Paeds Flashcards
What are epstein’s pearls?
They are also known as gingival cysts. They are formed of keratin and found on the gingivae as small white cysts. They are nothing to worry about, can reassure parents
What is congenital epulis
benign tumor of the oral cavity, is an extremely rare condition in newborn. It may lead to mechanical obstruction, therefore resulting in respiratory distress and difficulty in feeding
Does congenital epulis require excision?
It depends. If it is interfering with feeding or traumatised, May require excision.
What are Natal and neonatal teeth?
Natal - present at birth
Neonatal - teeth erupted within the first month of life (premature)
Which tooth is most likely to be neonatal?
Usually lower central incisors
Possible treatment options for natal or neonatal teeth?
Usually doesn’t require treatment, only if it causing ulcers (usually on the under surface of tongue)
- smooth out the teeth, removing is rare
Eruption cysts usually appear blue , why? What treatment for eruption cysts?
Filled with blood. Do not require treatment usually as the cysts disappears as the tooth erupts
When do teeth start to form?
Week 5 of intra uterine life (IUL)
When does hard tissue formation start?
Starts at 13 weeks
What is the most likely cause of defects in the primary dentition?
Difficult pregnancy for the mother or complications at birth
Need to know dates of calcification of crowns at birth
At birth,
Half of central incisors calcified
Third of lateral incisors
Tip of primary canines
Half of first primary molars
Third of second primary molars
Tip of cusps of first permanent molars
Explain the theory of eruption due to resorption of the overlying hard tissue
Dental follicle contains enzymes that intimate osteoclastic action, remodelling overlying bone and clearing a path for tooth eruption
Tooth pushes into mouth due to what
Possible theories
- root elongation
- Cellular proliferation at the apex of the tooth
- Localised change in blood pressure
- Metabolic activity within the PDL
When does eruption stop?
It only stops when the tooth comes into contact with something else otherwise it’ll continue erupting through life
Why does tooth eruption occur throughout life?
To compensate for vertical growth of the jaws
tooth wear
Which primary tooth is the exception when it comes to eruption order?
Usually lowers before uppers except the lateral incisors , uppers before lowers
When do the primary teeth erupt?
A - 6 - 12months
B - 9 - 16 months
D - 13- 19 months
C - 16 - 23 months
E - 23 - 33 months
Teeth of the same series erupt within 3 months of their contra lateral tooth
What age is primary dentition complete by usually?
2.5 - 3 years old
What are some differences between primary and permanent teeth ?
Primary molar crowns more bulbous
Primary incisor crowns and roots smaller
Primary molars are wider mesiodistally for leeway space
Primary teeth are usually whiter in colour
Primary incisors more upright while permanent incisors more proclined
What is present on an upper 2nd primary molar?
Transverse ridge
What is present on both upper and lower 1st primary molars
Prominent mesiobuccal tubercle
3 characteristics of primary roots
Narrower
Longer
Slender
Flared at the apex ( claw shape)
Why is pulpal exposure more likely in primary then permanent teeth
The pulp horns extend high occlusally, very close to the enamel
Large pulp chambers
Why is it impossible to do a complete rct of primary teeth
Too many ribbon like small accessory canals interconnecting
Is enamel/ dentine thinner or thicker in primary teeth
Thinner
Structure and function of anthropoid / primate spacing in primary teeth
Spacing mesial to upper canine and spacing distal to lower canine
Function is to align cusps of canine as well as to prevent overcrowding in permanent dentition
Leeway space dimensions in the upper and lower arch
Upper 1.5mm each side
Lower 2,5mm each side
What direction does the facial portion of the skull grow?
Downwards and forwards
Mixed dentition definition
From the time of eruption of first permanent tooth until loss of last primary tooth
6-11 years old
What is an exception to the eruption rule for permanent teeth?
Lowers before upper except for the second premolars
What is AP arch length
Anteroposterior arch length
Do permanent inicisors develop palatal or labial to the primary incisors
Palatal
What is transient spacing of the upper 1s
Ugly duckling teeth, the permanent central incisors grow outwards due to the close proximity of their roots to the erupting 2 and 3. It will self correct when the lateral incisors erupt and come down
upper central and lateral incisors are tipped laterally due to the crowding created by the unerupted canines, to produce a midline space (median diastema).
How long does it take for root formation to complete in permanent and primary teeth after eruption
1,5 years - primary
3 years - permanent
What can an anterior open bite in kids be caused by?
