PAEDIATRICS Flashcards
What is the gold standard for moisture control? Why is it not often used in pads?
Dental dam
Due to pt compliance, may be distressing for pt, spacing of dentition makes it harder
If you were to use dental dam on a paediatric patient, what would be a better tolerated technique of putting it on?
Split dam technqiue
What is a fissure sealant?
Fissure sealant is a protective coating that is placed onto teeth that protects the tooth from decay
Where would you position yourself for fissure sealants?
LR - behind
LL - infront
UR - behind
UL - behind
What can be used to achieve adequate moisture control for fissure sealants?
Cotton wool rolls
Dry guard
Saliva Ejector
Suction
Why do we need good moisture control for fissure sealants?
The resin used to F/S is moisture dependant and for good bond everything needs to be dry or else F/S will fail - can end up with caries trapping under sealant
Where do you place F/S on upper 6s? Lower 6s?
Upper 6 - occlusal surface, palatal fissure, carabelli
Lower 6 - occlusal surface, buccal fissure,
When might you use GIC over resin F/S?
If child is non compliant and moisture control will prove difficult - poor cooperation
How do we apply F/S
- Clean tooth surface and remove and debris and plaque
- Achieve moisture control - cotton wool rolls
- etch - 20/30 seconds 37% p acid then wash off
- dry surface, replace cotton wool
- place resin
- cure
- inspect
How do we apply GIC F/S?
Place GIC on forefinger, vaseline on middle finger and onto tooth
How to assess F/S?
check sealant is firmly adhered by trying to dislodge
check there isnt any airblows
check no material interproxima
When do we place fissure sealants?
children with extensive decay in primary molars should have FPM sealed quickly
poor background
special needs children
if FPM develops decay
In high risk kids what teeth can be sealed?
First permanent molars
Second permanent molars
All premolars
The palatal pit on the upper lateral incisors
What teeth do children have?
A - central incisor B - lateral incisor C - canine D - primary first molar E - primary second molar
What teeth erupt first? upper or lowers?
Lowers erupt first EXCEPT LATERIALS
What is sequence of eruption in baby teeth?
ABDCE
When do As erupt?
6-8 months
When do Bs erupt?
9-10 months
When do Cs erupt?
16-17 months
When do Ds erupt?
13-14 months
When do Es erupt?
Around 2 years
When is primary dentition complete by?
2.5-3 years
How long does it take the contralateral teeth to appear when one tooth has erupted
contra lateral teeth should have erupted within 3 months of the other
What erupts first in permanent teeth - lower or upper
Lower teeth tend to erupt before upper teeth with the exception of the second premolars
What is the sequence of eruption in upper permanent teeth
6, 1, 2, 4, 5, 3, 7, 8
FPM, back except canine after 5
What age do upper centrals erupt?
6-7 years old
What age do upper laterals erupt?
7-8 years old
What age do upper canines erupt?
11 years old (palpate at 9)
What age do upper 1st pre molars erupt?
10-11
When do upper second pre molars erupt?
10-11
When do second molars erupt?
12
When do 8s erupt?
18+
When do lower centrals erupt?
6
When do lower laterals erupt?
7
When do lower canines erupt?
9
When do lower first pre molars erupt?
10
When do lower second pre molars erupt?
10
When do lower 6s erupt?
6
When do lower 7s erupt?
12
When do lower 8s erupt?
18+
When is crown formation of teeth complete?
Eruption minus 3 years (ie lower 6 = 3)
When does crown calficiation start?
eruption - 6
When does root formation complete?
Eruption + 3
What are the 7 main risk factors for caries?
Diet Fluoride use Plaque control MH - medications with sugar Saliva SH Clinical evidence
What can clinical evidence be split into?
Caries experience
Otho
prosthetics
What do we look at in MH to determine risk?
medically compromised
physical disability
xerostomia
long term poly pharmacy
What would put a pt in higher caries risk via clinical evidence?
A dmft/DMFT equal to/greater than5 is high risk
Caries in 6’s at 6 years is high risk
3 year caries increment being equal to/higher than 3 is high risk
What are the 8 preventative elements of caries risk assessment?
Radiographs OHI Fluoride toothpaste Fluoride varnish Fissure sealant Sugar free meds Diet advice - diet diary Fluoride supplementation
How often should low risk pts get radiographs? kids?
12-18 months BWs
How often should high risk kids get BWs?
every 6 months BWs
What is the concentration of fluoride varnish?
22,600ppmF
What is a contraindication to F varnish?
Allergy to colophony
What is conc of fluoride mouthwash?
225ppmF
What are the cones of f tablets?
1mg
What is SDF and its conc?
Sodium diamine fluoride - 44,800
Functions of fluoride?
Incorporates with hydroxyapatite to form fluoroapatite which is more caries resistance
What toothpaste do we give to 3 and under?
1000ppm
but can give up to 1450ppmF
SMEAR
What toothpaste do we use for >3 years old?
pea size
1450ppmF
Who can be prescribed 2800ppmF toothpaste?
10-16
over 16 can have 5000ppmF
Who can be prescribed 5000ppmF toothpaste?
> 16 yr olds
What is fluoride varnish?
This is a high strength fluoride solution that is applied to the teeth to make them stronger and more resistance to any decay - it is applied 2x year in school and for high risk kids can be applied up to 4x year (school and dentist) - tastes of banana or bubblegum
When can children have mouthwash?
After 6 if they can spit it out
What is SDF?
SDF liquid contains silver and fluoride which work together to stop decay progressing further. It is a clear liquid, that has a temporary metallic taste while it is being painted on to teeth.
If your child is suffering from dental decay, it can progress rapidly, especially in baby teeth which have thinner enamel than adult teeth. By applying SDF liquid, your dentist can stop decay progressing which reduces the risk of toothache or infection. SDF liquid combined with improved oral hygiene and a change in diet can save teeth
How is SDF applied?
o protect your child’s lips and gums, your dentist will first apply petroleum jelly (or an alternative) and also place cotton wool next to their teeth. Their teeth will then be dried.
The SDF liquid is painted on to the teeth for 1-3 minutes. Following this the teeth are dried a second time. Sometimes, the dentist may then place a filling over the top.
This is all done in one appointment. A second appointment may be made to come back 2-4 weeks later to check the teeth and apply more SDF liquid if needed.
SDF liquid is usually reapplied every 6 months.
clinical procedure for SDF?
- dry tooth and clean tooth
- apply vaseline to gums and lips to protect
- use micro brush and apply SDF
Advantages of SDF
It is a simple procedure that reduces sensitivity and slows down or stops tooth decay. In many instances SDF is more effective than fluoride varnish.
It can buy time for children who cannot currently manage dental treatment by stopping the decay getting worse until they can have further dental treatmen
Disadvantages of SDF?
It permanently discolours the decayed area of teeth black. Healthy parts of the tooth do not discolour.
It can temporarily stain the skin, lips, gums and cheeks brown or white for 1-3 weeks, this will then disappear.
It can also discolour tooth coloured fillings, polishing these fillings can help remove this stain but it may stay visible at the join between the tooth and the filling.
In the unlikely event of SDF being accidentally spilled on clothes, it can leave a stain that does not come out.
Alternatives to SDF?
Keeping the tooth under review, but it is likely the decay will get worse
Placing fluoride varnish Filling the tooth
Placing a silver cap/crown Removing the tooth
