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Dentistry BDS4 > Paediatric dentistry > Flashcards

Paediatric dentistry Flashcards

1
Q

what are the principle aims of paediatric Tx?

A

development and maintenance of healthy, functional and attractive primary and secondary dentition
freedom from pain and infection
happy and cooperative patient
prevention is key

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2
Q

what behaviour management techniques can you use?

A 
Behaviour shaping
reinforcement
modelling
desensitisation
Tell/Show/Do
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3
Q

what types of medical management techniques are there?

A 
sedation:
oral (>12)
IV (>12)
IH (>7)
GA
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4
Q

How would you manage a child with reversible pulpitis?

A

emergency management: LA, excavate caries, restore with coltisol. if exposed pulp and vital, use iodoform
definitive: pulpotomy and SSC/extraction

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5
Q

How would you manage a child with irreversible pulpitis?

A

emergency management: LA, excavate caries, dress with iodoform, restore with coltisol, GI
definitive: pulpotomy/pulpectomy/extraction

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6
Q

What are general causes of delayed/failure of eruption?

A

Hereditary gingivofibromatosis, Down Syndrom, Gardner syndrome, hypothyroidism, cleidocranial dysostosis, rickets

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7
Q

What are local causes of delayed/failure of eruption?

A

congenital absence, crowding, retention of primary, supernumerary, dilaceration, dentigetous cyst, trauma to primary causing apical displacement, abnormal position of crypt, primary failure of eruption

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8
Q

What are infraoccluded teeth, how do you classify and what is the treatment

A

primary molar failing to maintain occlusion height and position with relation to adjacent teeth
If the marginal ridge is above the contact area - mild
if the marginal ridge is at the contact area - moderate
if the marginal ridge is below the contact area - severe

Radiographs to look for sucessor and ankylosis
monitor if successor is present
if no successor - planned XLA

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9
Q

What is hypodontia?

A

developmental absence of more than one tooth

8s, 2s, 5s

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10
Q

what is hyperdontia?

A

supernumerary teeth. Conical, tuberculate, supplemental, odontome

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11
Q

What are causes of hypomineralisation?

A

infection (turner tooth), trauma, irradiation, ameliogenensis imperfecta

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12
Q

What is MIH and what are the treatment options?

A

hypomineralisation of the enamel of 6s and 1s
yellow/white opacities
increased sensitivity, increase caries
veneers for incisors, extraction of poor prognosis molars

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13
Q

What do teeth with dentinogenesis imperfecta look like radiographically?

A

opalescent brown/blue image, bulbous crowns, short roots, narrow flame shaped pulps

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14
Q

List abnormalities of tooth form

A

gemination, fusion, macrodontia, microdontia, dens in dente (fissure seal as soon as possible after eruption), dilaceration (ortho to realign), turner tooth, taurodontism (elongation of pulp chamber)

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15
Q

What can cause extrinsic staining of a tooth?

A

chromogenic bacteria, diet, CHX MW, dietary tanins, poor OH and demineralisation

treat with abrasive prophy paste and OHI

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16
Q

What can cause intrinsic staining of a tooth?

A

Infection, ABs, enamel opacities, prohpyria, pulp necrosis, root canal medicaments

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17
Q

What is the method for microabrasion?

A

take tooth shade and imaging before treatment.
Gain consent, ensure pt understands it wont make teeth more white, just less brown
best on brown and orange defects
place petroleum jelly on gingiva
mix up bicarb and water paste, place on gingiva around tooth
place dam and wedgets to isolate teeth for MA - ensure no part of tooth is covered
place 18% HCl and pumice mix on tooth, rub for 5 seconds, wash, dry, repeat
max of 10x5 seconds, removes 100um of enamel
place non-coloured FV on tooth
smooth with finest sandpaper discs and final polish with toothpaste

take post op images, review 6 weeks after. post op instructions

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18
Q

Restoration materials for children

A

Cant use amalgam anymore - minimata convention
GI - quick, adhesion, F- release. poor wear resistance
RMGI - technique sensitive, good retention and wear resistance
compomer - modified composite, very moisure sensitive, good longevity
composite - needs good isolation, longer to place, good aesthetics and wear
SSC - good for molars
Hall technique - biological treatment for caries. well tolerated, quick to place

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19
Q

Indications for SSC

A 
Broken down primary molar
pulp therapy in primary molar
interim measure for secondary molar if pt needs crown but too young
developmental abnormalities
severe tooth loss from bruxism
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20
Q

Method of hall technique

A 
place separators a couple of days before
check molar for pulp pathology (not suitable)
select correct size
fill with GI cement
place on tooth - child bites down
clear away excess cement
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21
Q

Risk factors for nursing bottle caries

A

elongated breast feeding
milk bottle at night
feeding from a bottle with something other than milk or water

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22
Q

why is there a specific pattern for nursing bottle caries?

