Paeds Flashcards
How many different sizes are there per tooth?
6 sizes
When would you use preformed crowns?
When large or multi-surface carious teeth are involved
pulp treated teeth
Trauma
Enamel and dentine defects - imperfecta
Abutment for crown-loop space maintainer
Infraoccluded teeth to maintain mesial/distal space (vertical space)
When would you not use preformed crowns?
unrestorable tooth
failed pulp therapy
teeth that are soon to exfoliate
When would you be cautious about placing preformed crowns?
severe wear/ severe space loss
pre-cooperative
poor motivation
Multiple grossly carious teeth
When should you use preformed crowns in permanent teeth?
Hypomineralised molars Amelogenesis imperfecta temporary restoration severe erosion Dentinogenesis imperfecta
What are the advantages of preformed metal crowns?
Straightforward technique
quick and cheap
evidence of excellent longevity, low failure rates, compares well with other materials
failure can be easily corrected
What are the disadvantages of preformed metal crowns?
Poor aesthetics
may impede eruption of adjacent teeth if too big
may cause gingival inflammation if cement not removed completely
theoretical nickel allergy risk
What should you tell the patient/parent about the PMC
They stay on until the tooth falls out
They need to be brushed just like normal teeth
The glue tastes a bit like lemons/salt and vinegar crisps
They feel a bit funny to bite on to start with
How would you protect the child’s airways when using a PMC?
Gauze with adhesive handle
What is the technique to placing a PMC?
- topical/LA
- remove caries
- pulpotomy/pulpectomy if needed
- prepare tooth (occlusal reduction first, then meisial and distal reduction)5. Select crown
- Adapt crown or modify prep
- cementation
What do you cement the PMC with?
Glass ionomer (Aquacem) - creamier consistency
How would you adapt the crown to deal with problems?
- poorly adapted crown - crimp it
- space loss - modify shape and use crown from opposite side and arch
- gingival blanching - will resolve
- occlusal discrepancies - will resolve
What is the Hall technique?
- No tooth prep
- no local
- no try-in
- not for extensively carious teeth
- caries not removed but sealed into tooth to isolate it
How is the hall technique carried out?
If necessary place separators 1 week before
Topical (optional)
Choose crown
Airway protection
Try crown to contact point only
Fill crown with GIC
Push down as far as possible
Allow child to bite on band seater/cotton wool roll
Remove excess cement with wet gauze
Get child to bite together
Remove further cement with gauze, excavator or probe
Knotted floss between contact points (practice biting down with the child first)
What is the difference between the Hall technique and the conventional method of placing PMC?
No occlusal reduction - but anterior open bite will resolve itself in the next few weeks
No removal of caries
usually no local either
What is object permanence?
Understanding objects continue to exist when they cannot be seen
Why is child development relevant for dentists? 203
Predict what a child is experiencing in the dental surgery
Interpret what children are thinking, feeling and how they are behaving
Dental professionals to support young patients
What can an infant at 6 months do physically, emotionally and socially, sensory and cognitively? 203
Physical Sit without support Reach and grab a toy Put objects in their mouths Feeds themselves with fingers
Emotional and social
Distressed when their mother leaves
Increasing wariness to strangers
Sensory
Turn towards noise
Visually very alert – follow activities
Cognitive
Understand meaning of words such as ‘bye-bye’
Start to understand objects
What can an infant at 12 months do physically, emotionally and socially, sensory and cognitively? 203
Physical
Can (probably) walk alone
Can turn pages in a book
Throw toys deliberately
Emotional and social Emotionally labile Wary of strangers Reassurance from familiar adult Help with daily routines
Sensory
Know and respond to own name
Enjoy watching television
Cognitive
Understand simple instructions – wave ‘bye-bye’
What can an infant at 24 months do physically, emotionally and socially, sensory and cognitively? 203
Physical
Can run, jump, climb
Walk up and down stairs
Emotional and social May play alongside other children Easily frustrated leading to tears/tantrums Clingy at times/independent at times Dress independently
Sensory
Recognises themselves in photos
Cognitive
Speaks > 200 words and understand many more (favourite word - no!)
