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COH/ Orthodontics Flashcards

1
Q

What are the different infectious paediatric soft tissue lesions which may result from:

  1. Virus’?
  2. Bacteria?
  3. Fungus’?
A

1. Virus’

  • HSV1 → Primary herpetic gingivostomatitis + Herpes labialis
  • VZV → Chickenpox (palate)
  • EBV → Infectious mononucleosis/Glandular fever
  • HPV → Warts (Veruca Vulgaris)
  • Paramyxovirus → Mumps + Measles (Koplik’s spots)
  • Coxsackie → Hand,foot & mouth disease + Herpangina

2. Bacteria

  • Dental abscess
  • Risk of Ludwig’s angina (rare)

3. Fungal

  • Candidosis
  • Denture stomatitis
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2
Q

What are the main 6 groups of soft tissue lesions seen in paediatrics?

A
  1. Infections (Viral/Bacterial/Fungal)
  2. Ulcers
  3. White lesions (e.g. linear alba, geographic tongue or burn)
  4. Cysts
  5. Epulides (“swelling of the gingivae”)
  6. Factitious (Self-inflicted)
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3
Q

What is the difference in a “hypoplastic” or “ hypomineralised” tooth?

A

Hypoplastic = Smaller tooth

Hypomineralised = Less/altered enamel (so yellow appearance)

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4
Q

What are 3 potential causes of soft tissue “white lesions” in paediatric patients?

A
  1. Trauma/keratinisation (Linear alba)
  2. Geographic tongue
  3. Burns (chemical/heat)
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5
Q

What are 4 potential causes of ulceration in a paediatric patient?

A
  • Trauma
  • Aphthous (RAS) - Minor, major or herpetiform
  • Behçets disease
  • Erythema Multiforme
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6
Q

What 3 salivary gland cysts may a paediatric patient present with?

What are 2 cysts associated with newborns?

A
  1. Mucous Extravasation Cyst (MINOR SG cyst)
    * Often lower lip & related to trauma*
  2. Mucous Retention Cyst (SG cyst)
    * (Midline, floor of mouth - older age)*
  3. Ranula (SG cyst)
    * Floor of mouth - tx = resolves or marsupialisation*

NEWBORNS:

  1. Bohn’s Nodules (white keratin cysts on alevolar ridge)
  2. Epstein’s Pearls (white/yellow fluid-filled cysts on palate)
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7
Q

How does you BPE examination differ on children aged:

  • 6 years?
  • 7-11 years (mixed dentition)?
  • 12-17 years (permanent dentition)?
  • 17 years and above?
A

6 years and below: No BPE

Mixed dentition (7-11 years)

  • BPE codes 0-2
  • 6 reference teeth (UL6, UR1, UR6, LL6, LL1 + LR6)
  • Each tooth assessed at 6 points (DB, B, MB, DL, L + ML)

Permanent dentition (12-17 years):

  • FULL BPE codes (0-4*)
  • 6 reference teeth (as above)

17 years and above: Full BPE (all codes and teeth)

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8
Q

What is the most common pattern of periodontal disease in children/adolescents? Why?

A

Molar-Incisal Pattern

Due to tooth eruption timing

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9
Q

What are 4 types of epulis?

A
  1. Fibrous epulis
  2. Giant Cell epulis
  3. Congenital epulis of the Newborn
  4. OFG (+/- Crohns)
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10
Q

Name 6 common NON-plaque induced causes of gingival disease in paediatrics…

(HINT: think infections and epilus’)

A
  1. Trauma
  2. Primary Herpetic Gingivostomatitis (HSV1)
  3. Chicken Pox (VZV)
  4. Measels (Koplik’s Spots) ( Paramyxovirus)
  5. Fibrous epulis
  6. Giant Cell epulis
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11
Q

What are the 3 main risk factors for periodontal disease?

A
  1. Plaque (OH)
  2. Smoking
  3. Diabetes (uncontrolled)

(Most children can be managed by initial therapy as plaque = main cause)

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12
Q

What are the 3 main aetiological factors for dental trauma in children? (Give examples of each)

A
  1. Accidental (sports, falling or RTA)
  2. Non-accidental (fighting, physical abuse or animal-related)
  3. Iatrogenic (e.g. by anaesthetist during intubation)
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13
Q

What are 3 DENTAL factors associated with increased risk of paediatric dental trauma?

A
  1. Class II div 1 (overjet and proclination)
  2. Incompetent lip
  3. Previous experience of dental trauma
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14
Q

What are 8 ways in which trauma to a primary tooth can affect the permanent successor?

A
  1. Impaction (e.g. scarring of tissue impairs eruption)
  2. Ectopic eruption (abnormal position)
  3. Dilacteration of root
  4. Enamel hypoplasia
  5. Arrested crown or root development
  6. Root duplication
  7. Sequestration of tooth germ
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15
Q

Other than dental, what are two other impacts of dental trauma on a paediatric pt?

A
  1. Physical (difficulty eating + carrying out OH routine)
  2. Psychological (reduced socialising, smiling etc)
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16
Q

How can paediatric dental trauma be prevented? (4)

A
  • Avoid non-contact sports
  • Use of helmet and mouthguard in sports (stock, mouth-formed or custom)
  • Seatbelt wear (RTA)
  • Supervision with animals

Also: Education of general public on immediate management of avulsed tooth (storage, replantation etc)

17
Q

What instruction is given to the general public regarding immediate management of a:

  1. PRIMARY avulsed tooth?
  2. PERMANENT avulsed tooth?
A

1. PRIMARY avulsed tooth

  • Wash wound site and cease bleeding with compression
  • Find tooth (ensure not swallowed) - DONT REPLANT
  • Seek emergency dental appt

2. PERMANENT avulsed tooth

  • ​Find tooth (pick up by crown)
  • If dirty, wash breifly, then REPLANT into socket (keep tooth in position by pressing)
  • If not possible, keep tooth in glass of milk or saline (avoid water)
  • Seek immediate dental treatment
18
Q

What are the 3 types of soft tissue injury following dental trauma?

