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Paedriatric Dentistry Flashcards

1
Q

What are the indications for Inhalation Sedation in Adults and Children? (6)

A

Anxiety
Needle phobia
Gagging
Traumatic procedures
Medical conditions aggravated by stress
Unaccompanied adults requiring sedation

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2
Q

What are the contraindications of Inhalation Sedation in Adults and Children? (7)

A

Common cold
Tonsillar/Adenoidal enlargement
Severe COPD
First trimester of pregnancy
Fear of ‘mask’/ Claustrophobia
Patients with limited ability to understand
Obstruction of the operation field by mask

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3
Q

What are the components of the equipment utilised in Inhalation Sedation? (7)

A

Gas cylinders
Pressure reducing valves
Flow control meter
Reservoir bag
Gas delivery hoses
Nasal hood
Waste gas scavenging system

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4
Q

What is the purpose of the Flow Control Meter in the equipment used in Inhalation sedation?

A

Measures flow rates of up to 10 l/min
Blue= nitrous oxide
Clear= oxygen
Accuracy +/- 5%

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5
Q

What is the function of the Reservoir bag component of the Inhalation Sedation equipment?

A

2-3 litre bag; rubber or silicone
Should move visibly with each breath and must not collapse
Monitors respiration

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6
Q

What is the diameter of the gas delivery hose component of the Inhalation Sedation equipment?

A

2.5cm

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7
Q

What is the function of each hose of the gas delivery hoses in the Inhalation Sedation equipment?

A

One hose: delivers fresh gases from the machine
One hose: delivers waste gas to scavenging system

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8
Q

What are examples of Safety features of Inhalation Sedation equipment?

A

Pin Index System
Diameter Index System
Minimum Oxygen Delivery
Oxygen Fail Safe
Air entrainment valve
Oxygen flush button
Oxygen monitor
Reservoir bag
Colour coding
Scavenging System
Oxygen and Nitrous oxide pressure dials
Pressure reducing valves
One way expiratory valve
Quick fit connection for positive pressure oxygen delivery

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9
Q

What is the function of a Pin Index System in Inhalation Sedation?

A

Prevents the wrong cylinder being attached to the

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10
Q

What is the function of the Diameter index system in Inhalation Sedation?

A

Prevents cross connection of piping

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11
Q

What is the minimum oxygen delivery in Inhalation Sedation?

A

30%

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12
Q

When does the oxygen fail safe kick in in Inhalation Sedation?

A

When oxygen pressure <40 psi

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13
Q

What are the advantages of Inhalation Sedation? (9)

A

Rapid onset (2-3mins)
Rapid peak action (3-5mins)
Flexible duration
Rapid recovery
No injection (for sedation not LA)
Few side effects on patient
Drug not metabolised
Some analgesia (better for ischaemic > inflammatory pain)
No amnesia

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14
Q

What are the disadvantages of Inhalation Sedation? (8)

A

Expensive equipment
Expensive gases
Space occupying equipment
Environmental concerns
Requires ability to breath through nose
Chronic exposure risk (potentially)
Staff addiction
Difficult to accurately determine actual dose

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15
Q

What are the signs of adequate sedation? (10)

A

Patient relaxed/comfortable
Patient awake
Reduced blink rate
Laryngeal reflexes unaffected
Vital signs unaffected
Gag reflex obtunded/reduced
Mouth open on request
Decreased reaction to painful stimuli
Decrease in spontaneous movement
Verbal contact maintained

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16
Q

What are the symptoms of adequate Inhalation Sedation? (10)

A

Mental and physical relaxation
Lessened awareness of pain
Paraesthesia: lips, fingers, toes, legs, tongue
Lethargy
Euphoria
Detachment ‘floating feeling’
Warmth
Altered awareness of time
Dreaming
Small controllable ‘fits of giggles’

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17
Q

What are the signs and symptoms of over sedation (Inhalation Sedation)? (9)

A

Mouth closing
Spontaneous mouth breathing
Nausea/Vomiting
Irrational and sluggish responses
Decreased cooperation
Incoherent speech
Uncontrolled laughter/tears
Patient no longer enjoying effects
Loss of Consciousness

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18
Q

What are the pre-operative instructions prior to Inhalation Sedation? (8)

A

Have a light meal before appointment
Take routine medications
Child accompanied by competed adult
Adults must be accompanied on their first appointment
Do not drink alcohol on day of appointment
Wear sensible clothing
Arrange care of children during and after appointment
Plan to remain in clinic up to 30 minutes after treatment

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19
Q

Discuss Inhalation Sedation Technique:

A

Set up
Select nasal hood and connect hoses
Set dial to 100% O2
Set flow to 5-6l per min and position on patient nose
Encourage nasal breathing and verify reservoir bag movements
Reduce O2 by 10%
One min later reduce O2 by 10%
Reduce by 5% per minute until patient ready

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20
Q

What should you do to the O2 concentration when patient is over sedated?

A

Increase O2 in 5-10% increments

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21
Q

What should you do to the O2 concentration if the patient is under sedated?

A

Decrease O2 in 5% increments

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22
Q

What should you do to get to the recovery phase of Inhalation Sedation?

A

Increase O2 to 100%
Administer 100% for 2-3 minutes
Remove hood and turn gas flow off
Return patient up right, praise and reassure

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23
Q

Why do you leave the O2 at 100% for 2-3 minutes in Inhalation Sedation?

A

To prevent diffusion hypoxia

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24
Q

What is the success rate for Inhalation Sedation and why does it vary?

