Paediatrics Flashcards
1
Q
According to literature, does depth of carious lesion have an effect on the success of hall crown?
A
No, the relationship between depth of carious lesions and outcome is statistically considered to be NOT SIGNIFICANT
2
Q
According to literature, does observation of clear band of dentine have an effect on the success of hall crown?
A
Yes, statistically considered to be HIGHLY SIGNIFICANT
3
Q
How long does occlusal re-equilibration take after placing SS hall crowns?
A
4-6 weeks
4
Q
Why do we not place SS hall crowns in adults?
A
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.
5
Q
In what instance can multiple SS crowns NOT be placed in the same visit?
A
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)
6
Q
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.
A
Silver diamine fluoride (SDF)
7
Q
What are the three roles of SDF?
A
- Bacteriacidal
- Hydroxyapatite doping
- Collagen degradation inhibition
8
Q
When is SDF indicated for use in a treatment plan?
A
When child is pre-cooperative
9
Q
What are the contra-indications to use of SDF?
A
- 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
10
Q
What are the 5 take home messages about SDF?
A
- Dry before use
- Use twice per year
- Use 38%
- Stains everything it touches!
- SDF can be effective at arresting carious lesions
11
Q
What are the three appropriate treatment options for:
A lower E with D2 caries mesially.
A
- Selective caries removal and restore with composite
- ART and restore with composite or compomer
- No caries removal and restore with hall crown
12
Q
What are the three appropriate treatment options for:
A lower D with mesial and distal caries (mesial D1 and distal D3).
A
- Selective caries removal and restore with composite
- ART and restore with composite or compomer
- No caries removal and restore with hall crown
13
Q
Why might a patient with T1DM have a higher caries risk?
A
Due to the need to snack in order to prevent hypoglyceamia
14
Q
What is MIH?
A
A type of enamel defect
15
Q
What is the aetiology of MIH?
A
MULTIFACTORIAL:
- Childhood infections/ repeated fevers
- Specific antibiotics
- Genetic predisposition
- Environmental factors
16
Q
How does MIH present clinically?
A
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).
17
Q
What symptom is mainly associated with MIH?
A
Dentine Hypersensitivity
18
Q
When is thought be the “ideal time” to extract first permanent molars with poor prognosis, in a child?
A
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.
19
Q
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?
A
Stainless steel crowns
20
Q
Why are indirect restorations more likely to be successful in the long term for molars with MIH?
A
Because direct restorations can have difficulty bonding with weak enamel, whereas indirect restorations do not have this issue.
21
Q
Name two anomalies of tooth number.
A
- Supernumerary
- Hypodontia
22
Q
Name two anomalies of tooth size.
A
- Microdontia
- Macrodontia
23
Q
Name 5 anomalies of tooth form.
A
- Dens invaginatus
- Dens evaginatus
- Dilaceration
- Taurodontism
- Short roots
24
Q
At what age do primary A’s erupt?
A
6-9 months
25
At what age do primary B’s erupt?
7-10 months
26
At what age have all primary D’s erupted?
12-16 months
27
At what age do primary C’s erupt?
16-20 months
28
At what age do primary E’s erupt?
23-30 months
29
How long after eruption is root formation normally complete (for primary teeth)?
12-18 months
30
At what age do 1’s and 6’s erupt?
6-7 years
31
At what age do lower 2’s erupt?
7-8 years
32
At what age do upper 2’s erupt?
8-9 years
33
At what age do lower 3’s erupt?
9-11 years
34
At what age do 4’s and 5’s erupt?
10-12 years
35
At what age do upper 3’s erupt?
11-12 years
36
At what age do 7’s erupt?
11-13 years
37
At what age do 8’s erupt?
17-25 years
38
How long after eruption is root formation normally complete (for permanent teeth)?
2-3 years after eruption
39
Define, the developmental absence of primary or permanent teeth?
Hypodontia
40
Define, the developmental absence of 6 or more teeth (excluding 3rd permanent molars).
Oligodontia
41
Define, the complete absence of teeth.
Anodontia
42
At what stage in dental development does hypodontia occur?
Intitiation stage
43
What environmental factor is thought to cause hypodontia?
As sequelae of severe disease and cancer treatment in early childhood
44
What is the prevalence of non-syndromic hypodontia in the primary dentition?
<1%
45
What is the prevalence of non-syndromic hypodontia in the permanent dentition?
