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DG2016 - CK 2 > Paediatric > Flashcards

Paediatric Flashcards

1
Q

What 6 points should be considered when assessing child and parent attitudes to dentistry?

A
  • past dental history
  • previous extractions
  • previous GA
  • acceptance of oral health advice
  • attendance for treatment
  • compliance with OH
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2
Q

What are 4 factors that can contribute to difficulty in establishing healthy behaviours?

A
  • education, family health or social issues (deprivation)
  • complex child care arrangements
  • parent/carers lack of knowledge of the prevention of dental disease
  • children/families with additional needs
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3
Q

What age should children have their first dental exam?

A

age 1

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4
Q

What teeth should be included when doing a modified BPE in children?

A

UR6, UR1, UL6
LR6, LL1, LL6

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5
Q

What BPE codes should be used for children in the mixed dentition stage? (7-11)

A

BPE codes 0, 1, 2

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6
Q

What age can the full range of BPE codes be used in children when all permanent teeth have erupted?

A

age 12-17

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7
Q

Below which age are BPEs not indicated?

A

below age 7

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8
Q

Probing is not an acceptable method for diagnosing caries in which areas?

A

pits and fissures

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9
Q

Probing is an acceptable method of assessing caries in which areas?

A

exposed dentine

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10
Q

What is the name of the scoring system to assess caries and restorations?

A

ICDAS

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11
Q

What age are bitewings indicated in children?

A
  • aged 4 and above
  • when contact points cannot be fully assessed
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12
Q

When should bitewings be taken on children with an increased risk of developing caries?

A

6-12 months

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13
Q

When should bitewings be taken on children with primary teeth and not an increased risk of developing caries?

A

12-18 months

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14
Q

When should bitewings be taken for permanent teeth?

A

2 yearly

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15
Q

What is the guidance for enamel-only inter-proximal carious lesions on permanent molars?

A
  • explain their importance to the parent/carer
  • topical fluoride
  • high fluoride tp prescription (10 and above)
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16
Q

What should be done if there is a valid reason not to take radiographs as specified?

A
  • record in patients notes
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17
Q

What size films should be used in small children?

A

size 0

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18
Q

What are the 3 treatment options for dental infection in children?

A
  • XLA
  • pulp therapy is feasible
  • monitor for 3 months
    in exceptional circumstances, monitor asymptomatic dental infection whilst the child acclimatises to dental environment
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19
Q

What are 4 indicators of establish dental infection in children?

A
  • interradicular radiolucency
  • TTP in a non-exfoliating tooth
  • alveolar tenderness, sinus or swelling
  • non physiological mobility
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20
Q

What are 5 considerations when assessing the risk of pain or infection developing before exfoliation?

A
  • extent of the lesion
  • activity of the lesion
  • time to exfoliation
  • number of other lesions present in the dentition
  • co-operation from child and parent
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21
Q

What are the 3 main evidence-based indicators of a child being at an increased risk of developing caries within the next 3 years?

A
  • previous caries experience
  • resident in an area of deprivation
  • referral from healthcare worker who had identified the need for additional preventative care
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22
Q

How is caries risk assessed in children? (7)

A
  • diet history
  • previous dental history
  • current disease status
  • parent/child engagement
  • pattern of attendance
  • oral hygiene
  • siblings dental history
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23
Q

What are the 3 elements of developing a personal care plan?

A
  • managing pain (if present)
  • caries prevention
  • managing caries (and asymptomatic sepsis if present)
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24
Q

What are 3 factors complicating caries management?

A
  • children can find operative treatment unpleasant
  • clinicians can find operative treatment in children difficult to provide
  • children with decay tend to have multiple teeth affected
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25
Q

What are 2 factors simplifying caries management?

A
  • primary teeth have a limited lifespan, so slowing caries progress may be sufficient
  • many children and parents are happy with prevention of pain and sepsis as a treatment goal for primary teeth, with restoration of function and aesthetics of secondary importance
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26
Q

What teeth are the first priority when developing a personal care plan?

