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REVISION BDS > paeds > Flashcards

paeds Flashcards

1
Q

aims of primary dentition trauma management

A

presevre integrity of permanent successor and presver primary tooth where possible

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2
Q

aims of permanent trauma management

A

preserve vitality of tooth to allow root maturation and resotre crown to prevent function and aesthetic problems

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3
Q

components of trauma stamp

8

A

sinus/ tender in sulcus
TTP
mobility
colour
displacement
EPT
ECl/thermal
percussion notes
radiographs

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4
Q

factors that influences prognosis after trauma to tooth

A

root development
injury type
presence of infection
delay in seeking tx
PDL damage
age of child
degree of displacment
associated injuries

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5
Q

primary trauma
concussion

A

observe only

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6
Q

primary trauma
subluxation

A

observe only

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7
Q

primary trauma
lateral luxation

A

extract if occlusal interference

allow spontaneous reposition if not

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8
Q

primary trauma
extrusion

A

extract

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9
Q

primary trauma
intrusion

A

parallax
if towards developing tooth germ (lingual) - extract
if not (buccal) leave to reerupt

if not progress after 6 months - XLA

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10
Q

primary avulsion

A

radiograph to confirm -
DO NOT REPLANT

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11
Q

primary trauma alveoalr bone fracture

A

reposition and 4wk splint

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12
Q

post trauma complications
primary tooth

4

A

discolouration
discolouration and infection
disclouration due to loss of vitality
delayed exfoliation

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13
Q

post trauma complications
of primary on permanent dentition

6

A

enamel defect
delayed eruption
ecotopic eruption
abnormal tooth/root morphology (dilaceration)
arrest of tooth formation
complete failure to form

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14
Q

interceptive methods to prevent dental trauma

A

interceptive ortho for increased OJ >9mm
mouthguard for contact sports

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15
Q

3 contraindications for immediate replantation after avulsion of permanent tooth

A

immunocompromised child,
immature lower incisors,
other more serious/concerning injuries that required treatment

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16
Q

periodontal healing outcomes post replantation

4

A

regeneration
PDL/cemental healing
bony healing (ankylosis)
uncontrolled infection

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17
Q

periodontal healing outcomes post replantation

4

A

regeneration
PDL/cemental healing
bony healing (ankylosis)
uncontrolled infection

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18
Q

pulpal healing outocmes after replantation

3

A

regeneration
necrosis
uncontrolled infection

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19
Q

primary tooth features

4

A

Thinner enamel,
larger pulp horns,
broad contact points/areas,
bulbous crowns,
cervical constriction

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20
Q

leeway space

A

extra mesio-distal space occupied by primary molars which are wider than the permanent premolars that will replace them. Ideally 1.5mm upper and 2.5mm lower

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21
Q

mixed dentition

A

from when first permanent tooth erupts until the last primart tooth exfoliates

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22
Q

3 aims of paediatric dentistry

A

develop and maintain an intact, healthy, functional and aesthetic primary and permanent dentition (as few restored teeth as possible)
free from pain and infection (no active caries)
positive attitude towards future dental care

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23
Q

Caries risk assessment

7

A

clinical evidence
dietary habits
social history
fluoride use
plaque control
saliva
medical history

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24
Q

caries risk prevention components

7

A

radiographs - regular (6months high risk)
fluoride varnish
fluoride toothpaste
OHI
diet advice
fissure saelants
f supplements

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25
Q

early childhood caries

A

due to frequent sugar intake and/or reduced saliva flow (prolonged breast feeding, overnight use of drinking cups/bottles - juice, sugar medication)

upper incisors, first primary molars affected. Lower incisors protected by tongue and saliva

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26
Q

fluroide conc toothpastes and ages

A

1000ppmF (smear <3yrs old for low risk children)
1350-1500ppmF (<3yrs old for high risk children; all kids >4yrs old)
2800ppmF (0.619% NaF TP - high risk kids >10yrs)
5000ppmF (1.1% NaF TP - high risk individuals >16yrs. Not suitable for kids)

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27
Q

potentially lethal dose F
probable lethal dose F

how to manage

A

5mg/kg
15mg/kg

<5mg/kg - oral calcium (milk) and observe for few hours
>5mg/kg - oral calcium and go to A&E

