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3rd Year - Module 5 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Which number in the CHI number indicates if a person is male or female?

A

9th number - odd = male
even = female

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2
Q

What information should be written on the inside cover of a child’s main records folder?

A

Parent/carer’s name and contact number

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3
Q

What/who is effective prevention dependent on regarding a young child?

A

identifying and reaching all adults with regular care responsibilities of the child

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4
Q

What is pyrexia?

A

raised body temperature; fever.

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5
Q

If a child is over 7, where do you take the BPE score?

A

1s and 6s

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6
Q

What BPE codes are used in a child age 7-11?

A

0, 1, 2

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7
Q

What BPE codes are used in a child ages 12+?

A

0, 1, 2, 3, 4, *

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8
Q

Name three examples of non-carious opacities

A

1) fluorosis
2) hypoplasia
3) molar incisor hypomineralisation

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9
Q

What is enamel hypoplasia?

A

enamel defect characterised by thin or absent enamel

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10
Q

Name three dental anomalies

A

1) supernumaries
2) palatal pits on laterals
3) peg laterals

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11
Q

regarding carious lesions, what does code E1 mean?

A

carious lesion in outer half of enamel

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12
Q

regarding carious lesions, what does code E2 mean?

A

carious lesion into inner half of enamel

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13
Q

regarding carious lesions, what does code D1 mean?

A

carious lesion into dentine, less than 1/3 through

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14
Q

regarding carious lesions, what does code D2 mean?

A

carious lesion into dentine, less than 2/3 through

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15
Q

regarding carious lesions, what does code D3 mean?

A

carious lesion into dentine, more than 2/3 through

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16
Q

regarding carious lesions, what does code P mean?

A

carious lesion more than 2/3 through dentine, touching pulp

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17
Q

regarding carious lesions, what does a code with + mean?

A

periradicular pathology present

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18
Q

When charting which teeth have carious lesions on the yellow form, what must you also detail?

A

M, O or D and also carious code eg. D2

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19
Q

When charting, what does WSL stand for?

A

white spot lesion

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20
Q

When charting, what does Arr mean?

A

arrested caries

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21
Q

When charting, what does Op mean?

A

opacity

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22
Q

When charting, what does RR stand for?

A

retained roots

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23
Q

When charting, what does FS stand for?

A

complete fissure sealant

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24
Q

When charting, what does #FS stand for?

A

partial fissure sealant

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25
Q

In the yellow form, what reasons are given to consider referring a patient to orthodontics for something “missing”?

A

1) maxillary 3s not palpable at age 9 or older
2) missing 5s or 2s
3) abnormal eruption sequence

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26
Q

In the yellow form, what reasons are given to consider referring a patient to ortho under “overjet”?

A

1) >6mm and bothered?
2) >6mm, incompetent lips and sporty

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27
Q

In the yellow form, what reasons are given to consider referring a patient to ortho regarding bite?

A

1) crossbite - anterior or posterior, with displacement?
2) displaced contact points (crowding) - loss of space >4mm
3) overbite - anterior open bite, & bothered? traumatic?

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28
Q

What are the 3 Ps regarding treatment planning?

A

Pain relief
Prevention
Planned treatment for caries and other conditions

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29
Q

What kind of treatments come under prevention on the yellow form? 4 examples

A

Brushing advice
Fluoride
Dietary advice
Fissure sealants

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30
Q

Name three “sealing in” caries management techniques classed under planned treatment

A

1) Fissure sealant
2) PCR
3) Hall crown

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31
Q

What are the four contributors that can facilitate the development of dental caries?

A

1) time
2) sugar substrate
3) bacterial biofilm
4) susceptible tooth surface

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32
Q

When should a child start brushing their teeth?

A

As soon as they appear in the mouth

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33
Q

Can all lesions be arrested?

A

any lesion, at any stage of tissue destruction, non-cavitated or cavitated, can become arrested. Irrespective of age of patient

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34
Q

What do children recieve from Childsmile?

A

a dental pack containing a toothbrush and tube of toothpaste (at least 1000ppm) on at least 6 occasions by age 5

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35
Q

What does TIPPS stand for?

A

Talk
Instruct
Practice
Plan
Support

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36
Q

What are the five steps of motivational interviewing?

