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paeds > paeds 2nd year > Flashcards

paeds 2nd year Flashcards

1
Q

early problems

A

gingival cysts
congenital epulis
natal tooth
eruption cysts

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2
Q

when would you extract a natal tooth?

A
  • if mobile - inhalation risk
  • feeding problem
  • trauma (ulcer)
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3
Q

when would you treat a congenital epulis?

A
  • causing feeding problems
  • respiratory problem
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4
Q

what happens to a congenital epulis as you age?

A

shrinks

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5
Q

what should be done for gingival and eruption cysts?

A

keep eye

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6
Q

when do teeth start to form?

A

week 5 IUL

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7
Q

when does hard tissue formation start?

A

week 13 IUL

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8
Q

what do systemic disturbances during calcification cause?

A

defects in Enamel which was forming

- birth - 2nd molars

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9
Q

approximate calcification of crowns at birth

A 
1/2 central incisors
1/3 lateral incisors
tip of canines
1/2 1st molars
1/3 2nd molars
tip of cusps of FPM
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10
Q

multifactorial theories of eruption process

A

cellular proliferation at apex
localised change in bp/hydrostatic pressure
metabolic activity within PDL
resorption of overlying hard tissue

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11
Q

resorption of overlying hard tissue

A

due to enzymes in dental follicle - dark halo on radiograph
need remodelling of bone/ primary tooth tissue for eruption

BUT not necessary for tooth to erupt to cause resorption of bone

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12
Q

what happens when the dental follicle is activatedin eruption?

A

initiate OC activity in alveolar bone ahead of tooth
once crestal bone breached - follicle likely to play lesser role
- into supra-alveolar phase

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13
Q

theories about tooth pushing into mouth that have been discounted as major factors?

A

root elongation
PDL
local changes in vascular pressure

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14
Q

bone growth at where is essential for eruption?

A

at base of crypt (socket)

- but could be reactive to tooth movement

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15
Q

when does eruption stop?

A

when tooth contacts something - usually opposing arch

throughout life - compensate for vertical growth of jaws and tooth wear

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16
Q

primary dentition - lower/upper eruption

A

generally lowers before uppers except lateral incisors

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17
Q

what may variation in primary dentition eruption be due to?

A

genetic?

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18
Q

when do contralateral teeth usually erupt in primary dentition?

A

within 3m of each other

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19
Q

at what age is the primary dentition usually complete?

A

2.5-3years

very variable - some normal children have no teeth at 1

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20
Q

primary dentition - lower a

A

6m

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21
Q

primary dentition - lower b

A

12m

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22
Q

primary dentition - lower c

A

16m

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23
Q

primary dentition - lower d

A

13m

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24
Q

primary dentition - lower e

A

24m

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25
Q

primary dentition - upper a

A

8m

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26
Q

primary dentition - upper b

A

9m

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27
Q

primary dentition - upper c

A

17m

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28
Q

primary dentition - upper d

A

14m

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29
Q

primary dentition - upper e

A

25m

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30
Q

order of eruption primary dentition

A

A B D C E

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31
Q

primary dentition - how is permanent teeth fitting into the arch?

A

anterior spacing so no crowding in permanent
anthropoid/primate spacing
leeway space
facial growth
proclined path of eruption of permanent incisors - increases AP arch length so more space

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32
Q

primate/anthropoid spacing

A
  • mesial to U 3
  • distal to L 3
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33
Q

leeway space

A

extra MD space occupied by the primary molars and canine which are wider than the premolars and canine which will replace them

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34
Q

leeway space U arch

A

1.5mm per side

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35
Q

leeway space L arch

A

2.5mm per side

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36
Q

how does the facial skeleton grow?

A

downwards and forward

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37
Q

when does the mixed dentition stage begin and end?

A

when 1st permanent tooth erupts until exfoliation of last primary tooth

usually 6-11/12/13 years
FPM - exfoliation of U3

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38
Q

permanent dentition - order of eruption U arch

A

1st molars then front to back except canines

6 1 2 4 5 3 7 8

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39
Q

permanent dentition - order of eruption L arch

A

1st molars then front to back

6 1 2 3 4 5 7 8

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40
Q

permanent dentition - L/U eruption

A

generally L before U except 2nd premolars

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41
Q

where do permanent incisors develop?

