13. Paediatric Dentistry Flashcards
1
Q
Trauma 1
- 2 aims of trauma management in primary dentition
- 2 aims of trauma management in permanent dentition
- 8 components of trauma stamp
- 5 factors that prognosis of injury depends on
A
- Preserve integrity of permanent successor and preserve primary tooth where possible
- Preserve vitality of tooth to allow root maturation and restore crown to prevent occlusal problems
- Sinus/tender in sulcus, TTP, colour, mobility, displacement, EPT, thermal test (ECl), percussion note, radiographs
- Root development stage, injury type, presence of infection, time delay between injury and seeking treatment, PDL damage, age of child, degree of displacement, associated injuries
2
Q
Paeds trauma treatment planning
- 3 types of immediate treatment
- 2 types of initial treatment
- 3 types of permanent treatment
- When to review paeds trauma
A
- Adhesive dentine bandage, treat pulp exposure, remove pain, suture lacerations, reduce teeth
- Pulp treatment, ortho requirements, temporary restoration
- Apexogenesis/apexification, root filling, coronal restorations
- 1wk, 1mth, 3mths, 6mths, 12mths, 18mths, 2yrs,
3
Q
Crown fractures
- 3 types
- Management of E#
- Management of ED#
- 4 things management of EDP# depends on
- 4 management options for EDP#
A
- E#, ED#, EDP#
- Selective grinding or acid etch tip (AET) replacement with composite
- Account for fragment, bond fragment (composite bandage), radiographs, sensibility testing, FU and definitive restoration (6-8wks)
- Size of exposure, delay in seeking treatment, stage of root development, other associated injuries
- Direct pulp cap, partial (Cvek) pulotomy, full coronal pulpotomy, pulpectomy, conventional RCT, extraction
4
Q
EDP# management
- 3 indications for direct pulp cap
- 3 indications for partial pulotomy
- Stages in partial pulpotomy
- 3 indications for full coronal pulpotomy
- Stages in pulpectomy
- 2 management options for EDP# in non-vital tooth (and indications for each)
A
- Vital tooth, open apex, exposure <1mm, injury <24hrs
- Vital tooth, larger exposure (>1mm), injury >24hrs
- LA, dam, enlarge access at exposure site, amputate pulp 2-4mm into healthy pulp tissue, arrest bleeding with saline-soaked cotton wool, evaluate haemostasis, nsCaOH, GIC/composite
- Open apex, exposure >1mm, exposure >24hrs, contaminated exposure, impaired vascularity
- LA, dam, enlarge access at exposure site, remove roof of pulp chamber, extirpate coronal pulp, extirpate radicular pulp (2-3mm short of EWL), irrigation and shaping (CHX not NaOCl), obturation (ZOE, nsCaOH, iodoform paste), GIC, ssPMC
- Conventional RCT, pulpctomy ± apical barrier formation/apexification (MTA), extraction
5
Q
Root #
- 3 types
- 2 factors prognosis depends on
- Management of coronal third root #
- Management of middle third root #
- Management of apical third root #
- Management of vertical root #
- 4 root fracture outcomes
A
- Coronal third, middle third, apical third
- Position of fracture, communication of fracture line with gingival crevice
- Irrigate and reposition, 12wk flex splint. Often requires RCT/extraction (if obvious communication)
- Irrigate and reposition, 4wk flex splint. Often requires RCT to fracture line
- Irrigate, reposition, 4wk flex splint
- Often XLA
- Favourable - calcified tissue union across fracture line, CT union across fracture line, calcified and CT union
Unfavourable - granulation tissue, usually associated with loss of vitality
6
Q
CR#
- 5 management options for CR# in permanent teeth
- How should CR# of primary tooth be managed
A
- Remove fragment and restore, ortho extrusion of apical portion, surgical extrusion, decoronation, extraction
- Remove coronal fragments and obvious apical fragments (apical fragment can be left to resorb)
7
Q
Primary trauma associated injuries
Describe how you would manage the following in the primary dentition:
- Concussion
- Subluxation
- Lateral luxation
- Extrusion
- Intrusion
- Avulsion
- Alveolar bone fracture
A
- Observe only
- Observe only
- Extract if occlusal interference; allow to reposition spontaneously if no occlusal interference
- Extract
