Paediatrics Flashcards
1
Q
Eruption Sequence for Primary Teeth
A
a
b
d
c
e
2
Q
Which arch tends to erupt first
A
Lowers before uppers
3
Q
When do primary teeth erupt
A
6 months - 2.5 years
4
Q
Eruption sequence for permanent maxillary teeth
A
6
1
2
4
5
3
7
8
5
Q
Eruption sequence for permanent mandibular teeth
A
6
1
2
3
4
5
7
8
6
Q
How long should it take for a contralateral tooth to erupt
A
6 months or less
7
Q
When should you be able to palpate upper canines
A
By the age of 10/11
8
Q
Balancing extraction
A
Take out the contralateral tooth
9
Q
Compensating extraction
A
Take out the opposing tooth in opposing arch (upper/lower)
10
Q
Which primary teeth should be balanced
A
Cs
Ds under GA
11
Q
Which teeth should be compensated (2)
A
Lower 6
If taking upper, don’t take lower
12
Q
When is the ideal time to take out lower 6s (4)
A
- When the furcation begins to form on 7s
- In patients whose 8s are present
- In Class I patients
- In patients with mild/moderate crowding
13
Q
What can be used to deter digit sucking
A
Habit breakers
Can be removable or fixed
14
Q
When should digit sucking be stopped for teeth to return to normal eruption
A
Before the age of 10
15
Q
Infra-occluded deciduous teeth
A
Tooth has ankylosed to bone
More common in lower
16
Q
Infra-occluded deciduous teeth treatment (2)
A
If permanent successor - no treatment
If no permanent successor - wait a year then extract when 1mm of crown left showing
17
Q
What are good signs for upper canines being in the correct position in mixed dentition
A
Mobile Cs
Distally tipped laterals
18
Q
What can be done about ectopic canines
A
Extract both Cs (even if only 1 is ectopic)
Can be done up to the age of 13
19
Q
Toothpaste for a high risk 2 year old
A
1450ppm smear
20
Q
Ages for simplified BPE
A
7-11 years
21
Q
Ages for normal BPE
A
12+
22
Q
Simplified BPE codes
A
0, 1, 2
23
Q
When should fluoride varnish be applied
A
2+ years old
Twice a year
24
Q
Which surfaces of lower molar should also be fissure sealed
A
Occlusal and buccal
25
Which surfaces of upper molars should be fissure sealed
Occlusal and palatal
26
What can be used as a fissure sealant if a child is uncooperative
Glass ionomer
27
Contraindications to F varnish (6)
1. Ulcerative gingivitis
2. Stomatitis
3. Sensitivity to colophony
4. Severe cases of asthma
5. Allergy
6. Allergy to Elastoplast
28
Plaque Scores - Paeds
10 - Perfectly clean teeth
8 - Plaque at cervical margin
6 - Cervical third plaque
4 - Middle third plaque
29
When does calcification of upper third molars occur
7-9 years
30
When does calcification of lower third molars occur
8-10 years
31
No third molars seen on radiograph by age 14
If not seen by this age they will are unlikely to develop at all
32
Fissure Sealant Function (2)
1. Obliterate the fissures
2. Remove sheltered environment in which caries thrives
33
Positioning for fissure sealant
LL - In front of patient
Behind for all other quadrants
34
Moisture control aids (4)
1. Dry guards
2. Saliva ejector
3. Cotton wool rolls
4. Suction
35
What teeth should be fissure sealed in high risk individuals (6)
4, 5, 6, 7
Palatal pit on upper laterals
Large cingulums
36
Technique for applying resin fissure sealant (7)
1. Teeth cleaned
2. Tooth isolated with dam or cotton wool
3. Surface etched for 20-30 seconds
4. Surface washed and dried
5. Cotton wool replaced
6. Place and light cure sealant
7. Inspect
37
Technique for GIC fissure sealant (4)
1. Can use 20% polyacrylic acid to etch but not necessary
2. Tooth isolated
3. GIC run into fissures
4. Infilled resin, petroleum jelly or fluoride varnish placed to protect material
38
Quality assurance of fissure sealants (2)
1. Run probe along - shouldn't ping off
2. Should look like the shape of the fissures not a pool of material
39
What children are eligible for fissure sealants (4)
1. Children with special needs
2. Children from a disadvantaged background
