12/04 Flashcards
Cvek pulpotomy
partial pulpotomy
If pulp exposure larger
cervical pulpotomy
- non setting CaOH
- GI
- Comp
GI
self cure
Primary review
161
1 week
6 months
1 year
Permanent
661
2 weeks splint
SEA
Which must require RCT?
Avulsion
Intrusion
- survival of pulp is low
- OH
- chlorohexidine gluconate 0.12% twice daily for 1 week
- brush with soft toothbrush
- soft diet
- analgesia
- no contact sports
- check tetanus immunisation
- reassurance
- history, any medical issues
- trauma history
- E/O- abuse, no step deformity, haemorrhage
- I/O - no laceration, mobility, transillumination for fracture, SLEUTH
- diagnose
- radiograph?
- emergency tx
Complications can you get after trauma of primary teeth?
- discolouration
- vitality lost
- delayed exfoliation
- infection
Complication of perm tooth
- dilaceration
- delayed eruption
- odontoformation
- enamel defect
- ectopic
- arrested development
Most common in permanent
enamel dentine fracture
yellow
- ## close monitor
pink
- cervical root resorption
- RCT
- bleeding of pulp
grey
- pulp death
- break down of blood product
Factors affect diagnosis
- time between trauma and tx
- PDL damage
- type of injury
- infection
- stage of root development
Follow up of radiograph
- absence of PAP
- absence of furcation/ bone loss
- ideal continued root development
- no radiolucency
- no internal/ external R
Percussion note
dull - root fracture
high metallic - ankylose
Apexification vs Apexogenesis
Apexification - non- vital, open apex, artificial plug
- MTA, Biodentine
Apexogenesis- vital, allow it to grow
On radiograph, how do tell is ERR?
- take 2 PA
- root surface will be ragged
- actually RC is still one straight line
- change in position in parallax
Tramline
- external
- indistinct root surface
Internal
- root surface intact
- tramline not distinct
Tx for dilaceration
- rule out embedded fragments
- ortho repositioning
- suture
SHANARRI
- wellbeing indication
- national practice model
- record information about child
GIRFEC - get it right for every children
- safe
- healthy
- active
- nutured
- achieving
- responsible
- respected
- included
part of GIRFEC
Resilience matrix
GIRFEC
Steps when you suspect child abuse
- talk with dental team; call parents and set appt times; offer support; set target, monitor progress, keep records
- multidisciplinary team (school nurse, social work, senior colleague, health visitor, GMP, GDP) - pt < 5 yrs who has multiple FTA
- child protection referral; check if child if child is in child protection team, follow up in writing for statement of concern
measures you take to prevent child from maltreatment, growing in safe and caring environment and prevent impairement of child
Signs of child abuse
- bruising
- bilateral bruising
- bite marks
- burn marks
- hair pulling
- bruised ears
- bruising of different timelines
- tattoo bruising
- slap marks
Safety Triangle
- ear
- side of face
- neck
- top of shoulders
Intraoral
- tearing of frenum
- lip bruising
- bruising on palate
aetiology of child abuse
- drug use
- alcoholic
- mental health
Role as a GDP about child abuse
- recognise
- referral
- record
Suspicion index of child abuse
- delayed presentation
- previous untreated injury
- delayed in seeking help
- multiple failed attendance
- story doesn’t match up
- story vague
- abnormal interraction between child and parent
Abnormalities in
- microdontia
- hypodontia (DS, CLP, ectodermal dysplasia)
- macrodontia
- germination fusion
- Hyperdontia (CLP, Gardeners)
- Talon cusp
Tooth shape
- dens in dente
- Talon cusp
Manage dens- in dente
- seal pit
Talon cusp management
- selective grinding
- FV
Amelogenesis imperfecta
- congenital
- gene mutation affect enamel ECM molecule including amelogenin, enamalin and KLK4
Types of AI
- hypoplastic
- hypomineralise
- hypomaturation
- mixed with taurodontism
Consequences of AI
- sensitivity
- poor bonding
- susceptible to caries
MIH vs AI
AI - hereditary
MIH - environment
Radiographically for Ai
- opacity
types of DI
- osteogenesis imperfecta
- afro-african
Presentation of DI type 1
- multiple bone fracture
- blue sclera
DI radiograph
- obliterated pulp
- bulbous crown
if pt comes in with enamel defects?