~6%
46
In order, list the most common teeth affected by hypodontia. From most common to least.
1. Mandibular second premolars
2. Maxillary lateral incisors
3. Maxillary second premolars
4. Mandibular central incisors
47
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.
48
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
49
What is the appropriate radiograph for initial investigation of hypodontia and for confirmation of hypodontia?
Initial investigation = periapical
Confirmation = DPT
50
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
51
What % of the population are missing at least one of their 8’s?
30%
52
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
53
What is Ectodermal dysplasia?
A group of diseases affecting the structures arising from the ectoderm: teeth, hair, nails, sweat glands, salivary glands.
54
What is the most well known, easily recognisable type of Ectodermal dysplasia?
X-linked Hypohydrtic Ectodermal dysplasia
55
What are the characteristic features of Ectodermal dysplasia?
- sparse hair
- dry skin
- inability to sweat
- conical teeth with microdontia and hypodontia
56
At what stage of tooth development does supernumerary occur?
Initiation stage
57
What syndromes could be associated with supernumerary? Name 3.
1. Cleidocranial dysplasia
2. Cleft lip and palate
3. Gardner syndrome
58
What are the 4 types of supernumerary teeth?
1. Conical
2. Tuberculate
3. Supplemental
4. Odontome
59
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
60
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
61
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
62
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
63
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
64
What size of tooth is supernumerary usually associated with?
Larger teeth (macrodontia)
65
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.
66
What type of radiograph is indicated to exclude the presence of unerupted supernumeraries?
Parallax (and where necessary a CBCT)
67
If supernumerary is left unerupted and not removed, what consequence can this have?
Can cause resorption of roots of surrounding teeth
68
What are the 4 management options for supernumerary teeth?
1. Monitor
2. Simple extraction
3. Surgical extraction
4. Teeth which have been impeded may need to be surgically exposed +/- orthodontically repositioned
69
Define, a rare autosomal dominant condition characterised by hypoplastic or absent clavicles, short stature and characteristic facial features.
Cleidocranial dysostosis
70
What are the dental features of Cleidocranial dysostosis?
- supernumerary teeth
- delayed/failed exfoliation of primary teeth
- delayed/failed eruption of permannet teeth
71
At what stage of tooth development does microdontia occur?
Morphogenesis stage
72
What syndromes are associated with microdontia?
- ectodermal dysplasia
- cleft lip and palate
73
Microdont laterals are associated with increased incidence of palatally ectopic canines. True or false?
True
74
What are the management option for microdont teeth?
1. Accept
2. Orthodontic space redistribution
3. Composite build up
4. Extract
75
What is dens invaginatus?
When the enamel is folded in on itself creating an enamel lined cavity within the tooth.
76
At what stage during tooth development does dens invaginatus occur?
During morphogenesis stage
77
What teeth are most commonly affected by dens invaginatus?
Maxillary lateral and central incisors
78
What may be an early first indication of dens invaginatus?
Unexplained loss of vitality in the absence of trauma or caries
79
What are the 3 management options of dens invaginatus?
1. Fissure seal deep cingulum pits
2. If loss of vitality occurs, RCT treatment can be attempted. (Highly complex)
3. Extraction
80
What is dens evaginatus?
An additional cusp or tubercle (aka talon cusp)
81
During what stage of tooth development does dens evaginatus occur?
Morphogensis stage
82
What teeth are commonly affected by dens invaginatus?
- lower 2nd premolars in Asian populations
- maxillary incisors
83
What is dilaceration?
A bend in the root or crown of the tooth
84
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)
85
What teeth are most commonly affected by Dilaceration?
Permanent maxillary central incisors
86
What radiographs are usually required to assess dilaceration of a tooth?
Lateral cephalogram and CBCT
87
What is taurodontism?
Where there is elongated pulp chamber in a multi-rooted tooth resulting in differences in root morphology with a low bifurcation.
88
What environmental/acquired factors can cause arrested root development and therefore short roots?
1. Loss of vitality prior to apexogenesis
2. Result of illness or cancer treatment
3. Trauma
89
Where there is arrested development of roots due to loss of vitality, what will the dentine walls and root canals look like radiographically?
Dentine walls will be thin and root canal wide
90
Where there is arrested development of roots without loss of vitality, what will the root look like radiographically?
The roots may be tapered to a point
91
What is the treatment for non-vital teeth with arrested root development?