A

palatal to primary

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42
Q

permanent dentition - L1

A

6yrs

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43
Q

permanent dentition - L2

A

7yrs

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44
Q

permanent dentition - L3

A

9yrs

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45
Q

permanent dentition - L4

A

10yrs

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46
Q

permanent dentition - L5

A

11yrs

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47
Q

permanent dentition - L6

A

6yrs

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48
Q

permanent dentition - L7

A

12yrs

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49
Q

permanent dentition - U1

A

7yrs

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50
Q

permanent dentition - U2

A

8yrs

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51
Q

permanent dentition - U3

A

11yrs

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52
Q

permanent dentition - U4

A

10yrs

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53
Q

permanent dentition - U5

A

11yrs

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54
Q

permanent dentition - U6

A

6yrs

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55
Q

permanent dentition - U7

A

12yrs

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56
Q

ugly duckling phase

A

transient spacing U1s due to

  • close proximity of roots to erutping 2s, 3s
  • self correct when canine erupts
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57
Q

primary incisor root

A

may bend towards distal

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58
Q

what do primary incisor edges often show?

A

considerable wear

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59
Q

primary canines morphology

A

proportionately larger m-d - bulbous

mesial edge straighter

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60
Q

primary U first molar

A 
irregularly quadrilateral
narrower lingually than buccally
MD groove
3 roots
MB tubercle
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61
Q

primary U second molar morphology

A 
transverse ridge - MP to DB
3 roots
2 distinct fissures - mesial c, distal straight
largest cusp usually MB
similar to U FPM
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62
Q

primary lower 1st molar

A 
rectangular, broad m-d
MB tubercle
4 cusps
2 roots
buccal steeply lingually inclined
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63
Q

primary lower 2nd molar

A

similar to L FPM
3 buccal cusps - largest usually mesial
2 roots

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64
Q

primary incisor crowns

A

smaller and plumper
E in cervical region bulbous
distal edge of crown flares a bit more
Ls smaller

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65
Q

MIH definition

A

hypo mineralisation of systemic origin of 1-4 permanent molars, frequently associated with affected incisors

if on other teeth not MIH

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66
Q

MIH appearance

A 
'cheesy molars'
patches/whole tooth
incisors v well demarcated
 - white/yellow/brown
 - not symmetrical
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67
Q

MIH prevalence

A

10-20%

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68
Q

MIH most commonly affected teeth

A

4 molars

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69
Q

MIH tx need

A

10x more tx
fear and anxiety more common
behavioural management problems more common

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70
Q

hypomineralisation

A

Qualitatative enamel defect.
Reduced mineral content

  • problem with amelogenesis
  • secretory phase fine, maturation phase problem
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71
Q

bonding to hypo mineralised teeth

A

may be harder to bond to

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72
Q

hypoplasia

A

Quantitative defect : reduced bulk/thickness of E
amorphous
- secretory phase of amelogenesis affected

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73
Q

true hypoplasia

A

E never formed

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74
Q

acquired hypoplasia

A

post-eruptive loss of E bulk

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75
Q

bonding to hypoplastic teeth

A

should bond properly

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76
Q

why is it hard to determine the aetiology of MIH?

A

unclear diagnostic criteria
most parents can’t remember details from 8-10years before
variations in quality and completeness of case records
study pops small

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77
Q

critical period for MIH formation

A

generally agreed 1st year of life - developmental condition not hereditary
E matrix of crown of FPMs is complete by one

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78
Q

is MIH hereditary or developmental?

A

developmental

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79
Q

MIH 3 clinical periods of enquiry

A

pre-natal
perinatal
post-natal

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80
Q

MIH prenatal enquiry

A

health in 3rd trimester

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81
Q

MIH perinatal enquiry

A

birth trauma/anoxia
hypocalcaemia
pre-term birth (higher prevalence)

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82
Q

MIH post-natal enquiry

A 
prolonged breastfeeding (past 6m)
dioxins in breast milk
fever and meds (infections - measles, rubella, chicken pox)
SE status
rural v urban
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83
Q

yellow brown MIH teeth histology

A

more porous - whole enamel layer

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84
Q

white/cream MIH teeth histology

A

inner parts of E affected

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85
Q

how does MIH histology explain why sensitivity/difficult to anaesthetise?

