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Paeds Flashcards

1
Q

Give 5 members of paeds haemophilia team

A 
GDP, 
paediatric dentist
haematologist
haem specialist nurse
social workers
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2
Q

How is severity of haemophilia assessed

A

% of clotting factors
mild/mod/severe
6-40%/ 2-5%, <1%

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3
Q

How would you treat a patient with moderate haemophilia?

A

enhanced preventative care and rx with GDP/CDS

all tx in hospital setting w/ specialist

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4
Q

Two clinical manifestations of van Willebrands disease

difference between type I and type II vWb disease?

A

mucocutaneous haemotoma
gingival bleeding
post XLA bleeding

type I: quantitative effect on van Willebrand’s factor - loss to 20-50%.
type II: qualitative effect on vW factor
both autosomal dominant
type III: also quantitative effect- autosomal recessive

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5
Q

4 dental procedures that require no augmentation to coagulation factors

A

examination
flouride varnish
small occlusal restorations
supragingival scaling

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6
Q

4 management strategies for patients requiring augmentation of coagulation factors

A

coagulation factor replacement
DDAVP - desmopressin
antifibrinolytics- e.g tranexamic acid
local haemostatic measures

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7
Q

Give 1 possible complication of recombinant clotting factor therapy

A

antibody resistance

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8
Q

3 side effects of desmopressin use

A

hyponatraemia - low serum sodium levels
nausea
diarrhoea
headaches

tachycardia
desmopressin is man made vasopressin (Antidiuretic hormone) used for diabetes, bed wetting, haemophilia A and vWD

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9
Q

Risk of nerve blocks in patients with bleeding disorders

Give one alternative to nerve block

A

muscular haemotoma
- blood could flow into sublingual, submandibular, pterygoid spaces

alternative: articaine infiltration

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10
Q

Max INR for safely treating paediatric patients

A

2.5

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11
Q

When should you prescribe prophylactic antibiotics

A 
immunocompromised
hypertrophic cardiomyopathy 
previous infective endocarditis 
valve replacement
cardiac stent
adjunct to tx
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12
Q

6 extra oral features of Down Syndrome

A 
rounded skull
small midface
atlantoaxial instability
dysplastic ears
brushfield spots
short, broad neck
dry lips
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13
Q

6 intra oral features of Down Syndrome

A 
macroglossia
AOB
microdontia
hypodontia
fissured tongue
delayed eruption
class III occlusion
bifid uvula
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14
Q

4 medical conditions related to Down syndrome

A 
cardiovascular defects esp. VSD
cleft lip and palate
deafness
hypothyroidism
mental retardation
acute lymphoblastic leukaemia
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15
Q

Restorative options for pt with Down Syndrome

A

GI restorations- difficult to achieve moisture control
CHX gel or MW
LA if able. GA risk due to atlanto axial instability

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16
Q

What percentage of paediatric patients suffer from asthma?

A

7-19% in the UK

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17
Q

What is asthma?

A 
reversible airway obstruction
caused by:
- smooth muscle contraction
- inflammation in respiratory mucosa
- excess mucous secretion
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18
Q

Give 4 signs/symptoms a patient with asthma might display

A

shortness of breath
wheezing
rash
coughing

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19
Q

What medications would you expect a patient with asthma to be taking?

A

corticosteroid inhaler - brown- beclomethasone - preventer

beta 2 agonist inhaler - blue - salbutamol - reliever

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20
Q

How do asthma medications contribute to tooth wear

A
  • xerostomia - .:. sugary/acidic drinks used to aid
  • relaxed lower oesphageal sphincter- gastric reflux
  • inhaler is acidic
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21
Q

What are the dental effects of inhalers and what advice should be given

A
  • candidosis
  • erosion - from intrinsic (GORD) and extrinsic (acidic medication and sugary drinks)
  • xerostomia

advice:
try to rinse with water after every inhaler use,
use spacer is possible

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22
Q

What other considerations should be given to asthma patients?

A
  • –pt will have increased atopy (genetic tendency for allergic reactions) .:. increased chance of allergic reactions - COLOPHONY in fluoride varnish
  • –increased risk of adrenal suppression - from inhaled corticosteroids inhaler
  • –med emergencies risk
  • –SEDATION risk
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23
Q

How is asthma severity established?

A

last hospitalisation
clinical symptoms
measurements- peak expiratory flow, forced resp volume, oxygen saturation

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24
Q

What is cystic fibrosis?

incidence?