3. Extensive caries in primary dentition
4. If a 6 develops caries
40
How often should radiographs be taken for children
Low risk 12-18 months
High risk 6 months
41
From what age can you legally consent in Scotland
16
42
Can children consent
Yes if they are deemed Gillick competent
43
What concentration of fluoride is fluoride varnish
22,600 ppm F
44
Oral reservoirs for fluoride (2)
Mineral deposits (CaF)
Biologically/bacterially bound (CaF)
45
Dosage of F 0.25mg
6m-3y
46
Dosage of F 0.5mg
3-6 years
47
Dosage of F 1mgF
>6 years
48
Properties of duraphat (3)
Sodium fluoride
50mg/ml
22,600ppm F
49
Fluorosis (2)
Chronic toxicity
Developmental defect of enamel
50
How much F do young children need to swallow to risk fluorosis (3)
1mg / day - 1 year old
2mg / day - 5-6 year old
Fluorosis still possible at recommended intakes
51
Recommended F intake per day
0.05-0.07 mg/kg
52
Is fluorosis due to topical or systemic F
Systemic
53
What can cause primary teeth to be red
Porphyria
54
Which type of trauma is most common in children
Luxation
55
Trauma history - MH (3)
1. R. Fever
2. Congenital heart defects
3. Immunosuppression
56
Trauma history - the injury (5)
1. When
2. Where
3. How
4. Any other symptoms
5. Lost teeth/fragments
57
What may help show cracks in teeth (3)
Transillumination
Probing
Percussion
58
Types of luxation (3)
Lateral
Intrusive
Extrusive
59
Long term effects of trauma on primary teeth (3)
1. Discolouration
2. Infection
3. Delayed exfoliation
60
Discolouration immediately after trauma
Tooth may remain vital
61
Gradual discolouration weeks after trauma
Tooth non vital
62
Delayed exfoliation after trauma treatment
Extraction
63
Long term effects of trauma in permanent teeth (7)
1. Enamel defects
2. Abnormal tooth/root morphology
3. Delayed eruption
4. Ectopic tooth position
5. arrest in tooth formation
6. Complete failure of tooth to form
7. Odontome formation
64
How likely are enamel defects after paediatric trauma
44%
65
How likely is abnormal tooth/root morphology after paediatric trauma
8%
66
How long can premature exfoliation delay a permanent tooth by
1 year due to thickened mucosa
67
Home management for paeds trauma (4)
1. Soft diet for 2 weeks
2. Brush with soft brush after every meal
3. CHXD mw (0.12%) by parents 2x a day
4. Avoid contact sports
68
How often should paeds trauma be reviewed? (3)
1. 1, 3, 6 monthly
2. Radiographs 6 month
3. Intrusion more often
69
Enamel dentine fracture treatment (2)
Restore/bandage with composite or compomer
Don't use GI
70
Enamel dentine pulp fracture treatment
Endo or extract
71
Crown and root fracture treatment (2)
1. Extract coronal fragment
2. Leave root it will resorb physiologically
72
Alveolar bone fracture treatment (3)
1. Reposition segment
2. Splint for 3-4 weeks
3. Teeth may need to be extracted after stability has been achieved
73
Concussion/Subluxation treatment
Observation
74
Lateral luxation treatment (3)
Repositionunder LA
Flexible splint 4 weeks
2 week endo eval
75
Characteristic of primary teeth (4)
1. Bulbous crown
2. Splayed roots
3. Cervical constriction
4. Colour
76
What does a sinus indicate after trauma
Infection
77
Yellow tooth after trauma
Pulp obliterated, more dentine laid down
78
Grey tooth after trauma
Tooth non vital
79
Pink tooth immediately after trauma
More blood products in tooth
80
Pink tooth long after trauma
Root resorption
81
What colour can indicate an exfoliating tooth
Pink as gum is beginning to show underneath tooth
82
Mobility after trauma can indicate (2)
Infection
Root fracture
83
Rock solid teeth after trauma (3)
Be suspicious
Ankylosis
Luxation and poor reposition
84
Why is a tooth more likely to fracture after CaOH
It denatures collagen and makes the tooth more brittle
85
Sensibility testing in children
Notoriously unreliable
86
EPT numbers in paediatric trauma patients (2)
Compare them to adjacent teeth