A

50-90%
Patient populations, greater success with orthodontic extractions, poorer in patients with pain

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25
Q

What are the important aspects of a social history for IV sedation assessment?

A

Nature of fear
Phobia vs anxiety
General vs Specific
Anxiety questionnaire
Occupation
Escort
Alcohol
Responsibilities
Transport
Age

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26
Q

What are the important aspects of a dental history for IV sedation assessment?

A

Referral source
Previous bad experiences
Previous sedation/GA
Symptoms
Proposed procedure

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27
Q

What are the important aspects of a medical history for IV sedation assessment?

A

Drug history/allergy
Recreational drug use

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28
Q

Which drugs increase the sedative effect of midazolam?

A

Alcohol
Opioids
Erythromycin
Antidepressants
Antihistamines
Antipsychotics
Recreational drugs

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29
Q

What is ASA 1?

A

Normal healthy patient
Non smoker
Minimal alcohol

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30
Q

What is ASA 2?

A

Mild systemic disease

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31
Q

What is ASA 3?

A

Severe systemic disease
Limits activity but not incapacitating

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32
Q

What is ASA 4?

A

Severe systemic disease
Constant threat to life

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33
Q

What is ASA 5?

A

Moribund
Not expected to live >24 hours

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34
Q

What is ASA 6?

A

Brain dead for organ donation

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35
Q

Which ASA can be treated in primary care?

A

1 and 2

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36
Q

Which ASA can be treated in secondary care?

A

3 and 4

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37
Q

What questions should you ask an asthmatic in regard to IV sedation?

A

What drugs do they take and how often?
Have they been hospitalised?
Is it exacerbated by stress?

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38
Q

What is the definition of pharmacodynamic interactions?

A

Interactions between drugs which have similar or antagonistic pharmacological effects or side effects

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39
Q

What is the definition of pharmacokinetic interactions?

A

One drug alters the absorption, distribution, metabolism or excretion of another thereby increasing or reducing the amount of drug available in the system

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40
Q

What ASA category does pregnant put a person in?

A

ASA 2

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41
Q

What are the important features of a general examination for IV sedation?

A

Signs of anxiety
Discomfort with surroundings
Eye contact
Speech
Vital signs

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42
Q

What are the vital signs?

A

Heart rate
Blood pressure
Oxygen saturation
BMI

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43
Q

What is the BMI for underweight?

A

<18.5

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44
Q

What is the BMI for healthy weight?

A

18.5-24.9

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45
Q

What is the BMI for overweight?

A

25-29.9

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46
Q

What is the BMI for obese?

A

30

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47
Q

What is the BMI cut off for sedation?

A

35

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48
Q

What is a good working time for IV sedation patients?

A

45 minutes

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49
Q

What are the ideal features of an IV sedation agent?

A

Anxiolysis
Sedative effect
Ease of administration
Non-irritant
Quick onset
Quick recovery
No side effects
Amnesia
Low cost

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50
Q

What is the mode of action of benzodiazepines?

A

Acts on receptors in CNS to enhance effect of GABA
Prolongs the time for receptor repolarisation
Mimics effect of glycine on receptors

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51
Q

What allows benzodiazepines to attach to receptors?

A

Benzene ring

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52
Q

Why do sedative agents cause respiratory depression?

A

CNS depression and muscle relaxation
Decreases cerebral response to increased carbon dioxide
Synergistic relationship with other CNS depressants
Increased respiratory depression in already compromised patients

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53
Q

How do sedative agents affect the cardiovascular system?

A

Decrease blood pressure by muscle relaxation decreasing vascular resistance
Increasing heart rate due to baroreceptor reflex compensating for blood pressure fall

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54
Q

What are the side effects of sedative agents?

A

Tolerance
Dependance
Sexual fantasies (increases with dose)

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55
Q

Why is diazepam not given in water?

A

It is insoluble in water

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56
Q

What is the elimination half life of diazepam?

A

43 hours

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57
Q

What is the dosage of diazepam?

A

0.1-0.2mg/kg

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58
Q

What is the current gold standard sedative?

A

Midazolam

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59
Q

What is the elimination half life of midazolam?

A

90-150 minutes

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60
Q

Where is the metabolism of midazolam?

A

Liver and extra hepatic

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61
Q

What are the advantages of midazolam over diazepam?

A

Painless
Quicker onset
Quicker recovery
More reliable

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62
Q

Who makes up the sedation team?

A

Operator; sedationist
Second sedation trained person: dental nurse etc

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63
Q

How often is sedation training?

A

Annually

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64
Q

Why is the dorsum of the hand a cannulation site?

A

Accessible
Superficial and visible
Poorly tethered
Affected by peripheral vasoconstriction so may need to warm up hand

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65
Q

What is the second choice for cannulation area?

A

Antecubital fossa

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66
Q

What is ametop gel?

A

A topical anaesthetic

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67
Q

When must the assessment for intravenous sedation be carried out?

A

On a separate day

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68
Q

What must be done pre-operatively to intravenous sedation?

A

Pulse and blood pressure
Reconfirm consent

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69
Q

How is a patient monitored during intravenous sedation?

A

High volume aspiration
Pulse oximeter
Non invasive blood pressure (NIBP) measurements every 5-10 minutes

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70
Q

What emergency drugs should be prepared during intravenous sedation?

A

Flumazenil (antagonises benzodiazepines)

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71
Q

What is the drug administration of midazolam?

