Paeds Flashcards
3 policies within Scotland regarding child protection
GIRFEC
CYPA 2014
National guidance for CP in Scotland 2014
3 stages of managing dental neglect
Preventive dental team management
Preventive multi-agency management
Child protection referral
Explain step 1 of managing dental neglect (4)
- Raise concerns with parents
- Offer support
- Set targets
- Monitor progress
Explain step 2 of managing dental neglect
- Obtain details regarding HV from GMP
- Communicate with health visitor about concerns
- HV will visit family and arrange appointments
- Check if child is subject to child protection plan
Explain step 3 of managing dental neglect
Referral to social services by telephone followed by writing
5 examples of non-accidental injuries
- Delayed presentation
- Injuries that do not match with history
- Soft tissue injuries
- Injuries to both sides of body
- Injuries with specific pattern
- Injuries to the triangle of safety
4 responsibilities of the dental team in managing child abuse/ neglect
- Observe
- Record
- Communicate
- Refer for assessment
3 people you can go to for help and advice in managing child abuse/ neglect
- Experienced colleague
- Named safeguarding doctor/ nurse
- Social services (social care direct)
- CPA
Home care instructions for parent and child who had trauma to dentition
- analgesia
- soft diet 10 - 14 days
- brush teeth after every meal
- apply topical CHX MR using gauze
- warn re signs of infections + possible complications to dentition
Management of enamel-dentin fracture with no pulpal exposure in primary dentition (3)
- Account for fractured fragment
- Apply GI/ composite bandage
- Restore definitively with composite
Management of complicated crown fracture in primary dentition (2)
- Account for fractured fragment
- LA, pulpotomy, dress with non setting CaOH, temporise with GI, restore with composite
Management of crown root fracture in primary dentition (4)
- remove loose fragment & determine if crown can be restored
- if restorable
– no pulp exposed, GI bandage
– pulp exposed, pulpotomy/ RCT - if unrestorable, XLA loose fragments
Management of crown root fracture in primary dentition (5)
- no tx if coronal fragment not displaced
- if coronal fragment displaced but not excessively mobile allow to reposition spontaneously
- if coronal fragment displaced & excessively mobile & interfering with occlusion:
– XLA loose coronal fragment
– reposition loose coronal fragment +/- splint
Management of concussion in primary dentition (2)
no tx
KUO
Management of subluxation in primary dentition (2)
no tx
KUO
Management of lateral luxation in primary dentition (2)
(a) minimal/ no occlusal interference
- allow to reposition spontaneously
(b) severe displacement
- XLA OR
- reposition +/- splint
Management of intrusion in primary dentition (1)
allow to spontaneously reposition
diagnostic radiographs for intrusion in primary dentition (2)
- PA PLUS
- lateral pre maxilla
to assess danger to permanent tooth + counselling re prognosis
Management of intrusion in primary dentition (2)
(a) Interfering with occlusion
- allow to spontaneously reposition
(b) excessively mobile/ extruded >3mm
- XLA
Management of avulsion in primary dentition (2)
- radiograph to exclude intrusion
- DO NOT replant tooth
Management of alveolar fracture in primary dentition (3)
- reposition segment
- stabilise with splint 4/52
- may need to XLA teeth after alveolar bone stable
3 sequelae of trauma to primary tooth
- discolouration
- discolouration & infection
- delayed exfoliation
Complications of trauma in primary dentition to permanent successor
- enamel hypomineralisation
- enamel hypoplasia
- dilaceration
- arrested development of permanent tooth
- complete failure of permanent tooth to form
- ectopic permanent teeth
- delayed exfoliation of primary teeth
- delayed eruption
- odontome
Why sensibility testing may be unreliable in children’s teeth? (from IADT guidelines permanent teeth)
- Transient lack of neural response
- Undifferentiation of A-delta fibres in young teeth
- Common in post-traumatic pulp healing (esp after luxation)
3 medical conditions to be aware of if a child presents with dental trauma (which may affect treatment)
- Rheumatic fever
- Congenital heart defects
- Immunosuppression
6 E/O findings to note when examining trauma (think of facial/jaw fractures)
- Laceration
- Haematoma
- haemorrhage/ CSF leakage
- Subconjunctival haemorrhage
- Bony step deformities
- Limited mouth opening
7 things to note in a trauma sticker
- Colour
- Sinus
- Mobility
- TTP
- Percussion note
- Sensibility testing (cold & EPT)
- Radiogaphs
5 aspects which affect the prognosis of teeth
- Type of injury
- Injury to PDL
- Time between injury and presentation
- Stage of root development
- Presence of infection
Management of enamel fractures in permanent dentition
- 2 PA’s to rule out root fracture/ luxation
- Bond enamel fragment back
- Smooth enamel +/- definitive composite restoration
- Recall 6-8 wks, 6 mo, 1 yr
Management of enamel dentin fracture in permanent dentition
- Account for fragment
- 2 PA’s to rule out fractures, luxation
- Radiograph soft tissues to rule out embedded fragments
- Bond fragment to tooth// GI/ composite bandage
- Definitive comp restoration
Recall 6-8 wks, 6 mo, 1 yr
3 management options of enamel-dentin pulp fractures in permanent dentition
- Direct pulp capping
- Partial pulptomy
- Coronal pulpotomy
When is direct pulp capping indicated? (2)
- <24 hrs since injury
- Tiny (1mm) pulpal exposure
How is direct-pulp capping carried out? (6)
- LA, rubber dam
- Clean tooth with water then NaOCl
- Dry with CWP, attempt haemostasis w saline soaked CWP
- If haemostasis achieved, place setting CaOH
- Temporise with GI
- Restore with composite restoration
- RV 6-8 wk, 6 mo, 1 yr
When is partial pulpotomy indicated? (3)
- > 24 hrs since injury
- > 1mm pulpal exposure
- Haemostasis cannot be achieved/ haemorrhage during direct pulp capping
How is partial pulpotomy carried out? (7)
- LA, rubber dam
- Clean tooth with saline then NaOCl
- Remove 2mm of pulp surrounding exposure using high speed diamond round bur
- Dry and arrest bleeding with saline soaked CWP
- If haemostasis achieved dress with non setting CaOH
- Temporise with GI
- Restore with comp
RV 6-8 wk, 6 mo, 1 yr
When is full coronal pulpotomy indicated?
When pulp is necrotic/
Haemostasis cannot be achieved during partial pulpotomy
When is RCT indicated in immature incisors?
Signs of infection/ pulpal necrosis
What is a clinical problem when obturating immature incisors? (1) 3 options to overcome this problem (3)
- No apical stop for obturation
- Apexogenesis (CaOH in canals to stimulate hard tissue formation)
- Apical plug with MTA/ biodentine
- Regenerative endodontic technique
Describe the steps for an open apex pulpectomy
- LA, rubber dam
- Access
- Control haemorrhage with - LA/ sterile water
- Working length radiograph
- File to 2mm short of EWL
- Disinfect with NaOCl
- Temporise with non setting CaOH (no longer than 4-6 wks), CWP and GI
- Apical plug using MTA
- Heated GP obturation
6 management options of crown root fractures
- Remove fragment and restore
- Remove fragment & gingivectomy (palatal subgingivally extended fractures)
- Extrude apical fragment orthodontically, RCT, post and crown
- Surgical extrusion
- Decoronate
- Extract
