Child Dental Health Flashcards
What is the tooth germ composed of? (3)
Enamel Organ- ameloblasts and root sheath
Dental papilla- odontoblasts and pulp
Follicle- cementoblasts, osteoblasts and fibroblasts
What are the causes of hypodontia? (3)
Genetic
Environmental insult
Syndromes- trisomy 21, ectodermal dysplasia, mutations in the MSX1 gene on chromosome 4
What is the result of ectodermal dysplasia? (4)
- thin sparse hair
- absence of sweat glands
- multiple missing teeth
- microdontia
What are the abnormalities of size and form? (5)
- microdontia
- macrodontia
- double teeth
- dens in dente
- talon cusps
What is amelogenesis imperfecta?
A spectrum of hereditary defects in the function of ameloblasts and mineralisation of the enamel matrix
What are the classifications of amelogenesis imperfecta? (2)
Hypoplastic- thin, hard enamel, normal bond strength
Hypomineralised- full thickness enamel, very soft, impaired bond strength
What are the dental defects of amelogenesis imperfecta? (5)
- pulp calcification
- taurodontism
- delayed eruption
- gingival overgrowth
- skeletal anterior open bite
What is the differential diagnosis for amelogenesis imperfecta? (4)
- dental fluorosis
- chronological disorders of tooth formation
- renal disease
- trauma
What are the types of dentinogenesis imperfecta? (3)
Type I- associated with osteogenesis imperfecta
Type II- dentinogenesis imperfecta
Type III- brandywine isolate
What are the features of dentinogenesis imperfecta in the primary dentition? (4)
- amber
- attrition
- pulp obliteration
- spontaneous abscesses
What are the features of dentinogenesis imperfecta in the permanent dentition? (4)
- grey/ translucent
- short roots
- pulp obliteration
- spontaneous abscesses
What are the main clinical problems of dentinogenesis imperfecta? (4)
- poor aesthetics
- chipping and attrition of enamel
- exposure of dentine
- poor oral hygiene, gingivitis and caries
What are the non hereditary disturbances in formation? (4)
- molar incisor hypomineralisation
- dental fluorosis
- turners tooth
- dilaceration of tooth
What is turners tooth?
Affects the successional tooth and is hypo plastic enamel following infection around the interradicular area of primary teeth
What is piagets theory of cognitive development?
Developmental theory of human intelligence where understanding of the world is gained by learning through experiences
What is the definition of erosion?
The loss of tooth tissue due to acid which has not come from plaque
Occurs at pH <5.5
What is the presentation of erosion? (6)
- smooth and shiny
- palatal wear facets
- wear facets on cusps
- yellowing
- rim of enamel becomes visible from palatal aspect
- breaking up of incisal edge
What is the presentation of attrition? (4)
- flattened cusps
- enlarged masseter
- sometimes facial pain
- family member complaining of grinding noise at night
Why is crown preparation contraindicated in under 16 years? (4)
- large pulp/crown ratio and wide dentinal tubules may increase risk of pulpal stress or exposure
- changing gingival contour due to active and passive eruption of teeth
- cooperation may be limited
- advantageous to delay start of restorative cycle
What are the factors of asthma which produce airway obstruction? (3)
- airway smooth muscle spasm
- alteration in respiratory secretion, with mucous plugging of smaller airways
- inflammation
What is the dental care of the child with asthma? (4)
- dental things that may exacerbate e.g fluoride varnish
- recommended rinsing mouth out after inhaler use
- may be at risk of adrenal crisis
- inhalation sedation is safe for midl to moderate asthma
What is epilepsy impact on dental care? (5)
- triggers could be light drill section
- need to be able to manage an acute seizure in the dental surgery
- increased risk of tongue biting and trauma to incisors
- potential for gingival enlargement due to phenytoin
- dentures may be contraindicated in severe epileptics
What are the oral health implications for the child with diabetes? (3)
- may be decreased saliva flow
- caries risk from frequent sugar intake
- increased periodontal disease
What is cerebral palsy?
