Paeds Flashcards
Give 5 members of paeds haemophilia team
GDP, paediatric dentist haematologist haem specialist nurse social workers
How is severity of haemophilia assessed
% of clotting factors
mild/mod/severe
6-40%/ 2-5%, <1%
How would you treat a patient with moderate haemophilia?
enhanced preventative care and rx with GDP/CDS
all tx in hospital setting w/ specialist
Two clinical manifestations of van Willebrands disease
difference between type I and type II vWb disease?
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
4 dental procedures that require no augmentation to coagulation factors
examination
flouride varnish
small occlusal restorations
supragingival scaling
4 management strategies for patients requiring augmentation of coagulation factors
coagulation factor replacement
DDAVP - desmopressin
antifibrinolytics- e.g tranexamic acid
local haemostatic measures
Give 1 possible complication of recombinant clotting factor therapy
antibody resistance
3 side effects of desmopressin use
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
Risk of nerve blocks in patients with bleeding disorders
Give one alternative to nerve block
muscular haemotoma
- blood could flow into sublingual, submandibular, pterygoid spaces
alternative: articaine infiltration
Max INR for safely treating paediatric patients
2.5
When should you prescribe prophylactic antibiotics
immunocompromised hypertrophic cardiomyopathy previous infective endocarditis valve replacement cardiac stent adjunct to tx
6 extra oral features of Down Syndrome
rounded skull small midface atlantoaxial instability dysplastic ears brushfield spots short, broad neck dry lips
6 intra oral features of Down Syndrome
macroglossia AOB microdontia hypodontia fissured tongue delayed eruption class III occlusion bifid uvula
4 medical conditions related to Down syndrome
cardiovascular defects esp. VSD cleft lip and palate deafness hypothyroidism mental retardation acute lymphoblastic leukaemia
Restorative options for pt with Down Syndrome
GI restorations- difficult to achieve moisture control
CHX gel or MW
LA if able. GA risk due to atlanto axial instability
What percentage of paediatric patients suffer from asthma?
7-19% in the UK
What is asthma?
reversible airway obstruction caused by: - smooth muscle contraction - inflammation in respiratory mucosa - excess mucous secretion
Give 4 signs/symptoms a patient with asthma might display
shortness of breath
wheezing
rash
coughing
What medications would you expect a patient with asthma to be taking?
corticosteroid inhaler - brown- beclomethasone - preventer
beta 2 agonist inhaler - blue - salbutamol - reliever
How do asthma medications contribute to tooth wear
- xerostomia - .:. sugary/acidic drinks used to aid
- relaxed lower oesphageal sphincter- gastric reflux
- inhaler is acidic
What are the dental effects of inhalers and what advice should be given
- 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
What other considerations should be given to asthma patients?
- –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
How is asthma severity established?
last hospitalisation
clinical symptoms
measurements- peak expiratory flow, forced resp volume, oxygen saturation
What is cystic fibrosis?
incidence?
chromosomal abnormality affected chr7
production of xs thick mucous affecting lungs, pancreas and salivary glands
affects 1 in 2500
Signs and symptoms cystic fibrosis
recurrent respiratory infections low weight cough wheeze shortness of breath thickened saliva
4 intraoral manifestations of cystic fibrosis
thickened saliva
ENAMEL DEFECTS
delayed eruption
increased calculus
dental considerations of cystic fibrosis
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
why is inhalation sedation contraindicated in cystic fibrosis
high oxygen supplementation causes decreased respiratory rate
.:. ability to clear secretions reduces in long sedated periods
incidence of cancer in u15 y/o
1/600
list 5 most commmon childhood cancers
leukaemia lymphoma brain tumour wilm's tumour (kidneys) neuroblastoma
3 tx modalities cancer
chemo
radio
surgery
4 acute intra oral complications cancer tx
infections
haemorrhage
xerostomia
mucositis
what is mucositis?
ulceration of all mucosa types in oropharynx/ digestive tract usually as a result of chemotherapy
grading of mucositis?
0 none
1 soreness, erythema
2 ulceration, erythema - solid foods tolerated
3 ulceration, erythema - liquid foods only
4 oral alimentation impossible - life threatening
mgmt strategies mucositis?
- 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
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
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
minimum platelet count for injections/xla/scaling
> 80 (40-100) x10(9)/L
give 3 ways chemotherapy renders patients more susceptible to infection
- inhibits antibody response
- abolition of delayed hypersensitivity
- neutropenia
suppurating pocket assoc w/ 16. how to decide tx?
culture
sensibility testing
What is aplastic anaemia?
disease of bone marrow and the hematopoietic cells residing within - causes pancytopenia.
