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BDS3 > Paediatric Dentistry > Flashcards

Paediatric Dentistry Flashcards

1
Q

Who always has automatic parental responsibility?

A

Mother

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2
Q

How does a father acquire parental responsibility?

A

Being married to mother at time of conception or subsequently
Name on birth certificate (since May 06)
Parental responsibility agreement with the mother
Parental Responsibility order from the court

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3
Q

When does a step parent have parental responsibility?

A

Parental responsibility agreement with child’s parent
Parental responsibility order from the court
Appointed legal guardian by the court

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4
Q

GDC expectations for safeguarding of children

A

All registrants to be aware of the procedures involved in raising concerns about possible abuse or neglect of children and vulnerable adults
Responsibility to raise concerns about the possible abuse or neglect of children or vulnerable adults, know who to contact for further advice and how to refer

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5
Q

Child protection

A

Activity undertake to protect specific children who are suffering or are at risk of suffering significant harm

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6
Q

Children in need

A

Those who require additional support or services to achieve their full potential

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7
Q

Possible measures taken to minimise the risks of harm to children

A

Protecting children from maltreatment
Preventing impairment of children’s health or development
Ensuring that children are growing up in a safe and caring environment

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8
Q

Child abuse and neglect

A

Anything which those entrusted with the care of children do, or fail to do, which damages their prospects of safe and healthy development into adulthood

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9
Q

3 elements for definition of child abuse

A

Significant harm to child
Carer has some responsibility for that harm
Significant connection between carer’s responsibility for child and harm to child

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10
Q

The Children and Young People’s Act 2014

A

13 parts
4 major themes - Children’s rights, GIRFEC, early learning and childcare, ‘Looked After’ children

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11
Q

Big three concerns for parenting capacity

A

Domestic violence
Drug and alcohol misuse
Mental health problems

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12
Q

Child abuse categories

A

Physical
Emotional
Neglect
Sexual

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13
Q

What would be most likely to improve the oral health of all pre-school children?

A

Water fluoridation

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14
Q

What is always highest priority when making a treatment plan?

A

Relief of pain

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15
Q

What should be carried out first?
Anterior tooth restorations requiring LA
Simple restorations in the upper jaw requiring LA
Simple restorations in the lower jaw requiring LA
Pulpotomy in the lower jaw

A

Simple restorations in the upper jaw requiring LA

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16
Q

It is important that parents do not show small children what when at the dentist?

A

That they are nervous

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17
Q

What is an example of an injury that would not (in isolation) suggest child abuse?

A

Torn upper labial frenulum

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18
Q

How many children in Scotland are killed by a parent/parent substitute?

A

10 per year

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19
Q

Why might neglect go unnoticed?

A

Neglect is less incident focussed

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20
Q

3 stages in managing dental neglect are suggested by Child Protection and the Dental Team

A

Preventative dental team management
Preventative multi-agency management
Child protection referral

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21
Q

What proportion of serious head injuries in the first year of life are non-accidental?

A

95%

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22
Q

What proportion of injuries in abuse cases are found on the head and neck areas?

A

60%

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23
Q

When reading clinical guidelines, what does the strength of a strong key recommendation convey?

A

Based on available information, weighing up balance of benefit versus risk, almost all individuals would choose this option

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24
Q

What is motivational interviewing used for and what does the process involve?

A

Translating knowledge into behaviour
Seek permission, open questions, affirmations, reflective listening, summarising

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25
Q

Standard prevention for all children includes what at least once per year?

A

Toothbrushing demo on the child and age appropriate toothpaste advice
Advice to snack on sugar free foods such as oatcakes and be award of acid content in drinks

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26
Q

What is the protocol for enhanced prevention for children at increased risk of caries at each recall visit?

A

Standard prevention and hands on toothbrushing to child and parent/carer
Parents only may require more in depth support to change dietary habits, such as motivational interviewing

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27
Q

Which surface is fissure sealed in enhanced preventions if assessed as likely to be beneficial?

A

2s palatal pits

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28
Q

Standard prevention fluoride varnish

A

5% sodium fluoride varnish twice a year to all children over 2 years

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29
Q

Minimum dose of fluoride for toxicity

A

5mg/kg body weight

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30
Q

3 take home messages from the Marimho 2008 review of the evidence for topical fluorides

A

Additional topical fluorides such as mouthwashes, varnish and tablets used as well as toothpaste further reduce the occurrence of caries
Fluoride toothpaste prevents dental caries
The higher the caries rate, the greater the preventative effect of topical fluorides

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31
Q

Lowest amount of fluoride in toothpaste recommended for a 2 year old

A

1000ppmF

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32
Q

Strength of duraphat varnish

A

22,600ppmF

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33
Q

When should topical fluorides (other than toothpaste) be taken?

A

At a different time than toothbrushing

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34
Q

Correct drug information on a prescription to allow a tube of duraphat 2800ppm toothpaste to be dispensed

A

Sodium fluoride 0.619% toothpaste

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35
Q

When should parents start toothbrushing for their child?

A

First tooth erupts

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36
Q

How much toothpaste and what concentration for a 6 month old child at low caries risk

A

Smear of 1000ppmF twice daily

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37
Q

What should be asked if a parent calls to say their child has ingested toothpaste?

