Paeds Flashcards
What is Primary Herpetic Gingivostomatitis?
What virus?
It is an acute infectious disease
Caused by herpes simplex 1
How is Primary Herpetic Gingivostomatitis transmitted?
Droplet formation with 7 day incubation period
What are the symptoms of Primary Herpetic Gingivostomatitis?
Fluid filled vesicles- rupture to painful ragged ulcers on the gingivae, tongue, lips, mucosa
Severe oedematous marginal gingivitis
Fever
Headache
Malaise
Painful- leads to child not eating/drinking, therefore dehydration
What is the treatment of Primary Herpetic Gingivostomatitis?
Bed rest
Soft diet/hydration
Paracetamol
Antimicrobial gel or M/W
Aciclovir for immunocompromised children
What is the recurrent disease of Primary Herpetic Gingivostomatitis?
% affected?
Herpes labialis (cold sores)
50-75%
Where does Primary Herpetic Gingivostomatitis lay dormant?
Epithelial cells
What are the different classifications of hard tissue paediatric traumas?
Enamel
Enamel-Dentine
Enamel-Dentine-Pulp Fracture
Crown-Root fracture
Root fracture
What are the soft tissue classifications of paediatric traumas?
Concussion
Subluxation
Lateral Luxation
Intrusion
Extrusion
Avulsion
Alveolar fracture
What is a concussion injury?
Tooth tender to touch but has not been displaced
What is a subluxation injury?
Tooth tender to touch, increased mobility but has not been displaced
What is a lateral luxation injury?
Tooth has been displaced usually in a palatal/lingual or labial direction
What is an intrusion injury?
Tooth is displaced in an upwards direction into the alveolar bone
What is an extrusion injury?
Partial displacement of the tooth out of its socket
What is an avulsion injury?
The tooth is completely out of the socket
What do you check in a tooth that has suffered trauma?
Mobility
Colour
TTP
Sinus
Percussion note
Radiograph
Sensibility testing
What to advise to parents for homecare after an injury?
Analgesia for pain
Soft diet for 10-14 days
Brush teeth with soft toothbrush after every meal
Topical chlorhexidine m/w applied topically twice daily for 1 week using cotton bud
What is the treatment for a lateral luxation injury?
Minimal/no occlusal interference- allow to reposition spontaneously
Severe displacement- XLA or reposition
What is the treatment for an intrusion injury?
Allow to spontaneously reposition, irrespective of direction
Can take up to 6 months
What is the treatment for an extrusion injury?
Not interfering with the occlusion- allow to spontaneously reposition
Excessive mobility or extruded >3mm- XLA
What are the consequences of dental trauma to the primary tooth?
Discolouration
Discolouration and infection
Delayed exfoliation
What are the consequences of dental trauma of primary teeth to the permanent tooth?
Enamel defects
Abnormal crown/root morphology
Delayed eruption
Ectopic tooth position
Complete failure of tooth to form
What are the 3 treatment options for enamel-dentine-pulp fractures of permanent teeth that are vital? And when would you perform each?
Pulp cap- less than 1mm of exposure and within 24hrs
Partial pulpotomy - more than 1mm exposure or 24+hrs since trauma
Full coronal pulpotomy
What is involved in a pulp cap?
Covering the exposed pulpal tissue with either CaOH, biodentine, MTA
What is involved in a partial pulpotomy?
LA and dental dam
Remove 2mm of pulp
Place saline soaked cotton wool pellet over exposure until haemostasis achieved. If cannot be achieved then progress to a full coronal pulpotomy
Apply CaOH over
Restore
What is involved in a full coronal pulpotomy?
Begins with partial pulpotomy
Assess for haemostasis after application of saline soaked cotton wool
If hyperaemic or necrotic - proceed to remove all of the coronal pulp
Place calcium hydroxide in pulp chamber
Restore
What is the aim of a pulpotomy?
To keep the pulp tissue vital within the canal to allow normal root growth (apexogensis) both in the length of the root and the thickness of the dentine
Follow up 6-8 weeks, 6 months and 12 months
What is the procedure for trauma occurring to immature permanent teeth that are non-vital?
Placing an apical stop such as MTA or biodentine at the apex
What is included in a caries risk assessment?
Fluoride
Saliva
Plaque control
Clinical evidence
Medical history
Social history
Diet
What is included in a prevention plan for higher risk caries patients?
OHI
Diet advice
Fluoride toothpaste
FV
FS
Radiographs
Sugar free meds
What are the indications for using SDF?
Non-restorable dentine lesions
MIH-reduces sensitivity
Pre-cooperative
Delay sedation/GA
Asymptomatic cavitated lesions in primary teeth
What are the contraindications of SDF?
Allergy to silver or other heavy metals
Painful gums or mouth ulceration present
Lesions that involve the pulp
PA pathology
What are the disadvantages of SDF?
Permanent discolouration
Temporarily stains the soft tissues for 1-3 weeks
Discolours composite
Permanent discolouration of clothes if any spillages
What are the effects of SDF?