RCT with apexification
92
What is the normal pressure of arterioles supplying the dental pulp?
30mmHg
93
What is normal pulpal pressure, which allows blood to flow?
25mmHg
94
If pulpal tissue pressure is < than apical arteriolar pressure, the pulp dies. True or false?
False. > , is the correct answer.
95
What happens to a tooth if it becomes necrotic before the root is fully developed?
Arrested root development
96
What is transient apical breakdown (TAB)?
If a tooth is revascularising after a luxation injury, the increased cellular activity around the apex can result in a small, radiolucency “cap” appearing on radiograph. This is called TAB.
97
Why does a re-vascularised tooth always progress to pulp canal obliteration?
Because new cells growing from PDL only differentiate into a kind of primitive odontoblast, which rapidly calcifies the pulp.
98
Why is a test cavity of no use as a pulp health diagnostic test for a traumatised tooth?
In a tooth which is revascularised, the dentinal tubules remain empty so instrumenting dentine will not produce a pain response. Pain will not be produced until pulp is reached.
99
What is pulp canal obliteration?
Where odontoblast type cells that differentiate from the revascularising pulp tissue lay down dentine type tissue in a disorganised way until the while chamber is filled.
100
What are clinical and radiographic signs of pulp obliteration?
Clinical - yellow discolouration of crown
Radiographic - pulp cannot be seen
101
What is replacement resorption?
Characterised by a pathologic loss of tooth substance (dentin, PDL, cementum) with replacement by bone. So the root of the tooth ends up fused to the surrounding bone.
102
What type of trauma injury causes cells on both sides of the PDL to be crushed?
Intrusions
103
What type of trauma injury causes cells on the root surface to become dissected and die?
Avuslions
104
What are the consequneces of loss of the PDL for the remaining tooth?
Ankylosis and infra occlusion
105
Define, the process of fusion between the dentine or cementum of the tooth root and the alveolar bone, with obliteration of the PDL which progressively gets displaced by bone.
Ankylosis
106
Define, when a tooth/teeth is found below the occlusal level of the adjacent teeth, long after it should have reached occlusion.
Infra-occlusion
107
What are enamel infractions?
Incomplete enamel cracks
108
What does degloving of soft tissue mean?
Peeling of the soft tissue off of the underlying bone in an apical direction
109
Once damaged, how long does it take the junctional epithelium to re-attach?
4-5 days
110
What are the three age peaks of trauma in childhood/adolescence? and why?
1-2 years old (learning to walk)
8-10 years old (generally playing, learning to ride bikes etc.)
14-16 years (puberty, contact sports, violence)
111
What individuals are most predisposed to trauma of anterior teeth?
Those with increased overjet with protrusion of upper incisors and insufficient lip closure
112
If the tooth is directly injured with a crown or root fracture, what type of trauma is likely to have caused this?
Generally a result of to impact against something very hard i.e. the road.
113
If the tooth socket (periodontal injury) is directly injured, what type of trauma is likely to have caused this?
Generally the result of an impact against something relatively soft is.e. A fist or elbow.
114
It is common for dental trauma cases to involve both dental and periodontal injury at the same time. True or false?
False. It is unusual for a tooth to sustain both types of injury.
115
Name the 4 different types of dental injuries (just to the tooth) that can occur?
1. Enamel fracture
2. Enamel/dentine fracture
3. Enamel/dentine/pulp fracture
4. Root fracture (cervical or mid third)
116
Name the 4 different types of dento-alevolar injuries (just to the socket) that can occur?
1. Concussion (bruised)
2. Subluxation (loosened)
3. Luxation (displaced- extrusive, intrusive, lateral)
4. Avulsion
117
What is the best type of gum shield to recommend for contact sports?
Custom made
118
What are clinical signs of a root fracture?
1. Coronal segment may be mobile
2. Tooth TTP
3. Bleeding from gingival sulcus
4. Transient crown discolouration (red or grey)
5. May give initial negative result on sensibility test
119
What planes can a root fracture be in?
Horizontal or oblique
120
What plane of root fracture can usually be detect in a regular periapical radiograph?
Fractures in the horizontal plane, usually in the cervical third of the root.
121
What plane of root fracture can usually be detect in an occlusal radiograph?
Oblique fractures
122
What are clinical signs of subluxation?
1. Bleeding from gingival crevice
2. TTP
3. Increased mobility
123
What are clinical signs of intrusive luxation?
