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Dentistry year 3: Semester 6 > PAEDIATRIC > Flashcards

PAEDIATRIC Flashcards

1
Q

What are the four factors that combined lead to dental caries?

A
  1. Susceptible tooth surface
  2. Sugar substrate
  3. Time
  4. Bacterial biofilm
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2
Q

The child smile targets what age of children?

A

5- & 6-year-olds.

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3
Q

Oral health pack (toothbrush and tube of 1000ppm toothpaste) given to children at what stages in life and how many packs are given?

A
  1. At age 3 – 2 packs
  2. At age 4 – 2 packs
  3. At age 5 – 1 pack
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4
Q

For motivational interviewing the acronym SOARS is used what does stand for?

A

S = seek permission

O = open questions

A = affirmations

R = reflective listening

S = summarising

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5
Q

Measuring plaque score: what would be the scores for the plaque scores for a childs yellow form?

A

0 = tooth surface clean (10/10)

1 = appears clean but dental plaque can be removed from gingival 1/3 (8/10)

2 = visible plaque along the gingival margin (6/10)

3 = tooth surface covered with abundant plaque (4/10)

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6
Q

Radiographic detection of caries can be classified as E, D1, D2, D3, P. what do they stand for?

A

E = limited to enamel

D1 = Outer 1/3 dentine

D2 = middle 1/3 dentine

D3 = inner 1/3 dentine

P = has reached the dental pulp

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7
Q

High sugar content is more than how many grams per 100g of food?

A

15g

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8
Q

Medium sugar is between how many grams per 100g of food?

A

5-15g

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9
Q

Low sugar is between how many grams per 100g of food?

A

Is 5g or less per 100g of food

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10
Q

Why do we like fluoride?

A
  1. Inhibits demineralization, slowing decay
  2. Makes enamel more resistant to erosion
  3. In high concentrations, can inhibit bacterial metabolism/enzyme activity
  4. Fluoride is currently recognised as the major factor that is responsible for the reduction in caries prevalence worldwide.
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11
Q

Sign 138 recommends that fluoride varnish should be applied how many times a year?

A

At least twice yearly in all children.

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12
Q

SDCEP says apply 5% sodium fluoride varnish twice a year for all children over what age?

A

2 years of age

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13
Q

What happens if you ingest too much fluoride?

A

Nausea and vomiting associated with the ingestion of topical fluorides and dental fluorosis.

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14
Q

What is the toxic dose of fluoride?

A

Is 5mg per kg

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15
Q

If a child overdoses on fluoride, what can be given to minimize absorption?

A

By giving calcium containing solution.

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16
Q

Which tooth is the first to erupt and what age does it shed?

A

Lower Central incisors: eruption 6-10 months. Shed 6-7 years

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17
Q

Which tooth is the second to erupt and what age does it shed?

A

Upper central incisors: eruption 8-12 months. Shed 6-7 years

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18
Q

Which tooth is the third to erupt and what age does it shed?

A

Upper lateral incisors: 9-13 months. Shed 7-8 years

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19
Q

Which tooth is the fourth to erupt and what age does it shed?

A

Lower lateral incisors: 10-16 months. Shed 7-8 years

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20
Q

Which tooth is the fifth to erupt and what age does it shed?

A

Upper first molar: eruption 13-19 months. Shed 9-11 years

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21
Q

Which tooth is the sixth to erupt and what age does it shed?

A

Lower first molar: eruption 14-18 months. Shed 9-11 years

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22
Q

Which tooth is the 7th to erupt and what age does it shed?

A

Upper canine: eruption 16-22 months. Shed 10-12 years

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23
Q

Which tooth is the 8th to erupt and what age does it shed?

A

Lower canine: eruption 17-23 months. Shed 9-12 years

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24
Q

Which tooth is the 9th to erupt and what age does it shed?

A

Lower second molar: eruption 23-31 months. Shed 10-12 years

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25
Q

Which tooth is the 10th to erupt and what age does it shed?

A

Upper second molar: eruption 25-33 months. Shed 10-12 years

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26
Q

What are the stages of tooth development?

A
  1. Bud stage
  2. Cap stage
  3. Early Bell stage
  4. Late bell stage
  5. Crown and root formation
  6. Eruption stage
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27
Q

At what tooth development stage does the emergence of enamel organs present themselves, this occurs during the first 8 weeks of intrauterine life?