Sucking habit
What age can you palpate the canine high in the Buccal sulcus
10 years old
what material do we use for an emergency adhesive bandage of a crown fracture?
composite or compomer
NOT gic
what does the survival of the pulp depend on?
it depends on the associated PDL injury
extent of exposed dentine
age of patient (open or closed apex)
luxation
bacterial ingress
what is luxation
displacement of the tooth
what is avulsion
tooth is totally out
what do we do with a vital immature tooth
pulp cap
pulpotomy
pulpectomy
what to do with a non vital immature tooth
pulpectomy
apical barrier formation
apexification (outdated)
why are there concerns over using dycal for apexification?
reduces mineral content of dentine and makes tooth susceptible to root fracture
when would you choose apexification ie dycal over apical barrier formation ie MTA?
when the child is unable to sit still and cooperate
what is the depth of MTA in apical barrier formation?
at least 5mm of MTA
what to do with a mature tooth with exposed pulp?
pulp cap
pulpotomy
pulpectomy
rct
how many days after avulsion can you use dycal
7-10 days after avulsion to prevent ankylosis
first aid for avulsed tooth?
store in fresh cold milk or saliva
do not allow tooth to dry out
do not handle the root
re implant asap
flexible splint for 2 weeks
splinting times for avulsion
2 weeks
splinting time for luxation
4 weeks
splinting time for cervical 1//3 root fracture
4 weeks - 4 months
best wire for spilnitng
composite wire
what thickness of splint wire
0.6mm
amalgam ban for what age
under 15
what to consider when restoring a primary molar?
longevity of the tooth
extent of caries
cooperation of the child
what restorative material to use in children?
preformed metal crowns last the longest followed by
amalgam, compomer same
RMGIC
GIC
What is the Hall technique and why is it preferred?
termed biological caries control, requires no removal of caries, only seals caries in
preferred because of the low failure rate in children
quick
no prep involved
no LA
materials and instruments for stainless steel crown placement on children?
tapered diamond seprating bur
preformed metal crown
glass ionomer luting cement
crown crimping pliers
what causes a crown to be unable to sit properly
cannot sit if there is a ledge caused by a lack of knife edge during the marginal rirdge reduction
depth of occlusal reduction for crown prep
1-2mm
what causes rocking of the crown
cervical margin is more than 1mm beyond max curvature
by right it should only be ~0.5mm beyond max cruvature
what is canting of the crown caused by?
caused by uneven occlusal reduction
indications for the Hall technique?
no pulp involvement
enough sufficient sound tissue left to retain the crown
have sufficient space
hall tech vs conventional for crown
hall technique - no cavity prep, no drilling, just place crown over
conventional - need to prepare tooth ie marginal ridge and occlusal reduction
is gingival blanching a good sign for hall technique
yes, it shows a snug fit
examples of retainers to keep the space mesial to the molars?
band and loop
distal shoe
when to use fissure sealant and when to use finger press GIC?
if moisture control cannot be achieved
if patient compliance is an issue then use GIC as it is much quickler
if there is high degree of sensitivity eg MIH
enamel defects making drying of tooth painful
why is fissure sealant better than finger press gic?
finger press gic falls out easily, needs to be replaced frequently
what is a fissure sealant?
protective plastic coating used to seal fissures and pits to avoid getting food and bacteria caught in them and causing decay
why are fissures more vulnerable to caries?
1.less protected by fluoride
2.not possible to clean the base of a fissure with a toothbrush
what material is used for FS
bis gma
what is the difference between FS and CR?
FS => etch and FS, no bond required
CR =>etch bond CR
who should get FS placed?
all children esp high caries risk and medically compromised children
if there are caries in one FPM, what should we do?
have all 3 other FPMs sealed immediately and seal second permanent molars on eruption
why do we need to work efficiently for FS placement
needs to be dry
what happens if etch contacts with soft tissues
may cause burn so quickly rinse with copious amounts of water
why must the enamel be chalky white before you can place fs?
enamel must be etched otherwise resin will not adhere and FS will not stay
what to check for when placing fs?
that it has reached the base of the fissure - prevents leakage
no air bubbles
no voids underneath
avoid overfilling as it decreases retention
check using a probe to see if it dislodges
no material interproximally - otherwise remove with probe or floss
why is important to check that FS has been placed properly
no leakge
no dislodge
does not trap plaque or food
how often to review FS
4 months in highrisk
6months low risk
how to apply GIC finger pressed fissure sealant?
dry tooth with cotton wool instead of air - less painful and sensitive
apply GI from applicator
smooth into fissure and press
press until set
sets v fast
