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BDS4 > Paeds > Flashcards

Paeds Flashcards

1
Q

Types of hard tissue trauma

A 
Crown
- enamel infraction (crack)
- enamel #
- enamel-dentine #
- enamel-dentine-cementum #
- complex # (pulp exposure)
Root: cementum #
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2
Q

Types of PD trauma

A 
Concussion
- no abnormal loosening/displacement
- TTP+++
Subluxation
- abnormal loosening
- no displacement
- clinical: bleeding along gingiva
Extrusive luxation: partial displacement
Lateral luxation
- displacement (not axial)
- alveolar bone #/communition 
Intrusive luxation
- displacement into bone
-  tooth-bone contact 
- damage: blood supply 
Avulsion: complete displacement
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3
Q

Types of gingival + alveolar trauma

A

Gingiva

  • contusion (bruising)
  • abrasion
  • laceration

Bone

  • crack
  • through-through #
  • vertical # excl. PDL
  • vertical # incl. PDL
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4
Q

Sequelae of pulp following trauma

A 
Survival
Pulp Canal Obliteration 
Pulp Necrosis
Inflammatory Internal Resorption
- Transient
- Permanent
Replacement Internal Resorption
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5
Q

Discuss Pulp Canal Obliteration and Pulp Necrosis

A

PCO

  • overactive odontoblasts
  • clinical: yellowing (inc. dentine)

PN

  • polymorphs unable to ward off bacteria
  • inflammatory response: recruit cells, inc. blood supply
  • clinical: blackening (Hb -> haemocitirin Fe)
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6
Q

Discuss Inflammatory Internal Resorption and Replacement Internal Resorption

A

Inflammatory Internal Resorption
- Mechanism
— giant cells destroy infected tissue + resorb bone
— tooth vital; nerve may be damaged
- Transient (reversible)
— following giant cell resorption stems cells differentiate -> odontoblasts
Permanent (non-reversible)

Replacement Internal Resorption

  • tissue replaced by bone
  • stem cells -> osteoblasts
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7
Q

Sequelae of periodontal tissue following trauma

A 
Normal Healing
External Resorption
- Surface
- Inflammatory
- Replacement
— Arrested/Transient
— Progressive/Permanent
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8
Q

Discuss types of external resorption

A

Surface

  • self-limiting, transient
  • small, superficial cavities
  • limited to cementum + outer layers dentine
  • spontaneous healing

Inflammatory

  • expand: root + bone resorption
  • necrotic pulp constant stimuli for inflammation + osteoclast activity

Replacement

  • resorbed root replaced by bone
  • remodelling removes some tooth tissue
  • Transient (arrested) + Permanent (progressive)
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9
Q

Difference b/w ankylosis + replacement external resorption

A

Ankylosis

  • fusion b/w tooth surface + bone
  • w/o intervening inflamed connective tissue

Replacement external resorption has inflamed connective tissue

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10
Q

Sequelae of gingiva + root development following trauma

A

Gingiva

  • normal healing
  • attached gingiva loss

Root

  • continuous
  • disrupted
  • arrested
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11
Q

Aetiology of trauma

A 
Accidental
- slips/trips/falls
— cerebral palsy
— epilepsy 
- sports
- road traffic 
- bikes/scooters
Non accidental 
- assault
- physical abuse
Iatrogenic: intubation
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12
Q

Epidemiology of trauma

A

M:F 2:1
1/2 all children

Peaks

  • 3-6 (1ry dentition) as uncoordinated; 30%
  • 8-12 (permanent) play accidents; 20%
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13
Q

Prevention of trauma

A

NOT fully preventable due to accidental nature
- red. by identifying + eliminating risks

Cars: seat belts, child seats
Bikes: helmets
Contact sports: mouth guards
Supervision: child, pet
Non-contact sport
Education
- parents, caregiver, school
- 1ry care for traumatised teeth
- management for avulsed teeth
Health promotion
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14
Q

Types of dentine defects

A

Dentinogenesis imperfecta
Dentine dysplasia
Osteogenesis imperfecta

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15
Q

Signs of dentinogenesis imperfecta

A

Amber/grey/opalescence
Bulbous crowns (SSC difficult)
Wear easily: no scalloped EDJ so enamel chips, req. SSC
Pulpal obliteration