A

Bud stage.

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28
Q

At what tooth development stage is marked by the expansion and growth of the enamel organ.

A

During this stage Formation of tooth germ as enamel organ forms into cap shape that surrounds inside mass of dental papilla, with an outside mass of dental sac, both from the ectomesenchyme. Cap stage

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29
Q

Missing teeth as a result of them failing to develop is known as?

A

Hypodontia

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30
Q

Total lack of teeth in one or both dentitions?

A

Anodontia

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31
Q

Rare condition where more than 6 primary or permanent teeth are absent?

A

Oligodontia

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32
Q

hypodontia can be associated with certain syndromes such as?

A

Trisomy 21 (down syndrome)

and ectodermal dysplasia

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33
Q

ectodermal dysplasia is a group of inherited conditions which x or y linked?

A

X linked

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34
Q

multiple missing teeth can be complex and should involve a multidisciplinary team that includes?

A
  1. Paediatric dentist
  2. Orthodontist
  3. Restorative dentist
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35
Q

What are the two treatment options for missing upper laterals?

A
  1. Space closure – bring canine into lateral
  2. Space closure – placement of prosthesis
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36
Q

There are 4 types of supernumerary teeth, what are they?

A
  1. Mesiodens
  2. Supplemental teeth
  3. Conical supernumeraries
  4. Tuberculate supernumeraries
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37
Q

a condition in which one or more teeth appear smaller than normal?

A

Microdontia

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38
Q

a condition where one or more teeth grow at a different rate from the others and exceed the average size. The result is an abnormally large tooth or teeth that can causes challenges for the patient, such as teeth misalignment, overcrowding and confidence issues.

A

Macrodontia

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39
Q

Name this condition?

A

Dens in dente

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40
Q

Name this condition?

A

Talon cusp

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41
Q

Two teeth develop from on tooth germ is known as?

A

Double teeth

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42
Q

Spectrum of hereditary defects in the function of ameloblasts and mineralisation of enamel matrix, affects both primary & permanent dentitions, resulting in a condition called?

A

Amelogenesis imperfecta

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43
Q

What are the 5 main clinical problems with dentinogenesis imperfecta?

A
  1. Poor aesthetics
  2. Chipping and attrition of enamel
  3. Exposure of dentine
  4. Poor oral hygiene, gingivitis and caries
  5. Pain and infection, pulpal necrosis
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44
Q

How many types of dentinogenesis imperfecta is there?

A

Dentinogenesis imperfecta is a autosomal dominant inherited condition and consists of 3 types.

Type 1 – associated with OI

Type 2 – dentinogenesis on its own

Type 3 – brandywine isolate

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45
Q

The likelihood of skeletal abnormalities is common with which type of dentinogenesis imperfecta?

A

Type 1

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46
Q

What are the three types of amelogenesis imperfecta?

A
  1. Hypoplastic
  2. Hypocalcified
  3. Hypomature
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47
Q

What is the definition of attrition?

A

The process of reducing somethings strength or effectiveness through sustained attack or pressure.

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48
Q

Dentinogenesis imperfecta is present in both primary and permanent dentition, due to condition of the dentine, the dentition affected or more prone to developing what?

A

Spontaneous abscesses.

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49
Q

What are the treatment objectives for Dentinogenesis imperfecta in the primary dentition?

A
  1. Maintain occlusal face height
  2. Maintain oral hygiene
  3. Address sensitivity/infection/abscesses
  4. Preserve function, aesthetics and normal growth
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50
Q

What are the treatment objectives for Dentinogenesis imperfecta in the permanent dentition?

A
  1. Address aesthetics
  2. Protect incisors/first permanent molars from wear
  3. Maintain occlusal face height
  4. Maintain oral hygiene
  5. Address sensitivity/infection/abscesses
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51
Q

What are the treatment options for Dentinogenesis imperfecta in the primary dentition?

A
  1. Monitor wear
  2. Overdenture
  3. SSCs for posteriors, composite crowns for anterior
  4. Fluoride applications for sensitivity
  5. Extractions if abscessed
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52
Q

What are the treatment options for Dentinogenesis imperfecta in the permanent dentition?

