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3rd year dentistry > Paediatric dentistry > Flashcards

Paediatric dentistry Flashcards

1
Q

What is the recommended amount of toothpaste for brushing?

A

A smear for children under 3 years A pea sized amount for children 3 years and older

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2
Q

How often should fluoride varnish be applied?

A

Standard prevention = apply twice per year Advanced prevention = apply 1-2 additional times per year for children aged 2 years and older

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3
Q

How much fluoride does duraphat varnish contain?

A

22,600ppmF

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4
Q

Give four examples of how fluoride works

A

* slows down the development of decay by stopping demineralisation of dentine * makes enamel more resistant to acid attack from plaque bacteria *speeds up remineralisation * can stop bacterial metabolism (at high concentration) to produce less acid

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5
Q

What are the volumes of fluoride varnish?

A

For children 2-6 years 0.25ml For children over 6 with mixed dentition 0.4ml

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6
Q

Which medical conditions may influence treatment options for trauma?

A

Rheumatic fever, congenital heart disease, immunosuppression

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7
Q

In cases of trauma what should be observed in an e/o exam

A

laceration, haematomas, haemorrhage/CSF, subconjunctival haemorrhage, bony step deformities, mouth opening

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8
Q

In cases of trauma what should be observed in an i/o exam?

A

soft tissues, alveolar bone, occlusion, teeth, foreign bodies (check soft tissue damage), radiograph to check lacerations

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9
Q

what are the components of a trauma sticker?

A

sinus colour TTP mobility EPT ECl percussion note radiograph

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10
Q

how long should sensibility tests be carried out for following trauma?

A

at lease two years

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11
Q

what are the emergency aims and principles of treatment following trauma?

A

-aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by an adhesive dentine bandage -treat exposed pulp tissue -reduction and immobilisation of displaced teeth -tetanus prophylaxis? -antibiotics?

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12
Q

what are the permanent aims and principles of treatment following trauma?

A

-apexigenesis (normal continuation of growth) -apexification (inducing a calcified barrier at apex) -root filling +/- extrusion -gingival and alveolar collar modification if required -coronal restoration

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13
Q

what is the definition of dental anxiety?

A

occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences

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14
Q

what is the definition of dental fear?

A

a normal emotional response to objects or situations perceived as genuinely threatening

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15
Q

what is the definition of phobia?

A

a clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviour and interference with daily life

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16
Q

what are some physiological components of dental fear and anxiety?

A

breathlessness perspiration palpitations feeling of unease

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17
Q

what are some cognitive features of dental fear and anxiety?

A

interference in concentration hypervigilance inability to remember certain events while anxious imagining the worst that could happen

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18
Q

what are some behavioural reactions to dental fear and anxiety?

A

avoidance or disruptive behaviour to stop treatment being undertaken escape from the situation

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19
Q

what are some behaviour management techniques for a dentally anxious patient?

A

positive reinforcement tell, show, do acclimatisation systematic desensitisation voice control distraction role-modelling relaxation

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20
Q

list the order in which a treatment plan should be organised for a child patient

A

*first, any pain should be dealt with *simple exam, fluoride varnish, diet sheet, ask child to bring their own toothbrush next time. Take radiographs or explain for next time *brush teeth. Invite to sit on chair. Check diet, take radiographs. Polish and dry teeth (introduces slow speed and 3 in 1). Explain FS *FS or dressings. Introduce saliva ejector *remove caries with hand excavator if immediate temp required. Use slow speed, introduce topical, dam etc *restore upper teeth under LA *restore lower teeth under LA *pulp treatments and extractions

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21
Q

What is the optimal dose of fluoride in drinking water?

A

0.5 - 0.8ppm

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22
Q

Name two foods and/or drinks other than water that can have fluoride added to them

A

Fluoridated milk Fluoridated salt

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23
Q

List four methods of topical fluoride application for an eight year old child…

A
  • fluoride varnish 22,600 ppmF at least twice yearly - fluoride toothpaste 1,500 ppmF - fluoride tablets, 1mg per day - fluoride mouthrinse 250 ppmF
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24
Q

what are the four mechanisms by which topical fluoride helps prevent caries?