A

max primary incisors then molars. mand incisors are protected from tongue and saliva

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23
Q

indication for pulp therapy in children

A

child has medical condition (bleeding etc), tooth must be restorable
breakdown of marginal ridge, symptomatic, TTP, buccal swelling, sinus, interradicular radiolucency

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24
Q

How do you do a pulpotomy?

A

vital primary molar pulp
amputation of coronal pulp, leaving healthy radicular pulp
LA and rubber dam
cavity prep and excavate caries
remove pulp chamber roof
amputate coronal pulp with sterile round bur
cotton wool pledget with ferric sulphate (molar) or saline (incisors) for 1min
apply coltisol dressing
restore tooth

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25
How do you do a pulpectomy
treatment of choice for non-vital pulps LA and rubber dam remove necrotic pulp, file and irrigate canals with NaOCl place iodoform paste in canal restore with ZOE/coltisol and place SSC in molar
26
Common viral oral infections
``` primary herpetic gingivostomatitis secondary herpes labialis HFM disease herpangina warts chicken pox mumps measles ```
27
Common bacterial oral infections
impetigo strep throat ANUG
28
Common fungal oral infections
Candida - pseudomembranous candidiasis
29
Common causes of ulceration in children
aphthous ulcerations, trauma, acuter herpetic gingivostomatitis, herpangina, HFM, glandular fever
30
common causes of soft tissue swelling in children
Abscess, mucocele, eruption cyst, epulides, papilloma
31
What is hypodontia?
Missing tooth (not 8s)
32
Is hypodontia more common in primary or permanent dentition?
Permanent (3.5-6.5%) | primary is <1%
33
What teeth are most likely to be missing in hypodontia?
mand premolars>malx lats least likely to be missing are FPM and max centrals
34
What conditions are associated with hypodontia?
``` Ectodermal dysplasia Down syndrom CLP hurlers syndrome incontinentia pigmentii ```
35
What problems can occur with perm dentition with pts with hypodontia?
overerruption of teeth which would occlude can get infraocclusion of retained deciduous loss of bone if congenitally missing tooth
36
who is involved in the treatment of hypodontia?
Removable pros, ortho, restorative
37
What are treatment options for hypodontia?
overdenture, partial denture, composite, porcelain veneers, fixed pros
38
What are the problems for hypodontia pts?
``` abnormal shape/form spacing submerging deep OB reduced LFH ```
39
What abnormalities of tooth number are there?
hypodontia, anodontia, hyperdontia
40
what syndromes are associated with hyperdontia?
cleidocranial dysostosis
41
What types of supernumerary are there?
conical tuberculate supplemental (upper laterals) odontome (compound or complex)
42
What is the most common cause of delayed eruption of the permanent teeth?
supernumerary teeth
43
how do you decide which supplemental tooth to remove?
which one has poorest outcome, less aesthetic and less likely to be positioned correctly with ortho
44
What is a mesiodens?
a supernumerary tooth in the maxillary midline. it is descriptive of where the tooth is, not what it is also paramolar/distomolars
45
What anomalies of size and shape are there?
``` microdontia (2.5%) macrodontia (1% single tooth, 0.1% generalised) double (gemination/fusion) odontomes taurodontism dilaceration dens in dente accessory (talon) cusp ```
46
What is the radiographic appearance of a taurodont?
large, flamed shaped pulp chambers
47
How do you treat a talon cusp?
selective grinding - remove mm at a time, leave it for a couple of weeks, let the pulp respond and start to lay down tertiary dentine
48
Why do you seal dens in dente on eruption?
because the tooth is folded and the root anatomy and canals are abnormal and folded, they are very hard to root treat to maximum preventative measures are taken
49
What are abnormalities of roots?
short roots (can be caused iatrogenically by ortho treatment) radiotherapy roots dentine dysplasias accessory roots
50
What are causes of enamel abnormalities?
amelogenesis imperfecta (hypoplastic, hypocalcified, hypomaturational, mixed forms) environmental enamel hypoplasia (systemic, nutritional, metabolic, infection) localised enamel hypoplasia (trauma, infection of primary