A

chromosomal abnormality affected chr7
production of xs thick mucous affecting lungs, pancreas and salivary glands

affects 1 in 2500

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25
Q

Signs and symptoms cystic fibrosis

A 
recurrent respiratory infections
low weight
cough
wheeze
shortness of breath 
thickened saliva
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26
Q

4 intraoral manifestations of cystic fibrosis

A

thickened saliva
ENAMEL DEFECTS
delayed eruption
increased calculus

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27
Q

dental considerations of cystic fibrosis

A

sedation contraindicated

diet advice - high cal, probably sugary diet due to nutritional deficiency

ohi - carry toothbrush everywhere

antibiotic resistance and prescribing- recurrent infections

diabetes and liver disease

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28
Q

why is inhalation sedation contraindicated in cystic fibrosis

A

high oxygen supplementation causes decreased respiratory rate
.:. ability to clear secretions reduces in long sedated periods

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29
Q

incidence of cancer in u15 y/o

A

1/600

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30
Q

list 5 most commmon childhood cancers

A 
leukaemia
lymphoma
brain tumour
wilm's tumour (kidneys)
neuroblastoma
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31
Q

3 tx modalities cancer

A

chemo
radio
surgery

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32
Q

4 acute intra oral complications cancer tx

A

infections
haemorrhage
xerostomia
mucositis

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33
Q

what is mucositis?

A

ulceration of all mucosa types in oropharynx/ digestive tract usually as a result of chemotherapy

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34
Q

grading of mucositis?

A

0 none
1 soreness, erythema
2 ulceration, erythema - solid foods tolerated
3 ulceration, erythema - liquid foods only
4 oral alimentation impossible - life threatening

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35
Q

mgmt strategies mucositis?

A
  • general- avoid spicey foods, no strong MW
  • smooth cusps/ sharp edges on restorations
  • low level laser light therapy - stimulate collagen production
  • analgesia in form of lignocaine 2% solution
  • enhanced oh
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36
Q

a paediatric patient undergoing chemo for leukaemia presents with bleeding gums. why would this be?
what ohi to help?

give 3 local and 1 systemic haemostatic options

A

platelets levels low - <20-30 x10(9)/L

avoid toothbrushing. use CHX on swab to clean

local: pressure & gauze, ice, topical thrombin
systemic: platelet infusion

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37
Q

minimum platelet count for injections/xla/scaling

A

> 80 (40-100) x10(9)/L

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38
Q

give 3 ways chemotherapy renders patients more susceptible to infection

A
  • inhibits antibody response
  • abolition of delayed hypersensitivity
  • neutropenia
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39
Q

suppurating pocket assoc w/ 16. how to decide tx?

A

culture

sensibility testing

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40
Q

What is aplastic anaemia?

A

disease of bone marrow and the hematopoietic cells residing within - causes pancytopenia.

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41
Q

4 intra oral signs of aplastic anaemia?

A

ulceration
haemorrhage
infection
mucosal pallor

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42
Q

4 factors to consider before tx of aplastic anaemic?

A

increased infection risk
haemorrhage
increased risk of SCCa
anaemia

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43
Q

what is GVHD?

4 intra oral signs

A

Graft Versus Host Disease
where immune cells from graft tissue recognise host as foreign.
a frequent and serious complication following hematopoietic stem cell transplantation (HSCT)

lichenoid tissue reaction - can be reticular or erosive
xerostomia - due to salivary glands affected .:> increased caries rate
limited mouth opening
ulceration - can appear as canker sores
mucoceles
erythema

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44
Q

how might a child with renal failure appear at presentation? (3)

A

underweight - failure to thrive
pallid
fatigued

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45
Q

give 6 intraoral features of a child with renal failure?

A

GGEEPP

gingivitis
gingival hyperplasia
enamel hypoplasia
excess plaque accumulation
petechiae
pulp obliteration
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46
Q

when should dental tx be carried out for children with renal failure?

A

day after dialysis

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47
Q

implications of organ transplant for dental tx? (4)

A

cyclosporin immune suppressant -> gingival hyperplasia

corticosteroids -> pulp obliteration

bleeding disorders -> platelet dysfunction. care with la- haematoma likely in pterygoid region

long term immunosuppression -> poorly controlled infections

osseous lesions in jaw

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48
Q

5 early clinical features of diabetes

A 
polyuria
acetone breath
irritability
weight change
thirst
fatigue
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49
Q

5 late clinical features of diabetes

A 
dehydration
renal dysfunction
hypovolaemic shock
nausea
vomiting
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50
Q

5 oral manifestations of diabetes

A 
xerostomia
progressive periodontitis
caries
candida infection
oral neuropathies
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51
Q

3 features of a hypoglycaemic attack

A 
strong, bounding pulse
clammy skin
confusion
hunger
nausea
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52
Q

3 features of hyperglycaemic attack

A 
weak pulse
dry skin 
acetone breath
frequent urination
rapid breathing
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53
Q

prevalence of epilepsy in children

A

1/250

~0.5%

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54
Q

3 intraoral signs of epilepsy

A

trauma to teeth
soft tissue trauma
gingival hyperplasia (phenytoin)
recurrent oral ulceration

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55
Q

what is haemolytic anaemia?

A

type of anaemia with lysis of erythrocytes (RBCs)

can be intravascular/extravascular

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56
Q

how can haemolytic anaemics be diagnosed?

