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BDS5 > Orthodontics & Paediatric Trauma > Flashcards

Orthodontics & Paediatric Trauma Flashcards

1
Q

What are some MH & FH concerns?

A

MH: - Bleeding disorders (XLA) - Musco-skeletal disorders - Epilepsy (headbrace tolerance & phenytoin GH) - DM (increased infection & perio risk) - Asthma (steroid inhalers - candida risk) - Allergies (Ni? Latex?) - Eating disorders FH: Hypodontia & Skeletal III Base (e.g. Hapsburg Jaw)

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2
Q

What 4 Qs would you ask about a patients DH?

A

1) Previous dental tx - OH and cooperation 2) Previous orthodontic tx - when? what? did they finish? 3) Trauma - when? what? how? tx? 4) Habits - nail biting or digit sucking

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3
Q

Why is dental trauma relevant to ortho? (3) Which malocclusions are most at risk of trauma? (give statistics)

A

Increased risk of: ankylosis, root resorption, de-vitalisation Class II div. 2 22% (5mm OJ), 24% (9mm OJ) and 44% (9+mm OJ)

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4
Q

Why are oral habits (nail biting/digit sucking) relevant to ortho? What should we ask?

A
  • Aetiology of malocclusion - Retention of treatment - Increased risk of root resorption How long habit has gone on? Which digit do they suck? Have they ever attempted to quit? Are there any triggers (e.g. stress)?
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5
Q

What are 4 dental effects of digit sucking? According to ADA ,when does spontaneous resolution of digit sucking usually occur? When do we want it to have ceased?

A

1) Proclining of max. incisors 2) Retroclining of mand. incisors 3) AOB - Often asymmetrical 4) Posterior crossbite (due to narrowing of upper arch) ADA: 2-4 years Ideal: ASAP. Important to have ceased by age of permanent teeth eruption & before root maturation

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6
Q

In what position is the patients extra-oral skeletal examination in? Why? (3)

A

Normal head posture (looking forward) / Frankfort plane parallel to the floor. Why? Reproducible, Standardised & used in Cephalometry

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7
Q

What 3 ways can we measure the A-P skeletal position?

A

1) Bimanual palpation (A&B points) Class 1 (normal), 2 (mandible relatively retrusive) and 3 (mandible relatively protrusive) 2) Zero meridian line (vertical line dropped from ST nasion, perpendicular to frankfort plane) Class 1 (chin at or 2mm behind ZML), 2 (behind ZML) and 3 (in front of ZML) 3) Facial profile Class 1 (normal/straighter), 2 (convex) and 3 (concave)

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8
Q

What is the definition of: 1) Zero Meridian Line? 2) Frankfort Plane? 3) Mandibular Plane

A

1) Vertical line dropped from the ST nasion & is perpendicular to the true horizontal line (FP) with the patient in natural head position 2) Horizontal plane running from inferior border of orbit to porion (EAM) 3) Horizontal plane running along inferior border of mandible (connects menton and gonion)

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9
Q

What 2 ways can we measure the vertical skeletal relationship?

A

1) Angular (FMPA) Normal (intercept at occiput), Increased (before occiput) or Reduced (behind occiput) 2) Linear (LAFH) - Facial 1/3rds (hairline to glabella, glabella to subnasale, subnasale to gnathion) where mid 1/3rd should = lower 1/3rd - Lower 1/3rd can be further divided: 1/3rd (subnasale to upper lip) & 2/3rd (lower lip to ST gnathion)

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10
Q

In what position(s) do we measure transverse discrepancies? What 2 ways can this be done?

A

From front & then from behind patient (“birds eye view”) 1) Midline (glabella - philtrum - chin) 2) “Rule of 5th” - Face sectioned into fifths (vertical lines drawn at inner canthus of eye (x2), outer canthus of eye (x2), helix of ear (x2)) where should all be equal and eye-width

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11
Q

What do we assess regarding lips?

A

1) Morphology/fullness 2) Competency (may be reduced in Skeletal II/ red. LAFH) 3) Protrusion - Rickett’s E Plane & Naso-labial angle 4) Function - Strap-like lower lip? Method of achieving anterior seal?

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12
Q

What is the normal incisive display: 1) At rest? 2) During function (smiling)?

