Paeds

Question 1

What is MIH?

Answer 1

Molar Incisor Hypomineralisation
Developmental condition - disruption to enamel formation during first year of life
Unsymmetrical chalky white/yellow/brown blobs

Question 2

What teeth does MIH affect?

Answer 2

FPMs and/or incisors

Question 3

What are the treatment options for MIH in FPMs?

Answer 3

Composite/GIC restorations - short term option
SS Crowns - where sensitive or broken down
Adhesive retained copings - long term option
Extraction - where bifurcation of lower 7s visible radiographically

Question 4

What are the treatment options for MIH in incisors?

Answer 4

Acid pumice microabrasion - remove enamel lesions, follow with bleaching
Localised composite placement
External bleaching
Full composite/porcelain veneers

Question 5

What is the restorative sequence for children?

Answer 5

1 - prevention
2 - fissure sealants
3 - preventative restorations
4 - simple restorations
5- restorations and LA but not involving the pulp
6 - pulpotomies

Question 6

What instruments are used in SS crowns?

Answer 6

Tapered diamond separating bur
Preformed metal crowns
GI luting cement
Crown crimping pliers
Curved crown scissors

Question 7

What are common problems involving SS crowns?

Answer 7

Rocking - cervical margins of crown >1mm and beyond maximum bulbosity
Canting - occlusal surface reduction uneven
Loss of space - extensive caries and square prep

Question 8

Describe the Hall technique

Answer 8

No LA, no tooth prep, no caries removal
Cooperation is key
Separator in for 3-5 days

Question 9

What are the indications for using the Hall technique?

Answer 9

No sign of pulp involvement both clinically and radiographically
Sufficient sound soft tissue left

Question 10

What instruments are used in the Hall technique?

Answer 10

Mirror
Straight probe - to remove separators
Excavator - remove crown if needed, remove excess cement
Flat plastic - fill crown with GI luting cement
Cotton wool rolls - for child to bite down on and to remove excess cement

Question 11

Describe minor failures of a SS crown

Answer 11

Secondary caries
Crown worn, lost or needs other intervention
Crown lost but tooth restorable
Reversible pulpitis - resolved without pulpectomy or extraction

Question 12

Describe major failures of a SS crown

Answer 12

Irreversible pulpitis
Abscess - pulpotomy or extraction
Interradicular radiolucency
Crown lost and tooth unrestorable

Question 13

What are the disadvantages of unplanned extractions?

Answer 13

Loss of space increases risk of malocclusion
Reduced masticatory function
Impeded speech development
Psychological impact/trauma

Question 14

What are the indications for pulp treatment?

Answer 14

Under age 9
Good cooperation
Absent permanent successor
Space maintenance

Question 15

What are contraindications for pulp treatment?

Answer 15

Irregular dental attender
Poor cooperation
Cardiac defect
Multiple grossly carious teeth
Severe root resorption
Severe/recurrent pain or infection

Question 16

When is a pulpotomy indicated?

Answer 16

Caries involves pulp

Traumatic exposure of bleeding pulp

Question 17

Describe a pulpotomy?

Answer 17

Radicular pulp preserved
Ferric sulphate used to achieve haemeostasis
Root stumps covered with ZOE/CaOH
Pulp chamber willed with GI
Tooth restored with preformed metal crowns

Question 18

When should a pulpectomy be performed?

Answer 18

When tooth is non-vital and you have good patient cooperation

Question 19

What are the signs a pulpectomy is necessary?

Answer 19

Hyperaemic pulp - deep crimson coloured blood and failure to achieve haemeostasis following pressure
Necrotic pulp - no bleeding

Question 20

What are the symptoms a pulpectomy is necessary?

Answer 20

Irreversible pulpitis
Periapical periodontitis
Chronic sinus

Question 21

How can you tell clinically that a pulpectomy/pulpotomy has failed?

Answer 21

Pathological mobility
Fistula/chronic sinus
Pain

Question 22

How can you tell radiographically that a pulpectomy/pulpotomy has failed?

Answer 22

Increased radiolucency
Internal/external root resorption
Furcation bone loss

Question 23

What is early childhood caries?

Answer 23

Nursing caries
Affects upper anteriors and molars
Due to inappropriate use of feeding cups and bottles

Question 24

What diet advice should be given for early childhood caries?

Answer 24

Feeding cup with free-flow sprout from 6 months
Avoid putting a child to bed with feeding cup/bottle
Avoid putting drinks containing free sugars in the feeding cup/bottle

Question 25

What are the 7 elements of caries risk assessment?

Answer 25

Clinical evidence
Dietary habits
Social history
Fluoride use
Plaque control
Saliva
Medical history

Question 26

What are the 8 elements of prevention?

Answer 26

Radiographs - will miss 60% of caries if aren’t taken
Tooth brushing instruction
Strength of fluoride in toothpaste
Fluoride varnish
Fluoride supplementation
Diet advice
Fissure sealants
Sugar free medication

Question 27

What materials can be used for fissure sealants?

Answer 27

Unfilled bis-GMA - if able to get moisture control and patient is cooperative
GIC - patient not cooperating and unable to get sufficient moisture control

Question 28

Why are fissure sealants used?

Answer 28

Fissures more likely to be carious due to toothbrush bristles unable to penetrate their depth
Fissures more susceptible to caries due to reduced fluoride exposure
Fissure sealants are to prevent pit and fissure caries

Question 29

Why wouldn’t you use fissure sealants on a 20 year old?

Answer 29

Low risk and likely to not last

Question 30

What are the main functions of dental dam?

Answer 30

Moisture control
Isolation
Ensure resin bonds well

Question 31

How would you check a fissure sealant is appropriately placed?

Answer 31

No air-blows - with probe
No material interproximal y
No material flowed distally
Check material adhered to tooth with probe