Paediatrics Flashcards
What are the 5 R’s?
Recognition, re-orientation, remineralisation, repair, review
Name 8 specific techniques that can be used to build rapport with young patients and encourage them to undergo treatment?
- Enhancing control
- Relaxation (breathing)
- Tell-show-do
- Positive reinforcement and reward
- Modelling (use mum, dad, sibling)
- Desensitisation
- Structured time
- Hypnosis
What are the benefits of sequential treatment planning?
- can help reduce anxiety
- allows for acclimatisation to procedures
What could you call topical anaesthetic when speaking to a child?
“Tingle jelly”
What is the only situation where you would be giving a young child an IANB?
For pulpotomy procedure on lower E’s
A cartridge of 2.2ml lidocaine contains how many mg of lignocaine?
44mg
What chemical is used in inhalation sedation?
Nitrous oxide/oxygen
What medication is used for IV sedation?
Midazolam
How old does a child have to be in order to undergo IV sedation?
15 years old
What is the most effective medicinal treatment in the prevention of tooth decay?
The application of fluoride directly onto tooth
What is childsmile?
An initiative to give prevention and toothbrushing advice to nursing mothers and nursery school children
What acronym is used for a process important in motivational interviewing and what does it stand for?
SOARS,
S- seek permission
O- open questions
A- affirmations
R- reflective listening
S- summarise
Children and young people up to the age of 18 who are at standard risk of developing dental caries should be advised to use what concentration of fluoride toothpaste?
1500 ppmF
Children and young people up to the age of 10 who are at an increased risk of developing dental caries should be advised to use what concentration of fluoride toothpaste?
1450ppmF
Children and young people who are aged from 10 to 16, who are at standard risk of developing dental caries should be advised to use what concentration of fluoride toothpaste?
1000-1500ppmF
What is the toxic dose of fluoride ingestion?
5mg of fluoride per Kg
What plaque score is used in paeds at DDH?
Modified Silness and Loe plaque index
On the modified Silness and Loe plaque index, what does a plaque score of 0 (=10/10) indicate?
Tooth surface is clean
On the modified Silness and Loe plaque index, what does a plaque score of 1 (=8/10) indicate?
Appears clean but dental plaque can be removed from gingival 3rd
On the modified Silness and Loe plaque index, what does a plaque score of 3 (=4/10) indicate?
Tooth surface covered with abundant plaque
On the modified Silness and Loe plaque index, what does a plaque score of 2 (=6/10) indicate?
Visible plaque along gingival margin
What toothbrushing technique is most effective at reducing gingivitis and why?
Modified Bass technique. The toothbrush bristles reach under the gums to scrub off plaque before it hardens into tartar and causes gum disease
Describe the FRANKL scoring system
- assessed on a scale of 1-4
- 1= very comfortable at dentist and behaving well
- 2= acceptable of treatment, at times cautious
- 3= reluctant to accept treatment, uncooperative
- 4= refusal of treatment
Describe the MCDAS scoring system
- contains 8 questions
- each question has a 5 point scale (1 indicates no anxiety, 5 indicates highly anxious)
- overall scores may range from 8-40
What does an overall MCDAS score of below 19 indicate?
No dental anxiety
What does an overall MCDAS score of over 31 indicate?
Severe dental phobia
What are main risk factors for dental caries?
- High sugar intake
- Inadequate brushing/ use of fluoride toothpaste
- Pre-existing medical conditions
- SES
Why do we stage hall crown technqiue if several are needed, instead of placing them all at once?
After placement of a hall crown, OVD increases. If tow are placed on same side of mouth there will be too much change in occlusion and this can be very uncomfortable for patient.
What is the difference between diet and nutrition?
Diet = refers to the food and drink you intake/eat
Nutrition = refers to obtaining food that is necessary for health
What are intrinsic sugars?
Sugars held within the cell structure in foods (e.g. vegetables)
What are extrinsic sugars?
“Free” sugars, sugar present outside the cells structure (added sugars) (e.g. honey,milk)
How many times a day would you recommend as the maximum for eating non-milk intrinsic sugars?
Limit to no more than twice a day (max 24g)
What is the concentration of the topical fluoride, Duraphat?
22,600ppm
How would you calculate the toxic dose of topical fluoride?
The toxic dose is 5mg per kg
How could you quickly treat fluoride toxicity? And why?
Get patient to drink milk, the calcium in the milk bonds to the fluoride molecules reducing their concentration.
What are the indications for fissure sealing teeth?
- high risk caries
- MIH
- enamel defects
- deep fissures
- initial presentation of permanent molars
What are the advantages for using GI for fissure sealing?
- fluoride release
- quick to place
What are the advantages for using resin for fissure sealing?
- adheres to tooth surface better due to acid etching
- more strength, lasts longer
What concentration of fluoride toothpaste and what amount is appropriate to give to a child <3 years old?
1000ppm, smear
What concentration of fluoride toothpaste and what amount is appropriate to give to a child 3-6 years old?
> 1000ppm, pea sized
What concentration of fluoride toothpaste and what amount is appropriate to give to a child 7+ years old?
1350-1500ppm
What fluoride intervention is appropriate to give to a child 8+ years old?
0.05% sodium fluoride daily rinse
What fluoride intervention is appropriate to give to a child 10+ years old?
2800ppm toothpaste
What fluoride intervention is appropriate to give to a child 16+ years old?
2800/5000ppm toothpaste
How many times can topical fluoride varnish be applied per year?
2-4 times per year
What is the recommended dose of topical fluoride varnish for a child 2-5 years old?
