Paeds Flashcards
what are the parts of caries risk assessment
clinical evidence, fluoride exposure, diet, plaque control, medical history, social history, saliva
what are the parts of prevention
radiographs, fluoride varnish, fluoride supplement, diet advice, toothbruhsing advice, sugar free medication, fluoride toothpaste, fissure sealant
how frequently should fluoride varnish be applied in both high and low risk patients
4 times a year high risk
twice a year low risk
fluoride varnish - 22,600ppm
what are the fluoride toothpaste levels for patient younger than 3 years old, both high and low risk
smear of toothpaste
high risk - 13500-15000
low risk 1000ppm
what are the fluoride levels in tooth paste for patients 3-10 both high and low risk
pea size amount
low risk - 10000ppm
high risk 15000ppm
what are the fluoride levels in toothpaste for patients 10-16, both high and low risk
pea size amount
low risk - 15000ppm
high risk - 28000ppm
how does fluoride work
fluoride ions incorporated into hydroxyapatite, forms fluorapatite, stronger and less soluble in acid, enhance reminerallisation, prevent demineralisation, arrest caries, inhibit caries - prevents metabolising of bacteria
at what level is fluoride toxic
5mg/kg
what is the ideal time for extraction of lower 6s and why
calcification of bifurcation of 7s, seen radiographically. Allow for 7s to move forward and close space, caries free dentition with no spaces
what are disadvantages of removal of 6s
a lot for child to deal with, might need general anaesthetic, risks associated with this
what causes bottle caries
bottle overnight with milk, high sugar, low saliva and low clearance, sugar sits on upper incisors and first molars, lower incisors protected by tongue
what are some behaviour management techniques
tell show do, positive reinforcement, acclimitisation, voice control
what are some things that cause concern for neglect
delay in presenting with pain
injuries in non-accidental areas - cheek, face, ear, pinching or burn marks
vague story
story not matching injuries
optimal dose of fluoride in water
1mg
where can fluoride be found, other than water
milk, salt
what instructions should be given for brushing
should be supervised, brush twice a day - once at night before bed and at one other point, fluoride toothpaste, spit dont rinse, brush teeth as soon as erupt
what order should treatment be carried out
pain management, OHI, prevention (fluoride varnish, fissure sealant), small restorations without LA, LA restorations upper first, the pulp treatment
what is on the trauma stamp for permanent teeth
radiograph, mobility, TTP, percussion note, EPT, ECL, colour and sinus
what determines the prognosis of permanent teeth after traum
type of injury, stage of root development, time between injury and treatment, PDL damage, infection present
how are teeth with enamel fracture treated
either file down the sharp edges, or add composite to smooth out, review 6-8 weeks, 6 months, 12 months
how are teeth with enamel and dentine fractures treated
dentine bandage, restoration - if close to pulp, CaOH can be put as a liner, review 6-8 weeks, 6 months, 12 months,
how are teeth with enamel, dentine and pulp fractures treated
if less than 1mm and within 24 hours - direct pulp cap
if larger than 1mm or longer than 24 hours - partial pulpotomy, remove 2mm of coronal pulp, place CaOH and GI
if hyperaemic or necrotic - full pulpotomy
review in 6-8 weeks, 6 months and a year
how are root fractures classified and what has a better prognosis
apical, middle or coronal third
apical third has best prognosis - more PDL for crown to be held in by
how are different root fractures treated
apical and middle - flexible splint for 2 weeks
coronal third - flexible splint for 4 week
what are different outcomes of root fracture
calcified tissue laid down - similar to dentine
connective tissue - eburnation, rounding of fracture
bony - osteoblasts lay down bone along fracture line, two separate entities
what is concussion and subluxation and what is treatment and prognosis for each
concussion - damage to tooth and surrounding structures but no bleeding, mobility or displacement. normally no treatment required. chance of pulp survival high - 100 and 95%, root resorption low
review - 4 weeks, 6-8 weeks and year
subluxation - damage to tooth and surrounding structures, bleeding and mobility but no displacement. treatment - dont always need splint but may improve comfort, 2 week flexible splint, prognosis good 100 and 85% pulp survival, root resorption 1% and 3%
review - 2 weeks, 4 weeks, 6-8 weeks, 6 months and year
what is extrusion and lateral luxation, treatment options and prognosis
extrusion - axial displacement of tooth, PDL damaged, reduce and reposition, flexible splint for 2 weeks, prognosis 95% and 45% pulp survival, root resorption 5% and 7%
lateral luxation - displacement in non-axial direction, PDL damaged - tear and crushing injury. reposition and flexible splint for 4 week. pulp survival 95% and 25% root resorption 7% and 38%
review - 2 weeks, 4 weeks, 6-8 weeks, 3 months, 6 months and then yearly for 5 years
what is intrusion, treatment options and prognosis
displacement of tooth axially up the socket, crushing the PDL. requires extrusion. if open apex, less than 7mm - spontaneous. if open apex more than 7mm - orthodontic or surgical extrusion. if closed apex less than 3mm - spontaneous, 3-7mm orthodontic or surgical, more than 7mm - surgical. prognosis not good - closed apex will need RCT, better to initiate immediately to prevent external inflammatory resorption
what first aid should be given for avulsion
dont handle tooth by root, by crown only
if obvious debris rinse in cold water for 10 seconds
re-implant immediately if possible
if not, place in milk, saliva or physiological saline as storage medium.
go to dentist ASAP
what is EAT and EADT
extra alveolar time - out mouth
extra alveolar dry time - out mouth but not in storage medium
what is treatment for an avulsed tooth with an open apex and EAT less than 60 minutes
remove any debris, re-implant, confirm position clinically and radiographically, flexible splint for 2 weeks, chlorhexidine mouthwash twice a day. review 2 weeks, 4 weeks, 2 months, 3 months, 6 months, yearly
what is treatment for an avulsed tooth with a closed apex and EAT less than 60 minutes
remove any debris, re-implant, flexible splint for 2 weeks, carry out RCT within 10 days of trauma, place steroid antibiotic paste, remove in 2 weeks and place CaOH for 4-6 weeks, then obturate with GP. review 3 months, 6 months and yearly
what is treatment for an avulsed tooth with an open apex and EAT more than 60 minutes
remove any debris, re-implant, flexible splint for 4 weeks, review closely for signs of non vitality 2 weeks, 4 weeks, 2 months, 3 months, 6 months, yearly for 5 years
what is treatment for an avulsed tooth with a closed apex and EAT more than 60 minutes
remove any PDL cells, carry out RCT outside mouth if able, re-implant, flexible splint for 4 weeks. If RCT not done outside mouth, do it inside but within 10 days of trauma to prevent infection related root resorption
what are patient instructions after trauma
soft diet for 2 weeks, no contact sports for 2 weeks, brush as normal with soft brush, chlorhexidine mouthwash 2 times a day for 10 days
what are radiographic signs of non-vitality
root resorption - infection related, inflammatory caused
absence of continued root formation - root length and width unlike condralateral tooth
infection present - periapical abscess
what is damage to primary dentition after trauma
discolouration, with or without infection
delayed exfoliation
what is damage to permanent dentition after trauma to primary
enamel defects - hypomineralisation or hypoplasia
delayed eruption
arrest in tooth formation
ectopic eruption
what is the review period for primary trauma
after initial treatment, review after 1 month, 3months, 6 months and year
