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BDS3 - CDS > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

pharmocological types of behaviour management

A
  • local anaesthetic
  • pre-medication
  • inhalation sedation with nitrous oxide
  • intravenous sedation
  • general anaesthetic - requires justification
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2
Q

paeds behavoiur management
inhalation sedation

A
  • nitrous oxide
  • will not change a childs wish or want to avoid something
  • will allow sufficient decrease in anxiety to increase relaxation and help with ability to tolerat tx
  • works well combined with other non-pharmacological techniques
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3
Q

paeds behavoiur management
intravenous sedation

A
  • with propofol or midazolam
  • good options for complex tx in anxious adolescents
  • depending on maturity and size - usually over 12s
  • works well with other non-pharmacological techniques
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4
Q

paeds behavoiur management
levels of cooperation

A
  • pre-cooperative
  • children who lack cooperative ability
  • potentially cooperative
  • co-operative
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5
Q

paeds behavoiur management
communication

A
  • non verbal communication is key
  • using their names and repeating can assist in developing rapport
  • like to be treated as individuals
  • avoid dental jargon
  • lowering yourself physically
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6
Q

dental axiety/fear/phobia definitions

A
  • dental anxiety - reaction to unknown danger - very common when proposed tx never experienced before
  • dental fear - reaction to a known denture - involves fight or flight response when confronted with threatening situaiton
  • dental phobia - same as dental fear with much stronger response
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7
Q

dental fear and anxiety
physiological/cognitive/behavioural reactions

A
  • physiological - breathlessness, perspiration, palpations
  • cognitive - decreased concentration, hypervigilance, catastrophising
  • behavioural - avoidance of tx, escape from situations, aggression
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8
Q

paeds behavoiur management
factors affecting anxiety

A
  • previous medical/dental/social history
  • parental anxiety
  • parenting style
  • parental presence
  • child awareness of dental problem
  • behaviour of dental staff
  • child temperament
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9
Q

paeds behavoiur management
measuring dental fear and anxiety

A
  • MCDASf - modified child dental anxiety scale faces
  • quick and simple
  • questionare with scores 1-5 with corresponding face from least anxious to most anxious
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10
Q

inappropriate paeds behavoiur management

A
  • negative reinforcement - punishment or chastisement for unideal behaviours
  • hand over mouth technique
  • selective arental exclusion
  • bribery - depends
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11
Q

paeds behavoiur management
preparatory info

A
  • can also help decrease parental anxiety
  • welcome letters
  • patient info leaflets
  • videos online
  • acclimatisation
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12
Q

paeds behavoiur management techniques

A
  • preparatory info
  • voice control
  • non-verbal communication
  • enhanced control
  • tell-show-do
  • positive reinforcement
  • distraction
  • magic
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13
Q

paeds behavoiur management
non-verbal communication

A
  • happy smiling team
  • eye contact
  • modelling works best when a child of similar age
  • gentle pats
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14
Q

paeds behavoiur management
tell-show-do

A
  • used to familiarise patients with new procedures
  • age appropriate explanation of procedure
  • demonstration of procedure
  • perform procedure with minimal delay
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15
Q

paeds behavoiur management
enhanced control

A
  • allows pt a degree of control
  • stop, go, rest signals
  • this or that
  • which tooth do you want to start with
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16
Q

paeds behavoiur management
topical anaesthetic

A
  • dont hide taste - ask pt what flavour they like and say its a but like that mixed with toothpaste
  • dry mucosa, allow adequate time
  • warn re temporary numbness of tongue, throat, palate
  • usually 5% lidocaine or 18-20% benzocaine
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17
Q

paeds non-pharmacological pain management

A
  • relaxation techniques
  • distraction - counting of fingers, audio and visual, pt fav music or show
  • controlled language
  • control parental behaviour - parent squeezing leg, high tone of voice
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18
Q

paeds when to use articaine

A
  • consider as alternative to lidocaine IANB/IDB
  • can be considered in young patients for mandibular pulpal anaesthesia
  • never use articaine as IDB
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19
Q

paeds behavoiur management
chasing technique

A
  • topical anaesthetic buccally
  • give buccal infiltration
  • allow time for papilla to become anaesthetised
  • reposition needle perpendicular to papilla and inject into papilla
  • check palatal/lingual side of papilla for blanchine
  • inject into palatal or lingual blanched mucosa
  • chase blanched mucosa until area fully anaesthetised
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20
Q

paeds behavoiur management
building a tx plan

A
  • stage tx gradually increasing in complexity and challenges unless pt in pain
  • exam, acclimatisation, prevention etc
  • fissure sealants
  • restorative tx with LA upper then lower
  • extractions with LA upper then lower or most painful to least painful
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21
Q

types of disability

A
  • physcial - spina bifida
  • medical - cardiac defect
  • sensory - deaf, ASD
  • mental - learning impairment, AS
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22
Q

sensory impairments and their communication aids

A
  • visual - braille
  • hearing - BSL interpreting service, hearing loops
  • ASD - makaton, widget symbols
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23
Q

learning disability definition

A
  • a state of arrested or incomplete development of mind
  • significant impairment of intellectual, adaptive and social functioning
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24
Q

learning disability IQ classification

A
  • mild 50-70
  • moderate 35-49
  • severe 20-34
  • profound <20
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25
Q

autism summary

A
  • neurodevelopmental disorder
  • sprectrum disorder
  • affects social interaction and communication
  • limited and restricted patterns in behaviour
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26
Q

autism related conditions

A
  • ADHD
  • down syndrome
  • dyslexia
  • dyspraxia
  • epilepsy
  • GI issues
  • sleep disorder
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27
Q

non-verbal communication aids for pt with autism

A
  • makaton
  • PECS
  • widget symbols
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28
Q

autism dental applications

A
  • obtain a profile of likes and dislikes from the parent or schoo;
  • send out a social story explaining dental journey using PECS - picture exchange communication system
  • be ready and on time
  • de-clutter
  • consider alternative ways to take examination
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29
Q

down syndrome dental feature

A
  • maxillary hypoplasia
  • class III occlusion
  • macroglossia - enlargement of tongue
  • anterior open bite
  • hypodontia/microdontia
  • predisposition periodontal disease
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30
Q

down syndrome associated learning/medical problems

A
  • autism
  • cardiac defect
  • leukaemia
  • epilepsy
  • alzheimers/dementia
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31
Q

dental examination options for pt with special needs

A
  • knee to knee
  • on parents lap
  • in wheelchair
  • standing up
  • open wide disposable mouth rest
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32
Q

recommended toothpastes for pt with special needs

A
  • OraNurse toothpaste - contains fluoride, no foaming
  • durphate 2800ppmF - for high caries children with special needs, supervised use, 10+
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33
Q

pt with special needs
conscious sedation indications

A
  • selection criteria same as non special needs pt
  • no-cooperation
  • extensive tx
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34
Q

pt with special needs
conscious sedation considerations

A
  • avoid inhalation sedation in pt undergoing bleomycin therapy (high O2) and those with musculoskeletal disorders
  • joint cases
  • medical preassessment
  • ASA III and IV will require anaesthetist
  • ^^American Society of Anesthesiology Classification A system used by anesthesiologists to stratify severity of patients’ underlying disease and potential for suffering complications from general anesthesia
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35
Q

special needs pt
general anaesthetic aims

A
  • atraumatic anaesthetic induction - eg oral midazolam
  • complete comprehensive dental tx
  • eliminate pain and infection
  • establish basis for continued preventive care
  • short, uncomplicated recovery
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36
Q

paediatric pt consent summary

A
  • usually younger children will have consent form signed by parent(s)
  • teenagers deemed “gillick” competent may sign consent form
  • age 16 + can sign own form unless deemed adult with incapacity - need to ensure appropriate adult with incapacity certificate is available
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37
Q

special needs pt key legislation

A
  • AWI sct 2000
  • disability discrimination act 1995
  • equality act 2010
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38
Q

