Paediatrics Flashcards
According to literature, does depth of carious lesion have an effect on the success of hall crown?
No, the relationship between depth of carious lesions and outcome is statistically considered to be NOT SIGNIFICANT
According to literature, does observation of clear band of dentine have an effect on the success of hall crown?
Yes, statistically considered to be HIGHLY SIGNIFICANT
How long does occlusal re-equilibration take after placing SS hall crowns?
4-6 weeks
Why do we not place SS hall crowns in adults?
Because the bite will remain high, there is no facial growth and the bone remains elastic in the mandible and maxilla. This high bite will cause TMJ problems over time.
In what instance can multiple SS crowns NOT be placed in the same visit?
If they are adjacent or opposing as this will bring about too much change in occlusion at one time. Wait 4-6 weeks between placing these crowns (2 weeks for separator placement)
Define,
A clear, odourless, metallic-taste liquid that will stain most oxidizable surfaces black upon exposure to light due to formation of silver oxide layer.
Silver diamine fluoride (SDF)
What are the three roles of SDF?
- Bacteriacidal
- Hydroxyapatite doping
- Collagen degradation inhibition
When is SDF indicated for use in a treatment plan?
When child is pre-cooperative
What are the contra-indications to use of SDF?
- Silver allergy
- Pain - irrevsrible pulpitis or periapical periodontitis
- Infection - swelling, abscess or fistula
- Patient refusing or unable to cope with treatment
- Unable to isolate tooth
What are the 5 take home messages about SDF?
- Dry before use
- Use twice per year
- Use 38%
- Stains everything it touches!
- SDF can be effective at arresting carious lesions
What are the three appropriate treatment options for:
A lower E with D2 caries mesially.
- Selective caries removal and restore with composite
- ART and restore with composite or compomer
- No caries removal and restore with hall crown
What are the three appropriate treatment options for:
A lower D with mesial and distal caries (mesial D1 and distal D3).
- Selective caries removal and restore with composite
- ART and restore with composite or compomer
- No caries removal and restore with hall crown
Why might a patient with T1DM have a higher caries risk?
Due to the need to snack in order to prevent hypoglyceamia
What is MIH?
A type of enamel defect
What is the aetiology of MIH?
MULTIFACTORIAL:
- Childhood infections/ repeated fevers
- Specific antibiotics
- Genetic predisposition
- Environmental factors
How does MIH present clinically?
Often affects 1-4 of first permanent molars, incisors and sometimes canines. Characterised by poor quality enamel presenting with demarcated opacities (yellow/brown in colour).
What symptom is mainly associated with MIH?
Dentine Hypersensitivity
When is thought be the “ideal time” to extract first permananet molars with poor prognosis, in a child?
The commonly recommended time for their removal is said to be when mineralisation is just commencing in the bifurcation if the second permanent molars radiographically, this is approx between 8.5-10.5 years old.
What would be the most appropriate treatment option for first permanent molars with MIH that are being planned for extraction in future due to poor prognosis?
Stainless steel crowns
Why are indirect restorations more likely to be successful in the long term for molars with MIH?
Because direct restorations can have difficulty bonding with weak enamel, whereas indirect restorations do not have this issue.
Name two anomalies of tooth number.
- Supernumerary
- Hypodontia
Name two anomalies of tooth size.
- Microdontia
- Macrodontia
Name 5 anomalies of tooth form.
- Dens invaginatus
- Dens evaginatus
- Dilaceration
- Taurodontism
- Short roots
At what age do primary A’s erupt?
6-9 months
At what age do primary B’s erupt?
7-10 months
At what age have all primary D’s erupted?
12-16 months
At what age do primary C’s erupt?
16-20 months
At what age do primary E’s erupt?
23-30 months
How long after eruption is root formation normally complete (for primary teeth)?
12-18 months
At what age do 1’s and 6’s erupt?
6-7 years
At what age do lower 2’s erupt?
7-8 years
At what age do upper 2’s erupt?
8-9 years
At what age do lower 3’s erupt?
9-11 years
At what age do 4’s and 5’s erupt?
10-12 years
At what age do upper 3’s erupt?
11-12 years
At what age do 7’s erupt?
11-13 years
At what age do 8’s erupt?
17-25 years
How long after eruption is root formation normally complete (for permanent teeth)?
2-3 years after eruption
Define, the developmental absence of primary or permanent teeth?
Hypodontia
Define, the developmental absence of 6 or more teeth (excluding 3rd permanent molars).
Oligodontia
Define, the complete absence of teeth.
Anodontia
At what stage in dental development does hypodontia occur?
Intitiation stage
What environmental factor is thought to cause hypodontia?
As sequelae of severe disease and cancer treatment in early childhood
What is the prevalence of non-syndromic hypodontia in the primary dentition?
<1%
What is the prevalence of non-syndromic hypodontia in the permanent dentition?
~6%
In order, list the most common teeth affected by hypodontia. From most common to least.
- Mandibular second premolars
- Maxillary lateral incisors
- Maxillary second premolars
- Mandibular central incisors
Where a primary tooth is absent there is a low probability of the successor being absent. True or false?