A

Amount and strength of toothpaste
Age/weight of child

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38
Q

What should be used to etch before application of fissure sealant?

A

35-37% ortho-phosphoric acid

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39
Q

How is isolation for moisture control best achieved when placed fissure sealant?

A

Rubber dam

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40
Q

When is the ideal time to fissure seal first permanent molars?

A

Whenever the tooth has erupted sufficiently to allow for adequate isolation/moisture control

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41
Q

What is the most common material used for fissure sealant placement?

A

Bis-GMA resins

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42
Q

After placement, fissure sealants should be checked for

A

Air bubbles
Flash
Non-adherance

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43
Q

How often should fissure sealants placed in a child of high caries risk be radiographically reviewed?

A

6 months

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44
Q

What is the major advantage of using a glass ionomer fissure sealant?

A

It is easier to handle when moisture control is not ideal

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45
Q

What should be used to clean the tooth before fissure sealant placement?

A

Pumice and water

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46
Q

How should the occlusal surface of the tooth appear after adequate acid-etch and drying?

A

Chalky white/frosted

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47
Q

Which instrument should be used to check a fissure sealant after placement?

A

A sharp probe

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48
Q

Epidemiology of tooth trauma

A

Peak incidence 2-4 years old
Male>female
16-40% prevalence
Maxillary primary incisor teeth most common

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49
Q

Crown fractures classification

A

Enamel - fracture involves only enamel
Enamel-dentine - fracture involved enamel and dentine, pulp is not exposed
Complicated - Fracture involves enamel and dentine plus the pulp is exposed
Crown-root fracture - fracture involves enamel, dentine and root, pulp may or may not be involved (complicated or uncomplicated)

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50
Q

Concussion

A

Tender to touch but no displacement, no increase in mobility

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51
Q

Subluxation

A

Tooth tender to touch, has increased mobility but not been displaced

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52
Q

Lateral luxation

A

Tooth displaced usually in palatal/lingual or labial direction

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53
Q

Intrusion

A

Tooth usually displaced through the labial bone plate, or it can impinge on the permanent tooth bud

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54
Q

Extrusion

A

Partial displacement of tooth out of its socket

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55
Q

Avulsion

A

Tooth is completely out of the socket

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56
Q

Alveolar fracture

A

Fracture involves the alveolar bone (labial and palatal/lingual) and may extend to the adjacent bone

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57
Q

Most common injury type of primary dentition

A

Luxation (two thirds)

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58
Q

Steps to examination following traumatic injury to primary dentition

A

Reassurance
History
Examination
Diagnosis
Emergency treatment
Important information
Further treatment and review

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59
Q

How to take a trauma history

A

When/where/how was the injury sustained?
Any other symptoms or injuries?
Lost teeth/fragments?

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60
Q

Relevant medical history for dental trauma patient

A

Congenital heart disease
History of rheumatic fever or immunosuppression
Bleeding disorder
Allergies
Tetanus immunisation status

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61
Q

What would a duller percussion note of a tooth indicate following trauma?

A

Root fracture

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62
Q

What does a trauma stamp record in primary dentition?

A

Mobility +/-
Tooth colour - normal, grey, yellow, pink
TTP - +/-
Sinus - +/-
Percussion note - Normal/Dull
Radiograph taken +/-

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63
Q

When is it not appropriate to proceed with observation following a traumatic injury?

A

Risk of aspiration, ingestion or occlusal interference

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64
Q

What is the homecare in a case where the treatment of an injury is observation?

A

Analgesia
Soft diet 10-14days
Brush with soft toothbrush after every meal
Topical chlorhexidine gluconate 0.12% mouthwash twice daily for one week

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65
Q

Treatment for uncomplicated crown fracture

A

Cover all exposed dentine with glass ionomer/composite
Lost tooth can be restored immediately with composite or at a later visit

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66
Q

Treatment options for complicated crown fracture

A

Partial pulpotomy
Extract

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67
Q

Treatment for crown-root fracture

A

Remove the loose fragment and determine if crown can be restored
If restorable - no pulp exposed, cover exposed dentine with glass ionomer
If unrestorable - extract loose fragments, don’t dig

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68
Q

Treatment for root fracture

A

Coronal fragment not displaced - no treatment
Coronal fragment displaced but not excessively mobile - leave coronal fragment to spontaneously reposition even if some occlusal interference
Coronal fragment displaced, excessively mobile and interfering with occlusion - option A extract only the loose coronal fragment, option B reposition the loose coronal fragment +/- splint

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69
Q

Treatment for concussion of tooth

A

None
Observation

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70
Q

Treatment for subluxation

A

None
Observation

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71
Q

Treatment for lateral luxation

A

Minimal/no occlusal interference - allow to reposition spontaneously
Severe displacement - extraction and reposition (+/- splint)

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72
Q

Treatment for intrusion injury

A

Allow to spontaneously reposition, irrespective of direction of displacement

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73
Q

Treatment for avulsion (primary dentition)

A

Radiograph to confirm avulsion
DO NOT REPLANT

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74
Q

Radiographs used to determine direction on intrusion displacement

A

Periapical or lateral premaxilla
Not parallax as only one radiograph is used

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75
Q

Treatment for extrusion injury

A

Not interfering with occlusion - spontaneous repositioning
Excessive mobility or extruded >3mm - extract

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76
Q

Alveolar fracture treatment

A

Reposition segment
Stabilise with a flexible splint to the adjacent uninjured teeth for 4 weeks
Teeth may need to be extracted after alveolar stability has been achieved

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77
Q

Sequelae of trauma to the primary tooth

A

Discolouration
Infection
Delayed exfoliation

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78
Q

Asymptomatic discolouration

A

Vital or non-vital
Mild grey - immediate discolouration may maintain vitality
Opaque/yellow - pulp obliteration
if no signs of pulp necrosis or infection - no treatment

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79
Q

Symptomatic discolouration

A

Non vital
Sinus, gingival swelling, abscess
Increased mobility
Radiographic evidence of periapical pathology
Extract or root treat

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80
Q

What is the issue with delayed exfoliation?

