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BDS4 CDS Ortho > SCR - Ortho/Paeds Question > Flashcards

SCR - Ortho/Paeds Question Flashcards

1
Q

What problems are associated with leaving anterior crossbites untreated ?

A

Toothwear, gingival recession, displacement on closure.

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2
Q

What problems are associated with leaving posterior crossbites untreated ?

A

Displacement on closure, toothwear, facial asymmetry, eruption of permanent dentition into displaced ICP position, TMJ problems.

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3
Q

What problems are associated with leaving an increased OJ untreated ?

A

Increased risk of trauma, aesthetics (psychosocial problems and teasing).

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4
Q

What problems are associated with leaving a reverse OJ untreated ?

A

Displacement on closure, incisal edge wear, difficulty incising foods, speech.

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5
Q

What problems are associated with leaving a deep OB untreated ?

A

Gingival stripping, palatal ulceration.

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6
Q

What problems are associated with leaving digit sucking habits untreated ?

A

AOB, reduced OB, proclined uppers, retroclined lowers, increased OJ, posterior crossbite.

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7
Q

What problems are associated with leaving supernumerary teeth untreated ?

A

Impede eruption of associated teeth, displaced eruption of adjacent teeth, poor aesthetics, damage to adjacent teeth.

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8
Q

What problems are associated with early loss of primary teeth ?

A

Space loss, upper and lower inherent crowding, impaction of permanent successor.

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9
Q

What problems are associated with impacted FPMs ?

A

Pulpitis of E and premature exfoliation of E.

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10
Q

What are the management options for correcting an anterior crossbite ?

A

URA - Adams clasps on 6s and 4s and Z-spring and posterior bite plane.
2x4 fixed appliance.

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11
Q

What occlusal features are favourable for correcting an anterior crossbite ?

A

Palatal tipped tooth in crossbite, good OB, adequate space to move forward.

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12
Q

What are the management options for correcting a posterior crossbite ?

A

URA.
Rapid maxillary expansion screw.
Quad helix (fixed appliance).

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13
Q

What are the skeletal, dental and soft tissue aetiological features of an increased OJ ?

A

Skeletal - Class II SB, mandibular deficiency.
Dental - U incisor proclination, L incisor retroclination.
Soft tissue - lower lip trap, hyperactive lower lip.
Digit sucking habit.

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14
Q

What are the management options for correcting an increased OJ ?

A

URA - Adams clasps on 6s and Robert’s retractor.
Growth modification - headgear, twinblock, Frankel II.

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15
Q

What is the aim of growth modification in the correction of an increased OJ ?

A

Enhance mandibular growth, restrain maxillary growth, remodel glenoid fossa, retrocline upper incisors, distalise upper molars, mesialise lower molars.

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16
Q

What are the skeletal and dental aetiological features of a reverse OJ ?

A

Skeletal - Class III, hypoplastic maxilla, prognathic mandible.
Dental - mandibular displacement, retained upper deciduous incisors.

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17
Q

What are the management options for correcting a reverse OJ ?

A

URA - proclined upper incisors.
Growth modification - chin cup, reverse twin block, protraction headgear.

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18
Q

What are the aetiological features of the malocclusion developed from a digit sucking habit ?

A

Prevention of eruption of incisors, lowering tongue position, unopposed buccinator pressure on upper buccal surfaces.

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19
Q

What are the management options for correcting a digit sucking habit ?

A

Positive reinforcement.
Encourage cessation at home - nail varnish, plasters, gloves.
Habit breaker appliance - removable or fixed - expansion screw, goal post.

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20
Q

What is the management option for managing a deep OB ?

A

URA with FABP - allows passive eruption of molars and increase in OVD.

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21
Q

What are the features of a conical supernumerary tooth ?

A

Close to midline, usually 1 or 2 in number, don’t prevent eruption but can displace centrals.

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22
Q

How are conical supernumerary teeth usually managed ?

A

If erupt or impede tooth eruption - extract.
Wait 12 months if spontaneous eruption of permanent tooth.
If not, +/- surgical exposure of central with orthodontic traction.

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23
Q

How are tuberculate supernumerary teeth usually managed ?

A

Extraction - wait 12 months if spontaneous eruption of permanent tooth.
If not, +/- surgical exposure of central with orthodontic traction.

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24
Q

How are supplemental supernumerary teeth usually managed ?

A

Extract either supplemental or tooth - depending on tooth form, quality and position.

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25
Q

How are odontome supernumerary teeth usually managed ?

