Paeds Flashcards
Nursing bottle caries
- how achieve diagnosis
- presentations
- what advice and treatment you can provide
Presentations
- often pain
- grossly decayed upper central and lateral incisors and also Ds and lower canines - lower anteriors protected by tongue
Ask
- feeder bottle to bed? What does it contain
Instructions
- this is due to content in the bottle
- child should have a cup replacing bottle at 6 months
- instruct sugar free everything - milk, drinks etc
- safe snacks = cheese, breadsticks
Toothbrushing instruction
- you do it until they are 7 yo
- brush in morning and last thing at night
- only water after brushing at night
- spit dont rinse
Management
- extraction of these teeth under GA - risk vs benefit
- GIC remaining teeth
- fluoride supplements and varnish
- SDF
Child needing extractions, give option for GA and risks and benefits
First discuss other options
- treatment under LA
- treatment under IS
What will happen
- referral for GA assessment - if accepted hospital will remove all teeth they deem of poor prognosis to try to prevent future GA needed
- GA will involve a day in hospital
Risks of GA
- headache, nausea, vomiting, drowsiness
- risks of tx - pain, bleeding, bruising, swelling, infection, loss of space, need for stitches
Major and rare risks
- permanent brain damage
- death less than 1:100k
Primary herpectic gingivostomatitis presentation
- symptoms
- What i would tell the parent and child
- management options
Primary response to herpes simplex virus
Symptoms
- sore mouth
- sore throat
- malaise / lymph node enlargement
- erythematous gingiva and lips
- fluid filled vesicles rupturing to painful ulcers on soft tissue
What to ask
- how long have symptoms lasted
- do you have a fever
- less active than normal
- any analgesia used?
Treatment
- bed rest, high fluid intake
- OTC medication
- chlorhexadine MW
- aciclovir only in immunocompromised or severe infection
Paeds neglicence station
- mother is on the phone all appt and not listening - what do
- what would raise concern / types of injuries
- what advice to give regarding prevention
- how would you introduce a child protection referral
Explain nicely to mother that during treatment and discussion if i could have their full attention and they could refrain from using the mobile phone
Injuries in soft tissue areas not bony prominences
- regular missed appts
- gross decay
- muddy or ill fitting or tatty clothes
Index of suspicions
- delay in seeking help
- vague story with lack of detail
- preoccupied parent
- child says contradictory
If wishing to refer injuries
- only if this will not put child at risk
- explain concerns honestly and inform them of intention to refer. -these need to be reported - seek parents consent to share info
Pt presents with staining of tooth
- what questions would I ask
- reassure patient of causes and treatment options
Identify the cause of staining
- trauma?
- enamel defects - ask about pre, neo and postnatal illness etc
- MIH
- amelo/dentino imperfecta
- fluorisis
- decalcification
Treatment options
- microabrasion - removal of tooth structure with acid and pumice
- vital external bleaching - may not work - gingival recession risk, post op sensitivity, will not bleach restorations
- localised composite additions to enamel defects
- comp/porcelain veneers - tooth prep needed and need to wait until 18 for stable gingival level
Pt presents with missing tooth
- what might i ask
- what might be causes / treatment options
Ask about
- trauma
Causes
- hypodontia
- trauma
- ectopic
- supernumerary
Treatment
- palpate canines at 9 and central incisors from 6
- take 2 different radiographic views - PA and OPT? SLOB it
- orthodontic traction
- referral to ortho for management if ectopic
- resin retained bridge if suitable
- essix retainer with Pontic
- implant if over 18
- RPD
Recurrent ulceration in child.
Possible causes / investigations?
Hereditary disposition
Haematological deficiency
GIT disease - coeliac
Trauma - sharp area in mouth?
Allergy - SLS toothpaste etc
Initial investigations
- diet diary
- FBC
- haematinics
- coeliac screen
What strength of fluoride is allowed for each age?
0-3 - 1000ppmF
4-16 - 1450ppmF
High risk 10+ - 2800ppmF
High risk 16+ - 500oppmF
How place a hall crown?
Inform patient what hall crown is
- early enamel caries can be halted if it is not into the dentine
Place separators
- mesial and distal
- remove with blunt probe after 2-7 days
Sit child upright and use gauze to protect airway
- use sticky stick to select correct size for tooth - springiness
- use aqua em GIC to cement in the crown
- get child to bite on it with cotton wool to seat it
- remove all excess cement
- floss contacts
Give fluoride varnish information and POI
Reassure
- FV is placed topically and is minimally invasive
- promotes remineralisation and hinders demineralisation
Contraindicated in
- severe asthma
- colophony allergy
POI
- no eating or drinking for 1 hr
- avoid fluoride supplements today such as mouthwash
Fluoride toxicity
- 5mg/kg milk
15mg/kg referral
Trauma 11 EDP fracture and immature apex, what do?
Explain nature of the injury
- where the fracture is
Radiograph
- PA and occlusal
Investigations
- sensibility testing
- EPT testing
- pocketing
- TTP
- sound
Explain treatment - pulpotomy
- partial removal of pulp
- keep undamaged tissue alive
- LA needed and dental dam needed
- drilled out pulp tissue and dressed with MTA
- white filling in top and then monitor for symptoms