Only important between visits if a tooth was responding and now isn’t
87
How many signed of a non-vital tooth are needed to perform RCT in a paediatric trauma patient
>2
88
TAB
Transient Apical Breakdown
89
Transient apical breakdown (2)
Tooth resorbs at tip to try and let neurovascular bundle back into tooth
Needs close review
90
General types of paeds trauma
Hard tissue (teeth)
PDL
91
Treatment options for instrinsic discolouration of anterior teeth (6)
1. Enamel micro abrasion
2. Vital bleaching
3. Non-vital bleaching
4. Resin infiltrate
5. Composite
6. Veneers
92
Pre op records for all discoloured teeth (5)
1. Clinical photos
2. Shade
3. Sensibility testing
4. Diagram of defect
5. Pt assessment - VAS
93
VAS
Visual Analogue Scale
94
For discoloured teeth, what shade should be recorded
Shade of background and defect
95
What is microabrasion
Acid and pumice
96
Maximum application of microabrasion
10 x 5 seconds
OR
5 x 10 seconds
97
What is used to neutralise acid used in microabrasion
Sodium bicarbonate
98
What should be done after microabrasion (4)
1. Polish with finest soft flex disc
2. F varnish (not yellow)
3. Post op photos
4. Review 4-6 weeks
99
How many times can microabrasion be carried out
Only once
100
How much enamel does acid etching remove
100 microns
101
Advantages of microabrasion (4)
1. Conservative
2. Cheap
3. Low maintenance
4. Permanent results
102
What types of stain can microabrasion be used on (3)
Yellow-brown
White
Multi coloured
103
Disadvantages of microabrasion (3)
1. Removes enamel
2. Dental dam
3. Prediction of outcome difficult
104
Warnings for the pt after microabrasion (3)
1. Teeth dehydrated
2. Avoid highly coloured food or drinks for 24+ hours
3. If dying hair keep mouth shut
105
What should you wait for when bleaching young peoples teeth
Canines to fully erupt
106
PDS
Public Dental Service
107
Who are monthly capitation payments doubled for
Children with special needs/those who the GDP needs to spend double the time with
108
How does SIMD impact monthly capitation fee
Extra 25p per month where postcode is SIMD 1
109
What ages do you administer F varnish
2-12
110
How often do you administer F varnish in high risk children
2x a year
111
Important milestone ages for kids
3, 6, 9, 12
112
How long does it normally take the same tooth to erupt in the opposing arch
A year or less
113
Hypomineralisation symptoms that require treatment (3)
1. Hypersensitivity
2. Crumbling back teeth
3. Aesthetic concerns
114
Hypomineralisation management options (6)
1. Seal
2. Restore
3. PMC
4. Extraction (correct timing)
5. Aesthetic mgmt
6. Seek specialist opinion
115
By age 3...
All primary teeth should have erupted
116
By age 6...
FPM should have erupted
117
By age 9...
All permanent incisors erupted and canine palpable
118
By age 12...
Most if not all of primary dentition should have exfoliated
119
Things than can cause dry mouth in children (6)
1. Diabetes
2. Beta 2 antagonists
3. Corticosteroid inhalers
4. Anticonvulsants
5. Antiepileptics
6. Acne tx
120
MI
Motivational Interviewing
121
SDF
Silver Diamine Fluoride
122
Concentration of SDF
44,800ppmF
123
How does SDF work (3)
1. Occludes dentinal tubules
2. Silver is antibacterial
3. F encourages remineralisation
124
Why can caries be worse in primary molars (3)
1. Wider contact areas
2. Larger pulps
3. Faster spread into pulp
125
Why do we take radiographs so often for high risk kids
Caries can be underdiagnosed by up to 50% without them
126
If bitewings not possible, how can you check for caries
Separators
127
How old do children need to be for amalgam
15
128
Referral pathways for children (4)
1. PDS
2. Ortho
3. HDS
4. Non dental (child protection/social services)
129
When does root formation occur in relation to eruption
Within 3 years of crown eruption
130
At what age will root calcification of third molars occur
18-25
131
FiCTION protocol
Filling children's teeth: Indicated or not?