A

Left in situ.

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26
Q

What are the features of a tuberculate supernumerary tooth ?

A

Barrel shaped, causes failure of eruption of dental incisors, develop palatal to incisors.

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27
Q

What are the features of a supplemental supernumerary tooth ?

A

Normal tooth morphology, normally erupt.

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28
Q

What are the two forms of odontome ?
Where are they most common ?

A

Compound - normal organisation of dental tissue, anterior maxilla.
Complex - disorganised mass, posterior mandible.

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29
Q

What jaw are supernumeraries more commonly found ?

A

Maxilla 2% incidence in permanent dentition.

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30
Q

What gender are supernumeraries more common in ?

A

Males.

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31
Q

What medical conditions are associated with supernumeraries ?

A

CLP and cleidocranial dysotosis.

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32
Q

What is the most common cause of failure of eruption of U1 and 10% of diastemas ?

A

Supernumeraries.
Also - trauma to primary dentition causing dilaceration of permanent tooth or pathology.
Congenital absence of central incisors is rare.

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33
Q

How should you manage early loss of A’s and B’s as a result of caries ?

A

Do not require compensation or balancing - rarely affect midline.

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34
Q

How should you manage early loss of C’s as a result of caries ?

A

Balance to maintain centre line, do not require compensation.

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35
Q

How should you manage early loss of D’s and E’s as a result of caries ?

A

Space maintainence, little effect on centreline and no need to balance (only if under GA).

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36
Q

When is the best time to extract FPMs for spontaneous closure of 5-7’s ?

A

Calcification of bifurcation of 7s (8-9 years old).

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37
Q

You have to extract a patient’s upper FPM - do you balance or compensate ?

A

No.

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38
Q

You have to extract a patient’s lower FPM - do you balance or compensate ?

A

Compensate and balance if crowded.
Can balance with premolar on opposite side of the arch depending on requirement of space.

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39
Q

What guidelines are available for management of extractions of FPMs ?

A

RCS (2009) Clinical Effectiveness Committee

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40
Q

What is the consequence of early loss of mandibular FPMs ?

A

Distal migration of second premolar.

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41
Q

What is the consequence of late loss of mandibular FPMs ?

A

Poor spontaneous closure, mesial tipping and lingual rolling of 7.

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42
Q

What is the consequence of early loss of maxillary FPMs ?

A

Better space closure.
Use space maintainer or delay XLA if space required for ortho.

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43
Q

What are the aetiological features of impacted FPMs ?

A

Angle of eruption, ectopic crypt, morphology of E crown, small maxilla.

44
Q

What are the treatment options for managing impacted FPMs ?

A

Active observation - 66% disimpact.
XLA of E - regain space for premolar and treat crowding at later stage.
Disimpact - separators, band E and bracket with open coil.
Distal disking of e.
URA with finger spring.

45
Q

What is the cause of infraocclusion of primary molars ?

A

Temporary ankylosis.

46
Q

What teeth are most commonly affected by primary molar infraocclusion ?

A

D

47
Q

What are the signs of ankylosis of a primary molar ?

A

Percussion note, blurring or absence of PDL on radiograph.

48
Q

What two factors will influence the management of an infraoccluding primary molar ?

A

Presence of permanent successor and degree of infraocclusion.

49
Q

What teeth are most commonly affected by hypodontia ?

A

Lower 5s, upper 2s, upper 5s.

50
Q

How should a patient with hypodontia be managed ?

A

Refer as soon as possible.
Restorative treatment alone - composite build ups.
Early orthodontics to improve aesthetics - diastema.
Extraction of b’s.

51
Q

Define interceptive orthodontics.

A

Any procedure that will reduce or eliminate severity of developing malocclusion.

52
Q

How many mm diastema should close spontaneously ?

A

2.5mm

53
Q

On intra-oral assessment of a patient with delayed eruption of central incisors - what should you check ?

A

Palpate labially and palatally.
Is primary mobile ?
Is primary discoloured ?

54
Q

What is a balancing extraction ? What is the aim of this ?

A

Removal of tooth from the opposite side of the arch.
Aims to maintain position of centreline and symmetry.

55
Q

What is a compensating extraction ? What is the aim of this ?

A

Removal of tooth in opposing quadrant.
Aims to maintain buccal occlusion.

56
Q

Describe a removal space maintainer.

