Paeds Flashcards by Weng Yee Lee

3 policies within Scotland regarding child protection

GIRFEC

CYPA 2014

National guidance for CP in Scotland 2014

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3 stages of managing dental neglect

Preventive dental team management

Preventive multi-agency management

Child protection referral

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Explain step 1 of managing dental neglect (4)

Raise concerns with parents
Offer support
Set targets
Monitor progress

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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

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Explain step 3 of managing dental neglect

Referral to social services by telephone followed by writing

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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

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4 responsibilities of the dental team in managing child abuse/ neglect

Observe
Record
Communicate
Refer for assessment

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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

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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

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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

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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

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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

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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

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Management of concussion in primary dentition (2)

no tx
KUO

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Management of subluxation in primary dentition (2)

no tx
KUO

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Management of lateral luxation in primary dentition (2)

(a) minimal/ no occlusal interference
- allow to reposition spontaneously

(b) severe displacement
- XLA OR
- reposition +/- splint

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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

1. Direct pulp capping 2. Partial pulptomy 3. 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