Paediatric Dentistry Flashcards
what is a gingival cyst and where might you find it
white colour gingival lesion where keratin is formed
not to worry about
what is an eruption cyst
cyst overlying where the developing tooth is about to erupt
turns blue because it is filled with blood
resolves once tooth erupts
what role does the dental follicle play in tooth eruption
when it is activated it initiates osteoclast activity in the alveolar bone ahead of the tooth and clear a path of eruption
what is the order of eruption of primary teeth
A B D C E
when does the lower A tend to erupt
4-6 months
when does the B tend to erupt
7-16 months
when does the D usually tend to erupt
13-19 months
when does the C tend to erupt
16-22 months
when do Es tend to erupt
15-33 months
when do teeth in the same series erupt in comparison to their contra-lateral tooth normally
within 3 months
give four differences between the crowns of primary vs permanent teeth
primary incisors smaller in crown and root length
primary molars are wider mesio-distally
primary molar crowns are more bulbous
primary teeth are whiter
what is anthropoid spacing
maxilla - space in front of the C
mandible - space behind the C
how do permanent incisors develop relative to the position of primary incisors
paltal
from date of eruption, how long does it take for the permanent tooth root to complete apexogenesis
3 years
what is MIH
the hypomineralisation of 1-4 permanent molars frequently associated with affected incisors
what is hypomineralisation
disturbance in the formation of enamel which results in a reduced mineral content
what is hypoplastic enamel
a reduce in the bulk or thickness of normal mineralised enamel
what are the two types of enamel hypoplasia
true - enamel never formed
acquired - post-eruptive loss of enamel bulk
what are three theorised reasons why MIH teeth are very sensitive
Dentine hypersensitivity - due to the porous enamel
Peripheral sensitivity - pulpal inflammation leads to sensitisation
Central sensitisation - - from continued nociceptive input
how can MIH present
small, demarcated discoloured areas
dark, yellow areas that fracture off
how is MIH treated
micro-abrasion to remove outer surface of enamel to treat the brown or yellow parts
then bleaching to sort out the white/ cream parts
what are treatment options for MIH in molars
composite/ GIC restorations
stainless steel crowns
XLA
how are incisors with MIH treated
micro-abrasion
resin infiltration into patches
external bleaching
localised composite placement
why might you do endodontic treatment on primary molars
to try avoid unplanned extractions of primary teeth
give three disadvantages of extracting primary molars
loss of space
decreased masticatory function
impeded speech development
give three indications that pulp treatment would be achievable in the primary dentition
good co-operation
missing permanent successor
medical history does not allow extraction
give three contra-indications for undertaking pulp treatment in children
poor co-operation
poor dental attendance
advanced root resorption
what are the two main aims of pulpotomy
radicular pulp is preserved
bleeding controlled
what medicament would you use when undertaking a pulpotomy to arrest any bleeding and for how long
ferric sulphate for 20 seconds
how should pulpotomies in primary teeth be restored
root stumps covered with ZOE paste/ CaOH or MTA
build up GIC core
preformed metal crown on top
what are the three lining options for over root stumps of pulpotomies
calcium hydroxide
ZOE
MTA
what should you evaluate when looking at the pulp in a pulpotomy
bleeding
bright red and haemostasis = uninflamed pulp
deep crimson blood and continued bleeding after pressure = inflamed pulp
what are the two overall categories of dental trauma
dental hard tissue and pulp trauma
supporting tissue trauma
what is a concussion injury
PDL injury
tooth TTP but not displaced
no bleeding in sulcus
what is a subluxation injury
tooth TTP and increased mobility
tooth not displaced
bleeding from gingiva
what is lateral luxation injury
tooth displaced in palatal/ lingual or labial direction
What is intrusion injury
tooth displaced through labial bone plate or impinging on permanent tooth bud
what is an extrusion injury
partial displacement of the tooth out of its socket
what is an avulsion injury
tooth is completely displaced out of its socket
what are the six features of a trauma stamp
mobility
colour
TTP
sinus
percussion note
radiograph
a patient attends with an enamel fracture - what are your treatment options
if missing fragment can be accounted for - bond back on
smooth edges and place composite
a patient attends with an uncomplicated crown fracture with the exposed dentine being more than 0.5mm from the pulp - what is your treatment
cover exposed dentine with GIC or use bonding agent and composite
a patient attends with an uncomplicated crown fracture in which the dentine is within 0.5mm of the pulp - what is your treatment
CaOH lining placed and cover with GIC
what are the follow up times for an enamel fracture
6-8 weeks
1 year
what are the follow up times for an uncomplicated crown fracture
6-8 weeks
1 year
what is your treatment for a patient who attends with a complicated crown fracture and the apex is open
Pulp cap
partial pulpotomy
a patient attends with a complicated crown fracture and the root development is completed - what is your treatment
patial pulpotomy