A

1) explore current practice and attitudes
2) educational intervention
3) action planning
4) encouraging habit formation
5) repeat at each recall

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37
Q

What does SOARS stand for in the step 1, explore current practice and attitudes, part of motivational interviewing?

A

Seek permission
Open questions
Affirmations
Reflective listening
Summarising

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38
Q

What are three important factors regarding the patients thinking to work towards success?

A

Knowledge
Skills
Attitude

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39
Q

Children aged 10-16 at increased risk of caries should be advised to use toothpastes of what concentration?

A

2800ppm Fl

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40
Q

How often should fluoride varnish be applied in all children?

A

At least 2x yearly

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41
Q

How much toothpaste should be recommended for a child under 3 years old and how much Fluoride does this contain?

A

A smear - approx 0.1ml
0.1ml of 1000ppm toothpaste contains 0.1mgF

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42
Q

What volume should a pea sized blob of toothpaste be?

A

0.25ml

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43
Q

What does a 10/10 plaque score mean at DDH?

A

10/10 perfect

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44
Q

What does an 8/10 plaque score mean at DDH?

A

plaque at gingival line

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45
Q

What does a 6/10 plaque score mean at DDH?

A

1/3 covered in plaque

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46
Q

What does a 4/10 plaque score mean at DDH?

A

2/3 covered in plaque

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47
Q

Explain the Silness and Loe Plaque Index

A

0 - tooth surface clean
1 - appears clean but plaque scraped from gingival 1/3
2 - visible plaque along gingival margin
3 - tooth surface covered with abundant plaque

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48
Q

What plaque score should be recorded for each sextant?

A

The worst score found in each sextant

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49
Q

What is the difference between blue and pink disclosing tablet staining?

A

blue = old plaque
pink = newer plaque

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50
Q

How long can the first permanent molar take to come into full occlusion?

A

up to 2 years

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51
Q

What does the evidence recommend regarding flossing?

A

regular professional quality flossing may reduce interproximal caries risk in young children with low Fl exposure and poor OH

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52
Q

Name 8 techniques that can be used to enhance rapport with patients

A

1) enhancing control
2) relaxation - breathing
3) tell - show - do
4) positive reinforcement and reward
5) modelling (sibling, parent, teddy)
6) desensitisation
7) structured time
8) hypnosis

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53
Q

List the paediatric treatment plan options in order of least to most invasive

A

OHI
Diet
Fluoride
Sealants
Hall crowns
Restorations
LA
Extractions

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54
Q

What is the routine topical gel used?

A

Lidocaine gel (clear)

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55
Q

What is the second type of topical gel that can be used, why is it more expensive and what colour is it?

A

Benzocaine gel, flavoured (pink/orange/red)

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56
Q

How long should topical be applied to the tissues before administering LA?

A

2 mins

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57
Q

When is the only time an IANB would be used in a child patient?

A

Pulpotomy of lower Es

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58
Q

What LA technique is used for extraction of lower Es?

A

Buccal and lingual infiltration

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59
Q

What should always be administered prior to a palatal infiltration in a child?

A

Intra-papillary infiltration

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60
Q

What is currently recognised as the ‘gold standard’ LA?

A

2% lidocaine with 1:80,000 adrenaline

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61
Q

What is the maximum dose of lidocaine?

A

4.4mg/kg with max of 300mg

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62
Q

2% lidocaine translates to how many mg per ml?

A

20mg/ml

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63
Q

How many mg are contained in a 2.2ml cartridge of lidocaine?

A

44mg lidocaine

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64
Q

How many cartridges of lidocaine is the absolute maximum?

A

6.8 cartridges

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65
Q

What gases are used in inhalation sedation?

A

nitrous oxide and oxygen

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66
Q

What anaesthetic is generally used for IV sedation?

A

Midazolam

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67
Q

What is the minimum age that inhalation sedation can be used?

A

3 years old

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68
Q

how quickly can a patient recover from inhalation sedation?

A

full recovery within 15mins

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69
Q

What age is IV sedation NOT recommended at?

A

below 15 years old

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70
Q

How quickly does a patient recover from IV sedation?

A

not until the next day

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71
Q

How long does “short” general anaesthetic last?

A

1-5mins

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72
Q

How is “short” general anaesthetic administered?

A

through naso-pharyngeal airway

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73
Q

how is “long” general anaesthetic administered?

