Pads Flashcards
indications for primary molar pulpotomy
- good cooperation
- MH precludes xla
- necessity of tooth as space maintainer
- < 9y/o
- missing permanent
- vital tooth with carious/traumatic exposure
describe primary molar pulpotomy
- LA + Rubber dam
- access cavity and remove coronal pulp
- assess haemorrhage, place cotton wool with saline, bleeding bright red
- restore with CaOH, GIC core and preformed metal crown
why would you need to do pulpectomy instead of pulpotomy mid procedure
could not gain haemorrhage control
irreversibly inflamed pulp
elements of trauma review
- radiograph
- colour
- EPT
- ethyl chloride
- TTP
- percussion sound
- mobility
what baseline/special tests would you carry out before staining tx
- PA
- clinical photos
- colour shade of lesion and background
- trauma history?
- sensibility
outline the stages of micro abrasion
- PPE for pt and dentist
- apply dam
- sodium bicarbonate guard and vaseline on lips
- clean teeth with water
- 10 x 5 sec applications of 18% Hcl and pumice, wash directly into suction
- apply pro fluoride FV
- final polish with fine sandpaper disc
- apply toothpaste
what info for pt after micro abrasion
avoid highly coloured for at least 24 hrs
what bleaching agent is used for vital bleaching
10% carbide peroxide
3.3% hydrogen peroxide, 6.6% urea
aspects of history of trauma which could indicate non-accidental
- injuries don’t match story
- inconsistent stories
- bilateral injury
- delayed presentation
- different stages of healing
- fearful child
sequelae of primary trauma to primary dentition
- delayed exfoliation
- discolouration
- loss of vitality
- infection
sequelae of primary trauma to permanent dentition
- enamel defects [hypoplasia, hypomineralisation]
- delayed eruption
- abnormal morphology
- arrested development
- ectopic positioning
- complete failure to form
- odontome formation
pulpal exposure of >2mm 2 days ago
what tx
pulpotomy as been 2 days
describe in detail a behavioural management technique
tell-show-do
tell - procedure, how you will use ur instruments, have a look, layman’s
show - show her how mirror works, let her use it
do - place in mouth
how do you address issues of non-attendance
pt only showed up in pain
- ensure up to date contact details
- explain importance of dental
- non-judgemental
- explore attendance barriers
- book review appt before leaving
- record conservation in notes
- contact mum re now appt
evidence based brushing advice to help prevent caries
modified base technique
- tooth angled 45* angle from gingival margin downwards
- 2 mins
- fluoride
- 2x day
- pea size
- supervision
- spit don’t rinse
describe the paeds BPE
scores 0-2 for <12 y/o
0 - healthy
1 - BOP
2 - calculus or plaque retention factor
3 - 4-5mm
4 - >=6mm
* furcation
what teeth should you use to obtain BPE in paeds
16, 11, 26, 36, 41, 46
What is the normal depth from CEJ to alveolar bone crest?
1-2mm
child pt has probing depths of 4mm
what medical conditions may you expect
diabetes
papillon levure syndrome
what questions would you ask in regards to a traumatised tooth
what happened
when did it happen
any pain
do you have fragment
what factors have a determinant on the prognosis of a traumatised tooth
- type of injury
- pulpal involvement
- open or closed apex
- pulp vitality
when discussing trauma with parents, include
explain
complications
prognosis
tx options
tooth 11 fracture and don’t know where fragment is
options
soft tissue embedded - remove and suture if needed
inhaled - A+E, chest xray
ingested - A+E
pt presents with white/yellow/brown stains on teeth
what questions would you ask mum
pre-natal = gestational DM, medications, infections
peri-natal = preeclampsia, birth trauma, anoxia, preterm
post-natal = childhood infections measles TB chickenpox mumps
what questions would you ask to rule out fluorosis in suspected MIH pt
excessive fluoride use, fluoride delivery
what teeth
any sensitivity, pain, crumbling
issues with MIH
caries
severe breakdown
difficulty restoring due to poor bonding
poor prognosis
options for impacted upper molars
- allow spontaneous eruption until 7-8 y/o
- XLA of e
- orthodontic separators
- distal dicing of E
- ortho appliance with finger spring on 6
what features of permanent dentition allow for replacement of primary teeth without crowding
growth of maxilla and mandible
perm teeth are narrower [premoalrs]
leeway space
primate space mesial to U3, distal L3
proclamation of permanent teeth
what is leeway space and how does this relieve crowding
primary molars wider than premolars
extra space 1.5mm maxilla, 2.5mm mandible
pt has extrusion of 11
