paediatrics Flashcards
what are GDC expectations of registrants in managing cases of acute or neglect in children and vulnerable adults - 3
be aware of procedures involved in raising concerns about abuse or neglect
know who to contact for further advice
know how to refer to appropriate authority
what is safeguarding
Measures taken to minimise the risks of harm to children.
what is child protection
Activity undertaken to protect specific children who are suffering, or are at risk of suffering, significant harm
who are children in need
those requiring additional support or services to reach full potential
what is child abuse and neglect
anything which those entrusted with care of children do or fail to do which damages the child’s prospect of safe and healthy development
child protection legislation in Scotland
GIRFEC
national guidance for CP in Scotland 2014
children and young people act 2014
according to the CYPA 2014, when can information be shared
when safety is at risk
when benefit of sharing outweighs the public/individuals interest of keeping confidential
get consent when possible/safe to
what is the UN convection on the rights of child based on
needs of child
e.g.
right to be protected from harm
right to a good start in life
right to feel and be secure
big 3 contributing factors of child abuse
drugs and alcohol misuse
domestic violence
mental illness
how can a child contribute to child abuse
crying
soiling
unwanted pregnancy - forced sex
wrong gender
5 categories of child abuse
physical
emotional
neglect
sexual
non-organic - failure to thrive
what makes a child vulnerable- 3
under 5
irregular attender - repeatedly DNA, return in pain
medical problems and disabilities
in Scotland how many children are killed by parent/substitute
10 PER YEAR
how many children die in the UK as a result of child abuse and neglect
1-2 per week
what is the meaning of neglect
repeatedly failing to meet a Childs basic needs
what are a Childs needs
nutrition
warmth, clothing, shelter
hygiene and health care
stimulation and education
affection
what are the effects of neglect on a Childs needs
failure to thrive - short stature
inappropriate clothing - cold or sunburn
dirty - fingernails, head lice, dental caries
developmental delay
withdrawn or attention seeking
why does neglect of neglect occur
neglect is less incident focused
what are the long term effects of adults who are neglected as children?
greater incidence. of arrest, suicide, depression, diabetes and heart disease
define dental neglect
persistent failure to meet a Childs basic oral health needs
likely to result in serious impairment of a Childs oral/general health and
3 reasons other than neglect for obvious dental caries in children
inequalities in dental treatment access
individual susceptibility
inequalities in dental health - poverty
what is the effect of severe dental neglect on pt
toothache
disturbed sleep
absence from school
difficulty eating
risks associated with dental disease in child
bullying
antibiotic resistance
repeated GA
severe infection
after dental problems have been pointed out to parent/substitute, what indicates wilful dental neglect
irregular attendance
repeated FTA or late cancellations
returning in pain repeatedly
failure to complete treatment
repeated GA extraction
indicators of dental neglect
obvious dental disease
delayed presentation
practical care offered, child hasn’t returned
3 stages of managing dental neglect
preventative dental team management
preventative multi-agency management
child protection referral
what is involved in stage 1 of managing dental neglect - preventative dental team management
raise concerns with parents
offer support
set targets
record and monitor
what is involved in stage 2 of managing dental neglect - multi agency management
lease with other professions to see if concerns shared
agree joint plan of action
letter to HV if child <5 who fail appointments or don’t respond
what is involved in stage 3 of managing dental neglect - CP referral
referral to social services
telephone followed up by writing
types of physical abuse
over chastisement
acute /compassionate - shaking - remorse
chronic/pathological - no remorse
what percentage of head injuries in first year are non-accidental
95%
what percentage of body injuries on a 5 year old in A&E are non-accidental
10%
what percentage of childhood burns are non-accidental
10-12%
what percentage of head and neck injuries in abuse cases are non-accidental
60%
areas on body of non-accidental injuries
ears
triangle of safety - ears side of neck and face and shoulder
soft tissues of cheeks
forearms - raised to protect
chest and abdomen
inner arms
where are common areas on body accidentally injured
bony prominences - knees, shins, elbows
nose, palms, chin, forehead
match history
which of the following does not raise your concerns of an injury
a. injuries to both sides
b.injuries to soft tissues
c.injuries to bony prominences
d.injuries that don’t fit presentation
c. injuries to bony prominences
the rest all elevate concerns
orofacial signs of physical abuse