51
what are symptoms of AI?
honey coloured enamel, sensitivity, pitted enamel. it covers all the teeth and both dentitions
52
hypomineralisation vs hypoplasia?
hypomineralisation - secretory phase has happened normally but the mineralisation wave hasnt functioned properly and the enamel is soft and hard to bond to. right amount, wrong quality hypoplasia - the secretory phase goes wrong but that is there is mineralised properly. can bond to these properly wrong amount, right quality
53
what are signs of MIH?
1-4 incisors and 1-4 FPM, not symmetrical, well demarcated white and brown marks. sensitive, hard to anaesthetise
54
what are localised causes of hard tissue defects?
trauma or caries/abscess in primary
55
what is fluorosis?
fluorosis - symmetrical and diffuse, never occlusal surface of FPM responds well to microabrasion as marks are superficial
56
what are treatment options for fluorosis?
microabrasion, veneers, vital bleaching
57
what are generalised causes of hard tissue defects?
fluorosis MIH childhood illness
58
What are hereditary causes of hard tissue defects?
AI | DI
59
What are the 4 types of AI?
hypoplastic - minerals dont grown to correct length hypomineralised - crystals fail to grown in thickness and width hypomaturation - crystals fail to grown in width and thickness but normal length - incomplete mineralisation mixed with taurodontism
60
how would you diagnose AI?
family history, both dentitions, affects all teeth, tooth size, structure, colours, radiographs
61
What are clinical symptoms of AI?
``` AOB is common sensitivity caries poor aesthetics poor OH delayed eruption hard to bond to ```
62
How do you treat AI?
``` precentative therapy composite veneers/wash fissure sealants metal onlays SSC Ortho ```
63
What systsemic disorders can cause enamel defects?
``` EB incontinetia pigmentii downs prader willi prohpyria suberous sclerosis pseudohypoparathyroidism hurlers ```
64
what are anomalies of dentine?
DI dentine dysplasia odontodysplasia systemic disturbance
65
How many types of DI are there?
3 types - 1 = OI, 2, Brandywine
66
radiogrpahically what is seen on a pt with DI?
both dentitions affected, bulbous crowns, roots not splayed, obliterated pulps (harder to RCT and get abscesses), enamel loss
67
Clinically what is seen in pt with DI?
aesthetics problems, caries, spontaneous abscessed, poor prognosis teeth
68
What treatment is given for a pt with DI?
prevention, composite veneers, overdentures, removable pros, SSC
69
What can cause anomalies of cementum?
cleidocranial dysostosis, hypophosphatasia
70
what dental anomaly can hypophosphatasia cause
early loss of primary dentition and cementum abnormalities
71
How do you treat natal/neonatal teeth?
leave unless they are airway risk or causing problems with breastfeeding or ulcer on tongue
72
what are systemic causes for delayed eruption?
low birth weight, pre term, malnutrition, downs, hypothyroidism, hypopituitarism, cleidocranial dysostosis, gingival hyperplasia
73
What can cause premature exfoliation?
trauma, pulpotomy, hypophosphatasia, immunological deficiencies (cyclic neutropenia), chediak-higashi syndromw
74
what can cause delayed exfoliation?
``` infra-occlusion (1-9%) double primary hypodontia ectopic perms trauma ```
75
What is the procedure for a Cvek pulpotomy?
LA tooth isolation remove coronal 2-3mm of exposed pulp with high speed achieve hemostasis with cotton wool pledget and saline and pressure place nsCaOH, cover with RMGI, restore re-evaluate ever 3 months in first year if cant achieve haemostasis then move on to pulpotomy or pulpectomy
76
What are indications for pulpotomy?
asymtomatic tooth/transient pain carious/mechanical exposure of pulp restorable tooth
77
What is the procedure for a pulpotomy?
LA isolate tooth remove pulp chamber roof with non-end cutting bur remove coronal pulp with slow speed or excavator get haemostasis with saline and cotton wool apply MTA cover with RMGI place definitive restoration
78
What are advantages and disadvantages of microabrasion?
``` adv: easy conservative inexpensive fast no maintenance permanent ``` ``` disadv: removed enamel uses caustic chems hard to predict has to be done in house ```

Dentistry BDS4 (20 decks)

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