A
  1. Monitor wear
  2. Cast restorations on occlusal surfaces of FPMS (and premolars of required)
  3. Composite veneers
  4. Concern about enamel shear with fixed orthodontics, however, can be used with care
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53
Q

What is molar incisor hypomineralisation (MIH):

A

MIH is a tooth condition where enamel and dentine are softer than normal

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54
Q

What is the management plan of molar incisor hypomineralisation (MIH)?

A
  1. Early detection
  2. Prevention of caries and post-eruptive breakdown
  3. Desensitisation and remineralisation
  4. Long term treatment plan
  5. Maintenance
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55
Q

Early detection is the key to successful management of molar incisor hypomineralisation, at what stage/time would you try and detect MIH?

A

When incisors erupt before molars, you would look for opacity on an incisor. This Is a strong indicator of MIH.

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56
Q

If diagnosed with molar incisor hypomineralisation, what would you be in high risk of developing?

A

High caries risk.

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57
Q

How would you manage the prevention of caries and post-eruptive breakdown in MIH?

A

You may need to temporise with restorative material or stainless-steel crown – child anxiety and pain during treatment must be balanced against restoration type.

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58
Q

How would treat for desensitisation and remineralisation in the management of MIH?

A
  1. Repeated application of 5% sodium fluoride varnish
  2. Use of commercially available sensitive toothpaste
  3. Use of 0.4% stannous fluoride gels
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59
Q

What is fluorosis?

A

Dental fluorosis is a condition that causes changes in the appearance of tooth enamel. It is caused by overexposure to fluoride during the first 8 years of life.

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60
Q

What is turners’ tooth?

A

Turner’s tooth also called enamel hypoplasia, is a condition that reduces a tooth’s enamel thickness, increases tooth sensitivity, leaves the affected tooth more susceptible to decay, and results in an unsightly appearance.

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61
Q

At which week during embryology does the formation of dental lamina begin?

A

6 weeks

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62
Q

At which week during embryology does the tooth germ for primary teeth develop?

A

8 weeks

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63
Q

At which week during embryology does the tooth germ for permanent teeth develop?

A

14 weeks

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64
Q

At which week during embryology does the dentine and enamel formation begin in primary teeth?

A

18 weeks

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65
Q

At which week during embryology does the dentine and enamel formation begin for permanent 1st molars?

A

32 weeks

66
Q

Odontoblasts originate from where?

A

Dental papilla

67
Q

Ameloblasts originate from where?

A

Inner enamel epithelium

68
Q

Enamel formation is divided in to three process what are they?

A
  1. Presecretory – shape of crown determined ameloblasts develop and prepare to secrete the organic matrix
  2. Secretory – ameloblasts lay down organic matrix
  3. Maturation – ameloblasts transport specific ions to mineralise matrix
69
Q

What percentage of preschool children injure their deciduous tooth/teeth through trauma?

A

33%

70
Q

What is the annual incidence for dental trauma for school children under 19? .

A

1.3-4% (0.4%) population as a whole

71
Q

The type of injury sustained is dependant on impact. What type of impact would you need to sustain to fracture a tooth and displace a tooth?

A

An impact with a hard structure will result in a fracture, and an impact with a relatively soft structure will result in a displacement.

72
Q

An impact to the tooth can cause physiological damages to tooth and the structures supporting it. Name seven structures of the tooth that can be affected in dental trauma.

A
  1. Apical blood supply
  2. Bone
  3. PDL
  4. Pulp
  5. Gingivae
  6. Dentine
  7. Enamel
73
Q

What is primary and secondary intention healing?

A

Primary wound healing occurs when e.g., after a surgical incision in which the edges of the wound are connected by a suture. In general, such wounds would heal within 6-8 days. In contrast in secondary wound healing the wound cannot be closed by a primary wound closure.

74
Q

How does external inflammatory resorption occur through trauma?

A

External inflammatory resorption is one of the potential consequences of trauma to the teeth. It occurs when there has been a loss of cementum due to damage to the external surface of the tooth root during trauma, along with the root canal system being infected with bacteria.

75
Q

Minimal displacement of a tooth during trauma may cause ischaemia, however the tooth has the potential to revascularize, what are the conditions for it revascularize?

A

Likely to vascularise if apex >1mm

Rare if apex <0.5mm

76
Q

What causes a sclerotic pulp after trauma?

A

if a tooth has been displaced and lost its vascularisation, then if the tooth was to revascularize under the right conditions, then upon revascularisation it can activate a form of odontoblast that is a reactionary type, in to pulp and this type of odontoblast will begin to lay down more dentine, resulting in a sclerotic pulp.