abrasions and lacerations
neck - choke marks
hair pulling
bruising of face and ears - different stages of healing, punch, slap and grip marks
intra oral signs on physical abuse
bruises
tooth trauma
renal injury
contusions
medical conditions that may be mistaken for trauma
impetigo - cig burns
birth marks or coagulation problems - bruises
facial infection - trauma
what does the SHANARRI model stand for in wellbeing of children
safe
healthy
achieving
nurtured
active
respected
responsible
included
what may heighten your suspicions of abuse
delay seeking help
story vague and varies
story not compatible with inject
parents mood and behaviour abnormal
Childs interaction with parent abnormal
why is a dentist role so important in preventing death of a child by abuse
we may be the first person to notice signs of abuse in children and can get the child out of danger
contribute vital information to save child
which of the following is a dentist not required to do with child abuse
a diagnose
b observe
c record
d communicate
e refer for assessment
a diagnose
what orders can be implemented if a child is in immediate danger after a referral
child protection order
exclusion order
child assessment order
removal of police or authority of a judicial officer
3 pharmacological behaviour management techniques
inhalation sedation NO2
sedation with midazolam
GA
who are pre cooperative patients
very young children - communication can’t be established
who are children who lack co-operative ability
specific intellectual and LD
what percentage of communication is non-verbal
55%
what percentage of communication is words alone
7%
define dental anxiety
reaction to unknown fear
define dental fear
reaction to known fear
fight - flight - freeze
define dental phobia
same as dental fear - reaction to known fear
but much stronger response
physiological and somatic sensations of dental fear and anxiety
breathlessness
perspiration
palpitations
unease feeling
cognitive features of dental fear and anxiety
hypervigilant
interference with concentration
catastrophising
behavioral reactions of pt with dental fear and anxiety
avoidance of treatments and appointments
aggression
escape situations
factors affecting child and adolescent anxiety - 3
PMH -ve experience
PDH - adverse previous experience
parental anxiety
parental presence
dental staff behaviour
how can you measure dental fear and anxiety
MCSADf
modified child dental anxiety scale - faces
non-pharmacological BMT - 5
preparatory info - e.g. welcome letters
voice control - young children respond to tone
tell show do
enhanced control - stop signals
describe tell show do technique
tell - age appropriate procedure explanation
show - demonstrate procedure
do - perform procedure with minimal delay
describe enhanced control BMT technique and 3 examples
allows patient to have control over dentist
stop and go signals
ask patient which tooth they want to start with
structured time
aspects of non-verbal communication used to reduce anxiety
happy smiling team
eye contact
gentle pats on shoulder
non-pharmacological BMT - 5
distraction
tell show do
enhanced control - stop signals
give an example of a procedure desensitisation would be suitable for in an anxious patient
LA
example of topical anaesthetic
5% lidocaine
18-20% benzocaine - not for children under 2
non-pharmacological pain control techniques
relaxation
distraction
systematic desensitisation
max dose of lidocaine 2%
1x2.2ml per 10kg if body weight if fit and well
max dose of articaine 4%
0.8x2.2ml cartridge per 10kg of patient
between an upper LA restoration and lower LA restoration, which should you do first
upper
between an upper and lower tooth, which should be extracted first
upper
describe positive reinforcement and give an example
strengthening of a pattern of desired behaviour - likely to display again in future
e.g. smiles, praise, stickers, child centred phrases
what fungal organism oro-facial soft tissue infection
candida
3 viral orofacial infection examples
primary herpes
herpangina
hand foot and mouth
others to note
MMR - measles mumps and rubella
EBV
varicella zoster
what virus causes primary herpetic gingivostomatitis
herpes simplex virus 1
why is there a degree of immunity to herpetic gingivostomatitis in 1st year of life
circulating maternal antibodies
signs and symptoms of primary herpetic gingivostomatitis
fluid filled vesicles - rupture to ulcers on gingivae tongue and mucosa
severe oedematous marginal gingivitis
fever and cervical lymphadenopathy
treatment of primary herpetic gingival stomatitis
hydration
soft diet
acyclovir if immune compromised
which cells does herpetic gingivalstomatitis remain dormant in
epithelial
triggers of herpes labialis - cold sores
sunlight
stress
ill health
management of cold sores
acyclovir cream
which infections are caused by coxsackievirus A
herpangina
hand foot and mouth
where are vesicles found in the mouth in a pt with herpangina
vesicles in tonsil/pharyngeal region
what signs will a patient with hand foot and mouth disease display
ulcers - gingivae tongue cheek palate
