Paediatrics

Question 1

what two types of commonly used medications may present an adverse risk to asthmatic patients

Answer 1

NSAIDs
aspirin

Question 2

why may patients with asthma be at a higher risk for developing caries

Answer 2

prolonged use of beta-2 agonist inhalers can reduce salivary flow and make the oral environment acidic
a lot of asthmatics also mouth breathe

Question 3

why may patients with asthma be more susceptible to oral candidal infections

Answer 3

long term use of inhaled corticosteroids
reduced saliva flow

Question 4

how can an asthmatic’s candida risk be reduced

Answer 4

rinse mouth after taking medication
chew sugar free gum
use antimicrobial mouthwash after taking medicine
prescription of oral fluconazole or nystatin

Question 5

why are fluoride varnishes contra-indicated in asthmatics

Answer 5

colophony

Question 6

what is MIH

Answer 6

hypomineralisation of first permanent molars with the permanent incisors affected as well

Question 7

what is the radiographic and clinical evidence for the best time to extract FPMs of poor prognosis

Answer 7

bifurcation of 7s calcifying
5s and 8s present on radiograph
mild buccal segment crowding
class I incisors

Question 8

what are the treatments for FPMs with MIH

Answer 8

early detection, OHI, diet advice, NaF varnish application
GIC restorations
timed extractions
restore with composite resins
PMCs
pulp therapy in compromised molars

Question 9

what are treatments for anterior teeth with MIH

Answer 9

microabrasion
resin infiltration
external bleaching
composite restorations

Question 10

what type of prevention should cleft lip and palate patients receive

Answer 10

enhanced prevention

Question 11

why may patients with CL/P experience more dental caries

Answer 11

difficulty maintaining OH in cleft area
hypoplastic enamel
crowding and supernumerary teeth in cleft area
delayed oral clearance and reduced saliva flow
mouth breathing

Question 12

what dental anomalies are associated with CL/P patients

Answer 12

hypodontia
supernumerary teeth
shape and size anomalies (macro/microdontia)
developmental defects (hypoplasia/ hypomineralisation)

Question 13

when is the use of clotting factor replacement therapy indicated in dental treatment

Answer 13

before invasive oral surgery and the use of IAN block

Question 14

what is haemophilia

Answer 14

X linked hereditary disorder
Haemophilia A is deficiency of factor VIII and Haemophilia B is a deficiency of Factor IX

Question 15

what are the plasma activity levels for mild, moderate and severe for haemophilia

Answer 15

mild - 6-40IU/dL
moderate - 2-5 IU/dL
severe - less than I IU/dL

Question 16

what is the role of DDAVP

Answer 16

to release bound factor VIII

Question 17

how is dental treatment undertaken in haemophilia patients

Answer 17

careful not to damage the oral mucosa
can be given dentures as long as the dentures do not traumatise mucosa
risk of bleeding with matrix bands and wedges must be controlled

Question 18

what anaesthesia and analgesia information should you give to a patient with haemophilia

Answer 18

no NSAIDs unless previously discussed with haematologist
aspirin not to be used
IDB and lingual infiltration only given after raising clotting factors by appropriate replacement therapy

Question 19

what is Von Willebrand Disease

Answer 19

deficiency of Von Willebrand Factor
vWF stabilises factor VIII and enables platelet interaction with blood vessel wall

Question 20

what 4 ways can haemophilia patients be managed in the dental setting

Answer 20

coagulation factor replacement therapy (IV infusion 30 minutes before procedure)
release of endogenous stores (DDAVP)
improve clot stability with antifibrinolytic drugs (tranexamic acid given two hours before and continued for 7-10 days after)
local haemostatic measures

Question 21

name four examples of local haemostatic measures

Answer 21

sutures
oxidised cellulose (surgicel)
surgical splints
diathermy
local anaesthetic containing vasoconstrictor

Question 22

what is the minimum pre-operative plasma factor level for a dental extraction to be safely performed

Answer 22

50%

Question 23

what would a patient with factor inhibitors need to receive instead of factor concentrate

Answer 23

factor VIIa

Question 24

what pre-operative techniques should be done before treating a haemophilia patient

Answer 24

check plan with haemophilia clinic
factor replacement therapy
antifibrinolytic therapy
clean mouth

Question 25

what peri-operative techniques should be used for a patient with haemophilia

Answer 25

local haemostatic control
operator precision
no IDB or lingual infiltration
take tooth out atrumatically
do not leave any root remnants

Question 26

what post operative techniques should be used for a patient with haemophilia

Answer 26

no aspirin or NSAIDs
tranexamic acid
surgicel and suture
pressure
if still bleeding in 24 hours phone haemophilia centre
warm salty mouthwash after 24 hours

Question 27

why may patients who are nervous bleed more

Answer 27

increased heart rate causes blood to be pumped around body at higher rate which decrease the effect of vasoconstrictors