1. Tooth displaced axially
2. Immobile
3. Percussion gives high ankylotic sound
124
What are the radiographic signs of intrusive luxation?
1. The PDL space mat be absent from all or part of root
2. The CEJ is located more apically
125
What are the clinical signs of lateral luxation?
1. Displaced in a palatal/lingual or labial direction
2. Immobile
3. Percussion high ankylotic sound
4. Fracture of alveolar process
5. Sensibility tests will likely give negative results
126
How can you tell if the alveolus has fractured?
If 2 or more teeth are moving as a block
127
What are customs made gum shields made of?
Ethylene vinyl acetate
128
Describe the ideal gum shield?
One that covers teeth and extends into the labial sulcus
129
How would you assess a patient for signs of head trauma?
- history of loss of consciousness?
- was the incident witnessed?
- child acting “out of character”?
- history of vomiting, nausea?
- visual disturbances?
130
What can a haematoma on the floor of the mouth be suggestive of?
A fracture
131
What radiograph would be useful to take if concerned about condylar or mandibular fracture post trauma?
DPT
132
Give 4 examples of non-accidental injury?
1. Self-harm
2. Abuse
3. Boxing or other contact sparring sport
4. Bullying
133
What are typical sites of accidental injury (name 8)?
1. Forehead
2. Nose
3. Chin
4. Palm of hand
5. Knees
6. Shins
7. Elbows
8. Head injuries involving the parietal or occipital bone
134
What are typical sites of non-accidental injury (name 12)?
1. Eyes (black eyes, especially if bilateral)
2. Soft tissues of cheeks
3. Intra-oral injuries
4. Forearms
5. Chest and abdomen
6. Any groin or genital injury
7. Inner aspect of thigh
8. Soles of feet
9. Ears (pinch marks)
10. Triangle of safety
11. Inner aspect of arms
12. Back and side of trunk
135
If adjacent teeth move when assessing mobility of a trauma tooth, what might this indicate?
Alveolar fracture
136
What might a blood clot attached to the gingival crevice after recent trauma (<24 hrs) suggest?
Subluxation of the tooth
137
Why is taking an anetrior occlusal maxillary view and a periapical view recommended in trauma cases?
To assess for root fractures, sometimes these may not show up on PA views along due to angle of fracture.
138
What are the 5 initial steps to run through with a trauma patient?
1. Gather information
2. Head injury assessment
3. Non-dental injuries
4. Non-accidental injuries
5. Diagnosis of dental injury
139
How would you manage/treat a dental concussion?
Painkillers, soft diet, monitor and review.
140
Why might sensitivity tests of a traumatised tooth be negative at the time of injury?
Due to transient pulpal damage
141
What guidelines would consult in the case of dental trauma?
International Association for Dental Traumatology (IADT) guidelines
142
What are the three main desirable outcomes of treated a traumatised primary tooth?
1. Eliminate pain/symptoms
2. Prevent infection/further issues
3. Preserve and minimise damage to the permanent dentition
143
What are the three main desirable outcomes of treated a traumatised permanent tooth?
1. Eliminate pain/symptoms
2. Prevent infection/further issues
3. Preserve and minimise damage to permanent dentition
144
If a trauma patient has a minor laceration which doesn’t require intervention, what home management would you advise to them?
Advise to keep clean by using salt/water rinse
145
What is the purpose of a splint?
To stabilise teeth that have undergone injuries to the PDL until there is sufficient healing
146
What are the three ideal properties of a splint?
1. Flexible
2. Passive
3. User friendly
147
What do splinting times depend on?
How much damage has occured to the PDL
148
Which injury requires longer splinting time, lateral or extrusive luxation? (+ state the splint times)
Lateral luxation requires longer splint time (4 weeks), whereas extrusive luxation requires around 2 weeks.
149
What are the 4 types of healing outcomes for horizontal root fractures?
1. Non-healing (granulation tissue)
2. Hard tissue union (union of fractured parts)
3. Investing of connective tissue (PDL invests fracture)
4. Investing of connective tissue and bone
150
Why will cervical third root fractures require longer splinting than apical or mid third root fractures? How long should a cervical third root fracture be splinted for?
Because it will be more unstable.
Splint time = up to 4 months
151
What is the most common type of trauma injury in primary dentition?
Intrusion
152
What radiograph should be used to investigate potential intrusion of a tooth?