A

increase in neural density in pulp horn and subodontoblastic region
lots more innervation

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86
Q

MIH histology and immune cells

A

increase in immune cells, esp with post-eruptive E loss

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87
Q

MIH histology vascularity

A

increase in vascularity in sensitive MIH samples

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88
Q

MIH 3 pain mechanism theories

A

dentine hypersensitivity
peripheral sensitisation
central sensitisation

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89
Q

MIH pain mechanisms - dentine hypersensitivity

A

porous E/exposed D facilitates fluid flow within dentinal tubules to activate A delta nerve fibres (hydrodynamic theory)

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90
Q

MIH pain mechanisms - peripheral sensitisation

A

underlying pulpal inflammation leads to sensitisation of C fibres

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91
Q

MIH pain mechanisms - central sensitisation

A

from continued nociceptive input?

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92
Q

MIH clinical problems

A 
loss of tooth substance
 - breakdown of E
 - toothwear faster
 - secondary caries (poor resistance)
sensitivity
 - not all
 - some - can cause OH problem as may be too painful to brush
appearance
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93
Q

MIH tx options for FPMs

A

composite/GIC Rx
SSCs - much harder on FPM
adhesively retained copings - gold best
extraction around 8.5-9.5yrs

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94
Q

MIH tx of affected incisors

A 
acid pumice microabrasion
 - removes yellow/brown marks
external bleaching
 - makes rest of tooth whiter so less of a contrast
localised composite placement
 - camouflage
full composite veneers
full porcelain veneers >20yrs
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95
Q

considerations for extracting HFPMs

A

dental age - radiograph
skeletal pattern
future ortho needs
quality of teeth e.g. caries

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96
Q

what is ideal to see when timing ext of HFPMs?

A

calcification of bifurcation of L7s
before L7 erupts starts to drift forwards
like to see developing 8s - not always possible

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97
Q

what do you often ext at the same time as HFPMs?

A

U at same time (not necessarily now) according to RCS 2023 guidelines

98
Q

if ortho and crowded dentition when would you ext HFPMs?

A

keep 6s until 7s erupt - keep space in a crowded dentition to avoid ext of good premolars

99
Q

jaw relationship at birth

A
  • gum pads widely separated anteriorly (U &L)
  • Gum pad contact posteriorly
  • tongue resting on L gum pad and in contact with L lip
  • AOB
100
Q

characteristics of primary dentition

A

incisors spaced and upright
teeth smaller
reduced overjet
whiter

101
Q

psychology of child development

A 
motor
cognitive
perceptual 
language
social
102
Q

why is it suggested that motor development may be genetically programmed?

A

predictability of early “motor milestones”

103
Q

when is motor development completed?

A

in infancy

changes following ability to walk are refinements

104
Q

two aspects of motor development - eye-hand coordination and walking

A

walking 9-15m but variations

eye-hand coordination gradually becomes more precise and elaborate with increasing experience

105
Q

stages of cognitive development

A

sensorimotor
preoperational thought
concrete operations
formal operations

106
Q

sensorimotor

A

until about 2yrs

object permanence

107
Q

preoperational thought

A 
2-7yrs
predict outcomes of behaviour
egocentric
facilitated by language development
unable to understand why areas and vols remain unchanged even though shape and position may change
108
Q

concrete operations

A

7-11yrs
logic
see others perspective
still difficult to think in an abstract manner

109
Q

formal operations

A

11 years +

logical abstract thinking

110
Q

perceptual development

A

most research looks at eye movement
compared to adult a 6yr old will cover less of an object, take in less info and become fixated on details
selective attention by 7yrs

111
Q

what is needed for language development?

A

stimulation

112
Q

language - 1 yr old

A

understands 20 words, simple phrases, relates objects to words
uses 2-3 words, repetitive babble, tuneful jargon
sounds: b, d, m

113
Q

language - 2yr old

A

understands: simple commands, questions, joins in action songs
uses 100 words, puts 2 words together, echolalia
sounds: p, t, k, g, m

114
Q

language - 3yr old

A

understands prepositions (on, under), fcts of objects, simple conversations
uses 4 word sentences, what/who/where, relates experiences
sounds: f, s, l

115
Q

language - 4yr old

A

understands: colours, numbers, tenses, complex instructions
uses long grammatical sentences, relates stories
sounds: v, z, ch, j