Blockage of dentine tubules- arrests lesions and desensitises
Bacterial death
Inhibition of collagen degradation
How many times a year is fluoride varnish applied?
Low risk- 2x a year
High risk- 4x a year
How does FV work?
Works via sustained contact- resin hardens allowing F to be in contact with tooth
What is FV used for?
Preventative treatment used for high risk caries
Treating hypersensitivity
What are the contraindications for applying FV?
Allergies- colophony (elastoplast)
Ulcerative gingivitis
Severe asthma (hospitalised in last 6 months)
What is the aftercare advice after applying FV?
Avoid eating or drinking for at least an hour
Eat soft food all day
Avoid brushing that night only- brush as normal from next morning
What is the advice for an avulsion injury?
ONLY FOR PERMANENT TEETH
Hold tooth by the crown not the roots
Rinse under water for 10 seconds
Replace in socket - get child to bite onto tissue
If not replaced into the socket- store in milk, saliva or saline
Seek immediate dental advice
In teeth with a closed apex, what would you do for an avulsion injury?
Clean area
Verify tooth is in correct position
Splint teeth for 2 weeks
Suture any gingival lacerations
Initiate RCT within 2 weeks
What is the follow up for an avulsion injury for a tooth with a closed apex?
2 weeks
4 weeks
3 months
6 months and 1 year
Annually for at least 5 years
What is the treatment for teeth with an open apex that have been avulsed?
Only intervene if revascularisation has not occurred (signs of necrosis and infection) then apexification, pulpotomy, RCT
What are the outcomes in avulsion injuries?
Pulpal- regeneration (open apices), uncontrolled infection, necrosis
Perio- regeneration, PDL/cementum healing, ankylosis, infection
Root resorption
Discolouration
Mobility
What is the follow up for an avulsion injury of a tooth with an open apex?
2 weeks
1 month
2months
3months
6 months and 1 year
Annually for 5 years
What is the prognosis of avulsion injuries in teeth with open and closed apices?
Open apex 30% pulp survival over 5 years
0% closed apex
What does the prognosis of traumatised teeth depend on?
Stage of root development
Type of injury
If PDL is damaged
Infection
Time between injury and treatment
What different types of healing follow root fractures?
Calcified tissue healing
Connective tissue healing
Calcified and connective
Osseous healing
Non-healing granulation tissue
What is the treatment for fluorosis?
Microabrasion
Composite veneer
Spot bonding composite
What are the signs and symptoms of F overdose?
Nausea
Vomiting
Abdominal pain
Excess salivation
Altered taste
Tremors
Convulsions
Shallow respirations
Nervous system shock
What are the indications for a SSC?
> 2surface lesions
Pulpotomy
Developmental defects
High caries rate
Impaired OH
Space maintainer
Excess tooth surface loss
Explain the steps in the Hall crown technique?
No LA or tooth prep
Ortho spacer placed for 3-5 days
Size crown
Aim for subgingival fit
Seal with GIC
Get patient to bite down on crown for 2-3 minutes
Remove excess and floss contacts
POI- reassure about tight fit, will get used to feeling, occlusion tends to settle in a few weeks
What are the indications for planned removal of 6’s?
Bifurcation of the 7’s forming radiographically
8’s present
Class I occlusion
Reduced overbite
moderate lower crowding
Mild to moderate upper crowding
What are the effects of primary tooth trauma on primary teeth?
Discolouration
Infection
Delayed exfoliation
What are the effects of primary tooth trauma on permanent teeth?
Enamel defects
Delayed eruption
Dilaceration
Duplication
Ectopic teeth
Arrested development
What are the behaviour management techniques for dealing with paediatric patients?
Tell show do
Acclimatisation
Role modelling
Desensitisation
Distraction
Relaxation
Hypnosis
Positive reinforcement
What are the risks involved with GA?
Death 1 in 100,000
Brain damage
Headache
Pain
Nausea/vomiting
Sore throat
Drowsiness
Bleeding nose
What are the stages for managing abuse as a dental professional?
Preventative dental team management
-Raise concerns with parents, offer support
Preventative multi-agency management
-Liaise with other professionals
-Write letter to health visitor
Child protection referral- in writing and by phone
What are the causes of staining?
Fluorosis
MIH
Amelogenesis imperfecta
Dentinogenesis imperfecta
Tetracyline
Trauma
How is microabrasion carried out?
Clean teeth with pumice and water
Vaseline on soft tissues
Place rubber dam
Place sodium bicarbonate guard on gingivae
Remove enamel with HCL/pumice slurry with slow speed rubber cup- max 10 x 5 second applications)
Apply FV
Polish
Tell patient to avoid anything highly coloured for 24 hours
What are the steps involved in ICON placement?
Rinse and clean teeth
Apply icon-etch-rub in
Apply icon-dry
Do second etch and repeat with icon-dry
White lesions masked and accesible- apply icon-infiltrate
Remove excess and light cure
Do second infiltration
Polish