- family history
- any pregnancy trimester issues/ health
- social (malnutrition)
- if mum took any fluoride supplements
- if its a preborn baby
- any chicken pox/ measles
Tx for AI?
- composite veneers
- SSC
- fissure sealant
- metal onlay
- prevention
- ortho to fix openbite
SDF
- silver diamine fluoride
- 38% of 44800 ppm
- arrest caries
- block dentinal tubules
- antibacterial
- remineralisation
Contraindication
- irreversible pulpitis
- allergy to silver, fluoride and ammonia, iodine
- ulcer
- pregnant
- thyroid gland medication/ therapy if potassium iodide in SDF
- cannot involve pulp
Indication
- pre-cooperative pt
- self cleansing
- asymptomatic caries into dentine
- buy time to avoid/ delay GA/ sedation
- buy time for exfoliation
- colophony allergy if cannot use FV
- MIH
Disadvantages
- metallic taste
- temporary tattoo if on mucosa
- expensive
- difficult to diagnose
Review after SDF
- 2-4 weeks
- repeat if caries is still soft
- restore with hall crown/ GIC
Procedure
- vaseline around mucosa
- clean cavity
- gingival mask to isolate
- clean, dry
- apply SDF
- leave for 3 mins
- ## use cotton pellet to absorb excess
If pt has asthma
- reversible airway obstruction and bronchospasms
- blue- salbutamol (reliever, short acting b2 agonist)
- brown - prevent, long acting b2 agonist, cortisosteroid, increase candidiasis risk, use spacer, rinse after use
- if hospitalized in last 12 months
- use colophony free FV, ProFluorid
- need to know trigger
- dry mouth, higher caries risk
- erosion from inhaler if they don’t rinse
- avoid NSAIDS or Ibuprofen- causes bronchospasm
How do you manage asthma attack in hospital setting
- administer 100% O2
- 2 puffs inhaler
- 4 puffs/ min
- call ambulance 999
If unconscious then CPR then call 999
Asthma stages
- life threatening: everything goes down
- acute severe asthma: tachycardia, breathing> 25 breaths/ min
Haemophilia
X- linked recessive
A - factor 8
B - factor 9
Severe- clotting factor < 1%
Moderate 2-5 %
Mild 6-40%
Carrier >50%
Injection- need to do infiltration, cannot do IDB and Lingual infiltration
- liaise with haemophilia team
- if platelet count more than 100x10’9…, then can treat in GDP, provided FBC in less than 10 days
- hospital more than 50
- neutrophil more than 1, can treat tooth; if less than 1, give AB
vWB
autosomal dominant
- lack of vWB factor and f8
Autism
- they don’t like foaming toothpaste, so give Oranurse
- give like adapted toothbrush if they don’t like toothbrush
- quiet environment
- leaflet for them to familiarise with clinic
- ADHD, OCD, Dyslexia, Epilepsy
Cerebral palsy
4 types
- spastic: cortex
- ataxic: cerebellum
- dyskinetic: basal ganglia
- mixed
- Bruxism
- thick saliva
- delayed eruption
- caries
- enamel malformation
Down syndrome
E/O and I/O features
Diabetes type 1 and 2
Medical condition related to congenital heart defect
- DS
- Turner- small jaw, malocclusion, high palatal vault
- William syndrome
- Noonan syndrome
- Kabuki syndrome
Hutchinson’s incisors
- ## syphillis
most common oral cancer
acute lymphomablasmic leukaemia
Behavioural management
- acclimitisation
- tell show do
- ## motivational interviewing
Anxiety vs Dental phobia
dental phobia is avoidance
- behavioural