maculopapular rash on hands and feet
define oral ulceration
localised defect in surface of oral mucosa
epithelium destroyed exposing inflamed connective tissue
10 key facts when taking history of an ulcer
onset
frequency
site
number
size
duration
exacerbating diet factors
lesions in other area
associated MH
treatment so far - helpful or no
give causes of oral ulceration - 5
infection - e.g. herpes simplex
immunodeficiency
trauma
vitamin deficiency - iron b12 folate
haematological - leukaemia
what is the term for recurrent painful ulceration in oral cavity
recurrent apthous stomatitis
what is the most common cause of ulcers in children
recurrent apthous stomatitis
3 causes of RAU
GI disease
stress
hormonal disturbance - menstruation
investigations for recurrent apthous stomatitis
diet diary
FBC
haematinics
coeliac screen
what is orofacial granulomatosis
chronic inflammatory disorder, unknown cause
characteristic pathology of OFG
non-caseating giant cell granulomas which result in lymphatic obstruction
clinical features of OFG and oral crohns
lip swelling
gingival swelling
cobblestone buccal mucosa
peri-oral erythema
linear oral ulceration
difference between OFG and oral crohns
oral crohns is a manifestation of crohns disease - a chronic inflammatory bowel disease
OFG is a chronic inflammatory condition, unknown aetiology - characterised by non caseating granulomas
what is geographic tongue
idiopathic
shiny red area with loss of papillae on tongue surrounded by white margins
what is a fibroepithelial polyp
firm pink lump
cheeks lips or tongue
initiated by minor trauma
what is an epulide
solid swelling of oral mucosa - benign hyper plastic lesions
what are the 3 types of epulide
fibrous epulis
pyogenic granuloma
peripheral giant cell granuloma
describe a fibrous epulis
a pedunculate or sessile mass similar in colour to surrounding gingiva
formed of inflammatory cells and fibrous tissue
cured by removal
describe a pyogenic granuloma
soft deep red/purple swelling
often ulcerated
vascular proliferation and delicate fibrous stroma - haemorrhage spontaneously and with mild trauma
recur after removing
another name for pyogenic granuloma
pregnancy epulis
describe a giant cell granuloma
interproximal
dark red
ulcerated
multinucleate giant cells in a vascular stroma
what is a congenital epulis
rare benign lesion - occurs in neonates
granular cells covered with epithelium
HPV that causes verruca vulgaris
2 and 4
HPV that causes squamous cell papilloma
6 and 11
little cauliflower like growths
what is a mucocele
bluish soft transparent swelling - blockage of salivary gland
can affect major and minor
2 types of mucocelle
mucous extraction cyst - secretions rupture - most
mucous retention cyst - secretions retained in expanded duct
what is a radula
mucocele in FOM
can be minor or ducts of submandibular/sublingual glands
why take an ultrasound or MRI for a radula
ro exclure plunging renal - extending through FOM into submandibular space
what are bohns nodules and what are they remnants of
gingival cysts filled with keratin
remnants of dental lamina
what are Epstein pearls
small cystic lesions found along midline of palate
important questions to ask when taking history of TMD
symptoms
when it began
times it is worse
exacerbating factors
stress
habits
what is the normal extent of jaw opening
40-50mm
EO exam for TMD
palpate MOM for tenderness and hypertrophy
palpate TMJ for tenderness and clicking
assess opening and deviation
IO exam for TMD
tooth wear
signs of clenching/grinding - tongue scalloped, buccal mucosa ridges
management of TMD
manage stress
avoid habits
bite raising appliance if nocturnal grinding
avoid wide opening - use fist to support when yawning
soft diet
ibuprofen
ratio of Males:Females affected by ASD
3:1
how does autism affect people
spectrum - affects everyone differently
social communication - difficulties verbal and non-verbal, take literally, limited language, may not understand facial expressions
social interaction - can appear withdrawn, may not understand social norm like standing too close
over or under sensitivity to light, sound taste and touch
how does autism have an impact clinically
routine - upset if changed
limited variety of food - care with diet advice, work on timing>new foods
talk at length on own interests
sensory difficulties - busy waiting rooms, overwhelming, can have underdeveloped or overdeveloped senses
features of downs syndrome
large tongue
mid face hypoplasia
LD
medical problems associated with down syndrome
cardiac defects
leukaemia
epilepsy
dental features of open bite
maxillary hypoplasia
class 3
AOB
hypodontia and microdontia
cause of cerebral palsy
non progressive lesion of motor pathways in developing brain
brain damage early in development - fatal, birth or first few months
how does cerebral palsy affect body
delay in motor skills development
poor control over hand/arm
weakness
3 main types of cerebral palsy
spastic
ataxic
dyskinetic
which area of the brain is affected with spastic cerebal palsy and what is the affect
