Paedodontics Flashcards
What is the most important thing to find out about a paediatric patient during first session?
Have they had any previous treatment - other than that it is just like a standard exam with taking of bitewings at around 3-4 years old
What is the essence of paediatric dentistry?
TIME - always be mindful of the time - time is money but in this case - time for the kid to be sick of you is not long
Why does caries progress rapidly in decidious teeth?
- Thinner enamel and dentine
- Wider dentine tubules
- Large pulp chambers
- Extensive pulp horns
What is the best practice for paedeatric dentistry?
Always - early diagnosis. Always - prevention, fluoride introduction, CPP-ACP therapy. Early restorative treatment.
What are some of the contraindications for extraction for a child?
- Haemophilia
- Von Willebrands disease
- Platelet disorder
What are some of the medical contraindications for pulpotomy?
- Congenetial heath disease
- Immuno-compromised
- Poor healing potential
- Special needs/ or sever disability
What are some of the tooth specific factors for tooth extraction/pulpotomy?
- Stage of dental development
- Pulpal status
- Restorable or not
- Space management
What would you except the abscess to come out for the infected primary dentition first?
Around the buccal or palatal and lingual area due to large forcassion of the deciduous molars and premolars
What are some of the steps to coming to a pulpal diagnosis for deciduous teeth?
- History of pain
- Clinical examination - extent of caries, mobility, swelling/fistula
- Investigation - pulp test and radiographs
What is important to know before prescribing anti-biotics for a child?
Make sure you are planning to extract the cause of the infection very very VERY soon
What are some of the contraindications for primary pulp therapy?
- Presence of radiolucency/caries in the furcation
- Internal or external root resorption including physiological root resorption
- Furcation or periapical bone lesions
What is the aim of pulp treatment?
- Remove the diseased and bacterially contaminated tissue
- Establish an environment that will prevent any further and future bacterial contamination
What are the 4 levels of endodontic treatment?
- Indirect pulp cap
- Direct pulp cap
- Vital pulpotomy
- Pulpectomy
What is the important pre-requisite for utalisation of vital pulpotomy?
Reticular tissue of the pulp (in roots) should be vital. In children - the pulpotomy should be covered by a stainless steal crown!!!
What are the objective of pulpotomy?
- Preserve vital pulp
- Resolve existing reversible pulpitis
- Maintain tooth symptom free
- Permit normal exfoliation
- Cause no harm to secondary successor
- Cause no internal resorption or canal calcification
What is a big contraindication for a vital pulpotomy?
- Extra-pulpal pathology
- Irreversible pulpitis
- Complex medical history - think infective endocarditis
What are the steps for pulpotomy?
- LA and isolation
- Prepare access to remove caries - may start occlusal reduction here aswell
- Remove caries
- Gain access to pulp chamber
- Remove entire roof of pulp chamber - do not forget about corners - use large bur (no perforations)
- Achieve haemostasis with dry cotton pellet
- Place medicament over radicular pulp stumps - MTA for example or Feeric Sulphate
- Condense IRM into the chamber
- Restore with GIC
- Restore with a stainless steel crown
What is Formocresol?
It is a material containing formaldehyde which a potent tissue fixative. It is bactericidal and devitalising to the tissue.
It has a success rate of above 90% but highly depends on the coronal seal.
Controversy: formaldehyde is a carcinogen but there is no study that shows formocresol causes carcinomas.
What are the different Zones of inlammed pulp?
What is Ferric Sulpahte?
It is a haemostatic agent but it is not bactericidal. It is also signifcantly less toxic.
Because it essentially acts a sealant for the vital tissue - it is less forgiving than formocresol.
Success rate is around 90% again.
What is MTA?
Mineral Trioxide Aggregate - portland cement. Excelent sealant, has anti-bacteria effect.
Very high success rates but it is quite expensive.
Why should we restore primary teeth?
- Eliviate pain
- Eleviate infections
- Impact on quality of life
- Impact on self esteem
- Potential development of fear and anxiety
- Effect on permanent dentition
- Occlusion trouble
- Medical implications
What is something to consider in the context of contact area in the decidous teeth?
The contact areas are quite broad and flattened thus it is harder to restore the tooth and replicate an appropriate contact point
What is the aim in deciduous restorations?
Only restore the tooth ONCE until exfoliation
What are the factors to consider when selecting the material for tooth restoration for decidous tooth?
