Paediatric Flashcards
What 6 points should be considered when assessing child and parent attitudes to dentistry?
- past dental history
- previous extractions
- previous GA
- acceptance of oral health advice
- attendance for treatment
- compliance with OH
What are 4 factors that can contribute to difficulty in establishing healthy behaviours?
- 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
What age should children have their first dental exam?
age 1
What teeth should be included when doing a modified BPE in children?
UR6, UR1, UL6
LR6, LL1, LL6
What BPE codes should be used for children in the mixed dentition stage? (7-11)
BPE codes 0, 1, 2
What age can the full range of BPE codes be used in children when all permanent teeth have erupted?
age 12-17
Below which age are BPEs not indicated?
below age 7
Probing is not an acceptable method for diagnosing caries in which areas?
pits and fissures
Probing is an acceptable method of assessing caries in which areas?
exposed dentine
What is the name of the scoring system to assess caries and restorations?
ICDAS
What age are bitewings indicated in children?
- aged 4 and above
- when contact points cannot be fully assessed
When should bitewings be taken on children with an increased risk of developing caries?
6-12 months
When should bitewings be taken on children with primary teeth and not an increased risk of developing caries?
12-18 months
When should bitewings be taken for permanent teeth?
2 yearly
What is the guidance for enamel-only inter-proximal carious lesions on permanent molars?
- explain their importance to the parent/carer
- topical fluoride
- high fluoride tp prescription (10 and above)
What should be done if there is a valid reason not to take radiographs as specified?
- record in patients notes
What size films should be used in small children?
size 0
What are the 3 treatment options for dental infection in children?
- XLA
- pulp therapy is feasible
- monitor for 3 months
in exceptional circumstances, monitor asymptomatic dental infection whilst the child acclimatises to dental environment
What are 4 indicators of establish dental infection in children?
- interradicular radiolucency
- TTP in a non-exfoliating tooth
- alveolar tenderness, sinus or swelling
- non physiological mobility
What are 5 considerations when assessing the risk of pain or infection developing before exfoliation?
- 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
What are the 3 main evidence-based indicators of a child being at an increased risk of developing caries within the next 3 years?
- previous caries experience
- resident in an area of deprivation
- referral from healthcare worker who had identified the need for additional preventative care
How is caries risk assessed in children? (7)
- diet history
- previous dental history
- current disease status
- parent/child engagement
- pattern of attendance
- oral hygiene
- siblings dental history
What are the 3 elements of developing a personal care plan?
- managing pain (if present)
- caries prevention
- managing caries (and asymptomatic sepsis if present)
What are 3 factors complicating caries management?
- 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
What are 2 factors simplifying caries management?
- 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
What teeth are the first priority when developing a personal care plan?
keep the 6s and 7s free from both occlusal and approximal caries
What should be included in a personal care plan?
- 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
What are the 4 main ethical principles of consent?
- valid consent
- voluntary decision making
- ability to make an informed decision
- is dynamic - can change mind
What is meant by valid consent?
enough information to make a decision
What is meant by voluntary decision making?
without pressure or influence from family member or healthcare professional
What is meant by ability to make an informed decision?
- child may have the ability
- person with parental responsibility (PR)
Which legislation permits patients of 16, of sound mind, to give legally valid consent and does not preclude children under 16 from giving consent?
law reform act 1969
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
gillick competence
Which legislation sets out who has parental responsibility?
children act 1989
When giving consent, the Childs mother, but not the father has PR if they were not married, unless what 3 things?
- the father has acquired PR via a court order or PR agreement
- the couple subsequently marry
- named on the birth certificate
Legally appointed guardian can be appointed by who?
- court
- parent with PR in the event of their own death
What 3 other circumstances can have parental responsibility?
- 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)
What is the correct sequence of treatment for child patients?
- 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
What are 4 dental anxiety scales?
- modified child dental anxiety scale
- corahs modified dental anxiety scale
- venhams picture test
- childrens dental fear survey schedule, CFSS dental sub scale
What are 3 aims of behaviour management methods?
- improve communication process
- eliminate inappropriate behaviours
- reduce anxiety
What are 7 examples of behaviour management techniques?
- non verbal communication
- modelling
- tell, show, do
- distraction
- systemic desensitisation
- communication with patient
- giving patient control signals
What condition is being described?
