Paeds Flashcards
When is acyclovir prescribed for primary heretic gingivostomatitis?
Immunocompromised
Severe infection in the non-immunocompromised
What is primary hermetic gingivostomatitis and what are the symptoms?
Primary response to the herpes simplex virus
Sore mouth and throat, enlarged LNs
Also malaise and fever - systemic symptoms
Happens once or twice depending on type - commonly found in children
Lasts 7-10 days
What is the aciclovir prescription for primary herpetic gingivostomatitis?
200mg tablets or oral suspension (2000mg/5mg or 100mg/5ml)
25 tablets
1 tablet 5x daily
5x200mg for >2yo, 5x100mg for <2yo
What should be asked in a history for nursing bottle caries?
Pain history
Any analgesia and what - check within limits
Does the child have feeding bottle to bed
What is in the feeding bottle
What is the usual pattern for decay in nursing bottle caries?
Usually upper incisors, Ds and lower canines (lower incisors protected by tongue)
What advice should be given in nursing bottle caries?
Feeder cup replacing bottle from 6 months
No feeding at night (lactose in milk - decreased salivary flow and held in mouth)
No on-demand breastfeeding
No sweetened milk, soy milk (unless medically advised)
Milk and water only between mealtimes
Sugarfree variations of drinks/foods/medicines
Safe snacks include cheese, breadsticks, fruit
What toothbrushing instruction should be given to parents?
Assist the child until 7yo
Brush in the morning and last thing at night
No food/drink except water after brushing
Spit don’t rinse
What are the management options for nursing bottle caries?
Extraction of carious teeth under GA as in pain - discuss GA risks and benefits
GIC remaining teeth and review (acclimitisation)
Fluoride (supplements and varnish)
What questions should be asked in a PHG history?
No days symptoms
Does the child have a fever
Is child less active than normal
Analgesia used - did it work
What are the signs of PHG?
Lymphadenopathy
Malaise
Pyrexia
Erythematous gingivae
Ulceration
What are the symptoms of PHG?
Sore mouth and throat
Fever
Enlarged LNs
How can you explain PHG to pts?
Often has blisters on the tongue, cheeks, gums lips and roof of mouth
After the blisters pop ulcers will form
Other symptoms include high fever, difficulty swallowing, drooling and swelling
Because the sores make it difficult to eat and drink, dehydration can occur
Child may or may not develop cold sores in the future
How is PHG managed?
Fluid intake
Analgesia to control fever/pain
Bed rest, take it easy
Clean teeth with dam cotton roll or cotton cloth to rub around gums
Can use dilute CHX to swab gums
Only aciclovir if systemic infection or immunocompromised
When are Paeds radiographs taken?
Under 3 only for trauma, high CRA or delayed development
Bitewings high risk 6 monthly, low risk 12-18 monthly
What are the fluoride toothaste strengths?
1000 for up to 3 (smear)
1,450 4-16 years (pea)
2800 high risk 10+
5000 high risk 16+
What fluoride supplementation can be used for children?
Mouthwash 225pm children over 7
Fluoride varnish 3-4x yearly 22,600m
What should be covered under prevention advice?
Radiographs
Toothbrushing instruction
Strength of toothpaste
Fluoride supplementation
Dietary advice
Fissure sealants
Sugar free medicines
What are the non-accidental E/O signs of trauma?
Bruising of face
Bruising of ears
Abrasions and lacerations
Burns and bites
Neck - choke or cord marks
Eye injuries
Hair culling
Fractures - nose, mandible, zygoma
What are the I/O signs of non accidental trauma?
Contusions
Bruises
Abrasions and lacerations
Burns
Tooth trauma
Frenal injuries
What is in the index of suspicion for non-accidental trauma?
Delay in seeking help
Story vague, lacking in details, varying
Account not compatible with injury
Parents mode abnormal, preoccupied
Parents behaviour gives cause for concern
Child’s appearance and interaction with parents is abnormal
Child says something contradictory
History of previous injury
History of violence within the family
How should you take action against non-accidental trauma?
Provide any urgent dental tx
Tell parents - unless puts the child at risk
Explain concerns honestly - inform of intentions to refer, ‘these types of injuries have to be reported’
Seek parents consent to share info
Record incident and conversation
Refer to social services - be specific about reasons
Confirm referral acted upon
Arrange dental follow up
Be prepared for reporting in case of court
Always discuss with colleague
What are the causes of staining in children?