116
Q

feeding skills - pre 40 wks gestation

A

28wks - non-nutritive sucking

34wks - nutritive sucking

117
Q

feeding skills - 0-3m

A

rhythmical sucking
primitive reflexes
semi-reclined feeding position
liquid diet

118
Q

feeding skills 4-6m

A 
head control
more control of suck/swallow
munching
move towards semi-solid diet
starts babbling
119
Q

feeding skills 7-9m

A 
sitting feeding position
mashed
finger food
U lip involvement
chewing and bolus formation
bite reflex
120
Q

feeding skills 10-12m

A 
lumpy food
sustained bite
active lip closure
chewing - lateralisation
cup drinking
121
Q

feeding skills 24m

A

mature and integrated feeding pattern

122
Q

cleft type speech

A

resonance
articulation
nasal emission

123
Q

velopharyngeal incompetence

A

Soft palate doesn’t close tightly against back wall of throat during speech. Causes air to escape through nose

124
Q

bad effects of the family unit

A 
-enhance child's anxiety

behaviour contagion
improper preparation
discuss tx in hearing of child
threatening child with dental tx
125
Q

knee to knee

A

infants
Age under 3

parents can hold arms and legs

126
Q

3 aspects of behaviour management

A

communication
education
interaction

127
Q

components of communication

A

verbal 5%
paralinguistic 30%
non-verbal 65%

128
Q

language alternatives - cotton wool rolls

A

tooth pillows

129
Q

language alternatives - topical

A

bubblegum/minty gel

130
Q

language alternatives - probe

A

pointer/tooth counter

131
Q

language alternatives - excavator

A

tooth spoon

132
Q

language alternatives - HS

A

tooth shower

133
Q

language alternatives - SS

A

“mr bumpy”

tooth scrubber

134
Q

language alternatives - LA

A

special spray, sleepy juice

135
Q

What paralinguistic has to do with

A

tone

136
Q

2 reason to exclusion of parents from surgery

A

Competing with dentist for child’s attention
Convey own anxieties to their child( body language and words)

137
Q

anxiety in children

A

more irrational and less restrained than adults
wide variation
may be largely genetically determined

138
Q

anxiety influencing factors

A 
psychological make up
understanding
emotional development
prev experience
attitude of family/friends
behaviour of dentist
139
Q

role of dentist in reducing anxiety

A

prevent pain
friendly
establish trust
work quickly
calm
give moral support
be reassuring about pain
empathy
stop signals
Q for feeling

140
Q

what are anxious more likely to report?

A

pain

141
Q

Pros of good communication

A

improves info obtained from pt
enables dentist to communicate info to pt
increases likelihood of pt compliance
reduces pt anxiety

142
Q

increasing fear related behaviours

A 
ignoring or denying feelings
inappropriate reassurance
coercing/coaxing
humiliating
losing patience with pt
143
Q

aims of paediatric dentistry

A
  • reach adulthood with intact permanent dentition,
  • no active caries,
  • few Rxs as possible,
  • positive attitude to future care
144
Q

operative differences (Paeds and adults)

A 
developmental maturity/behaviour
constant change
developing dentition
access (small mouths)
tooth size and shape
preventive care
choice of Rx
145
Q

sequence of tx planning

A 
prevention
FS
preventive Rxs
simple fillings e.g. shallow cervical cavities
fillings needing LA but not into pulp
pulpotomies - U arch first
146
Q

factors that influence how caries is managed

A 
age
cooperation of child
extent of caries
tooth type
dental attendance
147
Q

what cavities may not require LA?

A

minimal

e.g. hand excavation/limited caries removal with SS

148
Q

lignocaine max dose

A

4.4mg/kg

149
Q

prilocaine max dose

A

6mg/kg

150
Q

preparing an occlusal cavity

A

around 1.5mm depth
preserve transverse ridge
maintain MR
straight walls - hold bur at right angle

151
Q

Primary lower molars occlusal fissure shape

A

S

152
Q

upper second molars occlusal cavity shape

A

D - straight

M - kidney bean

153
Q

interproximal cavity prep

A

isthmus 1/2-1/3 width of occlusal surface
axial wall follow contour of tooth
rounded line angles
occlusal extension should be shallower (pulp)

154
Q

box prep

A 
axial wall follows contour of tooth
rounded Line angles
no occlusal extension
SS rosebud to remove carious D
occlusal section no wider than width of bur
155
Q

material and whether LA depends on

A

caries extent
longevity of tooth
cooperation of child

156
Q

most successful material

A

PMCs

157
Q

longevity of Rx in primary molars

A

age (younger less cooperation)
type of tooth (1st molars small, Rxs don’t last as long)
type of cavity - surfaces involved
- occ last longer than IP

158
Q

fissure sealants

A

protective plastic coating used to seal pits and fissures to prevent food and bacteria getting caught in them and causing decay
- Bis GMA resin

159
Q

why are fissures vulnerable to caries?