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28
Q

fluorosis

A

long term excessive consumption of fluoride
causes a diffuse mottled pattern on teeth - varies to severe pitting and discolouration

tx - micro abrasion, composite masking

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29
Q

risks early loss primary teeth

A

space loss
crowding

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30
Q

risk early loss of permanent 6s

A

rotation and mesial drift 7s
distal drift of 5s

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31
Q

fissure sealant materials

A

Bis GMA (resin) or GIC

GIC used for poor moisture control, pre cooperative child, has a poorer retention

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32
Q

why fissure seal

A

material used to provide a barrier to fissure system to prevent caries development
seals fissures so food and debris cannot get caught in them

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33
Q

issues with Stainless Steel crowns
post placment

conventional

A

Rocking - cervical margin >1mm beyond max curvature
Canting - due to uneven occlusal reduction

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34
Q

Hall crown technqieu

A

no caries removal and no LA or tooth prep

seals caries in until tooth exfloiates (biological methods)

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35
Q

indications for Hall

2

A

asymptomatic
no clinical/radiographic signs of pulpal involvement

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36
Q

hall crown procedures

A

place ortho separators (3-5days)
remove separators
select cwon - check size against tooth but do not seat
fit with GIC - set until contact point engage and ask pt to bite on cotton wool on top
extrude excess GIC
POIG

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37
Q

major failures of Hall crowns

A

irreverisble pulpitis
abscess
interradicular radiolucency
resotraiton loos and tooth unrestorable

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38
Q

minor failures of hall crown

A

secondary caries
restoration loss but intervention possible (resotrable)
reversible pulpitis

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39
Q

aims of pulpotmies

A

stop/control bleeding
disinfect tooth
persever vitality of apical portiuon of radicualr pulp

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40
Q

indication for pulpotomies

A

Carious/traumatic exposure of bleeding pulp,
marginal pulpal inflammation,
reversible pulpitis, c
aries extending >2/3 into dentine radiographically

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41
Q

signs of pulpotomy failure

A

Clinical - pathological mobility, fistula/chronic sinus, early exfoliation, pain

Radiographic - increased radiolucency, root resorption, furcation bone loss

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42
Q

aim of behaviour management

A

To ease fear and anxiety, improve cooperation and promote understanding of the need for good dental health

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43
Q

fear

A

A normal emotional response to objects/situations perceived as genuinely threatening

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44
Q

anxiety

A

Occurs without a triggering stimulus present and may be due to unknown danger/previous negative experiences

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45
Q

phobia

A

A clinical mental disorder that interferes with daily life. Subjects display persistent/extreme fear of objects and/or situations and may demonstrate avoidance behaviour.

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46
Q

behaviour management strategies

7

A
  • Positive reinforcement (praise good behaviour)
  • Tell-show-do (explain what you will be doing, show the child the instruments, etc., perform procedure on child)
  • Acclimatisation (planned, sequential introduction of environment, people, instruments and procedures)
  • Desensitisation (gradual exposure to new stimuli or experiences of increasing intensity)
  • Distraction,
  • role modelling,
  • relaxation/hypnosis/CBT
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47
Q

factors influencing childs behvaiour

4

A
  • Understanding, emotional development,
  • previous adverse dental/medical experiences,
  • attitudes and previous experiences of family/peers,
  • behaviour of the dental team
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48
Q

signs of DFA

A

Thumb-sucking, nail-biting, nose-picking, fidgeting, clumsiness, stuttering, hiding, dizziness, stomach pain, headache, needing toilet, asking questions

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49
Q

general anaesthsia definintion

A

Any technique (using equipment or drugs) which produces a loss of consciousness and/or abolition of protective reflexes in specific situations associated with medical or surgical interventions

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50
Q

aims of GA in dentistry

A

Atraumatic induction,
completion of comprehensive or traumatic dental treatment,
elimination of pain and infection,
establish basis for continued preventive care, short and uncomplicated recovery

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51
Q

stages of GA

A

Induction, excitement, surgical anaesthesia, respiratory paralysis/overdose

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52
Q

adv of GA

A

Patient completely still,
improved access and vision,
multiple procedures can be undertaken,
no response to pain,
rapid onset of action