what splint would you use and what materials
SS 0.4mm flexible passive splint
to one tooth each side
2 weeks
phosphoric aci etch 37%, bond, composite
what advice to parent on phone regarding avulsion
- stay calm, reassure child
- pick tooth up via crown and avoid touching roots
- if debris, clean with milk or saliva
- reimplant and bite down on tissue/gauze
- if cannot reimplant, place in saline, HBSS, milk
what are the common outcomes of an avulsed tooth
- necrosis
- ankylosis
- inflammatory external root resorption
- discolouration
- mobility
clinical signs of dentinogenesis imperfecta
both dentitions affected
amber, blue/grey discolouration
enamel fracture and wear
spontaneous abscess
blue sclera of eye
radiographic signs of dentinogenesis imperfecta
bulbous crowns
pulp canal obliteration
short roots
occult abscesses
clinical management of dentinogenesis imperfecta
prevention
overdentured due to OVD loss
composite veneers
RPD
SS crowns
E/O features of DS
short stature
overweight
small midface
thick fissured dry lips
flat facial profile
upward slanting palpebral fissures
IO signs of DS
delayed eruption
macroglossia
fused teeth
AOB
class 3
crowding
maxillary hypoplasia
following root fracture, what types of healing is there
- healing with hard tissue formation
- healing with interposition of connective tissue
- healing with connective tissue and hard tissue/bone interposition
- no healing, granulation tissue
- pulp necrosis
how are root fractures managed?
dependant on area of fracture
splint 4 weeks if apical or mid, 4 months if cervical
primary - only splint 4 weeks if coronal fragment very mobile and interfering with occlusion, or xla
signs of fluorosis
mild - white specks
more severe - brown, yellow staining, mottled enamel, structure irregularities
affects all teeth
how to manage fluorosis
- do nothing
- enamel microabrasion
- vital bleaching
- resin infiltration
- composite bandage/restoration
- veneers
adv of non-vital bleaching
- aesthetic improvement
- minimally destructive
- can be done at home
- simple
disadv of non vital bleaching
- adequate root filling needed
- may cause cervical resorption
- may not work
- relapse
- crown brittleness
- will not tx fluorosis, amalgam, tetracycline
describe walking bleach technique
- isolate w rubber dam
- open pulp chamber, removal of GP to just below gingival margin
- 10% carbamide peroxide on cotton wool, placed over with normal cotton wool
- sealed with GIC
- renew no more than 2 weeks
can be redone up to 10 times
once done, apply nonset CaOH 2 weeks to reverse acidity then final restoration
what is the only time splint is used for primary teeth
alveolar fracture
4 weeks
what splint for avulsed tooth
0.4mm ss flexible passive
adjacent tooth either side
2 weeks
what is the difference between flexible and rigid splint
flexible is one tooth either side
rigid is two teeth either side
if EADT < 60 mins of avulsed tooth, what is management
- clean area with saline/water/chx
- reimplant tooth
- verify position
- splint 2 weeks flexible
- abx if needed, tetanus inquiry
- act 2 weeks with CaOH
child swallows fluoride
mum phones and is worried
what should you ask
what concentration and how much
how old/weight
any systemic symptoms
if child has ingested toxic dose, what advice would you give
what is toxic dose
5m/kg
drink milk and go to A+E
what is the most common cause of fluorosis in the UK
swallowing of toothpaste
child 10 y/o with fluorosis
what is the best tx option
when would you intervene
monitor
11 years as more mature enamel
fluoride supplementation for a 1 year old
TP - 1450ppm
tablet - 0.25mg
fluoride supplementation for 4 year old
TP - 1450ppm
tablet - 0.5mg
fluoride supplementation for 7 year old
TP - 1450ppm
tablet - 0.5mg
MW - 225ppm
signs of primary herpetic gingivostomatitis
young pt
blisters on gums
small vesicles which rupture to form ulcers
fever
pain
blisters on lips
what is the cause of primary herpetic gingivostomatitis
herpes simplex virus primary infection
management of primary herpetic gingivostomatitis
supportive
analgesia
soft diet
hydration
fluids
rest
refer if unable to eat/drink
what time frames are implicated in MIH and why
pre/peri/post natal
this the developmental period of incisors and first molars
enamel formation known as amelogenesis occurs
signs and symptoms of MIH
pain
crumbling
sensitivty
reduced funcyion
poor aesthetics
options available for MIH of incisors
accept/monitor
enamel microabrasion
compostite/GI
FS
veneers
options for MIH of molars
accept/monitor
SS crowns
XLA
what is the topical effect of fluoride
incorporated into the tooth structure by replacing OH ions to F in hydroxyapatite to create fluoroapatite
