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Module 7 Exam > Paeds > Flashcards

Paeds Flashcards

1
Q

What does IADT stand for?

A

International Association of Dental Traumatology (IADT)

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2
Q

Trauma: Relevant non-dental injuries to be aware of?

A

Head injuries
Overdose
Facial fractures
Facial lacerations

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3
Q

Why should splints be flexible and how is this achieved?

A

To avoid undue stress, and allow for functional tooth movement.

Wire of <0.4mm is used to achieve this.

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4
Q

Trauma sequelae: Yellow/brown

A

Pulpal obliteration (reparative dentine shining through)

X-ray shows pulpal narrowing

Associated w luxations

Sensibility test;
Vital = manage aesthetics
Non-vital = RCT
—> specialist referral

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5
Q

Trauma sequelae: Grey

A

Blood products from pulpal haemorrhage

Associated w luxations, avulsions, complicated crown fracture

Non-vital = RCT and aesthetics
…or XLA

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6
Q

Trauma sequelae: Pink area

A

Shine through of invading tissue, usually from external cervical root resorption (ECRR)

Soon = tooth revascularisation ?Monitor, frequently review, should reverse.

Later = suspect ECRR
Refer to specialist.

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7
Q

Root resorption types: Internal inflammatory resorption

A

Inflammation within the pulp is breaking down the dentine in the pulp.

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8
Q

How would you manage this sequelae?

A

This is internal inflammatory root resorption.

RCT and aesthetic management.

If root has perforated, bioactive root filling material may be used (MTA & Biodentine).

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9
Q

Root resorption types: Internal replacement resorption

A

internal inflammatory resorption —> get replaced with bone.

shows clinically and x-ray as IIR.

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10
Q

Root resorption types: External inflammatory resorption (EIR)

A

Damage to PDL and root surface stimulates this in trauma.

Vital tooth = reparative process and is self-limiting

Similar symptoms to periapical periodontitis.

X-ray notice root canal is still visible = EXTERNAL resorption process.

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11
Q

Root resorption types: External cervical resorption (ECR)

A

Osteoclastic cells from the adjacent periodontium are thought to invade the exposed root surface, via gaps in the cementum, and form a fibrovascular lesion (resorption phase), which may ultimately become calcified and develop into a fibro-osseous tissue (reparative phase).

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12
Q

Root resorption types: External surface resorption (ESR)

A

his is a non-infective, transient, pressure-induced resorption. This resorptive process will stop progressing once the source of the pressure has been removed, resulting in repair of the resorbed root-face with cementum.

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13
Q

Root resorption types: Transient apical breakdown

A

A non-infected transient resorption of the apical portion of the root and the adjacent bone.

Widening of the apical PDL = resolves within a year.

This phenomenon is essentially an external inflammatory resorption (EIR) with a short resorption phase followed by repair.

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14
Q

What are key features of a splint following trauma?

A

Passive, flexible and conform to the arch.

0.4mm stainless steel wire

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15
Q

Pulpal canal obliteration (PCO) occurs more frequently in teeth with…

A

open apices, and is indicative of viable tissue within the root canal.

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16
Q

Tx of fully developed teeth (mature teeth with closed apex) that have been intruded/extruded/laterally luxated. OR fractures (involving the root)

A

Treat endodontically EARLY.

Calcium hydroxide placed 1-2 weeks after trauma for up to 1 month —> then RC filling.

This is to avoid external inflammatory resorption (associated w infection).

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17
Q

Tx of incomplete developed teeth (immature teeth with open apex) that have been intruded/extruded/laterally luxated. OR fractures involving the root

A

Regular check ups —> pulp could revascularise!

Weigh this up with the chance of inflammatory root resorption (this will be rapid).

Combined injuries of poorer prognosis may be considered for earlier RCT.

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18
Q

Enamel-dentin fracture with pulp exposure

A

Complicated crown fracture

—> partial 2-3mm
—> coronal (whole coronal portion, reaching level of orifices)
—> extirpation (pulpEctomy)

Place non-setting calcium hydroxide cement.

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19
Q

Pulp capping

A

APEXOGENESIS

Vital pulp therapy
within 24 hours of the incident!