A

peripheral blood smear

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57
Q

3 categories of haemolytic anaemia and eg of each

A

membrane defects - spherocytosis

enzymatic defects - G6PD

structural defects - Sickle cell disease, thalassaemia

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58
Q

how might a patient with haemolytic anaemia present? (6)

A 
pallid
fatigued
ascites
underweight
oedema of legs
jaundiced
shortness of breath
FTT failure to thrive
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59
Q

6 oral related signs of sickle cell disease

A 
anaemia
ulceration
smooth tongue
jaw joint pain 
impaired growth
hypercementosis
skeletal deformities
osteoporosis of jaw
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60
Q

4 dental implications of sickle cell disease

A

poor infection control
post op antibiotics
prevention
inhalation risk

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61
Q

6 orofacial manifestations of thalassaemia?

A 
squirrel like appearance
large cheekbones
depressed nasal ridge
class II malocclusion
maxillary protrusion
candidosis
gingivitis
high caries incidence
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62
Q

6 intraoral manifestations of HIV

A 
oral ulceration
salivary gland enlargement
hairy leukoplakia
hepetic stomatitis
recurrent candida infections
kaposi sarcoma
xerostomia
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63
Q

How is HIV diagnosed

A 
ELISA
enzyme -
linked
immuno-
sorbent
assay
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64
Q

Current management of HIV

A

HAART
triple therapy

highly 
active
anti
retroviral
therapy
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65
Q

most common cause of anaemia in children?

4 intraoral signs of this anaemia

A

iron deficient anaemia

glossitis - inflammation causing sore, smooth looking, depapillated tongue
candida infections
apthous ulceration
pale mucosa 
angular cheilitis
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66
Q

what type of anaemia does i)b12 ii)fe iii) folate deficiency induce in pts

A

macrocytic
microcytic
macrocytic

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67
Q

how does the clinical presentation of the tongue differ from patients suffering from iron and b12 deficient anaemias

A

iron: large, red, smooth, depapillated
b12: fiery red, atrophic, sore, beefy

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68
Q

gi disease presenting with pigmented lesions in oral cavity and on lips

A

Peutz Jeghers

brown macules 2-5mm on lips, oral cavity and face

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69
Q 
what is gardner's syndrome
intraoral presentation (3)
A

colonic polyposis

supernumerary teeth
mandibular cysts

70
Q

what is coeliac disease?

3 intraoral presentation

A

lifelong autoimmune condition as reaction to gluten

apthous ulceration
mucosal erythema
chronological hypoplasia
depapillation of tongue

71
Q

what is crohns disease

5 intraoral presentation

A

inflammatory bowel disease (IBD) affecting any part of GI tract

full thickness gingivitis
cobblestoned mucosa
mucosal tags
ulceration
fissured tongue
72
Q

4 strategies to manage intraoral symptoms of crohns

A

dietary advice
steroids- topical/ systemic. betamethasone, hydrocortisone pellets 2.5mg
non-cinnamon containing toothpaste
correct anaemic deficiencies

73
Q

child brought in by non-parent. what do you need to establish prior to examination?

A

thorough history inc medical and drug history

consent- if carer has consent, situation, where consenting adult is

74
Q

describe a behavioural management technique

name 4 other techniques

A

tell show do
Tell: tell the patient what you’re going to do, Show: show the patient what you’re going to do, Do: get the patient,
Plan: long term

others:
desensitisation
modeling
distraction 
parental presence
positive reinforcement
voice control
75
Q

How would you address the issue of non attendance of a child?

A
  • ensure contact details are up to date
  • explain to parent necessity of attendance of pt and of consenting guardian presence
  • inform parent of need for child protection involvement in cases of non- compliance
  • arrange next appt on phone
  • record everything fully in notes
76
Q

evidence based toothbrushing advice?

A

2-5 mins / 2 x daily
pea sized amount/ 1450ppm toothpaste
modified bass technique/ 45 degree angle to gingival margin and brushing away from margin

77
Q

What does a BPE score of 3 mean?

A

probing depth of 3.5-5.5mm

78
Q

pt attends with fracture of 11. history?

A

account for missing fragment - swallowed/inhaled/embedded in soft tissue
how it happened
when it happened

79
Q

List 4 things that determine prognosis of fractured tooth

A
  • type of fracture
  • mobility
  • vitality
  • maturaturity of tooth - open/closed apex
80
Q

Pt presents with yellow/white/brown stains on teeth. Differential diagnosis?

How would you differentiate?

A

amelogenesis imperfecta
fluorosis
molar incisor hypomineralisation

AI - affects all teeth, familial aggregation, on radiograph molars can appear taurodont
F- affects all teeth, history of high fluoride in childhood- ingestion/ water. white opacities caries resistant
MIH- affects 1s and 6s only. susceptible to caries. well demarcated opacities

81
Q

What questions would you ask parent of child with white/yellow/brown staining?

A
  • childhood systemic illnesses? - measles, rubella, upper respiratory tract infections
  • pregnancy- did mother suffer from any systemic illnesses prenatally?
  • premature delivery?
  • prolonged breast feeding?
  • traumatic birth?
  • medications taken?
  • natural birth?
82
Q

Signs fluorosis?

aeitology?

how to quantity severity?

tx options?