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53
Q

disadv of GA

A

Death, brain damage, coma,
cost (anaesthetic team, equipment),
location (must have immediate access to ICU/PICU),
minor risks associated with GA (pain, headache, vomiting, nausea, drowsiness),
future outlook to dentistry (does not address DFA),
treatment side effects (pain, bleeding, swelling, bruising)

54
Q

indications for GA

A

Child pre-cooperative, extensive treatment required, patients required to be completely still, severe anxiety levels, surgical drainage of acute infected swelling (abscess),

55
Q

indications for GA

A

Child pre-cooperative, extensive treatment required, patients required to be completely still, severe anxiety levels, surgical drainage of acute infected swelling (abscess),

56
Q

contraindications for GA

A

tx not extensive enough - no sign of pain or infection currently

57
Q

child protection

A

any activity undertaken to protect specific children who are suffering, or at risk of suffering, significant harm

58
Q

safeguarding

A

Any measure taken to minimise the risks of harm to children

59
Q

child abuse and neglect

A

anything which those entrusted with the care of children do, or fail to do, which damages their prospects of safe and healthy development into adulthood

60
Q

triad needed for child abuse

A

Significant harm to child,
carer has some responsibility for harm caused,
significant connection between carer’s responsibility for child and the harm caused to the child

61
Q

4 types of child abuse

A

Physical, emotional, neglect, sexual, non-organic failure to thrive

62
Q

key markers of general neglect

A

Failure to thrive, short stature, developmental delay,
inappropriate clothing, cold injury, sunburn,
ingrained dirt (fingernails), head lice, rampant caries,
withdrawn or attention-seeking behaviour

63
Q

key piece of legistlation associated with child protection and safeguarding in Scotland

A

Children and Young People’s Act (Scotland) 2014

64
Q

SHANARRI indicators

A

Safe,
healthy,
achieving,
nurtured,
active,
respected,
responsible,
included

65
Q

vulnerable child examples

A

<5yrs old,
irregular dental attender,
medical problems, mental and/or physical disabilities, children in care

66
Q

contributing factors for child abuse

A

Drugs, alcohol, poverty, mental illness, domestic abuse, unrealistic expectations, crying, soiling, disability, unwanted, failure to live up to expectations, wrong gender, neighbourhood, housing conditions, intergenerational violence, violence towards pets, social isolation

67
Q

impact of child abuse
short term
long term

A

Short-term - physical health, emotional health, social development, cognitive development

Long-term - arrest, suicide attempts, major depression, diabetes, heart disease

68
Q

components of index of suscpicion

7

A

Delay in seeking help/treatment without good reasons,
vague story of incident lacking in detail and varying with each telling and person,
account not compatible with injury,
abnormal parent mood (preoccupied, detached, concerning),
abnormal child/parent interaction,
child may say something contradictory,
history of previous violence and/or violence within the family

69
Q

% of head and neck injuries in <1 are non accidental

% of abuse injuries to head and neck

A

95%

60%

70
Q

dental neglect defintion

A

The persistent failure to meet a child’s basic oral health needs, to the extent that this is likely to result in the serious impairment of a child’s oral or general health or development

71
Q

definition of wilful neglect

A

Failure to complete treatment after problems/dental neglect is pointed out

72
Q

components of managing dental neglect

3

A

Preventive dental team management,
preventive multi-agency management,
child protection referral

73
Q

4 expectation of dentla team when faced with case of suscpected child abuse

A

Observe,
record,
communicate,
refer for assessment

74
Q

signs of abuse
IO
EO

A

IO - contusions, bruises, abrasions, lacerations, burns, tooth trauma, frenal injuries

EO - facial bruising (ears, triangle of safety), pinch/slap/punch marks, bilateral injuries, burns and bites, choking marks, eye injuries

75
Q

MIH
what is it

A

Hypomineralisation of systemic origin.
Usually affects 1-4 permanent molars and is frequently associated with affected incisors

76
Q

clinical problems associated with MIH

4

A

Sensitivity,
poor aesthetics,
loss of tooth substance
issues in restoring - poor bond