A
  • fluoride slows down the development of decay by stopping demineralisation of dentine - it makes the enamel more resistant to acid attack from plaque bacteria - it speeds up remineralisation and can stop bacterial metabolism at high concentrations to produce less acid - The fluoride that enters the tooth produces fluoroxyapetite which makes the tooth much stronger once remineralisation occurs
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25
Q

What daily dose of fluoride tablet would you give to a four year old child at high risk of caries who lives in an area with <0.3ppm F in the water supply?

A

0.5mg/day

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26
Q

What is the management for an overdose of fluoride at <5mg/kg?

A

Give calcium orally (milk) and observe for a few hours

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27
Q

What is the management for an overdose of fluoride at 5-10mg/kg?

A

Give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital

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28
Q

what is the management for an overdose of fluoride at >15mg/kg?

A

admit to hospital immediately, cardiac monitoring and life support, IV calcium gluconate

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29
Q

why do modern protocols advise against induction of vomiting in the case of a fluoride overdose?

A

The risk of aspiration is too great

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30
Q

Define child protection

A

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

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31
Q

Define children in need

A

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

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32
Q

Define safeguarding children

A

Measures taken to minimise the risks of harm to children. This includes; - protecting children from maltreatment - preventing impairment of childrens health or development - ensuring that children are growing up in a safe and caring environment

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33
Q

What are the three elements that must be present to define child abuse?

A
  • significant harm to child - carer has some responsibility for that harm - significant connection between carers responsibility for child and harm to child
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34
Q

What acts are in place to protect children?

A
  • National guidance for child protection in Scotland - Children and Young peoples act - getting it right for every child
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35
Q

In children, what can be the result of severe dental disease?

A
  • toothache - disturbed sleep - difficulty eating/change in food preferences - absence from school
36
Q

What can dental disease put a child at risk of?

A
  • teasing due to poor dental appearance - repeated antibiotics - repeated GA for extractions - severe infection
37
Q

What are the three stages in managing dental neglect in children?

A
  • preventive dental team management - preventive multi-agency management - child protection referral
38
Q

What are the toxic doses of fluoride in terms of toothpastes at 1,000ppmF and 2,800ppmF?

A

5mg per kg of body weight

39
Q

what is leukaemia?

A

Cancer of the white blood cells.

Normally white blood cells are made in the bone marrow and develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and although the cells continue to divide in the bone marrow, they don’t mature. These immature cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are immature, they cannot work properly, leading to an increased risk of infection.

40
Q

How is ALL (acute lymphoblastic leukaemia) treated, and what are the stages?

A

Chemotherapy is the main treatment for ALL. The aim of treatment is to destroy the leukaemia cells and enable the bone marrow to work normally again.

The stages of chemotherapy are; induction, consolidation and CNS treatment, maintenance treatment and bone marrow transplantation.

41
Q

What are the short and long term effects of chemotherapy in the oro-facial region?

A

Short term;

*cytotoxic due to direct effect on cells, mucositis and decreased salivary gland function

*haemorrhagic due to bone marrow suppression, defective heamostasis resulting in petichiae, gingival bleeding

*infetious due to mone marrow suppression, viral, bacterial and fungal infections

*neurological (with vincristine); trismus and jaw pain

Long term;

*tooth agenesis

*micordontia

*crown hypoplasia

*disturbed root formation

**effect will be on teeth mineralising DURING chemotherapy**

42
Q

What is a congenital heart defect and how are they commonly categorised?

A

This is a structural defect or condition affecting the heart which develops in utero, before baby is born.

They are usually categorised as ‘cyanotic’ or ‘non cyanotic’ cardiac defects

Cyanotic cardiac defects occur where deoxygenated blood bypasses the lungs and enters the systemic circulation, or a mixture of oxygenated and deoxygenated blood circulates.

