Paediatrics Flashcards
behavioural management techniques (6)
positive reinforcement
tell show do
acclimatisation
desensitisation
distraction
role modelling
egs of acclimatisation
- introduce topical visit before using LA for 1st time
- give rubber dam sheet to ptx before planning to use it
- introduce 3:1, suction & cotton wool rolls on visit before fissure sealant
- use slow speed first with cup then bur then high speed later
communication with children
verbal = 5%
paralinguistic = 30% this refers to tone of voice
non verbal = 65%
5 sections of psychological development in children
- motor
- cognitive
- perceptual
- language
- social development
4 stages to cognitive development
- sensorimotor - until 2yrs
- preoperational thought - 2-7yrs
- concrete operations - 7-11yrs
- formal operations 11+yrs
calcification of teeth at birth
1/2 crown of a, d
1/3 crown of b, e
tip of c
tip of cusp 6
eruption sequence & dates of deciduous teeth
ABDCE
A - 6mths
B - 9mths
D - 12mths
C - 18mths
E - 24mths
teeth in same series erupt within 3mths of each other & primary dentition should be completed by 2.5-3yrs of age
ugly duckling phase
when there is transient spacing of 1st due to roots of centrals being in close proximity to 2s and 3s developing below
4 common anomalies in erupting dentition
- ED1 gene (x-linked) = peg shaped laterals in ectodermal dysplasia -> encodes ecdysplasmin A
- mutation of MSX1 gene on chromosome 4 (autosomal dominant) = missing 3rd molars & 2nd premolars
- PAX9 (autosomal dominant) gene on chromosome 14 = usually missing molars
- mutation of sonic hedgehog gene (SHH) chromosome 7 = solitary median central incisor & other developmental problems
hypodontia
missing tooth
if primary tooth missing, permanent successor most likely missing too
most often maxillary laterals & mandibular 2nd premolars
commonly associated with down syndrome & cleft lip and/or palate
management of hypodontia
retain primary tooth for as long as possible
bridge / rpd / overdenture
eventually implants but ptx must have excellent OH
hyperdontia / supernumeraries
more than the normal amount of teeth
supernumerary teeth are the most common cause for delayed eruption of a permanent incisor tooth
if contralateral tooth erupted 6mths ago & it hasn’t started yet then take radiograph to view positioning
types of supernumeraries
conical - cone shaped
tuberculate - barrel shaped, has tubercles
supplemental - looks like tooth of normal series, maybe smaller
odontome - irregular mass of dental hard tissue; compound / complex
anomalies of size & shape (8)
microdontia (F>M) e.g. peg shaped laterals
macrodontia
double teeth
odontomes
dilaceration - deviation or bend in the linear relationship of a tooth crown to its root
accessory cusps e.g. talon cusp
dens in dente - teeth growing within teeth
anomalies of root structure
short root anomaly - perm max incisors and 15% also have short roots on premolars; DO NOT PUT FIXED APPLIANCES ON THESE
accessory roots
dentine dysplasia
radiotherapy
anomalies of enamel structure (3)
congenital - amelogenesis imperfecta
environmental enamel hypoplasia
localised enamel hypoplasia
difference in hypoplasia & hypomineralisation
hypomineralisation - correct amount of enamel present but mineral content is not correct; often caused by trauma / MIH
hypoplasia - thin / absent enamel
amelogenesis imperfecta
hypomineralised - crystallites fail to grow in thickness & width in enamel
hypoplastic - enamel crystals do not grow to correct length
hypomature - enamel crystals grow incompletely in thickness / width with normal length; will also be incomplete mineralisation
problems associated with amelogenesis imperfecta (6)
sensitivity
caries/acid susceptibility
poor aesthetics
poor OH - hurts to brush, don’t like teeth so not bothered, calculus can act as barrier to protect from pain
delayed eruption
anterior open bite
solutions to amelogenesis imperfecta (6)
preventative therapy
comp veneers / wash
fissure sealants
metal onlays
ss crowns
orthodontics
problems with dentinogenesis imperfecta
aesthetics
caries/acid erosion susceptibility
spontaneous abscesses
solutions to dentinogenesis imperfecta
prevention - OHI
composite veneers
overdentures
removeable prosthesis
ss crowns
prognosis for teeth with this is very poor
radiograph of dentinogenesis imperfecta shows (3)
bulbous crowns
pulp canal obliteration
occult abscess formation
7 elements of caries risk
clinical evidence
dietary habits
social history
fluoride use
plaque control
saliva
medical history
8 elements of caries prevention
radiographs
toothbrushing instruction
strength of F in toothpaste