77
Q

questions to enquire about MIH and assoc time periods

A

Pre-natal (pre-eclampsia, gestational diabetes, syphilis),
natal/neonatal (full-term, birth trauma, prolonged/premature delivery, SCBU/NICU involvement),
post-natal (<2yrs - respiratory disease, measles, rubella, varicella, CHD, fluoride intake, nutrition)

78
Q

tx options for MIH molars

A

Composite restorations, SSC, extractions

79
Q

tx options for MIH incisors

A

Acid pumice micro abrasion, external bleaching, composite masking, veneers

80
Q

hypomineralisation

A

enamel formed is of normal thickness but less mineralised

81
Q

hypoplasia

A

enamel formed is thinner but correctly mineralised (true or acquired)

82
Q

how common in MIH

A

10-20%

83
Q

hypodontia

A

developmental abscence of 1 or more teeth

84
Q

hypodontia in priamry dentition

A

<1%

85
Q

hypodontia in permanent dentition

A

5%

86
Q

teeth commonly affected by hypodontia

A

8s,
lower 5s
upper 2s

87
Q

other dental problems assocaited with hypodontia

A

microdontia
abnormal shape and form
reduced LFH
deep overbite

88
Q

conditions associated with hypodontia

A

CLP
down’s syndrome
ectodermal dysplasia

89
Q

management options for hypodontia

A

nothing - accept
space closure with ortho (+/- resotrative camoflage)
space opening with opening and fill gap - RBB, RPD, implant

90
Q

supernumerary

A

tooth in addition to normal sequence
1-3%

most common is maxillary midline- mesiodens

91
Q

supernumerary effect on permanent dentition commonly

A

delayed eruption

92
Q

4 types of supernumerary

A

Conical
Odontome - complex and compound
Supplemental
Tuberculate

93
Q

management options for supernumeraries

A

KUO if not affecting permanent dentition
XLA if interfering with eruptions

94
Q

conditions assoc with supernumeraries

A

CLP
cleidocranial dysostosis

95
Q

developmental anomalies of dental shape and size

8

A

Microdontia, macrodontia, double teeth (gemination or fusion) odontomes, taurodontism, dilaceration, accessory cusps

96
Q

microdontia
what
how common
teeth commonly affected

A

Tooth that is smaller than normal.
2.5% permanent, <0.5% primary

upper laterals and 8s

97
Q

main complaint of microdontia pt

A

aesthetics - spaces present

98
Q

macrodontia
what
how common
generalised macrodontia is assoc with what condition

A

A tooth that is larger than normal.
1%
Hemifacial hypertrophy

99
Q

types of double teeth

A

<0.2%;
gemination (one tooth appears to split into 2)
fusion (where 2 teeth appear to fuse into 1)

100
Q

taurodontism

A

flame-like appearance of pulp, radiographic elarged and elongated of pulp chamber

high risk exposure of pulp

101
Q

dilaceration

A

Distorted crowns or roots (bend in crown/root).

Traumatic intrusion of primary incisor into developing permanent tooth germ.
esp Upper central incisors

tx - crown exposure and ortho alignment or XLA

102
Q

dens in dente

tx

A

‘Tooth inside a tooth’.

Fissure seal ASAP,
difficult to root treat so often require extraction

103
Q

root stucture developmental anaomaly

not dilaceration

A

shoot root anomaly

due to dentine dysplasia, radiotherapy or accessory roots

104
Q

3 groups of enamel structure anomalies

A

Amelogenesis Imperfecta
environmental enamel hypoplasia (systemic, nutritional, metabolic, infection)
localised enamel hypoplasia (trauma, primary tooth infection - Turner tooth)

105
Q

enquiry periods and questions for generalised environmelta/developmental enamel defects

A

Prenatal
* rubella, congenital syphilis, cardiac and kidney disease, gestational diabetes, pre-eclampsia

natal/neonatal
* prematurity, anoxia, c setion

postnatal
* otitis media, measles, varicella, TB, respiratory disease, CHD, vitamin deficiencies

106
Q

diseases assocaied with enamel defects

A

Downs syndrome,
Prader-Willi syndrome,
epidermolysis bulls,
porphyria,
Hurler’s syndrome,
tuberous sclerosis,
incontinentia pigmentii,
pseudohypoparathyroidism