aims of 2021 paeds perio guidelines

A
  • to outline a method for screening under 18s for periodontal disease during routine clinical examination - in order to detect gingivitis or periodontitis at earliest opportunity
  • to provide guidance on periodontal management and when it is appropriate to treat in practice or refer
  • optimising periodontal outcomes for children and adolescents
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39
Q

mnemonic for memorising 2017 perio classification

A
  • Please - periodontal health
  • Give - gingivitis biofilm induced
  • Gregv- gingivitis non-biofilm induced
  • Nine- necrotising periodontal disease
  • Percy - periodontitis
  • Pigs - periodontitis as manifestation of systemic disease
  • Straight - systemic disease affecting periodontal tissues
  • Past - periodontal asbcess/perio-endo
  • Meal - mucogingival conditions
  • Time - traumatic occlusal forces
  • Tonight- tooth and prosthesis related factors
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40
Q

describe plaque biofilm induced gingivitis

A
  • supragingival plaque accumulates on teeth –> inflammatory cells infiltrate in gingival CT
  • junctional epithelium becomes disrupted
  • allows apical migration of plaque and increase in gingival sulcus depth - gingival pocket/false pocket
  • no periodontal attachment loss
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41
Q

most apical extension of junctional epithelium is

A
  • cemento-enamel junction
  • CEJ
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42
Q

describe periodontitis that is currently stable

A
  • BOP <10%
  • PPD <= 4mm
  • no BoP at 4mm sites
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43
Q

describe periodontitis that is currently in remission

A
  • BOP >= 10%
  • PPD <= 4mm
  • no BoP at 4mm sites
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44
Q

describe periodontitis that is currently unstable

A
  • PPD >= 5mm
  • or
  • PPD >= 4mm and BoP
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45
Q

periodontal health features
specific measurements

A
  • gingival margin above CEJ - no recession
  • gingival sulcus 0.5-3mm deep on fully erupted tooth
  • in teenagers alveolar crest is situated 0.4-1.9mm apical to CEJ
  • <10% bleeding on probing
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46
Q

periodontal health reduced periodontium situations

A
  • non-periodontal pt - crown lengthening surgery, recession
  • periodontal pt - stable periodontitis
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47
Q

non-plaque biofilm induced gingivitis causes

A
  • manifestation of systemic conditions
  • genetic/developmental disorders
  • traumatic lesions
  • infective
  • drug induced
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48
Q

when to refer non plaque induced gingivitis

A
  • where extent of condition is inconsistent with level of oral hygiene observed
  • uneplained gingival enlargement, inflammation, bleeding, tooth mobility
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49
Q

periodontitis key features

A
  • apical migration of junctional epithelium beyond CEJ
  • loss of attatchment of periodontal tissues to cementum
  • transformation of junctional epithelium to pocket epithelium - often thin and ulcerated
  • alveolar bone loss
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50
Q

dynamic diagnoses of periodontitis
components

A
  1. staging
    * bone loss at worst site
    * stage I, II, III, Iv
  2. grading
    * rate of progression - %bone loss/age
    * grade A, B, C
  3. current periodontal status - stable, in remission, unstable
  4. risk assessment - smoking, poorly controlled diabetes
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51
Q

paeds perio reminders

A
  • in primary dentition some evidence of bone loss can occur in some children aound primary teeth
  • in mixed dentition be aware of false pocketing around erupting permanent dentition
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52
Q

gingival overgrowth related to

A
  • systemic and metabolic diseases
  • genetic factors - eg hereditary gingival fibromatosis
  • local factors
  • medication side effects - Ca channel blockers, cyclosporine
  • greater incidence seen in puberty
  • severity more intense in children than adults with similar amounts of dental plaque
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53
Q

gingival overgrowth tx

A
  • rigorous home care
  • frequent appointments for PMPR
  • +/- surgery - especially with drug induced gingival overgrowth
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54
Q

periodontitis as manifestation of systemic disease - paeds

A
  • papillon-lefevre syndrome
  • neutropenias
  • down syndrome
  • LAD
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55
Q

simplified basic periodontal examination summary

A
  • in all co-operative children aged 7-18 years old
  • siimplified - only 6 teeth
  • performed with WHO 621 probe - single black band
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56
Q

simplified basic periodontal examination method

A
  • 20-25g force application
  • probe inserted parallel to tooth and walked around gingival margin
  • on index teeth 16, 11, 26, 36, 31, 46
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57
Q

simplified BPE codes

A
  • BPE codes 0-2 ONLY for children 7-11 years old
  • all BPE codes 12-17 years
  • 0 = healthy
  • 1 = bleeding after gentle probing, black band fully visible
  • 2 = calculus or plaque retention factor, black band fully visible
  • 3 = pocketing 4-5mm, black band partly visible
  • 4 = pocketing >=6mm black band disappears
    • = furcation involvement
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58
Q

SDCEP plaque score for paeds summary

A
  • assess plaque levels in sextants - worst score in each sextant recorded
  • 10/10 = perfectly clean tooth
  • 8/10 = line of plaque around cervical margin
  • 6/10 = cervical 1/3rd of crown covered
  • 4/10 = middle 1/3rd of crown covered
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59
Q

pads perio prevention

A
  • hands on demonstration - supervised toothbrushing
  • modified bass technique
  • consider disclosing tablets
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60
Q

treatment and recall period for sBPE (paeds)

A
  • 0 = no perio tx (1 year)
  • 1 = OHI (1 year)
  • 2 = OHI, supra/sub PMPR, remove plaque retention factors (6 months)
  • 3 = OHI, PMRP in pockets, remove plaque retention factors (3 months do 6PPC in affected sextants)
  • 4 or * = full 6PPC, consider referal whilst doing initial therapy (code 3) very unusual in children
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61
Q
A
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62
Q

Measurements in gingival health

A
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63
Q

trauma to permanent teeth stats

A
  • peak period 7-10 years old
  • more common with large overjet - OJ>9mm doubles incidence
  • causes - falls, bikes, sport, fights
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64
Q

dental trauma
taking a detailed history

A
  • how/when did it happen
  • where are the lost teeth/fragments
  • any other symptoms
  • MH may influence tx options - rheumatic fever, congenital heart defects, immunosuppression
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65
Q

crown fracture examination

A
  • EO check for - laceration, haematomas, haemorrhage, mouth opening
  • IO - soft tissue, alveolar bone, occlusion, teeth
  • rule out facial/jaw #
  • check for penetrating wounds/foreign bodies
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66
Q

tooth mobility from trauma may indicate

A
  • displacement of tooth
  • root fracture
  • bone fracture
  • tactile test with probe to look for fracture lines or pulpal involvement
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67
Q

crown fracture sensibility test

A
  • compare injured tooth with adjacent non-injured tooth
  • always test adjacent and opposing teeth in addition to those obviously injured - may have recieved direct or indirect concussive injuries
  • continue sensibility testing for at least 2 years after an injury
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68
Q

dental trauma
detailed intraoral exam

A
  • sensibility test - thermal or electrical
  • percussion - duller note may indicate root #
  • occlusion - traumatic occlusion demands urgent tx
  • radiographs - intraoral, occlusal, OPT, soft tissue
  • classiy the trauma
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69
Q

classification of fractures

A
  • enamel fracture
  • enamel dentine fracture
  • enamel dentine pulp fracture
  • uncomplicated root crown fracture - pulp not involved
  • complicated root crown fracture - pulp involved
  • root fracture - apical, middle or coronal third
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70
Q

tooth fracture prognosis depends on

A
  • stage of root development
  • classification of injury
  • if PDL is damaged too
  • time between injury and tx
  • presence of infection
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71
Q

aims and principles of tooth fracture tx - emergency tx

A
  • retain vitality - protect any exposed dentine with adhesive dentine bandage
  • treat exposed pulp tissue
  • reduction and immobilisation of displaced teeth
  • tetanus prophylaxis
  • antibiotics?
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72
Q