name 2 materials that could be placed on top of a pulp wound
non-setting calcium hydroxide
non-staining calcium silicate
what is the follow up for a complicated crown fracture
6-8 weeks
3 months
6 months
1 year
a patient attends with a crown-root fracture with no pulp exposure and the tooth looks restorable - what is your treatment
cover exposed dentine with GIC
a patient attends with a crown-root fracture with a pulp exposure and the tooth looks restorable - what is your treatment
partial pulpotomy - in immature teeth
pulpectomy - mature teeth where root formation is finished
a patient attends with a crown-root fracture that is unrestorable - what is your treatment
extract the loose fragments
what is the follow up regime for an uncomplicated and complicated crown-root fracture
1 week
6-8 weeks
3 months
6 months
1 year
(yearly for 5 years)
a patient attends with a root fracture where the coronal aspect has not been displaced - what is your treatment
no treatment
a patient attends with a root fracture where the coronal fragment is displaced but not excessively mobile - what is your treatment
leave coronal fragment to spontaneously reposition
a patient attends with a root fracture where the coronal fragment is displaced and the crown is excessively mobile - what is your treatment
extract loose coronal fragment
reposition loose coronal fragment and splint for 4 weeks
in which direction do root fracture lines tend to run
obliquely
what is the follow up regime for a root fracture
4-5 weeks
6-8 weeks
4 months
6 months
1 year
yearly for 5 years
a patient attends with an alveolar fracture - what is your treatment
reposition the displaced segment
stabilise with a flexible splint for 4 weeks
suture any gingival lacerations
what is the follow up regime for an alveolar fracture
4-5 weeks
6-8 weeks
4 months
6 months
1 year
yearly for 5 years
what is the treatment for a patient presenting with a concussion injury
no treatment
what is the follow up regime for concussion injury
4 weeks
1 year
a patient presents with a subluxation injury - what is your treatment
no treatment
or passive flexible splint for 2 weeks if tooth excessively mobile
what is the follow up regime for a subluxation injury
2 weeks
3 months
6 months
1 year
a patient attends with an extrusion injury - what is your treatment
reposition tooth
stabilise for 2 weeks with splint
what is the follow up regime for an extrusion injury
2 weeks
4 weeks
8 weeks
3 months
6 months
1 year
yearly for 5 years
a patient presents with a lateral luxation injury - what is your treatment
palpate gingiva to feel apex of the tooth and push down on it while moving the coronal part of the tooth where you want it
splint for 4 weeks
endodontic evaluation at 2 week review
what is most likely to happen in a tooth with complete root formation after a lateral luxation injury
the pulp will most likely become necrotic and RCT should be started
what is hoped to happen when a tooth with incomplete root formation has a lateral luxation injury
spontaneous revascularisation occurs
what is the follow up regime for an lateral luxation injury
2 weeks
4 weeks
8 weeks
3 months
6 months
1 year
yearly for 5 years
a patient attends with an intrusion injury - what is your treatment
allow spontaneous repositioning
if no repositioning in 4 weeks - orthodontic repositioning required
what is the follow up regime for an intrusion injury
2 weeks
4 weeks
8 weeks
3 months
6 months
1 year
yearly for 5 years
what types of injuries will require a flexible splint
luxated
avulsed
root fractured
give three instructions for at home care following a TDI
avoid contact sports
good oral hygiene
rinse with antibacterial agent (eg chlorhexidine)
name three indications for GA for children’s dental treatment
medical compromising conditions
difficult or complex dental treatment
very young children
when is the primary dentition usually complete by
2 and a half - 3 years of age
what is leeway space
primary molars wider than premolars that will replace them
1.5mm per side on upper arch
2.5 per side on lower arch
what is the definition of MIH
hypomineralisation of systemic origin of 1-4 permanent molars, frequently associated with affected incisors
what is meant by hypomineralisation
disturbance of enamel formation resulting in reduced mineral content
what is meant by hypoplasia of enamel
reduced thickness of enamel
name three possible factors for MIH
measles
rubella
chicken pox
name three clinical problems MIH poses
loss of tooth substance
sensitivity
appearance
name three treatment options for MIH molars
composite/ GI restorations
stainless steel crowns
planned extractions
name five treatment options for MIH incisors
micro-abrasion
resin infiltration into patches
external bleaching
localised composite placement
veneers
name three broad ways in which children become dentally anxious
conditioning
modelling
information
name three characteristics of anxious patients
low pain threshold
pessimism
high neuroticism
what is used to assess anxiety in patients (adults)
modified dental anxiety scale (MDAS)
what is the cut off score for severe dental fear/ anxiety on MDAS
19/25
name two tools you can use to assess anxiety in children from 4-16
The Venham Picture test (4-11)
Modified Child Dental Anxiety Scale faces version (8-16)
give three treatment strategies for mild/ moderate anxiety
acknowledge patient’s anxiety and provide control
teach coping strategies
inhalation sedation