MIH
Fluorosis
Decal
Tetracycline
Trauma
Dentinogenesis/amelogenesis imperfecta
What are the tx options for staining?
Microabrasion
Vital external bleaching
Localised composite addition
Com/porcelain veneer
MCC - destructive
What are the pros and cons of microabrasion?
Easy to be done
Effective
Removal of tooth structure
Use of acid
What are the cons of vital external bleaching?
May not work
Gingival recession
Sensitivity
Will not bleach restorations
Release
Overbleaching
What are the risks of localised composite addition?
Adds bulk to the tooth
May not mask totally
What are the pros and cons of comp/porcelain veneers?
Good aesthetic
Tooth prep needed
Need to wait until 18 for stable gingival level
What are the causes of missing teeth?
Hypodontia
Trauma causing arrested tooth formation
Ectopic
Dilaceration
Supernumerary
What are the tx options for missing teeth?
RBB
Essix retainer
RPD
Implant if above 18
Ortho space closure
What is the procedure for removing a mucocele?
LA around site of swelling
Cut in gum
Removal in entirety
Sutures
What are the risks of mucocele removal?
Pain
Swelling
Bleeding
Bruising
Infection
Numbness
Sutures
What are the problems with hypodontia?
Space
Drifting
Overeruption
Aesthetics
Functional problems
When should children with hypodontia be referred to an orthodontist?
6-7 years or when further noticed
What are the tx options for hypodontia?
Nothing
Restorative only - composite, veneers, RBB, RPD
Ortho only
Restorative + ortho - space closure and reshape teeth to camouflage
What can you say to parents who are looking at making a complaint against a past dentist?
I cant comment as i dont know the full story
I can only offer this treatment at this present time
Whatever was offered previously will not change what tx is needed now
Only tell the practice will have a complaints procedure if the parent asks to complain
If will be unhelpful for me to be involved as i wasnt there and dont know the background or what treatment was and wasnt dont
I dont feel comfortable speculating on it
How do you carry out a knee to knee exam?
Introduce self and BDS5 student
Reassure parent
Explain what you intend to do
Sit across from parent with your knees touching theirs
Bring your knees together and ask parent to do the same
Ask parent to sit the child with their legs around the parents waist
Lower the child down into your knees and ask the parent to hold the child’s arms
What is included in a trauma stamp?
Mobility
Colour
TTP
Presence of a sinus
Percussion note
Radiograph
Ethyl chloride
Electric pulp test
What are the signs of subluxation?
TTP
Mobility
Bleeding from gum
No displacement
What is the tx for subluxation?
No tx needed
Can clean tooth with saline or CHX with gauze wipe due to age
What is the home care for subluxation?
Soft food for 1 week
Important to keep area clean and plaque free for good healing
OHI - brush with soft brush after every meal
CHX - 0.2% with cotton swab to area 2x daily for 1 week
What are the possible complications to the primary tooth after subluxation?
Pain
Swelling
Dark discolouration
Increased mobility
Delayed exfoliation
Infection
Child may not complain of pain - parent should watch for signs of swelling on gum however as infection may be present
What are the possible consequences of subluxation on the permanent tooth?
Premature or delayed eruption
Enamel hypoplasia/hypomineralisation
Crown/root dilaceration
Failure to erupt
Failure to form
Odontome formation
What is the follow up for subluxation?
1 week
6-8 weeks
What is involved in a caries risk assessment?
Clinical evidence
Diet
MH
SH
Saliva
Plaque control
Fluoride
What are the steps to placing a Hall crown?
Place separators between mesial and distal contacts
Floss 2 pieces through separator and pull tight down between contacts (not subgingival)
Leave for 2-7 days
Remove with blunt probe
Sit child upright
Place gauze to protect airway
Choose crown - aim to fit smallest size that will seat - should be springy
Dry crown and fill with GIC (Aquacem)
Dry tooth
Place crown and seat with finger pressure
Can seat by getting child to bite over gauze - second method
Remove excess cement with CWR
Get pt to bite for 2-3 minutes or finger pressure
Make sure all excess cement has been removed
Floss between contacts
Describe the process of consenting and referral for GA
Discussion of GA risks/benefits and all other alternative options
Referral to hospital for specialist to assess - if any other teeth of poor prognosis they will be added to plan to avoid future GA
GA will involve day in hospital - need to monitor for full recovery
Need of chaperone throughout