aims and principles of tooth fracture tx - intermediate tx

A
  • +/- pulp tx
  • restoration - minimally invasive acid etch restoration
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73
Q

aims and principles of tooth fracture tx - permanent tx

A
  • apexigenesis/apexification
  • root filling +/- root extrusion
  • gingival and alveolar collar modification if required
  • coronal restoration
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74
Q

enamel # management/follow up/prognosis

A
  • bond fragment of tooth or grind sharp edges
  • take 2 periapical radiographs to rule out tooth fracture or luxation
  • follow up 6-8weeks, 6 months and 1 year
  • 0% risk of pulp necrosis
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75
Q

enamel dentine # management/follow up/prognosis

A
  • either bond fragment to tooth or place composite “bandage” - line restoration if fracture close to pulp
  • take 2 periapical radiographs to rule out root fracture or luxation
  • radiograph any lip or cheek lacerations to rule out embedded fragment
  • sensibility testing and evaluate tooth maturity
  • definitive restoration
  • follow up 6-8weeks, 6 months and 1 year
  • 5% risk of pulp necrosis at 10 years
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76
Q

enamel / enamel dentine # follow up

A
  • review 6-8 weeks, 6 months and at one year
  • use trauma sticker for clinical review
  • check radiographs for - root development, width of canal and length, internal and external inflammatory resorption and periapical pathology
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77
Q

enamel dentine pulp # management

A
  • evaluate exposure - size of pulp exposure, time since injury, associated PDL injuries
  • choose from 3 options
    1. pulp cap
    1. partial pulpotomy
    1. full coronal pulpotomy
  • avoid full extirpation unless tooth is clearly non-vital
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78
Q

enamel dentine pulp # management
direct pulp cap tx/follow up

A
  • for tiny exposure 1mm within 24h window
  • should be non TTP and positive to sensibility test
  • trauma sticker and radiographic assessment
  • LA, rubber dam
  • clean area with water then disinfect area with sodium hypochlorite
  • apply calcium hydroxide (dycal) or MTA white to pulp exposure
  • restore tooth with quality composite restoration
  • review 6-8weeks, 6 months, 1 year
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79
Q

enamel dentine pulp # management
partial pulpotomy tx/follow up

A
  • for larger exposre >1mm or 24+ hours since trauma
  • trauma sticker and radiographic assessment
  • LA, dam, clean area with saline
  • disinfect area with sodium hypochlorite
  • remove 2mm of pulp with high speed round diamon bur
  • place saline soaked CW pellet over exposure until haemostasis achieved - if no bleeding or cant arrest bleeding proceed with full coronal pulpotomy
  • apply CaOH (dycal) or white MTA and then GI
  • restore with composite
  • follow up 6-8 weeks, 6 months and 1 year - clinical and radiographic review
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80
Q

enamel dentine pulp # management
full coronal pulpotomy tx/follow up

A
  • begin with partial pulpotomy
  • assess for haemostasis after application of saline soaked cotton wool
  • if cannot stop bleeding (hyperaemic) or necrotic proceed to full coronal pulpotomy
  • place calcium hydroxide in pulp chamber
  • seal with GIC lining and quality coronal restoration
  • follow up - 6-8weeks, 6 months and 1 year - clinical and radiographic review
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81
Q

enamel dentine pulp # management
aim of pulpotomy

A
  • to keep vital pulp tissue within the canal
  • to allow normal root growht (apexogenesis) both in legnth of root and thickness of the dentine
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82
Q

enamel dentine pulp # management
if tooth non-vital and immature apex

A
  • full pulpectomy required
  • problem - no apical stop to allow obturation with GP
  • options:
    1. CaOH placed in canal to induce hard tissue barrier to form (apexification)
    2. MTA/biodentine placed at apex to create cement barrier
    3. regenerative endodontic technique to encourage hard tissue formation at apex
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83
Q

enamel dentine pulp # management
non vital tooth with open apex tx steps

A
  • pulpectomy
  • rubber dam and access
  • haemorrhage control - LA/sterile water
  • diagnostic radiograph for WL
  • file 2mm short of WL
  • dry canal, non setting CaOH in pulp chamber plus cotton wool
  • GIC temp on top
  • best practice - extirpate pulp and have CaOH no longer 4-6 weeks after identified as non-vital then MTA plug and heated obturation
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84
Q

uncomplicated crown root # management

A
  • no pulp exposure
  • tx options:
  • fragment removal only and restore
  • fragment removal and gingivectomy - if palatal subgingival extension
  • extraction
  • decoronation - preserve bone for future implant
  • surgical extrusion
  • orthodontic extrusion of apical portion - endo, extrusion, post crown
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85
Q

complicated crown root # management

A
  • can be temporised with composite for up to 2 weeks
  • fragment removal and gingivectomy - if palatal subgingival extension
  • extraction
  • decoronation - preserve bone for future implant
  • surgical extrusion
  • orthodontic extrusion of apical portion - endo, extrusion, post crown
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86
Q
A
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87
Q
A
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88
Q

GA agents used

A
  • desflurane
  • seroflurane
  • isoflurane
  • often combines with nitrous oxide
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89
Q

what is MCDAS

A

modified child dental anxiety scale

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90
Q

range of techniques for pain control

A
  • behavioural techniques
  • local anaesthesia
  • conscious sedation
  • general aaesthesia
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91
Q

indications for the use of GA in children

A
  • the child needs to be fully anaesthetised before dental tx procedures can be attempted
  • the surgeon needs the child to be fully anaesthetised before dental tx can be performed
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92
Q

general considerations when discussing use of GA with child and carer

A
  • co-operative ability of the child
  • percieved anxiety and how child has responded to similar procedures
  • degree of surgical trauma anticipated
  • complexity of the operative procedure
  • medical status of the child
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93
Q

circumstances and conditions suitable for GA

A
  • severe pulpitis
  • acute soft tissue swelling
  • surgical drainage
  • single or multiple extractions in a young child unstuitable for conscious sedation
  • symptomatic teeth in more than one quadrant
  • biopsy
  • surigical extractions or exposure
  • established allergy to local anaesthesia
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94
Q

circumstances and conditions which rarely justify GA and circumstances that override limitations

A
  • carious, asymptomatic teeth with no clinical or radiographical signs of sepsis
  • orthodontic extraction of sound permanent premolar teeth in a healthy child
  • patient/carer preference except where other techniques have already been tried
  • circumstances that override above limitations:
  • physical, emotional, learning impairment
  • children who have attempted tx under LA/concious sedation and unable to co-operate
  • medical problems which are better controlled under use of GA
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95
Q

guidelines for the use of GA
explanation of risk

A
  • explain GA carried out by anaesthetic consultant
  • procedure will take place in operating theatre
  • small but real risk of catastrophe during GA
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96
Q

guidelines for the use of GA
tx planning

A
  • all tx required is carried out under a single GA
  • radiographs required unless limited diagnostic value
  • unrestorable asymptomatic teeth should be removed in addition to those causing pain or sepsis
  • most predictably successful restoration provided
  • further preventive advice
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97
Q

guidelines for the use of GA
consent

A
  • obtained at the time of tx planning and updated on the day of operation
  • ensure parents understand whether primary/permanent/both are in tx plan
  • interpreting services must be used if parents may not understand nature of proposed tx
  • explain that decision about no. fillings/X can sometimes only be made with the child fully anaesthetised
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98
Q

guidelines for the use of GA
pre-op assessment advantages

A
  • allowing dentist sufficiet tim to explain tx required and assess parents understanding
  • allowing parents and child time to consider tx and ask further Qs
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99
Q

guidelines for the use of GA
discharge

A
  • responsibility shared between dentist, anaesthetist and recovery nursing staff
  • pt and parents should recieve verbal and written POI
  • advice on any expected symptoms in first 24h
  • analgesics such as paracetamol recommended first 24-48 hours
  • specific OHI after surgery should be given
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100
Q

guidelines for the use of GA
clinical effectiveness

A
  • primary tooth restored under GA should be expected to exfoliate naturally without failure
  • PMC are most predictable and durable restoration
  • pulp therapy with caution under GA due to clinical failure rates unless contra-indications to X
101
Q

guidelines for the use of GA
repeat GA

A
  • undesirable in terms of morbidity, potential mortality, behavioural/emotional effects of pt and cost
  • can be due to failures in tx plan or failure of preventive counselling adoption
102
Q

safeguarding children
GDC expectations

A
  • expects all registrants to be aware of the procedures involved in raising concerns about possible abuse or neglect
  • have a responsibility to raise concerns
  • know who to contact for further advice and how to refer to appropriate authority
103
Q

what is child protection

A

activity undertaken to protect specific children who are suffering, or at risk of suffering, significant harm

