Paeds 1 - Restorative Flashcards
5 reasons to restore the deciduous dentition?
maintain form maintain space avoid GA avoid sepsis/infection - damage to perm acclimatisation
why do deciduous roots splay?
to make room for the tooth germ
if a deciduous tooth is prematurely extracted, how can this affect the eruption of the permanent tooth?
eruption of the perm tooth is stimulated by root resorption - this is absent if tooth is extracted - perm tooth may come in palatally/lingually
what can infection at the root of a deciduous tooth cause in the permanent successor?
opaque/brown staining
misshapen
what is Turners tooth?
permanent incisor is misshapen bc infection in deciduous tooth
why does caries happen faster in deciduous teeth?
larger pulp to crown ratio thinner enamel pulp horns nearer surface more aprismatic enamel contact points are flatter and wider
why is it harder to spot a WSL in primary tooth?>
demineralisation process is faster - often carious before noticed
where are the root canals on a LOWER deciduous molar?
MesioBuccal
MesioLingual
Distal
where are the root canals on an UPPER deciduous molar?
MesioBuccal
MesioLingual
Palatal
if creating an isthmus on a deciduous tooth ensure it is what size?
less than a 1/3 of width of buccal/lingual and palatal cusps = weakened structure if not
what is the preferred treatment of a deciduous Class II cavity?
Halls crown
why does occlusal caries suggest a higher decay risk in a primary tooth?
fissures in primary dentition are wider and flatter
what aspect of tooth morphology allows a halls crown to stay in place?
cervical constriction
what situations could a halls crown be used?
Large class II
badly broken down tooth
following a pulpotomy
hard tissue anomaly - amelogenesis imperfecta
what are the symptoms of reversible pulpitis?
pain on sweet/hot/cold
mainly when eating
pain stops when stimuli removed
short duration
what would you see with reversible pulpitis on exam?
on a radiograph?
- early carious lesion
- caries into dentine
what are the symptoms of irriversible pulpitis?
constant pain awake at night relieved by analgesics increased temp lymphadenopathy
what would you see with irriversible pulpitis on exam?
on a radiograph?
extensive marginal ridge destruction, sinus, swelling
caries close to pulp
treatment option for reversible?
irriversibly?
restoration
XLA/RCT
if under 7 years and doing an IDB use what kind of needle?
short needle
per kg/weight how much lidocaine with epinephrine can be given to a child?
1/10th of a cartridge per kg
per kg/weight how much prilocaine with felypressin can be given to a child?
1/11th of a cartridge per kg
what is the rule of 10?
childs age plus number of tooth
10 = IDB
why restore deciduous dentition?
restore form restore aesthetics restore function maintain space acclimatisation avoiding sepsis and infection to perm successors avoid extraction
what are the stages of deciduous tx planning?
relief of pain prevention at home professional prevention - stabilisation of caries - restorations - pulp therapy - extractions - behaviour management - reinforce prevention
if a child presents with toothache check for what?
abscesses caries trauma toothwear infection soft tissue lesions exfolliatoin/eruption
what to consider when trying to decide whether to restore or extract?
depends on type of pulpitis
likelihood pulpotomy will work
quality and quantity of tooth tissue left
prev extractions/edentulous spaces
what is temporisation?
placement of temporary dressing as effective pain relief until restoration can be completed, extracted or arranged to be under observation
what properties should the material used to temporise a tooth?
not be detrimental to pulp
good seal
doesnt conflict with final restoration material
what is stabilisation?
managing the child continual poor OH with active high amounts of caries needs thought and should be stabilised first before definitive restorations
how is stabilisation done?
remove caries from the margin
dress
buys time for cooperation to improve, tx of other restorable teeth
what are the advantages of stabilisation?
prevents lesion progression
arrests caries
prevent sensitivity in teeth
how does thinner enamel contribute to planning cavity prep?
caries penetration distance is more rapid-less distance
cracking/fractures are more common
small burs used
pulp horns near surface
how does the cervical bulge affect cavity prep?
floor of box tends to be too deep
re establishes floor by moving axial wall towarcs pulp = exposure risk
how does the narrow occlusal table affect the cavity prep?
cusp weakened by over extension of cavity prep in a bucco lingual direction
how do the broad contact areas located gingivally affect cavity prep?
difficulty in clearing buccal and lingual walls of box to clear contact
why do the large pulp horns situated below the cusps affect cavity prep?
isthmus must be narrow to avoid pulp exposure
reduce failure of material by deepening pulpoaxial line to increase material bulk