A

Consequences for the developing occlusion

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81
Q

Injuries to permanent teeth are more likely when trauma occurs to older or younger children?

A

Younger

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82
Q

Which type of dental trauma causes most disturbance to permanent dentition?

A

Intrusion

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83
Q

What are the possible injuries to permanent teeth following trauma to deciduous dentition?

A

Enamel defects (44%, most common)
Abnormal crown/root morphology
Delayed eruption
Ectopic position
Arrested development
Complete failure to form
Odontome formation

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84
Q

Two possible enamel defects in permanent dentition, caused by deciduous trauma

A

Enamel hypomineralisation - normal thickness, poorly mineralised, white/yellow
Enamel hypoplasia - reduced thickness but normal mineralisation, yellow/brown

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85
Q

Dilaceration

A

Abrupt deviation of the long axis of the crown or root portion of the tooth

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86
Q

Management of crown dilaceration options

A

Surgical exposure and orthodontic realignment
Improve aesthetics restoratively

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87
Q

Root dilaceration management

A

Combined surgical and orthodontic approach

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88
Q

When would you take radiographs for delayed eruption?

A

If 6 month delay compared to contralateral tooth

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89
Q

Ectopic tooth position management options

A

Surgical exposure and orthodontic realignment
Extraction

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90
Q

Treatment for odontome formation

A

Surgical removal

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91
Q

Splinting time for lateral luxation

A

4 weeks

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92
Q

Pulp necrosis is more likely in an intrusion injury of >___mm

A

3mm

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93
Q

An 11 year old presents 48 hours after a complicated crown fracture to tooth 21, what is the treatment required?

A

Pulpotomy

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94
Q

What can happen following root fractures in permanent teeth following dental trauma?

A

Hard tissue healing

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95
Q

Does pulp canal obliteration happen more often in open or closed apices teeth?

A

Open

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96
Q

Needle desensitisation

A

Teach relaxation, explain LA, practice LA, deliver LA

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97
Q

What technique should be used to help a child with a blunting coping style cope?

A

Explain what will happen and then use distraction techniques

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98
Q

What is the ideal tooth for a Hall crown?

A

Carious lesion with a clear band of dentine between it and the pulp

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99
Q

Normal child at 2 years old

A

Fear of unexpected movements, loud noises and strangers

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100
Q

Normal child at 3 years old

A

Reacts favourably to positive comments about clothes and behaviour
Less fearful of separation from parents
Experience will however dictate reaction to separation

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101
Q

Normal child at age 4

A

More assertive, can be bossy/aggressive
Fear of the unknown and bodily harm is at a peak
Fear of strangers has decreased
With firm and kind direction, will be excellent patients

102
Q

Normal child at age 5

A

Readily separated from parents
Fears have usually diminished
Proud of possessions
Comments on clothes will quickly establish a rapport

103
Q

Normal child at age 6

A

Seeks acceptance
Success in this can affect self-esteem
If while at dentist child develops a sense of inferiority or inadequacy, behaviour may regress to that of a younger age

104
Q

Normal child at age 7-12

A

Learn to question inconsistencies and conform to rules of society
Still have fears but are better at managing them

105
Q

Dental anxiety vs fear vs phobia

A

Anxiety - occurs without triggering stimulus and may be reaction to unknown danger or anticipatory due to previous negative experiences
Fear - is a normal emotional response to objects or situations perceived as genuinely threatening
Phobia - clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviour and interference of daily life

106
Q

Physiological and somatic sensations during dental fear and anxiety

A

Breathlessness
Perspiration
Palpitations
Feeling of unease

107
Q

Cognitive features of dental fear and anxiety

A

Interference with concentration
Hypervigilance
Inability to remember certain events while anxious
Imagining the worst that could happen

108
Q

Behavioural reactions to dental fear and anxiety

A

Avoidance - e.g. the postponing of a dental appointment, or with children disruptive behaviour in an effort to stop treatment being undertaken
Escape from the situation which precipitates the anxiety
Anxiety may manifest with aggressive behaviour especially in adolescents who are brought by their parents but do not want to be there

109
Q

Subtle signs of dental fear and anxiety

A

Younger children may time delay by asking questions
School age children may complain of stomach aches or ask to go to the toilet frequently
Older children may complain of headaches or dizziness, fidget or stutter, ‘can’t be bothered’

110
Q

Factors that influence fear and anxiety

A

Fear of choking
Fear of injections/drilling
Fear of the unknown
Past medical and dental experience
Dental experience of friends and siblings
Attitudes of parents
Preparation at home before the dental visit
Child’s perception that something is wrong with their teeth

111
Q

What scale can be used to assess children’s dental fear and anxiety?