- Parallax - if towards developing permanent tooth (lingual) then extract; if not (buccal) then leave to re-erupt. If no progress after 6/12, XLA
- Radiograph to confirm, do not replants
- Reposition, 4wk flex splint
8
Q
Primary trauma sequelae
- List 4 post-trauma complications that can occur after primary trauma that affects primary teeth
- List 7 post-trauma complications that can occur after primary trauma that affects the permanent successor
A
- Discolouration, discolouration and infection, discolouration associated loss of vitality, delayed exfoliation
- Enamel defects, delayed eruption, odontome formation, abnormal tooth/root morphology, ectopic tooth position, arrest of tooth formation, complete failure to form
9
Q
Permanent trauma associated injuries
Describe how you would manage the following in the primary dentition:
- Concussion
- Subluxation
- Lateral luxation
- Extrusion
- Intrusion
- Avulsion
- Alveolar bone fracture
- What does repositioning for intrusion injuries depend upon
- Give 2 prevention methods for dental trauma
- Describe first aid advice for an avulsed tooth
A
- Monitor and review
- 2wk flex splint
- Reposition, 4wk flex splint
- Reposition, 2wk flex splint
- If open apex - <7mm allow to reposition spontaneously; >7mm - surgical/ortho alignment
If closed apex - <3mm allow to reposition spontaneously; 3-7mm ortho/surgical alignment; >7mm - surgical alignment - Replant where possible, 2 or 4wk flex splint
- Reposition, 4wk flex splint
- Stage of root development (maturity of tooth)
- Interceptive ortho if OJ >9mm, mouthguard for contact sports
- Ask if primary/permanent (age of child, what tooth) - if primary then leave; if permanent, handle by crown only, wash off obvious debris, replant immediately and bite on cotton wool/tissue or store in saliva/milk/saline/buccal sulcus if can’t replant, seek immediate dental treatment
10
Q
Replantation
- Give 3 key features that replantation in cases of avulsion depends upon
- Give 4 contraindications for replantation after avulsion
- What do EAT and EADT mean and what should they be if considering replantation
- Give 4 types of periodontal healing outcomes post-replantation
- Give 3 types of pulpal healing outcomes post-replantation
A
- EAT, EADT, storage medium, pulp viability, time delay in seeking treatment
- Very immature tooth with EAT >90mins, immunocompromised child, immature lower incisors, other more serious/concerning injuries that required treatment
- Extra-alveolar time - time out of socket - ideally <60mins
Extra-alveolar dry time - time out of mouth - ideally <30mins - Regeneration, PDL/cemental healing, bony healing (ankylosis), uncontrolled infection
- Regeneration, controlled necrosis, uncontrolled infection
11
Q
Resorption
- List 4 types of resorption and describe them
A
- External surface - non-progressive. Due to damage to PDL which heals
External inflammatory - progressive. Initial damage to PDL, maintained by necrotic pulp. RCT required
External replacement - ankylosis. Initiated by severe PDL and cementum damage, normal repair doensn’t occur. Progressive, bone fuses to dentine
Internal inflammatory - progressive, initiated by non-vital pulp. Extirpation and nsCaOH required
12
Q
Growth and Development
- Give 3 dental features at birth
- Briefly describe the normal feeding development
- Describe how to perform a knee-to-knee exam
A
- Class II, few/no teeth, tongue resting on lower gum pad in contact with lower lip, widely separated gum pads (upper rounded, lower horseshoe)
- 0-3mths - liquid diet, rhythmic sucking
4-6mths - munching, more suck/swallow control
7-9mths - semi-solid diet, mashed, bite, upper lip involvement, chewing, bolus formation
10-12mths - solid diet, active lip closure, cup drinking, sustained bite
24mths - mature and integrated feeding pattern - Sit opposite parent, knee-to-knee, baby faces parent, lowered onto dentist knee, dentist takes control of head, parent controls arms and legs
13
Q
Tooth Development
- Give 4 morphological features of primary teeth that distinguishes them from permanent teeth
- Describe the eruption pattern and eruption dates of primary teeth
