Paediatrics Flashcards
Management of the paediatric dental emergency: What sorts of vaccines are children given at a young age?
MMR
Diptheria
polio
meningitis
then ACWY
special - flu, TB, hep B, chicken pox
Management of the paediatric dental emergency: What is the most common viral infection that will present to you?
herpes simplex - primary herpes
varicella- zoster (chickenpox - primary/ shingles (reactivation - lives in spinal root ganglia)
might be an underlying cause for a fit young person getting shingles
if all chicken pox blisters have crusted over then they are not infectious anymore
Management of the paediatric dental emergency: What are the viral features of measles/mumps (bacteria infection in the gland)?
kopek’s spots in the mouth
classical rash on the body
can get encephalitis swelling of parotid gland - mumps other glands swollen - mumps can't open mouth - mumps ear lobe turned up - mumps
rubella - rash, vomiting, stomach upset
Management of the paediatric dental emergency: What is a cocksackie virus?
Cause a series of conditions similar to primary herpes
- causes herpangina
hand foot and mouth disease -ulcers in mouth, spots on hand and feet
Epstein- barr virus - causes glandular fever, malaise, tired, lymphandonapathy
Management of the paediatric dental emergency: What sort of bacterial infections may children get?
Impetigo - ulcers/sores on face, very infective
streptococcal (scarlet fever) - sore throat, redness in cheeks
cat scratch disease - unwell, malaise, lymphadonpathy
ANUG - sore painful gingival, breakdown of interdental papilla, bad breath, know it when they walk in, check for underlying cause in children
actinomycosis - ulcers, sores on face, yellow colour liquid weeps?
meningitis - unlikely to present to dentist
Management of the paediatric dental emergency: How do you examine for a dental abscess?
- History of complaint
- Symptoms, duration Pain score, sleep, fluids (young children have less of tolerance of going without fluid)
- Medical history
- Dental history
- Social history
E/O
• Symmetry, swelling - how fast is the swelling going up?
• Lymph nodes
• Temperature - if above 38 degrees, need admitting?
• Rash
difficulty swallowing and difficulty opening mouth (truisms) - BAD
I/O • Soft tissues • Ulcers • Form (swelling) • Colour
I/O • Hard tissues • Carious teeth • Colour of teeth • Bone - see if you can see the cause of the swelling - drainage?
Management of the paediatric dental emergency: What things do you look for in examining a swelling/ulcer?
- Site
- Size
- Surface
- Texture
- Colour
Management of the paediatric dental emergency: Where may an abscess spread?
Fascial plains
sub-lingual
sub-mandibular
pharyngeal
Venous
ocular
Management of the paediatric dental emergency: What special investigations might you do for an abscess?
- Radiographs
- Vitality tests
- Bloods
Management of the paediatric dental emergency: What are the two most common problems?
Primary herpes
dental abscess
• In general the younger the child the more likely they are to have systemic problems
Management of the paediatric dental emergency: What are the symptoms of primary herpes?
- Fever
- Headache
- Malaise
- Mild dysphagia
- Lymphademopathy
- Oral ulceration - lots of tiny ulcers in the mouth
- Marginal gingivitis
• 14 days duration • Recurrent herpes labialis - some get cold sores ADMISSON • Dehydration • Fever
Management of the paediatric dental emergency: How do you manage primary herpes?
- Fluids
- Rest
- Analgesics
- Antipyretics
- Chlorhexidine
- Avoidcross-infection
- Antivirals
Management of the paediatric dental emergency: how do you manage a dental abscess?
- Drainage
- Antibiotics if spreading infection
- Antibiotics if systemic upset, BUT DOES NOT NEED
- Analgesic
- Antipyretic
- Follow-up
Management of the paediatric dental emergency: When does a child need admitting to hospital?
- Spreading infection
- Trismus
- Pyrexia
- Malaise
- Dehydration
- Dysphagia
Management of the paediatric dental emergency: What is the difficulty of LA when there is an infection?
- Co-operation - hurts a lot
- Decreased effectiveness - environment is acidic
- Risk of spreading infection - drive bacteria into the venous system, use a block and inject away from it
Management of the paediatric dental emergency: What do you have to be mindful of with a dental trauma?
