Deck 1 Flashcards
Dam clamp for anterior tooth
C or E
Dam clamp for premolars
E or EW
Dam clamp for molars
A, AW, FW or K
If asked to place dam for endo
- Select a clamp (anterior - C or E, premolar - E or EW, molar - FW, K or A or AW)
- Floss the clamp for airway protection
- Place the clamp
- Punch one hole in the dam sheet
- Place sheet over clamp
- Place frame
- Oroseal or opal dam
- Check with CHX
Advantages of Hall crown technique
Preformed metal crowns fitted quickly
Procedure non invasive
No caries removal/prep
Hall crown technique - if there is not enough space
If there is not already sufficient space for Hall crown, mesial and distal separators should be placed
2 lengths of floss threaded through the separator, stretch tight and floss separator through contact point
See the patient 3-5 days later for removal and place Hall crown
Disadvantage Hall crown technique
Can only be used when there is no radiographic or clinical signs of pulpal involvement
Must have sufficient tooth tissue left to retain the crown
Hall crown technique procedure
Sit child upright and place gauze/butterfly sponge for airway protection
Use sticky stick to try crown in
Choose smallest size that will seat
Crown should be subgingival or at least below cavity
Covers all cusps and approaches contact points with slight springiness - do not fully seat at this stage
Dry crown and tooth and fill crown with GIC (aquacem)
Seat the crown, encourage child to bite on cotton wool
Clean excess cement with CWR
Floss contacts
Reassure child and parent
Reassurances for child and parent about Hall crown
- crown is supposed to fit tightly and gums will adjust
- Child will get used to it within 24 hours
- Occlusion tends to adjust to given contacts bilaterally within few weeks
Minor faults from Hall technique
Secondary caries, crown worn/lost, reversible pulpitis without requiring pulpotomy or extraction
Major faults Hall technique
Irreversible pulpitis, abscess requiring pulpotomy/extraction, inter-radicular radiolucency, crown lost and tooth unrestorable
What is Hall technique?
Technique using preformed stainless steel crowns to seal carious lesions in deciduous teeth without LA, caries removal, tooth preparation
What is used to cement Hall crowns?
GIC - aquacem
What is non restorative cavity control?
Making the lesion cleansable (removing undermined enamel), supporting improvements in toothbrushing and diet, FV application, SDF application
What lesions are suitable for Hall technique?
Caries in primary molars, radiographically a clear separation between carious lesion and pulp, but caries is into dentine
Reversible pulpitis symptoms and management in child
Typically pain to cold/sweet, pain resolves on removal of stimulus, tooth not TTP, tooth difficult to localise
Restore, or place temporary dressing and restore later. If no dentine bridge, consider selective caries removal or pulpotomy
Irreversible pulpitis symptoms and management in child
Typically pain to hot/cold which does not resolve on removal of stimulus and does not resolve with placement of temp dressing
In co-operative child - XLA or pulpotomy of primary tooth, pulpotomy/RCT/XLA of permanent
Non co-operative - Refer for XLA under GA of primary, permanent tooth consider if pt will become cooperative for RCT or extraction or refer to SCD
Dry socket signs/symptoms
Pain often begins 3-4 days post op, can last 7-14 days
No blood clot present in socket
Moderate to severe dull aching pain
Keeps pt up at night
Throbs and radiates to ear
Exposed bone is sensitive and source of pain
Halitosis/bad taste - characteristic smell
What is dry socket?
Alveolar osteitis - inflammation of the alveolar bone following an extraction, usually due to blood clot failing to form or being lost from the socket. Usually NOT associate with infection
What is localised osteitis?
Inflammation affecting lamina dura
Predisposing factors to dry socket
Molars more common
Mandible more common
Smoking - reduced blood supply
Females>males
Oral contraceptive pill
Excessive trauma during XLA
Excessive mouth rinsing after XLA
Family history or previous dry socket
Initial management of dry socket
Reassurance
Recommend optimal analgesia - ibuprofen or paracetamol
Advise avoid smoking and maintain good OH
Advise pt to seek urgent dental care - give LA to relieve severe pin
Subsequent management of dry socket
Irrigate with saline to flush out food and debris
Curette/debride the socket to encourage bleeding and new clot formation
Whiteheads varnish paste (antibacterial and anesthetic) on ribbon gauze sutured into socket (requires removal)
or alvogyl - anaesthetic and LA (contains iodine)
Both promote clotting and enhance clotting framework while protecting bone
Recommend warm salty mouthwash or CHX
Antibiotics not required unless signs of spreading infection or immunocompromised
Initial history for facial trauma - mandibular fracture
Any associated headaches?
Loss of consciousness?
Nausea or vomiting?
Numbness/alteration of sensation of the face?
Any other injuries?