- What is the Leeway space and what is the ideal Leeway space
- What is the definition of the mixed dentition
- Describe the eruption pattern and eruption dates of permanent teeth
A
- Thinner enamel, larger pulp horns, broad contact points/areas, bulbous crowns, cervical constriction
2. A, B, D, C, E Central incisor - 4-6mths Lateral incisor - 7-16mths First primary molar - 13-19mths Canine - 16-22mths Second primary molar 15-33mths
- The extra mesio-distal space occupied by primary molars which are wider than the permanent premolars that will replace them. Ideally 1.5mm upper and 2.5mm lower
- From when the first permanent tooth erupts until the last primary tooth exfoliates
5. 6, 1, 2, 4, 5, 3, 7, (8) Central incisor - 6-7yrs old Lateral incisor - 7-8yrs old Canine - 9-11yrs old First premolar - 10-11yrs old Second premolar - 10-12yrs old First molar - 6-7yrs old Second molar - 12-13yrs old
14
Q
Caries Management 1
- What are 3 aims of paeds dentistry
- Give 4 methods of caries detection
- Give 8 classifications of caries
A
- Develop and maintain an intact healthy, functional and aesthetic primary and permanent dentition (as few restored teeth as possible), free from pain and infection (no active caries), positive attitude towards future dental care
- Direct vision (good light, dry tooth), BW radiographs, FOTI, temporary tooth separation (orthodontic separators)
- Decalcification, pit and fissure, smooth surface, approximate, ECC, recurrent/secondary, arrested, rampant/widespread gross
15
Q
Caries Management 2
- List the components involved in caries risk assessment
- List the components involved in caries risk prevention
- Define and describe the features of early childhood caries
A
- CRA - clinical evidence, dietary habits, social history, fluoride use, plaque control, saliva, medical history
- CRP - radiographs, FV, F toothpaste, TBI/OHI, diet advice, F supplements, fissure sealants, SF medicines
- Nursing bottle caries. Due to frequent sugar intake and/or reduced saliva flow. Common reasons include prolonged breastfeeding, overnight use of drinking cups (milk/juice), regular use of sugar-containing medication. Common pattern of attack - upper incisors, first primary molars. Lower incisors are protected by the tongue and saliva. Prevention - DHE regarding breastfeeding, drinking cup use, TBI as well as use of SF meds where possible
16
Q
Early Paeds
- Give 4 key features of OHI for paeds
- What are natal teeth and how should they be managed
- Give 4 methods of fluoride application
A
- Smear if <3yrs old, pea-sized if >3yrs old TP on dry brush; start brushing as soon as first tooth erupts; brush twice a day for 2 mins; spit don’t rinse; parent-assisted until 8yrs old; F- MW (225ppmF) where appropriate at another time of the day for children over 7yrs old
- Usually members of primary dentition, rather than supernumeraries. Should be retained as long as possible. Often mobile and if they interfere with breastfeeding/they are inhalation risk, should be removed (XLA)
- TP, FV, F- MW, F- supplements,
17
Q
Fluoride
- What are the different concentrations of fluoride toothpaste and when should they be used
- What are the different concentrations of fluoride supplements and when should they be used
- What is the potentially lethal dose of fluoride ingestion
- What is the probable lethal dose of fluoride ingestion
- How should fluoride overdose be managed
- What is fluorosis and how does it appear clinically
- Give 2 methods for managing fluorosis
A
- 1000ppmF (<3yrs old for low risk children)
1350-1500ppmF (<3yrs old for high risk children; all kids >4yrs old)
2800ppmF (0.619% NaF TP - high risk kids >10yrs)
5000ppmF (1.1% NaF TP - high risk individuals >16yrs. Not suitable for kids) - 0.25mg/day for kids 0.5-3yrs old
- 5mg/day for kids 3-6yrs
- 0mg/day for kids 6yrs +
- 5mg/kg
- 15mg/kg
- <5mg/kg ingested - oral calcium (milk) and observe for a few hrs; >5mg/kg - oral calcium, admit to hospital
- Long-term excessive consumption of fluoride. Mottled, variable appearance (faint white opacity to severe pitting and discolouration)
- Micro-abrasion, composite masking, composite veneers