If over 24 hours then pulp is likely contaminated and pulpotomy is opted for.
(IMAGE SHOWS PULPOTOMY)

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20
Q

Non-vital immature permanent tooth tx

A

Mineral trioxide aggregate (MTA) plug of ~4-5mm then normal GP on top.

Sets in the presence of moisture.

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21
Q

Neglect

A

the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.

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22
Q

Safeguarding vs child protection

A

Safeguarding = preventative approach to child protection

Child protection = reactive approach to suspected or known cases of abuse or neglect

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23
Q

What percentage of child victims of physical abuse show signs in the head and neck region?

A

60%

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24
Q

Key areas of non-accidental injuries occurring

A
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25
Q

What legislation sets out a statutory statement of parental responsibilities and rights and clarifies the law on guardianship?

A

Children (Scotland) Act 1995

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26
Q

Gillick Competence

A

In Scotland, under-16s can consent to medical or dental treatment if a doctor believes they understand the procedure, it’s risks, and alternatives.

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27
Q

Consent in Scotland: mother

A

Automatically has parental responsibility from birth and therefore can give consent for her child’s dental plan and subsequent treatment.

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28
Q

Consent in Scotland: father

A

Has parental responsibility if he’s married to the mother when the child is concieved, or marries her at any point afterwards.

If his name is on the child’s birth certificate then this works too even if unmarried.

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29
Q

Consent in Scotland: Same-sex couples

A

Civil partners at the time of the child’s conception will both have parental responsibility.

Can GAIN parental responsibility by obtaining a parental agreement or become a civil partner.

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30
Q

Consent in Scotland: Adopted parents

A

Parental responsibility is automatically transferred to the adoptive parents.

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31
Q

Consent in Scotland: Divorced parent

A

A divorced parent does not always need to get the consent of the other divorced parent for routine decisions.

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32
Q

Consent in Scotland: Step-parents

A

Only have responsibility if obtained through a court order or legal guardianship.

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33
Q

Consent in Scotland: Grandparents

A

Only have parental responsibility if obtained through a court order.

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34
Q

Consent in Scotland: Social workers

A

If under a care order, the local authority may consent, but this is typically done by someone with legal responsibility, not the social worker.

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35
Q

ACE

A

Adverse Childhood Experiences

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36
Q

What is an adverse childhood experiences?

A

stressful events during childhood that can have a profound impact on an individual’s present and future health.

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37
Q

________ under 4 years old suffer from sever physical abuse

A

1 in 1000 children under 4 years old suffer from sever physical abuse

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38
Q

CYP

A

Children and Young People

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39
Q

What does the GDC state about the dental teams role in safeguarding and child protection?

A

The dental team have an ethical responsibility to find out about and follow local procedures involved in raising concerns about possible abuse and neglect of children.

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40
Q

What does child abuse encompass?

A

Physical
Emotional
Sexual
Neglect

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41
Q

What parenting factors should you look out for that might indicate a child is at a greater risk of abuse?

A

Substance abuse, mental health issues, suffering from domestic abuse.

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42
Q

Professional curiosity

A

Is a combination of looking; listening; asking direct questions; checking
out and reflecting on information received
• Is about exploring and understanding what is happening with a child,
young person and their family
• Is about enquiring deeper and using proactive questioning and
challenge
• Is about understanding one’s own professional responsibility and
knowing when to act, rather than making assumptions, or taking things
at face value

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43
Q

UNCRC Scotlands Act 2024

A

United Nations Convention on the Rights of the Child (UNCRC)

Sets out the civil, political, economic, social, and cultural rights that all children are entitled to.

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44
Q

National Guidance for Child Protection Scotland 2021

A

It sets out the responsibilities and expectations of everyone who works with children. This includes practitioners working in health, police, third sector, local authority or education settings.

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45
Q

GIRFEC

A

Getting it right for every child .

The aim is to help children and young people to grow up feeling loved, safe and respected so that they can realise their full potential.

Includes SHANARRI indicatiors of wellbeing.

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46
Q

SHANARRI indicators

A

Safe
Healthy
Achieving
Nurtured
Active
Respected
Responsible
Included

47
Q

Types of vulnerable children in dentistry (3)

A
  1. Under 5s
  2. Irregular attenders
  3. Medical problems and disabilities
48
Q

Looked after children (LAC)

A

Compulsory measures of care by local authority.