A

1) 2-4mm 2) Full upper incisor display and up to 2mm gingivae

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13
Q

INTRA-arch analysis: What 6 aspects do we assess/report?

A

1) Teeth present (and OH) 2) Arch shape (U,V or Square) 3) Crowding/Spacing - Where? How much? (Mild <4mm, Mod. 4-8mm or Severe >8mm) 4) Rotations - Teeth, direction and amount of rotation 5) Angulation (slight mesial angulation) 6) Incisor inclination

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14
Q

What is the definition of “incisor inclination”? What is the range of normal incisor inclination?

A

The angle formed by the maxillary/mandibular plane and long axis of the tooth Upper: 109° (+/-5°) Lower: 93° (+/- 6°)

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15
Q

INTER-arch analysis? What 7 things do we assess/report?

A

1) Incisor relationship (BSI) 2) Canine relationship 3) Molar relationship (Angles) 4) Overjet 5) Overbite 6) Crossbite +/- displacement 7) Centrelines (Coincidence of philtrum/max. CL, max/mand. CL and mand CL/chin point)

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16
Q

What is the difference between overjet & overbite (define)? What is a normal range?

A

OJ = Horizontal or A-P discrepancy between maxillary incisal edge and labial surface of mandibular incisors (Normal = 2-4mm) OB = Vertical overlap of mandibular incisors by maxillary incisors (Normal = 2-4mm or 1/3rd-2/3rd lower incisors covered)

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17
Q

What is meant by a complete overbite? What IOTN would this be?

A

OB (vertical overlap of mandibular incisors by maxillary incisors) where mandibular incisors contact with upper incisors or palate Traumatic? IOTN 4f Non-traumatic? 3f

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18
Q

What is the definition of a crossbite? What should we assess? What are the 2 main types (define)?

A

CxB = Lateral discrepency in the bucco-lingual relationship between mandibular and maxillary teeth - Location (Ant/Post? Uni/Bilateral?) - Type* - Displacement? (“mandibular deviation between ICP & RCP/ CO & CR”) due to premature contact Type: 1) Buccal CxB = Buccal cusp of mandibular teeth occlude buccal to buccal cusp of maxillary 2) Lingual CxB/”Scissor Bite” = Buccal cusp of mandibular teeth occlude lingual to lingual cusp of maxillary

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19
Q

What is the 1) Angle’s 2) Andrew’s definition of Class I molar relationship?

A

1) The MB cusp of maxillary 1st molar occludes with mid-buccal groove of mandibular 1st molar 2) [Above] AND DB cusp of maxillary 1st molar contacts MB cusp of mandibular 2nd molar

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20
Q

What is the BSI classification definition of: 1) Class I? 2) Class II div. 1? 3) Class II div. 2? 4) Class III?

A

1) Mandibular incisal edge occludes on/immediately below cingulum plateau of maxillary incisor 2) …. posterior to cingulum plateau… Maxillary incisors are proclined or normal inclincation & there is an increased OJ. 3) …posterior to cingulum plateau… Maxillary incisors are retroclined & OJ is minimal or increased. 4) …anterior to cingulum plateau… OJ is reduced or reversed.

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21
Q

What are the canine class I/II/III definitions?

A

1) Class I = The maxillary canine tip occludes directly in the embrasure between the mandibular canine and premolar 2) Class II = …mesial/anterior to… 3) Class III = …distal/posterior to… 1/2 unit = 1/2 tooth width (making edge-to-edge on either side) Full unit = Whole tooth unit (sits in another embrasure)

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22
Q

What is the Angle’s classification of molar relationships? 1) Class I? 2) Class II? 3) Class III?

A

1) MB cusp of maxillary 1st molar occludes with mid-buccal groove of mandibular 1st molar 2) ..mesial/anterior to… 3) …distal/posterior to…

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23
Q

What is meant by incisal definitions of: 1) Class II “Indefinite” (Gravely 1964) ? 2) Class II “Intermediate” (Williams and Stephen 1992)?

A

Class II Incisal (mand. incisors occlude posterior to maxillary cingulum plateau)… 1) one incisor is proclined & the other retroclined 2) incisors are upright or retroclined with an increased OJ

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24
Q

What are the 4 main aims of treatment?