A

2mg bolus
1mg increments every minute

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72
Q

What is the drug administration of midazolam?

A

2mg bolus
1mg increments every minute

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73
Q

What is the end point of intravenous sedation?

A

Slurring and slowing of speech
Relaxed
Delayed response to commands
Willingness to accept treatment
Vergil’s sign ptosis
Eves sign-loss of motor coordination

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74
Q

What is the maximum dose of midazolam?

A

7.5mg

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75
Q

What makes the therapeautic dose of midazolam change?

A

Sleep
Alcohol
Stress
Drugs

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76
Q

What makes the therapeautic dose of midazolam change?

A

Sleep
Alcohol
Stress
Drugs

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77
Q

What are the steps for managing respiratory depression?

A

Talk, shake, hurt
Head tilt, chin lift, jaw thrust
O2 (2l/min via nasal cannulae)
O2 (5l/min via Hudson mask)
Flumazenil
Ambu bag
Airways

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78
Q

What is the preparation and dose of Flumazenil?

A

500mcg in 5ml
Dose; 200mcg then 100mcg increments every minute until a response is seen

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79
Q

What is the half life of Flumazenil?

A

50 min

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80
Q

What is anéxate?

A

Flumazenil

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81
Q

What is the meaning of Child Protection?

A

Activity undertaken to protect specific children who are suffering, or are at risk of suffering harm

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82
Q

What is the meaning of Children in Need?

A

Those who require additional support or services to achieve their full potential

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83
Q

What is the meaning of Safeguarding Children?

A

Measures taken to minimise risks of harm

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84
Q

What are three methods of safeguarding children?

A

Protecting children from maltreatment
Preventing impairment of children’s health or development
Ensuring children grow up in a safe and caring environment

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85
Q

What are the three factors of child abuse?

A

Carer has some responsibility for the harm
Significant connection between the carer’s responsibility to the child and the harm to the child
Significant harm to the child

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86
Q

What are the features of a wellbeing wheel?

A

Achieving
Active
Healthy
Included
Nurtured
Respected
Safe
Responsible

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87
Q

Which three features can decrease parental capacity?

A

Domestic abuse
Drug and alcohol misuse
Mental health problems

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88
Q

What 4 factors are associated with vulnerable children?

A

Under 5’s
Irregular attenders
Medical problems and disability
Looked after children

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89
Q

What 4 factors are associated with vulnerable children?

A

Under 5’s
Irregular attenders
Medical problems and disability
Looked after children

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90
Q

What are the five types of neglect?

A

Nutrition
Warmth, clothing and shelter
Hygiene and healthcare
Stimulation and education
Affection

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91
Q

What are the short term effects of childhood neglect?

A

Physical health
Emotional health
Social and cognitive development

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92
Q

What are the long term effects of child neglect?

A

Increased arrests
Suicide attempts
Major depression
Diabetes
Heart disease

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93
Q

What are three indicators of dental neglect?

A

Obvious dental decay
Impact on child
Practical care offered, child does not return for treatment

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94
Q

What are the three stages of management for child neglect?

A

Preventive Dental Team Management
Preventive Multi-agency Management
Child Protection Referral

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95
Q

What are the ten features of the Index of Suspicion?

A

Delay in seeking help
Story is vague, lacking in detail and varies from person to person
Account is not compatible with the injury
Parent’s mood is abnormal
Parents behaviour is a cause for concern- refusal of treatment or hospital admission, aggression to staff
Child’s appearance and interaction with parent is abnormal
Child may contradict parents
History of previous injury
History of violence within family

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96
Q

What are the expectations of the dental team when dealing with child neglect?

A

Observe
Record
Communicate
Refer

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97
Q

X

A
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98
Q

What percentage of abuse injuries are found in the head and neck area?

A

60%

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99
Q

What is motivational interviewing and how is it conducted?

A

Translating knowledge into behaviour
Seek permission, open questions, affirmations, reflective listening, summarising

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100
Q

What is standard prevention?

A

Tooth brushing demo once a year
OHI and diet advice

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101
Q

What is enhanced prevention?

A

Tooth brushing demo and diet advice each appointment

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102
Q

Where should fissure sealant be placed in enhanced prevention?

A

2’s palatal pits

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103
Q

What is the toxic dose of fluoride?

A

5mg/kg body weight

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104
Q

What % of 2800 ppm toothpaste is fluoride?

A

0.619%

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105
Q

What age does tooth trauma most commonly occur?

A

2-4 years

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106
Q

What gender is mostly affected by tooth trauma?

A

Male

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107
Q

Which teeth are mostly affected by tooth trauma?

A

Maxillary incisors

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108
Q

What are the features of a concussed tooth?

A

Tender to touch
No displacement
No increased mobility

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109
Q

What are the features of subluxation?

A

Tender to touch
No displacement
Increased mobility

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110
Q

What are the features of lateral luxation?

A

Tooth displaced in palatal/lingual/labial direction

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111
Q

What are the features of lateral luxation?

A

Tooth displaced in palatal/lingual/labial dirección

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112
Q

What are the features of intrusion?

A

Tooth displaced apically

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113
Q

What are the features of extrusion?

A

Partial displacement of tooth out of socket

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114
Q

What are the features of extrusion?

A

Partial displacement of tooth out of socket

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115
Q

What are the features of avulsion?

A

Tooth completely out of its socket

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116
Q

What are the four features of a paediatric patient assessment?