Anterior maxillary occlusal radiograph
153
Why might teeth go orangey/yellow in colour following trauma?
Pulp canal obliteration
154
Is a tooth with pulp canal obliteration vital or non-vital?
Vital (how else would it lay down dentine!)
155
Why is it important to review trauma cases?
Not all sequelae of trauma are immediate. Many complications and some effects can occur months/years after the initial incident.
156
What are the main consequneces of trauma to primary teeth?
1. Pulpal necrosis
2. Pulpal obliteration
3. Root resorption
4. Damage to the successors
157
What are clinical and radiographic signs of primary tooth pulpal necrosis?
1. Persistent grey colour that does not fade
2. No reduction in size of pulp cavity radiographically
3. Radiographic signs of periapical inflammation
4. Clinical signs of infection: tenderness, sinus, suppuration, swelling
158
How can you treat a primary tooth with pulpal necrosis if there are radiographic or clinical signs of infection and symptoms?
Extraction
159
What is transient discolouration of traumatised teeth?
Where tooth can initially appear discoloured immediately after trauma as there is blood in the tubules, however this is reversible and will fade.
160
What are the clinical and radiographic signs of primary tooth pulpal obliteration?
1. Clinically the tooth may become a yellow/opaque colour
2. Radiographically, the pulp chamber will shrink
161
How do you treat primary tooth pulpal obliteration if…
1. The tooth is asymptomatic
2. Radiographic or clinical signs of infection/inflammation and symptomatic
1. Nothing, only monitor
2. Extract
162
What are the radiographic and clinical signs of primary tooth root resorption?
1. Radiographically signs of root resorption
2. Possible clinical mobility
163
At what age range is trauma of a primary tooth most likely to cause damage to the successor tooth?
6 months -3 years of age
164
What type of trauma injury carries the most risk of damage to a permanent successor tooth?
Intrusive luxation
165
What post-traumatic complications occurs more frequently in teeth with open (immature) apices which have suffered severe luxation injury?
Pulp canal obliteration
166
In a tooth with an enamel/dentine fracture, where the dentine is exposed within 0.5mm of the pulp (pink but not bleeding), what should your treatment be?
Place a calcium hydroxide lining and cover with a material such as GI
167
When are clinical follow ups require for a traumatised tooth with an enamel/dentine fracture and no pulp exposure?
After 6-8 weeks
After 1 year
168
When are clinical follow ups require for a traumatised tooth with an enamel/dentine/pulp fracture?
After 6-8 weeks
After 3 months
After 6 months
After 1 year
169
How do you treat an uncomplicated crown-root fracture (without pulp exposure)?
Removal if the coronal or mobile fragment, and subsequent restoration.
170
When are clinical follow ups required for a traumatised tooth with an uncomplicated or complicated crown-root fracture?
After 1 week
After 6-8 weeks
After 3 months
After 6 months
After 1 year
Every year for at least 5 years
171
What can bleeding from the gingival crevice after trauma indicate?
Root fracture or subluxation
172
What type of traumatic injury, fits these clinical findings:
1. Associated fracture of alveolar bone
2. Immobility
3. Metallic sound upon percussion
Lateral luxation
173
If an avulsed tooth has a delayed replantation, what is an expected outcome upon healing?
Ankylosis-related (replacement) root resorption
174
Why when administering LA after trauma injury should you try and avoid using LA with a vasoconstrictor?
there are concerns as to whether there are risk of compromising healing by using LA with a vasoconstrictor
175
When is there a need for clinical and radiographic reviews to be more frequent in a trauma case?
Where the traumatised tooth has an open apex
176
Why are pulp sensibility tests not recommended in primary tooth trauma?
They are unreliable
177
What instrcutions for home care should you give a parent if their child has experienced dental trauma to encourage successful healing to take place?
1. Clean the affected area with a soft brush or cotton swab
2. Use alcohol-free Chlorohexidine gluconate 0.12% mouth rinse applied topically twice a day for one week
178
Name 5 anomalies of tooth structure where the anomaly is associated with enamel.
1. MIH
2. Fluorosis
3. Amelogenesis imperfecta
4. Chronological hypoplasia
5. Turner teeth
179
What is the aetiology of turner teeth?
Enamel defect in a permanent tooth caused by periapical inflammatory disease in the overlying primary tooth
180
Name 4 anomalies of tooth structure where the anomaly is associated with dentine.
