Paeds Flashcards
Types of hard tissue trauma
Crown - enamel infraction (crack) - enamel # - enamel-dentine # - enamel-dentine-cementum # - complex # (pulp exposure) Root: cementum #
Types of PD trauma
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
Types of gingival + alveolar trauma
Gingiva
- contusion (bruising)
- abrasion
- laceration
Bone
- crack
- through-through #
- vertical # excl. PDL
- vertical # incl. PDL
Sequelae of pulp following trauma
Survival Pulp Canal Obliteration Pulp Necrosis Inflammatory Internal Resorption - Transient - Permanent Replacement Internal Resorption
Discuss Pulp Canal Obliteration and Pulp Necrosis
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)
Discuss Inflammatory Internal Resorption and Replacement Internal Resorption
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
Sequelae of periodontal tissue following trauma
Normal Healing External Resorption - Surface - Inflammatory - Replacement — Arrested/Transient — Progressive/Permanent
Discuss types of external resorption
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)
Difference b/w ankylosis + replacement external resorption
Ankylosis
- fusion b/w tooth surface + bone
- w/o intervening inflamed connective tissue
Replacement external resorption has inflamed connective tissue
Sequelae of gingiva + root development following trauma
Gingiva
- normal healing
- attached gingiva loss
Root
- continuous
- disrupted
- arrested
Aetiology of trauma
Accidental - slips/trips/falls — cerebral palsy — epilepsy - sports - road traffic - bikes/scooters Non accidental - assault - physical abuse Iatrogenic: intubation
Epidemiology of trauma
M:F 2:1
1/2 all children
Peaks
- 3-6 (1ry dentition) as uncoordinated; 30%
- 8-12 (permanent) play accidents; 20%
Prevention of trauma
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
Types of dentine defects
Dentinogenesis imperfecta
Dentine dysplasia
Osteogenesis imperfecta
Signs of dentinogenesis imperfecta
Amber/grey/opalescence
Bulbous crowns (SSC difficult)
Wear easily: no scalloped EDJ so enamel chips, req. SSC
Pulpal obliteration
Important differentiating factor b/w dentinogenesis and amelogenesis imperfecta
Dentinogenesis imperfecta affects 1ry teeth worse than permanents whereas amelogenesis affects both equally
Classification of enamel defects
Genetic
Environmental
Idiopathic
Classification of amelogenesis imperfecta
1: Hypoplastic
2: Hypomaturation
3: Hypocalcified
4: Hypomaturation/Hypoplasia/Taurodontism
Discuss hypoplastic AI
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
Discuss hypomaturation AI
Mild defect of protein processing + crystalline growth
Normal thickness
Less hard cf T1
Wears easily
X-ray: similar to dentine
Discuss hypocalcified AI
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
Discuss T4 AI
Varied appearance w/ features from T1+2
All: taurdontism, sensitivity
Why can enamel be affected by the environment?
Ameloblasts v sensitive to environment
- O2 levels
- specific concentrations of ions
Types of environmental enamel defects
Tetracycline staining
Hyperbilirubinaemia
Fluorosis
Chronological hypoplasia
Discuss tetracycline staining
Chelates Ca2+, incorporates into teeth
Initially: dentine yellow-green, visible through enamel
Later: tetracycline oxidises -> brown
Don’t prescribe: <12y, pregnant mothers
Affect of hyperbilirubinaemia on teeth
Bilirubin can be taken into teeth where becomes trapped
Yellow/blue-green staining
Discuss fluorosis + chronological hypoplasia
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
What is MIH?
Molar incisor hypomineralisation
Idiopathic cause of enamel defects
Characterised by:
- hypomineralisation of 1-4 of 6s
- associated w/ opacities on Is
Clinical features of MIH
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
Tx aims for MIH/enamel defects
Improve aesthetics
Red. sensitivity
Prevent wear/breakdown
- maintain arch length + OVD
Tx options for ant. teeth w/ enamel defects
Accept/none FV/tooth mousse for sensitivity Micro-abrasion Infiltration Comp Porcelain veneer
Discuss enamel micro-abrasion and infiltration Tx
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
Management of MIH in post. teeth
XLA Consider - severity/symptoms - part of generalised condition - developmental age (ideal time for XLA) - crowding - skeletal relationships - hypodontia
Classification of soft tissue lesions in children
Infectious
- viral
- bacterial
- fungal
Ulcers White lesions Cysts Epulides Systemic disease related Factious
