Paediatric Flashcards
what is the pattern of eruption of primary dentition
generally lowers before uppers except upper later
a,b,d,c,e
when is primary dentition complete by
2.5 to 3 years
what are some differences between primary and permanent teeth
primary has more narrow roots which tend to flare out to make way for permanent
primary enamel and dentine is much thinner
pulp is much larger and more easily exposed in a restoration
what can be seen in first primary molars
large mesiobuccal tubercle
what is in a second upper primary molar
transverse ridge
what is in a second lower primary molar
3 cusps
how is space created for permanent dentition
anthroid space - infront of upper canine and behind lower canine
primary molars are much bigger than the permanent premolars to come - leeway space
also incisors are more tilted in permanent
what is the pattern of eruption in permanent teeth
first molar, central incisor, lateral incisor
then upper - first premolar, second premolar, canine, 2nd and 3rd molars
lower - canine, 1st and 2nd premolar, 2nd and 3rd molar
why is orthodontics not given until canine is through
canine pushes the incisors together
what is the ugly duckling phase
when the roots of incisors are displaced ditsally, creating a gap midline
what is the sequence of restorations in paeds
prevention, fissure sealant, preventative restoration, shallow restoration, restoration requiring LA, pulpotomy
what should be the depth of occlusal cavity
no deeper than 1.5mm, risk pulpal exposure
what are the indications to use a crown
no radiographic evidence of caries into pulp, enough sound tissue for a crown to bond to
what are the benefits of using a crown
lasts much longer, less likely to get secondary caries, doesnt require LA or tooth prep so child doesnt have to co-ordinate too much
what other restorative materials are available and how do they compare to one another
amalgam (but not now), composite, compomer, RMGI, GI
amalgam lasts longer than all
compomer lasts longer than composite and RMGI
RMGI is better than GI
composite is not ideal - requires good moisture control - rubberdam, need LA
what instruments are required for placement of stainless steel crown
fissure bur, crown climper pliers, GI cement
what factors influence caries management in children
compliance, extent of caries, OH, space maintainer
what are the indications and contraindications for a pulpotomy
indications - reversible pulpitis, good haemostasis, good co-operation, space maintainer, medical history prevents exraction, hypodontia
contraindications - poor co-operation, poor dental attendance, multiple grossly carious teeth,
what are some disadvantages of extraction of primary teeth
allows for drifting, especially permanent molar, traumatic, impeeded speech and masticatory
what is used in pulpotomy for controlling bleeding, calming pulp and cement
ferric sulphate held on for 20 seconds to stop bleeding, the calcium hydroxide or zinc oxide eugenol, then GIC cement for crown
what are the indications for a pulpectomy
irreversible pulpitis, cannot achieve haemostasis, periapical absess, pulp necrosis
briefly describe steps in a pulpectomy
remove roof of pulp chamber, remove coronal pulp, try ferric sulphate to reduce bleeding, use filers to remove pulpal tissue, then rinse pulp chambers with chlorhexidine, fill with CaOH, and over coronal, can then place GI cement for crown
why should the files be stopped 2mm from working length
to prevent damage to developing tooth, apices are open so can go through to permanent tooth
what is the first thing that should be done when a tooth is fractured
prevent bacterial ingress as this causes pulpal death
what treatments are available for a pulpal exposure due to fracture in a vital immature tooth
pulp cap - stop bleeding, CaOH, then restoration - small exposure
pulpotomy - some pulpal tissue removed, arrest haemorrage, CaOH, GIC lining, restoration - large exposure
allows for continued root formation
what treatments are available for pulpal exposure of a non-vital immature tooth
pulpectomy - removal of necrotic tissue
barrier formation
apexification
what is involved in barrier formation
MTA is placed at the ends of the root, to seal off the apex, this is a thick cement, wait for this to harden (24hours), then can pack against this for filling root canals
what is involved in apexification
place CaOH in root canal to induce apical barrier formation, place it then go back 3 months later, remove and place more, do this 3 times - takes 9 months - then definitive restoration
what are some disadvantages of apexification
every time you go back in, cause harm
CaOH in root canals may cause dentine to become brittle
what can calcium hydroxide be used for
in a pulpotomy - inducing a calcific barrier between pulp and restoration. also alkaline so good antibacterial properties
what treatment plans are available for pulp exposure in a mature tooth
pulp cap - small exposure less than 24 hours
pulpotomy or pulpectomy - convential RCT
what is first aid for an avulsed tooth
dont handle the root, dont allow it to dry out, place in saliva or fresh milk, you can wash under cold water for 10 seconds if obvious debris, get it reimplanted quickly
what kind of splint is used for an avulsed tooth
flexible - composite wire is best
what is disctintive of molar incisive hypomineralisation
well demarcated - chalky white or yellow/brown stains, depending on how much enamel is effected. Don’t have to have all teeth effected, can have just one molar. Not symmetrical
what is the difference between hypomineralisation and hypoplastic teeth
hypomineralisation - problem at mineralisation phase in development, secretory phase is fine. tooth forms but doesnt harden well
hypoplastic - secretory phase doesnt happen well, tooth doesnt form the right shape. but mineralises fine so is hardened
what is the difference between true hypoplastic and acquired
true - erupts in the wrong shape. acquired - might be hypomineralised, as it is soft, then breaks off and wrong shape
what are the 3 clinical periods of enquiry in children with MIH
prenatal, peri-natal, post-natal
what questions can be asked at each stage of enquiry
prenatal - any problems in the last trimester of pregnancy, e.g. pre-eclampsia, or gestational diabetes
perinatal - was the birth particularly traumatic? did the baby spend any time in the special baby unit?
post-natal - did they have any infections? how long were they breast fed for?
what are some likely causes of MIH
prolonged breast feeding, past 6 months and not on solid foods, deprivation
what differences were found in MIH teeth compared to normal teeth
more neural activation, more vascular, more immune cells
what are the clinical problems with MIH
loss of tooth tissue, more tooth wear, less caries resistant, increased sensitivity and poor appearance
what is the problem with using composite in MIH
poor bonding to the tooth with reduced enamel mineral content
how does the treatment change for patients depending on their age
young - dont want to bleach, more likely to just do composite coverage
teen - can do acid pumice microabrasion followed by bleaching
older - can do veneers
what is considered in extraction of HFPM’s
severity of MIH, age, skeletal, future ortho needs
what age would HFPM be extracted
depending on when bifurcation of 7’s is seen, means when 7 erupts, can drift mesially, prevent any gaps. must also take out upper 6’s or will over erupt
why might upper 6s not be extracted at same time as lower 6s
if overcrowded, wait until the 7 comes in before extracting. creates the space required for orthodontics, without losing the 5 too