Non progressive neuromuscular disorder caused by brain damage during the pre, peri or post natal period
What are the oral health implications for children with cerebral palsy? (4)
- poor oral hygiene due to poor manual dexterity
- periodontal disease
- malocclusion
- tendency to bruxism
What is the dental care of the child with cerebral palsy? (3)
- access to dental surgery and transfer to chair from wheelchair
- gag reflex may make it difficult for patients to tolerate intraoral instruments
- may be possible to coordinate GA for medical procedures with dental care in some circumstances
What is von willibrands due to?
Deficient or abnormal plasma protein, platelet function or von willebrand factor
What are the types of anaemias? (3)
- deficiency anaemia
- sickle cell anaemia
- thalassaemia
What are the long term complications as a consequence of cancer treatment? (4)
- reduced salivary flow
- hypodontia
- enamel discolouration
- supernumerary teeth
What are the causes of autism? (4)
- advanced paternal age
- certain drugs in pregnant mothers
- some infectious agents
- genes
What is ADHD?
Attention deficit hyperactivity disorder
What is a sinus?
A tract or fistula leading to a cavity which may be filled with pus
What is a fistula?
An abnormal connection between 2 epitheliased surfaces
What is a haemangioma?
Malformation of blood vessels, cavernous and capillary variants
What is an eruption cyst?
Enlargements of dental follicle that appear before eruption, rarely requiring treatment
What is a fibroma?
Benign tumour composed of fibrous connective tissue
What is herpangia?
Ulcers on tonsils and palate
What are the symptoms of hand foot and mouth disease? (2)
- maculopapular rash
- intra oral vesicle> ulcers
What is mumps?
Swelling of one or more of the major salivary glands that has flu type symptoms
What is infectious mononucleosis? (2)
- epstein barr virus
- oedematous tonsils
What is the origin of a dentigeous cyst?
Reduced enamel epithelium
What is a juvenile ossifying fibroma?
Benign, rapid, fibrous tissue with varying mineralised material
How do you recognise emotional abuse? (4)
- poor growth
- developmental delay
- educational failure
- social immaturity
How do you recognise sexual abuse? (4)
- direct allegation
- sexually transmitted infection
- pregnancy
- trauma
How do you recognise neglect? (4)
- failure to thrive
- short stature
- inappropriate clothing
- frequent injuries
What are the features that would lead you to be concerned about a child? (4)
- delay in presentation
- discrepancies between history and examination findings
- developmentally inappropriate findings
- previous concern about child or siblings
What is a team around the child meeting?
Brings agencies together where concerns about a child or family identified but not enough for standing intervention
What is a child protection conference?
Meeting to decide if child should be subject to child protection plan and placed on the child protection register
What is the management of an advanced lesion on a primary anterior tooth? (3)
- selective caries removal
- complete caries removal
- non restorative cavity control
What is the management of a molar occlusal advanced lesion on a primary tooth? (2)
- selective caries removal
- hall technique
What is the difference between sensitivity and specificity?
Sensitivity is how many things your test will pick up
Specificity is how many things you pick up that are actually disease
What is the appearance of a primary initial occlusal lesion?
Non cavited, dentine shadow or minimal enamel cavitation
What is the appearance of primary initial proximal lesions?
White spot lesions or shadow
What are the peak ages of incidence of dental trauma? (3)
- 1-2
- 8
- 15
What is anachoresis?
Potential collection or deposit of particles at a site, as of bacteria or metals that have localised out of the bloodstream in areas of inflammation
What are the types of dental injuries? (7)
- enamel infraction
- enamel fracture
- enamel dentine fracture
- enamel dentine pulp fracture
- crown root fracture without pulp involvement
- crown root fracture with pulp involvement
- root fracture
What are the clinical features of an enamel dentine pulp fracture? (4)
- normal mobility
- not tender to percuss
- exposed pulp sensitive to stimuli
- radiographically enamel dentin loss is visible
What is the name for a fracture involving enamel, dentin and cementum with loss of tooth structure but not exposing the pulp?
Crown root fracture without pulp involvement
What are the clinical features of root fractures? (4)
- the coronal segment may be mobile and may be displaced
- the tooth may be TTP
- bleeding from gingival sulcus may be noted
- transient crown discolouration may occur
What radiographs are when root fractures are in the oblique plane?
An occlusal view, radiographs with varying horizontal angles
Name 4 periodontal injuries
- concussion
- subluxation
- luxation
- avulsion
What is subluxation?