104
Q

GIRFEC key points

A
  • getting it right for every child
  • named person for every child as single point of contact - advise & support families and to raise and deal with concerns about a childs wellbeing
  • national practice model - wellbeing wheel (SHANARRI), my world triangle, resilience matrix
  • single childs plan - planning process for individual children who have wellbeing needs
105
Q

definition of child abuse

A
  • 3 elements must be present
  • significant harm to child
  • carer has some responsibility for that harm
  • significant connection between carers responsibility for child and harm to child
106
Q

CYPA

A

children and young persons act 1993

107
Q

CYPA and information sharing

A
  • information can be shared when safety is at risk
  • or when benefits of sharing info outweight the public or individuals interest in keeping info confidential
  • good practice to get consent where possible and safe to do so
  • share what you need to and keep a note of what and why you have shared the info
108
Q

what is UNCRC and list of rights

A
  • the UN convention on the rights of the child
  • right to respect
  • right to information about yourself
  • the right to be protected from harm
  • the right to have a say in your life
  • the right to a good start in life
  • the right to be and feel secure
109
Q

child abuse aetiology/contributing factors

A
  • adult - drugs, alcohol, poverty, unemployment, marital stress, mental illness, isolation
  • child - crying, soiling, disabililty, unwanted pregnancy, wrong gender
  • community/environmental - poor housing conditions, neighbourhood
    family violence and dysfunctional family - intergenerational cycle, violence towards pets, poverty
110
Q

parenting capacity
big 3 concerns

A
  • domestic violence
  • drug and alcohol misuse
  • mental health problems
  • cumulative problems increase the likelihood of negative outcome
111
Q

child abuse categories

A
  • physical
  • emotional
  • neglect
  • sexual
112
Q

vulnerable children

A
  • under 5s
  • irregular attenders - repetedly DNA, return in pain, exposed to risks of GA
  • medical problems and disabilities
113
Q

dental neglect definition

A
  • persistent failure to meet a childs basic oral health needs
  • likely to result in serious impairment of a childs oral or general health and development
114
Q

neglect of the childs needs

A
  • nutrition
  • warmth, clothing, shelter
  • hygiene and health-care
  • stimulation and education
  • affection
115
Q

effects of neglect

A
  • failure to thrive/short stature
  • inappropriate clothing - cold injury sun burn
  • ingrained dirt in finger nails, head lice, dental caries
  • developmental delay
  • withdrawn or attention seeking behaviour
116
Q

indicators of dental neglect

A
  • irregular attendance
  • repeated failed appts/late cancellations
  • obvious dental disease yet child has not returned for tx
  • failure to complete tx
  • returning in pain at repeted intervals
  • repeated GA for dental extractions
117
Q

managing dental neglect

A
  • guidance - cpdt.org.uk or bda.org/childprotection
  • 3 stages
  • preventive dental team management
  • preventive multi-agency management
  • child protection referral
118
Q

managing dental neglect
stage 1

A
  • preventive dental team management
  • raise concerns with parents
  • offer support
  • set targets
  • keep records and monitor progress
119
Q

managing dental neglect
stage 2

A
  • preventive multi agency management
  • liase with other professionals - school nurse, GP, social worker etc to see if concerns shared
  • child may be subject to common assessment framework CAF at this level
  • check if child has child protection plan
  • agree joint plan of action
  • review at agreed intervals
  • letter to healthcare visitor if child under 5 who fail appts and fail to respond to letter from GDP
120
Q

managing dental neglect
stage 3

A
  • child protection referral
121
Q

physical abuse Scotland

A
  • already illegal to hit a child with an object or to hit them anywhere on the head
  • from NOV 2020 it is illegal to physically punish a child
122
Q

physical child abuse
major clinical features

A
  • skin lesions - bruises, burns, bites, lacerations
  • bone fractures
  • intracranial lesions
  • visceral lesions from blunt trauma
123
Q

physical child abuse
extraoral orofacial signs

A
  • bruising of face
  • bruising of eats
  • abrasion and lacerations
  • burns and bites
  • neck - choke or cord marks
  • eye injuries
  • hair pulling
  • fractures - nose > mandible > zygoma
124
Q

physical child abuse
intraoral orofacial signs

A
  • contusions (bruise)
  • abrasions and lacerations
  • burns
  • tooth trauma
  • frenal injuries
125
Q

physical child abuse
index of suspicion

A
  • delay in seeking help
  • story vauge, lacking in detail
  • account not compatible with injury
  • parents mood abnormal or gives cause for concern
  • childs appearance and interaction with parent abnormal
  • history of previous injury
  • history of violence within family
126
Q

safeguarding children
how can we help

A
  • share concerns - named person
  • know where to go for help and advice
  • child protection adviser
  • social work/social services
  • NSPCC helpline
127
Q

safeguarding children
what happens after I refer

A
  • if child is in immediate danger - child protection order, exclusion order, removal by police or authority of a JP
  • otherwise investigation, initial assessment, discussion - decide if child at risk of significant harm
  • then joint investigation (scotland) or no further CP action but may get additional support (england/wales/NI/scot)
128
Q

dental trauma epidemiology

A
  • male > female
  • maxillary primary incisor teeth most likely affected
  • peak incidence 2-4 years of age
  • aetiology - falls, bumping into objects, non-accidental
129
Q

classification of injuries
dental hard tissues and pulp

A
  • enamel fracture - uncomplicated crown fracture
  • enamel and dentine fracture - uncomplicated
  • enamel, dentine and pulp fracture - complicated crown fracture
  • crown-root fracture - complicated or uncomplicated
  • root fracture
130
Q

classification of injuries
supporting tissues

A
  • concussion
  • subluxation
  • lateral luxation
  • intrusion
  • extrusion
  • avulsion
  • alveolar fracture
131
Q

dental trauma
general patient management stages

A
  1. reassurance
  2. history
  3. examination
  4. diagnosis
  5. emergency tx
  6. important information
  7. further tx and review
132
Q

injury prevalence of primary dentition

A
  • luxation most prevalent 62-69%
  • avulsion and ED# 7-13%
  • root #2-4%
  • crown-root# 2%
133
Q

dental trauma management
reassurance

A
  • decrease pt and pant anxiety
  • may still be in shock if injury justy occured
  • stay calm
134
Q

dental trauma management
history

A
  • trauma history: when, where, how, any other symptoms or injuries
  • MH: bleeding disorders, CVD, allergies, tetanus immunisation status
  • DH: previous trauma, tx experience, legal guardian, child attitude
135
Q

dental trauma management
trauma examination

A
  • EO: lacerations, haematoma, mouth opening, CSF, bony step deformities
  • IO: soft tissue wounds/foreign bodies, alveolar bone, occlusion, teeth
136
Q

dental trauma management
detailed IO exam trauma stamp

A
  • mobility
  • colour
  • TTP
  • sinus
  • percussion note
  • radiograph
137
Q

