PAEDIATRICS

Question 1

What is definition of ECC and Severe ECC?

Answer 1

Early childhood caries (ECC): Dmfs ≥ 1 in primary tooth of child 71 months (~6yrs) or younger

Severe ECC
- Child < 3 years → Any sign of smooth-surface caries
- Child 3-5 years
Dmfs ≥ 1 in primary maxillary anterior tooth OR
3 years = Dmfs ≥ 4 OR
4 years = Dmfs ≥ 5 OR
5 years = Dmfs ≥ 6
Risk factors:

Question 2

List risk factors for ECC

Answer 2

o Patient
 Pathogenic organisms
• Mutans streptococci, lactobacilli
• Early inoculation from parents/siblings = Higher risk of ECC
 Host/tooth factors
• Immature enamel of newly erupted teeth
• Enamel hypoplasia
• Salivary quality and quantity
 Diet
• Frequent nighttime bottle feeding with milk
• Breastfeeding
o Protective against caries in infancy
o >12 months at nighttime increases risk of ECC due to modulation by other factors)
• Sippy cup with sugar drinks
• Frequent sugary snacks between meals
o Family
 Caregiver experience
 SES
 Health literacy
 Views towards medical care
o Community level
 Dental services
 Food environment

Question 3

When are silver compounds indicated and contraindicated?

Answer 3

• Indicated: Arrest caries as interim treatment for patients who cannot receive traditional restorative treatment – pre-cooperative, special needs, delayed treatment)
• Contraindications:
o Silver allergy
o Symptomatic tooth or pulpally involved (1mm of dentine between cavitation and pulp)
o Presence of stomatitis or ulcerative gingival conditions

Question 4

What are contraindications for Hall Technique for SCC?

Answer 4

 Contraindications:
• Caries >1/3 dentine
• Symptomatic teeth
• Mobile teeth

Question 5

What are the steps in a pulpotomy?

Answer 5

1. LA and rubber dam
2. Eliminate caries and pulp chamber roof with HS drill
3. Amputate coronal pulp and radicular tags with SS round bur and spoon excavator
4. Achieve haemostasis – irrigation and pressure with cotton pellet
5. Apply therapeutic agent (medicament)
   Ferric sulfate → Burnish stumps with microbrush 15s > Rinse > Dry
   MTA/Biodentine → Apply paste/putty over pulp stumps
6. Apply IRM base
7. Apply GIC core
8. Cover with SSC

Question 6

Which is the most correct pulp treatment in a carious exposure of primary tooth?
(A) Indirect pulp cap
(B) Direct pulp cap
(C) Pulpotomy
(D) Pulpectomy

Answer 6

C)

B) is an option but success rate is lower and especially in carious exposure (more likely to use in mechanical iatrogenic exposure)

Question 7

Reasons for early tooth loss (primary teeth)

Answer 7

• Caries
• Trauma
• Ectopic eruption of adjacent teeth
• Infection
• Dental crowding

Question 8

What considerations prior to space maintainer being placed?

Answer 8

• Presence of permanent successor
• Years until eruption of permanent successor
• Rest of dentition/occlusion - if need ortho in future, do all tx at once
• Patient cooperation and OH
• Antagonist teeth - overeruption of opposing tooth can act as a space maintainer