1. Dentinogenesis imperfecta
2. Dentine dysplasia
3. Hypophosphataemic rickets
4. Intrinsic staining
181
Define, hypophosphaetaemic rickets?
Disorder of bone mineralisation caused due to defects in the renal handling of phosphorus.
182
Name an anomaly of tooth structure where the anomaly is associated with cementum.
Hypophosphotasia
183
Disruption of Amelogenesis in what stage of enamel formation causes MIH?
Early maturation phase
184
What LA should be considered as first line if a patient has MIH and requires anaesthesia?
Articiane
185
What index is widely used in the literature to classify severity of fluorosis?
The thylstrup and Fejerkov index
186
What are the three main types of Amelogenesis imperfecta?
1. Hypoplastic
2. Hypocalcified
3. Hypomaturation
187
What type of amelogenesis imperfecta is described?
Teeth small due to thin enamel, pitted, pointed cusps, discoloured, sensitive, bond strength good.
Hypoplastic amelogenesis imperfecta
188
What type of amelogenesis imperfecta is described?
Soft enamel, discoloured, severe sensitivity, delayed or failed eruption, bond strength poor.
Hypocalcified Amelogenesis Imperfecta
189
What type of amelogenesis imperfecta is described?
The mildest form. White mottling, sometimes brown patches, looks similar to fluorosis.
Hypomaturation amelogenesis imperfecta
190
Define, chronological hypoplasia.
Quantitive defect of enamel caused by a systemic environmental factor, affecting multiple teeth in a linear pattern.
191
During what stage of Amelogenesis is chronological hyperplasia triggered?
Environmental insult during secretory phase of amelogenesis
192
What radiographic features would indicate chronological hypoplasia?
V-shaped radiolucencies or notches interproximally
193
What is the cause of isolated dentinogenesis?
Caused by mutation of the DSSP gene and is autosomal dominant.
194
What is the cause of syndromic Dentinogenesis imperfecta?
A feature of Osteogenesis imperfecta which is a collagen defect
195
What is the management of Dentinogenesis imperfecta?
1. Provide restorations to address aesthetics
2. Prevent attrition
3. Maintain occlusal vertical dimension
196
Mutation of what gene causes dentine dysplasia?
Mutation of DSPP gene
197
What type of inheritance causes hypophosphataemic rickets, and what gene is involved?
X-linked dominant inheritance of faulty PHEX gene
198
What are two main causes of intrinsic discolouration of dentine?
1. Medication induced: (tetracyclines)
2. Hyperbilirunaemia (childhood liver disease)
199
What is hypophosphotasia?
A group of disorders of bone formation caused by defects in the alkaline phosphotase gene.
200
Mutation of what gene causes hypophosphatasia?
Mutations in the ALPL gene resulting in reduced production of alkaline phosphatase.
201
What is a key clinical feature of hypophsophotasia?
Premature exfoliation of fully rooted primary teeth due to defects in cementum formation, usually occurs at 2-4 years old.
202
What is the management of hypophosphotasia?
Identification and referral to paediatric dentist and/or endocrinologist
203
What is a casual term used for regional odontodysplasia?
“Ghost teeth”
204
What is regional odontodysplasia?
Severe qualitative and quantitative defects of enamel and dentine usually affecting more than one region of the maxilla and mandible.
205
Why is regional odontodysplasia described as “ghost teeth”?
As the teeth lack mineralisation and appear more radiolucent than usually on radiograph.
206
What is the aim of a splint?
To stabilise teeth, wallowing time for PDL damage to repair. In essence it prevents further trauma and allows healing of the traumatised tooth.
207
What are the requirements for a completed fitted splint on a traumatised tooth?
1. Passive
2. <2mm off tooth surface
3. Conforms to dental arch curvature
4. Not overlying gingivae
5. Flexible
6. Have no unnecessary plaque traps or overhangs
7. Have no sharp edges
208
Where on the tooth should a splint be placed?
Roughly on the incisal 3rd of tooth, away from gingiva.
209
What instruments should you use to remove a wire splint fixed with composite?
Slow speed rotary instrument and tungsten carbide debond bur
210
Before removing the entire splint, what should you assess?
Only remove composite off traumatised tooth and assess its mobility.
211
If a traumatised tooth is still mobile after the required period of splinting, what is the management?
Further investigation and onward referral.
