Paediatrics Flashcards
What are treatment options for discoloured teeth?
Microabrasion, bleaching, resin infiltration, local comp rest., veneers - direct and indirect, do nothing
what should be recorded in the pre-op sheet for discoloured teeth
clinical photos, sensibility testing, shade, diagram of defect, radiographs, patient assessment
what is micro abrasion
the removal of the surface layer of opaque enamel
what are some advantages of micro abrasion
removes brown/yellow stain, effective, conservative, inexpensive, can be used before bleaching, easily performed, permanent results
what are some disadvantages of micro abrasion
removal of enamel - destructive, senstivity, may get more staining
need protective wear for patient, dentist and nurse
HCl is caustic
results are unpredictable - may appear more yellow
must be done by dentist
what is the clinical technique for micro abrasion
protect soft tissues with dental dam
place sodium bicarbonate guard behind teeth
slurry of HCl for 5 seconds on tooth - can repeat 10 times but wash off and review colour and shape after each one
once happy - place fluoride varnish - clinpro is more white in colour
polish with sandpaper - the finer/smoother prisms look less stained
polish with toothpaste
how much enamel is lost with micro abrasion and compare this to enamel etching
100 microns are lost with micro abrasion - 10 are lost with etching so losing 10x the amount
when and why must micro abrasion be reviewed
review 4-6 weeks after, advise patient not to drink or eat highly coloured foods as teeth are dehydrated and will stain. Review as can offer a second cycle but only if some improvement has been seen with first lot, if not the second wont work either. Can only do 2 rounds. Must take pre and post op photographs
what bleaching techniques are available for a vital tooth
external bleaching only. Chairside power bleaching or at home night guard bleaching
what bleaching techniques are available for a non-vital tooth
internal bleaching - inside outside technique, walking bleach technique
why is chairside bleaching not normally recommended
it uses rapidly reactive, unstable hydrogen peroxide - damage to soft tissue and eyes - causes sensitvity and more expensive
what instructions are given to patients for night guard at home bleaching
brush teeth with toothpaste
place gel in mouth guard
put in over teeth and seat - remove excess from gums
rinse gently and dont swallow
wear over night or for at least 2 hours
brush teeth and rinse with cold water
sensitive toothpaste may be required
what are advantages of non-vital tooth bleaching
conservative, good results, gingival level of adolescents is unstable for fixed restoration so this is good in mean time, simple, no irritation to gingiva
what are important factors when deciding if a non-vital tooth is appropriate for internal bleaching
good root filling - to length and condensed, no pathology
anterior teeth without large restorations
not amalgam discolouration
not fluorosis or tetracycline discolouration
what is the clinical technique of walking bleach - non vital internal bleaching
access cavity, remove GP to ECJ, place bleaching agent on cotton wool ball and place in access, place dry cotton wool ball on top and then GI over this. 2 weeks later, remove GI and replace balls - can do this up 6-10 times. Regression of 50% at 2-6 years
what is the clinical technique of inside out bleaching
access cavity, custom mouthguard made. Patient puts bleaching agent in back of tooth and mouth guard. replaces the gel every 2 hours except through the night. wear guard all the time except when eating and cleaning. 10% carbamide peroxide used
what are potential complications with non vital bleaching
over bleaching, brittleness, external cervical resorption, failure to bleach, spilling of bleaching agents
how can external cervical resorption be prevented
layer of GI cement above GP cone - but can prevent adequate bleaching
non setting calcium hydroxide placed for 2 weeks before final restoration - neutralises any acidity in PL
what is resin infiltration
infiltration of enamel lesions with low-viscosity resin and cured. surface layer is eroded with etch, lesion becomes desicated and gives access - resin placed and can infiltrate through. causes lesions to lose discolouration and appear similar to sound enamel
what are the parts to caries risk assessment
clinical evidence, diet, plaque control, fluoride exposure, medical history, social history, saliva
what are the parts to preventions
fluoride varnish, fluoride toothpaste, fluoride supplement, fissure sealants, radiographs, diet advice, change medication, toothbrushing advice