A

endo-tracheal intubation

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74
Q

What is the largest acidic dietary source in children?

A

soft drinks

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75
Q

What are intrinsic sugars?

A

those that are present naturally within the cellular structure of food

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76
Q

What are non-milk extrinsic sugars?

A

sugar released from fruit when it is blended or juiced, table sugar and sugar that is added to foods such as sugary drinks, confectionery, cakes, biscuits and buns

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77
Q

What can extrinsic sugars be split into?

A

Milk sugars
Non-milk extrinsic sugars

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78
Q

Is there any evidence that intrinsic sugars or lactose cause caries?

A

No

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79
Q

What does NCD stand for?

A

Non-communicable disease

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80
Q

What are NCDs?

A

Non-communicable diseases are diseases that are not spread through infection or through other people, but are typically caused by unhealthy behaviours

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81
Q

How many deaths are as a result of NCD?

A

3/4

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82
Q

Caries risk is to be considered significant is someone is exposed to sugar how many times daily?

A

More than 4 times daily

83
Q

How many times daily does WHO recommend free sugar exposure?

A

No more than 4x daily

84
Q

What three days should a diet diary document?

A

two weekdays
one weekend day

85
Q

What personal circumstances may impact or restrict a patient’s dietary choices? 5 examples

A

1) autistic spectrum disorder - selective of foods
2) medical conditions - sugary medication
3) food intolerances
4) financial concerns
5) education

86
Q

What are the three requirements for affecting change in health related behaviour?

A

Knowledge
Skills
Attitude

87
Q

What type of chewing gum can be recommended?

A

Xylitol chewing gum

88
Q

How many g of sugar in 100g of food is considered HIGH sugar?

A

more than 15g per 100g food

89
Q

How many g of sugar in 100g of food is considered MEDIUM sugar?

A

between 5g and 15g per 100g food

90
Q

How many g of sugar in 100g of food is considered LOW sugar?

A

5g or less per 100g food

91
Q

When should acidic drinks be confined to?

A

Mealtimes

92
Q

The SDCEP guidelines recommend giving dietary advice how often?

A

at least once per year

93
Q

What are the benefits of fluoride? 3 examples

A

1) inhibits demineralisation, slowing decay
2) increases enamel erosion resistance
3) in high concn can inhibit bacterial metabolism/enzyme activity

94
Q

What percentage of outer surface enamel is composed of apatite?

A

approx 85%

95
Q

When does demineralisation occur?

A

When there is an imbalance between mineral loss and mineral gain

96
Q

What is the composition of enamel?

A

85% apatite
12% water
3% protein

97
Q

What is the composition of dentine?

A

47% apatite
20% water
33% protein

98
Q

How much does the solubility of apatite fall with the drop of 1 pH unit?

A

10 times

99
Q

What is formed when H+ combines with PO43- and OH-?

A

H2PO43- and H20
dihydrogen phosphate and water

100
Q

When the solution becomes undersaturated and promotes enamel dissolution, what has happened to the concentrations of P043- and OH-?

A

Reduced

101
Q

What is the normal pH of saliva?

A

around 7.0

102
Q

oral fluids are supersaturated with respect to what?

A

hydroxyapatite (HAp)
Fluorhydroxyapatite (FHAp)

103
Q

When the pH of the oral fluids decreases, what happens to concentrations of HAp and FHAp?

A

saliva and biofilm become undersaturated with HAp while still supersaturated with FHAp.
HAp dissolves from subsurface and FHAp forms in surface layers to provide resistance to subsequent demineralisation

104
Q

What is the primary mineral in saliva?

A

Hydroxyapatite (HAp)

105
Q

When fluoride is added to the oral environment, what happens?

A

the hydroxyl (OH-) in apatite crystal can be replaced with F- ions to make fluorapatite

106
Q

Why is the formation of fluorapatite good?

A

It is less soluble than hydroxyapatite and has higher resistance to caries and erosion

107
Q

What pH causes dissolution of HAp?

A

critical pH is 5.5

108
Q

What is the critical pH of FAp?

A

4.5

109
Q

How is fluorapatite formed?

A

by substitution of OH- with F-

110
Q

What is a critical pH?

A

the pH at which a solution is just saturated with respect to a particular mineral. Below this dissolution occurs

111
Q

What direct bacteria inhibition is caused by fluoride?

