Paeds Flashcards
What questions would you ask mum about antenatal period?
Did you have any infections or illnesses during pregnancy?
Hypocalcaemia, vit. D deficiency or hypertension?
What teeth are affected in MIH?
Hypomineralisation of permanent molars (1-4 and affected incisors
What questions would you ask mum about birth of child?
How was child delivered?
Was child delivered prematurely?
Were there any complications during birth?
What questions would you ask mum about child’s health from birth to 2 years old?
Has child had chicken pox?
Has child had rubella?
Has child had measles?
Any other relevant childhood illness - asthma, cardiac problems, epilepsy?
Why do we ask mum about these time periods?
MIH has a higher prevalence amongst children who had pre-natal, natal or post-natal medical problems. Mothers of MIH affected children experienced more disease throughout pregnancy.
In MIH, what might the patient complain of?
sensitivity to hot and cold
appearance of teeth
Would the dentine be affected in MIH?
Dentine would not be affected by the hypomineralisation. Effects would be felt however - dentine would become hypersensitive as it has become exposed due to porous enamel. This facilitates fluid flow within tubules to activate Adelta nerve fibres (hydrodynamic theory).
Significant increase in neural density in pulp horn and subodontoblastic region. Significant increases in immune cell accumulation especially with post eruptive enamel loss. Significant increases in vascularity in sensitive MIH samples. Underlying pulpal inflammation leads to sensitisation of C fibres.
Outline the formation of dentine.
Dentinogenesis is the first feature in the crown stage (late bell stage) of development. Must occur before the formation of enamel. Odontoblasts differentiate from cells of dental papilla. Deposition of dentine matrix (mainly collagen) which is predentine which is later mineralised. Primary dentine formed before root formation and forms the outermost layer of mantle dentine and an inner layer of circumpulpal dentine. Secondary dentine forms after root formation and grows at a slower rate. Tertiary dentine (reparative dentine) forms in response to stimuli such as attrition or caries.
Outline the formation of enamel.
Amelogenesis during the crown stage (late bell stage) of tooth development after formation of dentine by internal enamel epithelium cells differentiating into ameloblasts.
Made in two stages: protein matrix is deposited (partially mineralised) and then organic part is removed and mineralisation is completed (maturation).
Secretory stage first and maturation stage occurs to complete enamel formation.
What is a flexible splint used for and how long should it be left in situ? What is a rigid splint used for?
Used for a avulsions and luxations.
Should be left in situ for 2 weeks for avulsions
Should be left in situ for 4 weeks for laxations (apical and middle 3rd root fractures)
Should be left in situ for up to 4 months for cervical laxations
Rigid - 4weeks - dento-alveolar fractures
Why is CaOH becoming outdated as a treatment for apexification?
Some concerns about long term CaOH use inside root canals - reduces mineral content of dentine and makes tooth more susceptible to root fracture
Recent research may also suggest that some barriers formed are full of holes
Average time for CaOH to harden is 9 months, compared to MTA which is 24hrs
What are the advantages of the hall technique?
Allows pre formed metal crown to be placed over carious primary molars - shown to be one of the most successful techniques for restorating primary teeth
Quick and non-invasive
Does not require LA
Does not require any tooth preparation or caries removal
What instruments are required for the hall technique?
mirror,
straight probe - removing cement after fitting,
excavator - remove crown if needed,
flat plastic - load with cement
cotton wool - wipe away cement
gauze for airway/elastoplast to secure crown, band forming pliers
What teeth are suitable for the hall technique?
primary molars (Ds and Es)
How would you choose the stainless steel crown for the hall technique?
choose smallest crown that will cover all cusps, and approaches the contact points, with a slight feeling of ‘spring back’
adjustments may have to be made using Adams pliers
if unsuitable remove crown using excavator before cement sets
When would you use separators?
use seperators through contacts that are tight or where there has been loss of mesio-distal width of a tooth due to marginal ridge fracture
What are the indications for hall technique?
no radiographical sign of pulpal involvement (i.e. asymptomatic tooth)
sufficient amount of sound tooth tissue
anxious child (about LA)
child is willing to cooperate
Describe the hall technique procedure.