May still be at home but are receiving of care.

Respite care provides short-term relief for primary caregivers, giving them time to rest, travel, or spend time with other family and friends.

49
Q

Dental neglect

A

Persistent failure to meet a CYP’s basic oral health needs, likely to result in the serious impairment of their oral or general health or development.

50
Q

Why is the number of carious teeth not used as an indicator of severity of dental neglect?

A
  • Multi-factorial aetiology of dental caries
  • Variation in individual susceptibility
  • Inequalities in dental health (social class etc)
  • Inequalities in access to dental treatment
  • Difference in treatment philosophies

Attempting to see which parents aren’t looking after their children, caries might be an innocent mistake.

51
Q

What should you do if you are suspecting of dental neglect?

A
  1. Preventative dental team response —> raise concerns with parents, offer support, set targets and monitor progress.
  2. Multiagency approach —> contacting other professions who you know are involved with the family.
  3. Child protection referral
52
Q

What are you at risk of with four or more ACEs?

A

Heart disease, type 2 diabetes, mental illness, commit violence, in prison

53
Q

What is your RESPONSIBILITY as a dentist when suspecting neglect?

A

Observe
Record
Communicate
Refer for assessment
NOT diagnose

54
Q

It is illegal to _______ a child on the _______ in Scotland

A

It is illegal to hit a child on the head in Scotland.

55
Q

Referrals of concern may elicit three different outcome pathways (3)

A
  1. No progression of concern (other services may be necessary)
  2. Single agency response (further assessment)
  3. Inter-agency response (investigation —> action —> case conference)
56
Q

WNB1

A
57
Q

WNB2

A
58
Q

WNB3

A
59
Q

WNB4

A

Letter to the GP

60
Q

Who are your local contacts you should be aware of in a case of concern of a child?

A
  1. Paediatric consultant on call
  2. Lead person for child protection
  3. Social work including out of hours
  4. Police Public Protection Unit - Telephone 101
  5. Child protection advice line
61
Q

How many children in the UK are effected by MIH?

A

1 in 8

62
Q

Why might we decide to XLA a SOUND upper 6 if we’re choosing to XLA the opposing carious lower 6???

A

A compensating XLA

NOT RECOMMENDED unless there is a clear occlusal requirement or likelihood of upper 6 being unopposed for a significant period of time.

63
Q

Balancing extraction

A

Removal of a 6 from the opposite side of the same dental arch.

64
Q

What is the ideal window for extraction of compromised 6s?

A

When the 7 is developing (8-10 years) - X-ray shows bifurcation mineralised.

More critical to time the lowers.

Too late = already in place but mesial drift causes a tilting of the 7.

65
Q

Interceptive XLA of 6s: Why might orthodontists want to temporarily maintain maxillary poor prognosis FPMs if a patient has a class II div I incisor relationship?

A

To use that spacing in the future when repositioning the incisors.

66
Q

Enamel hypoplasia (hypoplastic) vs enamel hypomineralisation

A

Hypomineralisation = mineral deficit, occurring at the POST-secretory stage, FAST post-eruptive caries.

Hypoplasia = thickness deficit, occurring at the secretory stage, SLOW post-eruptive caries.

67
Q

Why is there such hypersensitivity in MIH vs hyperplasia?

A

As the enamel in MIH is POROUS, the dentine is more exposed, bacteria can penetrate through and this can cause sub-inflammatory reaction in the pulp tissue.

68
Q

Splint: root fracture apical/mid 1/3

A

4 weeks

69
Q

Splinting: concussion

A

No displacement; no splinting

70
Q

Splinting: subluxation

A

2 weeks

71
Q

Splinting: Luxation extrusive

A

2 weeks

72
Q

Splinting: Luxation intrusive

A

4 weeks

73
Q

Splinting: luxation lateral

A

4 weeks

74
Q

Splinting: Avulsion

A

2 weeks

75
Q

Splinting: Root fracture cervical 1/3

A

4 months

76
Q

Behavioural management techniques (11)

A

DEMENT VIC BS
o D – distraction
o E – enhanced control – signalling with hand etc
o M – modelling – older sibling, video of ideal etc.
o E – empathy
o N – non-verbal communication
o T – tell do show

o V – voice control
o I – information (preparatory)
o C – coping strategies

o B – behavioural shaping and positive reinforcement – use of stickers etc
o S – systematic desensitisation

77
Q

Fluoride varnish (Duraphat) F- ppm

A

22,600ppm (2.26%)

78
Q

Toxic fluoride dose is…

A

5mg per kg.