107
Q

Turner tooth

A

Infection of primary tooth leads to a disturbance in enamel and dentine formation of the permanent tooth

108
Q

4 main types of amelogenesis imperfecta

A

Hypoplastic,
hypocalcified (hypomineralsied),
hypomaturational,
mixed forms

109
Q

amelogenesis imperfecta appearance radiographically

A

No contrast between dentine and enamel

110
Q

is amelogenesis due to,…
genetic
environmental
both

A

genetic - familial inheritance
autosomal dominant

genes associated: AMELX, ENAM, KLK4, MMP205

111
Q

problems associated with amelogenesis imperfecta

A

Sensitivity,
poor aesthetics,
caries susceptibility,
issues in bonding
delayed eruption,
AOB

112
Q

management options for amelogenesis impefercta

A

**Preventive therapy (FS),
composite masking, **
indirect restorations (inlays),
SSC,
ortho

113
Q

4 dentine structure anomalies

A

Dentingensis imperfecta
dentine dysplasia
odontodysplasia,
systemic disturbance (nutritional, metabolic, drugs)

114
Q

dentine dysplasia
what
types

A

rare disorder characterised by normal enamel but abnormal dentine and pulp morphology

type 1 and 2 and Bradywine

115
Q

general disorders assoc with dentine defects

5

A

Osteogenesis imperfecta,
Ehlers-Danlos syndrome,
vit D resistant rickets,
hypophosphatasia,
brachio-skeletal genital syndrome

116
Q

odontodysplasia
affected teeth appear

A

Localised arrest in tooth development.
Thin layers of enamel and dentine, large pulp chambers - ‘ghost teeth’

117
Q

types of dentinogensis imperfecta
features

A

Type I - associated with osteogenesis impefercta -bone issues, blue sclera
Type II - autosomal dominant, limited to teeth only
Bradywine

118
Q

clinical and radiographic features of dentinogensis imperfecta

A

Clinical - opalescent blue/brown hue, bulbous crowns, short roots, abnormal ADJ

Radiographic - pulp chambers almost indistinct (narrow almost obliterated), no contrast between dentine and pulp

119
Q

problems associated with dentinogenesis imperfecta

A

Aesthetics,
caries susceptibility,
spontaneous abscess,
poor prognosis

120
Q

problems associated with dentinogenesis imperfecta

A

Aesthetics,
caries susceptibility,
spontaneous abscess,
poor prognosis

121
Q

management of dentinogensis imperfecta

A

Preventive,
composite veneers,
overdentures,
composite masking,
removable prostheses,
SSC

122
Q

systemic disorders assocaited wtih cementum anomalies

A

Cleidocranial dysplasia, hypophosphatasia

123
Q

causes of hypercementosis

4

A

response to inflammation,
mechanical stimulation,
Paget’s disease,
idiopathic

124
Q

concrescence definition

A

Uniting of the roots of 2 teeth by cementum

125
Q

premature tooth eruption associated with

3

A

High birth weight, precocious puberty, natal/neonatal teeth

126
Q

delayed tooth eruptions associated with

5

A

Pre-term birth,
low birth weight,
malnutrition,
gingival hyperplasia/overgrowth,
associated systemic disorders (downs, hypothyroidism, hypopituitarism, cleidocranial dysplasia)

127
Q

reasons for premature exfoliation

6

A

Trauma,
primary tooth pulpotomy,
hypophosphatasia,
immunological deficiency (cyclic neutropenia),
histiocytosis,
Chediak-Higashi syndrome

128
Q

reasons for delayed exfoliation

5

A

infra occlusion (ankylosis)
double primary teeth (gemination/fusion)
hypodontia
ectopic permanent successor
trauma

129
Q

what are infra occluded teeth
how common
most likely tooth
associated with

A

Teeth that become ankylosed (fused) to the bone and appear to sink towards the gingiva (submerging teeth) - they don’t grow but everything else grows around them.
1-9%.
Commonly L5
hypodontia in permanent dentition

130
Q

management of infraoccluded teeth

A

Usually exfoliate (around 11-12yrs) but not uncommon for them to be retained into adulthood.

Retain as long as possible, extract when 1mm of crown showing supragingivally

REVISION BDS (43 decks)

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