Paeds

Question 1

what are the parts of caries risk assessment

Answer 1

clinical evidence, fluoride exposure, diet, plaque control, medical history, social history, saliva

Question 2

what are the parts of prevention

Answer 2

radiographs, fluoride varnish, fluoride supplement, diet advice, toothbruhsing advice, sugar free medication, fluoride toothpaste, fissure sealant

Question 3

how frequently should fluoride varnish be applied in both high and low risk patients

Answer 3

4 times a year high risk
twice a year low risk
fluoride varnish - 22,600ppm

Question 4

what are the fluoride toothpaste levels for patient younger than 3 years old, both high and low risk

Answer 4

smear of toothpaste
high risk - 13500-15000
low risk 1000ppm

Question 5

what are the fluoride levels in tooth paste for patients 3-10 both high and low risk

Answer 5

pea size amount
low risk - 10000ppm
high risk 15000ppm

Question 6

what are the fluoride levels in toothpaste for patients 10-16, both high and low risk

Answer 6

pea size amount
low risk - 15000ppm
high risk - 28000ppm

Question 7

how does fluoride work

Answer 7

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

Question 8

at what level is fluoride toxic

Answer 8

5mg/kg

Question 9

what is the ideal time for extraction of lower 6s and why

Answer 9

calcification of bifurcation of 7s, seen radiographically. Allow for 7s to move forward and close space, caries free dentition with no spaces

Question 10

what are disadvantages of removal of 6s

Answer 10

a lot for child to deal with, might need general anaesthetic, risks associated with this

Question 11

what causes bottle caries

Answer 11

bottle overnight with milk, high sugar, low saliva and low clearance, sugar sits on upper incisors and first molars, lower incisors protected by tongue

Question 12

what are some behaviour management techniques

Answer 12

tell show do, positive reinforcement, acclimitisation, voice control

Question 13

what are some things that cause concern for neglect

Answer 13

delay in presenting with pain
injuries in non-accidental areas - cheek, face, ear, pinching or burn marks
vague story
story not matching injuries

Question 14

optimal dose of fluoride in water

Answer 14

1mg

Question 15

where can fluoride be found, other than water

Answer 15

milk, salt

Question 16

what instructions should be given for brushing

Answer 16

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

Question 17

what order should treatment be carried out

Answer 17

pain management, OHI, prevention (fluoride varnish, fissure sealant), small restorations without LA, LA restorations upper first, the pulp treatment

Question 18

what is on the trauma stamp for permanent teeth

Answer 18

radiograph, mobility, TTP, percussion note, EPT, ECL, colour and sinus

Question 19

what determines the prognosis of permanent teeth after traum

Answer 19

type of injury, stage of root development, time between injury and treatment, PDL damage, infection present

Question 20

how are teeth with enamel fracture treated

Answer 20

either file down the sharp edges, or add composite to smooth out, review 6-8 weeks, 6 months, 12 months

Question 21

how are teeth with enamel and dentine fractures treated

Answer 21

dentine bandage, restoration - if close to pulp, CaOH can be put as a liner, review 6-8 weeks, 6 months, 12 months,

Question 22

how are teeth with enamel, dentine and pulp fractures treated

Answer 22

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

Question 23

how are root fractures classified and what has a better prognosis

Answer 23

apical, middle or coronal third

apical third has best prognosis - more PDL for crown to be held in by

Question 24

how are different root fractures treated

Answer 24

apical and middle - flexible splint for 2 weeks

coronal third - flexible splint for 4 week

Question 25

what are different outcomes of root fracture

Answer 25

calcified tissue laid down - similar to dentine connective tissue - eburnation, rounding of fracture bony - osteoblasts lay down bone along fracture line, two separate entities

Question 26

what is concussion and subluxation and what is treatment and prognosis for each

Answer 26

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

Question 27

what is extrusion and lateral luxation, treatment options and prognosis

Answer 27

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

Question 28

what is intrusion, treatment options and prognosis

Answer 28

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

Question 29

what first aid should be given for avulsion

Answer 29

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

Question 30

what is EAT and EADT

Answer 30

extra alveolar time - out mouth | extra alveolar dry time - out mouth but not in storage medium

Question 31

what is treatment for an avulsed tooth with an open apex and EAT less than 60 minutes

Answer 31

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

Question 32

what is treatment for an avulsed tooth with a closed apex and EAT less than 60 minutes

Answer 32

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

Question 33

what is treatment for an avulsed tooth with an open apex and EAT more than 60 minutes

Answer 33

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

Question 34

what is treatment for an avulsed tooth with a closed apex and EAT more than 60 minutes

Answer 34

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

Question 35

what are patient instructions after trauma

Answer 35

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

Question 36

what are radiographic signs of non-vitality

Answer 36

root resorption - infection related, inflammatory caused absence of continued root formation - root length and width unlike condralateral tooth infection present - periapical abscess

Question 37

what is damage to primary dentition after trauma

Answer 37

discolouration, with or without infection | delayed exfoliation

Question 38

what is damage to permanent dentition after trauma to primary

Answer 38

enamel defects - hypomineralisation or hypoplasia delayed eruption arrest in tooth formation ectopic eruption

Question 39

what is the review period for primary trauma

Answer 39

after initial treatment, review after 1 month, 3months, 6 months and year