A

1) Skeletal 2) Soft Tissue 3) Dental Crowding/Alignment/Levelling/CxB correction/Centrelines/ Correct or maintain Incisal,Canine,Molar relationships 4) Retention

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25
Q

What are Andrew’s 6 Keys of Ideal Occlusion?

A

1) Class I Molar relationship 2) Correct angulation 3) Correct inclination 4) No rotations 5) No spacing 6) Flat Curve of Spee THINK: SCAM RI (Republic of Ireland)

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26
Q

What are the 4 main aetiology catagories for malocclusion?

A

1) Skeletal 2) Dento-alveolar (Dental) 3) Soft Tissue 4) Other: Habits/ Genetics

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27
Q

Ideal Diagnostic Summary - GO!

A

[Age] y/o [F/M] presenting with: - Class __ Incisor relationship - on a [mild/mod/sev] Skeletal ___ base - ____ FMPA & ____ LAFH - [No/___] Transverse discrepancies Malocclusion complicated by: Missing teeth? OJ? Crossbite? Displacement of contacts? OB? Other: General OHI? Crowding? Molar relationships?

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28
Q

What is the meaning of IOTN? What are the 2 components? What are 6 benefits? What are 6 disadvantages?

A

Index of Orthodontic Treatment Need 1) Dental Health (MOCDO) graded 1-5 2) Aesthetics graded 1-10 (mainly used for DH grades 3+) Benefits: 1) Uniform scale 2) Standardised for use in teaching 3) “ use in clinical research 4) “ monitoring care 5) can be used to discuss risks vs. benefits of treatment 6) useful to allocate NHS care to those with greatest tx need Disadvantages: 1) Relates to dental factors only - Not skeletal or ST 2) Doesn’t account for growth potential 3) Doesn’t account for patient concern (psycho-social wellbeing of malocclusion) 4) Not an index of treatment complexity 5) generalised spacing not recorded 6) Extraction of deciduous tooth (submerged deciduous = tooth IOTN 5s) could take patient to IOTN 2 !!

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29
Q

What is the IOTN of a patient with hypodontia… 1) 1 tooth in any 1 quadrant? 2) 2 teeth in 1 quadrant? 3) 1 tooth in 3 separate quadrants?

A

1) 4h 2) 5h 3) 4h (“1 tooth per quadrant”)

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30
Q

What is the IOTN of a patient with an ectopic canine?

A

IOTN 5i (This is the IOTN for a patient with ANY impacted or ectopic tooth)

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31
Q

How does the IOTN vary based on a patients overjet?

A

OJ over 9mm = 5a OJ 6.1-9mm = 4a OJ 3.6-6mm with incompetent lips (3a) / competent lips (2a) Reverse OJ over 3.5mm WITH speech/masticatory problems = 5m Reverse OJ over 3.5mm WITHOUT “ = 4b Reverse OJ 1.1-3.5mm WITH speech/masticatory problems = 4m

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32
Q

What is the IOTN of a patient with an open bite over 4mm?

A

4e

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33
Q

How do you measure contact displacement for IOTN? What are the IOTNs for: - Displacement over 4mm? - Displacement 2.1-4mm? - Displacement 1.1-2mm?

A

Look for area of most crowding: measure (with ruler) distance from anatomical contact points Displacement: - Over 4mm (IOTN 4d) - 2.1-4mm (IOTN 3d) - 1.1-2mm (IOTN 2d)

34
Q

CxB: What is the IOTN for: 1) Posterior lingual CxB (scissor bite)? 2) CxB with over 2mm ICP:RCP discrepancy? 3) CxB with 1.1-2mm ICP:RCP discrepancy

A

1) 4l 2) 4c 3) 3c

35
Q

What are the following IOTN scores (high treatment needs) reference to? 1) 5a? 2) 5h? 3) 5i? 4) 5m? 5) 5p? 6) 5s?

A

1) 5a = OJ over 9mm 2) 5h = Hypodontia (“more than 1 tooth in any quadrant”) 3) 5i = Impaction or Ectopic tooth (excluding 8s) 4) 5m = Reverse OJ over 3.5mm WITH masticatory/speech issues 5) 5p = Cleft lip or palate 6) 5s = Submerged

36
Q

Radiographic Report?