A

interacts with enzyme enolase to reduce acid production

112
Q

What indirect bacterial inhibition is caused by fluoride?

A

limits phosphoenolpyruvate, inhibiting/decreasing the amount of sugar entering the cell

113
Q

What fluoride varnish is routinely used?

A

Duraphat

114
Q

What is the concentration of Fl in duraphat?

A

22,600ppm Fl (2.26%)

115
Q

What are three contraindications of fluoride varnishes?

A

1) Asthma
2) allergies to colophony/elasoplast
3) patients with ulcerative gingivitis/stomatitis

116
Q

According to SDCEP guidelines, how often should sodium Fl varnish be applied in children over 2 (all patients)?

A

twice a year

117
Q

A child can receive two applications of Fl varnish per year through Childsmile, is it acceptable to apply a further 2 applications in practice?

A

Yes, it is acceptable for children to have varnish applied 4x per year

118
Q

For high risk patients, how often should sodium Fl varnish be applied?

A

5% sodium fluoride varnish applied an additional 1-2 times per year to children over 2yrs, unless provided via Childsmile

119
Q

Childsmile offers application of fluoride varnish twice yearly from what age?

A

18 months

120
Q

What volume of fluoride varnish should be used in patients aged 2-5?

A

approx 0.25ml

121
Q

What volume of fluoride varnish should be used in patients aged 6+?

A

approx 0.4ml

122
Q

You should never use more than what volume of fluoride varnish?

A

never use more than a kernel of sweetcorn

123
Q

What happens if you ingest too much fluoride?

A

nausea and vomiting
dental fluorosis

124
Q

What are the symptoms of fluoride overdose?

A

abdominal pain
abnormal taste (salty or soapy)
convulsions
diarrhoea
drooling
headache
heart attack, irregular heartbeat
nausea, vomiting
shallow breathing
slow heartbeat
tremors
weakness

125
Q

What is the toxic dose of fluoride?

A

5mg per kg bodyweight

126
Q

If a child weighs 15kg, what is their toxic dose of fluoride?

A

75mg

127
Q

How much fluoride is in 1ml of 1450ppm toothpaste?

A

1.45mg per ml

128
Q

What do you do in acute fluoride overdose?

A

minimise absorption by calcium containing solution (milk)
find out weight and how much has been consumed
transfer to A&E

129
Q

What does fluorosis occur as a result of?

A

excess fluoride ingestion when teeth are forming

130
Q

Children aged 10-16 who are at an increased risk of developing dental caries should be advised to use a toothpaste of what concentration?

A

2800ppmF

131
Q

Children of what age should be assisted with brushing?

A

under 7 years

132
Q

High risk patients under age 10 should be advised to use a toothpaste of what concentration?

A

1350-1500ppmF

133
Q

High risk patients over age 16 should be advised to use a toothpaste of what concentration?

A

5000ppmF

134
Q

What type of decision maker is a type 1 decision maker?

A

intuitive, experiential, non-sequential, habitual, non-verbal thinking, right brain

135
Q

What side of the brain does a “type 1” decision maker use?

A

Right brain

136
Q

What type of decision maker is a type 2 decision maker?

A

sequential, structured, logical, analytical, verbal, left brain

137
Q

What side of the brain does a “type 2” decision maker use?

A

Left brain

138
Q

What is considered an initial occlusal lesion and how will it present clinically and radiographically?

A

non-cavitated, dentine shadow or minimal enamel cavitiation
radiograph - outer 1/3 dentine

139
Q

What is considered an advanced occlusal lesion and how will it present clinically and radiographically?

A

dentine shadow or cavitiation with visible dentine
radiograph - middle or inner 1/3 dentine

140
Q

What is considered an initial proximal lesion and how will it present clinically and radiographically?

A

white spot lesions or shadow
radiograph - lesion confined to enamel

141
Q

What is considered an advanced proximal lesion and how will it present clinically and radiographically?

A

enamel cavitation and dentine shadow or cavity with visible dentine
radiograph - may extend into inner 1/3 dentine

142
Q

What is considered an initial anterior lesion and how will it present clinically and radiographically?

A

white spot lesions but no dentinal caries

143
Q

What is considered an advanced anterior lesion and how will it present clinically and radiographically?

A

cavitation or dentine shadow

144
Q

What is the HbA1c level of a non-diabetic?