False, there is a high probability of the successor being absent.
What are the clinical features of hypodontia? (8)
- failure of a primary tooth to exfoliate at the expected time
- a permanent tooth hasn’t erupted several months after the primary exfoliates
- teeth erupting out of sequence
- the contra lateral tooth has been erupted for >6months
- other teeth appear unusually spaced
- microdontia of unerupted teeth
- no tooth palpable in buccal or lingual/palatal sulcus
- infraocclusion of primary molars
What is the appropriate radiograph for initial investigation of hypodontia and for confirmation of hypodontia?
Initial investigation = periapical
Confirmation = DPT
What is the management of hypodontia?
- usually referral to secondary care: paediatrics or orthodontics depending on age and stage of development
- preventative advice from GDP to maintain oral health of remaining dentition
What % of the population are missing at least one of their 8’s?
30%
what notable syndromes is hypodontia usually associated with?
- Ectodermal dysplasia
- trisomy 21 (Down’s syndrome)
- cleft lip and palate
- solitary median maxillary central incisor syndrome
What is Ectodermal dysplasia?
A group of diseases affecting the structures arising from the ectoderm: teeth, hair, nails, sweat glands, salivary glands.
What is the most well known, easily recognisable type of Ectodermal dysplasia?
X-linked Hypohydrtic Ectodermal dysplasia
What are the characteristic features of Ectodermal dysplasia?
- sparse hair
- dry skin
- inability to sweat
- conical teeth with microdontia and hypodontia
At what stage of tooth development does supernumerary occur?
Initiation stage
What syndromes could be associated with supernumerary? Name 3.
- Cleidocranial dysplasia
- Cleft lip and palate
- Gardner syndrome
What are the 4 types of supernumerary teeth?
- Conical
- Tuberculate
- Supplemental
- Odontome
What type of supernumerary is described:
Most common (~75%), likely to erupt if not inverted, can impede eruption of other teeth, often occur in midline maxilla in pairs.
Conical supernumerary
What type of supernumerary is described:
Barrel shaped, do not usually erupt, very likely to impede eruption of other teeth, often occurs in pairs.
Tuberculate supernumerary
What type of supernumerary is described:
Normal anatomy, likely to erupt, less likely to impede eruption of other teeth, often a lateral incisor, 3rd premolar or 4th molar.
Supplemental supernumerary
What type of supernumerary is described:
Collection of tooth tissue, two types: compound and complex, will not erupt, very likely to impede eruption of other teeth.
Odontome supernumerary
If there is a delay in the eruption of a maxillary central incisor, what is your immediate thought as to the cause of this?
Supernumerary
What size of tooth is supernumerary usually associated with?
Larger teeth (macrodontia)
When is a radiograph indicated for presence of a supernumerary?
When the permanent tooth is still not erupted >6months after the contra-lateral tooth and/or the teeth are erupting out of sequence.
What type of radiograph is indicated to exclude the presence of unerupted supernumeraries?
Parallax (and where necessary a CBCT)
If supernumerary is left unerupted and not removed, what consequence can this have?
Can cause resorption of roots of surrounding teeth
What are the 4 management options for supernumerary teeth?
- Monitor
- Simple extraction
- Surgical extraction
- Teeth which have been impeded may need to be surgically exposed +/- orthodontically repositioned
Define, a rare autosomal dominant condition characterised by hypoplastic or absent clavicles, short stature and characteristic facial features.
Cleidocranial dysostosis
What are the dental features of Cleidocranial dysostosis?
- supernumerary teeth
- delayed/failed exfoliation of primary teeth
- delayed/failed eruption of permannet teeth
At what stage of tooth development does microdontia occur?
Morphogenesis stage
What syndromes are associated with microdontia?
- ectodermal dysplasia
- cleft lip and palate
Microdont laterals are associated with increased incidence of palatally ectopic canines. True or false?
True
What are the management option for microdont teeth?
- Accept
- Orthodontic space redistribution
- Composite build up
- Extract
What is dens invaginatus?
When the enamel is folded in on itself creating an enamel lined cavity within the tooth.
At what stage during tooth development does dens invaginatus occur?
During morphogenesis stage
What teeth are most commonly affected by dens invaginatus?
Maxillary lateral and central incisors
What may be an early first indication of dens invaginatus?
Unexplained loss of vitality in the absence of trauma or caries
What are the 3 management options of dens invaginatus?
- Fissure seal deep cingulum pits
- If loss of vitality occurs, RCT treatment can be attempted. (Highly complex)
- Extraction
What is dens evaginatus?
An additional cusp or tubercle (aka talon cusp)
During what stage of tooth development does dens evaginatus occur?
Morphogensis stage
What teeth are commonly affected by dens invaginatus?
- lower 2nd premolars in Asian populations
- maxillary incisors
What is dilaceration?
A bend in the root or crown of the tooth
What is often the cause of dilaceration of permanent teeth?
Often a result from trauma to the primary tooth (highest risk being avulsion or intrusion)