Non-cyanotic defects usually occur when blood is shunted from the left side of the heart to the right, through a structural defect in the septum. These patients can often retain a near-normal oxygen saturation in their systemic circulation

43
Q

What is infective endocarditis?

A

An infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect

44
Q

Which patients are most at risk of developing infective endocarditis?

A

Adults and children with structural cardiac defects at risk of developing infective endocarditis;

*acquired valvular heart disease with stenosis or regugitation

*hypertrophic cardiomyopathy

*previous IE

*structural congenital heart disease, including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defect, fully repaired veentricular septal defect or fully repaired patent ductus arteriousus, and closure devices that are judged to be endothelialised

*valve replacement

45
Q

Regarding infective endocarditis, what are the NICE recommendations for dental treatment?

A

Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.

Chlorhexidine mouthwash should not be offered as prophylaxis against IF to people at risk of IE undergoing dental procedures

46
Q

What clinical features can present in a patient with infective endocarditis?

A

IE can present in two ways, acute and subacute. The acute presentation usually takes place over a few days, with the patient becoming rapidly more unwell. The subacute presentation occurs much more gradually, over weeks or a few months.

Clinical symptoms include;

*Temp above 38 degrees

*shortness of breath on exertion

*fatigue

*muscle and joint pains

*unexplained weight loss

*Flu like symptoms

*pale skin

*heart murmur

47
Q

How are root fractures classified?

A
  • Position of fracture; apical, middle or coronal third
  • Displacement of fragments; displaced or undisplaced
  • Stage of root development; mature (closed apex) or immature (open apex)
48
Q

What factors determine the prognosis of root fractured teeth?

A
  • Age of the child; open or closed apex
  • Degree of displacement
  • Associated injuries; eg crown fracture
  • Time between injury and treatment
  • Presence of infection
49
Q

What investigations should be carried out in the case of a root fracture?

A
  • Trauma sticker
  • Sensibility tests
  • Radiographs; from at least two angles (PA/occlusal)
50
Q

How should a root fracture be treated?

A
  • LA not usually required
  • Soft diet for 1 week and good OH
  • Apical or middle third root fracture if displaced; clean area with water/saline/chlorhexidine, reposition tooth with digital pressure, flexible splint for four weeks, review with radiographs 6-8 weeks, 6 months, 1 year and 5 years
  • Coronal third requires flexible splint for four months
51
Q

What are the potential healing outcomes for a root fracture?

A
  • Calcified tissue union across fracture line
  • Connective tissue
  • Calcified and connective tissue
  • Bone/osseous
52
Q

What are the potential non healing outcomes for a root fracture?

A

-Granualation tissue, usually associated with loss of vitality

53
Q

What treatment should be carried out in apical and middle third root fractures if a tooth becomes non vital?

A
  • Extirpate to fracture line
  • Dress NS CaOH then MTA/Biodentine just coronal to fracture line
  • Root fill with GP to fracture line
  • Apical fragment; remain in situ with own PDL, resorb. If infected; ABs/apicectomy
54
Q

What types of dental trauma require two weeks flexible splint?

A
  • Subluxation
  • Extrusion
  • Avulsion - open and closed apex <60mins EADT
55
Q

What types of dental trauma require four weeks flexible splint?

A
  • Luxation
  • Apical/middle third root fracture
  • Dento-alveolar fractures
  • Avulsion - closed apex >60 mins EADT
56
Q

What type of dental trauma requires four months flexible splint?

A

Coronal third root fracture

57
Q

What treatment should be carried out after an extrusion/lateral luxation injury?

A
  • Reposition under LA
  • Flexible splint; ectrusion 2 weeks, luxation 4 weeks
58
Q

What treatment should be carried out after an intrusion injury?

A
  • High risk of resorption; endo treatment usually necessary with closed apex. Interin CaOH dressing recommended
  • Review after two weeks
  • Slint removal after four weeks
  • Review 6-8 weeks, 6 months, 1 year then yearly for 5 years
59
Q

What endo treatment options should be followed following an intrusion injury?