A

ideally 48mmol/mol or below 5.7%

145
Q

What is the HbA1c level of a diabetic?

A

6.5% or more

146
Q

What HbA1c level indicates pre-diabetes?

A

5.7% to 6.4%

147
Q

What is HbA1c level?

A

average blood glucose (sugar) levels for the last two to three months

148
Q

What can you administer to an unconscious diabetic?

A

glucagon

149
Q

What are the signs of reversible pulpitis?

A

clinical signs of caries
not TTP
no abnormal mobility
no signs of infection

150
Q

Does the management of reversible pulpitis include pulpal intervention?

A

No

151
Q

What are the signs of irreversible pulpitis?

A

clinical signs of caries
not TTP
no abnormal mobility
no signs of infection

152
Q

What are the signs of periradicular periodontitis?

A

clinical signs of caries
increased mobility
TTP
signs of infection - swelling, suppuration, sinus tract

153
Q

What are the symptoms of reversible pulpitis?

A

pain short lived
does not linger
pain in direct response to stimuli

154
Q

What are the symptoms of irreversible pulpitis?

A

spontaneous pain
prolonged
lingers on removal of stimulus
pt wakes up from sleep

155
Q

What are the symptoms of periradicular periodontitis?

A

often acute symptoms gone
dull throbbing pain
can be asymptomatic

156
Q

Is the pulp proportionally smaller or larger in primary teeth compared to permanent teeth?

A

larger

157
Q

Is there a direct clinical way of confirming diagnosis of pulpal status?

A

no

158
Q

Which radiographs are ideal for determining pulpal status?

A

Periapicals - visualise entire tooth as well as periapical tissues

159
Q

What is an example of vital pulp therapy?

A

pulpotomy

160
Q

What is a pulpotomy?

A

removal of the coronal portion of the pulp of a tooth such that the pulp of the root remains intact and viable

161
Q

What is an example of a non-vital pulp therapy?

A

pulpectomy

162
Q

What is a pulpectomy?

A

removing the nerve and pulp of a tooth

163
Q

When is pulp therapy contraindicated?

A

in immunocompromised patients and those at risk of infective endocarditis

164
Q

According to SDCEP, what is the aim of pulp therapy?

A

to enable a primary molar with disease to be retained free from pain and sepsis until exfoliation

165
Q

Maintaining vital radicular pulp tissue via pulp therapy allows what?

A

the roots to undergo normal resorption

166
Q

What does the pulpotomy procedure involve?

A

the removal of inflamed pulpal tissue leaving an intact radicular pulp tissue to which a medicament is applied before placing a coronal restoration

167
Q

What is one important reason that pulpotomy may be indicated instead of removal of the tooth?

A

hypodontia - missing permanent successor

168
Q

When would we NOT carry out a pulp therapy?

A

Precooperative child
multiple therapies needed (>3)
close to exfoliation
tooth unrestorable
signs of infection
radiographic signs of infection
medically contraindicated

169
Q

What is the difference between primary and permanent 2nd molars regarding enamel cap?

A

cap of primary molars thinner and has more consistent depth

170
Q

What is the difference between primary and permanent 2nd molars regarding dentine thickness?

A

greater thickness in primary teeth over pulpal wall at the occlusal fossa

171
Q

What is the difference between primary and permanent 2nd molars regarding pulp horns?

A

higher in primary molars, especially mesial horns and pulp chambers are proportionally larger

172
Q

What is the difference between primary and permanent 2nd molars regarding cervical ridges?

A

cervical ridges are more pronounced particularly on the buccal aspect of primary first molars

173
Q

What is the difference between primary and permanent 2nd molars regarding enamel rods?

A

enamel rods at the cervix slope occlusally instead of gingivally as in permanent teeth

174
Q

What is the difference between primary and permanent 2nd molars regarding the shape of neck?

A

primary molars have a more constricted neck

175
Q

What is the difference between primary and permanent 2nd molars regarding roots?

A

primary molars have longer roots which are more slender than permanent roots

176
Q

What is the difference between primary and permanent 2nd molars regarding flare of roots?