dental trauma management
special investigations

A
  • trauma stamp
  • radiographs: periapical, anterior occlusal, panoramic, soft tissue
138
Q

dental trauma management
emergency tx primary tooth

A
  • observation often most appropriate option
  • unless risk of aspiration, ingestion or occlusal interference
  • tx depends on childs maturity and ability to cope
139
Q

dental trauma management
homecare advice

A
  • analgesia
  • soft diet for 10-14 days / normal diet with everything cut small, chew with molars
  • brush with soft toothbrush after every meal
  • topical chlorhexidine gluconate 0.12% mouthrinse applied topically twice daily for one week
  • warn re signs of infection
140
Q

dental trauma management
crown-root#

A
  • remove loose fragments and determine if crown can be restored
  • if restorable and no pulp exposed: cover exposed dentine with GIC
  • if pulp exposed: pulpotomy or endodontic tx
  • if unrestorable: extract loose fragments
141
Q

dental trauma management
root#

A
  • coronal fragment not displaced: no tx
  • coronal fragment displaced but not excessively mobile: leave coronal fragment to spontaneously reposition
  • coronal fragment displafced, excessively mobile and interfering with occlusion: A extract only loose coronal fragment, B reposition loose fragment +/- splint
142
Q

dental trauma management
avulsion of primary teeth

A
  • radiograph to confirm avulsion
  • do not replant
143
Q

dental trauma primary tooth management
concussion/subluxation

A
  • no treatment
  • observation
144
Q

dental trauma primary tooth management
lateral luxation

A
  • minimal/no occlusal interference: allow to reposition spontaneously
  • severe displacement: extract or reposition +/- splint
145
Q

dental trauma primary tooth management
extrusion

A
  • not interfering with occlusion: spontaneous repositioning
  • excessible mobility or extruded >3mm : extract
146
Q

dental trauma primary tooth management
intrusion

A
  • allow to spontaneously reposition
  • use either periapical or lateral premaxilla (extra-oral film)
  • being able to assess danger to permanent tooth allows better tx re prognosis
  • if apical tip of intruded tooth can be seen and tooth appears shorter - apex displaced towards/through labial bone plate
  • if apex of tooth cannot be visualised and tooth appears elongated - apex displaced towards permanent tooth germ
147
Q

direct complications of dental trauma to primary tooth

A
  • discolouration
  • dicolouration and infection
  • delayed exfoliation
148
Q

dental trauma primary tooth management
alveolar fracture

A
  • reposition segment
  • stabilise with flexible splint to adjacent uninjured teeth for 4 weeks
  • teeth may need to be extracted after alveolar stability has been achieved
149
Q

dental trauma primary tooth
discolouration

A
  • asymptomatic vital or non vital tooth
  • mild grey - may maintain vitality#
  • opaque/yellow - pulp obliteration
  • if no signs of pulp necrosis or infetion - no tx
  • review
150
Q

dental trauma primary tooth
discolouration and infection

A
  • symptomatic non vital tooth
  • sinus, gingival swelling, abscess
  • increased mobility
  • radiographic evidence of periapical pathology
  • extract or endodontic tx
151
Q

complications of trauma in primary dentition to the permanent successor

A
  • enamel defects
  • abnormal crown/root morphology
  • delayed eruption
  • ectopic tooth position
  • arrested development
  • complete failure of tooth to form
  • odontome formation
152
Q

complications of trauma in primary dentition to the permanent successor
enamel defects

A
  • enamel hypomineralisation - poorly mineralised, no tx or composite masking +/- localised removal or tooth whitening
  • enamel hypoplasia - reduced thickness of enamel but normal mineralisation - either no tx or composite masking
153
Q

complications of trauma in primary dentition to the permanent successor
abnormal crown/root morphology

A
  • dilaceration - abrupt deviation of the long axis of the crown or root portion of the tooth
  • crown dilaceration management options
  • surgical exposure and orthodontic reallignment
  • improve aesthetics restoratively
  • root dilaceration/angulation/duplication - combined surgical and orthodontic approach
154
Q

complications of trauma in primary dentition to the permanent successor
delayed eruption

A
  • premature loss of primary tooth can delay eruption of around 1 year
  • due to thickened mucosa
  • radiograph if >6month delay compared to contralateral tooth
  • surgical exposre and orthodontic allignment may be required
155
Q

complications of trauma in primary dentition to the permanent successor
ectopic tooth position options

A
  • surgical exposure and orthodontic realignment
  • or
  • extraction
156
Q

complications of trauma in primary dentition to the permanent successor
arrested development

A
  • options:
  • endodontic tx
  • extraction
157
Q

complications of trauma in primary dentition to the permanent successor
complete failure of tooth formation/odontome formation

A
  • tooth germ may sequestrate spontaneously
  • or may require removal
  • odontome formation requires surgical removal
158
Q

paeds oral medicine
oro-facial soft tissue infections

A
  • viral: primary herpes, herpangina, hand foot and mouth, varicella zosterm epstein barr virus, MMR
  • bacterial: staphylococcal, streptococcal, syphylis, TB
  • fungal: candida
159
Q

paeds oral medicine
oral ulceration definition

A
  • localised defect in surface oral mucosa
  • where covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
160
Q

paeds oral medicine
oral ulceration history 10 key facts

A
  1. onset
  2. frequency
  3. number
  4. site
  5. size
  6. duration
  7. exacerbating dietary factors
  8. lesions in other areas
  9. associated medical problems
  10. tx so far: helpful/unhelpful
161
Q

paeds oral medicine
oral ulceration causes

A
  • infection: hand foot and mouth/herpes simplex/ herpes zoster/EBV, bacteria TB/syphylis
  • immune mediated disorders: crohns, coeliac, SLE (lupus)
  • inherited or acquired immunodeficiency disorders
  • anaemia/leukaemia/agranulocytosis
  • trauma
  • vitamin deficiencies - iron, b12, foate
  • recurrent apthous stomatitis
162
Q

paeds oral medicine
recurrent apthous ulceration
appearance and pattern

A
  • most common cause of ulceration in children
  • typically round or ovoid in shape with grey or yellow base
  • varying degree of perilesional erythema
  • 3 patterns:
  • minor <10mm
  • major >10mm
  • herpetiform 1-2mm
163
Q

paeds oral medicine
recurrent apthous ulceration aetiology

A
  • aetiology unclear
  • aetiological factors:
  • hereditary predisposition
  • haematological and deficiency disorders
  • GI disease
  • minor trauma in susceptible individual
  • stress
  • allergic disorders
  • hormonal disturbance - menstruation
164
Q

paeds oral medicine
recurrent apthous ulceration investigations

A
  • diet diary
  • full blood count
  • haematinics
  • coeliac screen
165
Q

paeds oral medicine
recurrent apthous ulceration management

A
  • manage exacerbating factors - nutritional deficiencies/traumatic factors/avoid sharp or spicy food
  • diet analysis may suggest exacerbating food groups
  • low ferritin = 3 months of irom supplementation
  • low folate/b12/positive coeliac screen = referral to paediatrician for further investigation
  • prevention of superinfection - corsodyl 0.2% mouthwash
  • protect healing ulcers - gengigel topical gel / gengigel mouthwash (hyaluronate)
  • symtomatic relief - LA spray, difflam
166
Q

paeds oral medicine
primary herpetic gingivostomatitis overview

A
  • acute infectious disease caused by herpes simplex virus 1
  • primary infection common in children - transmission by droplet formation
  • 7 day incubation period
  • almost 100% poupulation are carriers
  • degree of immunity from circulating maternal antibodies so infection rare in first 12 months
  • lasts 14 days and heals with no scarring
  • remains dormant in epithelial cells and recurrent disease 50-75%
  • triggered by sunlight, stress, other causes of ill health
167
Q