A

less protected by F than IP or smooth surfaces

can’t clean base of fissures with a toothbrush - bristle won’t fit

160
Q

FS materials

A

bis-GMA resin (after acid etch)

GIC

161
Q

FS indications

A

high caries risk
medically compromised
learning difficulties
physical/mental disability

162
Q

FS tooth selection

A

greatest benefit on occlusal surfaces of permanent molar teeth
should also seal cingulum pits of U incisors, buccal pits of L molars, palatal pits of U molars
may seal primary molars in high risk

163
Q

resin FS placement procedure isolation options

A

single tooth dental dam

dry guards and cotton wool

164
Q

resin FS placement procedure

A

clean occlusal surface pumice and water
35% phosphoric acid etch
wash and dry
check chalky/frosted
resin to fissure pattern -brush/microbrush/excavator
remove excess with dry micro brush
spidery not swimming pools
light cure
Check with probe

165
Q

what happens to any etched surface not eventually covered with sealant?

A

will remineralise within 24hrs

166
Q

FS checks

A

firmly adhered - use probe
no air blows
no material flowed IP - remove with sharp probe and floss
check no excess distal to tooth in STs

167
Q

FS reviewing

A 
clinically every 4-6m
radiographically as per CRA
 - check no shadowing underneath
 - high risk every 6m
 - low risk every 12-18m
168
Q

indications for GI FS

A

where good moisture control can’t be achieved
- high risk children with PE molars
- special needs children
- poorly cooperating children
where high sensitivity - developmental or hereditary E defects
- drying tooth can be extremely painful

169
Q

pros and cons of GI FS

A

F release
poorly retained, require regular reapplication
- not as durable as composite - wears down over time

170
Q

GI FS placement

A

attempt to dry tooth with air/CW
apply GI from applicator
smooth into fissures using a gloved finger
keep finger over GI until set or place Vaseline to reduce moisture contamination

171
Q

stained fissure

A

a fissure that is discoloured, brown or black
also includes fissures where area of white/opaque E i.e. normal translucency lost but no evidence of surface breakdown/cavitation

172
Q

diagnosis of a stained fissure

A 
visual (dry tooth)
probe
BWs
electronic
FOTI -Fiber-optic transillumination
CO2 laser
air abrasion

grater accuracy when 2-3 methods used together

173
Q

stained fissure - investigation possible outcomes

A

1 - caries doesn’t enter dentine
2 - inconclusive
3 - into dentine

174
Q

tx of stained fissure where caries doesn’t enter dentine

A

FS and monitor

175
Q

tx of stained fissure where inconclusive

A

clean stained fissure with small SS bur - if only hard material encountered then FS

176
Q

tx of stained fissure where into dentine

A

Rx tx
small PRR or SR - where defect filled with small amount of composite then sealed over the top with a FS
large - conventional composite (/amalgam)

177
Q

caries in FPMs tx planning

A

maximise prevention
always prioritise FPMs in any mixed dentition tx plan
pulp much more likely to be exposed on caries removal

178
Q

ext of poor prognosis of FPMs

A

if poor prognosis can allow development of a caries free dentition in adolescent without spacing
appropriate removal time
- calcification of bifurcation of L7s forming (8.5-10yrs)
- 5s and 8s all present and in good position on OPT
- mild buccal segment crowding
- class 1 incisors

179
Q

conventional crown prep - components of reduction

A

MR reduction
occ reduction
buccal and lingual

180
Q

conventional crown prep - MR reduction

A

knife edge
see gingivae
tapered diamond separating bur at 90 degrees

181
Q

conventional crown prep - occ reduction

A

1-2mm
follow contour
straight fissure bur

182
Q

conventional crown prep - buccal and lingual

A

peripheral reduction only

removing any sharp angles produced

183
Q

SSC instruments

A 
tapered diamond separating bur
PMCs
GIC
crown crimping pliers
curved crown scissors
184
Q

common problems with SSCs

A

rocking
canting to one side
loss of space (due to caries removal)