A

History
Patient factors
Goals
Treatment plan

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117
Q

What do patient factors consist of?

A

Understanding
Co-operation
Coping style

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118
Q

What does MCDASf stand for?

A

Modified child dental anxiety scale (faces)

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119
Q

What are the options of methods of pain and anxiety management?

A

Non-pharmacological behaviour management
Local anaesthesia
Sedation
General anaesthetic

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120
Q

What is used for inhalation sedation?

A

Nitrous oxide and oxygen

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121
Q

What are the indications of inhalation sedation in paeds?

A

Age (must be amenable to hypnotic suggestion, understand nasal breathing)
Anxiety level (mild to moderate)
Management of gag reflex
Medical considerations
Previous dental history
Dental needs

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122
Q

What are the contraindications for inhalation sedation in paeds?

A

Age (under 4)
Anxiety level
Medical considerations
Previous dental history
Dental needs
Patient choice

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123
Q

What is the consenting procedure for inhalation sedation in paeds?

A

Check understanding
Written pre-operative and post-operative instructions

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124
Q

What are the important factors of providing inhalation sedation in paeds?

A

Keep talking to patient
Ensure child avoids mouth breathing

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125
Q

What are the important factors of providing inhalation sedation in paeds?

A

Keep talking to patient
Ensure child avoids mouth breathing
Monitor
Post op instructions

126
Q

What drugs are used for IV sedation in paeds?

A

Midazolam
Propofol

127
Q

What are the indications for IV sedation in paeds?

A

Age
Anxiety level
Medical considerations
Previous dental history
Dental needs

128
Q

What are the contraindications for IV sedation?

A

Age
Anxiety level
Medical considerations
Dental needs

129
Q

What does TCI mean?

A

Target controlled infusion

130
Q

When is TCI Propofol used?

A

For very long and short procedures
Mean rapid onset and recovery

131
Q

What is the consenting procedure for IV sedation in paeds?

A

Check understanding
Written pre and post op instructions

132
Q

What are the alternative sedative techniques to IV and inhalation sedation?

A

Oral and transmucosal sedation

133
Q

What are the 9 features of a trauma stamp?

A

Radiograph
TTP
Colour
Ethyl Chloride
Thermal
Sinus
Mobility
Displacement
Percussion

134
Q

What are the radiographic signs of tooth trauma?

A

Periapical radiolucency
Internal inflammatory resorption
External inflammatory resorption
Ankylosis

135
Q

What is the definition of a strong recommendation?

A

Based on available information, weighing up balance of benefit vs risk, almost all individuals would choose this option

136
Q

What is the aim of pads dental treatment?

A

To reduce the risk of the child experiencing pain, infection or treatment-induced anxiety

137
Q

What does a comprehensive assessment include?

A

Patient history
Clinical examination
Caries risk assessment

138
Q

What are the five factors of motivational interviewing?

A

Seek permission
Open questions
Affirmations
Reflective listening
Summarising

139
Q

Where should fissure sealant be placed in enhanced prevention patients?

A

2’s palatal pits

140
Q

What are the components of silver diamine fluoride?

A

Silver
Fluoride
Ammonium ions

141
Q

What are the indications for use of SDF?

A

Asymptomatic cavitated carious lesions in primary teeth
Non-restorable dentinal lesions
Root caries
Pre-cooperative children and adults whose behaviour/medical conditions limit invasive restorative treatment

142
Q

What are the contraindications for use of SDF?

A

Not able/willing to brush teeth
Potassium iodide contraindicated in pregnant/breast feeding women, patients undergoing thyroid surgery/medication
Patients with ulceration, mucositis, stomatitis
Allergy to silver, fluoride or ammonia

143
Q

What method can be used for needle desensitisation?

A

Teach relaxation
Explain LA
Practice LA
Deliver LA

143
Q

What prevention should be carried out alongside providing SDF?

A

Dietary advice
OHI
Topical fluoride application

144
Q

What are the causes of child dental anxiety?

A

Parental anxiety
Difficult medical experiences
Difficult dental experiences

145
Q

What are some physiological and somatic associations with dental anxiety?

A

Breathlessness
Perspiration
Unease

146
Q

What is concussion?

A

An injury to the tooth supporting structures without increased mobility or displacement
Pain to percussion

147
Q

What are three signs of a brain injury?

A

Amnesia
Vomiting
Nausea

148
Q

How long should an avulsed primary tooth be under review?

A

Until eruption of the permanent

149
Q

What is the role of dental professionals in regard to neglect?

A

Know how to refer concerns about abuse or neglect
Know who to contact for further advice about abuse or neglect of children
Raise concerns about the possible abuse or neglect of children

149
Q

What is the definition of child protection?

A

Activity undertaken to protect specific children who are suffering or at risk of suffering significant harm

149
Q

Which act made it illegal to smack a child?

A

The Children (Equal Protection from Assault) (Scotland) Bill

150
Q

What are three examples of factors that can decrease parenting capacity?

A

Domestic violence
Drug/alcohol misuse
Mental health problems

151
Q

How many children per year are killed by a parent/parent substitute?

A

10

152
Q

Why does neglect of neglect occur?

A

Neglect is less incident focused

153
Q

What are three long term effects of child neglect?

A

Greater incidence of heart disease
Greater incidence of diabetes
Greater incidence of neglect

154
Q

What are the three stages in managing dental neglect?

A

Preventive dental team management
Preventive multi-disciplinary agency management
Child protection referral

155
Q

Which % of serious head injuries in the first year of life are non-accidental?