paeds oral medicine
primary herpetic gingivostomatitis signs and symptoms

A
  • fluid filled vesicles which rupture to painful ulcers on gingivae, tongue, lips, BM, PM
  • severe oedematous marginal gingivitis
  • fever
  • headache
  • malaise
  • cervical lymphadenopathy
168
Q

paeds oral medicine
primary herpetic gingivostomatitis tx

A
  • bed rest
  • soft diet/hydration
  • paracetamol
  • antimicrobial gel/MW
  • acyclovir (antiviral med) for immunocompromised children
  • most common complication is dehydration
  • managed with topical acyclovir cream
169
Q

paeds oral medicine
coxsachie A virus conditions overview

A
  • herpangina: vesicles in tonsillar/pharyngeal region, lasts 7-10 days
  • hand foot and mouth: ulceration on the gingivae/tongue/cheeks and palate, rash on hands and feet, lasts 7-10 days
170
Q

paeds oral medicine
orofacial granulomatosis overview

A
  • uncommon chronic inflammatory disorder
  • idiopathic or associated with systemic granulomatous conditions (crohsn or sarcoidosis)
  • average onset at 11 years
  • males> females
  • characteristic pathology is non ceacating giant cell granulomas which then results in lymphatic obstruction
  • may be predictor for future chrohns disease
  • A granuloma is a tiny cluster of white blood cells and other tissue
171
Q

paeds oral medicine
orofacial granulomatosis clinical features

A
  • same features as oral crohns
  • lip swelling most common
  • full thickness gingival swelling
  • swelling of non labial facial tissues
  • peri-oral erythema
  • cobblestone appearance of buccal mucosa
  • linear oral ulcreation
  • angular chelitis
172
Q

paeds oral medicine
orofacial granulomatosis diagnoses

A
  • clinical - lip biopsy not essential
  • investigations:
  • measure growth - paediatric growth charts
  • FBC
  • haematinics
  • patch testing - identify triggers
  • diet diary to identify any triggers
  • faecal calprotectin
  • endoscopy risky in childhoos
  • serum angiotensin converting enzyme raised in sarcoidosis
173
Q

paeds oral medicine
orofacial granulomatosis management

A
  • can be difficult
  • oral hygiene support
  • symptomatic relief as per oral ulceration - LA spray, difflam
  • dietary exclusion
  • manage nutritional deficiencies which may contribute
  • topical steroids
  • short courses of oral steroids
  • intalesional corticosteroids
  • surgical intervention
174
Q

paeds oral medicine
solid swellings

A
  • fibroepithelial polyp
  • epulides
  • congenital epulis
  • HPV associated mucosal swellings
175
Q

paeds oral medicine
solid swellings fibroepithelial polyp

A
  • common
  • firm pink lump: pedunculated (stalk) or sessile (fixed/immobile)
  • mainly in cheeks along occlusal line, lips or tongue
  • once established remains constant size
  • thought to be initiated by minor trauma
  • surgical excision is curative
176
Q

paeds oral medicine
solid swellings - epulides

A
  • common solid swelling of the oral mucosa
  • benign hyperplastic lesions
  • 3 main types:
  • fibrous epulis
  • pyogenic granuloma
  • peripheral giant cell granuloma
177
Q

paeds oral medicine
solid swellings - fibrous epulis

A
  • pedunculated or sessile mass
  • firm consistency
  • similar colour to surrounding gingivae
  • inflammatory cell infiltrate and fibrous tissue
178
Q

paeds oral medicine
solid swellings - pyogenic granuloma

A
  • type of epulides
  • soft, deep, purple/red swelling
  • often ulcerated
  • haemorrhage spontaneously or with mild trauma
  • vascular proliferation supported by a delicate fibrouos stroma
  • probably a reaction to chronic trauma
  • tend to recur after removal
179
Q

paeds oral medicine
solid swellings - peripheral giant cell granuloma

A
  • type of epulides
  • pedunculated or sessile swelling
  • typically dark red and ulcerated
  • usually arises inter-proximally and has hour glass shape
  • multinucleate giant cells in a vascular stroma
  • may recur after surgical excision
  • radiographs may reveal superficial erosion of interdental bone
180
Q

paeds oral medicine
solid swellings - congenital epulis

A
  • rare lesion
  • occurs in neonates
  • most commonly anterior maxilla
  • F>M
  • granular cells covered with epithelium
  • benign
  • simple excision curative
181
Q

paeds oral medicine
solid swellings - HPV associated swellings

A
  • veruuca vulgaris: may have skin wart association, solitary or multiple intr-oral lesions,caused by HPV 2 and 4, most commonly on keratinized tissue (gingivae and palate)
  • squamous cell papilloma: small pedunculated cauliflower like growths, benign, HPV 6 and 11, vary in colour from pink to whitemsurgical excision tx
182
Q

paeds oral medicine
fluid swellings

A
  • mucoceles
  • ranula
  • bohns nodules
  • epstein pearls
183
Q

paeds oral medicine
fluid swellings - mucoceles

A
  • bluish, soft, transparent cystic swelling
  • cann affect minor or major salivary glands
  • most = minor SG of lower lip
  • most will rupture spontaneously
  • surgery only if lesion fixed in size, removal or cyst and adjacent damaged minor salivary gland
  • 2 variants: mucous extravasation or retention cyst
184
Q

paeds oral medicine
fluid swellings - ranula

A
  • mucocele in FOM
  • can arise from minor salivary glands or ducts of sublingual/submandibular gland
  • ultrasound or MRI needed to exclude plunging ranula (extend through FOM to submental or submandibular space)
  • occasionally found to be lymphangioma - benign tumour of lymphatics
185
Q

paeds oral medicine
fluid swellings - bohns nodules

A
  • gingival cysts
  • remnants of dental lamina
  • filled with keratin
  • occur on alveolar ridge
  • found in neonates (1st 28 days)
  • usually disappear in early months of life
186
Q

paeds oral medicine
fluid swellings - epstein pearls

A
  • small cystic lesions
  • found along palatal midline
  • thought to be trapped epithelium in palatal raphe
  • in 80% neonates
  • disappear in 1st few weeks
187
Q

paeds oral medicine
TMJDS overview

A
  • temporomandibular joint dysfunction syndrome
  • most common condition affecting temporomandibular region
  • characterised by pain, masticatory muscle spasm, limited jaw opening
188
Q

paeds oral medicine
TMJDS history

A
  • description of presenting symptoms
  • when did discomfort begin
  • is pain worse at any time of day
  • exacerbating factors
  • habits
  • stress
189
Q

paeds oral medicine
TMJDS examination

A
  • palpation of MOM at rest and when teeth are clenched - assess tenderness and/or hypertrophy
  • palpation of TMJ at rest and when opening/closing - assess tenderness and click/crepitus
  • assessment of opening - any deviation of the jaw, extent of opening
  • assessment of any dental wear facets
  • signs of clenching/grinding: scalloped lateral tongue surface, buccal mucosa ridges
190
Q

paeds oral medicine
TMJDS management

A
  • symptomatic relied: ibuprofenm alternating hot and cold packs
  • if measure unsuccessful referral to specialist care indicated
  • reduction of exacerbating factors: stress management, avoid clenching, grinding, chewing gum, nail biting
  • bite raising appliance may be considered if there is nocturnal grinding/clenching
  • allow over worked muscles to rest: avoid wide opening, soft diet which requires little chewing
191
Q

what is the name of the guidance for paeds caries management

A
  • SDCEP
  • prevention and management of dental caries in children
192
Q

SDCEP paeds guidelines
overview (flow diagram)

A
  • assessing the child and the family
  • defining needs and developing a care plan
  • if child in pain manage pain
  • caries prevention
  • if caries present manage caries
  • recall
193
Q