185
Q

SSCs - rocking

A

cervical margin >1mm beyond max curvature, difficult to contour margins sufficiently to contact tooth throughout
= open margins and unstable crown
solution - adjust tooth prep - stable crown 0.5mm beyond max curvature

186
Q

SSCs - canting to one side

A

uneven reduction of occlusal surface

187
Q

SSCs - loss of space

A

extensive caries - drifting of adjacent teeth
ideal - rectangular prep
not ideal - square prep

188
Q

SSCs crown selection

A

measure MD width of crown or space with dividers
OR trial and error after crown prep
OR impression and crown prep on model

189
Q

contouring crown

A

Ensure tight cervical fit but not snap fit
- pliers
don’t establish contact area (with adjacent tooth) if there wasn’t one present

190
Q

disadvantages of conventional SSCs

A

LA and extensive tooth prep
need child cooperation
risk damage to FPM when prepping E

191
Q

indications for conventional SSC

A

large multi surface Rxs
abutment for space maintainers
rampant caries
protection of molars in children with Bruxism

192
Q

Hall technique procedure

A 
dry crown and fill with GIC
dry tooth
partially seat crown until engages with contact points
remove finger and encourage child to bite or fully seat with finger pressure
 - blanching of gingivae good
remove extruded cement ASAP
hold/bite (CW) 2-3mins
reassurance
floss between contacts
193
Q

Hall technique parent and child reassurance

A

crown supposed to fit tightly, gum will adjust
will get used to feeling of crown within 24hrs
occlusion tends to adjust to give even contacts bilaterally within a few weeks

194
Q

Hall technique airway protection

A

sitting up
sticky material
Gauze in airway

195
Q

split dam technique

A

floss - thread through one hole in clamp, tie to secure then wrap floss around bow then through second hole. tie. 2 ends should hang out of mouth - safety feature in case clamp breaks
put clamp in mouth with clamp holders
punch two holes in dam 1cm apart. join with scissors
put in mouth - stretch over clamp until visible
then stretch forward - hold at anterior teeth with wedget elastic
frame - ensure it doesn’t discomfort pt and that they can breathe through nose

196
Q

what is the Hall technique known as?

A

biological caries management - no LA/prep

197
Q

what to call SSC to child

A

princess/transformer tooth
Iron man helmet

198
Q

Hall technique - what to do if contacts are an issue

A

separators - remove 3-5days

199
Q

cementing crown in Hall technique

A

GIC

200
Q

where should Hall technique crown sit?

A

ideally sub gingival or at least below margins of cavitation

201
Q

Hall crown sizes

A

2-7

202
Q

Hall technique contraindications

A

pulpal involvement
insufficient sound tissue left to retain crown
dental sepsis
aesthetics
PAP
at risk of endocarditis

203
Q

how to place separators and where shouldn’t they sit?

A

2 pieces of floss

not sub gingival

204
Q

Hall technique indications

A

non-cavitated/cavitated occlusal lesions if pt unable to accept FS/Rx
proximal lesions - cavitated/non-cavitated

205
Q

review of hall crown tech - minor failure

A

new/secondary caries
worn/lost but tooth restorable
reversible pulpitis txed without requiring pulpotomy/ext

206
Q

review of hall crown tech - major failure

A

irreversible pulpitis
abscess requiring pulpotomy/ext
interradicular radiolucency
unrestorable

207
Q

restoration of primary incisors - cervical

A

hand excavate/SS
wash and isolate - dam/CW
GIC and Vaseline or compomer

208
Q

restoration of primary incisors - IP

A

hand excavate/SS
wash and isolate
acetate strip, restore with compomer/composite

209
Q

space maintainers

A

band and loop (band on 6’s)

distal shoe retainer (crown on Ds)

210
Q

band and loop space maintainer

A

cement with GI

as soon as you see premolar erupting take it off

211
Q

distal shoe retainer

A

sits subgingivally to guide 6

212
Q

disadvantages of unplanned primary extractions

A 
loss of space (malocclusion risk)
decreased masticatory function
impeded speech development
psychological disturbance
trauma from anaesthesia/surgery
213
Q

indications for pulp tx of primary teeth

A

good cooperation
MH precludes ext - e.g. inherited bleeding disorder
missing permanent successor
need to preserve tooth e.g. space maintainer
child under 9 - otherwise starting to exfoliate