A
  • Type of radiograph - Grade - Teeth Present (erupted/unerupted) - R/O - R/L - Bone levels - Pathologies outside of above (e.g. ID canal, maxillary sinus, condyles) - Ectopic? (1) Position (2) Angulation & degree (3) position of crown & position of roots
37
Q

What is the incisal classification (BSI) of Class 2 div. 1?

A
  • Mandibular incisal edges occlude posterior to the cingulum plateau of maxillary incisors - Maxillary incisors are proclined or average inclination - Increased OJ
38
Q

What are the possible aetiological factors in Class 2 div 1 malocclusion? (HINT: divide into 4 categories)

A

1) SKELETAL - Mandibular retrognathia (80%) or maxillary prognathia - LAFH (often reduced but varies) 2) SOFT TISSUE - Incompetent lips with lip trap (proclines upper incisors) - Increased mentalis muscle activity (retroclines lower incisors) 3) DENTAL - Crowding - leading to proclined upper incisors 4) HABITS - Digit sucking leading to (5) (5) - Proclined upper incisors - Retroclined lower incisors - Increased OJ - AOB (usually asymmetric) - Narrowing of upper arch +/- Posterior CxB

39
Q

What are the dental features of a class 2 div 1 malocclusion?

A

1) Increased OJ (always) 2) Proclined maxillary incisors (or normal) 3) Class 2 molar relationship 4) Crowding or Spacing 5) OB - Deep (reduced LAFH), Reduced or Incomplete

40
Q

Why do we treat class 2 div 1 malocclusion? (3)

A

1) Increased risk of trauma (44% risk if OJ over 9mm, IOTN 5a) 2) Aesthetics 3) Psychological wellbeing

41
Q

What are the 4 treatment options for a pt with Class 2 div 1 malocclusion?

A

1) Accept/No treatment 2) Interceptive/Growth Modification 3) Camouflage 4) Orthognathic surgery

42
Q

When might you do no treatment/accept malocclusion? (4)

A

1) Mild malocclusion (IOTN) 2) Patient not concerned 3) Acceptable aesthetics 4) Poor OH N.B. If Class 2 div 1 may consider mouthguard for contact sports due to trauma risk

43
Q

What is the difference between a URA & a functional appliance? (define both) How are they similar?

A

BOTH are types of active, removable appliances which are only useful in an actively growing patient

URA (Upper Removable Appliance) = Maxillary removable appliance which can be used in mild-mod skeletal II or III malocclusions in an actively growing patient to bring about simple movements (tipping, crossbite correction, OB correction)

Functional Appliance = Orthodontic appliance utilising forces exerted by the stretching of oral/facial musculature (MOM, facial expression & periodontium) to produce dental and skeletal changes in an actively growing patient. FA’s posture the mandible forwards, away from its resting position.

44
Q

If using fixed appliances for camouflage of class 2 div 1 malocclusion, what extractions would we consider?

A

Upper 4s, lower 5s (Ideally upper arch XLA only)

45
Q

When might orthognathic surgery (+ fixed appliances) be considered for a malocclusion? (3)

A

1) Severe skeletal maloccusion (AP/Vertical/Transverse) 2) Poor facial appearance 3) Non-growing patient

46
Q

What are 9 features of a good candidate for FUNCTIONAL APPLIANCES?

A

1) Growing patient (F:10-13y/M:11-14y) 2) Good cooperation/Well-motivated 3) Good OH 4) Mild-Moderate Skeletal II 5) Reduced LAFH 6) Low (or normal) FMPA 7) Increased OJ 8) Increased OB 9) Proclined maxillary & retroclined mandibular incisors

47
Q

What are 6 features of a poor candidate for functional appliances?

A

1) Non-growing 2) Poorly motivated (wont wear) 3) Poor OH 4) Very mild skeletal discrepency 5) High FMPA with reduced OB (FA can make this worse) 6) Retroclined maxillary & Proclined mandibular incisors

48
Q

What are the 2 main changes seen on functional appliance use? What is the % contribution of both?

A

1) Dento-alveolar changes (70%) 2) Skeletal changes (30%)

49
Q

What is orthodontic headgear? Where is the force applied? What force is applied & how long should it be worn each day?