SDCEP paeds guidelines
clinical assessment overview

A
  • assess childs plaque levels and their toothbrushing skills and discuss with child/parent
  • assess dentition - visual examination for caries on clean and dry teeth
  • consider taking BW to diagnose extent of any caries - assess activity of each carious lesion
  • assume all lesions are active unless evidence that they are arrested
  • assess risk of lesion causing pain or infection before exfoliation (primary dentition) for tx plan
  • discuss findings on the clinical assessment with the child and parent
194
Q

SDCEP paeds guidelines
classification of carious lesions in primary teeth

A
  • categories: occlusal; proximal; anterior; special cases
  • caries classified as either initial or advanced
  • initial: non cavitation, white spot lesion or dentine shadow or minimal enamel cavitation, radiographically lesion confined to enamel or outer third dentine
  • advanced: cavitation or dentine shadow, can have visible dentine, radiographically middle or inner third dentine
195
Q

SDCEP paeds guidelines
classification of carious lesions in primary teeth
special cases

A
  • pulpal involvement: clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically
  • near to exfoliation: clinically mobile and radiograph shows root resorption
  • arrested caries: any tooth with arrested caries where aesthetics is not a priority
  • unrestorable: crown destroyed by caries or fractures, or pulp exposed with pulp polyp (pain/infection free)
196
Q

SDCEP paeds guidelines
classification of carious lesions in permanent teeth

A
  • categorised into: occlusal; proximal; anterior; special cases
  • either initial, moderate or extensive - anterior is initial or advanced (same as primary classification)
  • initial: non cavitated, white spot lesion, stained fissures/discoloured
  • moderate: enamel cavitation or dentine shadow, visible dentine, up to middle third dentine
  • extensive: cavitation with visible dentine, widespread dentine shadow, inner third dentine
  • special cases: pulpal involvement or unrestorable
197
Q

SDCEP paeds guidelines
reversible pulpitis management

A
  • restore
  • or place dressing and restore later
198
Q

SDCEP paeds guidelines
irreversible pulpitis management pre-cooperative child

A
  • try to dress with sub-lining of corticosteroid-antibiotic paste
  • prescribed pain relief
  • primary - refer for tx/X with sedation or GA
  • permanent - carry out RCT or X - if child remains uncooperative refer for specialist care
199
Q

SDCEP paeds guidelines
irreversible pulpitis management in cooperatve child

A
  • primary - carry out X or appropriate pulp therapy
  • permanent - carry out RCT or X
  • if multiple abscessed teeth: in primary dentition refer for X with sedation/GA and in permanent carry out RCT or X (may require specialist care)
200
Q

SDCEP paeds guidelines
oral health promotion advice

A
  • brush twice a day using fluoride toothpaste
  • advice amount of toothpaste and fluoride conc appropriate for childs age/caries risk
  • supervised brushing until child can brush effectively
  • spit dont rinse
  • how a healthy diet can prevent caries
  • for all children place FS on permanent molars as early as possible after eruption
  • for all 2+ apply FV at least 2 x year
201
Q

SDCEP paeds guidelines
toothpaste amount

A
  • <3 years: use a smear
  • > 3 years: use a pea-sized amount
202
Q

SDCEP paeds guidelines
fluoride amount

A
  • standard prevention: 1000-1500ppmF all ages
  • enhanced prevention up to age 10: 1350-1500ppmF
  • age 10+ enhanced prevention: consider 2800ppmF
203
Q

SDCEP paeds guidelines
standard orevention for all children

A
  • give toothbrushing advice at least onec a year
  • demonstrate brushing on the child annually
  • give dietary advice at least once a year
  • place sealants in all pits and fissures of peranent molars as soon as possible after eruption
  • check existing FS for wear and integrity at every recall visit
  • top up worn or damaged sealants
  • apply sodium fluoride varnish twice a year age 2+
204
Q

SDCEP paeds guidelines
enhanced prevention for children at increased risk of caries

A
  • at each recall visit give hand on TB instruction
  • at each recall visit provide dietary advice
  • recommend use of 1350-1500ppmF for up to 10 years and 2800 10+
  • consider use of GI as temp sealant on partially erupted 6s and 7s until tooth fully erupted
  • FS palatal pits on 12, 22 and occlusal and palatal surfaces of Ds, Es and 7s
  • ensure FV applied 4 x year aged 2+
  • utilise any community/home support
  • in unable to provide FS then ensure FV application is optimal and attempt again if cooperation improves
205
Q

SDCEP paeds guidelines management of caries in permanent teeth if 6s with MIH

A
  • if not severe, not sensitive and do not require restoration - enhanced prevention (FS etc) and monitor
  • if small defects that require restoration - adhesive restorative materials
  • if molars sensitive use GIC as FS
206
Q

supporting tissue injuries

A
  • concussion
  • subluxation
  • lateral luxation
  • intrusion
  • extrusion
  • avulsion
  • alveolar fracture
207
Q

supporting tissue injuries
important considerations

A
  • impact of injury on:
  • surrounding bone
  • neurovascular bundle
  • root surface
  • nature of trauma: separation injury; crushing injury
208
Q

supporting tissue injuries
general points

A
  • remember history
  • baseline sensibility tests
  • radiographs
  • post-trauma homecare instructions
209
Q

supporting tissue injuries
concussion overview/findings/tx/follow up

A
  • injury to tooth supporting structures without abnormal loosening or displacement of tooth
  • clinical findings: pain on percussion
  • tx: no tx
  • follow up clinical and radiographic: 4 weeks and 1 year
210
Q

supporting tissue injuries
subluxation overview/findings/tx/follow-up

A
  • injury to tooth supporting structures with abnormal loosening
  • but without tooth displacement
  • clinical findings: tender to percussion, increased mobility, bleeding from gingival crevice may be present
  • tx: normally no tx, splint if excessive mobility or tenderness when biting
  • follow up clinical and radiographic: 2 weeks (including splint removal), 12 weeks, 6 months and 1 year
211
Q

supporting tissue injuries
concussion/subluxation monitoring

A
  • trauma stamp
  • sensibility tests: thermal and electrical - false negative result is possible
  • radiographs: root development, comparison with contralateral tooth, resorption
212
Q

supporting tissue injuries
extrusion overview/findings/tx/follow-up

A
  • tooth suffers axial displacement partially out of the socket
  • findings: tooth appears elongated; usually displaced palatally; tooth mobile; bleeding from gingival sulcus
  • tx: resposition under LA by pushing it back into socket; splint
  • follow up: 2 weeks (inlcuding splint removal); 4 weeks; 8 weeks; 12 weeks; 6 months; 1 year
  • then annually for at least 5 years
213
Q

supporting tissue injuries
lateral luxation overview/findings

A
  • displacement of a tooth in socket in a direction other than axially
  • can be accompanied by comminution or fracture of alveolar plate
  • clinical findings:
  • tooth appears displaced in socket
  • tooth immobile
  • high ankylotic percussion tone
  • may be bleeding from gingival sulcus
  • root aex may be palpable in sulcus
214
Q

supporting tissue injuries
lateral luxation tooth prognosis

A
  1. incomplete root formation: spontaneous revascularisation may occur; if pulp becomes necrotic or sign of external resorption - endo tx
  2. complete root formation: pulp will likely become necrotic; commence endodontic tx; corticosteroid-antibiotic or CaOH as intra-canal medicament to prevent development of inflammatory external resorption
215
Q

supporting tissue injuries
lateral luxation tx and follow-up

A
  • reposition under LA
  • splint
  • follow up:
  • 2 weeks endo evaluation
  • 4 weeks splint moval
  • 8 weeks; 12 weeks; 6 months; 1 year
  • annually for at least 5 years
216
Q

supporting tissue injuries
intrusion overview/clinical findings

A
  • tooth forced into socket in axial direction and locked into bone
  • clinical findings:
  • crown appears shortened
  • bleeding from gingivae
  • ankylotic high, metallic percussion tone
217
Q

