paeds Flashcards
How to treat a small occlusal cavity in a lower D of a 2 year old?
Fluoride Varnish, OHI and Diet Advice
Which children are classed as lacking cooperative ability?
Specific medical problems e.g: profound learning disabilities.
Triad of Anxiety
- Physical Symptoms
- Behaviours
- Emotions
4 Stages of Piaget’s Cognitive Development
- Sensorimotor (learning by doing things)
- Pre-operational Thought (inflexible)
- Concrete Operations (apply logic)
- Formal Operations (logical abstract thinking)
When is it advised for children to have their first checkup?
Prior to 1st birthday to gain eruption advice.
Who can consent to a child’s treatment?
- Mum
- Dad if they are married to the mum +/- name on the birth certificate or have a PR form from court.
- Legally appointed guardian.
- Someone with a residence order.
- Local Authority designated to care for the child.
In what situation would it be acceptable to proceed with treatment on a child without relevant consent?
Where delaying treatment would place the patient at significant risk (e.g: pt left in pain, medically compromised or risk of sepsis etc).
Contraindications for GA in children.
- When alternative methods of pain control haven’t been excluded.
- Medical conditions (e.g: acute respiratory tract infections, congenital heart disease, obesity).
- Simple orthodontic extractions.
Why should the patient fast prior to GA administration?
Pt should fast 6 hours prior to GA as it could cause food or stomach acid to get into lungs.
Parental responsibility can be given over court order under what circumstances?
- Death of a parent when the child has a court order for a new guardian.
- Mum unable to consent (e.g: due to being in prison)
- Local authority designated in care order.
What antibacterial agent does breast milk contain?
Lactoferrin kills strep mutans.
TBI for children under 3
Smear of toothpaste with at least 1000ppm.
Adult should brush/supervise.
TBI for children aged 3-6
Pea sized amount of 1000ppm toothpaste.
Adult supervision.
How old must a child be to be prescribed NaF mouth rinse?
8 years old
What concentration is NaF mouth rinse?
0.05%
DBOH breast feeding advice:
0-6 months - breastfeed only
> 6 months - breast feed + no added sugar solids + free flow cup
(bottle feeding should be stopped after 1 year and brushing should start when baby teeth come through)
Brushing advice for 3-6 year olds.
twice a day with 1000 ppm toothpaste
PEA SIZED AMOUNT
Brushing advice for 7-18 year olds.
1350-15000 ppm toothpaste
+
22,600 ppm fluoride varnish twice a year
Recommended sugar intake for 1-4 year olds:
5 cubes (19g)
(around 4g per cube)
Recommended sugar intake for 7-10 year olds.
6 cubes (24g)
Recommended sugar intake for 11+ year olds.
7 cubes (30g)
What age should BWs be taken from?
4 years old
low risk - 12-18 months
medium risk - 12 months
high risk - 6 months
What should you do if primary tooth trauma leads to pulp necrosis?
XLA without delay
What is different with sensibility testing in primary teeth?
Unreliable so other tests must be done.
What does a high pitched noise on TTP indicate?
PDL damage
BW interval for high caries risk:
6 months
BW interval for moderate caries risk:
12 months
BW interval for low caries risk:
12-18 months
What ppm of fluoride should be used in under 3s?
a smear of 1000 ppm
What ppm of fluoride should be used for ages 3-6?
Pea sized amount of 1000 ppm.
What ppm of fluoride should be used in adults?
1350 - 1500 ppm
At what age can you prescribe fluoride mouthwash?
over the age of 8
DBOH sugar cubes / grams for 4-6 years
5 cubes (19g)
DBOH sugar cubes / grams for 7-10 years old
6 cubes (24g)
DBOH sugar cubes / grams for 11+
7 cubes (30g)
What is the minimum age for chlorhexidine usage?
12 years
What is appropriate to prescribe to a 9 year old pt with high caries risk?
230ppm of 0.05% F mouth rinse
What is appropriate to prescribe to a 13 year old pt with high caries risk?
0.619% of 2,800ppm NaF toothpaste
What is appropriate to prescribe to a 17 year old pt with high caries risk?
1.1% 5000ppm NaF toothpaste
What treatment should be carried out on high-risk pts where their 6s are erupting?
fissure sealants
What age can IHS with NO be carried out, given the child is cooperative and understands tx?
6+
From what age can IVS be given?
12+
pre-op instructions for IHS
light meal 2 hours before, take any meds as normal
Up to what age is it recommended for parents to supervise brushing?
7
Toxic dose of fluoride ingestion per kg of body weight.
5mg/kg
When is pulp therapy not recommended in children?
when there is more than 3 teeth requiring tx
What percentage of physical child abuse presents with orofacial trauma?
50%
If an impacted / unerupted permanent incisor is ankylosed, what is the first line of treatment?
extraction
Fluoride concentration in SDF
44,800ppm
5 indications for PMCs
- caries (on 2 or more surfaces)
- following pulp treatment
- developmental problem (AI or DI)
- extensive tooth surface loss
- space maintenance
What is needed structurally in order to place a PMC?
a distinct band of sound dentine
4 contraindications for PMCs
- pain
- close to exfoliation (rad shows root resorption over 1/2 way)
- nickel allergy
- not enough tooth structure for retention
Describe the conventional PMC technique.
Caries removed and space drilled around for the tooth to fit crown.