Loosened- no displacement but bleeding from gingival crevice
What is lateral luxation?
The tooth is displaced usually in a palatal/lingual or labial direction. Fracture of the alveolar process is present
What are degloving injuries?
When soft tissue drags and gets unsheathed
Name 3 types of extra oral injuries
- grazes/lacerations
- contusions
- inclusion of foreign bodies
What is an alveolar fracture?
When 2 or more teeth move as a block. The fracture involves the alveolar bone and may extend to the adjacent bone.
What are the features of pulpal necrosis in a primary tooth? (4)
- persistent grey colour to the tooth that does not fade
- no reduction in size of pulp cavity
- radiographic signs of periapical inflammation
- clinical signs of infection- tenderness, sinus, suppuration and swelling
What are the features of primary tooth pulpal obliteration? (2)
- clinically the tooth may become a yellow/opaque colour
- radiographically the pulp chamber will shrink
What damage can occur to the crown of the successor tooth? (5)
- white/yellow/ brown enamel hypo mineralisation at 2-7 years
- white yellow brown enamel hypo mineralisation and circular enamel hypoplasia
- crown dilaceration at 2 years
- odontoma like malformations at 1-3 years
- sequestration of permanent tooth germs
What damage can occur to the root of the successor tooth? (3)
- root duplication at 2-5 years
- root duplication at 2-5 years
- arrest of root formation at 5-7 years
What are the permanent teeth complications of trauma? (5)
- pulp necrosis
- resorption
- ankylosis
- external resorption
- internal résorption
Why should you not use calcium hydroxide if you are starting RCT within 2 weeks of reimplanting an avulsed tooth?
May contribute to replacement resorption
What is the treatment for permanent tooth pulpal necrosis with an open apex? (2)
- need to create an apical stop
- or regenerative endodontic techniques
What are regenerative endodontic techniques?
Works on the principle of activating stem cells to recreate the dental pulp. Intention is to allow continued root growth
What are the disadvantages of using calcium hydroxide for apical barrier formation?(3)
- time consuming to get a result
- incomplete apical barrier formation with vascular inclusions may lead to bacterial invasion
- changes the composition/structure of the dentine which results in a higher incidence of cervical root fractures
What are the advantages of using MTA for apical barrier formation?(3)
- reliable
- shorter time
- confirmed hard barrier
What is the appearance of permanent tooth pulp canal obliteration? (3)
- reactionary dentine formation in the root canal and pulp chamber causes the space to narrow
- radiographically this can be seen by the pulp chamber and root canal shrinking
- clinically the tooth may darken and will have a reduced response to sensibility tests
What are the types of inflammatory root resorption? (4)
- external inflammatory resorption
- cervical resorption
- internal resorption
- replacement resorption
When does external inflammatory resorption occur?
If teeth have necrotic pulps and associated infection, giant cells are activated in the PDL and the stimulus is in the infected canal
What is cervical resorption due to?
Damage to the cervical region. It is inflammation caused by PDL microflora or infected root canal
When will internal inflammatory resorption occur?
When infected necrotic pulp may activate underlying vital tissue resulting in the resorption process
What is the presentation of internal inflammatory resorption? (2)
A round symmetrical radiolucency. Usually centred on the canal. Unlike external resorption, the canal walls are not usually superimposed
When does replacement resorption (ankylosis) occur?
When more than 20% of the PDL is damaged before replanting or repositioning, bone cells are able to colonise the surface of the root faster than the PDL. Tooth will be integrated into the bone and subsequently remodelled in the normal bone remodelling process
What can we do for tooth discolouration following RCT? (5)
- crown +/- core
- ceramic veneer
- internal bleaching
- external bleaching
- composite camouflage
What are the options available for space maintenance? (5)
- partial acrylic denture
- resin bonded bridge
- porcelain bonded to metal bridge
- transplant of a premolar
- implant
What is the best time to extract canines?
Age 10-13
Within how many months as a rule of thumb would you expect to see eruption of a tooth antihero?
6 months
When does bifurcation of the 7’s occur?
At around age 10
What is the path physiological reason behind submerging primary molars?
Disturbance of cell rests of malassez