supporting tissue injuries
intrusion tx immature root formation

A
  • spontaneous repositioning independent of degree or intrusion
  • if no-eruption within 4 weeks - ortho repositioning
  • monitor the pulp condition
  • spontaneous revascularisation may occur
  • if pulp becomes necrotic or infected or signs of inflammatory external resorption start endo tx ASAP when tooth position allows
218
Q

supporting tissue injuries
intrusion tx mature root formation

A
  • <3mm: spontaneous repositioning and if no eruption within 8 weeks reposition surgically and splint (for 4 weeks) or reposition orthodontically before ankylosis develops
  • 3-7mm: reposition surgically and splint or orthodontically
  • > 7mm reposition surgically and spling (4 weeks)
  • pulp almost always becomes necrotic
  • start endo tx at 2 weeks or as soon as tooth position allows
219
Q

supporting tissue injuries
intrusion follow up

A
  • 2 weeks - start endo tx if tooth pos allows
  • 4 weeks -splint removal
  • 8 weeks; 12 weeks; 6 months; 1 year
  • annually for at least 5 years
220
Q

supporting tissue injuries
avulsion overview/critical factors

A
  • tooth totally displaced from socket
  • clinical findings: socket empty or filled with coagulum
  • one of the few real emergency situations in dentistry
  • critical factors:
  • extra alveolar dry time EADT
  • extra alveolar time EAT
  • storage medium
  • management factors: maturity of root, PDL cell condition
221
Q

supporting tissue injuries
avulsion emergency adivice

A
  1. ensure permanent tooth
  2. hold by cvrown
  3. encourage attempt to place immediately into socket - if dirty rinse with milk, saline or saliva
  4. bite on gauze/hankerchief to hold in place
  5. seek immediate dental advice
  • if replantation not possible store in:
    1. milk
    2. HBSS (salt solution)
    3. saliva
    4. saline
    5. water
222
Q

supporting tissue injuries
avulsion management closed apex and tooth already replanted

A
  • clean injured area
  • verify tooth position and apical status - clinical and radiograph
  • place splint
  • suture gingival lacerations if present
  • consider antibiotics and check tetanus status
  • provide post-op instructions
  • follow-up
  • commence endo tx within 2 weeks using CaOH up to 1 month or carticosteroid-antibiotic paste 6 weeks
223
Q

supporting tissue injuries
avulsion management closed apex EADT<60 mins

A
  • PDL cells may be viable but compromised
  • remove debris
  • replant tooth under LA
  • splint
  • suture gingival lacerations if present
  • consider antibiotics and check tetanus status
  • POI
  • follow up
  • commence endo tx within 2 weeks using CaOH up to 1 month or carticosteroid-antibiotic paste 6 weeks
224
Q

supporting tissue injuries
avulsion management closed apex EADT>60 mins

A
  • PDL cells likely to be non-viable
  • remove debris
  • replant tooth under LA
  • splint
  • suture gingival lacerations if present
  • consider antibiotics and check tetanus status
  • POI
  • follow up
  • commence endo tx within 2 weeks using CaOH up to 1 month or carticosteroid-antibiotic paste 6 weeks
225
Q

supporting tissue injuries
avulsion management closed apex follow-up

A
  • 2 weeks - splint removal and have commenced endo by then
  • 4 weeks; 12 weeks; 6 months; 1 year
  • annually for at least 5 years
226
Q

supporting tissue injuries
avulsion management closed apex if delayed replantatio

A
  • poor long term prognosis - ankylosis related root resorption
  • decision to replant almost always correct
  • referral to paediatric specialist/inter-disciplinary management
227
Q

supporting tissue injuries
avulsion management open apex if tooth already replanted

A
  • clean injured area
  • verify tooth position and apical status - clinical and radiographic
  • place splint
  • suture gingival lacerations if present
  • consider antibiotics and check tetanus status
  • POI
  • follow up
  • endo tx only if definite signs of pulp necrosis and infection of root canal system
228
Q

supporting tissue injuries
avulsion management open apex EAT over and under 60 mins

A
  • EAT<60 mins potential for spontaneous healing
  • > 60 mins PDL cells likely non viable - likely outcome is ankylosis related root resorption
  • management same for both
  • remove debris
  • replant under LA
  • splint
  • suture gingival lacerations if present
  • consider antibiotics and check tetanus status
  • POI and follow up
  • endo tx only if definite signs of pulp necrosis and infection of root canal system
229
Q

supporting tissue injuries
avulsion management open apex goal

A
  • revascularisation is goal
  • risk of external infection-related root resorption so clone monitoring
  • endodontic tx if signs of pulp necrosis and infection
  • delayed replantation can result in: akylosis related root resorption
230
Q

supporting tissue injuries
avulsion management open apex follow up

A
  • 2 weeks - splint removal
  • 1 week; 2 weeks; 12 weeks; 6 months; 1 year
  • annually for at least 5 years
231
Q

supporting tissue injuries
avulsion management
when not to replant

A
  • medical contraindications
  • child immunocompromised
  • other serious injuries requiring preferential emergency tx
  • potential dental contraindications: very immature apex and extended EAT, very immature lower incisorsin young child finding it difficult to cope
232
Q

supporting tissue injuries
dento-alveolar # overview/clinical findings/tx

A
  • fracture of alveolar bone which may ormay not include alveolar socket
  • clinical findings: complete alveolar fracture extending buccal-lingual; segment mobility with several teeth moving together; occlusal disturbance; gingival laceration
  • tx: reposition any segment; splint; suture gingival lacerations if present; monitor pulp condition of all teeth involved
233
Q

supporting tissue injuries
dento-alveolar # follow-up

A
  • monitor clinically and radiographically
  • root development, canal width and length - compare with neighbouring teeth
  • 4 weeks (including splint removal)
  • 8 weeks, 4 months, 6 months, 1 year
  • annually for at least 5 years
234
Q

supporting tissue injuries
types of splint

A
  • chair side: composite and wire; titanium trauma splint; orthodontic brackets and wire; acrylic
  • lab made: vacuum formed splint (essex); acrylic
235
Q

supporting tissue injuries
composite and wire splint

A
  • stainless steel wire up to 0.4mm in diameter
  • ensure passive
  • flexible - include one tooth either side of traumatised tooth/teeth
236
Q

supporting tissue injuries
titanium trauma splint

A
  • rhomboid mesh structure
  • 0.2mm thick
  • secured to teeth with composite resin
237
Q

supporting tissue injuries
dento-alveolar # advice

A
  • soft diet for 7 days
  • avoid contact sport whilst splint in lace
  • careful oral hyiene
  • with use of chlorhexidine gluconate mouthwash 0.12%
238
Q

supporting tissue injuries
main post-trauma complications

A
  1. pulp necrosis and infection
  2. pulp canal obliteration
  3. root resorption
  4. breakdown of marginal gingiva and bone
239
Q

supporting tissue injuries
external surface resorption

A
  • superfician resorption lacunae - repaired with new cementum
  • response to localised injury
  • not progressice
240
Q

supporting tissue injuries
external infection related root resorption

A
  • non-vital tooth
  • inidiated by PDL damage and propagated by root canal toxins reaching external root surface
  • diagnosis: indistinct root surface, root canal tramlines intact
  • rapid
  • management: remove stimulus, endo tx
  • non setting CaOH 4-6 weeks then obturate
241
Q

supporting tissue injuries
ankylosis related root resorption

A
  • initiated by severe damage to PDL and cemenutm
  • normal repair does not occur - bone cels faster than PDL fibroblasts
  • radiographically shows ragged root outline and no obvious PDL space
  • tx: plan loss
242
Q

supporting tissue injuries
internal infection related root resorption

A
  • due to progressive pulp necrosis
  • radiographically shows symmetrical expansion of root canal walls (ballooning) and tramlines of root canal indistinct, root surface intact
  • tx: remove stimulus, endo tx
  • non setting CaOH 4-6 weeks then obturate with GP
  • if progressive plan for loss

BDS3 - CDS (13 decks)

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