Paediatric Dentistry

Question 1

Caries

1. 7 CRA components
2. 8 CRP components
3. Paeds treatment plan order
4. 5 types of caries
5. 4 detection methods
6. 6 treatment options

Answer 1

1. Clinical evidence, dietary evidence, MH, SH, saliva, plaque control, F use
2. Radiographs, dietary advice, TBI, TP F, FV, FS, F supplements, SF meds
3. OHI, FV, FS, restoration no LA (upper before lower), restorations with LA (upper before lower), pulp treatments, extractions
4. Arrested, rampant, early childhood/nursing bottle, secondary/recurrent, interproximal, pit and fissures, smooth surface
5. Visual (dry tooth, direct light), radiographs, orthodontic separators, FOTI

6. Complete removal and restoration
Partial removal and restoration/seal
No removal and Hall crown
Prevention only
Make self-cleansing
FS only

Question 2

Early X6

1. Best time
2. 2 pros
3. 2 cons

Answer 2

1. Beginning of calcification of bifurcation of L7, 5s and 8s all present, class I incisors, mild buccal segment crowding
2. Caries-free dentition, 7s can erupt mesially into space
3. Loss of permanent teeth, future anxiety/fear to treatment, 5s may drift distally

Question 3

Pulp treatment

1. 2 indications
2. 2 contraindications
3. Function of pulpotomy, pulpectomy
4. 4 radiographic signs of failure

Answer 3

1. MH excludes extraction, good cooperation and motivation, good attendance
2. Poor attendance, poor cooperation and motivation
3. Pulpotomy - remove disease/infection, control bleeding and retain radicular pulp
   Pulpectomy - remove/control infection by removing all (radicular) pulp, cleaning and obturating
4. Furcation bone loss, internal inflammatory resorption, external inflammatory resorption, PAP

Question 4

Behaviour management

1. 4 reasons
2. 4 features
3. 4 management techniques

Answer 4

1. Previous experience, parents opinions/experiences, new/unknown environment, peer stories
2. SoB, increased HR, sweating, palpitations, fidgeting, hypervigilance, aggression
3. Distraction, tell-show-do, acclimatisation, desensitisation, role modelling, positive reinforcement, relaxation/hypnosis/CBT

Question 5

Permanent trauma

1. 4 ways to track progression
2. Aim of emergency treatment
3. Management of E#, ED#, EDP#
4. Displaced root # (3 types of healing, 2 signs of non-healing)
5. Management of concussion, subluxation, extrusion, intrusion
6. Management of avulsion (and first aid techniques, 4 storage mediums, ideal EAT and EADT)
7. 3 replant contraindications
8. 4 types of post-replant resorption
9. Management of dento-alveolar #
10. How often to radiograph/follow-up

Answer 5

1. Colour, TTP, radiographs, EC (ethyl chloride thermal test), EPT (electric pulp test), mobility, sinus, displacement, percussion note
2. Retain vitality of tooth and reduce/immobilise displaced/mobile teeth
3. E# - bond fragment/grind sharp edges
   ED# - bond fragment/composite bandage and restore
   EDP# - direct pulp cap (<1mm, <24hrs), pulpotomy (>1mm, >24hrs - partial initially - if fail to stop bleeding onto full coronal), pulpectomy (if long exposure/necrotic/still bleeding after full coronal pulpotomy)
4. LA, digital reposition, splint (4 week flexible splint if apical/middle third #; 4 month flexible splint of coronal third #)
   Healing - calcified tissue union across # line, CT, both
   Non-healing - granulation tissue, usually associated with loss of vitality
5. Concussion - observe
   Subluxation - 2 week flexible splint
   Extrusion - reposition, 2 week flexible splint (if open apex) or 4 week flexible splint (if closed apex)
   Intrusion - open apex - <7mm leave, >7mm ortho/surgical realignment. Closed apex - <3mm leave, 3-7mm ortho, >7mm surgical. 4 week flexible splint
6. Replant. 4 week flexible splint (unless open apex/EADT <60mins, then 2 week flexible splint)
   Hold by crown, wash obvious debris off under cold running water, stick back in socket, bite on tissue, get to dentist ASAP
   Saliva, milk, physiological saline, blood
   EAT <60mins, EADT <30mins
7. Other more serious injuries that require investigation/treatment, immunocompromised, very immature lower incisors, very immature tooth with EAT >90mins
8. Internal inflammatory, external inflammatory, external surface, replacement ankylosis
9. Reposition, ensure occlusion as before (selective grinding if required), 4 week flexible splint
10. 2/4weeks post-treatment, 6 months, every year for 5 years

Question 6

Primary trauma

1. When urgent treatment
2. Management of E#, ED#, EDP#, CR#
3. Management of dento-alveolar #
4. Management of concussion, subluxation, lateral luxation, intrusion, extrusion, avulsion
5. 3 effects of trauma on primary dentition
6. 4 LT effects of trauma on permanent dentition

Answer 6

1. If traumatic occlusion
2. E# - grind
   ED# - compomer/composite bandage
   EDP# - pulp therapy or extract
   CR# - extract coronal fragment and obvious/visible apical fragment. If not obvious, leave to resorb
3. Reposition, 4 week flexible splint
4. Concussion - observe
   Subluxation - observe
   Lateral luxation - if no occlusal interference - leave; if occlusal interference/traumatic occlusion - extract
   Intrusion - if towards permanent tooth germ - extract (use parallax to tell)
   Extrusion - extract
   Avulsion - do not replant
5. Discolouration, infection, delayed exfoliation - early discolouration = usually will stay vital. Delayed ‘bruising’ - usually sign of loss of vitality
6. Delayed eruption, ectopic position, arrest in development/formation, failure to form, odontome formation, enamel defects, anatomy/morphology abnormalities

Question 7

Perio

1. Define biological width
2. What is the width
3. Simplified BPE
4. When MW and what F

Answer 7

1. Dimension of soft tissue attached to tooth coronal to alveolar crest
2. 2mm
3. 0-2 (bleeding, calculus). 16, 11, 26, 36, 31, 46. For 7-11yrs
4. > 7yrs, can spit. 225ppmF

Question 8

GA

1. Define
2. 2 types
3. 4 stages
4. 2 indications
5. 2 risks/contraindications

Answer 8

1. Technique which causes loss of consciousness and/or abolition of protective reflexes in specific situations associated with medical/surgical interventions by depressing specific areas of the brain
2. IV, inhalation sedation
3. Induction, excitement, surgical anaesthesia, respiratory paralysis/overdose
4. For pre-cooperative/anxious, if child required to be still
5. GA risks - death, coma, etc., future anxiety towards dental treatment

Question 9

Child protection

1. Define
2. Define child abuse/neglect
3. Define dental neglect and wilful neglect
4. 3 features of dental team management
5. 4 things expected of dental team
6. 4 features from index of suspicion

Answer 9

1. Activity undertaken to protect specific child who are at risk of/from suffering harm
2. Actions/inactions of those entrusted with the care of children do/fail to do which damages the child’s prospect of a safe and healthy development into adulthood
3. Dental neglect - the persistent failure of those responsible for the care of the child to maintain an appropriate level of oral health. Obvious disease, care offered, not taken up
   Wilful neglect - when a problem is pointed out but not corrected/acted upon
4. Preventive dental team management, preventive multi-agency management, child protection referral
5. Observe, record, communicate (raise concerns), refer for assessment
6. Delay in seeking treatment, story changing/vague/doesn’t match presentation of injuries, unusual pattern of injuries (bilateral, soft tissues, etc.), unusual child/carer interaction, concerning carer behaviour (pre-occupied, detached, concerning)