creates a stronger structure to make less susceptible to acids, demineralisation, reduced acid [roduction, remineralisation
replaces lost calcium and phosphate ions
systemic effects of fluoride
fluorosis
toxicity
eruption dates for primary dentition
- Incisors: 6-10 months (lower first)
- Molars: 13-19 months (first molars first)
- Canines: 16-22 months
Second Molars: 23-33 months
eruption dates for permanent dentition
6-7 = first molars
7 = upper centrals
8 = lower centrals, upper laterals
9 = lower laterals, lower canines
10-12 = premolars
11= upper canine
12 = second molar
18+ = third molars
when do roots fully form
2-3 years post eruption
what orofacial injuries are suspicious
burn marks
hand/finger marks
ear/neck injuries
bites
bilaterally
you wish to refer child following signs of abuse
who do you refer to and how do you do it
thorough documentation and examinations
share concerns with dental team and multi-agency
check if subjected to child protective plan
phone social services, ensure written follow up 48hrs no more than 2 week
if immediate danger then child protection order, exclusion order or police removal
pulpotomy indications
vital tooth
carious/trauma exposure
space maintainer
no permanent successor
cooperative child
MH precludes xla
<9 y/o
pulpotomy contraindications
uncooperative child
> 9y/o
unable to gain haemorrhage control
severe infection/irreversible pulpitis
immunocompromised/cardiac defect
multiple grossly carious
severe pain
pulpectomy procedure
- LA, rubber dam
- remove pulp chamber
- 2mm from EWL
- CHX
- obturate CaOH and inform paste
- restore GIC + SSC
name 4 types of amelogenesis imperfecta
1 - hypoplastic = enamel not grown correct length
2 - hypocalcified = enamel not correct thickness
3 - hypomaturational = normal length, incomplete thickness and mineralisation
4 - taurodontism
cause of amelogenesis imperfecta
autosomal dominant
genetic
recessive
x-linked
problems occurring with amelogenesis imperfecta
sensitivty
caries
acid susceptibility
poor aesthetics
poor OH
AOB
delayed eruption
management of amelogenesis imperfecta
preventative
FS
SS crowns
composite veneers
metal onlay
ortho tx
name causes of enamel defects
MIH - peri/pre/post
infections
liver disease
trauma
nutritional deficiencies
fluorosis
4 year old pt presents with gross caries anteriorly, including smooth surface
what is the diagnosis
nursing bottle caries
how does nursing bottle caries occur
prolonged use
bottle as pacifier
high sugar/acid liquid
spares lowers due to tongue
tx plan for pt with nursing bottle caries
no longer use, don’t take to bed, brush teeth then no more use
milk and water only between meals
OHI, diet advance
sweets at mealtimes
supervised brushing
caries removal/rest if cooperative, consider ga if severe
3 types of dentinogenesis imperfecta
1 - osteogenesis imperfecta
2 - autosomal dominant
3 - brandywine
radiographic signs of dentinogenesis imperfecta
bulbous crowns
thin and short roots
pulp obliteration
occult abscesses
associated problems with dentinogenesis imperfecta
sensitivity
caries
acid susceptibility
poor prognosis
spontaneous abscess
poor aesthetics
management of dentinogenesis imperfecta
prevention
OVD loss so overdentures
composite veneers
PRD
SS crowns
indications for stainless steel crowns
cooperative pt
carious primary tooth
no pulpal involvement, pathology or infection
over 2 surfaces affected
after pulpotomy or pulpectomy
conventional SS crown placement procedure
- LA, rubber dam
- 1mm occlusal removal with flat fissure
- clear contact area
- select crown, ensure good fit, adjust as needed with band forming pliers
- dry tooth, GIC in crown, seat lingually and snap buccally, gingival blanching normal
- remove excess cement
- bite down hard or finger pressure
- check contacts and occlusion
signs/symptoms of stainless steel crown failure
loss of crown
dislodged
secondary caries
rocking
canting
pulpitis
abscess
adv of planned xla of permanent first molar
can assess best time to allow for 7’s to medially drift to close space
allows caries free dentition
signs for suitable timing of first molar xla
5’s present
7’s calcification of bifurcation, medially tilted
8’s present
disadvantages of planned xla of first molars
poor aesthetics
loss of functional tooth
bad experience
put off dentist
most common cardiac defect in children
ventricular septal defect (VSD)
hole between ventricles
condition where VSD commonly seen
ventricular septal defect
Down syndrome
name medical issues commonly associated wit Down syndrome
ventricular septal defect
alzheimers
epilepsy
obesity
hypothyroidism
hearing loss
perio