77
Q

The transportation of foreign bodies via blood or lymph and subsequent collection at a site of inflammation, is known as what?

A

Anachoresis

78
Q

Classification of dental trauma (WHO 1995) is in 4 categories, what are they?

A
  1. Dental (tooth) injuries
  2. Periodontal injuries
  3. Soft tissue injuries
  4. Skeletal injuries
79
Q
  1. Enamel infraction (incomplete crack)
  2. Enamel fracture
  3. Enamel dentine (uncomplicated)
  4. Enamel, dentine, pulp (complicated)
  5. Crown root without pulp involvement
  6. Crown root with pulp involvement
  7. Root (cervical or mid 1/3)

The above type of injuries falls into which category of the WHO dental trauma classification?

A

Dental (tooth) injuries

80
Q

What type of dental (tooth) injury is this?

A

Enamel infraction.

81
Q

What type of dental injury is this?

A

Enamel fracture

82
Q

What type of fracture is this?

A

Enamel dentine fracture

83
Q

What IS EXPOSED IN this type of fracture?

A

Enamel, dentine pulp fracture

84
Q

What type of fracture is this?

A

Crown root fracture with pulp involvement

85
Q

What type of fracture is this?

A

Crown root fracture without pulp involvement

86
Q

What type of fracture is this?

A

Root fracture

87
Q

What is a tooth luxation?

A

Tooth luxation occurs when trauma, such as a fall, disrupts the tissues, ligaments and bone that hold a tooth in place. Tooth luxation can also affect the tooth’s nerves and blood supply. A luxated tooth is sometimes loose, angled or moved out of the socket.

88
Q

Dental luxation is a general term encompassing 6 types of pathology. Dental luxation falls in to the category of periodontal injuries for dental trauma, what are they?

A
  1. Concussion: tender tooth, no loosening/displacement
  2. Subluxation: tender tooth, loosening without displacement but bleeding from gingival crevice.
  3. Extrusive luxation: marked loosening, tooth appears longer/displaced
  4. Lateral luxation: displacement without loosening
  5. Intrusive luxation: displacement into alveolar bone
  6. Avulsion: tooth is out of socket
89
Q

When clinically investigating an enamel infraction (incomplete crack), if the tooth is tender what would you evaluate it for?

A

If tenderness is observed, evaluate the tooth for a possible luxation injury or root fracture.

90
Q

What radiographic abnormality would you expect to see for an enamel infraction?

A

No radiographic abnormalities.

91
Q

What radiographic abnormality would you expect to see for an extrusive luxation?

A

Radiographically increased periodontal ligament space.

92
Q

With intrusion of the primary teeth, if the root is displaced towards the permanent successor (palatally), what would be the treatment plan?

A

Extract.

93
Q

With intrusion of the primary teeth, if the root is displaced away from the permanent tooth (labially), what would be the treatment plan?

A

The best way to manage a intrusive primary tooth, displaced slightly labially, would be to monitor it.

Measure and document the amount of intrusion, using fixed reference points to serve as a baseline.

94
Q

What category of luxation does this periodontal injury fall in to?

A

Extrusive luxation

95
Q

What category of luxation does this periodontal injury fall in to?

A

Intrusive luxation

96
Q

What category of luxation does this periodontal injury fall in to?

A

lateral luxation

97
Q

What category of luxation does this periodontal injury fall in to?

A

lateral luxation

98
Q

What is the management plan for a lateral luxation that has been displaced palatally?

A

Extract

99
Q

What is the management plan for a lateral luxation that has been displaced labially?

A

Remove tooth from the socket and use forceps to reposition it back in the socket. You will need to place a flexible splint for about four weeks. After that, your dentist will monitor your pulp

100
Q

With avulsions, when would you put the tooth back in?

A

when it is a permanent tooth.

101
Q

Soft tissue injuries are a classification under the dental trauma classification. What are the two types of soft tissue injuries?

A

Intra oral and extra oral

102
Q

What is a degloving injury:

A

A degloving injury is a traumatic injury that results in the top layers of skin and tissue being torn away from the underlying muscle, connective tissue or bone.

103
Q

What are contusions commonly known as?

A

Bruises

104
Q

Skeletal injuries that fall under the dental trauma classification are?