A 
varying severity
white flecks
opaque white lines
pitting
brown spots

quantity of fluoride intake, type of intake, renal function, metabolic function.

long term ingestion of high fluoride, fluoridated water of >1ppm

Dean’s index

micro/macroabrasion
bleaching
composite restorations 
veneers
full crowns
83
Q

implications of MIH

A
  • increased sensitivity
  • increased caries susceptibility
  • behavioural problems & amp anxiety
  • difficulty achieving anaesthesia
  • difficulty restoring lesions
  • poor aesthetics
84
Q

5 groups of aeitiologies of MIH

A
  • pre/peri and neonatal problems
  • exposure to environmental contaminants
  • exposure to fluoride
  • common childhood illnesses
  • medically compromised children
85
Q

5 tx options impacted first molars

A 
Leave and monitor
coronectomy
discing of Es 
orthodontic fixed appliance
XLA molar
XLA E
86
Q

Features of permanent dentition that allow for replacement of primary teeth without crowding?

A
  • Growth of maxilla
  • Primate space- physiological spacing between primary teeth
  • proclination of permanent teeth
  • Extension of dental arch
  • Leeway space-
87
Q

Leeway space

A

combined mesiodistal width of primary canine, first and second molar is greater than the combined mesiodistal width of the permanent canine, first and second premolars

88
Q

pt suffering from extrusion. tx

A

extrusion splint

cut and manipulate passive splint (SS)
clean and dry area
acid etch areas to be splinted
fix with composite resin

follow up 2 weeks, 4 weeks, 6-8 weeks, 6 months, 1 year, 5 years
clinical exam and radiographs, sensibility testing, mobility, TTP, check colour and sinus

89
Q

On a follow up visit post- trauma a radiograph reveals an irregular apical structure.
what could be causing this?
what else would you expect to see?

tx?

A

external inflammatory root resorption

widened pdl
loss of lamina dura

RCT, CaOH dressing
apical surgery

90
Q

avulsion of permanent incisor. pt on phone, what to do.

A

reassure pt
do not handle by root
rinse under cold running water for 10s
reimplant ASAP (check is definitely not primary tooth)
or store in saliva, milk, Hank’s saline and visit GDP

91
Q

pt arrives in practice. reimplanted mature tooth closed apex. what to do

A

leave tooth in place
clean area w/ water spray
suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact

RCT 7-10 days after reimplant
CaOH placed as intracanal medicament for up to a month before obturation.
OR antibiotic corticosteroid (odontopaste)

92
Q

patient instructions following reimplant of avulsed tooth

A

avoid contact sports
CHX rinse bid/7days
soft food for up to 2 weeks
brush w soft toothbrush after each meal

93
Q

what to do if pt presents w/ mature avulsed tooth in storage medium

A

if saliva, milk or Hank’s balanced salt solution and EADT extra oral dry time of <60 minutes can reimplant

  • clean root surface and apical foramen with stream of saline- remove debris and dead cells
  • administer LA
  • irrigate socket with saline
  • examine socket - if socket wall fracture position this with suitable instrument
  • reimplant tooth with digital pressure, no force
    then as before—

suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact

RCT 7-10 days after reimplant
CaOH placed as intracanal medicament for up to a month before obturation.
OR antibiotic corticosteroid (odontopaste)

94
Q

If pt presents with mature avulsed tooth and EADT >60 minutes what do you do

A

can do delayed reimplantation - to restore aesthetics, function and maintain alveolar bone contour

ankylosis expected + root resorption. soaking in sodium fluoride solution thought to help slow down process

-Clean with saline and remove any non-viable soft tissue carefully
-RCT can be carried out extraorally or 7-10 days post reimplantation
-LA
- irrigate socket with saline
- examine socket - if socket wall fracture position this with suitable instrument
- reimplant tooth with digital pressure, no force
-suture gingival lacerations if present
=verify normal positioning of tooth clinically and rads
-apply flexible splint- 4 weeks
-prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
-tetanus booster- if uncertain or immunisation/soil contact

95
Q

If pt presents with avulsed immature tooth reimplanted…

A

leave tooth in situ
clean area w/ water spray
suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact

GOAL revascularisation at apex
if does not occur need to RCT - if evidence of pulp necrosis

follow up - 2 weeks, 4 weeks, 3 months, 6 months, 1 year , 5 year

96
Q

if pt presents with avulsed immature tooth with extraoral dry time <60 minutes…

A

need to: weigh up risk of revascularisation versus infection related root resorption

if saliva, milk or Hank’s balanced salt solution and EADT extra oral dry time of <60 minutes can reimplant