A

Faces Version Modified Child Dental Anxiety Scale
Quick and easy to use

112
Q

Why is inhalation sedation with nitrous oxide useful for anxious children?

A

Increases suggestibility

113
Q

What group is IV sedation usually used on?

A

12+

114
Q

Two most commonly used LAs

A

Lidocaine 2%
Articaine 4%

115
Q

% of children in the UK with a disability

A

6%

116
Q

Causes of disability

A

Genetic
Developmental - injury, infection, parental health during pregnancy
Unknown cause

117
Q

Classifications of learning difficulties

A

Mild
Moderate
Severe
Profound

118
Q

Is ASD more common in males or females?

A

Males 3:1

119
Q

Autism Spectrum Disorder

A

Lifelong developmental disorder which affects how people communicate and interact with the world around them
More than 1 in 100 in UK
SPECTRUM - everyone is different, different levels of support required

120
Q

Potential difficulties for people with autism spectrum disorder

A

Social communication
Social interaction
Repetitive and restrictive behaviour
Over and under sensitivity to light, sound, taste or touch
Extreme anxiety
Meltdowns or shutdowns

121
Q

Strategy for children who do not speak/have limited language

A

Use preferred mode of communication e.g. Makaton/visual symbols

122
Q

Strategy for children who think people always mean exactly what they say

A

Concrete language
Direct requests
Avoid jokes/sarcasm

123
Q

Strategy for children who do not understand facial expressions or body language

A

Avoid body language, gestures or facial expressions without accompanying them with verbal instruction

124
Q

Strategy for children who find busy waiting rooms difficult

A

1st appt of the day
Quieter clinic
Avoid waiting
Side room to wait

125
Q

Another name for Down Syndrome

A

Trisomy 21

126
Q

Physical features of Down Syndrome

A

Large tongue
Mid face hypoplasia

127
Q

Down syndrome increases predisposition to (3)

A

Cardiac defects
Leukaemia
Epilepsy

128
Q

Dental features of Down Syndrome

A

Maxillary hypoplasia
Class III occlusion
Macroglossia
Anterior open bite
Hypodontia/microdontia
Predisposition to periodontal disease

129
Q

Incidence of cerebral palsy

A

2:1000 live births

130
Q

Cerebral Palsy

A

Non progressive lesion of motor pathways in the developing brain
Caused by brain damage in early development, either foetal, during birth or during first few months of infancy
Can cause abnormalities of movement and posture in various body parts, and delays in motor skills development, poor control over hand and arm movement, weakness, abnormal walking, difficulties swallowing, excessive drooling

131
Q

Other issues often associated with cerebral palsy

A

Learning difficulties (60%)
Epilepsy (40%)
Visual/hearing impairment +/- speech and language disorders
Joint contractures/scoliosis/hip subluxation
Reflux
Many patients are highly intelligent but may have such severely impaired speech that they appear to have a severe learning impairment

132
Q

3 types of cerebral palsy, and what part of the brain they affect, and their presentations

A

Spastic (80%) - cortex - increased muscle tone
Ataxic - cerebellum - coordination/balance
Dyskinetic - basal ganglia - uncontrollable movements

133
Q

Types of spastic cerebral palsy

A

Diplegia - muscle stiffness mostly in legs, arms less/not affected
Hemiplegia - affects only one side of a persons body, usually the arm is more affected than the leg
Quadriplegia - most severe form, affects all four limbs, the trunk and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities

134
Q

Ataxic CP

A

Problems with balance and coordination
May be unsteady when walking
Might have a hard time with quick movements or controlled movements
Difficulty controlling hands or arms when reaching for something

135
Q

Dyskinetic CP

A

Problems controlling movement of hands arms feet and legs, difficult to sit and walk
Uncontrollable movements can be slow and writhing or rapid and jerky
Sometimes the tongue and face are affected - difficulty sucking, swallowing, talking

136
Q

Dental considerations of patients with cerebral palsy

A

Difficulty tolerating dental treatment
Increased malocclusion (usually class II)
Increased dental trauma
Bruxism
Drooling
Poor OH
Pathological oral reflexes - biting
Calculus if peg fed
Periodontal disease
Hyperplastic gingivitis
Self mutilation
Unsafe swallow

137
Q

Incidence of childhood cancer <15 years old

A

1:450

138
Q

Most common childhood cancer

A

Leukaemia

139
Q

% of childhood cancers that can be completely cured

A

82%

140
Q

Leukaemia

A

Cancer of white blood cells
Can affect lymphocytes or myeloid cells (including neutrophils)
3/4 cases are acute lymphoblastic leukaemia
White blood cell production gets out of control, continue to divide in the bone marrow but do not mature
Fill up bone marrow preventing healthy blood cell synthesis

Pallor due to decreased RBCs
Increased bleeding/bruising due to lack of platelets
Infection due to lack of functioning WBCs

141
Q

Oral manifestations of leukaemia

A

Gingival swelling
Ulceration
Spontaneous gingival bleeding
Unusual mobility of teeth
Petechiae
Mucosal pallor
Herpetic infections
Candidosis

142
Q

Cancer therapy that may have oral complications

A

Surgery to head and neck
Chemotherapy
Radiotherapy to head and neck
Bone marrow transplant

