Child Dental Health Flashcards
What is silver diamine flouride (SDF) and what is it used for in dentistry?
It is a topical medicament composed of silver, ammonium and fluoride ions that can be used to manage and prevent dental caries, as well as relieving dentinal hypersensitivity
What do the individual components of SDF do to manage and prevent dental caries?
Silver compounds: possess antimicrobial properties
Fluoride: remineralisation of enamel and dentine
What characteristic colour does SDF stain?
Black
Why does SDF stain black upon exposure to light?
Due to the formation of silver oxide layer
What would you use to cover the patients lips when using SDF for treatment to prevent staining?
Petroleum jelly
During a procedure involving SDF, what sensation might the patient feel?
Tingling sensation
What does ART stand for?
Atraumatic restorative treatment
What does ART involve?
Minimally interventive approach involving selective caries removal using only hand instruments and the placement of GI cement.
What sort of cavities does ART manage?
Single surface cavities in primary and permanent teeth
when May ART be used for permanent dentition?
In situations where cooperation is limited
Is ART undertaken with or without the use of LA or rotary instruments?
Without
After ART, how long should you advise the patient to wait before eating or drinking anything other than water?
1 hour
What are orthodontic separators used for?
To open proximal contacts and create space
In what three situations may separators be used to create space?
- Prior to fitting preformed metal crown using Hall technique
- To aid caries diagnosis by allowing visualisation and access to proximal contacts
- When placing proximal sealants
If too much pressure is applied when placing a separator, what could be the consequence?
The band may be pushed apical to the contact point and become submerged into the gingival sulcus
What type of carious lesions is the Hall technique useful for managing?
Multi-surface carious lesions
what are the clinical requirements for use of the Hall technique on primary molar teeth?
- tooth must have no clinical or radiographic signs of pulpal pathology
- radiograph must show a clear band of dentine between the cavity and the pulp
How would you establish a baseline indicator of occlusal vertical dimension?
Measure the distance between the mid point of the maxillary canine gingival margin and the mid point of the gingival margin of the corresponding mandibular canine tooth directly below.
What instrument might you use to establish a baseline indicator of occlusal vertical dimension?
A periodontal probe
what sizes of metal crown are most commonly selected for use?
Sizes 4,5 and 6
What are the two ways of protecting the airway when trying to place a selected crown over a tooth?
- Place a sheet of gauze in the oral cavity
- Affix the crown to your finger with a piece of adhesive tape
What is a main consideration that should be taken when using the adhesive tape technique to place crown?
It is important to ensure that the patient does not have an allergy to Elastoplast
What two ways can you ensure that a crown becomes fully seated on the tooth?
- Continue to apply firm pressure with your finger
- Instruct patient to bite down firmly on a cotton wool roll
What sign would indicate that proper seating of the crown on a tooth has occurred?
Blanching of the surrounding gingiva
How would you record an INCREASE in occlusal vertical dimension (OVD)?
Retake the canine reference measurement (b). Subtract the initial measurement (a) from the final measurement (b). The remainder tells us how much the OVD has increased.
(B) - (a) = increase in OVD
How long may it take after placement of a crown for its to return to the original OVD?
A week or two
The periodontal probe can be used to measure mesio-distal distance of a tooth. What other instrument can be used?
Vernier callipers
How do you prevent palatal ledge formation when placing a crown?
Ensure that gentle pressure is exerted palatally in order to allow full seating and prevent palatal ledge formation
Glass ionomer performs well in multi surface cavities. True or false?
False
What is a pulpotomy?
Where inflamed and possibly infected coronal pulp tissue is removed from a carious primary tooth to preserve healthy radicular pulp.
when would you decide to take a pulpotomy?
When a tooth shows signs of irreversible pulpal inflammation
OR
where radiographically there is no “normal” appearing dentine separating the pulp tissue from a carious lesion
when would a pulpotomy not be suitable?
If the tooth is showing clinical or radiographic signs of infection or periradicular periodontitis
What are the four advantages to using a rubber dam?
- Protect airway
- Increase patient comfort
- Reduce the chance of bacterial ingress
- Enhance moisture control
when placing rubber dam, what tooth should you choose to clamp?