A

An orthodontic appliance which generates EXTRA-ORAL forces on the MAXILLA (500g per side) to restrict AP growth in Skeletal II malocclusions. Can also direct forces to vertical dimension to intrude or extrude molars. Must be worn 14hours a day

50
Q

What are the 5 dento-alveolar changes observed on functional appliance wear?

A

1) Retroclining of maxillary incisors 2) Proclining of mandibular incisors 3) OJ reduction 4) Mandibular molars erupt forwards/mesially 5) Maxillary molars erupt distally

51
Q

What are the 3 skeletal changes observed on functional appliance wear?

A

1) Growth at the condyles (~1-3mm) 2) Mild maxilla restraint (~0.7mm) 3) Glenoid fossa remodelling to be more anterior

52
Q

What is the definition of a functional appliance? For what skeletal malocclusions is it used?

A

Used in Mild-Mod Skeletal II in a growing patient Removable orthodontic appliance which utilises forced generated by stretching of the oral and facial musculature (MOM, Facial expression and periodontium) to produce dental and skeletal changes via posturing the mandible forwards, away from its resting position

53
Q

Are functional appliances myo-tonic or myo-dynamic? What do these mean?

A

often BOTH! Myo-tonic = Passive muscle stretching Myo-dynamic = Active muscle stretching during function

54
Q

What is the only individual tooth movement URAs can produce?

A

Tipping (Can also give block movement of multiple teeth or influence eruption via bite planes)

55
Q

What are 7 risk factors for dental trauma?

A
  1. Malocclusion (class II div 2, 44% OJ over 9mm)
  2. Lip incompetence
  3. Age (lack of coordination in younger pt)
  4. Gender (males 2:1)
  5. Contact sports
  6. MH (e.g. epilepsy)
  7. Previous dental trauma
56
Q

What are 7 potential implications of trauma to primary teeth on successors?

A
  • Impaction (e.g. early loss of deciduous & scar tissue formation)
  • Ectopic
  • Impaired formation - Enamel hypoplasia or hypomineralisation (discolouration)
  • Arrested crown/root formation
  • Dilaceration
  • Root duplication
  • Sequestration (loss) of tooth germ
57
Q

How can dental trauma be prevented?

A
  • Education
  • Favour non-contact sports
  • Mouthguard for contact sports
  • Helmet use on bikes
  • Supervision with animals
  • Correctly fitted seats/seatbelts in cars (RTA)
58
Q

What is the

  1. Dental
  2. Physical
  3. Psychological

Impact of dental trauma?

A

DENTAL:

  • Pain/infection/swelling
  • Mobility
  • Difficulty carrying out OH
  • Discolouration
  • Devitalisation
  • Damage to permanent successor (7) - e.g. impaction, ectopic, enamel hypoplasia/mineralisation, dilaceration, root duplication

PHYSICAL:
Difficulty eating food & carrying out OH

PSYCHOLOGICAL:
Smiling/laughing/socialising

59
Q

What is the most common dental trauma?

A

Crown fracture to permanent teeth (upper central incisors) - 71%

Permanent injuries often crown fracture & Deciduous injuries often subluxation

60
Q

Dental Trauma:

What important history Qs need to be asked & why?

A

WHEN? Time since injury - Avulsion timings & neglect cases

  • *WHERE?** Foreign body contamination? Tetanus vaccine status
  • Tetanus given as 5 doses: First 3 aged 8,12&16weeks. Booster at 3y4m & final booster at 14 years (NHS England)*

HOW? Loss of consciousness or aspiration of tooth = A&E Referral / Safeguarding? / Can identify RF for prevention (e.g. mouthguard for sports)

MEDICAL HISTORY:

  • Immunocompromised pt (e.g. leukaemia) = C/I to reimplantation of avulsed tooth
  • Tetanus vaccine status - Booster required?

DENTAL/SOCIAL HISTORY: Previous trauma? (RF/Safeguarding)

61
Q

Clinically, how should dental trauma be assessed at chairside?

(Pre-liminary steps & Special Investigations)

A
  • Thorough History & locate tooth
  • Wash face & assess any ST injuries
  • TIQ: Hard Tissue Injury (extent of coronal fracture)
  • Change/disturbance in occlusion?