143
Q

Dental implications of cytotoxic drugs

A

Short term
Mucositis
Increased infection risk
Increased bleeding risk
Long term
Affect developing dentition - enamel hypoplasia, microdontia, thin roots

144
Q

Dental relevance of radiotherapy to the head and neck

A

Short term - mucositis, decreased salivary flow (often permanent, increases caries, infection risk and causes taste disturbance), direct damage to taste buds
Longer term - malocclusion, increased risk of soft tissue neoplasm, risk of osteoradionecrosis, affects to developing dentition (hypodontia, microdontia, enamel hypoplasia, defects of root formation)

145
Q

Incidence of congential cardiac defects

A

6-8/1000 births
1:125

146
Q

Classifications of congenital cardiac defects

A

Cyanotic - deoxygenated blood able to enter systemic circulation
Acyanotic - Normal levels of oxyhaemoglobin in systemic circulation

147
Q

Most common acyanotic CCD

A

Ventricular septal defect

148
Q

Most common cyanotic CCD

A

Tetralogy of Fallot

149
Q

50% of Down Syndrome patients have

A

An atrial septal defect

150
Q

Dental implications of congenital cardiac defects

A

Medications increasing bleeding risk
Higher risk of GA
Careful use of adrenaline containing LA
Increased risk of enamel hypoplasia
Risk of infective endocarditis resulting from an oral bacteraemia

151
Q

Patients at higher risk of infective endocarditis

A

Acquired valvular heart disease with stenosis or regurgitation
Hypertrophic cardiomyopathy
Previous IE
Structural congenital heart disease, including surgically corrected or palliated structural conditions
Valve replacement

152
Q

Infective endocarditis

A

IE can occur when bacteria enter the blood stream, causing a bacteraemia and then adhere and multiply on the damaged heart surface, resulting in inflammation of the endocardium - significant morbidity (between 5 and 40%)

153
Q

Sub group of patients at risk of IE, requiring special consideration

A

Prosthetic valve, including transcatheter valves or where any prosthetic material was used for valve repair
Previous IE
Congenital heart disease - any type of cyanotic CHD, including those repaired with prosthetic material

154
Q

What should be considered for patients requiring special consideration at risk of IE, when carrying out invasive dental procedures?

A

Antibiotic prophylaxis

155
Q

Guidelines for antibiotic prophylaxis for dental care

A

Nice Guidelines CG64

156
Q

3 risks of bacteraemia

A

Poor OH
Dental infection
Invasive dental procedure

157
Q

Invasive dental procedures

A

Placement of matrix bands
Placement of subgingival rubber dam clamps
Sub-gingival restorations including fixed pros
Endo treatment before apical stop has been established
Preformed metal crowns
Full periodontal exams
Root surface instrumentation/sub gingival scaling
Incision and drainage of abscess
Dental extractions
Surgery involving elevations of a muco-periosteal flap or mucogingival area
Placement of implants

158
Q

Non-invasive procedures

A

Infiltration or block LA injections in non-infected soft tissues
BPE
Supra-gingival scale
Supra-gingival restorations
Supragingival orthodontic bands and separators
Removal of sutures
Radiographs
Placement or adjustment of orthodontic or removable prosthodontic appliances

159
Q

Most common inherited bleeding disorders

A

Von Willebrand’s disease
Haemophilia A
Haemophilia B

160
Q

Non-inherited bleeding disorders

A

Warfarin/aspirin use
Chemotherapy induced thrombocytopenia

161
Q

Primary haemostasis

A

Vasoconstriction after injury
Platelet plug formation

162
Q

Secondary haemostasis

A

Formation of fibrin through coagulation cascade

163
Q

Tertiary haemostasis

A

Fibrinolysis
Formation of plasminogen, then plasmin

164
Q

Von Willebrand disease

A

Inherited deficiency on VW factor
Most common inherited bleeding disorder (1%)
Autosomal dominant

VW factor mediates platelet adhesion and aggregation, and is a carrier of factor VIII

165
Q

Dental considerations of Von Willebrand’s disease

A

Invasive treatment must be carried out in hospital setting

166
Q

Haemophilia A and B effects

A

Haemophilia A - lack of clotting factor VIII
Haemophilia B - lack of factor IX

167
Q

Categorisation of haemophilia

A

Haemophilia is classified depending on the amount of clotting factor present
Mild >5%
Moderate 1-5%
Severe <1%

168
Q

Haemophilia gene

A

X linked recessive
Males with the gene are affected
Women are carriers

169
Q

Impacts of dental disease in children with disabilities

A

Increased caries risk
Delayed diagnosis
Delayed management
Need for multidisciplinary planning
Pain/infection can be difficult to manage
Health risk posed by dental infection
Risks posed by dental treatment

170
Q

Aims of 2021 Guidelines for periodontal screening and management of children and adolescents under 18 years of age

A

Outline a method of screening for under 18s during the routine clinical dental exam in order to detect the presence of gingivitis or periodontitis at the earliest opportunity

Provide guidance on periodontal management and when appropriate, treat in practice or refer, optimising periodontal outcomes for children