The tooth distal to the one undergoing treatment
What is a split dam technique?
Where the interproximal dam between adjacent holes is cut
When might it be useful to use a split dam technique?
If the tooth is to be restored with a preformed metal crown
what is another word used for root canal treatment?
Pulpectomy
If bleeding from the pulp does not occur during pulpotomy and the pulp appears necrotic (grey), what can be assumed and what would the appropriate course of treatment be?
The pulp is assumed to be non-vital and a pulpectomy or extraction would be required
How would you achieve homeostasis of the pulp post pulpotomy?
Place a cotton pad soaked in ferric sulphate onto the remaining pulpal tissue and canal entrances and leave for 1-2 minutes.
What substance might you place on the exposed pulp tissue after achieving homeostasis with ferric sulphate?
Mineral Trioxide Aggregate (MTA)
what material would you fill the pulp chamber with before placing a preformed metal crown?
Zinc oxide eugenol material
Why is the Hall technique generally preferred over the traditional stainless steel/preformed metal crown technique?
The traditional technique is a less conservative approach as it requires occlusal reduction and in some cases, proximal preparation to provide space for the crown.
In what situation would the traditional stainless steel crown technique be preferable to the Hall technique? And why?
Following a pulpotomy
Because reduction of the occlusal surface helps to reduce further trauma to the pulp as would have ben caused by occlusal loading following the hall technique.
What is the effect of SDF on bacteria?
Silver interacts with bacterial cell membranes and bacterial enzymes that can inhibit bacterial growth.
Silver ions degrade cell walls, disrupt bacterial DNA synthesis and intra cellular metabolic processes, leading to apoptosis.
Is the pulp proportionately larger in the primary or permanent dentition?
Primary
What do these symptoms in a tooth suggest?:
- not TTP
- no sensitivity to heat
- sharp pain to cold substances or sweets
Reversible pulpitis
What do these symptoms in a tooth suggest?:
- not TTP
- sensitivity to heat
- Sensitivity to cold that lasts more than 30 secs
- intense, spontaneous pain
Irreversible pulpitis
What would be the course of treatment required for irreversible pulpitis?
Pulpectomy or extraction
What type of radiographs would you use for assessing pulpal status and why?
Ideal: periapical
Sufficient: vertical bitewing
They demonstrate the full length of the primary root
Medically, when is pulp therapy contraindicated?
For immunocompromised patients, and those at risk of endocarditis
How many roots and root canals does a mandibular primary molar have?
Two
How can root canal morphology differ in mandibular primary molars?
One or sometimes two distal root canals
How many roots and root canals does a maxillary primary molar have?
Three
How does ferric sulphate induce homeostasis?
Forms ferric ion protein complex when it interacts with blood, this arrests bleeding by sealing vessels.
what may prevent the use of MTA in pulpotomy?
It is expensive
What are the 4 main steps to a pulpectomy technique?
- Dry root canals
- Fill canals with calcium hydroxide
- Restore pulp chambers with glass ionomer core
- Restore tooth with stainless steel crown and take post op. Radiograph
What are the two major causes of dental anomalies?
Genetics and environmental factors
What is hypodontia?
Missing teeth as a result of failure to develop
What is anodontia?
Total lack of teeth in one or both dentitions
What is oligodontia?
Rare condition where more than 6 primary or permanent teeth are absent
If a patient has anodontia, what other important structure will be missing?
Alveolar bone
What is the prevalence of hypodontia in the primary dentition?
<1%
What is the prevalence of hypodontia in the permanent dentition?
3-6%
What is the female to male ratio of hypodontia?
4:1
What teeth are most commonly missing in a case of hypodontia? name from most commonly missing to least commonly missing.
- Mandibular 3rd molars
- Mandibular second premolars
- Maxillary lateral incisors
- Maxillary second premolars
What two genetic syndromes is hypodontia associated with?
Down syndrome and Ectodermal dysplasia
What is a significant feature of Ectodermal dysplasia?
Absence of sweat glands
Which is rarer, hypodontia or supernumerary?
Supernumerary
What is the prevalence of supernumerary in the primary dentition?
0.2-0.8%
What is the prevalence of supernumerary in the permanent dentition?