S/Is:

  1. Discolouration?
  2. Tender to palpation?
  3. TTP?
  4. Percussion Sound (high-pitched metallic consistent with intrusion, lateral-luxation or ankylosis)
  5. Mobility? & Any displacement
  6. Deep pocketing?
  7. Abscess or Sinus tract?
  • Pulp sensibility tests (permanent only, NOT deciduous)
  • Radiographs - PA +/- ST
  • Extra & Intra-Oral Photographs
62
Q

On percussion tests of a traumatised tooth, what 3 sounds may you hear?

What do these mean?

A
  1. Normal
  2. Dull
  3. High-pitched/ Metallic - Closer proximity of root & bone (observed in intrusion, lateral-luxation or ankylosis)
63
Q

When & what radiographs taken for dental trauma?

What are you assessing?

A

IADT (2020)

  1. PA of TIQ
  2. 2 PAs of each contralateral tooth
  3. 1 Occlusal
  4. Consider PA of lower maxillary incisors if trauma to mandibular incisors

For permanent teeth: PAs taken at each review

Assessing:
Extent of fracture/displacement, root morphology/maturity, continued root formation, PAP, root resorption, bone levels

64
Q

What is MIH?

What are some possble aetiologies? (5)

A

Molar Incisal Hypomineralisation

= Hypomineralisation presenting as demarcated, qualitative defects in the enamel of one to four FPMs & often effecting incisors (20% less mineral content) - Affects 1 in 6

Aetiology:

  • Pre/Peri/Post birth complications (e.g. low birth weight or oxygen starvation)
  • Childhood illness in first 3 years of life (e.g. RTI or chickenpox)
  • Antibiotics
  • Genetics
  • Exposure to environental pollutants
65
Q

How can MIH present?

How is it classified (Mathu-Muju & Wright)?

A

Clinical Presentation:
“Examination should be performed on clean, wet teeth”

  • White or Brown enamel opacities over 1mm
  • Post-eruptive breakdown (may have fractures)
  • Asymmetrical distribution
  • +/- caries
  • +/- Hypomineralised Es (predictor of MIH)

Pt may complain about appearance of teeth or sensitivity

Classification:

1) MILD = Opacities present on non-stress bearing areas (no hypersensitivity/caries)

2) MODERATE = Opacities present & PEB on 1 or 2 surfaces (no cuspal involvement) & normal sensitivity

3) SEVERE = Opacities, PEB (cuspal involvement/crown destruction), hypersensitivity, caries & aesthetic concerns

66
Q

What are 5 diferential diagnoses to MIH? Discuss

A

1) Fluorosis - Symmetrical, caries resistant & history of higher F intake

2) Amelogenesis Imperfecta - Family history, symmetrical & affects primary & secondary dentition

3) White Spot Lesion/ Caries - Areas of plaque accumulation

4) Enamel Hypoplasia - Reduced enamel thickness (may see on rads) with regular & smooth lesion borders (vs sharp & irregular in MIH)

5) Traumatic Hypomineralisation - Localised & history of trauma

67
Q

What are 7 potential clinical issues with MIH?

How can these be overcome?

A
  1. PEB ⇒ Dentine hypersensitivity & risk of pulpal involvement
    Sensitivity managed with prevention/desensitising agents/restorations, also consider use of RD to avoid sensitivity of adjacent teeth during tx
  2. Difficulty anaesthetising (chronic pulpal inflammation)
    Consider articaine infiltrations, IHS or (extreme) GA
    Consider sedative interim restoration (GIC) if uncontrollable
  3. Difficulty bonding (reduced enamel mineral content & PEB)
    Consider 5.25% NaOCl etch
  4. Aesthetic concerns
  5. Early tooth loss
  6. Psycho/social impact
  7. Occassional molar eruption difficulty (due to enamel roughness)
68
Q

What are the treatment options for:

  1. Incisal MIH?
  2. Molar MIH?
A

Incisal MIH

  1. Accept
  2. Microabrasion
  3. Resin Infiltration (ICON)
    * 15% HCl etch (removes surface layer), Dry (ethanol) & Resin (methacrylate-based) infiltrate which has similar refractive index to normal enamel. Also observed to improve composite bond if used pre-restoration*
  4. Composite Veneers
  5. Bleaching (over 18 y/o)
  6. Ceramic Veneers (over 18y/o as ideally want ginigval margin to stabilise)

Molar MIH

  1. Accept
  2. Resin Infiltration (ICON)
  3. Composite (/GIC) Restorations & FS
  4. PMC (SSC)
  5. XLA
69
Q

What are 6 treatment considerations for MIH?