A
  1. Laceration (tearing)
  2. Abrasion (frictional wear)
  3. Contusion (bruising)
19
Q

What are the 6 types of dental trauma injuries related to the PDL?

How do they differ in terms of displacement or loosening?

A
  1. Concussion (no loosening or displacement but very TTP)
  2. Subluxation (loosening, no displacement)
  3. Intrusion (displacement axially INTO alveolar bone)
  4. Extrusion (partial displacement)
  5. Lateral luxation (lateral displacement → alveolar bone #)
  6. Avulsion (complete displacement out of socket)
20
Q

What are the 5 types of clinical fractures involving the crown (+/- root)?

A
  1. Enamel infraction (crack)
  2. Enamel fracture
  3. Enamel-Dentine fracture
  4. Enamel-Dentine-Pulp fracture
  5. Complicated crown fracture
    AKA Crown-Root fracture (+/- Pulpal involvement)
21
Q

What are the 4 types of dental trauma injuries of the alveolar bone?

A
  1. Infraction (crack) / “Communication”
  2. Alveolar socket wall fracture
  3. Alveolar process fracture (+/- socket wall involvement)
  4. Vertical fracture (+/- PDL involvement)
22
Q

What are 5 cells and 3 tissue types found in the dental pulp?

A
  1. Fibroblasts
  2. Odontoblasts (line outer layer)
  3. Progenitor/Stem cells
  4. Inflammatory cells (e.g. polymorphs, T cells and macrophages)
  5. Giant cells
  6. Neural tissue
  7. Vascular tissue
  8. Loose CT - Type 1, 3 and 5 collagen
23
Q

What are 4 special tests following dental trauma?

A
  1. VISUAL
    ST injury, tooth fracture, discolouration and mobility
  2. PERCUSSION SOUND & TTP
    Dull or high-pitched metallic sound (intrusion, ankylosis or lateral luxation)
  3. PULP SENSIBILITY
    Electrical (EPT) or Thermal (Endo-frost or Ethyl-chloride)
  4. RADIOGRAPHS
    PA, OPG +/- Occlusal
    May want ST (e.g. CBCT)
24
Q

What 3 types of dental trauma (related to PDL catagory) produce a high-pitched metallic sound on percussion?

A
  1. Intrusion
  2. Lateral luxation
  3. Ankylosis
25
In relation to the pulp, what are the 5 main outcomes for dental trauma? For each of these, what changes would you see radiographically or clinically?
1. **Pulp Survival (PS)** *Mild trauma → Secondary/Tertiary dentine* 2. **Pulp Canal Obliteration (PCO)** *Excessive trauma → Reparative dentine produced by progenitor cells (stimulated by odontoblast death)* *Radiographically: Reduction in pulpal volume Clinically: Yellowing!* 3. **Pulp Necrosis (PN)** *Inflammation - Invasion of polymorphs Radiographically: PAP (R/L - Abcess or cyst) Clinically: Grey* 4. **Inflammatory Internal Resorption (IIR)** *Inflammation - Invasion of polymorphs AND Giant cells Radiographically: Expanding R/L in pulp chamber* *Clinically: May appear pink* 5. **Replacement Internal Resorption (RIR)** *Stem cells differentiate into odontoblasts and areas are replaced with bone*
26
How is the level of sensibility after dental trauma affected by root development stage?
Sensibility DECREASES as root development INCREASES (open → closed apex) UNTIL full development (where sensibility increases to highest)
27
What is meant by Ankylosis? What term is it sometimes used interchangably with?
Fusion between the tooth surface (cementum) and alveolar bone (Interchangable term with Replacement External Resorption)
28
What are the 2 main outcomes of dental trauma on the periodontal tissues??
1. Normal healing 2. External Resorption - Surface ER - Inflammatory ER - Replacement ER (Transient or Permanent)
29
How can resorption be catagoried by: 1. Site (2)? 2. Pathology/Nature? (2) 3. Progression (3)?
**1) SITE** * Internal (pulpal) * External (periodontal) **2) PATHOLOGY** * Inflammatory * Replacement **3) PROGRESSION** * Transient * Permanent * Arrested
30
What are 4 factors affecting the ability of pulp survival in a traumatised tooth?
1. Severity of blood supply damage (worst in intrusion or avulsion) 2. Site & Size of exposure 3. Length of exposure 4. Stage of root development (higher chance of revascularisation in an open apex)
31
For **Pulp Canal Obliteration (PCO)** what would you expect for the following: * Discolouration? * TTP? * Percussion sound? * Mobility? * Pulp vital? * Radiographically?
* Yellowing * No * Normal * Normal * Yes (usually) * Decrease in pulp chamber/canal size
32
For **Pulpal Necosis (PN)** what would you expect for the following: * Discolouration? * TTP? * Percussion sound? * Mobility? * Pulpal vitality? * Radiographically?
* Grey * TTP! * Dull * Increased mobility * Non-vital * PAP - Abscess or cyst
33
For **Inflammatory Internal Resorption (IIR)**, what would you expect for the following: * Discolouration? * TTP? * Percussion sound? * Mobility? * Pulpal vitality? * Radiographs?
* May be pink * TTP * Dull * No * Vital! * Radiolucent expansion in pulp canal (internal)
34
What are 3 rules that should be adhered to when fitting a splint after dental trauma?
* Shouldn't be in contact with gingiva * Ideally flexible * Should allow palatal access (if later pulpal therapy to be done)

BDS4 (5 decks)

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