1.5-3.5%
What is the most common site for supernumerary teeth?
Anterior maxilla, normally between central incisors
What are the four types of supernumerary?
- Mesiodens
- Supplemental teeth
- Conical supernumeraries
- Tuberculate supernumeraries
What supernumerary is described?
Normally found at the midline between the two central incisors, usually peg shaped.
Mesiodens
What supernumerary is described?
If not inverted, there is a good chance they will erupt. If inverted, they may migrate superiorly towards nose.
Conical supernumerary
What supernumerary is described?
Don’t tend to migrate but may impede eruption of adjacent teeth
Tuberculate supernumerary
What two conditions can supernumerary be associated with?
- Cleft lip and palate
- Cleidocranial dysostosis
What is cleidocranial dysostosis? And what is its characteristic features?
When the jaw and brow area sticks out. The middle of the nasal bridge is wide, collar bones may be missing or abnormally developed. Primary teeth do not fall out at expected time.
What is microdontia?
A condition where the teeth are smaller than normal, and often peg shaped.
What teeth are most commonly affected by microdontia?
Lateral incisors
What is macrodontia?
A dental condition where a tooth or group of teeth are abnormally larger than average
What is dens in dente?
A rare developmental tooth anomaly characterised by invagination of the enamel organ into the dental papilla that begins at the crown and often extends to root even before the calcification of the dental tissues
What is talon cusp?
A rare dental anomaly in which a cusp-like mass of hard tissue protrudes from the cingulum area of maxillary or mandibular anterior teeth
What are the two types of “double teeth” ?
Fusion and gemination
What is the difference between fusion and gemination?
Fusion is an abnormal shaped tooth resulting from fusion of two separate tooth germs (two roots), whereas gemination is two teeth developing from one tooth germ (one root)
Why is dens in dente very important to pick up at clinical examination?
Because it can result in an area of caries, leading to pulpitis and periapical infection
What is amelogenesis imperfecta?
Spectrum of hereditary defects in the function of ameloblasts and mineralisation of enamel matrix
What are the two subtypes of amelogenesis imperfecta?
- hypoplastic type
- hypomineralised type
Which type of amelogenesis imperfecta is described?
Thin, but hard enamel, with normal bond strength. Inadequate deposition of enamel matrix. Teeth affected prior to eruption.
Hypoplastic type
Which type of amelogenesis imperfecta is described?
Full thickness enamel, but very soft; impaired bond strength. Teeth affected post eruption.
Hypomineralised type
What are the most common types of inheritance for amelogenesis imperfecta?
Autosomal dominant or X-linked
What inheritance does dentinogenesis imperfecta have?
Autosomal dominant
How many types of dentinogenesis imperfecta are there?
Three
How is type 1 dentinogenesis imperfecta characterised?
Occurs as part of osteogenesis imperfecta
Which type of dentinogenesis imperfecta occurs on its own, as a rare and severe condition affecting tooth development?
Type 2
What type of dentinogenesis imperfecta is most common?
Type 2
What medication would someone with osteogenesis imperfecta likely take to increase bone mineral density and reduce fractures?
Bisphosphonates
Why may a spontaneous abscess form in association with dentinogenesis imperfecta?
Because the teeth often have open, patent channels in dentine, leaving the pulp communicating with the oral cavity
What are five non-hereditary disturbances in formation of teeth?
- molar Incisor hypomineralisation (MIH)
- dental fluorosis
- turner’s tooth
- dilaceration of tooth
- metabolic abnormalities
Which non-hereditary disturbance in formation of a tooth is incredibly common, with cases in up to 20% of the population?
Molar Incisor hypomineralisation
What is MIH?
Developmental defect in enamel structure
What teeth does MIH typically present in?
Primarily first permanent molars and central incisors
What is Turner’s tooth?
Also referred to as enamel hypoplasia, it is a condition that reduces enamel thickness, increasing tooth sensitivity. May be following infection around the inter-radicular area of a primary tooth.
what clinical feature would be an indication of metabolic disturbances in the teeth?
Generalised pattern or discolouration of the teeth
When do anomalies such as supernumerary or hypodontia occur during tooth development?
At initiation or bud stage
What is the most common type of supernumerary?