- common, developmental condition resulting in enamel defects of incisors and molars
- need extra protection
- unknown aetiology
molar incisor hypomineralisation
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
stepwise technique
What would happen to the adjacent 5s and 7s following early loss of maxillary 6s before complete eruption of 7s?
7 = rotation and mesial movement
5 = distal drift
What would happen to the adjacent 5s following loss of the mandibular 6s before optimum age?
5 = drifts distally and rotates
What happens to the adjacent 7s following loss of the 6s after optimum age?
7s = mesial tilting
What is the optimum age to extract first permanent molars?
ideally between 8 1/2 to 10 years old
What is a classic sign of an indication when to extract first permanent molars?
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
Before extracting first permanent molars, what should be checked radiographically?
- check 5s and 8s are present on OPG
- furcation of the 7s
What are 3 important points relating to dental caries in primary dentition?
- rapid caries progression
- small teeth with large pulp chambers
- caries must be treated early for long-term success
Which type of pulp capping has a better success rate?
indirect pulp capping
Which treatment provides a very effective seal and a ‘fluoride reservoir’?
preformed metal crowns cemented with GI
If unable to take bitewings on a child, which radiograph can be taken instead?
lateral oblique
What is the main cause of early childhood caries?
sleeping with a bottle
What are the 4 principle strategies for managing caries in the primary dentition?
- 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
Amalgam shall not be used on which 3 categories of patients according to EU regulation 2017/852?
- 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
What is recommended for caries more than 2mm into dentine in Ds?
- very small teeth
- large pulps
- thin enamel
- consider XLA
What is ART?
- atraumatic restorative treatment
- removal of caries with hand instruments and filling with GI
What is the gold standard treatment for caries in primary teeth?
- no caries removal, seal with restoration
- either fissure seal or halls technique
Hall crowns are primarily used for which teeth?
Ds and Es
Which information is printed on hall crowns?
- palmer notation and size on buccal surface
What is the hall technique?
- 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
What are 2 indications for the hall technique?
- class 1 non-cavitated or cavitated lesions if patient is unable to tolerate conventional treatment
- class 2 lesions, cavitated or non-cavitated
What are 3 contra-indications for the hall technique?
- 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
What is a potential management of caries if the tooth is a due to exfoliate within the year?
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
What are 6 reasons to restore primary teeth?
- 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
What are factors contributing to not extracting primary teeth?
- no signs or symptoms
- tooth close to exfoliation
- hypodontia
- early loss of other primary teeth
- number of carious teeth
What are 3 indications for XLA of primary teeth?
- swelling extra oral
- swelling intra oral
- sinus
What are 5 treatment options for teeth with caries and pulp involvement?
- indirect pulp treatment
- pulpotomy
- pulpectomy - non vital
- preformed crowns
- extraction
What 3 reasons should balancing extractions be considered?
- 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
What are 3 reasons balancing extractions are not necessary?
- loss of primary incisors
- loss of Ds unless a centre line shift is developing
- loss of Es
if in doubt, arrange a orthodontic assessment
What are 5 reasons for XLA of primary dentition?
- recurrent infection in primary teeth
- unnecessary use of analgesics and abx
- missing school
- difficulty eating
- potential damage to the permanent successor from infection
What are 2 situations when to leave carious teeth?
- asymptomatic teeth close to exfoliations
- arrested caries with no signs of infection (clinical and radiographs)
What are 4 potential problems with early loss of primary teeth?
- 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)
Indirect pulp capping has a high success rate when?
- pulp is not inflamed
- coronal restoration is sealed
Which material appears to encourage internal resorption if pulp is inflamed?
calcium hydroxide
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
vital pulpotomy
What are the stages of pulpotomy?
- 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
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
formocresol
Which pulpotomy medicament is the following?
- effective, promotes biological healing
calcium hydroxide
Which pulpotomy medicament is the following?
- 1% triamcinolone, 3% chlortetracycline
- has an obtundant effect, is bactericidal, inhibits osteoclastic activity
ledermix
Which pulpotomy medicament is the following?
- haemostat, high clinical success rate, much less toxic than formocresol
ferric sulphate
Which pulpotomy medicament is the following?
- most current option
biodentine
What are 5 indications for a pulpotomy?
- 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
Which material would the canals be filled with during a pulpectomy?
vitapex (iodoform and calcium hydroxide)
How would a tooth be restored following a pulpectomy?
zinc oxide eugenol and a preformed metal crown