  • clean root surface and apical foramen with stream of saline- remove debris and dead cells
  • AT THIS POINT- thought to aid revascularisation if application of topical antibiotics (doxycline soak 1mg per 20ml for 5 minutes prior to reimplantation).
  • administer LA
  • irrigate socket with saline
  • examine socket - if socket wall fracture position this with suitable instrument
  • reimplant tooth with digital pressure, no force
    then as before—

suture gingival lacerations if present
verify normal positioning of tooth clinically and rads
apply flexible splint- 2 weeks
prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
tetanus booster- if uncertain or immunisation/soil contact

AVOID RCT UNLESS EVIDENCE OF PULP NECROSIS

97
Q

if pt presents with avulsed tooth immature and eadt >60 minutes

A

can do delayed reimplantation - to restore aesthetics, function and maintain alveolar bone contour

ankylosis expected + root resorption. soaking in fluoride solution thought to help slow down process

-Clean with saline and remove any non-viable soft tissue (necrotic PDL) carefully
-RCT can be carried out extraorally or 7-10 days post reimplantation
-LA
- irrigate socket with saline
- examine socket - if socket wall fracture position this with suitable instrument
- reimplant tooth with digital pressure, no force
-suture gingival lacerations if present
=verify normal positioning of tooth clinically and rads
-apply flexible splint- 4 weeks
-prescribe ABs doxycycline bid/ 7 days - amoxycillin if pt under 12 years old (discolouration risk with tetracyclines)
-tetanus booster- if uncertain or immunisation/soil contact

98
Q

eruption dates permanent teeth

A 
6 y/ o - U6s, L6s erupt, 
         L1s begin to
7 y/o - L2s and U1s
8 y/o - U2s
9 y/o - L3s, palpate for Us
10 y/o - U4s, L4s, U5s
11 y/o - L5s, U3s, L7s
12 y/o - U7s
17+ - U+L8s
99
Q

Main difference in splinting times and why?

A

flexible splint for 2 weeks if EADT <60 mins

for 4 weeks if EADT >60mins

100
Q

common outcomes of avulsed teeth (5)

A 
discolouration
pulp necrosis
ankylosis 
mobility
root resorption
101
Q

How do osteogenesis imperfecta and dentinogenesis imperfecta relate?

A

1/2 of patients with osteogenesis imperfecta will suffer from dentinogenesis imperfecta- whilst the other half will have unaffected teeth and just require routine care.

102
Q

What is osteogenesis imperfecta
dental implications
general signs

A

brittle bone disease!!
lots of different types- range in severity and effects

OI always associated with bone fragility. Can affect growth of the jaws.
OI does have dental implications though -

  • class III malocclusion
  • anterior open bite
  • impacted teeth
  • altered dental development
general signs:
blue sclera of eye
multiple bone fractures
short height
large head
easy bruising
range of bone deformities- scoliosis
103
Q

Mum brings in baby with one erupted tooth gray/blue in colour. What could it be?
Any signs to look for if more teeth present?

A

DI - can occur alone or with OI. enamel is normal but dentine and DEJ is abnormal. Enamel cracks away from dentine, and dentine can grow into pulp chamber .:.

  • discolouration of tooth,
  • reduced feeling in tooth
  • high caries susceptibility
  • bulbous crowns
  • slender shorter roots.
  • pulp chamber obliteration
  • occult abscess (no obvious signs)
104
Q

Difference between flexible and rigid splint?

A

flexible - 1 tooth either side

rigid - 2 teeth either side of trauma

105
Q

4 types of healing after root fracture

which type would give most poor prognosis?

A

interposition of the following can occur at the fracture line:

  • of calcified tissue
  • of both calcified and connective tissue
  • of connective tissue
  • of granulation tissue

poor prognosis: granulation tissue would show loss of vitality of tooth and pulpal necrosis/ infection causing an inflammatory response

106
Q

mgmt of root fractures

A

undisplaced- soft diet and monitor

displaced- LA, reposition, splint

107
Q

root fracture what is it? classification?

A

fracture of dentine, pulp and cementum

horizontal
or vertical

horizontal - number, location, position, extent.
e.g simple apical displaced total horizontal root fracture

vertical - separation and position
e.g complete intraosseous vertical root fracture

108
Q

History to take after traumatic event

SI

A 
time and place of event
reason for injury
any previous dental injuries
any pain/ spontaneous
any other associated injuries/symptoms- nausea/loss of consciousness/headache
systemic health review

SI:
sensibility testing - can be transient loss of pulp vitality
+pulse oximeter

radiographs

109
Q

indicators of positive healing in root fractures (5)

A 
assymptomatic
continued positive pulp testing
signs of healing between root fragments
absence of apical periodontitis
continued root development in immature teeth
110
Q

if tooth starts to discolour- yellowy after root fracture what is it

A

v common finding - 2/3 of root fractures will have partial or complete pulp obliteration

coronal pulpal obliteration
caused by revascularisation of pulp
apical pulp obliteration seen in case of interposition of calcified tissue and those with interposition of calcified and connective tissue.