214
Q

contraindications for pulp tx

A 
poor cooperation
poor dental attendance
cardiac defect
multiple grossly carious teeth
advanced RR
severe/recurrent pain or infection - ext
215
Q

endo options for a vital tooth and success

A

pulp capping - poor

vital pulpotomy - 85-100%

216
Q

endo options for a non-vital tooth and success

A

pulpectomy - 90%

217
Q

potential complications of pulp tx

A

early resorption leading to early exfoliation

over-preparation

218
Q

aim of vital pulpotomy

A

preserve radicular pulp

219
Q

vital pulpotomy

A

LA and dam
access - remove caries
amputation
- remove coronal pulp with excavator/SS
- ferric sulphate 20s - control bleeding
pulp stump evaluation - minimal oozing
restore
- ZOE/CaOH
- GIC
- SSC

220
Q

hyperaemic pulp

A

continued bleeding
deep crimson

221
Q

how to spot a non-vital primary molar - signs (after opening pulp)

A

hyperaemic pulp - bleeding +++

pulp necrosis and furcation involvement

222
Q

how to spot a non-vital primary molar - symptoms

A

irreversible pulpitis
periapical periodontitis
chronic sinus

223
Q

primary molar pulpectomy

A 
EWL: pre-op radiograph
access - open roof and remove caries
remove coronal pulp
RC prep (2mm short of apex)
 - CHX irrigation
obturate with Vitapex (2mm) - CaOH and iodoform paste
GIC core
SSC
post-tx radiograph
224
Q

follow up of pulp tx - clinical

A 
clinical failure
 - pathological mobility
 - fistula/chronic sinus
 - pain
review every 6m
225
Q

follow up of pulp tx - radiographic

A 
radiographic failure
 - increased radiolucency
 - internal/external resorption
 - furcation bone loss
review every 12-18m
226
Q

direct pulp cap

A

arrest haemorrhage with pressure (moist CW)

Ca(OH)2

227
Q

apexification with CaOH2 and cons

A

induces calcific barrier
But:
porous
makes dentine brittle (reduced mineral content )- root fracture

228
Q

MTA - apical barrier formation

A

Mineral trioxide aggregate
5mm
after 24hrs can obturate with heated GP system
place using obtura probes, disposable MTA carriers or experimentally using Venflon

229
Q

flexible composite splint

A 
0.3mm SSW - bend to ensure passive
cut to size
etch, bond, apply composite
sink wire
cure
smooth
keep away from gingivae
one abutment either side
230
Q

pulpal involvement occurs quickly in primary molars

A

small
large pulp chambers
broad contact points make caries diagnosis difficult
irreversible pathological changes before pulpal exposure
early radicular pulp involvement

231
Q

why can’t you use conventional RCT?

A

roots variable in number, divergent and curved
canals ribbon-shaped
physiological resorption
root morphology changes with age
potential to damage developing permanent successor
small mouths - access restricted

232
Q

why shouldn’t you keep carious primary teeth under observation?

A

pain
infection
interference with development of underlying permanent - enamel hypoplasia

233
Q

potential complications of pulp therapy

A

early loss
failure to exfoliate
enamel defects of successor
over-preparation - perforation

234
Q

indications for SSCs

A 
badly broken down teeth
following pulp tx
severe E hypoplasia on malformed teeth
as abutment for space maintainer
fractured teeth
235
Q

what can physiologic mesial drift lead to?

A

decrease in arch length
FPMs (esp mandibular) exert big force
if space - molars erupt medially and premolars and canines erupt distally

236
Q

deciduous teeth

A 
molars wider than premolars
incisors smaller
molars more bulbous
whiter
roots flare apically
pulp
 - large
 - horns high occlusally
RCs
 - ribbon shaped
thin E, thin coronal D
shorter posterior arch length
237
Q

space maintainers - loss of incisor

A

none

238
Q

space maintainers - loss of canine

A

Band and loop but balancing ext preferable

239
Q

space maintainers - loss of D

A

band/crown loop

240
Q

space maintainers - loss of E

A

if FPM - band/crown and loop

UE FPM - distal shoe, guides FPM

paeds (7 decks)

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