A
  1. Alveolus – 2 or more teeth moving as a block
  2. Mandible
  3. Maxilla
  4. Cranial injuries
105
Q

What prevention measure that involves two phases can be put in place to reduce the incidence of incisal trauma?

A

Two phase overjet reduction (first phase started age 7-11 years with functional appliances then second phase in adolescence).

106
Q

What type of gum shields are these?

A

Boil and bite (type 2)

107
Q

What type of gumshield is this?

A

Custom made (type 3)

108
Q

Immediate management of trauma

A patient arrives immediately following trauma, in terms of patient safety, what will be the first thing you assess?

A

Assess for possible aspiration – are all lost teeth/tooth fragments accounted for.

109
Q

A patient arrives immediately following trauma, what do you want to look out for extra orally?

A
  1. Abrasions
  2. Lacerations
  3. Palpate and look for signs of skeletal fractures (asymmetry)
  4. Inferior border of mandible
  5. Zygomatic arch
  6. Battle signs
  7. Bilateral periorbital bruising
110
Q

A patient arrives immediately following trauma, what do you want to look out for intra orally?

A
  1. Bruising
  2. Haematoma
  3. Floor of mouth
  4. Lacerations
  5. Degloving injuries
  6. Displacement of soft tissues
  7. Steps in occlusion (mandibular/maxillary fracture)
  8. Mandibular deviation on opening (condylar fracture)
111
Q

What do we want to make sure isn’t present intra/extra orally, when a patient arrives immediately following trauma?

A

Ensure that there are no foreign bodies present – gravel, etc.

112
Q

Where would you expect to find typical accidental injuries?

A
  1. Head injuries – parietal bone, occipital or forehead
  2. Nose
  3. Chin
  4. Palm of hand
  5. Elbows
  6. Knee
  7. Shins
113
Q

What needs to be remembered when assessing accidental injuries?

A
  1. Involve only bony prominences
  2. Match the history
  3. Are in keeping with the development of the child
114
Q

Where would you expect to find abusive injuries?

A
  1. Ears – especially pinch marks involving both sides of ears
  2. The triangle of safety (ears, side of face, and neck top of shoulders. – accidental injuries in this area are unusual.
  3. Inner aspects of arms
  4. Back and side of trunk except directly over the bony spine.
  5. Black eyes, especially if bilateral
  6. Soft tissues of cheeks
  7. Intra-oral injuries
  8. Forearms when raised to protect self
  9. Chest and abdomen
  10. Any groin or genital injury
  11. Inner aspects of thighs
  12. Soles of feet
115
Q

forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening, is defined as sexual abuse. How would you recognise this in a patient?

A
  • direct allegation (disclosure)
  • sexually transmitted infection
  • pregnancy
  • trauma
  • emotional and behavioural signs e.g. delayed development, anxiety and depression, self-harm, drug, solvent or alcohol abuse
116
Q

emotional abuse is defined as - persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. How would you recognise this in a patient?

A
  • poor growth
  • developmental delay
  • educational failure
  • social immaturity
  • lack of social responsiveness, aggression or indiscriminate friendliness
  • challenging behaviour
  • attention difficulties
  • concerning parent-child interaction
117
Q

neglect is defined as - the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. includes failing to ensure access to appropriate medical care or treatment. How would you recognise this in a patient?

A
  • failure to thrive
  • short stature
  • inappropriate clothing
  • frequent injuries
  • ingrained dirt
  • developmental delay
  • withdrawn or attention seeking behaviour
  • failure to respond to a known significant dental problem
118
Q

if you have concern that a child has undergone some form of abuse, what do you do?

A
  • assess the child
  • take a history
  • examine carefully
  • talk to the child
  • discuss with an appropriate colleague
  • decide if you still have concerns
119
Q

if you still have concerns that a child has or is going through some form of abuse, what do you do?

A
  • provide urgent dental care
  • talk to the child and parents
  • explain your concerns
  • inform of your intention to refer
  • seek consent to sharing information
  • keep full clinical records
  • refer to social services
  • confirm referral has been acted upon
120
Q

if you no longer have concerns that a child is going through some form of abuse, what do you do?

A
  • provide necessary dental care
  • keep full clinical records
  • provide information about local support services for children and families
  • arrange dental follow-up
121
Q

how would you manage dental neglect?