- Head injury - first thing, are they confused?
* Account for lost tooth - could it be in the lungs? - chest x ray?
Dental care for the medically compromised child: What is the medical model of health?
Medical care/treatment is seen as the main issue
The focus is on cure and rehabilitation through medical intervention
‘The personal tragedy theory of disability’
Dental care for the medically compromised child: What is the social model of health?
It is society which disables people with impairment by its failure to include them
Dental care for the medically compromised child: What is an impairment in the medical model?
loss or abnormality of physiology or anatomical structure or function
Dental care for the medically compromised child: What is an impairment in the social model?
the functional limitation within the individual caused by physical, mental or sensory loss
Dental care for the medically compromised child: What is disability in the medical model?
restriction of activity as a consequence of impairment
Dental care for the medically compromised child: What is disability in the social model?
the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical or social barriers
Dental care for the medically compromised child: What does b520 of the ICF by the WHO say?
Caring for body parts
Looking after parts of the body, such as skin, face, TEETH, scalp, nails & genitals, that require more than washing & drying
Dental care for the medically compromised child: What does b280 of the ICF by the WHO say?
Sensation of pain
Sensation of unpleasant feeling indicating potential or actual damage to some body structure
Dental care for the medically compromised child: What is challenging behaviour?
behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour that is likely to seriously limit or deny access to the use of ordinary community facilities
Dental care for the medically compromised child: What aspects of disability may affect dental care? LEARN
- Makes treatment potentially dangerous
- More at risk of dental disease
- Compliance with personnel care
- Compliance with treatment
Dental care for the medically compromised child: Why are disabled people potentially more at risk of dental disease?
- Cleft lip & palate - hypoplasia, don’t swallow normally to clear food
- Down syndrome - diet less controlled, brushing poor, per risk greater but genetically lower risk of caries
- Cerebral Palsy - harder to brush teeth, may have intellectual impairment
Dental care for the medically compromised child: Why is dental treatment potentially more dangerous?
- Cardiac lesion, - endocarditis
- Immuno-compromised - gums may bleed more easily, dental abscess may be life threatening
- Bleeding tendency - e.g. warfarin
Dental care for the medically compromised child: Why may there be issues with compliance of personal care?
- Autism - some patients don’t comply
- ADHD - may not sit still for treatment
- Cerebral palsy
- brushing is harder
- drugs causing xerostomia
- radiotherapy damaging salivary glands etc
Dental care for the medically compromised child: Why may there be issues with compliance of treatment?
- Learning delay
- ADHD
- Crebral palsy
Dental care for the medically compromised child: What may autistic children have difficulty with?
Social interaction
Communication
Inflexibility in thinking and behaviour
Dental care for the medically compromised child: How is ADHD managed?
Management - medications, behaviour modifications, lifestyle changes, and counselling
Dental care for the medically compromised child: Delivering better oral health
Look up children section
Dental care for the medically compromised child: What are the features of downs’ syndrome?
- Trisomy21
- Typical appearance – upslanting palpebral fissure, simian fold, reduced muscle tone
- ReducedIQ
- Congenital heart disease
- Gastric reflux
- Thyroid dysfunction
- Immune deficiency , increased risk of leukaemia.
- Atlanto-axialinstability - need to support the head during extractions
- Oral – less caries, more perio disease, delayed eruption, macroglassia (large tongue).
Dental care for the medically compromised child: What are the features of cerebral palsy?
caused by oxygen starvation around time of birth
• Damage to the motor control centres
abnormal muscle tone (i.e. slouching over, reflexes, motor development or coordination.
• Sometimes cognition - 30% of people only
• Sometimes epilepsy
Dental care for the medically compromised child: What does SEAMLESS stand for?
All people that are disabled should have:
S Should have opportunity E Education A Access M Multidisciplinary L Linkwork E Empowerment S Special Care Dentistry / Paediatric Dentistry S Service provision
Dental care for the medically compromised child: What are the problems people with special needs face?
- Poorer dental health
- Problems with access
- Complex needs
- Dental health one of many priorities
Child protection: What are the categories of abuse?
physical abuse - hitting, bruising, burning, fabricating and induced illness etc
sexual abuse
emotional abuse
neglect (including dental neglect)