132
Most successful restorative tx option for caries in primary teeth
PMC
Hall technique
133
Common problems with stainless steel crowns (3)
1. Rocking
2. Canting
3. Loss of Space
134
Rocking of SS crown cause
Cervical margin >1mm away
135
Canting of SS crown cause
Uneven occlusal reduction
136
Types of failure from Hall technique
Minor
Major
137
Minor failure from Hall technique (4)
1. Secondary caries
2. Crown lost
3. Requires intervention
4. Reversible pulpitis treated w/o pulpotomy or extraction
138
Major failure from Hall technique (4)
1. Irreversible pulpitis
2. Abscess
3. Interradicular radiolucency
4. Filling lost and tooth unrestorable
139
Paeds - Indications for pulp tx (5)
1. Co-operation
2. MH precludes extraction
3. Missing permanent successor
4. Necessity to preserve tooth
5. Child <9
140
Paeds - Contraindications for pulp tx (6)
1. Poor co-operation
2. Poor attendance
3. Cardiac defect
4. Multiple grossly carious teeth
5. Advanced root resorption
6. Severe/recurrent pain/infection
141
Primary tooth pulp cap success rates
Poor
142
Paeds pulpal evaluation
Normal bleeding - uninflamed pulp
Abnormal bleeding - inflamed pulp
143
Normal bleeding of pulp (2)
1. Bright red
2. Good haemostasis
144
Abnormal bleeding of pulp (2)
1. Deep crimson
2. Continued bleeding after pressure
145
Pulpotomy
Vital
146
Pulpectomy
Non-vital
147
Can severe infection in a primary molar with facial swelling be treated with pulpectomy
No - extract
148
AET
Acid Etched Tip
149
What can be used for a dentine bandage
Composite or compomer
150
When is a pulp cap indicated (2)
Small exposure
<24 hours old
151
Why are pulpotomies used in immature teeth
Root formation can continue
Apexigenesis
152
Pulpectomy in an immature tooth (2)
1. Apical barrier formation
2. Mineral trioxide aggregate used
153
How long should you wait for MTA to harden
24 hours
154
Exposed Pulp Tx Options (3)
1. Pulp cap - small, <24hrs
2. Pulpotomy - large
3. Pulpectomy - large
155
Avulsed teeth first aid (6)
1. Store in fresh milk/saliva
2. Don't let dry out
3. Don't touch root
4. Quick rinse under water IF obvious debris
4. Re-implant quickly
5. See a dentist immediately
156
If caries just in enamel in children
Fissure sealant
157
If caries into dentine but small in children
PRR
SR
158
PRR
Preventative Resin Restoration
159
SR
Sealant Restoration
160
TDI
Traumatic Dental Injury
161
Follow up time for uncomplicated crown fractures (2)
6-8 weeks
1 year
162
Follow up time for root fracture (6)
4 weeks
6-8 weeks
4 months
6 months
1 year
5 years
163
When should the splint be removed following a root or alveolar fracture (2)
4 weeks
4 months if cervical third root fracture
164
Concussion follow up (2)
4 weeks
1 year
165
Follow up for luxation (7)
2 weeks
4 weeks
8 weeks
12 weeks
6 months
1 year
Yearly 5 years
166
Time limit for retransplantation of avulsed teeth
60 minutes
167
Flexible splint is used for (3)
Avulsions
Luxations
Some fractures
168
Rigid splint is used for
Dento-alveolar fractures
169
Wire used for flexible splints
0.6 SSW
170
Follow-up time for complicated crown fracture (4)
6-8 weeks
3 months
6 months
1 year
171
Follow up time for crown-root fracture (6)
1 weeks
6-8 weeks
3 months
6 months
1 year
5 years - yearly
172
Follow up time for subluxation (4)
2 weeks
12 weeks
6 months
1 year
173
Difference in enamel-dentine fracture tx compared to enamel only (3)
1. Segment must be rehydrated in saline for 20 minutes prior to rebonding
2. Exposed dentine needs GI or bonding agent + composite
3. If within 0.5mm of pulp - CaOH lining
174
Best storage mediums for an avulsed tooth (5)
Milk
HBSS
Saliva
Saline
Water
175
Apexification
Open apex filled with CaOH to stimulate hard barrier
176
Follow up for mature apex avulsion (6)