A
  • raise concerns with parents
  • explain what changes are required
  • offer support
  • keep accurate records
  • continue to liaise with parents/carers
  • monitor progress
  • if concerned that child is suffering harm, involve other agencies or proceed to make a child protection referral
122
Q

What is the difference between diet and nutrition?

A

In a nutshell, diet refers to all the food that you consume through the day, on a regular basis. Nutrition on the other hand refers, refers to the fuel that your body requires to function optimally and maintain good health. It refers to the right mix of nutrients.

123
Q

What is the difference between intrinsic and extrinsic sugars?

A

Intrinsic sugars are contained within the cell structure of foods such as fruit and vegetables. Extrinsic sugars are sugars added to a product during preparation such as caster sugar added to cake.

124
Q

What does the Frank score used to evaluate?

A

Is one of the most widely used behaviour evaluation scale in paediatric clinical practice. Scale from 1 – 4 (1. defo positive, 2. positive, 3. negative, 4. defo negative)

125
Q

What is the MCDAS used for?

A

Known as the modified child dental anxiety scale, uses faces to select how a child feels in the practice. Out of 30, the higher the number the more upset the patient is.

126
Q

What is the tell show do?

A
  1. Tell – your dentist explaining to you what they’d like to do
  2. Show – showing you what is involved
  3. Do – performing the procedure
127
Q

What is a knee-to-knee exam?

A

You (the parent) will sit in the dental chair with your child sitting in your lap facing you while the dentist pulls up a chair. The dentist and the parent will sit knee to knee, and you’ll lean the child backwards into their lap. The dentist will then conduct the knee-to-knee exam by inspecting their mouth.

128
Q

What are the stages of Piaget’s theory of child development?

A
  1. Sensorimotor stage: 2 years
  2. Preoperational stage: 2- 7 years
  3. Concrete operational stage: 7-11 years
  4. Formal operational stage: 12 and up
129
Q

How would you manage a concussed permanent tooth?

A
  1. Maintain good oral hygiene
  2. Use a soft toothbrush
  3. Possibly rinse with chlorhexidine
  4. Parents to look for signs of loss of vitality/infection; pain, discoloration (grey), swelling sinus tract, mobility.
130
Q

How would you manage subluxation of the permanent teeth?

A
  1. Usually requires flexible splint to stabilize the tooth for patient comfort. Generally splint the adjacent tooth mesially and distally. Splint may be required for up to two weeks.
  2. Soft diet 1 week
  3. Maintain good oral hygiene
  4. Use a soft toothbrush
  5. Possibly rinse with chlorhexidine
131
Q

How would you manage subluxation for a primary teeth?

A
  1. No active treatment – do not splint primary teeth
  2. Observe and document
  3. Soft diet for 1 week
  4. Maintain good oral hygiene
  5. Soft toothbrush
  6. Chlorohexidine alcohol free – with cotton swab twice daily for 1 week
132
Q

If extrusion is less than 3mm in primary teeth, and the tooth is immature, can you reposition it?

A

yes but be careful as intruding the tooth could damage the permanent tooth.

133
Q

How would you manage lateral luxation of the permanent teeth?

A
  1. Any exposed root surface should be cleaned with saline prior to repositioning
  2. Local anaesthesia is required
  3. Gently reposition the tooth with forceps or digital pressure to disengage it and gently reposition it into its original location. Pre trauma photos are useful for guiding this.
  4. Stabilize the tooth for 4 weeks using flexible splint. 4 weeks is indicated due to associated bone fracture. Care must be taken when removing the splint to ensure that the tooth is no longer abnormally mobile
  5. Soft diet 1 week
  6. Good oral hygiene
  7. Rinse with chlorhexidine
134
Q

Which guidelines do you want to use for trauma?

A

IADT trauma guidelines

135
Q

So why review trauma cases?

A
  1. Not all sequelae of trauma are immediate
  2. Many complications and side effects can occur months/years after the initial treatment
136
Q

When are you most likely to get damage to the successor tooth after a trauma?

A

Immediately following trauma, especially with intrusion or lateral luxation.

137
Q

What to look for with pulpal necrosis on primary teeth?

A
  1. Persistent grey colour to tooth that does not fade
  2. No reduction in size of pulp activity
  3. Radiographic signs of periapical inflammation
  4. Clinical signs of infection: tenderness, sinus, suppuration, swelling.
138
Q

Pulpal obliteration - what to look for - what to do?

