Paediatric Dentistry - Operative Flashcards
how would you stop an enamel caries lesions progressing and promote remineralisation s
show parent the lesion and explain treatment and why it is successful
demonstrate effective brushing of the lesion
give dietary advice
apply fluoride varnish to the lesion 4x yearly
keep record of site and extent of lesion
when would you review an enamel caries lesion to see if arrested or not
if after 3 months the active lesions are not arrested consider alternative strategy
when is the hall technique useful
a primary tooth with advanced lesions in occlusal or proximal surface
when is the hall crown technique only suitable
when there is clear unaffected dentine between the lesion and the pulp
list the steps in the hall technique
ensure child is sitting upright
assess whether separators are required - requires 2nd visit 3-5 days later to remove them and fit the crown
ensure airway is protected (gauze)
select correct size of PMC
ensure PMC is well filled with GIC
seat PMC over the tooth - get child to bite down
ask child to open - check crown is seated evenly
remove excess cement and clear contacts with floss
avoid excess cement reaching tongue
what is Icon technique
the tooth is isolated, etched using ethanol to dry out the pores that have been created and then unfilled, low viscosity resin is flowed into pores blocking them
what is ART and what is it suitable for
atraumatic restorative technique - using hand instruments to prepare cavity and restored using GIC
suitable for primary teeth with single surface lesions
what is the stepwise caries removal technique
place LA and gain access
remove all caries on cavity walls
over the pulp - selectively remove caries as to not expose the pulp
use temp restoration - one thats different colour
wait 6-12 months and place LA and remove temp restorations
remove any remaining carious tissue until hard dentine reached
place permanent restoration
how to make a lesion cleansable
no LA unless subgingival
using high speed or hand instruments remove undermined enamel to make lesion accessible to toothbrushing
resulting cavity depends on extent of the lesion
what is the technique for conventional crown placement in primary teeth
give LA
protect airway
remove caries - if pulpal exposure is a risk place indirect pulp cap
occlusal reduction
cut mesial and distal slices
select correct size of crown
cement in place with GIC and clear contacts
what are contraindications of pulp therapy in deciduous teeth
teeth that are close to exfoliation
children who are pre-cooperative or immunocompromised
what is the technique for a pulpotomy
give LA
cut access cavity making sure entire roof of pulp chamber is clear and consider rubber dam
remove contents of pulp chamber with slowspeed or hand excavator
irrigate pulp chamber with saline
identify entrances to canals
if still bleeding place cotton wool dampened in ferric sulphate (deciduous only)
if bleeding cannot be controlled progress to pulpectomy
remove cotton wool and place MTA or ZOE cement
fill cavity with ZOE cement and then place PMC
when is balancing extractions indicated in primary dentition
one C is to be extracted
one C has exfoliated prematurely
centre line shift developing after extracting one D
when are balancing extractions not usually indicated in primary dentition
loss of primary incisors
loss of Ds unless centre line shift develops
loss of Es
at what age is extraction of 6s most favourable
8-10 years
what factors influence optimal outcomes of extracting first permanent molars
bifurcation of 7s is seen to be forming on OPT
second premolars and third molars are all on OPT
mild buccal segment crowding
class I incisor relationship present
name the order of severity of MIH from best outcome to worst outcome
white/cream
yellow
brown
what three time periods should you ask a parent with a child with MIH about
prenatal - pre-eclampsia or gesgational diabetes
perinatal - birth trauma/ anoxia
post natal - prolonged breast feeding, illness in first 2 years
treatment options for MIH molars
composite/ GIC restorations
stainless steel crowns
adhesively retained copings
timed extractions (correct time for XLA of 6s)
what is the treatment options for MIH incisors
micro-abrasion
resin infiltration
external bleaching
localised composite placement
what are the pumice microabrasion technique steps
HCl 18% used
pt wears glasses and bib
clean teeth with pumice and water
petroleum jelly placed on gums and lips
rubber dam placed
sodium bicarbonate guard placed
HCl pumice slurry in prophy cup
max 10 x 5 second applications
wash directly into aspirator after each 5 second application
apply fluoride varnish (NOT DURAPHAT)
polish with finest soft flex discs
what should patients be warned about after microabrasion
teeth are dehydrated - warn pt to avoid highly coloured food and drinks for 24 hours
when should microabrasion be reviewed
4-6 weeks and take post op photographs
what is the rules for bleaching teeth in children
products containing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for purpose of treating or preventing disease
what are the options for bleaching teeth
vital bleaching (external)
- chairside
- night guard
non-vital (internal)
- inside out technique
- walking bleach technique
what is used with nightguard vital bleaching
10% carbamide peroxide gel
cut windows in customised tray over any teeth you do not want to bleach
how much 10% carbamide peroxide gel should be applied per tooth for at home whitening trays
half a piece of popcorn kernel per tooth
what is the walking bleaching technique
root filling removed to below gingival margin
bleaching agent placed on cotton wool and put in access cavity
dry cotton wool placed over the top
sealed in with GIC
what is the inside out method for internal bleaching
access cavity left open on the tooth
custom made mouthguard
patient applies bleaching agent to back of tooth and tray
worn all the time except eating and cleaning
gel changed every 2 hours apart from night
eventually restore with white GP and composite resin