A

95%

156
Q

What % of abuse injuries are found on the head and neck?

A

60%

157
Q

At what age range do primary teeth erupt?

A

6 months to 2.5 years

158
Q

What is the order of primary tooth eruption?

A

a b d c e

159
Q

What are four factors of primary tooth occlusion?

A

Upright incisors
Spaced
Terminal E’s: flush terminal plane
Class I molar relationship

160
Q

How common are natal teeth?

A

1 in 3000

161
Q

What are the three phases of tooth eruption?

A

Pre-eruptive phase
Eruptive phase
Post-eruptive phase

162
Q

What happens during the pre-eruptive phase?

A

Crown formation

163
Q

What happens during the eruptive phase?

A

Crown reaches occlusal plane

164
Q

What are the two stage of the eruptive phase?

A

Intra-osseous
Extra-osseous

165
Q

What happens during the post-eruptive phase?

A

Tooth movement/eruption

166
Q

What are the three stages of the intra-osseous phase?

A

Root formation
Movement occlusally or incisally
Reduced enamel epithelium fuses with the oral epithelium

167
Q

What are the three stages of the extra-osseous phase?

A

Penetration of crown through epithelium
Crown moves until contact with opposing tooth
Environmental factors: muscles from cheeks, lips and tongue determine final position

168
Q

What is the gubernacular cord?

A

Remnant of the dental lamina that allows the permanent tooth to retain contact with the lamina propria of the oral mucosa

169
Q

What are the roles of the dental follicle?

A

Initiates resorption of the bone overlying the tooth
Creates eruption pathway
Promotes alveolar bone growth

170
Q
A
171
Q

What are the radiographic signs of a non-vital tooth on a radiograph?

A

Furcation bone loss
External and Internal resorption
Radiolucencies
Periapical periodontitis

172
Q

What is the treatment for an enamel-dentine fracture?

A

Bond fragment/composite bandage
2 Periapicla radiographs to rule out root fracture/luxation

173
Q

What is the treatment for an enamel-dentine fracture?

A

Bond fragment/composite bandage
2 Periapicla radiographs to rule out root fracture/luxation

174
Q

What does preventive dental team management involve?

A

Single unit approach
Raise concerns with parents
Offer support
Set targets
Keep records
Monitor progress

175
Q

What does preventive multi-agency management involve?

A

Liase with other professionals to see if concerns are shared
Child may be subject to common assessment framework (CAF)
Check if child is subject to child protection plans
Agree joint plan of action; to be reviewed at agreed intervals
Letter to health visitor of child under 5 who fails to respond to letter from practice

176
Q

What does a child protection referral involve?

A

Follow local guidelines
Refer to social services if required

177
Q

What does a child protection referral involve?

A

Follow local guidelines
Refer to social services if required

178
Q

What are the long term effects of trauma on the permanent dentition?

A

Discolouration
Delayed exfoliation of primary
Enamel defects (44%)
Abnormal tooth/root morphology
Crown or root duplication
Delayed eruption (1%)
Ectopic tooth position
Arrest in development
Complete failure in permanent tooth formation
Odontome formation
Undeveloped tooth germ

179
Q

What does immediate vs delayed discolouration suggests?

A

Immediate- vital tooth
Delayed- non-vital tooth

180
Q

What is the treatment for hypomineralisation?

A

Mask with composite
Localised removal and restore with composite
External bleaching

181
Q

What is the treatment for hypoplasia?

A

Repair with composite or porcelain veneers when gingival level is stabilised at 16 years old

182
Q

What is the treatment for crown/root dilacerations?

A

Surgical exposure and orthodontic treatment

183
Q

Why can primary tooth trauma lead to delayed permanent tooth eruption?

A

Premature loss of primary teeth
Delayed eruption due to thickened mucosa

184
Q

What is the treatment for delayed permanent tooth eruption?

A

Surgical exposure and orthodontic treatment

185
Q

What is the treatment for delayed permanent tooth eruption?

A

Surgical exposure and orthodontic treatment

186
Q

When should you not replant an avulsed tooth?

A

Immunocompromised
Other more serious injuries
Very immature apex and >90 mins EAT
Very immature lower incisors in young people finding it difficult to cope

187
Q

What are the clinical findings of dentó-alveolar fracture?

A

Complete fracture from buccal to lingual
Segment mobility and displacement with several teeth moving together
Occlusal disturbance

188
Q

What is the treatment of a dentó-alveolar fracture?

A

Reposition any displaced segment
Stabilise by splinting for 4 weeks
Suture gingival lacerations if present
Monitor pulp condition of all involved teeth

189
Q

How long should a lateral luxation be splinted?

A

4 weeks

190
Q

What is the sequel are of trauma to primary teeth?

A

Discolouration
Infection
Delayed exfoliation

191
Q

What is dilaceration?

A

Abrupt deviation of the long axis of the crown or root portion of the tooth

192
Q

What are the contraindications for preformed metal crowns?

A

Irreversible Pulpitis
Periapical pathology
Insufficient tooth tissue to retain crown

193
Q

What are the contrindications to fluoride varnish?

A

Hospitalised due to severe asthma
Allergy in last 12 months
Allergy to sticky plasters/ colophony

194
Q

What is the difference between a trauma splint and an orthodontic wire?

A

Trauma splint- 0.4mm
Ortho wire- 0.7mm

195
Q

What are the SDCEP plaque scores?