A

What to look for

  • Clinically, the tooth may become a yellow/opaque colour
  • Radiographically, pulp chamber will shrink

What to do

Nothing if asymptomatic

Extract if radiographic signs and/or clinical signs of infection/inflammation

139
Q

What is a dilacerated tooth?

A

Deviation of root shape from the normal long axis formation. Has the potential to inhibit eruption

140
Q

What are the complications caused by a dilacerated primary tooth on its permanent successor?

A
  1. Common – loss of vitality and pulp necrosis
  2. Resorption
  3. Ankylosis
  4. External resorption
  5. Internal resorption
  6. Other issues – discolouration, original misdiagnosis, failed initial treatment.
141
Q

What do you look for, with a permanent tooth pulpal necrosis?

A
  1. No response to sensibility testing
  2. Greyish discolouration
  3. Patient symptoms, history
142
Q

For an open apex why do we not create a barrier with calcium hydroxide?

A

It makes the dentine dry out and brittle and can result in root fracture.

143
Q

What is the preferred method of closing an open apex to make a barrier?

A

Using MTA

144
Q

How much MTA should be used as a plug?

A

5mm

145
Q

Pulp necrosis occurs in about 20% of root fractures, the greater the amount of initial displacement, the greater the chance of necrosis. The root apical to the fracture usually retains vitality, how do you treat this?

A
  1. Apical 1/3 and mid 1/3 root fractures, treat up to the point of the fracture – do not extend beyond the fracture into apical portion.
  2. MTA apical stop may be required at the fracture line
  3. If apical portion becomes non vital, may require surgical removal
146
Q

Which type of dentine is responsible for permanent tooth pulp canal obliteration?

A

Reactionary dentine

147
Q

Multi nuclear giant cells are responsible for what when they are stimulated as part of the inflammatory response?

A

Inflammatory resorption.

148
Q

External inflammatory response occurs with teeth that have both?

A

Necrotic pulps and associated infection.

149
Q

In external resorption, the giant cells are activated in the?

A

Activated in the PDL, and the stimulus is the infected canal

150
Q

When does ankylosis usually occur?

A

Usually occurs after large luxation or avulsion injuries. When more than 20% of the PDL is damaged before replanting or repositioning, then bone cells are able to colonize the surface of the root faster than the PDL.

151
Q

What two vitality testing do we not do on primary tooth?

A
  1. Electric pulp testing
  2. Thermal testing
152
Q

What is the purpose of doing a pulpotomy technique?

A

A (vital) pulpotomy is a technique used for managing the traumatised permanent incisor where there is an enamel/dentine fracture and a pulpal exposure. The purpose is to remove (amputate) infected and inflamed pulp tissue. The remaining healthy pulpal tissue surface is then treated with calcium hydroxide or MTA. The objective of this procedure is to maintain the tooth’s vitality and also allow the root to continue development in the case of immature teeth.

153
Q

How would you arrest the bleeding in a pulpotomy?

A

Arrest the bleeding using a cotton wool pledget soaked in sterile water/saline. Adrenaline free local anaesthetic can be used as an alternative to sterile water/saline. Do not use water from the 3 in 1 syringe!

154
Q

What would you dress the exposed pulpal surface with in a pulpotomy?

A

Dress the exposed pulpal surface with calcium hydroxide or MTA or other non-staining calcium silicate cements.

155
Q

What would use to cover the dressing of calcium hydroxide or MTA in a pulpotomy?

A

Cover the calcium hydroxide or alternative with resin modified glass ionomer cement. This functions as a lining in preparation to receive composite restoration immediately.

156
Q

What is a composite bandage used for?

A

A composite bandage is a temporary dressing placed on a tooth immediately after an enamel dentine fracture or an enamel dentine pulp fracture that has undergone a pulpotomy.

157
Q

We must be careful not to splint teeth for too long as this can lead to?

A

Ankylosis or external resorption

158
Q

Which management theory identifies work as natural play and rest.

A

Theory y (X theory carrot and stick)

159
Q

What is Adair’s characteristics of a work group?

A
  1. Definable membership
  2. Group consciousness
  3. Sense of shared purpose
  4. Interdependence
  5. Interaction
  6. Ability to act in unitary manor
160
Q
A

Dentistry year 3: Semester 6 (16 decks)

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