sit child upright - gauze swab to protect airway
smallest crown that covers all cusps - DO NOT SEAT - should spring back
dry crown, fill with GI luting cement - no air inclusions
dry tooth if possible
if cavity is large, some cement may be placed within it before placing the crown
place crown over tooth, fully seat crown by either using finger pressure or by partially seating crown until it engages with contact points then asking child to bite down on crown
remove excess cement, hold crown in place for 2-3 mins, floss contacts, give child a sticker
What are prevention and patient advice?
brushing, topical fluoride varnish e.g. Duraphat, fissure sealant, dietary advice, reassure patient that they will be used to the feeling within 24hrs, even bite within weeks
A parent calls your practice and tells you that their 8 year old daughter has just knocked out her front tooth. What is the dental term given to an injury of this sort?
Avulsion
List the instructions you would give the parent on the telephone.
Store in fresh cold milk or saliva - do not allow tooth to dry out
Do not handle root
Can wash for 10s under cold water while holding crown if obvious debris
Re implant if possible
The patient has fully erupted lateral incisors. What term best describes the type of splint you would construct?
Flexible splint
What are the ideal materials to use to construct a splint and where exactly would you place them?
A splint is constructed using a 0.6mm stainless steel wire, cut to size and then contoured (to make it passive)
Composite resin is then applied to labial/buccal surface of traumatised tooth and those adjacent
Wire is then placed into composite, shaped, cured and smoothed off
The tooth subsequently becomes non-vital; it has an incomplete root apex. After the necrotic pulp has been extirpated, what material should be used to fill the canal?
5mm of MTA (mineral trioxide aggregate) should be placed at apical end of root
Wait 24hrs for MTA to harden then obturate with a heated GP system
What are you trying to achieve by doing this?
Apexification
Provides apical barrier against which to condense root canal filling (gutta percha)
What is the eruption sequence for deciduous teeth?
Lowers before uppers - erupt in order As Bs Ds Cs Es As = 6-7months Bs = 7-8months Ds = 12-15months Cs = 18-20months Es = 24-36months
What is the normal eruption sequence for the permanent dentition?
6yrs = lower 1s, upper and lower 6s 7yrs = upper 1s, lower 2s 8yrs = upper 2s 11yrs = lower 3s, upper and lower 4s 12yrs = upper 3s, upper and lower 5s, upper and lower 7s
What are the minor and major outcomes after a 2 year follow up comparing Hall technique and conventional technique?
minor failures = new/secondary caries, filling/crown worn, lost or requiring other intervention; restoration lost but tooth restorable; reversible pulpitis treated without requiring pulpotomy or extraction
major failures = irreversible pulpitis; abscess requiring pulpotomy or extraction; inter-radicular radiolucency; filling lost and tooth unrestorable
What are the disadvantages of unplanned primary tooth extraction?
Loss of space causing increased risk of malocclusion Decreased masticatory function Impeded speech development Psychological disturbance Trauma from anaesthesia/surgery
What are the indications for pulpal treatment?
Good cooperation
Avoidance of general anaesthesia
Medical history precludes extraction eg bleeding disorder
Missing permanent successor
Over riding necessity to preserve the tooth eg space maintainer
Child under 9yrs old
What are the contraindications for pulpal treatment?
Poor cooperation Poor dental attendance Cardiac defect Multiple grossly carious teeth Advanced root resorption Severe/recurrent pain or infection
What are the signs of failure following a review of pulpal treatment?
Clinical failure (clinical review 6 monthly) - pathological mobility, fistula/chronic sinus, pain Radiographical failure (radiograph review 12-18 monthly) - increased radiolucency, external/internal resorption, furcation bone loss
What are the indications for stainless steel crowns?
Badly broken down primary teeth and young permanent teeth (tooth not satisfactory for an amalgam)
Primary and young permanent teeth following a pulpotomy or partial pulpectomy
Severe enamel hypoplasia on malformed teeth
As an abutment for a space maintainer
Fractured teeth
What are some dietary and OHI you would give to a patient with a splint?
soft food diet for 2 weeks
chlorhexidine mouthwash
ensure good oral hygiene -> brushing, fluoridated toothpaste
reduce frequency of sugary intake