111
Q

tx for root fracture with pulpal necrosis

A

long term CaOH therapy
followed by conservative RCT within 7-10 days for mature apex
for immature apex apexification to be completed first the RCT

CaOH has weakening effect on tooth .:. MTA can be used for horizontal root fractures for faster healing

112
Q

contributory factors to pulpal necrosis in root fractures

A

displacement of coronal fragment
use of rigid splints
mature apex at time of fracture
marginal periodontitis

113
Q

aetiology of vertical root fractures

prognosis

A

extensive restorative tx
endodontic tx
parafunctional habits

can treat
e.g guided tissue regeneration
or fixation and application of MTA

but normally XLA

114
Q

advantages and disadvantages of non vital bleaching

A

:) easy
safe
conservative
no lab assistance needed (walking bleach technique)

\:( 
brittle teeth
external cervical resorption
relapse
may fail
over-bleaching
115
Q

walking bleach technique

A

pre-op shade
photographs
radiographs to check RCT

dam
gain access
remove restoration
GP removed to gingival margin
ensure good coronal seal
10% carbamide peroxide soaked cotton pledget placed in cavity
sealed with GIC
pt to return every 2 weeks for up to 10 replacements/ happy with shade
then nsCaOH placed to reverse acidity
then final restoration
116
Q

child ingested toothpaste

3 questions to ask pt

A

conc of toothpaste
amount swallowed
age/weight of child

117
Q

toxic dose fluoride

tx if ingested

A

potentially toxic 5mg/kg

a&e immediately
oral calcium

118
Q

most common cause of fluorosis in uk

A

fluoride in water supply

119
Q

family w/3 children aged 1,4,7. live in area with 0.3ppm water supply F-.
what supplementation would you suggest

A

for 1 y/o - fluoride drops 0.25mg

for 4 y/o - fluoride chewable tablets 0.5mg

for 7 y/o- fluoride MW 225ppm. 1mg needed

120
Q

3 y/o pt presents with blisters on gums. dx?

any other features you’d expect

tx

A

primary herpetic gingostomatitis

  • contagious
  • herpes simplex virus type 1
  • 6 month - 6 y/o
  • most common viral infection of mouth
symptoms:
blisters 1-3mm in size
painful, erythematous gingiva
ulcers on gingiva, lips,mucosa
halitosis
malaise
refusal to eat
high fever
headache
irritability

tx:
supportive only- reassurance, rest, fluids
appropriate analgesia
OHI - CHX
advise parent of contagious nature- childs eyes
refer if concern re: refusal to eat/

121
Q

issues caused by herpes simplex virus reactivation

A

herpes labialis - cold sores (15-30%)

bell’s palsy

122
Q

topical effects of fluoride

A

promotes remineralisation
hydroxyapatite-> fluorapatite
bactericidal
decrease acid production of plaque

123
Q

effects of primary tooth trauma on a primary tooth

A

discolouration
delayed exfoliation
infection
loss of vitality

124
Q

effects of primary tooth trauma on a permanent tooth

A 
delayed eruption
enamel defects
arrested development
ectopic placement
abnormal morphology
125
Q

eruption dates primary dentition

A

Upper: 7, 9, 18, 14, 24 months
Lower: 6, 8, 16, 12, 20 months

126
Q

eruption dates permanent dentition

A

Upper: 7, 8, 11, 10, 10, 6, 12 years
Lower: 6, 7, 9, 10, 10, 6, 12 years

127
Q

factors that increase index of suspicion of child welfare in injured child

A 
delay seeking tx
injuries not matching story
inconsistent story
contradictory info from child
abnormal behaviour/mood child
abnormal behaviour parent 
previous history of injury
128
Q

orofacial injuries suspicious of mistreatment

A

cigarette burns
hand/finger marks
bites
ear/neck injuries

129
Q

how to refer pt on if concerned about welfare

A

A - Assess
H - History
E - Examination
T - Talk to the child and parent about concerns (if you feel safe)
D - Document: everything and in the patients own words
M - multiagency (Contact senior colleague and/or e.g. dental protection for advice.)
48
R - refer: Child protection services for information. Social services for referral. Ensure you follow up within 48hours. If
possible take photographs with permission. Consider contacting police if you feel child is in immediate danger.

130
Q

indications pulpotomy(6)

A 
Avoid XLA,
 co-operation, 
space maintenance, 
caries 2/3 into dentine, 
exposure >1mm, 
marginal ridge destroyed,
avoid GA, 
MH precludes XLA, 
no permanent successor.
131
Q

contraindications pulpotomy (6)

A 
congenital heart disease
immunosuppression
suppurating pulp chamber
>2/3 root resorption
severe pain
severe infection
severe bone loss
space management
132
Q

Why and how would you carry out pulpotomy?

A

Indication: exposure of bleeding pulp with no previous symptoms and no clinical/radiological sings of infection.
e.g traumatic exposure
or large iatrogenic exposure

LA and dental dam,
Access → remove caries and unroof pulp chamber,
Amputate coronal pulp w/ excavator/slow
speed,
irrigate and dry pulp,
control haemorrhage (20s ferric sulphate),
assess pulp (→if abnormal bleeding then
pulpectomy),
Restore→ CaOH/MTA at stumps, GIC luting cement, SSC.