79
Q

If you suspected a fluoride overdose…?

A

Give milk, gather info, A&E.

80
Q

High risk of caries 10-16 yrs old fluoride dose?

A

2800ppm

81
Q

Simplified BPE for children

A
82
Q

IV sedation w midazolam age..

A

not for under 15yrs

83
Q

Eruption dates: U 1s

A

7-8 years old

84
Q

Eruption dates: L 1s

A

6

85
Q

Eruption dates: U 2s

A

8-9

86
Q

Eruption dates: L 2s

A

7-8

87
Q

Eruption dates: U 3s

A

11-12

88
Q

Eruption dates: L 3s

A

9-10

89
Q

Eruption dates U 4s

A

10-11yrs

90
Q

Eruption dates: L 4s

A

10-12

91
Q

Eruption dates: U 5s

A

10-12

92
Q

Eruption dates: L 5s

A

11-12

93
Q

Eruption dates: 6s

A

6

94
Q

Eruption dates: U 7s

A

12-13

95
Q

Eruption dates: L 7s

A

11-13

96
Q

Eruption dates: 8s

A

17-21

97
Q

Stepwise caries removal

A
  1. Access and remove superficial caries.
  2. Temporise
  3. 6-12 months later permanent.

Allows reactionary dentine to be laid down.

98
Q

Hall crown technique

A
  1. X-ray shows clear band of dentine between pulp and cavity.
  2. Separators placed
  3. Pt seen 3-5 days later for removal and fit.
  4. Attempt to size a preformed metal crown (feel spring back - don’t fully seat)
  5. Dry tooth and fill metal crown w glass-ionomer luting cement.
  6. SEAT crown - pushing and biting
  7. Remove excess cement, 2-3 mins of pressure for setting.
  8. Floss contacts.
99
Q

Tooth trauma splinting technique

A
  1. Bend wire (safety handle)
  2. Cut wire
  3. Etch prime and bond (two end teeth first!)
  4. Ensure happy w position
100
Q

What conditions are hypodontia associated with?

A

Ectodermal dysplasia (peg laterals may be seen)
Cleft/lip and palate
Downsyndrome

101
Q

What are the most commonly absent teeth seen in hypodontia?

A

upper 2s, 5s, 8s

102
Q

Types of supernumaries

A

Supplemental
Conical
Tuberculate
Odontome

103
Q

Mesiodens and paramolars

A

Location based classification;
Mesiodens - midline
Paramolars - molar region

104
Q

What genetic conditions are associated with supernumerary teeth?

A

Cleidocranial dysplasia, oral-facial-digitial, Gardner syndrome

105
Q

Microdontia and macrodontia

A

Anomalies effecting tooth size

Microdontia is associated with ED.

Macrodontia can be a result of either fusion of adjacent tooth-germs or an attempt at separation of a single tooth germ to form two separate teeth (gemination). —> Upper centrals most commonly effected.

106
Q

What dental treatment may cause tooth root shortening ?

A

Orthodontic tx

107
Q

Dens evaginatus vs invaginatus

A

enamel epithelium invagination into the dental papilla during development.

want to resin sealant these !!

108
Q

Resin fissure sealant application technique

A

Dry, etch, and sealant —> then cure.

No bond!

109
Q

Taurodontism

A

Taurus = “bull”

Failure of invagination of Hertwig’s root sheath.

110
Q
A

Autosomal dominant Amelogenesis imperfecta

— hypomineralisation and hypoplasia

all teeth are affected similarly

111
Q

Sedation: Inhalation

A

Nitrous oxide/oxygen

112
Q

Sedation: IV

A

Intravenous with Midazolam

113
Q

Sedation: for needle phobic patients who want Midazolam?

A

Oral and transmucosal sedation

Module 7 Exam (7 decks)

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