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16
Q

Important differentiating factor b/w dentinogenesis and amelogenesis imperfecta

A

Dentinogenesis imperfecta affects 1ry teeth worse than permanents whereas amelogenesis affects both equally

17
Q

Classification of enamel defects

A

Genetic
Environmental
Idiopathic

18
Q

Classification of amelogenesis imperfecta

A

1: Hypoplastic
2: Hypomaturation
3: Hypocalcified
4: Hypomaturation/Hypoplasia/Taurodontism

19
Q

Discuss hypoplastic AI

A 
Malfunction of enamel matrix formation 
Enamel abnormal thickness: v thin, sometimes absent 
Hard + translucent 
Chips easily 
Random pits + grooves
- black staining w/ CHX Tx

X-ray: normal

20
Q

Discuss hypomaturation AI

A

Mild defect of protein processing + crystalline growth

Normal thickness
Less hard cf T1
Wears easily

X-ray: similar to dentine

21
Q

Discuss hypocalcified AI

A

Severe defect initial crystalline mineralisation + calcification

Normal thickness; v brittle
Opaque/chalky appearance
Prone to staining + v rapid wear

X-ray: less radiopaque cf dentine

22
Q

Discuss T4 AI

A

Varied appearance w/ features from T1+2

All: taurdontism, sensitivity

23
Q

Why can enamel be affected by the environment?

A

Ameloblasts v sensitive to environment

  • O2 levels
  • specific concentrations of ions
24
Q

Types of environmental enamel defects

A

Tetracycline staining
Hyperbilirubinaemia
Fluorosis
Chronological hypoplasia

25
Q

Discuss tetracycline staining

A

Chelates Ca2+, incorporates into teeth
Initially: dentine yellow-green, visible through enamel
Later: tetracycline oxidises -> brown

Don’t prescribe: <12y, pregnant mothers

26
Q

Affect of hyperbilirubinaemia on teeth

A

Bilirubin can be taken into teeth where becomes trapped

Yellow/blue-green staining

27
Q

Discuss fluorosis + chronological hypoplasia

A 
Fluorosis 
- excessive fluoride intake 
— fluoridated H2O mainly Somalia 
- mild: opaque white flecks 
- severe: hypoplastic patches -> brown/black staining 
- check MH: older children/siblings

Chronological hypoplasia

  • 1ry dentition
  • lines/rings missing enamel
  • symmetrical
  • Tx: flowable, if O affected -> onlay
28
Q

What is MIH?

A

Molar incisor hypomineralisation
Idiopathic cause of enamel defects

Characterised by:

  • hypomineralisation of 1-4 of 6s
  • associated w/ opacities on Is
29
Q

Clinical features of MIH

A

White-cream/yellow-brown demarcated opacities
Sensitive
Atypical restorations; cusp tips > fissures
Caries in unusual places
Asymmetric

Ms
- opacities porous
- post-eruptive breakdown + caries
- confused w/ AI hypoplasia
— chipped enamel sharp cf smooth for hypoplasia
30
Q

Tx aims for MIH/enamel defects

A

Improve aesthetics
Red. sensitivity
Prevent wear/breakdown
- maintain arch length + OVD

31
Q

Tx options for ant. teeth w/ enamel defects

A 
Accept/none
FV/tooth mousse for sensitivity
Micro-abrasion 
Infiltration 
Comp
Porcelain veneer
32
Q

Discuss enamel micro-abrasion and infiltration Tx

A

Microabrsion

  • indications: fluorosis, mild defects
  • remove 100um enamel (removes opacity)
  • post-Tx: white F toothpaste, avoid staining 48h

Infiltration (ICON)

  • resin infiltrate
  • indications: MIH
  • contraindications: AI
33
Q

Management of MIH in post. teeth

A 
XLA
Consider
- severity/symptoms 
- part of generalised condition 
- developmental age (ideal time for XLA)
- crowding
- skeletal relationships 
- hypodontia
34
Q

Classification of soft tissue lesions in children

A

Infectious

  • viral
  • bacterial
  • fungal
Ulcers
White lesions 
Cysts
Epulides
Systemic disease related
Factious

BDS4 (10 decks)

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