4 intra oral signs of aplastic anaemia?
ulceration
haemorrhage
infection
mucosal pallor
4 factors to consider before tx of aplastic anaemic?
increased infection risk
haemorrhage
increased risk of SCCa
anaemia
what is GVHD?
4 intra oral signs
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
how might a child with renal failure appear at presentation? (3)
underweight - failure to thrive
pallid
fatigued
give 6 intraoral features of a child with renal failure?
GGEEPP
gingivitis gingival hyperplasia enamel hypoplasia excess plaque accumulation petechiae pulp obliteration
when should dental tx be carried out for children with renal failure?
day after dialysis
implications of organ transplant for dental tx? (4)
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
5 early clinical features of diabetes
polyuria acetone breath irritability weight change thirst fatigue
5 late clinical features of diabetes
dehydration renal dysfunction hypovolaemic shock nausea vomiting
5 oral manifestations of diabetes
xerostomia progressive periodontitis caries candida infection oral neuropathies
3 features of a hypoglycaemic attack
strong, bounding pulse clammy skin confusion hunger nausea
3 features of hyperglycaemic attack
weak pulse dry skin acetone breath frequent urination rapid breathing
prevalence of epilepsy in children
1/250
~0.5%
3 intraoral signs of epilepsy
trauma to teeth
soft tissue trauma
gingival hyperplasia (phenytoin)
recurrent oral ulceration
what is haemolytic anaemia?
type of anaemia with lysis of erythrocytes (RBCs)
can be intravascular/extravascular
how can haemolytic anaemics be diagnosed?
peripheral blood smear
3 categories of haemolytic anaemia and eg of each
membrane defects - spherocytosis
enzymatic defects - G6PD
structural defects - Sickle cell disease, thalassaemia
how might a patient with haemolytic anaemia present? (6)
pallid fatigued ascites underweight oedema of legs jaundiced shortness of breath FTT failure to thrive
6 oral related signs of sickle cell disease
anaemia ulceration smooth tongue jaw joint pain impaired growth hypercementosis skeletal deformities osteoporosis of jaw
4 dental implications of sickle cell disease
poor infection control
post op antibiotics
prevention
inhalation risk
6 orofacial manifestations of thalassaemia?
squirrel like appearance large cheekbones depressed nasal ridge class II malocclusion maxillary protrusion candidosis gingivitis high caries incidence
6 intraoral manifestations of HIV
oral ulceration salivary gland enlargement hairy leukoplakia hepetic stomatitis recurrent candida infections kaposi sarcoma xerostomia
How is HIV diagnosed
ELISA enzyme - linked immuno- sorbent assay
Current management of HIV
HAART
triple therapy
highly active anti retroviral therapy
most common cause of anaemia in children?
4 intraoral signs of this anaemia
iron deficient anaemia
glossitis - inflammation causing sore, smooth looking, depapillated tongue candida infections apthous ulceration pale mucosa angular cheilitis
what type of anaemia does i)b12 ii)fe iii) folate deficiency induce in pts
macrocytic
microcytic
macrocytic
how does the clinical presentation of the tongue differ from patients suffering from iron and b12 deficient anaemias
iron: large, red, smooth, depapillated
b12: fiery red, atrophic, sore, beefy
gi disease presenting with pigmented lesions in oral cavity and on lips
Peutz Jeghers
brown macules 2-5mm on lips, oral cavity and face
what is gardner's syndrome intraoral presentation (3)
colonic polyposis
supernumerary teeth
mandibular cysts
what is coeliac disease?
3 intraoral presentation
lifelong autoimmune condition as reaction to gluten
apthous ulceration
mucosal erythema
chronological hypoplasia
depapillation of tongue
what is crohns disease
5 intraoral presentation
inflammatory bowel disease (IBD) affecting any part of GI tract
full thickness gingivitis cobblestoned mucosa mucosal tags ulceration fissured tongue
4 strategies to manage intraoral symptoms of crohns
dietary advice
steroids- topical/ systemic. betamethasone, hydrocortisone pellets 2.5mg
non-cinnamon containing toothpaste
correct anaemic deficiencies
child brought in by non-parent. what do you need to establish prior to examination?
thorough history inc medical and drug history
consent- if carer has consent, situation, where consenting adult is
describe a behavioural management technique
name 4 other techniques
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
How would you address the issue of non attendance of a child?
- 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
evidence based toothbrushing advice?
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
What does a BPE score of 3 mean?
probing depth of 3.5-5.5mm
pt attends with fracture of 11. history?
account for missing fragment - swallowed/inhaled/embedded in soft tissue
how it happened
when it happened
List 4 things that determine prognosis of fractured tooth
- type of fracture
- mobility
- vitality
- maturaturity of tooth - open/closed apex
Pt presents with yellow/white/brown stains on teeth. Differential diagnosis?
How would you differentiate?
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
What questions would you ask parent of child with white/yellow/brown staining?