A

keep the 6s and 7s free from both occlusal and approximal caries

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27
Q

What should be included in a personal care plan?

A
  • discuss and explain caries prevention and management options with the child and parent
  • ? contact childs health visitor or school nurse
  • plan to carry out preventive interventions for permanent teeth before treatment of primary teeth (fissure seals)
  • devise and agree an initial care plan with the child and parent/carer that includes the expected number and duration of apps, be prepared to modify if child in unable to accept some treatments or there are changes in caries
  • obtain informed consent for the agreed care plan
  • consider staging treatment with a month or two between
  • ensure complete and accurate records are kept
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28
Q

What are the 4 main ethical principles of consent?

A
  • valid consent
  • voluntary decision making
  • ability to make an informed decision
  • is dynamic - can change mind
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29
Q

What is meant by valid consent?

A

enough information to make a decision

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30
Q

What is meant by voluntary decision making?

A

without pressure or influence from family member or healthcare professional

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31
Q

What is meant by ability to make an informed decision?

A
  • child may have the ability
  • person with parental responsibility (PR)
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32
Q

Which legislation permits patients of 16, of sound mind, to give legally valid consent and does not preclude children under 16 from giving consent?

A

law reform act 1969

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33
Q

What is the term used to describe the following?
- child under 16 may be able to: understand nature of treatment and purpose, understand risks and limitations, compare alternatives
- wise to get permission of child to discuss with parent
- extreme caution if parent not available

A

gillick competence

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34
Q

Which legislation sets out who has parental responsibility?

A

children act 1989

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35
Q

When giving consent, the Childs mother, but not the father has PR if they were not married, unless what 3 things?

A
  • the father has acquired PR via a court order or PR agreement
  • the couple subsequently marry
  • named on the birth certificate
36
Q

Legally appointed guardian can be appointed by who?

A
  • court
  • parent with PR in the event of their own death
37
Q

What 3 other circumstances can have parental responsibility?

A
  • a person in whose favour a court has made a residence order concerning the child
  • local authority designated in care order (but not when the child is being looked after under section 20 of the children act - accommodated or in voluntary care)
  • local authority or other authorised person holding an emergency protection order (usually not foster parent)
38
Q

What is the correct sequence of treatment for child patients?

A
  • prevention
  • fissure seals
  • preventive restorations
  • simple fillings eg. shallow cervical cavities
  • fillings requiring LA but not into pulp
  • more extensive restorative work
  • extractions
    UPPER ARCH FIRST DUE TO LA BEING SIMPLER
39
Q

What are 4 dental anxiety scales?

A
  • modified child dental anxiety scale
  • corahs modified dental anxiety scale
  • venhams picture test
  • childrens dental fear survey schedule, CFSS dental sub scale
40
Q

What are 3 aims of behaviour management methods?

A
  • improve communication process
  • eliminate inappropriate behaviours
  • reduce anxiety
41
Q

What are 7 examples of behaviour management techniques?

A
  • non verbal communication
  • modelling
  • tell, show, do
  • distraction
  • systemic desensitisation
  • communication with patient
  • giving patient control signals
42
Q

What condition is being described?
- common, developmental condition resulting in enamel defects of incisors and molars
- need extra protection
- unknown aetiology

A

molar incisor hypomineralisation

43
Q

Which caries management technique is the following?
- suitable for a permanent tooth with an extensive lesion on occlusal or proximal surfaces
- aims to avoid pulpal exposure by selectively removing caries from cavity walls
- sealing the remaining caries with an adhesive restoration
- waiting 3-6 months for reactionary dentine to be laid down and then completing caries removal to hard dentine

A

stepwise technique

44
Q

What would happen to the adjacent 5s and 7s following early loss of maxillary 6s before complete eruption of 7s?