133
Q

indication and tx pulpectomy

A

indication: exposure of non-bleeding or severely hyperaemic pulp, irreversible pulpitis or clinical/radiological signs of
periapical periodontitis or acute abscess.

LA and dental dam,
Access → remove caries and unroof pulp chamber,
Amputate coronal pulp w/ excavator/slow
speed,
remove radicular pulp using barbed broaches. WL from radiograph, file canals 2mm short
of apex (important not to go past apex - tooth germs),
irrigate w/ CHX, dry canals,
obturate with CaOH and iodoform
paste (Vitapex),
restore with GIC and SSC.

vitapex is premixed CaOH and iodoform paste used as temp or permanent root canal filling post pulpectomy

134
Q

WHat is AI

Give 4 types of amelogenesis imperfecta

A

disorder of tooth development

hypoplastic
hypocalcified
hypomaturational
mixed w/ taurodontism

135
Q

Signs and symptoms AI

A

teeth that are:

small
discoloured
pits/ grooves
prone to rapid wear/breakage

136
Q

Cause AI

A

genetic mutation of enamel extracellular matrix molecules e.g amelogenin, enamelin

137
Q

Mgmt AI

A 
enhanced prevention
composite veneers
fissure sealants
SSC
metal onlay
138
Q

Dental implications AI

A 
aesthetics
sensitivity
caries/acid susceptibility
delayed eruption
AOB
139
Q

4 y/o presents. gross caries across anteriors inc smooth surface
cause
tx

A

nursing bottle caries

cariogenic drinks left in bottle for child to feed on overnight

complete/ partial caries removal +/-. temporisation GIC
or if severe- XGA
Fluoride varnish 4xyear 22600ppm
consider supplements
advice:
avoid taking bottle to bed
advise against on demand feeding
milk and water only between meals
sugar free swaps of foods
not soya unless on medical grounds
spit dont rinse when toothbrushing, pea sized 1450 w/ parental supervision
140
Q

3 types of dentinogenesis imperfecta

A
  1. associated with osteogenesis imperfecta
  2. autosomal dominant
  3. brandywine
141
Q

Dental implications dentinogenesis imperfecta

A 
aesthetics
caries
occult abscess
poor long term prognosis
root fracture
142
Q

indications SSC

A 
>2 surfaces affected/ broken down
tx for severe MIH defects
post pulpotomy/pulpectomy
space maintainer
marginal ridge breakfdown
143
Q

how to place SSC conventionally

A
  • consent
  • LA, dam
  • tooth prep - 1mm removal occlusal w/flat fissure bur, clear contacts w/ fine taper bur
  • crown selection - measure MD, adjust w/ band forming pliers
  • isolate and dry tooth
  • mix GIC
  • seat lingually, snap buccally
  • look for gingival blanching
  • remove XS cement w/ probe
  • check contacts and occlusion
144
Q

how does hall technique differ to conventional crown placement

A

no LA
no toothprep
no caries removal

145
Q

how would you judge a crown has failed

A 
secondary caries
pulpitis
crown lost
crown rocking
abscess
146
Q

advantages of planned extraction of FPMs

indications of suitability for planned extractions of FPMs

A

spontaneous space closure
reduction in possible ortho need
caries free dentition

bifurcation of 7s forming
class I incisors
mild buccal crowding

147
Q

2 disadvantages of planned XLA

A

bad experience
GA if goes wrong
difficult achieveing anaesthsia

148
Q

most common cardiac defect in children?

which condition is this highly associated with

mgmt of these pt

A

ventricular septal defect
-where connection between two ventricles

assoc/w/ down syndrome

mgmt: prevention to avoid tx. OHI to minimise endocarditis risk. xla rather than pulptx. consult with cardiologist. avoid sedation
refer to specialist care.

149
Q

mgmt of external inflammatory resorption

A

Extirpate the pulp and carry out chemomechanical disinfection. Place non setting CaOH dressing. Reassess to see if
resorption has stopped. If yes, complete endo, if not continue w/dressing and plan replacement.

150
Q

7 factors making up prevention plan

A
  1. OHI/ tooth brushing instruction
  2. Diet Advice
  3. Fluoride toothpaste
  4. F varnish
  5. F supplements
  6. Fissure
    sealants
  7. Radiographs
  8. Sugar free medication.
151
Q

fluoride supplementation in areas of <0.3ppm F-

A

1mg/day fluoride tablets

152
Q

name 3 sources of fluoride found in food and drink

A

beer
tea
cucumber
bony fish

153
Q

clinical trauma review (trauma stamp) (8)

A 
colour, 
displacement (ONLY AT 1st VISIT), 
mobility, 
sinus/tender in sulcus,
 EPT,
 Ethyl chloride, 
TTP, 
Radiographs.
154
Q

cause of external inflammatory root resorption?
clinical signs?
mgmt?