171
Q

PGGNPPSPMTT 2017 World Workshop classifications of paediatric perio

A

Periodontal health
Gingivitis - biofilm induced
Gingival diseases and conditions - non biofilm induced
Necrotising periodontal disease
Periodontitis
Periodontitis as a manifestation of systemic disease
Systemic diseases or conditions affecting the periodontal supporting tissues
Periodontal abscesses and endo-perio lesions
Mucogingival deformities and conditions
Traumatic occlusal forces
Tooth and prosthesis related factors

172
Q

Periodontal health

A

A state free from inflammatory periodontal disease, that allows an individual to function normally and avoids physical or mental consequences due to current or past disease

173
Q

Features of health periodontium

A

Gingival margin several milimeters coronal to the CEJ
Gingival sulcus 0.5-3mm deep on a fully erupted tooth
In teenagers - alveolar crest is situated between 0.4-1.9mm apical to CEJ

174
Q

Classification of reduced periodontium

A

Non-periodontal patient - crown lengthening surgery, recession
Periodontal patient - stable periodontitis

175
Q

How can periodontal health be examined in practice

A

BPE
<10% BOP

176
Q

Gingival conditions

A

Plaque biofilm induced gingivitis - intact or reduced periodontium
Non plaque biofilm induced gingivitis/gingival lesions

177
Q

Plaque biofilm induced gingivitis

A

As supragingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in the gingival connective tissue
Junctional epithelium becomes disrupted
Allows apical migration of plaque and increase in gingival sulcus depth

178
Q

Non dental biofilm induced gingival diseases sub-classification

A

Genetic/developmental disorders
Specific infections
Inflammatory and immune conditions and lesions
Reactive processes
Neoplasms
Endocrine
Nutritional and metabolic diseases
Traumatic lesions
Gingival pigmentation

179
Q

Aetiology of necrotising gingivitis

A

Fusiformspirochaetal microbial aetiology
Socioeconomic factors - developing countries
Risk factors - smoking, immunosuppression, stress, malnourishment, poor diet
Local factors - root proximity, tooth malposition
Systemic factors - HIV
Underlying undiagnosed pathology in an immunosuppressed host

180
Q

Features of necrotising gingivitis

A

Pain
Necrosis of interdental papilla - punched out appearance
Ulceration
Spontaneous bleeding
Secondary foetor oris
Pseudomembrane may be present
+/- lymphadenopathy
Fever
Many manifest in teenagers
May progress to necrotising periodontitis

181
Q

Predisposing factors for periodontal diseases

A

Malocclusion - instanding or rotated tooth, traumatic occlusion
Traumatic dental injury to the PDL - luxation/intrusion/avulsion
Tooth anatomy plaque retentive factors
Restoration overhangs
Ortho/pros appliances
Incompetent lip seal - dry mouth

182
Q

Modifying risk factors for periodontal disease

A

Smoking
Metabolic factors - hyperglycaemia/T1D
Pharmacalogical agents (cyclosporin)
Nutritional factors (Vit C deficiency)
Increased sex steroids (puberty, pregnancy)
Haematological conditions (Leukaemia)

183
Q

Factors influencing gingival hyperplasia

A

Systemic and metabolic diseases
Genetic factors
Local factors
Side effect of some medications (cyclosporin, phenytoin, calcium channel blockers)
Puberty

184
Q

Treatment for gingival hyperplasia

A

Rigorous home care
Frequent PMPR
+/- surgery, especially with drug induced

185
Q

4 main distinguishing factors of periodontitis

A

Apical migration of junctional epithelium, beyond CEJ
Loss of attachment or periodontal tissues to cementum
Transformation of junctional epithelium to pocket epithelium
Alveolar bone loss

186
Q

Pathogens found in teenagers with periodontitis

A

Porphyromonas gingivalis
Prevotella intermedia
AA
Tannerella forsythia

187
Q

Features of necrotising periodontitis

A

Necrosis/ulceration of the interdental papilla
Bleeding of gingival tissues
PDL loss and rapid bone loss
Pseudomembrane formation
Lymphadenopathy
Fever

188
Q

Who is necrotising stomatitis likely to affect?

A

Severely systemically compromised patients

189
Q

With regards to diagnosing periodontal diseases in mixed dentition, be aware of

A

false pocketing around erupting permanent dentition

190
Q

Which pathogen is thought to be most associated with molar-incisor pattern periodontitis?

A

AA

191
Q

Systemic conditions that put children at increased risk of periodontal disease

A

Papillon lefevre syndrome
Neutropenia
Chediak-Higashi syndrome
Leucocyte adhesion deficiency syndrome
Ehlers-Danlos syndrome
Langerhans’ cell histiocytosis
Hypophosphatasia
Down syndrome

192
Q

What should be assessed as periodontal screening in a routine exam

A

Gingival condition
OH status
Assess if any calculus
Assess local risk factors

193
Q

Who should have the sBPE performed as part of routine exam?

A

All co-operative children age 7-18

194
Q

What probe is used for sBPE

A

WHO 621/CPITN probe
0.5mm ball
Black band 3.5mm-5.5mm

195
Q

How much force should be applied to carry out BPE?

A

20-25g

196
Q

What do the codes for sBPE mean?

A

0 - health
1 - BOP, black band fully visible
2 - calculus or plaque retention factor, black band fully visible
3 - shallow 4/5mm pocket, black band partly visible
4 - Black band disappears
* furcation involvement

197
Q

Which sBPE codes are used at which ages?