how is ventricular septal defect managed in dental setting
good prevention, OH
liaise with physician/cardiologist before invasive tx
may be need of abx prophylaxis due to infective endocarditis risk
10 y/o presents with extrusion of upper incisor
what splint
2 week flexible passive splint
pt following extrusion injury has now got external inflammatory resorption
how is this managed
remove stimulus, assess tooth vitality
RCT with nonset CaOH 6-8 weeks
check stabilisation of RR
if not, continue CaOH
obturate with GP
CaOH ESSENTIAL to stopping inflammatory resorption
what factors make up caries risk assessment
clinical evidence of previous disease
fluoride
diet
saliva
medical history
social, SE status
plaque control
what factors make up a prevention plan
OHI
diet advice
fluoride usage
f varnish
fissure seal
attendance
how often bitewings in high risk pt
6 months
what toothpaste strength for high risk 7 y/o
1450ppm
what fluoride supplement for 7y/o high risk
1mg per day
what is the optimum fluoride concentration in water
0.7mg/l
0.7ppm-1ppm
name sources of fluoride found in food and drink
black tea
seafood
spinach
oatmeal
raisins
how does fluoride work topically
incorporation of fluoride into enamel structure by replacing OH ions with F in hydroxyapatite to fluorapatite
promotes remineralisation, less susceptible to acid demineralisation, antibacterial, decreased acid
oral signs of fluorosis
white speckled
brown/yellow staining
surface irregularities
mottled appearance
fluorosis tx
accept
enamel microabrasion
vital bleaching
resin infiltration
composite bandage
composite veneers
what is the cause of external inflammatory resorption
loss of dental tissues, damage to PDL and pulp
initiated via PDl damage, propagated by RC toxins reaching external surface
necrotic pulp
reaction to trauma
clinical signs of external inflammatory resorption
mobility
discolouration
pain,t enderness percussion
non-vital so negative sensibility
radiographic signs of external inflammatory resorption
irregular root surface, loss of structure
radiolucent area surrounding root indicating bone loss
moth eaten
initial management of external inflammatory root resorption
analgesia, sensibility
remove stimulus
RCT non-set CaOH
assess progression, replace if needed
obturate
micro abrasion indications
superficial enamel irregularities
white staining
fluorosis,
post ortho
adv of micro abrasion
easy, simple
conservative
can be repeated
minimal after care
permanent
disadv of microabrasion
HCl caustic
unpredictable
removes enamel [100. microns ]
surgery only
reasons for anxious child when visiting dentist
- fear of unknown
- media
- parents perception
- stories from friends, siblings
- pain
how is anxiety measured in children
modified child dental anxiety scale [faces]
questions which answer related to various “smiley” faces
such as
how do you feel in the waiting room
8 behaviour management techniques
acclimatisation
desensitisation
tell show do
stop signals [enhanced control]
behaviour shaping
positive reinforcement
structured time
relaxation
distraction
6 y/o with pain LRQ with gross caries 85, buccal swelling
he has haemophilia A
what is diagnosis
what is tx of choice
how to carry out procedure
periapical abscess
pulpotomy/pulpectomy
atraumatic, liaise with haematology, consider referral
abx if needing referral
infiltration not idb
may need ddavp
ensure cessation of bleeding
local haemostatic agents
thrombin
surgicel
resorbable gelatin sponge
oxidised cellulose
la with vasoconstrictor
ferric sulphate
autism triad of impairment
social interaction
social communication
restricted/repetitive behaviours
autism features
sensory sensitivity
emotional dysregulation
range of intellectual ability
difficult with abstract concepts
how are autistic pt managed in dental setting
avoid sarcasm, jokes
no excessive noise
acclimitisation
keep same team
first thing, avoid waiting times
avoid chitchat
fissure sealants indications
all
high caries
learning disability
medically compromised
fissure sealant materials
BISGMA resin
GIC
4 types of cerebral palsy
1 - spastic
2 - ataxic
3 - athetoid
4 - mixed
further classification of cerebral palsy
hemiplegia
diplegia
paraplegia
quadriplegia
what is cystic fibrosis
chromosome 7 abnormality
CFTR gene
thick, excessive mucous in lungs, pancreas and salivary glands
general signs/symptoms of cystic fibrosis
recurrent infections
thick saliva
shortness breath
underdeveloped
cyanosed lips
blue fingertips
dental considerations of cystic fibrosis
thick saliva so decreased caries but increased calculus
enamel defects
delayed eruption
avoid GA and sedation
risk of infection
GORD
malabsorption
