PAEDIATRIC SCENARIOS OSCE

Question 1

You get a phone call to say that a seven year old has had an accident and their 11 has fallen out, they have the tooth. What advice do you give the caller over the phone?

Answer 1

• don’t touch the root of tooth when picking it up
• remove any debris by running tooth under cold water for 10s
• store in milk or saliva if possible (if not use water)
• reinsert tooth if possible
• stop bleeding with gauze
• get appointment ASAP

Question 2

You get a phone call to say that a seven year old has had an accident and their 11 has fallen out, they have the tooth. How soon does tooth need to be re-inserted to (probably) avoid root therapy?

Answer 2

less than 45 minutes from avulsion (if the apex is open, which it should be due to age of patient)

Question 3

You get a phone call to say that a seven year old has had an accident and their 11 has fallen out, they have the tooth and arrive at your clinic in time. What treatment option do you suggest? Explain this?

Answer 3

Placing a flexible splint would be best treatment.

• check no fragments remain in socket
• reinsert tooth
• cut orthodontic wire and manipulat so that the shape ensures it will be passive to each tooth
• etch tooth that has been reimplanted, as well as adjacent teeth at either side of reimplated tooth
• place composite onto these teeth and sink wire into composite, light cure and smooth off

Question 4

what is the difference between a flexible and ridgid splint?

Answer 4

FLEXIBLE = 1 tooth either side of reimplanted tooth
RIDGID = 2 teeth either side of reimplanted tooth

Question 5

You get a phone call to say that a seven year old has had an accident and their 11 has fallen out, they have the tooth but a flexible splint is not suitable for this specific patient. What other options are there? What is bad about this?

Answer 5

Vaccum splint

- terrible for oral hygiene

Question 6

When would you perform the Hall Technique on a patient?

Answer 6

On primary molars that are carious but do NOT involve the pulp (given there is sufficient tooth matter left available to crown)

Question 7

what equipment is neccessary to perform the Hall Technique on a patient?

Answer 7

• mirror
• probe
• excavator
• flat plastic (to load crown with cement & clear from margins)
• band forming pliers (to shape and adjust crown)
• separators (to open contact point)

Question 8

A young patient enters your surgery with a carious 85. After examining the patient you conclude that there is no pulpal involvement, what would be the best treatment option?

Answer 8

Hall Technique

Question 9

A young patient enters your surgery with a carious 85 and you conclude that the Hall Technique is the best option of treatment. How do you choose the correct crown size?

Answer 9

Best guess & try in (should be some resistance for crown to go onto tooth but not too much)

Question 10

A young patient enters your surgery with a carious 85 and you conclude that the Hall Technique is the best option of treatment. Explain the steps of this treatment.

Answer 10

• place separators a few days prior to treatment to open contacts
• remove separators and prepare tooth
• choose & dry crown and mix cement
• load crown with cement, place over dry tooth surface and seat crown (partially)
• get patient to bite down to fully seat crown
• clear any excess cement and floss contact
• get patient to continue biting down for 2 mins if possible

Question 11

Why is the Hall Technique so ideal for young patients?

Answer 11

• quick and efficient for children that wont sit long
• no LA required
• no tooth prep/caries removal
• high success rate

Question 12

how is GI cement usually mixed?

Answer 12

3 scoops powder to 3 drops water, mix with spatula

Question 13

How does conventional crown prep differ to the Hall Technique?

Answer 13

• clear contacts with tapered diamond separating burr to achieve 15 degree angle and knife edge finish
• reduce occlusal height by approx. 1-2mm (ensure rounded angles)
• select crown and finish as per Hall Technique

Question 14

A child enters your surgery with a pulp-involved carious legion on their 74. This particular child is very scared of the dentist and will not co-operate well with you, what is the best treatment option for this pateint?

Answer 14

Extraction of tooth

• quicker than root treatment
• prevention of worsening pain caused by infection

Question 15

A child enters your surgery with a pulp-involved carious legion on their 85. This particular child has a known cardiac defect. What treatment option would be best for this patient and why?

Answer 15

Extraction of tooth.

- important to remove and infection/bacteria to prevent conditions such as infective endocarditis

Question 16

A 7 year old child enters your surgery with a pulp-involved carious legion on their 74. This particular child does not appear to have any problems with sitting in the dental chair for a prolonged period of time, what treatment option would be best?

Answer 16

Pulp treatment would be best option.

- prevents closing of space leading to crowded permanent teeth

Question 17

A 9.5 year old child enters your surgery with a pulp-involved carious legion on their 74. This particular child does not appear to have any problems with sitting in the dental chair for a prolonged period of time, what treatment option would be best?

Answer 17

Extraction as tooth will be close to exfoliation anyway