Paeds Flashcards
what is MIH
Hypomineralisation of systemic origin of 1-4 permanent molars, frequently associated with affected incisors
- enamel isn’t formed properly and not right colour
prevalence of MIH
10-20%
what is hypo mineralised
- disturbance of enamel formation resulting in a reduced mineral content
- may struggle to bond things
what is hypoplastic
- reduced bulk or thickness of enamel
- may be
- true - enamel never formed - secretory phase hasnt worked but mineral content normal
- aquired - post eruptive loss of enamel bulk
findings in MIH
- increase in neural density in pulp horn and subodontoblastic regions
- increase in immune cell accumulation
- increased sensitivity
pain mechanisms in MIH
- dentine hypersensitivity - porous enamel of exposed dentine facilitates fluid flow within dentine tubules to activate As nerve fibres (hydrodynamic theory)
- peripheral sensitisation - underlying pulpal inflammation leads to sensitisation of C-fibres
- central sensitisation - from continued nociceptive input
MIH aetiology
- unclear
- ask about prenatal, natal and post natal period
pre natal MIH causes
their general health in 3rd trimester eg. pre-eclampsia, gestational diabetes
natal MIH causes
- birth trauma
- pre term birth
- lack of oxygen during birth
- forceps during delivery
post natal MIH causes
- prolonged breast feeding
- dioxins in breast milk
- fever and medication
- socioeconomic status
- rural vs urban
childhood infections which could cause MIH
- measles , rubella, chicken pox
Tx options for MIH molars
- restorations
- stainless steel crowns
- adhesive retained copings
-extractions
Tx options for MIH incisors
- acid pumic microabrasion
- resin infiltration
- external bleaching
- localised composite placement
- combination of above
- full composite veneers
- full porcelain veneers
characteristics of primary dentition
- incisors upright
- incisors are spaced
- teeth are smaller
- reduced overjet
- more white in colour
max dose LA children
Lignocaine max dose is 4.4mg/kg (a 10th of a cartridge per Kg). A 2.2ml cartridge of 2% lignocaine has 44mg of active agent
prilocaine 3% (with felypressin) max dose is 6mg/kg. (just less than a 10th of cartridfe per kg). A 2.2ml cartridge has 66mg
what is hall technique
- no need for LA or prep
-child co-op
-separators - GI to cement
-sealing caries in primary molars
some common problems with paeds crowns
- rocking - cervical margin >1mm beyond curvature
-canting - uneven occlusal reduction
-loss of space
disadvantages of unplanned primary molar extractions
- loss of space causing increased risk of malocclusion
- if E is extracted can be mesial drift of FPM resulting in space loss
- decreased masticatory function
- impeded speech development
- psychological disturbance
- trauma from anaesthesia/surgery
indications for pads pulp treatment
- good co-operation
- medical history precludes extraction
- missing permanent successor
- over-riding necessity to preserve the tooth
- eg. space maintainer
- child under 9 years old
contra-indications for pulp tx child
- poor co-operation
- poor dental attendance
- cardiac defect
- multiple grossly carious teeth - more than 3
- advanced root resorption
- severe/recurrent pain or infection
what is a pulpotomy
- removal of coronal pulp and maintain radicular pulp
evaluate bleeding after
- normal bleeding = healthy
-abnormal bleeding = pulp inflammation
- restore with ZOE/caOH, then GIC then crown
what is pulpectomy
- remove radicular pulp and clean root canal system
-obtuarate with material that will resorb at same rate as primary tooth and eliminated rapidly if extruded through pulp
how to see failure of pulpotomy/pulpectomy
- clinical failure (clinical review 6 monthly)
- pathological mobility
- fistula/chronic sinus
- pain
- radiographic failure (radiograph 12-18 monthly)
- increased radiolucency
- external/interal resorption
- furcation bone loss
what does survival of pulp depend on
- associated periodontal ligament injury
- extent of exposed dentine
- age of the patient (open verses closed apex)
what is a FS
- a protective coating to seal fissures and pits
- aim to prevent dental caries or prevent caries progression
- usually bis GMA resin
what are indications for GI FS
- where good moisture control cannot be achieved
- partially erupted molars
- pre-cooperative
- where there is a high degree of tooth sensitivity due to developmental or hereditary enamel defects
- useful as release fluoride but are poorly retained and need regular reapplication
how to diagnose stained fissure
- visual (dry tooth)
- probe/explorer
- bitewing radiographs
- electronic
- fibre optic transillumination
- CO2 laser
- air abrasion
treatment of stained fissure
- if caries dont enter dentine provide fissure sealant and monitor
- if diagnosis inconclusive it is prudent to clean stained fissure with small slow speed
- if diagnostics show it is carious into dentine - restorative treatment needed
- if lesion remains small a preventative resin restoration or sealant restoration can be given - small amount of composite then sealed with fissure sealant on top
- if large then conventional composite restoration needed
appropriate time to remove FPM
- bifurcation of the lower 7 is seen to be forming on an OPT (typially around 8.5-10 years of age)
- 5’s and 8’s are all present and in good position in the OPT
- mild buccal segment crowding
- class I incisor relationship
Calcification of crowns at birth (rough approximation)
1/2 of central incisors
1/3 of lat incisors
Tip of primary canines
1/2 of First primary molars
1/3 of second primary molars
Tips of cusps of FPM
When do teeth start to form
Week 5 intra uterine life
Possible theories behind tooth eruption
- cellular proliferation at apex of tooth
-localised change in BP/hydrostatic pressure
-metabolic activity within PDL
-resorption of overlying hard tissue
-follicle plays role in active tooth eruption
Order of eruption
Lower teeth first
ABDCE
Dates of primary tooth eruption
Central (4-6 months)
Lat incisors (7-16)
1st molar (13-19)
Canine (16-22)
2nd molar (15-33)
When is primary dentition usually complete
2-3 years
Difference between primary and permanent crowns
- smaller in crown and root (primary)
-primary molars wider mesiodistally and more bulbous
Primary teeth usually whiter
What is present on 1st molars (anatomically )
Prominent mesiobuccal tubercle
Different between primary and permanent roots
Primary roots - narrower
Roots are longer and more slender
Tend to flare apically
Difference between primary and permanent pulps
Pulp chambers of primary teeth are larger
Pulp horns extend high occlusally
Difference in primary and permanent hard tissue
Thickness of coronal dentine much thinner than permanent teeth
Enamel is thin
What is primate spacing
- spacing medial to upper deciduous canine
-spacing distal to lower deciduous canine
What is leeway space
Extra mesio-distal space occupied by primary molars
1.5mm on upper
2.5mm lower
When does mixed dentition phase begin
Begins from first permanent tooth erupts until exfoliation of last primary tooth
6-11
Eruption sequence of upper arch permanent
6, 1,2,4,5,3,78
Lower arch permanent eruption sequence
1,2,3,4,5,6,7,8
Ages for permanent eruption dates
6s - 6
1 - 6-7
2- 7-8
3 - 9 lower 11 upper
4- 10
5 - 10
7 - 12
What is ugly duckling phase
Transient spacing of upper 1 due to close proximity of their roots to the erupting 2s and 3s
How long does it take for completion of root formation
From date of eruption 3 years for permanent tooth root to complete apex genesis
