Paediatric Dentistry Flashcards
caries prevention
- hx & exam based on recall
- OHI to be given at least x1 yearly
- dietary advice to be given at least x1 yearly
- topical F varnish applied 2-4x yearly
- fissure sealants
- BW every 6/12mths
what to look out for in hx & exam
MH - autism / learning difficulties / anything that can impact good OH
SH - living arrangements & involvement of social work
DH - last visit, brushing habits, fluoride consumption
diet - quantity & frequency of sugar intake
exam - clean & dry teeth to assess for early signs of decay. set appropriate recall based on risk factors
OHI to be given
brush 2x daily for 2mins before bed & 1 other time
if <7 need assistance
advise able pt to spit not rinse
<3 = 1000mmpF smear
>3 = 1450ppmF
3-6 = pea size
if HIGH RISK
8+ = prescribe 0.05% NaF MW
10+ = 2800ppmF
16+ = 2800/5000ppmF
dietary advice to give
- promote balanced diet
- beverages to be milk / water
- reduce frequency of sugar intake to max x4 daily ideally during mealtimes
- non cariogenic snack choices i.e. cheese / veg
- do not eat or drink following night time brushing
- be wary of hidden sugars
topical F varnish
apply topical FV 2.2% NaF from age of 3
LOW RISK = x2 yr
HIGH RISK = x4 yr
0.25ml for 2-5yrs & 0.4ml for 6+yrs
advise pt to avoid eating, drinking & brushing for 30mins
contraindications - colophony allergy (sticky plasters), having been hospitalised due to severe asthma & ulcerative gingivitis
fissure sealants
for all high caries risk pt seal FPMs on eruption using resin based cement
if pt is uncooperative or tooth is PE then seal using GIC due to its better moisture tolerance
check integrity of FS at subsequent appts
procedure for FS
- assess pt cooperation (if non coop / PE teeth then use GIC & prescribe high F toothpaste)
- clean teeth from debris using - cotton pledget to wipe / toothbrush with no toothpaste, bristle brush with no prophy / straight probe gently into fissures
- isolate & dry teeth using cotton rolls & suction or dry guard (arrow points into mouth??)
- etch using 37% phosphoric acid for 30secs
- rinse teeth & dry
- replace wet CW rolls
- apply resin FS up to 1/3 of cuspal incline & include all pits and fissures
- light cure for 20secs
- wipe sealant using cotton pledget to remove unpleasant taste
- use straight probe to check integrity of sealant as if it can be picked off it needs redone as poorly placed ones lead to leakage & caries
- monitor as subsequent appts checking integrity. top up and maintain esp in high risk pts
vital pulpotomy of a primary molar
- assess pt compliance; must be able to tolerate LA, dam & radiographs
- check MH & re obtain consent
- LA & dam
- remove caries present & access pulp chamber with high speed handpiece
- remove roof of pulp chamber (endo-Z bur / safe ended bur)
- using large excavator or slow speed round bur remove the coronal pulp
- rinse chamber & apply gentle pressure with a damp cotton pellet soaked in ferric sulfate for 15secs, check bleeding has stopped & if not reapply for 15 secs ( failure to achieve haemostasis is a sign that the radicular pulp is inflamed; pulpectomy / XLA indicated)
- fill pulp chamber with ZOE / MTA / diodentine
- remove dam
- used preformed metal crown and seat with GIC luting cement
- ask pt to bite down on CW roll
- remove excess cement & floss interproximally
- carry out annual radiographic review
pulpotomy is indicated when a vital restorable tooth has: (4)
- large proximal carious lesion (inc 1/3 or more of marginal ridge)
- a carious / mechanical exposure of vital coronal pulp tissue
- no radicular pulpitis i.e. no spontaneous pain, haemorrhage from radicular tissue controlled
- no abscess / fistula or when XLA is contraindicated
hall crown technique
- place separators in contact points if they are there
- remove 3-5 days later
- place gauze to protect airway
- select appropriate crown size (correct size will give spring back) but do not fully seat
- dry crown & place GIC. elastoplast tape can be used as extra measure for airway protection
- dry tooth & verify direction of crown cementation
- seat crown with combination of finger pressure & child biting on to CW roll - warn child of sound & taste i.e. will hear a click and will taste like salt & vinegar crisps
- remove excess cement & floss interproximal
- remove cause & ask pt to maintain firm pressure until set
- reassure pt & parent that high bite will settle and advise post op pain relief if needed
- recall 3 mths
microabrasion technique
PPE must be worn !
pt requires glasses & bib
MUST place rubber dam
18% HCl used - very strong
petroleum jelly to protect soft tissues
sodium bicarbonate guard to protect gingiva
oroseal around ginigval margin prior to dam to ensure adequate seal
HCl pumice slurry in slowly rotating rubber cup (5 secs) max is 10x5secs applications
polish with sandpaper discs then place fluoride
why not duraphat placed after microabrasion
dark colour & teeth very porous so use white varnish i.e. profluorid; remineralises & helps with sensitivity
what conc HCl is used
18%
why polish using sandpaper discs post microbabrasion
SEM evidence shows compacted relatively prismless layer of surface enamel; this changes optical properties of enamel so areas of intrinsic discolouration become less perceptible
what is oroseal
cellulose based material applied via syringe which adheres to wet dam / gingival or mucosal tissues & is used when adequate seal is difficult to obtain with compromised teeth / roots