A
  • Endo treatment can prevent the necrotic pulp from initiating infection related root resorption
  • Consider in all cases with completed root formation where the chance of pulp revascularization is unlikely
  • Endo therapy within 3-4 weeks post trauma
  • Temp CaOH recommended
60
Q

What factors influence successful healing following reimplatation of avulsed tooth?

A
  • Minimal damage to pulp and PDL
  • EADT
  • EAT
  • Type of storage medium
  • If the patient attends and the tooth has already been reimplanted;
  • Do not remove. Leave as is and splint
  • Radiograph to establish stage of root development
61
Q

What advice is given to the public regarding avulsion?

A
  • Hold by crown of tooth only
  • Rinse in cold running water
  • Replace in socket and get child to bite on tissue
  • If unable to replace, store in milk, saliva or normal saline
  • Seek immediate dental advice
62
Q

What adivce is given for all avulsed teeth with an EAT of under 60 minutes?

A
  • Replant tooth under LA
  • Flexible splint for two weeks
  • Consider ABs and check tetanus status
63
Q

What are the treatment options for a replanted avulsed tooth with an open apex?

A
  • If the decision is made not to root treat the tooth it must be closely monitored clinically and radiographically for signs of continued growth vs loss of vitality
  • Review at 2 weeks (splint removal), 4 weeks, 2 months, 3 months, then yearly
  • If the tooth is found to be non vital, extirpate pulp and refer to paeds specialist
64
Q

What is the recommended treatment for a replanted evulsed tooth with a closed apex?

A
  • After replantation and splinting, remove pulp as soon as possible, ideally day 0
  • Following extirpation and disinfection, place antibiotic-steriod paste as intra canal medicament, leave in place for two weeks
  • Remove splint after 2 weeks
  • At 2 weeks, clean and replace intracanal medicament with NS CaOH
  • Obturate with GP should take place within 4-6 weeks
  • Refer to paes specialist
65
Q

What are the treatment options for an avulsed tooth with an EAT of >60 minutes if the apex is closed?

A
  • Unlikely to get PDL healing
  • The aim is for bony healing so scrub the root clean of dead PDL cells
  • Extra-oral endo can be carried out prior to reimplantation
  • Replant tooth under LA
  • Flexible splint for 4 weeks
  • Consider ABs
  • If extra coronal antibiotics not carried out, extirpate at 7-10 days and use NS CaOH as initial intercanal medicament for four weeks prior to obturation
  • Review 3, 6, 12 months then yearly
66
Q

What are the treatment options for an avulsed tooth with an EAT of >60 minutes and an open apex

A
  • Unlikely to get PDL healing
  • Small chance that pulp may still revascularise
  • Do not root treat unless signs of loss of vitality on follow up
  • Replant tooth under LA
  • Flexible splint for four weeks
  • Consider ABs, check tetanus status
  • Monitor closely for signs of necrosis vs continued root development
67
Q

When should an avulsed tooth NOT be replanted?

A
  • Almost never
  • If very immature apex and EAT >90 mins, may still be best to replant
  • If the child is immunocompromised
  • If the child has other serious injuries and warrent preferential emergency treatment
  • Very immature lower incisors in a young child finding it difficult to cope
  • Even as a temp space maintainer, the right choise is usually to replant especially when guiding position of adjacent erupting tooth
68
Q

What treatment should be carried out following dentoalveolar fracture?

A
  • LA
  • Reposition, ‘apical lock’ may be present
  • Flexible splint for 4 weeks
  • ABs
  • Monitor clinically and radiographically (check root development, canal width and length, compare with neighbouring unaffected tooth)
  • Check for signs of inflammatory resorption
69
Q

What are the signs of external surface resorption?

A
  • Damage to PDL which subsequently heals
  • Non progressive eg maxillary canines on maxillary laterals, excessive orthodontic forces
70
Q

What are the signs of external inflammatory resorption?