F varnish
F supplementation
diet advice
fissure sealants
sugar free medicine
health education
process where individuals / group of people have increased knowledge related to health. dental / dietary health education alone have been proven not to work so must form part of an overall prevention plan with health promotion
health promotion
supporting knowledge people have gained from health education and translating this into positive behaviours. it should impact a wide variety of areas i.e. social, economic, structural environments as well as improving policies of public & local institutions
what determines previous caries experience
dmft >5 or DMFT >5
>10 initial lesions
caries in 6s at 6yrs
3yrs caries increment >3
Bohn’s nodules
white benign keratinised marks from epithelial remnants of salivary glands found on buccal / lingual mucosa or on hard palate away from mucosa
epstein pearls
white benign keratinised marks found on palate filled with fluid
radiographs for mixed dentition
high risk - every 6 months
low risk - every 12-18 months
pattern of caries attack in primary dentition
- lower molars
- upper molars
2nd molars then 1st - upper anteriors
if upper and lower incisors affected there is uncontrolled caries
space maintenance
if primary toot extracted the permanent tooth will drift mesially causing crowding - earlier a tooth is lost the more space will be lost
primary tooth XLA affected by
tooth size
jaw relation
muscle behaviour
age at loss
which tooth is extracted
band & loop maintainers can be used to maintain space when 6s have erupted
when is optimum time to remove 6s
when the permanent 7 crown can be seen formed on a radiograph as well as calcification of the birfurcation
if maxillary 6s lost before complete 7 eruption
rotation & mesial movement of 7
distal drift of 5s
mandibular 6s lost before optimum age
tilting of 7s
mandibular 6s lost after optimum age
distal drift & rotation of 5s
benefits of using rubber dam (7)
decrease soft tissue damage
decrease risk of inhalation
decrease risk of cross infection
produces isolation & moisture control
retracts gingivae & cheeks
produces more effective inhalation sedation
increases ptx & operator confidence
ideal sequence of restoration
fissure sealants
preventative restorations
simple fillings e.g. shallow cervical caries
fillings requiring LA but not into pulp
pulpotomies / pulpectomies
XLA
what indicates pulpal involvement visually
marginal ridge breakdown
if caries is 2/3s into dentine
when to restore pit & fissure caries
- microcavitation
- shadowing under enamel after cleaning & drying tooth
- dental caries on radiograph
why should you not use duraphat
if patient is allergic to sticky plasters as they will be allergic to colophomy
or if they have been hospitalised for asthma in the last year
indications for pulp treatment in kids
good cooperation
want to avoid GA
space preservation
no permanent successor
medical history precludes XLA e.g. bleeding disorder
contraindications for pulp treatment in kids
poor cooperation
poor motivation
multiple grossly carious teeth
poor dental attendance
medical history precludes endo i.e. cardiac defect, immunosuppression or poor healing
XLA indications
severe pain
pus in pulp chamber
gross bone loss
advanced root resorption
cellulitis
non inflamed v inflamed pulp
non inflamed - normal bleeding, blood will be bright red & haemostasis will be achieved
inflamed - deep crimson blood with continued bleeding after pressure
when to do a vital pulpotomy
pulp minimally inflamed, marginal ridge destroyed, caries extends 2/3s into dentine or if any doubt pulp is involved
aim of vital pulpotomy
to stop bleeding, disinfect coronal part of radicular pulp yet preserve vitality of apical portion of pulp
technique of vital pulpotomy
LA rubber dam access
remove caries & roof of pulp chamber with diamond bur
remove coronal pulp with excavator
haemorrhage control with pressure & ferric sulfate for 4-5 mins
restore placing ZOE paste over pulp stumps with GIC core & preformed ss crown
success = 85-100% over 3yrs
when to do non vital pulpectomy
for non vital primary molar
indicated when hyperaemic pulp, pulpal necrosis & furcation involvement
symptoms inc - irreversible pulpitis, periapical periodontitis, chronic sinus
aim of non vital pulpectomy
to prevent / control infection by extirpation of radicular pulp followed by cleaning and obturation of canals
technique for non vital pulpectomy
LA rubber dam & access
coronal pulp extirpated with root canal prep to 2mm short of apex
canals obturated with vitapex then GIC core placed with ss crown
success = 90% over 3yrs