A

10: perfectly clean tooth
8: line of plaque around cervical margin
6: cervical 1/3 crown
4: middle 1/3 crown

196
Q

How long should a mid/apical root fracture be splinted?

A

4 weeks

197
Q

What is the treatment of an enamel fracture?

A

Bond fragment or smooth
Take 2 periapicals

198
Q

When should an enamel fracture be reviewed?

A

6-8 weeks
6 months
1 year

199
Q

What is the treatment of an enamel dentine fracture?

A

Bond or composite bandage
Take 2 periapicals

200
Q

When should an enamel dentine fracture be reviewed?

A

6-8 weeks
6 months
1 year

201
Q

What is the treatment of an enamel dentine pulp fracture if less than 1mm?

A

Pulp cap

202
Q

What is the treatment of an enamel dentine pulp fracture if more than 1mm or untreated for 24 hours?

A

Partial pulpotomy

203
Q

What is the treatment of an enamel dentine pulp fracture if the tooth is non vital?

A

Pulpotomy

204
Q

When should an enamel dentine pulp fracture be reviewed?

A

6-8 weeks
6 months
1 year

205
Q

What is the treatment of a crown root fracture?

A

Post crown
Fragment removal
Decoronate

206
Q

What is the treatment of a concussion?

A

No treatment

207
Q

When should you review a concussion?

A

4 weeks
1 year

208
Q

What is the treatment of a subluxation?

A

No treatment or splint

209
Q

When should you review a subluxation injury?

A

2 weeks (SR)
12 weeks
6 months
1 year

210
Q

How long should you splint for a subluxation injury?

A

2 weeks

211
Q

What is the treatment for a lateral luxation?

A

Reposition under LA
Splint

212
Q

How long should you splint a lateral luxation?

A

4 weeks

213
Q

When should you review a lateral luxation?

A

2 weeks
4 weeks (SR)
8 weeks
12 weeks
6 months
Annually

214
Q

What is the treatment for intrusion of an immature tooth?

A

Spontaneous reposition
Orthodontic reposition after 4 weeks

215
Q

What is the treatment of <3mm intrusion of a mature tooth?

A

Spontaneous reposition
Reposition after 8 weeks

216
Q

What is the treatment of a 3-7mm intrusion of a mature tooth?

A

Surgical or orthodontic repositioning

217
Q

What is the treatment of a >7mm intrusion of a mature tooth?

A

Surgical repositioning

218
Q

How long should you splint for an intrusion?

A

4 weeks

219
Q

When should you review an intrusion injury?

A

2 weeks
4 weeks (SR)
8 weeks
12 weeks
6 months
1 year

220
Q

What is the treatment of an extrusion injury?

A

Reposition and splint

221
Q

How long should you splint an extrusion injury?

A

2 weeks

222
Q

When should you review an extrusion injury?

A

2 weeks (SR)
4 weeks
12 weeks
6 months
1 year
Annual

223
Q

What is the treatment of an avulsion of a tooth with a closed apex?

A

Replant and splint
Endo after 2 weeks

224
Q

When should you review an avulsion on a closed apex tooth?

A

2 weeks (SR)
4 weeks
3 months
6 months
1 year
Annually

225
Q

How long should you splint an avulsion?

A

2 weeks

226
Q

What is the treatment of an avulsion of an open apex tooth?

A

Replant

227
Q

When should you review an avulsion on an open apex tooth?

A

2 weeks (SR)
1 month
2 months
3 months
6 months
1 year
Annually

228
Q

What is the treatment of an alveolar fracture?

A

Reposition and splint

229
Q

How long should you splint an alveolar fracture?

A

4 weeks

230
Q

How long should you splint an alveolar fracture?

A

4 weeks

231
Q

When should you review an alveolar fracture?

A

4 weeks (SR)
6 weeks
4 months
6 months
1 year
Annually

232
Q

When should pulp treatment be carried out in paediatrics?

A

MH excludes extraction
Good cooperation
Good attendance e

233
Q

How does pulp treatment failure present?

A

Furcation bone loss
Internal inflammatory resorption
External inflammatory resorption
PAP

234
Q

What are methods of anxiety management?

A

Distraction
Tell-show-do
Acclimatisation
Desensitisation
Role modelling
Positive reinforcement

235
Q

How does post replant resorption present?

A

Internal inflammation
External inflammation
External surface resorption
Replacement ankylosis

236
Q

What teeth are affected by early childhood caries and why?

A

Upper anteriors and molar teeth due to inappropriate use of feeding cups and bottles

237
Q

How can early childhood caries be prevented?

A

Diet: promote and support breast-feeding
Fluoride: no benefit of fluoride supplements during pregnancy
Oral hygiene

238
Q

What dietary advice should be given to prevent early childhood caries?

A

Use of a feeding cup rather than bottle from 6 months (free-flow spout)
Drinks containing free sugars should never be put in a bottle
Children should not be put to bed with a feeder bottle or cup
Soya milk is potentially cariogenic
Avoid sweetened drinks
Food and confectionary containing free sugars should be minimised and restricted to meal times
Non sugar sweeteners recommended
Plain water or milk between meals
Sugar free medications

239
Q

What advice should be given for the consumption of sweetened drinks if they are going to be drank?

A

Meal times only
Diluted
Drink through a straw (to back of mouth)

240
Q

What are examples of good non-cariogenic snacks?

A

Cheese
Milk
Fruite
Savoury sandwiches
Crackers
Breadsticks

241
Q

What should be included in a diet diary?