A

7 = rotation and mesial movement
5 = distal drift

45
Q

What would happen to the adjacent 5s following loss of the mandibular 6s before optimum age?

A

5 = drifts distally and rotates

46
Q

What happens to the adjacent 7s following loss of the 6s after optimum age?

A

7s = mesial tilting

47
Q

What is the optimum age to extract first permanent molars?

A

ideally between 8 1/2 to 10 years old

48
Q

What is a classic sign of an indication when to extract first permanent molars?

A

when furcation of the second permanent molars has started to form on a radiograph

  • allows second permanent molar to erupt into acceptable occlusion with 5s
49
Q

Before extracting first permanent molars, what should be checked radiographically?

A
  • check 5s and 8s are present on OPG
  • furcation of the 7s
50
Q

What are 3 important points relating to dental caries in primary dentition?

A
  • rapid caries progression
  • small teeth with large pulp chambers
  • caries must be treated early for long-term success
51
Q

Which type of pulp capping has a better success rate?

A

indirect pulp capping

52
Q

Which treatment provides a very effective seal and a ‘fluoride reservoir’?

A

preformed metal crowns cemented with GI

53
Q

If unable to take bitewings on a child, which radiograph can be taken instead?

A

lateral oblique

54
Q

What is the main cause of early childhood caries?

A

sleeping with a bottle

55
Q

What are the 4 principle strategies for managing caries in the primary dentition?

A
  • no caries removal, seal with a crown using the hall technique
  • no caries removal and fissure seal
  • selective caries removal and restoration (walls prepared to hard dentine with adequate depth for restorative material, previously known as partial caries removal)
  • pulpotomy
56
Q

Amalgam shall not be used on which 3 categories of patients according to EU regulation 2017/852?

A
  • deciduous teeth
  • children under 15 years
  • pregnant or breastfeeding women, except when deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient
57
Q

What is recommended for caries more than 2mm into dentine in Ds?
- very small teeth
- large pulps
- thin enamel

A
  • consider XLA
58
Q

What is ART?

A
  • atraumatic restorative treatment
  • removal of caries with hand instruments and filling with GI
59
Q

What is the gold standard treatment for caries in primary teeth?

A
  • no caries removal, seal with restoration
  • either fissure seal or halls technique
60
Q

Hall crowns are primarily used for which teeth?

A

Ds and Es

61
Q

Which information is printed on hall crowns?

A
  • palmer notation and size on buccal surface
62
Q

What is the hall technique?

A
  • first app: use ortho separators to open contact points if needed
  • second app: no LA, clean food debris and plaque from cavity, cement with GI
63
Q

What are 2 indications for the hall technique?

A
  • class 1 non-cavitated or cavitated lesions if patient is unable to tolerate conventional treatment
  • class 2 lesions, cavitated or non-cavitated
64
Q

What are 3 contra-indications for the hall technique?

A
  • signs or symptoms of irreversible pulpitis
  • clinical or radiographic signs of pulpal exposure or periradicular pathology
  • teeth that would normally be considered unrestorable using conventional methods
65
Q

What is a potential management of caries if the tooth is a due to exfoliate within the year?

A

no caries removal - prevention with or without self cleansing
- open the cavity in order to expose it to fluoride and toothbrushing to encourage caries to arrest

66
Q

What are 6 reasons to restore primary teeth?

A
  • easier to disrupt biofilm
  • symptoms in children
  • limit the damage of dental caries
  • ensure adequate function
  • restore aesthetics
  • maintain the natural space available for the developing permanent dentition
67
Q

What are factors contributing to not extracting primary teeth?

A
  • no signs or symptoms
  • tooth close to exfoliation
  • hypodontia
  • early loss of other primary teeth
  • number of carious teeth
68
Q

What are 3 indications for XLA of primary teeth?

A
  • swelling extra oral
  • swelling intra oral
  • sinus
69
Q

What are 5 treatment options for teeth with caries and pulp involvement?