A

Adams clasp UR6 and UL6 (0.7mm HSSW).
Labial bow UR3 to UL3 (0.7mm HSSW) OR Southend clasp.
Baseplate - extend acrylic around teeth to prevent drift.
+/- mesial stop (0.6mm HSSW).

57
Q

Describe a fixed space maintainer.

A

Band and loop.
Palatal and lingual arches.

58
Q

At what age should you refer a patient if you have any doubts about the prognosis of the 6s ?

A

8-9 years old.

59
Q

On extraction of permanent 6s, what is the most ideal occlusion for successful eruption ?

A

Calcification of bifurcation of 7s.
8s present.
Class 1 average/reduced OB.
Moderate lower crowding.
Mild/moderate upper crowding.

60
Q

Your patient has an anterior Xbite, what should you check on oral examination ?

A

Mandibular displacement, mobility of lowers, toothwear, gingival recession.

61
Q

What is the risk of relapse of a posterior Xbite ?

A

50%

62
Q

What two factors will reduce the risk of relapse of a anterior Xbite ?

A

OB and growth.

63
Q

At what age of stopping a digit sucking habit, do you have the greatest degree of spontaneous correction of malocclusion ?

A

9-10 years old.

64
Q

When does calcification of permanent maxillary and mandibular central incisor occur ?

A

3-4 months.

65
Q

When does calcification of permanent lateral incisors occur ?

A

Maxilla 1 year.
Mandible 3-4 months.

66
Q

When does calcification of permanent maxillary and mandibular canine occur ?

A

4-5 months.

67
Q

When does calcification of permanent first premolars occur ?

A

6 months to 2 years - maxilla before mandible.

68
Q

When does calcification of permanent second premolar occur ?

A

2-3 years old - maxilla before mandible.

69
Q

When does calcification of permanent maxillary and mandibular first molar occur ?

A

0-1 months.

70
Q

When does calcification of permanent maxillary and mandibular second molar occur ?

A

2.5-3 years old.

71
Q

What is the prime age for interceptive extraction of the c for an ectopic canine is ?

A

10-13 years old.

72
Q

By what age if the dental follicle of the third molars is not present are you unlikely to have them ?

A

11 years old.

73
Q

How long after tooth eruption should completion of root formation occur in permanent dentition ?

A

3 years.

74
Q

How long after tooth eruption should completion of root formation occur in primary dentition ?

A

1.5 years.

75
Q

By what age should primary dentition be fully erupted by ?

A

2.5-3 years old.

76
Q

What is the sequence of eruption of maxillary permanent teeth ?

A

6 1 2 4 5 3 7 8

77
Q

What is the sequence of eruption of mandibular permanent teeth ?

A

6 1 2 3 4 5 7 8

78
Q

Between what ages is your mixed dentition phase ?

A

6-11 years old.

79
Q

How to manage reversible pulpitis in a child ?

A

Restore - restoration or MCC.

80
Q

How to manage irreversible pulpitis in pre-cooperative child ?

A

Temporise with ZOE (Odontopaste - corticosteroid and antibiotic).
If primary tooth - refer for XLA.
If permanent tooth - RCT or XLA referral for specialist.

81
Q

How to manage irreversible pulpitis in cooperative child ?

A

If primary tooth - XLA or pulp therapy.
If permanent tooth - XLA or RCT in GP.
Temporise with ZOE (Odontopaste - corticosteroid and antibiotic) if required.

82
Q

How to manage PA periodontitis or PA abscess in pre-cooperative child ?

A

Primary - refer for XLA.
Permanent - refer for XLA or RCT.

83
Q

How to manage PA periodontitis or PA abscess in cooperative child ?

A

Primary - XLA or pulp therapy.
Permanent - XLA or RCT in GP.

84
Q

What antibiotic can be prescribed to child for management of spreading odontogenic infection ?

A

PenV -
6-12 years old - 250mg 4x daily 5 days.
12+ years old - 500mg 4x daily 5 days.

85
Q

What are the five components of caries prevention for low caries risk children ?

A

1450ppmF toothpaste - smear <3s and pea-sized amount >3s.
Fluoride varnish application 2x annually.
3 min toothbrushing OHI annually + diet advice.
FS on all molars (RMGI) once fully erupted.
Recall period - 6 monthly.

86
Q

What are the five components of caries prevention for high caries risk children ?

A

1450ppmF toothpaste - smear <3s and pea-sized amount >3s.
Consider 2800ppmF toothpaste for over 10 years old.
Fluoride varnish application 4x annually.
3 min toothbrushing OHI and diet advice at every recall appt.
Temp GI FS on erupting teeth, RMGI on fully erupted teeth.
Recall period - 3 monthly.