2 weeks
1 month
3 months
6 months
1 year
Yearly 5x
177
Follow up for immature apex avulsion (7)
2 weeks
1 month
2 months
3 months
6 months
1 year
Yearly 5x
178
Endo for immature apex avulsion
Do not initiate unless definitive signs of pulp necrosis and infection
179
Favourable outcomes for avulsion - closed (8)
1. Asymptomatic
2. Functional
3. Normal mobility
4. TTP -
5. Normal percussive sound
6. No radiographic evidence of resorption
7. No radiolucencies
8. Lamina dura normal
180
Favourable outcomes for avulsion - open (7)
1. Asymptomatic
2. Functional
3. Normal mobility
4. TTP -
5. Normal percussive sound
6. Continued root formation
7. Pulp canal obliteration (healing)
181
Types of resorption that can occur post avulsion (2)
1. External inflammatory
2. Ankylosis related replacement
182
Dental anomalies (4)
1. Number
2. Size and shape
3. Structure
4. Eruption and exfoliation
183
Conditions associated with hypodontia (4)
1. Ectodermal dysplasia
2. Down syndromee
3. Cleft palate
4. Hurler's syndrome
184
Problem with missing laterals
Overeruption of canines - restorative issues
185
Age for veneers
Early 20s
186
Most common cause of delayed eruption of permanent incisor
Supernumerary
187
Accessory cusp
Talon cusp
188
Management of dens in dente
Seal and enhanced prevention as difficult to RCT
189
Root anomalies (4)
1. Short roots
2. Radiotherapy
3. Dentine dysplasias
4. Accessory roots
190
Enamel anomalies (5)
1. Amelogenesis imperfecta
2. Environmental enamel hypoplasia
3. Localised enamel hypoplasia
4. Hypomineralised enamel
5. Hypoplastic enamel
191
Hypomineralised enamel (2)
Shape of tooth correct
Qualitative issue
192
Hypoplastic enamel (3)
Quantitative problem
Shape incorrect
Can often see levels
193
Amelogenesis imperfecta types (4)
1. Hypoplastic
2. Hypomineralised
3. Hypomaturation
4. Mixed with taurodontism
193
Amelogenesis imperfecta gene
X linked
Autosomal
194
Amelogenesis imperfecta diagnosis (5)
1. Affects all teeth
2. Affects both dentitions
3. May be new
4. Family history
5. Radiographs
195
Amelogenesis imperfecta - Hypoplastic type
Enamel crystals do not grow to correct length
196
Amelogenesis imperfecta - hypomineralised type
Crystallites fail to grow in thickness and in width
197
Amelogenesis imperfecta - hypomaturational
Enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation
198
Amelogenesis imperfecta problems (6)
1. Sensitivity
2. Caries risk
3. Aesthetics
4. Poor OH
5. Delayed eruption
6. AOB
199
Amelogenesis imperfecta management (6)
1. Prevention
2. Composite veneers
3. Fissure sealants
4. Metal onlays
5. SSC
6. Ortho
200
Dentine anomalies (4)
1. Dentinogenesis imperfecta
2. Dentine dysplasia
3. Odontodysplasia
4. Systemic disturbance
201
Dentinogenesis imperfecta diagnosis (5)
1. Both dentitions affected
2. Enamel loss
3. Family history
4. Bulbous crowns (can be mistaken for primary teeth - check roots)
5. Obliterated pulps (I & II)
202
Dentinogenesis imperfecta problems (4)
1. Aesthetics
2. Caries risk
3. Spontaneous abscess susceptibility
4. Poor prognosis
203
Dentinogenesis imperfecta management (5)
1. Enhanced prevention
2. Composite veneers
3. Overdentures
4. Removal prostheses
5. SSC
204
Limited to dentine only (3)
1. Dentinogenesis imperfecta type II
2. Dentine dysplasia types I & II
3. Fibrous dysplasia of dentine
205
Tooth structure defects general tx overview (3)
1. Prevention and pain control
2. Restoration of lost tissue
3. Harness growth
206
Cementum anomalies (2)
1. Cleidocranial dysplasia
2. Hypophosphatasia
207
Delayed eruption associations (4)
1. LBW children
2. Malnutrition
3. Downs
4. Cleidocranial dysplasia
208
Premature exfoliation associations (3)
1. Trauma
2. Hypophosphatasia
3. Cyclic neutropnaemia