A

infected/necrotic pulp release bacterial toxins, which travel up dentinal tubules and stimulate osteoclasts to resorb the root .:. cementum and bone resorption.

mobility, negative sensibility testing, may be TTP
moth eaten appearance of PDL and root on RADS

RCT, dress with CaOH and review every 3 months. if progressing continue with CaOH. if abating obturate ad monitor

155
Q

indications for microabrasion

A 
fluorosis
ortho decal
trauma
pre-veneer to mask staining
MIH - with predominantly brown lesions- little affect otherwise

up to 100ym removed

156
Q

benefits and negatives microabrasion

A 
\:) easy
permanent
conservative
effective
easy after care

:( caustic acid
in surgery only
enamel removal
unpredictable

157
Q

describe process of microabrasion

A

pre op photos/diagrams/ shade guide/ sensibility/ rads if indicated

ppe
prepare solutions- pumice, 18% hydrochloric w/ pumice and sodium bicarbonate. labelled well.
clean teeth w/ pumice
vaseline applied to gingiva
dental dam positioned
sodium bicarbonate barrier applied to gingiva
acid+pumice rubbed onto affected surface 5 seconds with wooden stick
washed thoroughly
repeated up to 10 times, 100 microns removal if 10
thoroughly clean
apply flouride TP
soft flex disc used to remove prism-less layer
fluoride varnish applied
review 4-6 weeks
post op rads/photos

advice: no coloured foods for 24 hours. anything that would stain a white tshirt.

158
Q

3 conditions assoc/ w/ hypoplasia

A

ectodermal dysplasia
down’s syndrome
cleft lip and palate

ED- two or more of ectodermal develop abnormally - skin hair teeth nails sweat glands mucous membranes

159
Q

percentage incidence of primary and permanent hypodontia?

A

primary 0.9%

permanent ~6%

160
Q

bleaching product components

A

10% carbamide peroxide

3.3% h202
6.6% urea

161
Q

Why could a child be anxious before the dentist?

A 
'infection' from parents
negative experience previously
expectation of pain/uncomfort
friends negative/ unusual experiences
media
uneducated on modern analgesic techniques
162
Q

How do you measure childhood anxiety?

A

MCDAS
modified child dental anxiety scale
pictures of faces for numbers

163
Q

8 behavioural management techniques

A 
modeling
acclimitisation
desensitisation
tell show do
distraction
positive reinforcement
progressive muscle relaxation
hypnotherapy
164
Q

6 y/o haemophilia A pt attends practice with buccal swelling and grossly carious 85.
What is haemophilia A?
dx?
tx?

A

genetic disorder caused by deficiency in factor VIII clotting protein

periapical abscess assoc/w/85
avoid XLA due to clotting issues
atraumatic pulpotomy if poss.
antibiotics given if needing to refer

XLA -> DDAVP - desmopressin - manufactured factor VIII available for mild-mod haemophilia A
atraumatic XLA
infiltration LA if possible
ensure clot, suture socket
oral tranexamic acid given post op, may be required pre-op

165
Q

name 3 local haemostatic agents

A 
LA w/ vasoconstrictor
tranexamic acid
thombin, fibrin
surgicel
ferric sulfate
gelfoam
166
Q

triad of impairment in autism?

A

social impairment in :

  • interaction
  • imagination
  • communication
167
Q

features of autism? (6)

A 
hypersensitivity
hyposensitivity
obsessive 
learning difficulties
tubular sclerosis
epilepsy
168
Q

mgmt of autistic patients dental visits

A

plan visit: info leaflets, social story, acclimitisation visit

timing: first appt of day or first after lunch, child can wait in car
environment: quiet surgery, no radio, no interruptions, taste of FV
communication: makaton, learning boards, avoid casual chit chat, literal speech
extra: oranurse unflavoured toothpaste

169
Q

indications for fissure sealants?

materials used

A 
medically compromised
caries in primary dentition
high caries risk
learning difficulties
mental&amp;physical handicap

bisGMA resin, GIC

170
Q

describe technique for fissure sealant placement

A

isolate tooth, saliva ejector, cotton wool or dam
clean tooth thoroughly - toothbrush/prophy
rinse 20 seconds
etch 20 seconds 37% phosphoric acid, wash, dry thoroughly, replace cotton wool, check for frosted appearance
apply thin fissure sealant in fissures and pits,
inc. buccal palatal extension if app.
cure 30 secs
check with sharp probe
check for excess
review

if GIC do not need as good moisture control and do not need to etch

171
Q

4 types of cerebral palsy

How could it be further classified?

A

spastic
ataxic
athetoid
mixed

types based on how severely brain damage has affect muscle tone- strength and tension of muscles
could be hypo or hypertonia.
hypo- low muscle tone, loss of strength and firmness.
hypertonia- high muscle tone, causes rigidity and spasmodic movement,

monoplegia, - one limb
Hemiplegia, - one side of body
diplegia, triplegia, quadriplegia, -2,3,4 limbs respectively

Past MSAs (23 decks)

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