A

7-11 0,1,2
12-17 0,1,2,3,4,*

198
Q

What are the index teeth for the sBPE?

A

16,11,26,36,31,46

199
Q

What is the purpose of the sBPE?

A

Screening tool to identify patients who would benefit from further investigation

200
Q

SDCEP plaque scores

A

10/10 perfectly clean tooth
8/10 line of plaque around cervical margin
6/10 cervical 1/3 of crown covered
4/10 middle 1/3 of crown covered

201
Q

Where a BPE score of 3 or 4 is measured, what are the next steps?

A

6ppc (localised to 3 BPE, or full if 4)
Check bone levels with BWs for posteriors, PAs for anteriors, or OPT (esp. if for ortho treatment

202
Q

What must be carried out before ortho treatment?

A

BPE

203
Q

What technique for toothbrushing should be taught?

A

Modified bass technique

204
Q

Viral orofacial soft tissue infections

A

Primary herpes
Herpangina
Hand foot and mouth
Varicella Zoster
Epstein barr virus
Mumps
Measles
Rubella

205
Q

Bacterial orofacial soft tissue infections

A

Staphylococcal
Streptococcal
Syphilis
TB
Cat Scratch Disease

206
Q

Cause of fungal orofacial soft tissue infections

A

Candida

207
Q

Primary herpetic gingivostomatitis

A

Acute infectious disease caused by Herpes Simplex Virus I
Primary infection common in children
Transmission by droplet 7 day incubation
Degree of immunity from circulating maternal antibodies therefore infection rare in first year
Almost 100% of adults carry

208
Q

Signs and symptoms of primary herpetic gingivostomatitis

A

Fluid filled vesicles - rupture to painful ragged ulcers on gingivae, tongue, lips, buccal and palatal mucosa
Severe oedematous marginal gingivitis
Fever
Headache
Malaise
Cervical lympadenopathy

209
Q

Treatment for primary herpetic gingivostomatitis

A

Bed rest
Soft diet
Hydration
Paracetamol
Antimicrobial gel or mouthwash
Aciclovir for immunocomprimised children

210
Q

Most common complication of primary herpetic gingivostomatitis

A

Dehydration

211
Q

Following infection of primary herpetic gingivostomatitis, what happens?

A

Herpes simplex I remains dormant in epithelial cells
Recurrent 50-70% as herpes labials (cold sores)
Triggered by sunlight, stress, other causes of ill health
Managed with topical acyclovir cream

212
Q

Management of herpes labialis

A

Topical acyclovir cream

213
Q

Herpangina cause

A

Coxsackie A virus

214
Q

Hand foot and mouth cause

A

Coxsackie A virus

215
Q

Herpangina presentation

A

Vesicles in the tonsillar/pharyngeal region
Lasts 7-10 days

216
Q

Hand foot and mouth presentation

A

Ulceration on the gingivae/tongue/cheeks and palate
Maculopapular rash on the hands and feet
Lasts 7-10 days

217
Q

Oral ulceration

A

A localised defect in the surface oral mucosa, where the covering epithelium is destroyed, leaving an inflamed area of exposed connective tissue

218
Q

10 key facts when collecting history on oral ulceration

A

Onset
Frequency
Number
Site
Size
Duration
Exacerbating dietary factors
Lesions in other areas
Associated medical problems
Treatment so far (helpful/unhelpful)

219
Q

Causes of oral ulceration

A

Most commonly Recurrect Apthous Stomatitis - No clear underlying cause
Infection
Immune mediated Disorders
Vesiculobullous disorders
Inherited or acquired immunodeficiency disorders
Neoplastic/Haematological
Trauma
Vitamin deficiencies

220
Q

Appearance of recurrent apthous ulceration

A

Round or ovoid with grey or yellow base amd varying degree of perilesional erythema
Minor <10mm, Major >10mm, Herpetiform 1-2mm, multiple

221
Q

Aetiological factors for RAU

A

Hereditary predisposition
Haematological deficiency
GI disease
Minor trauma
Stress
Allergies
Hormonal disturbance

222
Q

Investigations following RAU

A

Diet diary
FBC
Haematinics (folate, b12, ferritin)
Coeliac screen

223
Q

Management of RAU

A

Diet analysis may suggest exacerbating food groups - manage accordingly
Low ferritin - 3 months of iron supplementation
Low folate/b12 or positive anti-transglutanimase antibody- refer to paediatrician or GI specialist

224
Q

Orofacial Granulomatosis

A

Uncommon chronic inflammatory disorder
Idiopathic or associated with systemic granulomatous conditions
Average age of onset 11
Males>females
Characteristic pathology is no caseating giant cell granulomas which then result in lymphatic obstruction
May be predictor of future Crohn’s

225
Q

Clinical features of orofacial granulomatosis and Crohn’s

A

Features of both are identical
Lip swelling - most common
Full thickness gingival swelling
Swelling of the non labial facial tissues
Peri-oral erythema
Cobblestone appearance of the buccal mucosa
Linear oral ulceration
Mucosal tags
Lip/tongue fissuring
Angular chelitis

226
Q

Orofacial granulomatosis aetiology

A

Largely unknown
Limited evidence of genetic factors
Numerous associated allergens reported - cinnamon compounds, benzoates, much higher IgE mediated atopy rates compared to general population