Short attention span
Likes to share songs and conversations
What can an infant at 5 months do physically, emotionally and socially, and cognitively? 203
Physical
Skip, hop, stand on one foot
Ride a bike without stabilisers
Use a knife and fork
Emotional and social Like to do things unaided Make-believe play Play with other children and make friends (I am not your friend today) Confuse fact and fiction Help others when distressed
Cognitive
Interested in reading/writing
Likes jokes
Fluent in speech
What are the three theories of child development? 203
Cognitive Development -Piaget
Development of personality- Freud
Psychosocial development- Erikson
What is cognitive development? 203
Development of thinking
Includes language & communication
How children come to learn and understand about their body and their health
Size of the child is a poor indicator
What is Piaget’s cognitive development theory? 203
Children think differently to adults (not less competently)
Interested not in if children answered questions correctly, but how they reached their answers
Four discrete stages - sensorimotor, pre-operational, concrete operational, formal operational
Piaget suggested there is a qualitative change in how children think as they progress though stages
What assimilation? 203
Bringing new information into an existing body of knowledge
What is accommodation? 203
Altering the body of knowledge to include new knowledge that is inconsistent ith what is already known
What is equilibrium? 203
Balance between applying previous new knowledge and accounting for new knowledge
What is schema? 203
System of action or mental representation that people use to understand the world
What does the sensorimotor stage of cognitive development involve? (Piaget) 203
Birth to 2 years
Infants explore the world through their senses and applying their developing motor skills
Birth to 1 month: Inborn survival reflexes (grasping and sucking)
Infants initially will look at visual stimuli and turn heads towards a noise, but are not interested in the object itself
At 3 months they begin to follow moving objects with their eyes
At 6 months they can grasp and hold objects
At 12 months they explore objects
Imitate actions they have seen others perform – pretend to feed a toy
Use words to represent objects
Object permanence
– understanding objects continue to exist when they cannot be seen
What does the pre-operational stage of cognitive development involve? (Piaget) 203
2-7 years
Rapid development of language
Egocentrism – others see the world as they do
Development of symbolism to make sense of the world– represent a horse by making galloping movements
What does the concrete operational stage of cognitive development involve? (Piaget) 203
7-12 years
Logical reasoning – real-world objects or events
Cause-and-effect
Empathise with others
Understanding that the physical properties of objects stay the same even though the appearance might change (can’t do with hypothetical objects)
What does the formal operational stage of cognitive development involve? (Piaget) 203
> 12 YEARS
Need exposure to principles of scientific thinking to reach this stage
Abstract reasoning – think and reason about hypothetical objects or events (take a mental representation and reason about them)
Hypothetico-deductive reasoning for complex problem solving
What is formal operational egocentrism? 203
Young people believe others are as preoccupied with their appearance and actions as they are themselves
Construct and react to an ‘imaginary audience’ where they are the centre and focus of attention
‘Audience’ may also contribute to feelings of self-consciousness
Believe in the uniqueness of their own feelings and their own immortality (personal fable)
What is the criticism of Piaget’s theory? 203
Observations based on a few children
If a child is observed not completing a test, does that mean that they are cognitively not capable of it?
Is learning really this orderly?
Underestimates children
Social and cultural effect (Vygotsky’s theory) - children learn tasks that are too difficult to manage alone from interactions with another person
What are the 3 parts of Freud’s personality theory? 203
Id Contains drives/ needs No conscious mental processes Babies/infants are governed by their ID Works on the pleasure principle (maximum amount of pleasure/ avoid pain) e.g. if you are hungry the Id compels you to eat
Ego
Mediator (police) between ID and Superego and demands of reality
Rational and logical
Negotiating is more effective way of meeting drives/needs then, ‘I want’
Superego Develops from 4-years Contains moral lessons have learned Duty, obligation and conscience Punishes wrong-doings with feelings of guilt
When do defence mechanisms occur in Freud’s theory? 203
Ego contains defence mechanisms that become active whenever unconscious instinctual drives of the id come into conflict with internalised rules of the superego (causes state of anxiety)
What type of defence mechanisms exist? 203
Repression: mind’s active attempt to prevent traumatic memories from our conscious awareness most powerful
Projection: attribute personal short-comings to others (blame others)
Denial: refuse to acknowledge realities
Conversion: outlet for intrapsychic conflict is physical symptoms (blindness/paralysis)
What is Erikson’s psychosocial development? 203
Theories on how we interact with others
8 stages (5 in childhood/adolescence) – successful completion results in a healthy personality and sense of self
Two options for each stage – success or failure
What are the 5 stages of Erikson’s theory in childhood? 203
Trust versus mistrust
(birth to 1 year)
Autonomy versus shame and doubt (1 to 3 years)
Initiative versus guilt
(3 to 6 years)
Industry versus inferiority
(6 years to 12 years)
Identity versus role confusion
(12 to 18 years)
What individual differences affect child development? 203
Disabilities – learning/physical
Psychological variables
Intelligence (Arnup et al., 2002)
Coping strategies (Versloot et al., 2004)
Learned behaviour
Family factors
Parenting styles
What type of parenting styles exist? (PAAN)
Authoritarian
Highly controlling, strict & punitive (Because I said so..)
Do not allow their child to disagree with their decisions
Leads to anxiety, poor communication skills
Authoritative
Clear and realistic expectations for behaviour
Set high standards for behaviour and encourage children to be independent
Lead to children with high self-esteem and self competent
Permissive
Responsive
Makes few demands on behaviour and sets few guidelines
Avoid confrontation
Lead to children who experience problems with authority and lack self-control
Neglectful/rejecting
Uninvolved in child’s life
Impacts on self-esteem
What are the practical tips for managing toddlers in the dental surgery?
Generally considered pre-cooperative for dental treatment
Communication skills are limited so common response of upset is to cry
Do not separate from a parent – examine on parent’s lap
Keep appointment times short
What are the practical tips for children age 3 and 4 in the dental surgery?
Considered potentially co-operative Gain attention with lots of distraction Let them ‘help you’ where possible Use appropriate language (childrenese) Short attention span so work steadily and avoid pauses
What are the practical tips for managing school aged children in the dental surgery?
Usually have sufficient co-ordination to brush their own teeth and can follow ‘rules’ about oral care
Try and involve children in what you are doing
Respond well to positive reinforcement
Use appropriate language and simple explanations, and encourage questions
What are the practical tips for managing teenagers in the dental surgery?
Develop an adult concept of health
Supported to make own health care decisions
May be motivated by concerns about attractiveness
May be easily embarrassed and sensitive to criticism
Seen without parents?
