5. Paediatric Dentistry Flashcards
When do teeth start to form
Calcification, crown completion, eruption completion and root formation completion of maxillary primary central incisor (4) and maxillary primary second molar (4)
Crown calcifications at birth (6)
Bone remodelling is essential for
Dates and order of eruption of primary teeth (5)
Features of primary teeth compared to permanent teeth (6)
How much anterior spacing is desired in primary dentition
Definition of Leeway space
Definition of mixed dentition
5wks iul
13-16wks iul, 1.5mths, 8-12mths, 33mths
16-23wks iul, 11mths, 25-33mths, 47mths
a - 1/2, b - 1/3, c - tip, d - 1/2, e - 1/3, 6 - tip of cusps
Eruption
a - 4-8mths, b - 7-16mths, d - 13-19mths, c - 16-22mths, e - 15-33mths
Smaller, whiter, roots longer and slenderer, large pulp chambers, incisors upright and spaced, reduced ovejet
3-6mm
Extra mesiodistal space occupied by primary molars compared to permanent premolars
From eruption of first permanent tooth to exfoliation of last primary tooth
Jaw relationship at birth (3)
Stages of child development (5)
When is motor development completed
Stages and description of cognitive development (4)
Examples of speech and language disorders (3)
Normal language development at 1 year (2)
Normal language development at 2 years (2)
Normal language development at 3 years (2)
Normal language development at 4 years (2)
Gum pads widely separated anteriorly, tongue resting on lower gum pad, tongue in contact with lower lip
Motor, cognitive, perceptual, language, social
Infancy
Sensorimotor - up to 2 yrs - prime object is object permanence. Pre-operational though - 2-7yrs - egocentric. Concrete operations. Formal operations - 11yrs+ - logical abstract thinking
Learning difficulties, cerebral palsy, delayed S&L development
1 - understands 20 words/simple phrases; uses 2-3, babble
2 - understands simple commands/questions; uses 100 words, 2 together, echolalia
3 - undertands prepositions, object functions, simple conversations; uses 4 word sentences, who/what/where, relates experience
4 - understands numbers, colours, tenses; uses long grammatical sentences
Requirements of normal speech production (2)
Cleft-types speech involves (3)
Competent airway and articulators
Resonance, articulation and nasal emission
Paediatric feeding
Normal feeding pre-40 weeks gestation (2) Normal feeding 0-3mths (5) Normal feeding 4-6mths (3) Normal feeding 7-9mths (3) Normal feeding 10-12mths (3) Normal feeding by 2yrs
28wks iul - non-nutritive sucking; 34wks iul - nutritive sucking
Normal oral tone, rhythmic sucking, gag/swallow, semi-reclined, liquid diet
Head control, root reflex control (suck/swallow/gag), semi-solid diet
Sitting, chewing, upper lip involvement, bite, mashed food
Active lip closure, cup drinking, lumpy food
Mature and integrated feeding pattern
Effect of family unit (2)
Manifestations of paediatric anxiety (4)
Paediatric anxiety is related to (3)
Types and examples of communication (3)
How is paediatric anxiety reduced (4)
Pain perception is influenced by (6)
A child should reach adulthood with (4)
Behaviour contagion, enhancing child’s anxiety
Nail-biting, thumb-sucking, stomach pain, stuttering
Psychological make-up, previous experience of them/family/peers, dentist and team behaviour
Verbal (5%), paralinguistic (30% - tone, volume), non-verbal (65% - gaze, PPE, gesture)
Preventing pain, calm manner, pain reassurance, moral support
Control, communication, previous experience, anxiety, expectation of pain, anticipation of pain
An intact dentition, as few restored teeth as possible, no active caries, positive attitude to future dental care
Best paediatric dentistry restorative materials (5)
Common problems with stainless steel crowns (3)
When is the Hall technique used
Minor Hall technique failures
Major Hall technique failures
Disadvantages of unplanned primary tooth extraction (2)
PMC > amalgam = composer > RMGIC > GIC
Rocking, canting, loss of space
When no radiographic/clinical signs of pulpal involvement
New/secondary caries
Irreversible pulpitis, abscess requiring extraction
Loss of space –> increased risk of malocclusion, impeded speech development
Indications for paediatric pulp treatment (2)
Contraindications for paediatric pulp treatment (2)
When is a pulpotomy used
Direct pulp evaluations (2)
When is a pulpectomy used (4)
Aim of paediatric pulpectomy
Management of incisor E#, ED# and EDP# (3)
Pulp treatment of vital immature tooth (3)
Pulp treatment of non-vital immature tooth (3)
Pulp treatment of non-vital mature tooth (4)
Avulsed permanent tooth first aid (5)
Good cooperation, <9yrs old
Poor attendance, poor cooperation
For carious/traumatic exposure of bleeding pulp
Normal bleeding (non-inflamed, good clotting, bright red), abnormal (inflamed, poor clotting, deep crimson)