227
Q

investigations for OFG diagnosis

A

Measure growth
FBC
Haematinics
Patch testing to ID triggers
Diet diary to ID triggers
Faecal calprotectin
Endoscopy risky in childhood
Serum angiotensin converting enzyme (raised in sarcoidosis)

228
Q

OFG management

A

Refer
OH support
Dietary exclusion
Manage nutritional deficiencies
Topical steroids
Topical tacrolimus
Short course oral steroids if severe or unresponsive to topical

229
Q

OFG management

A

Refer
OH support
Dietary exclusion
Manage nutritional deficiencies
Topical steroids
Topical tacrolimus
Short course oral steroids if severe or unresponsive to topical

230
Q

Most common mucosal lesion of the tongue in children

A

Geographic tongue

231
Q

Geographic tongue

A

Shiny red areas on the tongue with loss of filiform papillae surrounded by white margins
Idiopathic non contagious
Can cause intense discomfort in children esp. with spicy food, tomato, citrus fruit/juice

232
Q

Management of geographic tongue

A

Bland diet during flare ups

233
Q

Common causes of sold swellings

A

Fibroepithelial polyp
Epulides
Congenital epulis
HPV associated mucosal swellings
Neurofibromas

234
Q

Fibroepithelial polyp

A

Common
Firm pink lump
Mainly in the cheeks
Once established, constant size
Initiated by minor trauma
Surgical excision is curative

235
Q

Epulides

A

Common solid swelling of the oral mucosa
Benign hyperplastic lesions
3 main types - fibrous epulis, pyogenic granuloma, peripheral giant cell granuloma
Related to chronic inflammation esp. calculus/plaque
More common in maxilla
Surgical excision to manage, as well as management of exacerbating factors
Majority anterior to molars
Tendency to reoccur

236
Q

Fibrous epulis

A

Type of epulide
Similar to fibroepithelial polyp
Firm consistency
Similar colour to surrounding gingivae

237
Q

Pyogenic granuloma/pregnancy epulis

A

Both types of vascular epulis
Identical - only difference pregnancy
Soft deep red/purple swelling
Often ulcerated
Haemorrhage spontaneously or with mild trauma
Vascular proliferation supported by a delicate fibrous stroma
Probably a reaction to chronic trauma such as calculus
Tend to recur

238
Q

Peripheral giant cell granuloma

A

Type of epulide
Pedunculated or sessile swelling
Typically dark red and ulcerated
Usually arises interproximally and has an hourglass shape
Radiographs may reveal superficial erosion of interdental bone
Multinucleate giant cells in a vascular stroma
May recur after surgical excision

239
Q

Congenital Epulis

A

Rare lesion
Occurs in newborns
Most commonly affect the anterior maxilla
F>M
Granular cells covered with epithelium
Benign
Simple excision is curative

240
Q

HPV associated swellings

A

Verruca vulgaris
Squamous cell papilloma

241
Q

Verruca vulgaris

A

Solitary or multiple intra-oral lesions
May be associated with skin wards
Caused by HPV 2 and 4
Most commonly on keratinised tissue - gingivae and palate
Most resolve spontaneously
Can be removed surgically

242
Q

Squamous cell papilloma

A

Small pedunculated cauliflower like growths
Benign
HPV 6 and 11
Vary in colour pink/white
Usually solitary
Treatment - surgical excision

243
Q

Mucocele

A

Cyst arising in connection with minor salivary glands
2 variations - normal secretions rupture into adjacent tissues mucous extravasation cyst or secretions retained in an expanded duct mucous retention cyst
Most - minor glands of the lower lip, can affect major or minor glands
Most will rupture spontaneously
Only surgically excise if lesion is causing distress or disturbance
Tendency to recur

244
Q

Ranula

A

Mucocele in FOM arising from minor glands or ducts of sublingual/submandibular gland
Ultrasound or MRI needed to exclude plunging ranula
Occassionally found to be lymphangioma

245
Q

Bohn’s nodules

A

Gingival cysts seen commonly on the alveolar ridge of newborns
Remnants of dental lamina
Filled with keratin
Usually disappear by 3 months

246
Q

Epstein pearls

A

Small cystic lesions found along mid palatal line common in newborns
Thought to be trapped epithelium in the palatal raphe
Usually disappear after first few weeks

247
Q

TMJDS

A

Most common condition affecting TMJ redion
Characterised by pain, masticatory muscle spasm
Limited jaw opening

248
Q

Extraoral exam of TMJDS

A

Palpation of the muscles of mastication at rest and when clenched to assess tenderness or hypertrophy
Palpation of the TMJ at rest and when opening and closing to assess tenderness and click
Assessment of opening for deviation and extent of opening

249
Q

Normal jaw opening

A

40-50mm

250
Q

Intraoral examination of TMJDS symptoms

A

Assessment of any dental wear facets
Signs of clenching/grinding - scalloped lateral tongue surface, buccal mucosa ridges

251
Q

Management of TMJDS

A

Explain it is due to overworking and misuse of muscles
Management of stress
Avoid habits such as clenching, chewing, nail biting
Bite raising appliance considered if nocturnal grinding
Allow over worked muscles to rest - avoid wide opening, soft diet with little chewing
Ibuprofen for symptomatic relief, hot and col packs

BDS3 (20 decks)

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