- 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?
Signs fluorosis?
aeitology?
how to quantity severity?
tx options?
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
implications of MIH
- increased sensitivity
- increased caries susceptibility
- behavioural problems & amp anxiety
- difficulty achieving anaesthesia
- difficulty restoring lesions
- poor aesthetics
5 groups of aeitiologies of MIH
- pre/peri and neonatal problems
- exposure to environmental contaminants
- exposure to fluoride
- common childhood illnesses
- medically compromised children
5 tx options impacted first molars
Leave and monitor coronectomy discing of Es orthodontic fixed appliance XLA molar XLA E
Features of permanent dentition that allow for replacement of primary teeth without crowding?
- Growth of maxilla
- Primate space- physiological spacing between primary teeth
- proclination of permanent teeth
- Extension of dental arch
- Leeway space-
Leeway space
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
pt suffering from extrusion. tx
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
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?
external inflammatory root resorption
widened pdl
loss of lamina dura
RCT, CaOH dressing
apical surgery
avulsion of permanent incisor. pt on phone, what to do.
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
pt arrives in practice. reimplanted mature tooth closed apex. what to do
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)
patient instructions following reimplant of avulsed tooth
avoid contact sports
CHX rinse bid/7days
soft food for up to 2 weeks
brush w soft toothbrush after each meal
what to do if pt presents w/ mature avulsed tooth in storage medium
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)
If pt presents with mature avulsed tooth and EADT >60 minutes what do you do
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
If pt presents with avulsed immature tooth reimplanted…
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
if pt presents with avulsed immature tooth with extraoral dry time <60 minutes…
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
if pt presents with avulsed tooth immature and eadt >60 minutes
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
eruption dates permanent teeth
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+L8sMain difference in splinting times and why?
flexible splint for 2 weeks if EADT <60 mins
for 4 weeks if EADT >60mins
common outcomes of avulsed teeth (5)
discolouration pulp necrosis ankylosis mobility root resorption
How do osteogenesis imperfecta and dentinogenesis imperfecta relate?
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.
What is osteogenesis imperfecta
dental implications
general signs
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
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?
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)
Difference between flexible and rigid splint?
flexible - 1 tooth either side
rigid - 2 teeth either side of trauma
4 types of healing after root fracture
which type would give most poor prognosis?
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
mgmt of root fractures
undisplaced- soft diet and monitor
displaced- LA, reposition, splint
root fracture what is it? classification?
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
History to take after traumatic event
SI
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
indicators of positive healing in root fractures (5)
assymptomatic continued positive pulp testing signs of healing between root fragments absence of apical periodontitis continued root development in immature teeth
if tooth starts to discolour- yellowy after root fracture what is it
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.
tx for root fracture with pulpal necrosis
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
contributory factors to pulpal necrosis in root fractures
displacement of coronal fragment
use of rigid splints
mature apex at time of fracture
marginal periodontitis
aetiology of vertical root fractures
prognosis
extensive restorative tx
endodontic tx
parafunctional habits
can treat
e.g guided tissue regeneration
or fixation and application of MTA
but normally XLA
advantages and disadvantages of non vital bleaching
:) easy
safe
conservative
no lab assistance needed (walking bleach technique)
\:( brittle teeth external cervical resorption relapse may fail over-bleaching
walking bleach technique
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
child ingested toothpaste
3 questions to ask pt
conc of toothpaste
amount swallowed
age/weight of child
toxic dose fluoride
tx if ingested
potentially toxic 5mg/kg
a&e immediately
oral calcium
most common cause of fluorosis in uk
fluoride in water supply
family w/3 children aged 1,4,7. live in area with 0.3ppm water supply F-.
what supplementation would you suggest
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
3 y/o pt presents with blisters on gums. dx?
any other features you’d expect
tx
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/
issues caused by herpes simplex virus reactivation
herpes labialis - cold sores (15-30%)
bell’s palsy
topical effects of fluoride
promotes remineralisation
hydroxyapatite-> fluorapatite
bactericidal
decrease acid production of plaque
effects of primary tooth trauma on a primary tooth
discolouration
delayed exfoliation
infection
loss of vitality
effects of primary tooth trauma on a permanent tooth
delayed eruption enamel defects arrested development ectopic placement abnormal morphology
eruption dates primary dentition
Upper: 7, 9, 18, 14, 24 months
Lower: 6, 8, 16, 12, 20 months
eruption dates permanent dentition
Upper: 7, 8, 11, 10, 10, 6, 12 years
Lower: 6, 7, 9, 10, 10, 6, 12 years
factors that increase index of suspicion of child welfare in injured child
delay seeking tx injuries not matching story inconsistent story contradictory info from child abnormal behaviour/mood child abnormal behaviour parent previous history of injury
orofacial injuries suspicious of mistreatment
cigarette burns
hand/finger marks
bites
ear/neck injuries
how to refer pt on if concerned about welfare
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.
indications pulpotomy(6)
Avoid XLA, co-operation, space maintenance, caries 2/3 into dentine, exposure >1mm, marginal ridge destroyed, avoid GA, MH precludes XLA, no permanent successor.
contraindications pulpotomy (6)
congenital heart disease immunosuppression suppurating pulp chamber >2/3 root resorption severe pain severe infection severe bone loss space management
Why and how would you carry out pulpotomy?
