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)