A

Everything eaten
At least one day must be a Saturday/Sundat

242
Q

What are the modes of getting fluoride?

A

Fluoridated water
Toothpaste
Supplements: drops, tablets, mouthwash
Professional delivered: varnishes

243
Q

When should toothbrushing begin?

A

As soon as the first primary tooth erupts

244
Q

What age lacks the dexterity to independently brush their teeth effectively?

A

Under 8

245
Q

What concentration of fluoride is in children’s toothpaste?

A

1000ppm

246
Q

What age is children’s toothpaste used?

A

First tooth - 3 years

247
Q

What is the fluoride concentration of standard toothpaste?

A

1400-1500ppm

248
Q

What is the fluoride concentration of enhanced toothpaste?

A

2800 or 5000ppm

249
Q

What advice should be given to parents once their childs first tooth has erupted?

A

1000ppm toothpaste
Smear of toothpaste
Spit out don’t swallow
Small headed toothbrush

250
Q

From what age should a pea sized amount of toothpaste be used?

A

> 3 years

251
Q

What is the level of fluoride toxicity?

A

5mg/kg body weight

252
Q

What is the management for a fluoride accident if <5mg/kg administered?

A

Give milk (calcium) and observe for a few hours

253
Q

What is the management for a fluoride accident if 5-15mg/kg administered?

A

Give milk and admit to hospital

254
Q

What is the management for a fluoride accident if >15mg/kg administered?

A

Admit to hospital
IV calcium gluconate
Cardiac monitoring and life support

255
Q

How often do high risk children get radiographs?

A

6 months

256
Q

How often do standard risk children get radiographs?

A

12-18 months

257
Q

What are the disadvantages of a primary tooth extraction?

A

Loss of space; increased malocclusion
Decreased masticatory function
Decreased speech development
Psychological disturbance
Trauma

258
Q

What are the indications for paediatric pulp treatment?

A

Good co-operation
Medican history precludes extraction
Missing permanent successor
Need to persevere tooth as a space maintainer
Child under 9 years old

259
Q

What are the contraindications for paediatric pulp treatment?

A

Poor co-operation
Poor dental attendance
Advanced root resorption
Cardiac defect
Multiple grossly carious teeth
Recurrent pain/infection

260
Q

What are the stages of a pulpotomy?

A

Remove roof of pulp chamber
Remove coronal pulp with sterile excavator/slow large round steel bur
Place a cotton pellet with ferric sulphate for 20 seconds
Place zinc oxide/eugenol in pulp chamber and restore using metal preformed crown

261
Q

What are the stages of pulpectomy?

A

Remove roof of pulp chamber
Remove contents of pulp chamber
Use files to remove pulpal tissue (-2mm of length)
Irrigate with chlorhexidine, dry with paper points
Obturate canals with vitapex (CaOH) and iodoform paste
Seal with ZOE/GIC and restore with preformed metal crown

262
Q

What are the indications for pulpectomy over pulpotomy?

A

Non-vital pulp
Irreversible pulpits

263
Q

What are clinical signs of pulpectomy failure?

A

Pathological mobility
Fistula/chronic sinus
Pain

264
Q

What are radiographic signs of pulpectomy?

A

Radiolucency
External/internal resorption
Furcation bone loss

265
Q

What traumas are splinted for 2 weeks on a flexible splint?

A

Avulsion

266
Q

What traumas are splinted for 4 weeks on a flexible splint?

A

Luxation
Root fracture

267
Q

What traumas are splinted for 4 weeks on a rigid splint?

A

Dento-alveolar fracture

268
Q

What are the advantages of the hall technique?

A

No LA needed
Not invasive
Less stressful for patient
Effective
Retains tooth

269
Q

What instruments are used for the placement of hall crowns?

A

Preformed metal crowns
GI luting cement
Diamond tapered separating bur
Crown crimping pliers
Curved crown scissors

270
Q

What factors are considered when sizing up SS crowns?

A

Trial and error
Measuring m-d length

271
Q

What are the indications for hall technique?

A

No pulp involvement
Remaining tooth tissue

272
Q

What are the treatment options for intrinsic discolouration in permanent anterior teeth in children and adolescents?

A

Enamel microabrasion
Bleaching
Resin infiltration technique (ICON)
Localised composite restoration
Veneers (direct/indirect)

273
Q

What pre-op records should you have for discoloured teeth?

A

Standardisation of recording of aesthetic procedures
Clinical photos
Shade
Sensibility testing, check for sensitivity
Diagram of defect
Radiographs if clinically indicated
Patient assessment e.g VAS

274
Q

What should be considered when carrying out HCL pumice technique?

A

PPE worn
Patient wearing glasses and bib
Clean teeth with pumice and water
Petroleum jelly to gingiva
Rubber dam placed
Sodium bicarbonate guard (and excess available)

275
Q

What is the technique for HCL pumice?

A

HCL pumice slurry in slowly rotating rubber cup (5 secs)
Maximum 10 x 5 second applications
Wash direct into aspirator after every 5 second application
10 x 5 secs completed on anterior teeth
Fluoride varnish application
Polish with finest sandpaper disc
Final polish with toothpaste

276
Q

What is the benefit of using sandpaper discs?

A

Changes the optical properties of the enamel so that areas of intrinsic discolouration become less perceptible

277
Q

What is the benefit of using sandpaper discs?

A

Changes the optical properties of the enamel so that areas of intrinsic discolouration become less perceptible

278
Q

How much enamel is lost when using prophy with toothpaste?