87
Q

What are the three contraindications for fluoride varnish application (Duraphat) ?

A

Severe asthma hospitalised in past 12 months.
Severe allergy hospitalised in past 12 months.
Under 2s.

88
Q

When would it be appropriate to opt for non-restorative cavity control as a treatment option for a primary tooth ?

A

Unrestorable or asymptomatic.
Close to exfoliation.

89
Q

What are contraindications for Hall technique ?

A

Pulpal involvement or PA radiolucency.

90
Q

Why are MIH teeth more difficult to anaesthetise ?

A

Chronic inflammation of pulp due to presence of bacterial ingress due to poor enamel quality.

91
Q

What are the six possible differential diagnoses for enamel defects ?

A

Fluorosis - diffuse.
Amelogenesis imperfecta - genetic, both dentitions.
Caries - clear primaries ? Unlikely.
Trauma to primary predecessor - history,
Tetracycline staining - history.
Enamel hypoplasia - localised enamel quantity defect.

92
Q

What are physical signs of dental fear and anxiety ?

A

Breathlessness, sweating, palpitations, nausea.

93
Q

What are cognitive signs of dental fear and anxiety ?

A

Poor concentration, hypervigilance, worry, amnesia.

94
Q

What are behavioural signs of dental fear and anxiety ?

A

Avoidance, aggression.

95
Q

What are some non-pharmalogical behaviour management techniques ?

A

Enhanced control - rest breaks, stop signals.
Preparatory information.
Acclimatisation - staging tx.
Positive non-verbal communication.
Role modelling.
Voice control.
Tell show do.
Positive reinforcement.
Distraction.
CBT.
Hypnosis.

96
Q

What are some pharmalogical behaviour management techniques ?

A

Topical LA - 5% lidocaine gel.
LA - chasing technique, wand.
IV sedation with Propofol - targeted controlled infusion (anaesthetist lead.
IH sedation with nitrous oxide - titration, combined with CBT and hypnotic suggestion.

97
Q

What are the preventative measures for orthodontic decal ?

A

Case selection, fluoridated mouthwash, personalised OHI inc ID brushes, diet advice, regular GDP visits (now HCR so 3 monthly), F varnish application.

98
Q

What are the treatment options for orthodontic decal ?

A

Acid pumice (18% HCl) microabrasion.
Localised composite restorations if cavitated.
Composite wash or veneer.
Vital bleaching.
Porcelain veneer.

99
Q

What are the three options for orthodontic retention ?

A

Thermoplastic retainer.
Fixed retained (HSSW bonded with composite 3-3).
URA - Adams clasp on 6s and labial bow 3-3s.

100
Q

What are two acts which relate to child protection ?

A

Child Protection Scotland 2014.
Children & Young Peoples Act 2014.

101
Q

What are the three types of vulnerable children ?

A

Under 5s, those with medical conditions/disabilities, irregular attenders.

102
Q

Define dental neglect according to British Society of Paediatric Dentistry.

A

Persistent failure to meet child’s OH needs, likely to result in significant impairment of oral/general health and development.

103
Q

What are signs of dental neglect ?

A

Repeated cancellation or FTAs to appointments.
Repeated pain on presentation.
Repeated requirement for GA.
Failure to complete tx or adhere to patient specific dental plan.

104
Q

What is the first stage of handling dental neglect suspicion ?

A

PREVENTATIVE DENTAL TEAM MANAGEMENT
- Raise concerns with parent and offer support.
- Raise concerns with colleague.
- Set targets for parent/child for self care plan.
- Record in notes and monitor progress.

105
Q

What is the second stage of handling dental neglect suspicion ?

A

PREVENTATIVE MULTIAGENCY MANAGEMENT
- Check if child is on child protection register.
- Liaise with school, GP, social worker, nurse.
- Common Assessment Framework used for MDT approach.
- Agree plan of action and review.
- Write letter to health visitor if FTA >5.

106
Q

What is the third stage of handling dental neglect suspicion ?

A

CHILD PROTECTION REFERRAL
- To social services via local guidelines.
- For joint investigation OR nothing with additional support.
- Immediate harm ? Child protection order.

107
Q

You have concerns regarding possible child neglect, who can you speak to for advice on how to manage the situation ?

A

Named person, experienced colleague, child protection adviser, social services, children’s service department.

BDS4 CDS Ortho (7 decks)

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