0.25 ml
What is the recommended dose of topical fluoride varnish for a child 6+ years old?
0.4ml
What are the three contraindications to fluoride varnish treatment?
- Colophony allergy
- Have been hospitalised with severe asthma
- Ulcerative gingivitis
What is meant by nutrition?
The intake of nutrients
What oral disease is linked with malnutrition?
Periodontal disease
What are the two subgroups of extrinsic sugars?
- milk sugars
- non-milk extrinsic sugars
Give three examples of non-milk extrinsic sugars?
- Sugar added to tea or coffee
- Sugar added to manufactured products or in cooking
- Sugars released in fruit juices, smoothies and pulps
How often should sugary food be consumed in one day?
No more than 4 times daily
What are the three key requirements for affecting change in health-related behaviour?
- Knowledge
- Skills
- Attitude
What weight of sugars per 100g of food is considered high sugar intake?
15g sugars per 100g of food
What weight of sugars per 100g of food is considered medium sugar intake?
Between 5g and 15g sugars per 100g of food
What weight of sugars per 100g of food is considered low sugar intake?
5g of sugars or less per 100g of food
When should solid food be introduced to babies?
Around the 6 month mark
What foods are good for nutrition?
- fruit
- vegetables
- fish
What type of foods should we cut down in as they are not nutritious?
- processed foods
- saturated fat and sugar
What is the primary mineral in saliva?
Hydroxyapatite
Name 9 types of fluoride delivery?
- Toothpastes
- Mouthrinses
- Varnishes
- Gels
- Tablets
- Water
- Milk
- Salt
- Slow release glass beads
What is the concentration of duraphat fluoride varnish?
22,600ppm
What volume of fluoride varnish should be applied for patients aged 2-5 years old?
0.25ml
What volume of fluoride varnish should be applied for patients aged 6 years and above?
0.4ml
What are the acute symptoms of toxic fluoride dose?
Nausea and vomiting
What is the probable toxic dose of fluoride?
5mg/kg of body weight
What should you do as a dentist in the case of an acute overdose of fluoride?
- To minimise absorption of fluoride, give a calcium contains solution (e.g. milk)
- transfer child to A+E
What patient signs suggest a dental phobia?
- excessive dental fear and anxiety for at least 6 months
- avoiding dental care
- fear is out of proportion
- clinically significant distress or functional impairment
What are the three pathways that lead to fears and anxieties?
- Direct conditioning
- Vicarious learning/modelling
- Exposure to threatening information
Give 4 examples of direct conditioning that may lead a child to feel anxious or fearful of attending the dentist?
- pain/feelings of helplessness
- issues with behaviour/ personality of dental professional
- serious treatment failures/clinical errors
- feelings of embarrassment
Name four endogenous factors that could lead to a person having anxiety?
- Genetics
- General anxiety
- Age (young are more anxious)
- Gender (females typically have more anxiety)
What age should a child be in order to fill out a MCDAS form?
At least age 8
What is the collective term for unco-operative behaviours that act to disrupt the provision of dental treatment?
Behaviour management problems
What technique is widely used to familiarise a patient with a new procedure?
Tell, show do
What are the 5 steps you would use to explain placement of a fissure sealant to a child?
- shampoo (with acid etching)
- Wash ( 3 in 1)
- Dry ( 3 in 1)
- White paint (fissure sealant)
- Special torch (LED curing light)
Name three negative reinforcement techniques, that are no longer used in the UK?
- selective exclusion of parents
- hand over mouth
- papoose board
What is gillick competence?
Outlines whether a child (under age of 16) can consent to their own medical treatment without their parents having to know or give permission.
What does GIRFEC stand for?
Get it right for every child
When caries progresses from ADJ to pulp, what occurs?
Odontoblast adjacent to carious lesion demonstrate and inflammatory response and reactionary dentine is deposited as a protective measure
How many roots and canals do mandibular primary molars have?
2 roots
2 canals ( mesial and distal)
How many roots and canals do maxillary primary molars have?
Three roots
Three canals ( mesiobuccal, distobuccal, palatal)
What are the properties of mineral trioxide aggregate (MTA)?
- biocompatible
- induces are tissue formation
- good success rate
- expensive
What material is used to for RCT of primary teeth?
Non-setting calcium hydroxide
Why is gutta percha unsuitable for RCT of primary teeth?
It is not resorbable
What management strategy should be used for preventative anxiety management?
Non-pharmacological behaviour management (NPBMT)
What BMT can be used for inattentive but communicative children?
Voice control
What BMT is widely used to familiarise a patient with a new procedure?
Tell,show,do
What is meant by baby led weaning?
Weaning a child onto solid foods
What is colostrum?
The milk a mother produces in the first few days after birth, which has extra immunity antibodies.
At what age are babies able to observe and react to the emotions of others?
12 months
At what age are children able to assert themselves and have a sense of self?
2 years old
At what age does a baby start crawling?
Between 8-12 months
At what age should children start to learn to walk?
Around 1 year old
Name 4 types of communications aids?
- interpreting services: in person and virtual
- BSL
- makaton
- PECS/social stories
What is makaton?
Makaton is a unique language that uses symbols, signs and speech.
What are the 4 pillars of prevention in paediatric dentistry?
- Fluoride (varnish or toothpaste)
- OHI
- Dietary investigations
- Sealants
At what age do maxillary canines errupt?
10-12 years old
What teeth are used to chart a simplified BPE on a child?
Index teeth: permanent first molars, upper right permanent central incisor and lower left permanent central incisor
What is the restoration of choice after carrying out pulp treatment on a deciduous tooth?
Stainless steel crown