A
  1. Site & Severity of MIH
  2. Restorability
  3. Long-term prognosis & treatment costs
  4. Age & Cooperation of patient
  5. Orthodontic opinion:
    - Malocclusion
    - Presence of 5,7&8
    - Timing
  6. Patient/Parent expectations & wishes
70
Q

What is the MIH treatment needs index?

A

The Würzburg MIH Concept

0 = No MIH

1 = MIH (no defect, no hypersensitivity)

2 = MIH - Defect (no hypersensitivity)
(a) less than 1/3rd (b) 1/3rd-2/3rd (c) over 2/3rd or close to pulp

3 = MIH - Hypersensitivity (no defect)

4 = MIH - Defect AND Hypersensitivity
(a) / (b) / (c) - as above

71
Q

What is Amelogenesis Imperfecta?

What are the 4 main types?

A

Genetically inherited enamel defect which may present (&is classified) as:

  1. Hypoplastic AI
    Reduced enamel thickeness, hard & translucent with pitting/grooves
  2. Hypocalcified AI
    Weak enamel, may appear chalky/opaque & easily stain/wear. Radiographically less opaque than dentine
  3. Hypomaturate AI
    Mottled, soft & more prone to wear
  4. Hypomaturation-Hypoplasia with Taurodontism
    Above (2&3)
    Taurodontism: Body & pulp chamber enlarged & pulp floor & furcation more apically displaced
72
Q

Mital et al.

What 4 Qs should be asked to aid diagnosis of Amelogenesis Imperfecta?

A
  1. Has anyone in the family had anything similar?
  2. Any medical concerns which may have caused sufficient metabolic disturbance to affect enamel formation?
  3. Does it affect all the teeth in a similar manner (including primary dentition)?
  4. Is there a chronological distribution to the defect’s appearance? (chronological enamel hypoplasia?)
73
Q

How should paediatric pain be managed in symptoms of:

  1. Irreversible pulpitis?
  2. Pulpal abscess/Periradicular periodontitis?
A

1. Irreversible Pulpitis

  • Assess diagnosis, if uncertain from history/clinical findings: temporise & review symptoms in 3-7 days
  • Pre/Un cooperative? Attempt corticosteroid (odontopaste) dressing, temporise & refer for XGA (primary) or RCT XLA/XGA (permanent)
  • Cooperative? Pulp therapy (primary)/RCT (permanent) or XLA

2. Pulpal Abscess/Periradicular Periodontitis

  • ABx only if systemic symptoms/swelling
  • LOCAL MEASURES:
  • Primary: Hand-excavate & allow drainage (dont place dressing UNLESS pain before drainage established, then place corticosteroid dressing & temp restoration which can be easily removed) - ST incision rarely indicated.
  • Permanent: Extirpate +/- ST Incision/Drainage under LA if large
  • Primary: Pulp therapy or XLA/GA
    Permanent: RCT or XLA/GA
  • Try to avoid extraction at first dental appt
74
Q

How is consent gained for extraction under GA?

A
  • Assessment of pt age: Gillick competency?Who has parental responsibility?
  • Write teeth to be extracted AND “extraction of any other teeth deemed necessary” (make aware teeth may be added to tx plan)
  • Explain procedure, child put to sleep by anaesthetician in hospital setting & require post-op observation & escort
  • Explain risks & benefits to patient:
    Risks: (all those with extraction) & post-GA nausea/sore-throat/respiratory & cardiac problems/ mortality (1in250,000)
  • “A key aspect of consent is that a clinician cannot obtain informed consent for a procedure they are not trained to perform themsleves” - therefore assessment & consent would be done by anaesthesiologist beforehand
  • General pre-op fasting rules: no meals after 6hr before, no liquids 2hr before

RCS (2008) Guidelines for use of GA in Paediatric Dentistry

75
Q

According to SDCEP, what are 7 factors that can help assess the risk of carious lesions progressing to pain/infection?