what guidelines are used for caries risk and prevention
sign 138, SDCEP
what toothbrushing advice should be given
brush twice a day, including once before bed, fluoride toothpaste, spit dont rinse, should be supervised
what is the indication for fissure sealants
for all first permanent molars of all children regardless of risk factor
in high risk children - deciduous molars caries free, and premolars
what are the steps for fissure sealants
patient and tooth selection
tooth isolation - rubber dam, cotton wool
clean tooth - pumice and slurry
etch - 35% phosphoric acid and dry
apply resin sealant
light cure
check retention, remove flash, check for air bubbles
what materials are required for fissure sealants
rubber dam or cotton wool roll, dry guard, saliva ejector
35% etch
pumice and slow speed
resin
light cure
probe, excavator, microbrush, mirror
how can hard tissue defects be divided and give examples
localised - trauma or abscess of primary
generalised - environmental or hereditary
environmental - fluorosis or MIH
hereditary - ameleogenesis imperfecta
what is the difference hypomineralisation and hypoplastic
2 phases of enamel development - secretory and mineralisation
secretory lays down jelly like shape of tooth, if there is a problem with this - the tooth will be hypoplastic - insufficient bulk/thickness of enamel
mineralisation - increasing mineral content and thus hardness - if there is a problem with this, the tooth will be hypomineralised
what is AI and how is it diagnosed
AI is an inherited condition in which there is a malfunction with enamel development - either secretory or mineralisation. diagnosis - family history, appearance (affects all teeth, tooth size, colour, shape, yellow/brown or white), radiographic - no difference between enamel and dentine
what medical conditions have an enamel defect - not ameleogenesis imperfecta
epidermolysis bullosa, prader-willi, downs
how to tell the difference between fluorosis and MIH
MIH - only molars and incisors
fluoride - all teeth
ask if they lived in fluorodated area
what questions are asked to get diagnosis of MIH
pre-natal - problems in last trimester of pregnancy - pre-eclampsia, gestational diabetes, infections
natal - premature birth, time special baby unit, traumatic birth
post-natal - infections in first year of life, how long they were breast fed for
what is the calcification dates of FPMs and incisors
FPMs - 7-8 months after ovluation, crown formed at 1 year of life
incisors - start 3-4 months after birth, complete by 3-6 years
when would you consider balancing an XLA
XLA of tooth on same arch but condralateral side - prevent midline shift
primary canines
when would you consider compensating an XLA
XLA of same tooth on opposite arch - opposing tooth
prevent over eruption
if XLA of lower FPM - XLA upper FPM, over eruption would prevent drifting of 7 and space closure
what guidelines are available for planned XLA of FPM
RCS Clinical Effectiveness Committee 2009
what is the order of treatment planning
prevention and acclimitisation first - OHI, Diet advice, fluoride varnish - can introduce aspirator, cotton wool rolls, 3n1
fissure sealants - polish with prophy cup to introduce slow speed
small restorations with no LA - stabilisation phase
larger restorations with LA - start with maxillary
pulpotomy and extractions
what is fluorosis
defect in mineralisation of enamel due to high levels of systemic fluoride during enamel development, causes white lines in mild form or brown/yellow marks in more severe form
what age are children at risk of fluorosis until
until calcification is complete of all crowns - age 8 on SIGN 138 guidelines
for cosmetic purposes - until age 3 for anterior crown development
what is the recommended fluoride levels for children
until age 8 - 0.1mg/kg/day
from age 8 - 10mg/day
supplement
until age 3 - 0.25mg/day
age 3-6 - 0.5mg/day
6+ 1mg/kg/day
what are the recommendations for different levels of fluoride ingestion
less than 5mg/kg - give calcium (milk) orally and observe
5-15mg/kg - give calcium (milk or calcium gluconate) and take to hospital for observation
more than 15mg/kg - urgent hospital referral, intensive care and cardiac obs - IV cardiac gluconate
what are the components fear and anxiety
physiological - breathlessness, perspiration, palpitations
cognitive - hypervigilance, loss of concentration, inability to remember
behavioural - avoidance, asking questions, missing appts
how can you reduce a patients anxiety
acclimitisation
