Paediatrics Flashcards
When does hard tissue start to form in a foetus?
13 weeks i.u.l.
When do teeth start to form in a foetus?
5 weeks intra uterine life (i.u.l.)
At what ages should you assist your child with brushing their teeth?
Until child is >7
At what age can a child start using fluoride mouthwash?
6 - still need to assess if child can properly expectorate
How often should topical fluoride varnish be applied to a child’s dentition?
At least twice yearly for pre-school children assessed as being high risk
What contributes to a child being considered high risk?
Oral hygiene Diet Area they live Parents oral health Parent smoking Previous caries
Define health education.
A process that results in individuals or groups having increased knowledge related to health.
How often should you take radiographs for caries in children?
High risk - bitewings every 6 months
Low risk - bitewings every 12 to 18 months
You miss 60% of interproximal caries if you don’t take bitewings.
How can you diagnose caries?
Clinical exam - visual Radiographs Temporary tooth separation Electric caries meter Fibre-optic transillumination Air abrasion CO2 laser
What is nursing caries?
Caused by inappropriate use of feeding cups and bottles - use at night, sugary drinks, not a free-flow spout
Usually affects the upper anterior and molar teeth
When should use of a free flow spout feeder cup (rather than a bottle) be recommended?
From 6 months
Sweetened drinks should not be advocated, however when you suspect they are being used, what advice should you give?
Mealtimes only
Dilute as much as possible
Drink through a straw held at the back of the mouth
What non-sugar sweetener should be encouraged?
Xylitol
What are the only safe drinks to drink in between meals?
Plain water
Plain milk
What are appropriate snacks for toddlers?
Crackers Breadsticks Fruit Savoury sandwiches Rice cakes Crisps?
What concentration of fluoride is in fluoridated water?
1.0ppm
How much toothpaste is recommended for children under 3?
Smear - 0.1ml
How much toothpaste is recommended for children aged 3 and over?
Pea-sized amount - 0.25ml
What dose of fluoride tablets can be given to children?
6 months - 3 years: 0.25mg/d
3 years - 6 years: 0.5mg/d
6 years and over: 1mg/d
Can also be given in drops
When does tooth eruption begin?
6 months
As a general rule what order do primary teeth erupt?
Lower before upper.
Anterior to posterior.
12435
When is eruption of primary teeth complete?
24 months
What are the characteristics of the primary dentition?
Incisors upright & spaced
Deep overbite
Teeth are smaller & whiter in colour
What are the aspects of the psychology of child development?
Motor Cognitive Perceptual Language Social
What are the stages of cognitive development?
Sensorimotor (until 2) Preoperational thought (2-7years) Concrete operations (7-11years) Formal operations (11+ years)
What is object permanence?
The understanding that objects continue to exist even when they cannot be observed (seen, heard, touched, smelled or sensed in any way).
What is the language of a one year old?
Understands a vocabulary of 20 words, simple phrases and relates objects to words.
Uses 2-3 words, repetitive babble and tuneful jargon
Sounds: b, d, m
What is the language of a two year old?
Understands simple commands, questions, joins in action songs
Uses a vocabulary of 100 words, puts two words together, echolalia (repeat noises and phrases that they hear)
Sounds: p, t, k, g, n
What is the language of a three year old?
Understands prepositions (on, under etc.), functions of objects and simple conversations
Uses 4 word sentences, what, who, where etc., relates experiences
Sounds: f, s, l
What is the language of a four year old?
Understands colours, numbers, tenses, complex instructions
Uses long grammatical sentences, relates stories
Sounds: v, z, ch, j
What is dysphonia?
Disorders of the voice.
An impairment in the ability to produce voice sounds using the vocal organs.
What is dysarthia?
Motor speech disorder resulting from neurological injury of the motor component of the motor-speech system
What is velopharyngeal insufficiency (VPI)?
Failure of the separation between nose and mouth because of an anatomical dysfunction of the soft palate, the lateral or posterior wall of the pharynx.
What speech problems might children with clefts have?
There is no separation between the nasal cavity and the mouth, meaning that:
The child can’t build up air pressure in the mouth because air escapes out the nose.
There is less tissue on the roof of the mouth for the tongue to touch.
What speech problems are caused by oronasal fistulas?
There is nowhere for the tongue to touch on the palate so air leaks out the nose producing nasal sounds.
What is the treatment for cleft palate?
Feeding Early intervention Input modelling Articulation therapy Communication support
What are the secondary surgeries for cleft lip/palate?
Rhinoplasty Fistula closure Pharyngoplasty Alveolar bone graft Osteomy
What is the normal development of feeding skills in the infant?
Pre 40 weeks gestation
28 weeks - non nutritive sucking
34 weeks - nutritive sucking
What is normal feeding of a child aged 0-3 months?
Normal oral tone Rhythmic sucking Primitive reflexes - gag, rooting, suck/swallow Semi-reclined feeding position Liquid diet
What is normal feeding of a child aged 4-6 months?
Head control More control of suck/swallow Munching Semi solid diet Starts babbling
What is normal feeding of a child aged 7-9 months?
Sitting feeding position Mashed food consistency Finger food Upper lip involvement Chewing and bolus formation Bite reflex Mouthing
What is the normal feeding of a child aged 10-12 months?
Lumpy food Sustained bite Active lip closure Chewing - lateralisation Cup drinking
What is the normal feeding pattern of a child aged 24 months?
A mature and integrated feeding pattern
What is the effect of the family unit on the child’s attitude towards dentistry?
Behaviour contagion
Well-intentioned but improper preparation
Enhancing anxiety
Threatening child with dental treatment
What frightens children about the dentist?
The unknown Sight of syringes Sight, sound and sensation of drill Mutilation Choking Strangers
What are the signs of anxiety in children?
Thumb-sucking Nail-biting Nose-picking Clumsiness Stuttering Headache Fidgeting No speech Need to go to the toilet Clinging to parent
What are the components of communication?
Verbal (5%)
Paralinguistic (30%)
Non-verbal (65%)
What is verbal communication?
The actual words the person uses
Try to avoid the use of jargon and specific terms
Children are not small adults - approach and language should be modified to match their abilities and understanding
Alternative words for dental equipment is often used in paeds, when should you avoid this?
Autistic children - they will take everything literally
What is paralinguistic communication?
30%
Refers to tone of voice used
Issuing commands in a loud voice is more effective than using a normal voice
What is non-verbal communication?
65%
Includes a range of behaviours and environmental factors which we often interpret without conscious awareness.
Facial expression, gaze gesture, bodily contact, clothes, spatial awareness
What should you do if patient is incapable or unwilling to sit for examination?
Position the child in the lap of the dentist and parent
Permits the child to be in direct visual and physical contact with the parent
Why might you exclude parents from the surgery?
Unable to refrain from competing with the dentist for their child’s attention.
Unintentionally convey their own anxieties to the child through body language and words.
Role should be as a passive and silent helper.
