
Matrix secretion

Question 2

What is MIH

Answer 2

A multifactorial condition resulting in decreased enamel mineralisation of the permanent molars and incisors.
Normal amount of enamel but decreased quality.

Question 3

When does enamel develop?

Answer 3

In 3rd trimester of pregnancy until 3 years old

Question 5

In MIH, what phase of amelogenesis is affected?

Answer 5

Mineralisation phase

Question 6

When are the enamel matrices of FPM and incisors developed by?

Answer 6

FPM during 1st year of life
incisors by age 2

Question 8

How does MIH present?

Answer 8

Asymmetrical, chalky white/ yellow/ brown marks on permanent molars / incisors

Question 9

What questions to ask mum regarding MIH?

Answer 9

Pre natal - any illnesses during third trimester of pregnancy eg gestational diabetes, pre-eclampsia
Peri natal - was the birth traumatic eg c section
Post natal - any illnesses in the first 3 years of life

Question 10

What are the clinical problems of MIH? (6)

Answer 10

Post eruptive breakdown (dentine exposure and pulp at risk)
Sensitivity (may lead to poor oral hygiene)
Difficulty with bonding due to poor mineralisation
Local anaesthesia problems as pulp is chronically irritated
Behaviour management problems
Aesthetic problems

Question 11

What are the treatment options for MIH?

Answer 11

Enhanced caries prevention
Composite / GIC restorations
Micro-abrasion/ resin infiltration
Crowns / onlays / veneers

Question 12

What is enhanced prevention?

Answer 12

Fluoride varnish 4 x yearly
Toothbrush demonstration at every appointment
Fissure sealant of molars and premolars
Diet advice at every appointment
High fluoride toothpaste (<10 years- 1500ppm / 10-16 years- 2800ppm / >16 years - 5000ppm)
Review every 3 months
Utilise any community/ home support

Question 13

When is best timing for extraction of FPMs?

Answer 13

Calcification of bifurcation of lower 7s
8s present
Mild to moderate crowding

Question 14

What is fluorosis?

Answer 14

Diffuse white opacities without clear boundary associated with the ingestion of fluoride during enamel development
Symmetrical, bilateral pattern
Caries resistant teeth

Question 15

What is the purpose of fluoride varnish?

Answer 15

Minimally invasive treatment in which fluoride varnish is placed on the tooth to promote remineralsiation (hardening of the tooth) and to prevent demineralisation (softening of the tooth)
Involves drying the tooth and place a gel over tooth
Can be applied up to 4 x yearly
Contraindications- severe asthma, colophony allergy
Post op- no eating or drinking for 30 mins

Question 16

What is the management for fluoride toxicity?

Answer 16

5mg/ kg - milk
5-15 mg/ kg - ipecac syrup, milk
>15mg/ kg - hospital referral

Question 17

What is tooth mousse?

Answer 17

Can provide relief of sensitivity
Topical cream (CPP-ACP) - milk derived protein - to strengthen teeth and promote remineralisation of enamel

Question 18

What is primary herpetic gingivostomatitis?

Answer 18

Contagious primary infection caused by herpes simplex virus.
Very common condition, self limiting and will resolve in 7-10 days.
Often presents as blisters on lips/ tongue/ gums/ roof of mouth - after blister pops, ulcers will form.
This can make it sore to swallow/ eat.

Question 19

What is the management of primary herpetic gingivostomatits?

Answer 19

Reassure parents and child
Encourage fluid intake
Analgesia to control pain / fever (calpol)
Suck on ice cubes
Clean teeth with damp cotton roll
Dilute CHX as mouthwash
Antibiotics only recommended if systemically unwell / immunocompromised

Review patient in 2 weeks

Question 20

What antibiotics are prescribed for primary herpetic gingivostomatits ?

Answer 20

Aciclovir 200mg tablets, 1 tablet 5 x daily for 5 days (25 tablets)

Question 21

What is nursing bottle caries?

Answer 21

Pattern of caries associated with baby having bottle of milk over night - affects lingual of upper incisors and lower canines.

Question 22

What is the diet advice for child with nursing bottle caries?

Answer 22

Feeder cup replacing bottle from 6 months old
No on demand breastfeeding
Be aware of hidden sugars in oat milk/ almond milk
Milk and water only between meals
Only water overnight
Assist with toothbrushing

Question 23

What is the management of nursing bottle caries?

Answer 23

Extraction of various teeth (under GA) warn of risks of GA
Fluoride - topical

Question 24

What are the risks of GA?

Answer 24

Common minor risks:
- headache, nausea, vomitting, drowsiness, sore throat from intubation, child upset when waking

Risks from treatment:
- pain, bleeding, bruising, swelling, infection, loss of space, stitches may need to be placed

Major risks:
- 3 in 1 million adverse effects - machine used to help breathe during operation, very small risk wont be able to breathe independently afterwards

Question 25

What is involved in GA assessment appointment?

Answer 25

Treatment planning- with knowledge that this may change on day- any required treatment carried out Consent- written: - all options give - side effects and complications - pre-op fasting - post op arrangements- adult escort with no other children - post op care and pain management

Question 26

What is included in caries risk assessment? (7)

Answer 26

Clinical evidence Diet MH SH Saliva Plaque control Fluoride exposure

Question 27

What are the key elements of prevention? (8)

Answer 27

Radiographs (6 months) Diet advice Tooth brushing Fluoride toothpaste Fluoride supplement Fluoride varnish Fissure sealant Sugar free medication

Question 28

What is included on a trauma stamp?

Answer 28

Colour Sinus TTP Percussion Mobility Radiograph EPT Ethyl chloride

Question 29

What are the indications for hall crown placement?

Answer 29

Early to moderate proximal lesions involving dentine of primary molars with no signs of symptoms of pulpal involvement Radiographically- visible band of normal dentine between lesion and pulp on bite wing

Question 30

What are the contraindications for hallcrown?

Answer 30

Clinical / radio graphic signs of pulpal involvement Insufficient tooth tissue for crown retention Aesthetic concerns Patient cooperation Risk of bacterial endocarditis

Question 31

What are the steps of hall crown placement?

Answer 31

Place separator for 2-7 days Size crown- should cover all cusps, approaches contact point with springiness (almost always size 3/4), do not fully seat Fill with GIC (aquacem) Dry tooth, place crown, ask patient to bite Remove excess cement Ask pt to continue to bite until set

Question 32

What are post op instructions for hall crown?

Answer 32

Tooth and gum may feel uncomfortable when you go home, this will settle Analgesia if necessary