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.
indication and tx pulpectomy
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
WHat is AI
Give 4 types of amelogenesis imperfecta
disorder of tooth development
hypoplastic
hypocalcified
hypomaturational
mixed w/ taurodontism
Signs and symptoms AI
teeth that are:
small
discoloured
pits/ grooves
prone to rapid wear/breakage
Cause AI
genetic mutation of enamel extracellular matrix molecules e.g amelogenin, enamelin
Mgmt AI
enhanced prevention composite veneers fissure sealants SSC metal onlay
Dental implications AI
aesthetics sensitivity caries/acid susceptibility delayed eruption AOB
4 y/o presents. gross caries across anteriors inc smooth surface
cause
tx
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
3 types of dentinogenesis imperfecta
- associated with osteogenesis imperfecta
- autosomal dominant
- brandywine
Dental implications dentinogenesis imperfecta
aesthetics caries occult abscess poor long term prognosis root fracture
indications SSC
>2 surfaces affected/ broken down tx for severe MIH defects post pulpotomy/pulpectomy space maintainer marginal ridge breakfdown
how to place SSC conventionally
- 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
how does hall technique differ to conventional crown placement
no LA
no toothprep
no caries removal
how would you judge a crown has failed
secondary caries pulpitis crown lost crown rocking abscess
advantages of planned extraction of FPMs
indications of suitability for planned extractions of FPMs
spontaneous space closure
reduction in possible ortho need
caries free dentition
bifurcation of 7s forming
class I incisors
mild buccal crowding
2 disadvantages of planned XLA
bad experience
GA if goes wrong
difficult achieveing anaesthsia
most common cardiac defect in children?
which condition is this highly associated with
mgmt of these pt
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.
mgmt of external inflammatory resorption
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.
7 factors making up prevention plan
- OHI/ tooth brushing instruction
- Diet Advice
- Fluoride toothpaste
- F varnish
- F supplements
- Fissure
sealants - Radiographs
- Sugar free medication.
fluoride supplementation in areas of <0.3ppm F-
1mg/day fluoride tablets
name 3 sources of fluoride found in food and drink
beer
tea
cucumber
bony fish
clinical trauma review (trauma stamp) (8)
colour, displacement (ONLY AT 1st VISIT), mobility, sinus/tender in sulcus, EPT, Ethyl chloride, TTP, Radiographs.
cause of external inflammatory root resorption?
clinical signs?
mgmt?
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
indications for microabrasion
fluorosis ortho decal trauma pre-veneer to mask staining MIH - with predominantly brown lesions- little affect otherwise
up to 100ym removed
benefits and negatives microabrasion
\:) easy permanent conservative effective easy after care
:( caustic acid
in surgery only
enamel removal
unpredictable
describe process of microabrasion
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.
3 conditions assoc/ w/ hypoplasia
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
percentage incidence of primary and permanent hypodontia?
primary 0.9%
permanent ~6%
bleaching product components
10% carbamide peroxide
3.3% h202
6.6% urea
Why could a child be anxious before the dentist?
'infection' from parents negative experience previously expectation of pain/uncomfort friends negative/ unusual experiences media uneducated on modern analgesic techniques
How do you measure childhood anxiety?
MCDAS
modified child dental anxiety scale
pictures of faces for numbers
8 behavioural management techniques
modeling acclimitisation desensitisation tell show do distraction positive reinforcement progressive muscle relaxation hypnotherapy
6 y/o haemophilia A pt attends practice with buccal swelling and grossly carious 85.
What is haemophilia A?
dx?
tx?
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
name 3 local haemostatic agents
LA w/ vasoconstrictor tranexamic acid thombin, fibrin surgicel ferric sulfate gelfoam
triad of impairment in autism?
social impairment in :
- interaction
- imagination
- communication
features of autism? (6)
hypersensitivity hyposensitivity obsessive learning difficulties tubular sclerosis epilepsy
mgmt of autistic patients dental visits
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
indications for fissure sealants?
materials used
medically compromised caries in primary dentition high caries risk learning difficulties mental&physical handicap
bisGMA resin, GIC
describe technique for fissure sealant placement
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
4 types of cerebral palsy
How could it be further classified?
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