- Caries risk and rate
- Size and type of lesion
- Pulp status
- Age
- Stage of root development
- Overall developmental status
- Tooth anomalies
- Level of cooperation
- Material properties
- Moisture control
- Oral hygiene
- Motivation for regular attendance
- Longevity
What are the advantages of stainless steel crowns?
Durable, longevity is greate, relatively inexpensive, minimal technique sensitivity and is very conservative.
What are the disadvantages of stainless steel crown?
Poorer aesthetics and impaction of erupting 6’s
What are indication for stainless steel crowns?
- Pulp therapy
- Multisurface caries
- Developmental defects
- Early wear and loss of occlusal height
- Failure of other restoration
- Space maintenance
- Fractured teeth
- High caries risk
- Young children undergoing general anaesthesia
What are the step-by-step procedures in administration of a stainless steal crown for a child?
- Consent, LA, Rubber dam - always consider quadrant care
- Do occlusal reuciton first - just remove 1mm - Remove caries and do the pulpotomy steps
- prep the crown normally
- Trial and error size selection - consider mesial-distal width as the main guide - if that fails try the contra-lateral upper molar
- Flex the crown and snap it into the undercut areas of the tooth - make sure you snap it into subgingival area on the buccal
- Ensure it can not be removed with rocking or come loose
- Remember Size 4 is better for first molar and size 5 for second molars
What is Hall Technique?
It is when you place stainless steel crown on carious primary molars without carious excavation or tooth preparation BUT THIS TECHNIQUE IS VERY CASE SPECIFIC
What are the recommendations for use of amalgam in children?
Not recommended in Australia because it is just hard to manipulate but you can still do it with consent
What is the failure rate of stainless steel crowns comparing to other restorative materials?
Stainless steel crowns are better comparing to other materials in children
What is a compomer?
It is a combination between composite and GIC but more of a composite
What kind of restorations could you offer your kid-patients for their anterior teeth?
Composite strip crowns or full metal crowns but both technique are quite difficult and require a lot of moisture control so maybe stick to normal composite technique for now.
What is chronological hyperplasia?
It is when there is hyperplasia only in certain areas of the decidous teeth
What is important to understand with general anaesthesia?
- It is very expensive
- A lot of treatment will be done
- There rate of children coming back with caries is high - behaviour change is needed
What do we do with posterior teeth in very young kids with high caries risk?
Stainless steal crown
What do we do with posterior teeth in not-so-young children with low caries risk?
Try to use CR or RMGIC in small slots - consider sandwich techniques
What is essential for a long lasting fissuer sealing?
MOISTURE CONTROL
What are some of the options we have for children with mild or moderate anxiety levels?
- Conscious sedation
- General anesthesia
When should you consolidate a treatment plan?
Try to get it done by the end of the first appoitment to allow for advanced planning thus increasing compliance
What patient qualify for conscious sedation in SA dental?
Only ASA I and ASA II patient - so healthy patient or patient with mild controlled conditions
ASA III and above need to be treated in a hospital environment
What is a good indication of cooperation for children in a dental chair?
If we can take bitewings on a kid it is a good indication of behaviour
Why is important to provide children with good experience of dental treatment?
To give them less dental anxiety
What is dental fatigue?
It occurs in children due to multiple repeated visits for dental treatments is associated with decrease in cooperation and increase in behaviour problems in chair
In paediatrics, what does an exam appointment include?
- Exam
- Removal of plaque
- Diet counselling
- Fluoride application
- Child and parent education
- Discussion of treatment option
What kind of approach we should ideally utilise with paediatric patients?
Quadrant dentistry
What should we tell the patient when treatment planning for a paediatric patient?
Always assume the worsts and always set expectations right
What is important with sim clinic teeth in terms of pulp removal?
Do not chase red - you will have no tooth left.
What kind of technique we use on deciduous teeth in terms of rubber dam?
Cuff technique
What kind of sealant we use in deciduous teeth in sim clinic?
IRM
What kind of clamp could you use for deciduous preparations?
12A clam with floss
What kind of bur could you use for occlusal reductionfor deciduous teeth?
Use diamond of flat fissure
How do you a stainless steel crown?
First put it on the lingual/palat than stretch it over (roll) the buccal buldge
What do we cement stainless steel crowns with?
RMGIC
What is crimping?
It is the slight bending of the crown margins in order to achieve better fit!