Mesiodens
When do anomalies of size such as macrodontia and microdontia occur during tooth development?
Bell stage
When do anomalies of size such as fusion and gemination occur during tooth development?
Cap stage
What conditions are associated with generalised microdontia?
- Down’s syndrome
- pituitary dwarfism
- Ectodermal dysplasia
What condition is associated with generalised macrodontia?
-pituitary gigantism
Is fusion more common in primary or permanent teeth?
Primary
By counting teeth, how would you know the abnormality in size is fusion and not gemination?
If fusion, tooth count is one less than normal. If gemination, tooth count is normal.
What is taurodontism?
A developmental disturbance of a tooth in which body is enlarged at the expense of the roots. ( vertically elongated pulp chamber and short roots)
What is dilaceration?
Abnormal bend in root of a tooth
What is the main cause of dilaceration?
Traumatic injury to primary tooth
What are the two enamel hypoplastic defects that occur in association with congenital syphilis?
- Hutchinson’s incisors
- Mulberry molars
What is the characteristic feature of Hutchinson’s incisors?
Hypoplastic notch
What is the characteristic feature of mulberry molars?
Globular enamel
What stage of tooth development would an abnormality such as amelogenesis imperfecta and dentinogensis imperfecta occur at?
Bell stage
What are the three characteristic dental features of dentinogenesis imperfecta?
- Bulbous crowns
- Bell-shaped crowns
- Obliterated pulps
What condition of the eye is linked with dentinogenesis imperfecta?
Blue sclera
what is concrescence?
Union of two adjacent teeth by cementum only
What is an enamel pearl?
Chunk of enamel blocking attachment of sharpey fibres
Why will a patient automatically have a periodontal pocket if they have an enamel pearl on a molar tooth?
The sharpey fibres cannot attach so therefore o the PDL does not adhere to the cementum of tooth root
What are the key structural differences of primary teeth, in comparison with permanent teeth?
- whiter
- bigger pulp:crown ratio
- more divergent roots
- thinner enamel
What can the concern be surrounding primary teeth with big pulp:crown ratio?
Easier to hit the pulp horns when giving restorative treatment
What primary tooth specifically has very big pulp with very thin enamel on the crown?
D’s
Why do primary teeth roots diverge so much?
So that they diverge around the successor (permanent tooth)
How do permanent and primary differ in terms of contact points between teeth?
Primary- flat,wide contact points
Permanent- narrow contact points
When do primary teeth start to erupt?
6 months
Which primary teeth erupt first?
Mandibular central incisors (A’s)
When is the primary dentition complete?
2.5 years old
When does the mixed dentition stage begin?
6 years old
What are the first permanent teeth to erupt as part of the mixed dentition?
Mandibular central incisors (1’s)
What are the 2 main phases of the mixed dentition?
- Eruption between 6-8 years old
- Eruption between 10 and 12 years old
What is the age range for the eruption of incisors and first permanent molars?
6-8 years old
What permanent teeth erupt between the ages of 10-12 years old?
- canines
- premolars
- second molars
When is the permanent dentition established?
12 years old
What are the main features of the established permanent dentition?
- no spacing or overcrowding
- no rotated teeth
- horse-shoe shaped arch
- good interdigitation
- functionality
At what age does the lower canines and 1st premolars erupt?
10 years old
At what age does the upper canines and 2nd premolars erupt?
11 years
At what age do the second permanent molars erupt?
12 years
At age 9, what tooth are you looking to be able to palpate in the buccal sulcus?
Canines
What is the curve of spee?
The curvature of the mandibular occlusal plane
Which teeth are affected by MIH?
1’s, 2’s and 6’s
Why are the 1’s, 2’s and 6’s effected by MIH and not other teeth?
Because 1’s,2’s and 6’s all developed at the same time in utero.
In the early stages of tooth development, what plays an important part in shaping the dental arches?
The tongue
What does spacing of the primary dentition allow for?
Allows the permanent dentition to align itself correctly, and contributes to establishing a class 1 molar and incisor relationship.
What proportion of the developing permanent tooth root must be formed in order for accelerated eruption of the permanent to occur upon early removal of the predecessor primary tooth?
1/3 to 2/3 of the root