A
  1. Site & Site of lesion
  2. Activity of lesion - Arrested/Active?
  3. Time til tooth exfoliation
  4. Number of other carious lesions
  5. Childs MH
  6. Childs cooperation
  7. Parental cooperatiom - prevention & attendence for appts
76
Q

What are the different types of dental trauma (necessary for complete diagnosis) ?

  1. Soft Tissue? (3)
  2. Hard Tissue (7)
  3. Periodontal? (6)
A

1. SOFT TISSUE

Laceration, bruising or abrasion

**2. HARD TISSUE** 
Enamel infarction (crack), E#, "Uncomplicated" ED #, "Complicated" EDP#, (Uncomplicated/Complicated)Crown-Root#, Root#, Alveolar bone#

3. PERIODONTAL

Concussion = TTP, No mobility/displacement
Sub-luxation = Mobility (no displacement)
Extrusion = Axial displacement away from alveolar bone (appears elongated)
Lateral Luxation = Displacement horizontally & alveolar bone communication
Intrusion = Axial displacement towards (INTO) alveolar bone
Avulsion = Complete displacement of tooth out of socket

77
Q

What are the possible PULPAL outcomes following trauma?

How might these appear clinically & radiographically?

A
  1. Pulp Survival (PS)
    Tertiary/Reactionary dentine laid down
  2. Pulp Canal Obliteration
    ‘Excessive healing’ - REPARATIVE dentine formation (odontoblasts die & replaced by odontoblast-like progenitor cells)
    Signs: Yellow discolouration (dentine) & radiographic reduction in pulp chamber/canal size(sclerosis)
  3. Pulpal Necrosis
    Signs: Grey/black discolouration (haemoglobin breakdown to haemosiderin), Dull percussion tone & R/L PAP
  4. Internal Resorption
    (a) Surface IR -     Transient/self-limiting
    (b) Inflammatory IR - Radiographic “punched out” R/L consistent with pulp cavity, Pink spot clinically & Dull percussion tone
    (c) Replacement IR - Differentiation of stem cells into osteoblasts, radiographic “irregular R/L & R/O appearance” of pulp
78
Q

What are the possible PERIODONTAL/ROOT outcomes following dental trauma?

How may these appear clinically or radiographically?

A
  1. Normal healing
    +/- Continued root formation in immature apex
  2. Disrupted/Arrested root formation
  3. External Resorption
    (a) Surface ER -    Transient/self-limitinf
    (b) Cervical ER - Localised cervical resorption in vital tooth
    (c) Inflammatory ER - Radiographic R/L irregular root outline
    (d) Replacement ER/ “Ankylosis” - Radiographic replacement of root surface with bone “fused/irregular” R/O appearance (Ankylosis often term when ABSENCE of inflammation)
79
Q

What are 4 factors that effect likelihood of pulp survival after trauma?

A
  1. Severity of injury/ pulpal exposure
  2. Severity of damage to pulpal supply (worst intrusion, avulsion or severe lateral luxation)
  3. Maturity of tooth (open > closed apex)
  4. Length of traumatic exposure
80
Q

What is SDF?

What are the advantages/disadvantages?

A

Silver Diamine Fluoride (44,800ppm F)

Advantages:

  • Antibacterial effect of Silver
  • Fluoride - remineralisation & more effective vs. FV
  • Does NOT induce pulpal inflammation & acts as barrier
  • Quick, easy, non-AGP

Disadvantages:

  • Off-licence use (only licensed for sensitivity)
  • Staining - Black staining of carious lesions & staining to lips/gingivae which may last 1-3weeks
  • Staining of clothes if spilt
  • Metallic taste
  • Cannot restore function teeth with large holes may still need restoration/removal of overhangs
  • Contraindicated in: Silver allergies, gingival ulceration or pulpal pathologies
81
Q

How is SDF applied?

What are the alternative treatment options?

A

SDF Stages:

  • Cotton woll isolation & vasaline over lips & gums (stain prevention)
  • Teeth dried & SDF directly applied to affected areas
  • Teeth dried again & restoration may be placed on top
  • Review 2-4weeks later & SDF application recommended every 6 months (BSPD)

Alternatives:

  • No treatment & monitor
  • FV
  • FS
  • Hall Technique PMC
  • Restoration
  • Extraction

BDS5 (5 decks)

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