Non-vital pulp, irreversible pulpitis, necrotic pulp, chronic sinus
To prevent infection by extirpation of radicular pulp followed by canal cleaning and obturation
E# - selective grinding, AET; ED# - AET, reattach crown fragment; EDP# - pulp cap/pulptomy/pulpectomy
Direct pulp cap (small, <24hrs), pulpotomy (larger, delay in Tx), pulpectomy (large, >24hrs)
Pulpectomy (remove all pulp), apical barrier formation (MTA), apexification
Direct pulp cap (small, <24hrs), pulpotomy (larger, delay in Tx), pulpectomy (large, >24hrs), conventional RCT
Store in fresh milk/saliva, handle crown only, wash under water if obvious debris, replant quickly, 2wk flexible splint
Definition of fissure sealant
Materials used for fissure sealants (2)
Indications for fissure sealant placement (3)
Where are fissure sealants applied to (4)
Indications for GIC fissure sealants (2)
Advantage/disadvantage of GIC fissure sealants
Definition of stained fissure
Diagnosis methods of stained fissure (3)
Treatment of stained fissure (3)
Best time for extraction of first permanent molars
Ideal features when considering extraction a 6 (3)
Protective plastic coating used to seal pits and fissures to prevent food and bacteria getting caught in them and causing decay
Bis-GMA resin, GIC
High caries risk, medically compromised, physically/mentally handicapped, caries in one first permanent molar (seal other 6s and 7s on eruption)
Occlusal surface of permanent molars, upper incisor cingulum pits, lower molar buccal pits, upper molar palatal pits
When good moisture control cannot be obtained, sensitivity due to enamel defects
Release fluoride, poorly retained so have to be regularly reapplied
Brown, black or discoloured fissure/white opaque enamel
BW xray, visual, probe
Enamel only - fissure sealant, monitor
Inconclusive diagnosis - clean fissure and fissure sealant
Into dentine - preventive resin restoration/sealant restoration - small - composite and fissure sealant or large - conventional restoration
Beginning of calcification of bifurcation of lower 7s
Mild buccal segment crowding, class I incisor relationship, all 5s and 8s present
Paediatric caries risk indicators (8)
Paediatric caries risk assessment (7)
Teeth most commonly affected by nursing/early childhood caries (2)
Main cause of nursing caries
OH, diet, bacterial exposure, socioeconomic status, breast/bottle feeding, fluoride exposure, prenatal smoking, parental OH status
Clinical evidence, dietary habits, social history, fluoride use, plaque control, saliva, MH
Upper anteriors and upper and lower molars
Due to inappropriate use of feeding cups/bottles
Paediatric caries prevention (6)
Ways of obtaining fluoride (4)
Fluoride in toothpastes (4)
Suspected fluoride toxicity - what information do you need (3)
Fluoride toxicity management (3)
Practice-based prevention (2)
Community-based prevention (2)
Aim of community-based prevention
Radiographs, toothpaste, fissure sealants OHI, dietary counselling SF medicines
Water, toothpaste, supplements, professionally-delivered (varnishes)
1000ppm, 1400-1500 (standard - >7yrs or <7yrs and high risk), 2600ppm (>10yrs and high risk), 5000ppm (>16yrs)
Weight of child, amount swallowed, ppmF of toothpaste
<5mg/kg - oral Ca and monitor; 5-15mg/kg - hospital and oral Ca; >15mg/kg - hospital, life support, cardiac monitor, IV calcium gluconate
Fluoride varnish (x2/yearly if high risk), floss between contact areas
Health education and health promotion
Tp reduce early childhood caries risk
Definition of molar incisor hypomineralisation, MIH
Definition of hypomineralisation
Definition of hypoplasia
Types of hypoplasia (2)
Features of MIH molars (3)
Causes of MIH pain (3)
MIH clinical problems (3)
Hypomineralised molar treatment (3)
Affected incisor treatment (2)
Hypomineralisation of systemic origin of 1-4 permanent molars, frequently associated with affected incisors
Disturbance of enamel formation - reduction in enamel mineral content
Reduced enamel bulk/thickness
True/acquired
Increase in neural density, immune cell accumulation and vascularity
Dentine hypersensitivity, peripheral sensitisation and central sensitisation
Loss of tooth substance, sensitivity, appearance
Restoration, PMC, extraction
Acid pumice micro abrasion, external bleaching
Measles incubation period
Measles duration of illness
Measles signs and symptoms (3)
If untreated, measles can lead to (2)
Rubella duration of illness
Rubella signs and symptoms (2)
If untreated, rubella can lead to
Varicella duration of illness
Varicella signs and symptoms (2)
If untreated, varicella can lead to (2)
10-14 days
8-10 days
Fever, rash, cough
Secondary infection, otitis media
8-10 days
Mild fever, maculopapular rash
Encephalitis
6-10 days
Low grade fever, rash
Secondary infection, pneumonia
