paeds Flashcards
what are Piaget’s four stages of cognitive development?
<2yo sensorimotor
2-7yo preoperational
7-11yo concrete operational
≥12yo formal operational
why is it recommended that toothbrushing is done by parents until at least 7yo?
≤6yo = likely to miss areas and swallow large amounts of toothpastes
what percentage of school children are afraid of the dentist and what consequences does this have?
16%
avoid attending = deterioration of oral health
often need more complicated and traumatic treatment
what are the three most significant risk factors in the development of dental anxiety in children?
- new carious lesions
- toothache
- extractions
give some of the manifestations of dental anxiety in children (~6)
- thumb sucking, nail biting, nose picking
- clumsiness, stuttering
- needing to go to the toilet, stomach pain
- headache, dizziness
- fidgeting, clinging to parent, hiding
- silence
what is behaviour contagion and how could this affect a child’s dental anxiety?
- “tendency of a person to copy certain behaviours of others around them”
- enhances a child’s anxiety (copying parents/family)
when does a parent’s presence help the child in a dental appointment?
<5yo behave better with parent present (separation anxiety)
when would you exclude the parent from a dental appointment?
- competing with dentist for child’s attention
- unintentionally conveying their own anxieties to the child (verbal or non-verbal)
what are the different components of communication and their relative importance?
- verbal communication 5% - language used
- paralinguistic communication 30% - tone, loudness, pitch
- non-verbal communication 65% - behaviour and environment
how might you adjust your verbal communication when speaking to a child?
- avoid jargon and specific terms that the pt may not understand
- avoid emotive language
how might you adjust your paralinguistic communication when speaking to a child?
commands given in a loud voice are better received by children
describe the epidemiology of dental trauma in children (demographic, type)
- males
- peaks at 2-4yo (walking) and 8-10yo (sports)
- more in primary teeth than permanent, especially maxillary central incisors
- crown fractures most commonly
risk factors for dental trauma in children (6)
- activities and environment more important than gender or age
- hyperactivity
- poor motor coordination
- increased OJ (>5mm) and incompetent lips
- anterior open bite
- epilepsy
what needs to be included when taking the history of dental trauma in a child? (6)
- where, when and how?
- attending with?
- loss of consciousness (A&E)
- previous TDIs
- all tooth fragments accounted for?
- NAI - any other injuries, does story match between adult and child, any delays?
describe the EO examination for paediatric dental trauma (3)
- clean face and oral cavity with saline/water
- looking for lacerations, tooth fragments
- exclude facial fractures by palpating facial skeleton and mandible, step deformities, difficulties opening/closing
what is a degloving injury?
traumatic injury where the entire gingiva/alveolar mucosa is separated from the underlying bone
what radiographs may you take following paediatric dental trauma and why? (5)
- PA = open/closed apex, detect root fracture
- USO = parallax with PA, detect root fracture
- DPT = developing dentition, facial fractures
- soft tissue radiograph (30-50% exposure) = tooth fragments
- lateral skull = relationship of teeth to successors
what things may be included in the trauma stamp? (up to 7)
- colour
- mobility
- sinus
- TTP
- percussion
- ethyl chloride (unreliable in primary teeth)
- EPT (unreliable in primary teeth)
how many clinical and radiographic signs do you need before starting endo tx following trauma?
at least 3
define a splint (tooth)
rigid or flexible device/compound used to support, protect or immobilise teeth that have been loosened/replanted/fractured/subjected to certain endodontic/surgical procedures
what are the different materials that can be used for splinting teeth? (5)
- composite/wire
- acrylic ProTemp splint
- soft mouthguard (eg if no teeth to place splint)
- brackets/orthodontic wire (lengthy splinting)
- titanium trauma splint (TTS)
what is the difference between rigid and flexible splinting and which is preferred?
- rigid splint = completely immobilises tooth (≥2 teeth either side, thicker wire), increased risk of ankylosis
- flexible splint preferred = allows some functional movement of teeth (usually 1 tooth either side)
give some features of an ideal splint (5)
- easy to place, remove and maintain (often buccal)
- cleansable
- discourages plaque retention
- does not impinge on gingival tissues
- no occlusal interference
- enables endodontic treatment and sensibility testing
when would you place a splint, what type and for how long? (paeds)
- permanent teeth usually
- 2 weeks flexible = most traumatic dental injuries
- 4 weeks flexible = associated alveolar bone fractures, apical/mid-1/3 root fractures
- 4 months rigid = cervical 1/3 root fractures