cortex - increased muscle tone (stiffness)
which area of the brain is affected with ataxic cerbal palsy and what is the affect
cerebellum - coordination/balance - unsteady
which area of the brain is affected with dyskinetic cerebal palsy and what is the affect
basal ganglia - uncontrolled movements
diplegia spastic CP meaning
muscle stiffness both legs or both arms, arms less affected
hemiplegia spastic CP meaning
affects only one side persons body - arm more than leg
quadriplegia spastic CP meaning
all 4 limbs, trunk and face affected - can’t walk
give an example of communication aid for visually impaired
braille
give an example of communication aid for hearing impaired
BSL
Give an example of communication aid for ASD
Makaton
what cells are affected by leukaemia
WBC - lymphocytes and myeloid cells
3/4 of leukaemia cases are acute lymphoblastic leukaemia. describe acute lymphoblastic leukaemia
WBC production in bone marrow uncontrolled and cells do not mature
immature dividing cells fill bone marrow and stop it making healthy blood cells
how might a leukaemia pt present
pallor
bruise and bleed easy as lack of platelets
infection - lack of functioning WBC
oral presentation of leukaemia
gingival swelling
ulceration
gingival bleeding
what category of drugs are used in chemo
cytotoxic
oral effects of chemotherapy
mucositis
infection risk - decreased neutrophils
increased bleeding risk - decreased platelets
oral effects of radiotherapy
mucositis
taste bud damage
hypo salivation as salivary glands affected leading to caries and infection
ORN risk
chemo and radio effect on developing dentition
enamel hypoplasia and microdontia
there are more but these are mutual
name a syndrome linked to congenital heart defect
downs syndrome
most common acyanotic congenital cardiac defect
ventricular septal defect
2 classifications of congenital cardiac defect and what they mean
cyanotic - deoxygenated blood can enter systemic circulation
acyanotic - normal levels of oxyhemoglobin in systemic circulation
dental implications of congenital heart defect
medications - increased bleeding tendency - warfarin or aspirin
GA risk
infective endocarditis
which pt are at increased risk of infective endocarditis
previous IE
congenital heart disease
valve replacement
hypertrophic cardiomyopathy
valvular disease with stenosis
in the dental setting, what poses risk of bacteria to patient at risk of IE
invasive procedure
poor OH
dental infection
2 examples of non-inherited bleeding disorders
chemotherapy induced thrombocytopenia
blood thinning medication - warfarin/aspirin
describe primary secondary and tertiary haemostasis
primary - vasoconstriction after injury and platelet plug formation
secondary - fibrin formation through coagulation cascade
tertiary - fibrinolysis - formation of plasminogen then plasmin
what is the most common inherited bleeding disorder
VWD
what factors are low in VWD
von willebrands factor
factor 8
what pattern of inheritance is VWD
autisomal dominant
what are the functions of VW factor - 3
mediates platelet adhesion
mediates lately aggregation
caries factor 8
haemophilia A and B can be categorised into mild moderate and severe depending on the level of factor present - what are the levels for each?
mild >5%
moderate 1-5%
severe <1%
what pattern of inheritance is haemophilia
x linked recessive
what does x linked recessive mean
males who have affected gene are affected
females who have affected gene are carriers
which tooth paste might you recommend for a child with sensory impairment
oranurse
unflavoured and non foaming
causes of gingival overgrowth
medication - cyclosporin, phenytoin
systemic and metabolic disease
genetic - hereditary gingival fibromatosis
what is periodontitis
multifactorial inflammatory disease associated with dysbiotic biofim causing progressive destruction of tooth supporting structures
4 main distinguishing factors of perio
apical migration of JE
alveolar bone loss
loss of attachment of perio tissues to cementum
JE transforms into pocket epithelium
systemic diseases linked to periodontitis in paediatric patients
papillon Lefèvre syndrome
neutropenia
downs syndrome
features of NP
necrosis/ulceration of papilla
PDL loss
rapid bone loss
pseudomembrane formation
what is necrotising stomatitis
severe inflammatory condition where necrosis extends beyond gingiva to soft tissues leading to bone denudation
which BPE code do you always stage and grade
4
what ages do you only use BPE code 0 1 and 2 for
7-11
causes of a reduced periotontium
recession
crown lengthening surgery
periodontitis - stable
non dental biofilm causes of gingivitis
trauma - damage to PDL
genetic - hereditary fibromatosis
infective - bacterial, fungal, viral
drug induced - cytotoxic, immunosuppressant
systemic disease
microbe associated with NG
fusiformspirochateal
when do you use BPE codes 0 1 2 only
7-11
probe for sBPE
WHO 621 single black band
3 reasons you would refer a perio pt to specialist services
stage 2 or 3 not responding to treatment
grad C or stage 4
perio as direct manifestation of systemic disease