giving the patient control - stop signals, rest breaks, providing them information
how can cerebral palsy effect dental health
poor manual dexterity - poor OH
limb spasms - unable to get dental treatment safely
gag reflex
regurgitation - acid causing erosion
not in control of their diet or OH
how can a patient in a wheelchair be treated
transfer board
wheelchair recliner
hoist
what legislation protects children
children and young people act 2014
what are types of abuse
sexual, physical, emotional, neglect
what is dental neglect defined as
british society of paeds - the persistent failure to meet childs oral health needs likely to result in impairment of childs oral or general health or development
what does dental disease put children at risk of
severe infections, teasing, multiple GAs, repeated antibiotics - resistance
what is indicators of dental neglect
obvious dental disease apparent to non-dental professional, but no treatment sought after
missing multiple appoints despite support given to carer - not returned for treatment
impact on child - sleep loss, eating effected, missing school, teasing
what guidance should be followed when managing suspected abuse/neglect
british dental association
child protection and dental team
what are the stages of management of suspected dental neglect/abuse
stage 1 - dental team management
stage 2 - preventative multi-agency management
stage 3 - child protection referral
what medical condition is associated with supernumerary teeth
cleidocranial dysplasia
what are some anomalies related to shape of teeth
peg shaped laterals
dens in dentine
talon cusp
dilaceration
what is the relevance of osteogenesis imperfecta
often associated with dentinogenesis imperfecta, have multiple fractured bones
what are dentine conditions that only effect dentine
dentinogenesis imperfecta type 2
dentine dysplasia
what medical conditions are associated with dentine anomalies
osteogenesis imperfecta
ehlers-danos syndrome
rickets
what should be considered when deciding to extract fpm
AGE, skeletal pattern, future ortho needs, quality of teeth
what are causes of delayed eruption
medical conditions - downs, hypothyroidism
premature, low birth weight
malnutrition
gingival hyperplasia
what are causes of delayed exfoliation
trauma, infra-occlusion, ectopic successor, hypodontia
what are causes of premature exfoliation
trauma
following pulpotomy
immunological deficiency
what advice should be given to all patients post trauma
avoid contact sports for 2 weeks
soft diet for 2 weeks
maintain good oral hygiene - soft brush after every meal
and rinse with chlorhexidine 0.12% twice a day
what are types of trauma complications
pulpal necrosis and infection
root resorption
pulp canal obliteration
break down of marginal gingiva and bone
how does replacement resorption happen and how does it appear
severe damage to PDL, osteoblasts faster at healing than PDL fibroblasts, PDL becomes replaced with bone - dentine fused directly to bone
appears - tooth is infraoccluded as included in bone remodelling, no PDL space seen radiographically
what is pulp canal obliteration
response of vital pulp - progressive hard tissue formation within pulp chamber - narrowing of pulp chamber and canal
what types of trauma is pulp canal obliteration more likely to be seen
luxation, extrusion, intrusion, root fractures
why do immature teeth have a better prognosis following trauma
wider apices - more blood vessels - better healing capacity
what is subluxation and what are the symptoms
damage to surrounding tooth structures, no displacement but may have mobility
symptoms - increased mobility, TTP, bleeding at gingival crevice
what is lateral luxation and what are the symptoms
displacement of tooth in a socket in any direction other than axially
symptoms - tooth immobile, ankylosis percussion note (metallic), fracture of alveolus, sensibility tests likely to be negative
why is RCT initiated in a closed apex tooth following lateral luxation
high chance of pulpal necrosis, doing pulp extirpation early prevents external infection related root resorption
how can root fractures be classified and why is this helpful
apical third, mid third, coronal third
coronal third fractures have the worst prognosis and must be splinted for 4 months
if a tooth has discoloured yellow following trauma, what is this indicative of
pulp canal obliteration - tertiary dentine laid down in pulp chamber, reduces light transmission
what are the properties of splints
must be passive and flexible
must allow for adequate oral hygiene
must allow for clinical monitoring and sensibility tests
ease of placement
aesthetics