A

5-10 microns

279
Q

How much enamel is lost when prophy with pumice?

A

5-50 microns

280
Q

How much enamel is lost when ortho bracket bonding/debonding?

A

5-50 microns

281
Q

How much enamel is lost when acid etching?

A

10 microns

282
Q

How much enamel is lost when 10 x5 secs HCL pumice microabrasion?

A

100 microns

283
Q

What is in the proprietary kits for microabrasion?

A

Opalustre (ultradent)- 6,6% HCl acid and silicone carbide particles in a water soluble paste
Prema Kit 10% HCL acid in a prep of fine grit silicon carbide particles in water soluble paste

284
Q

What are the advantages of microabrasion?

A

Easily performed
Conservative
Inexpensive
Teeth need minimal subsequent maintainance
Fast acting
Removes yellow-brown, white and multicoloured stains
Effective
Results are permanent
Can be used before or after bleaching

285
Q

What are the disadvantages of microabrasion?

A

Removes enamel
HCl acid compounds are caustic
Requires protective apparatus for patient, dentist and dental nurse
Prediction of treatment outcome is difficult
Must be done in dental surgery
Cannot be delegated

286
Q

How should microabrasion be reviewed?

A

Warn patient to avoid highly coloured food and drinks for at least 24 hours
Review patient 4-6 weeks after and take post-op photographs

287
Q

What are the options for external vital bleaching?

A

Chairside power bleaching
Night guard vital bleaching at home

288
Q

What are the options for non-viral bleaching?

A

Inside out technique
Walking bleach technique

289
Q

What % of hydrogen peroxide is used for vital chairside bleaching?

A

15-38%

290
Q

What is night guard vital bleaching?

A

10% carbamide peroxide gel
Tray

291
Q

What fluoride is applied post microabrasion and why

A

Profluoride
As duraphat is yellow and may stain

292
Q

What are the instructions to patients receiving night guard vital bleaching?

A

Brush teeth thoroughly
Apply a little gel to tray
Set over teeth and press down
Remove excess
Rinse gently, do not swallow
Wear overnight or for at least 2 hours
Remove, brush and rinse with cold water

293
Q

Discuss the carbamide peroxide reaction?

A

10% carbamide peroxide
—>
3% hydrogen peroxide, 7% urea
—>
Water, ammonia and CO2

294
Q

What are the advantages of non-vital bleaching?

A

Simple
Tooth conserving
Original tooth morphology
Gingival tissues not irritated by restoration
Adolescent gingival level not a restorative consideration
No laboratory assistance for walking bleach

295
Q

What are the tooth selection factors for non vital bleaching?

A

Adequate root filling- no clinical disease, no radiological disease
Anterior teeth without large restorations
Not amalgam intrinsic discolouration
Not fluorosis or tetracycline discolouration

296
Q

What is the walking bleach method?

A

Oxidising process allowed to proceed gradually over days

297
Q

What is the inside out bleaching method?

A

10% carbamide peroxide gel, can seal in if cooperation is an issue

298
Q

What are the factors of frequency and regression for the walking bleach method?

A

Renew bleach- ideally no more than 2 weeks between appointments
If no change after 3-4 renewals- stop
6-10 changes total
Regression 50% at 2-6 years

299
Q

What are the stages of combination ‘inside-out’ bleaching?

A

Access cavity of tooth open
Do not necessarily need GI lining
Custom made mouth guard (cut windows in guard of the teeth you don’t want to bleach)
Patient applies bleaching agent to back of tooth and tray
Patient keeps access cavity clean- replacing gel, removing food debris
Worn all the time except eating and cleaning
Gel changed every 2 hours except over night

10% carbamide peroxide used

300
Q

How is the pulp chamber restored following internal bleaching?

A

Non-setting calcium hydroxide paste for 2 weeks, seal in with GIC then:

White GP and composite resin- facility to re-bleach

Or

Incrementally cured composite- no re-bleaching but stronger tooth

(Veneer or crown prep if regression)

301
Q

What are the potential complications of non-vital bleaching?

A

External cervical resorptions
Spillage of bleaching agents
Failure to bleach
Over bleach
Brittleness of tooth crown

302
Q

What is the function of a layer of cement of GP in internal bleaching?

A

Prevents bleaching agent from getting to external surface of root
Can prevent adequate bleaching of cervical area

303
Q

Why is non setting calcium hydroxide applied two weeks before final restoration in internal bleaching?

A

Reverses any acidity

304
Q

What is the effect on soft tissue in cases of short term exposure to bleaching in pulp?

A

Minor ulcerations/irritation
Plaque reduction
Aids wound healing

305
Q

What is the effect on soft tissue of long term exposure of bleaching in the pulp chamber?

A

Possible delayed wound healing
Possible periodontal harm
Mutagenic potential

306
Q

What is Recaldent?

A

CPP-ACP (casein phosphopeptide-amorphous calcium phosphate) milk derived protein

307
Q

What is resin infiltration?

A

Infiltration of enamel lesions with low-viscosity light curing resins
Surface layer is eroded, lesions desiccated and president infiltrant is applied
Resin penetrates lesion driven by capillary forces
Infiltrated lesions lose their discoloured appearance and look similar to sound enamel

308
Q

What factors should be considered in regard to tooth prep in paediatric patients needing veneers?

A

Aesthetics
Relative tooth position
Masking dark stain
Age
Psyche
Plaque removal

Finals (20 decks)

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