A
  • Damage to PDL initially. Maintained and propagated by necrotic pulp tissue via dentinal tubules
  • Progressive
  • Diagnosis; root surfaces indistinct. Tramlines of root canal intact
  • Treatment; pulp extirpation. Mechanical and chemical irrigation, NS CaOH
  • after 6 weeks obturate
  • if progressive plan ahead for prosthetic replacement
71
Q

What are the signs of internal inflammation?

A
  • Initiated by non vital pulp
  • Progressive
  • Diagnosis; tramlines of root canal indistinct, root surfaces intact
  • Treatment; extirpation, mechanical and chemical irrigation, NS CaOH
72
Q

What is pulp canal obliteration?

A
  • Response of a vital pulp
  • Progressive hard tissue formation within pulp cavity
  • Gradual narrowing of pulp chamber and pulp canal, total or partial obliteration
  • Treatment; conservative (only 1% give rise to PAP)
73
Q

What is the recommended immediate home managment for ALL primary tooth injuries?

A
  • Soft diet for 10-14 days
  • Brush teeth with soft toothbrush after every meal
  • Topical chlorhexidine by parent twice daily for one week
  • After initial treatment, review 1, 3, 6 months with radiographs every 6 months if possible
  • Intrusion requires monthly review for 6 months then 6 monthly. Radiograph initially then 6 monthly
74
Q

What treatment should be carried out for a crown or root fracture of a primary tooth?

A
  • Extract coronal fragment
  • Don’t be overzealous to remove any root fragments that aren’t obvious. These should be left to resorb physiologically
75
Q

What treatment should be carried out following an alveolar bone fracture in a child in the primary dentition?

A
  • Reposition segment. Splint to adjacent teeth 3-4 weeks
  • Teeth may need to be extracted after alveolar stability has been achieved
  • This is only the case where a splint will be used in the management of primary trauma
76
Q

What treatment should be carried out following cuncussion or subluxation of a primary tooth?

A

Observation only

77
Q

What treatment should be carried out following lateral luxation of a primary tooth?

A
  • Radiograph
  • If there is no occlusal interference, allow to position spontaneously
  • If there is occlusal interference, extract
78
Q

Describe localisation of an intrusion injury

A

-Take a PA radiograph.

*If the apical tip appears shorter than that of the contralateral tooth then it has been displaced toward or through the buccal plate (this is the preferable direction - away from the developing tooth germ)

*If the apical tip is indistinct and the tooth appears elongated in comparison to the contralateral tooth then the apex is displaced toward the permanent tooth germ.

-Lateral premaxilla radiograph identifies the direction of displacement as it provides a lateral view

79
Q

What treatment should be carried out following an intrusion injury in the primary dentition?

A
  • If tooth has been displaced labially away from the tooth germ, leave to re-erupt
  • If no progress after 6 months extract
  • If displaced palatally, toward permanent tooth germ extract
80
Q

What treatment should be carried out following and extrusion injury in the primary dentition?

A

extract

81
Q

What treatment should be carried out following avulsion of a primary tooth?

A
  • Radiograph to confirm avulsion
  • NTR, do not replant!
82
Q

What treatment should be carried out following trauma to a primary tooth if there is delayed exfoliation?

A

extract or permanent successor will erupt ectopically. Primary tooth may not resorb normally

83
Q

Following trauma in the primary dentition, what are some of the possible long term effects on the permanent dentition?

A
  • Enamel defects
  • Abnormal tooth/root morphology
  • Delayed eruption
  • Ectopic tooth position
  • Arrest in tooth formation
  • Complete failure of tooth to form
  • Odontome formation
84
Q

Describe hypomineralisation and some treatment options

A
  • White/yellow spots.
  • normal thickness of enamel.
  • Treatment options include; none, mask with composite, localised removal and restore with composite, external bleaching
85
Q

Describe hypoplasia and some treatment options

A
  • Yellow/brown areas
  • Less than normal enamel thickness
  • Treatment options include; restore with composite, porcelain veneer (when gingival level stabilised, at least 16yo)
86
Q

What are treatment options for crown dilaceration?

A

Surgical exposure, ortho realignment, improve appearance

87
Q
A

3rd year dentistry (16 decks)

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