A
  • indirect pulp treatment
  • pulpotomy
  • pulpectomy - non vital
  • preformed crowns
  • extraction
70
Q

What 3 reasons should balancing extractions be considered?

A
  • one C is to be extracted due to dental disease
  • one C has exfoliated early due to eruption of the permanent lateral incisor
  • centre line shift is developing following extraction of one D
71
Q

What are 3 reasons balancing extractions are not necessary?

A
  • loss of primary incisors
  • loss of Ds unless a centre line shift is developing
  • loss of Es
    if in doubt, arrange a orthodontic assessment
72
Q

What are 5 reasons for XLA of primary dentition?

A
  • recurrent infection in primary teeth
  • unnecessary use of analgesics and abx
  • missing school
  • difficulty eating
  • potential damage to the permanent successor from infection
73
Q

What are 2 situations when to leave carious teeth?

A
  • asymptomatic teeth close to exfoliations
  • arrested caries with no signs of infection (clinical and radiographs)
74
Q

What are 4 potential problems with early loss of primary teeth?

A
  • space loss
  • crowding/impaction of permanent teeth
  • early or late eruption of permanent dentition depending on stage of development
  • damage to permanent teeth (very rare, if wrong XLA technique used)
75
Q

Indirect pulp capping has a high success rate when?

A
  • pulp is not inflamed
  • coronal restoration is sealed
76
Q

Which material appears to encourage internal resorption if pulp is inflamed?

A

calcium hydroxide

77
Q

Which pulp treatment is the following?
- vital, inflamed tissue is removed from pulp chamber
- medicament is placed over radicular pulp stumps
- pulp stumps are covered with zinc oxide/eugenol cement
- coronal restoration is placed
- success depends upon extent of pulpal inflammation

A

vital pulpotomy

78
Q

What are the stages of pulpotomy?

A
  • saliva control is the key to success
  • remove all caries from EDJ
  • remove soft dentine
  • remove lid of pulp chamber and as much surrounding soft dentine as poss
  • remove pulp from pulp chamber with sharp large excavator or large round slow speed bur
  • gently compress pulp remnants with a dry cotton pledget (bleeding should stop in a few mins)
  • place cotton wool pledget moistened with ferric sulphate in pulp chamber, leave for 20 seconds and remove
  • pulp remnants will have a black residue - dry gently
  • if bleeding continues - inflam of radicular pulp should be suspected
  • pack pulp gently with with zinc oxide/eugenol leaving no voids
  • restore cavity with GI
79
Q

Which pulpotomy medicament is the following?
- formaldehyde and tricresol in glycerine and water
- historically used, fixes pulp tissue, very effective, is highly toxic and would not gain regulatory approval today

A

formocresol

80
Q

Which pulpotomy medicament is the following?
- effective, promotes biological healing

A

calcium hydroxide

81
Q

Which pulpotomy medicament is the following?
- 1% triamcinolone, 3% chlortetracycline
- has an obtundant effect, is bactericidal, inhibits osteoclastic activity

A

ledermix

82
Q

Which pulpotomy medicament is the following?
- haemostat, high clinical success rate, much less toxic than formocresol

A

ferric sulphate

83
Q

Which pulpotomy medicament is the following?
- most current option

A

biodentine

84
Q

What are 5 indications for a pulpotomy?

A
  • preservation of tooth is considered necessary
  • large proximal carious lesion with involvement of marginal ridge, where radiograph shows caries extends further than 2/3 of dentine depth
  • no radicular pulpitis, inflammation contained to coronal pulp
  • bleeding easily controlled when coronal pulp removed
  • no history of spontaneous pain and no abscess
85
Q

Which material would the canals be filled with during a pulpectomy?

A

vitapex (iodoform and calcium hydroxide)

86
Q

How would a tooth be restored following a pulpectomy?

A

zinc oxide eugenol and a preformed metal crown

DG2016 - CK 2 (10 decks)

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