A

roots of the primary molars flare out nearer the cervix than those of the permanent teeth

177
Q

What are the main steps involved in carrying out a pulpotomy? 4

A

1) rubber dam (split dam for ease)
2) remove roof of pulp chamber
3) remove coronal pulp
4) apply medicament to radicular pulp stumps

178
Q

Name a haemostatic agent and explain how it arrests bleeding

A

Ferric sulphate (15.5%)
forms ferric ion protein complex when interacts with blood, this arrests bleeding by sealing vessels

179
Q

Name three possible medicaments used for haemostasis during pulpotomy

A

1) ferric sulphate (15.5%)
2) saline
3) LA with vasoconstrictor

180
Q

If haemostasis is not achieved and there is continuation of bleeding, what is done?

A

extraction or pulpectomy

181
Q

What are the steps that are followed when haemostasis is achieved in pulpotomy?

A

1) apply medicament to radicular pulp stumps
2) fill pulp chamber with zinc oxide eugenol cement
3) restore tooth with stainless steel crown

182
Q

What are the advantages of using MTA (mineral trioxide aggregate) as the medicament following pulpotomy?

A

biocompatible and produces very little inflammation
induces hard tissue formation
good success rate

183
Q

What are the two recommended medicaments for the pulp floor following pulpotomy?

A

MTA or Ferric sulphate

184
Q

If a pulpectomy is indicated in a child, what is the tooth restored with?

A

canals filled with non-setting calcium hydroxide
restore pulp chamber with GI core
Restore with stainless steel crown

185
Q

Why is non-setting calcium hydroxide used as the obturating material in a paediatric patient instead of gutta percha?

A

Gutta percha is a non-resorbable material

186
Q

What is a large danger of pulpectomy in primary teeth?

A

Extrusion of files or materials into periapical tissues damaging developing tooth germ

187
Q

What are 5 potential complications of primary molar pulp therapy?

A

1) early resorption leading to early exfoliation
2) over-preparation
3) infection
4) caries
5) pulpectomy

188
Q

What are the clinical signs of successful pulp therapy?

A

absence of symptoms
no infection, sinus or swelling
no mobility or tenderness
retention of tooth
natural exfoliation

189
Q

What are the radiographic signs of successful pulp therapy?

A

no bone loss in furcation region
no evidence of internal resorption

190
Q

What are the signs of infection in a pulp therapy treated tooth?

A

radiographic
inter-radicular radiolucency
TTP in non-exfoliating tooth
alveolar tenderness, sinus or swelling
non-physiological mobility

191
Q

What are the signs of clinical failure following pulp therapy?

A

pathological mobility
fistula/chronic abscess
pain

192
Q

When should signs of clinical failure following pulp therapy (fistula/chronic abscess, pathological mobility, pain) be reviewed?

A

6 monthly

193
Q

What are the signs of radiographic failure following pulp therapy?

A

increased radiolucency
external/internal resorption
furcation bone loss

194
Q

How often should the radiographic signs of failure be re-radiographed?

A

12-18 monthly

195
Q

If we have a precooperative patient, what can we do to manage a reversible pulpitis?

A

crown?
can it be kept clean?
can be remove the stimulus or alter the environment?

196
Q

How would you treat a non-cavitated lesion with radiographic occlusal caries involvement 1/3 into dentine?

A

fissure seal then fluoride or fluoride then seal

197
Q

How would you treat a non-cavitated lesion with radiographic occlusal caries involvement 2/3 into dentine?

A

fissure sealant and fluoride

198
Q

How would you treat a non-cavitated lesion with radiographic occlusal caries fully through dentine?

A

Fissure sealant, monitor, OHI, diet advice, Fl toothpaste

199
Q

How would your treatment differ between cavitated and non-cavitated lesions?

A

Cavitated lesions would receive stepwise removal

200
Q

Explain the stages involved in stepwise caries removal

A

1) slow speed to remove soft caries until hard leathery dentine is reached but still carious
2) etch, prime and bond
3) liner - vitrebond (glass ionomer)
4) restore - composite, resin composite or amalgam
5) monitor
6) at 6 months can re-enter and remove more caries as pulp shrinks but this is mainly historical

201
Q

How is the treatment of a proximal lesion different from an occlusal lesion?

A

matrix band required
need to remove contact point
much bigger margin, more likely to fracture

202
Q

What is the main sign of successful inferior alveolar block?

A

Numb lip on same side as block

203
Q

What is the maximum LA dose in children per kg?

A

5mg/kg

3rd Year - Module 5 (12 decks)

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