(drill instead of sep placement)
Describe the Hall Crown Technique
Biological Approach
- prevents progression by sealing the bacteria inside the crown.
Which material is used for cementing PMCs?
GIC luting cement (e.g: aquacem)
Other than severe asthma, in which other circumstance would fluoride varnish be contraindicated?
Ulcerative Gingivitis
Which 2 receptors does nitrous oxide work on?
GABA and NMDA
What is the minimum concentration of oxygen used during inhalation sedation?
30%
3 types of mouthguard
- stock
- boil and bite
- custom made
Which incisal relationship is most prone to injury?
Class II
- due to increased overjet
What is the primary function of a splint?
To immobilise the tooth whilst healing takes place.
- prevents further damage to PDL.
- helps reduce pain.
Why is a primary tooth more likely to luxate than fracture?
Because the bone is more malleable and has shorter roots.
Why is a pulpotomy favoured over a pulpectomy in immature teeth?
Helps the rest of the tooth to remain vital - a non-vital tooth wouldn’t continue to develop and mature.
What is the base of MTA?
tricalcium silicate
Which ingredient in MTA causes discolouration?
Bismuth Oxide
Which irrigant should be used in the endodontic treatment of immature teeth?
chlorhexidine
- hypochlorite contraindicated due to risk of hypochlorite incident.
Would you expect a laterally luxated tooth to be mobile?
No - wedged into the socket with bony lock.
Characteristics of ectodermal dysplasia.
- hypodontia
- microdontia
- maxillary hypoplasia
- fine / abnormal hair
- inability to sweat (heat intolerance)
affects males more due to being X linked
Peak age for TDI
7-11
What is the proper term for ankylosis?
(which type of resorption)
root replacement resorption
The 4 categories of abuse?
Physical
Neglect
Emotional
Sexual
Define Gillick Competency
When a child (under 16) is able to consent to their own treatment without the need for parental permission / knowledge.
Which 4 things does a child need to be able to do to be deemed Gillick Competent?
- understand the treatment, consequences and alternative.
- retain the information
- weigh it up to make a decision
- communicate the decision
What is a Caldecott Guardian?
A senior person responsible for protecting the confidentiality of people’s health and care information and making sure it is used correctly.
How long are pt records kept?
Until the pt is 25 years old or 11 years after tx.
(whichever is longer)
How old must a chid be to be prescribed NaF mouth rinse?
8 years old - 0.05%
What concentration should high risk children aged 10+ have in their toothpaste?
2800ppm
What fluoride concentration should high risk children aged 16+ have in their toothpaste?
2800-5000ppm
Most appropriate radiographs for locating an ectopic canine?
OPG and PA
Disturbances in morphodifferentiation cause which type of dental anomaly?
size and shape
A disturbance affecting dental lamina formation causes which type of anomaly?
number
A disturbance affecting matrix deposition and mineralisation causes which type of developmental anomaly?
structure
Which 2 genes are involved in hypodontia?
PAX-9
MAX-1
3 syndromes associated with hypodontia:
- ectodermal dysplasia
- down syndrome
- cleft lip and palate
4 syndromes associated with hyperdontia:
- cleidocranial dysplasia
- oral-facial digital syndrome
- gardeners
- cleft lip and palate
What is the name for localised enamel hypoplasia and what 2 things typically cause it?
Turner Tooth
caused by:
1. trauma
2. infection
What is the cause for MIH?
Unknown - can be linked to traumatic births, childhood illness etc.
How old must a pt be to receive RCT?
11
Which 3 things can occur to the permanent successor of a tooth prior to lateral luxation?
- dilaceration
- misshapen crown
- pitting / discolouration
How quickly does a tooth usually erupt relative to its contralateral number?
6 months
What is the ideal age for XLA of 6s and why?
9-10 years
- calcification of the bifurcation of 7s has happened
- after eruption of laterals but before 7s
Before which procedure would you need to do a sickle cell test in a child?
before GA extraction
What can cause premature eruption / exfoliation of primary teeth with normal roots?
hypophosphatasia
If a child has epilepsy and gingival hyperplasia, which drug is most likely causing this?
phenytoin
At what age should you start monitoring perio?
7 years old
A child presents with spontaneous gingival bleeding.
What is the likely cause of this?
leukaemia
Which disease would indicate performing a pulpotomy on a 5 year old?
von willebrand disease
What is the most common cancer in children?
Acute Lymphoblsatic Leukaemia
How would you manage a root fracture in a primary tooth?
Extract coronal portion and leave the apical part to resorb as normal.
At what age do you do a full BPE on a child?
12
At what stage of embryo development does cleft lip and palate occur?
weeks 6-12
After a primary molar pulpotomy, what material would you restore with?
stainless steel crown
Which condition results in a large tongue, heart defects and congenitally missing 3s?
down’s syndrome
What would cause bleeding gums, fever and feeling unwell?
primary herpetic gingivostomatitis
Which teeth are included in the modified BPE?
UR6, UR1, UL6, LR6 , LL1, LL6
What is the fluoride content in FV?
22,600ppm
3 risks associated with SDF?
- gingival irritation
- metallic taste
- irreversible dark stains
Differences between primary and permanent teeth.
- more bulbous crowns
- shorter clinical crown
- divergent roots
- more cervical furcation
- more elastic bone
- larger pulp chamber
