Paeds all Flashcards
chickenpox: - caused by? incubation period? what% of cases subclinical? route of transmission? recovery time?
varicella zoster 14-21 days 50% droplets, airbourne route 2-3 weeks
clinical features of chickenpox?
ulcers rash cervical lymphadenitis fever malaise
shingles is a complication of chicken pox caused by?
affects what nerve?
associated with?
herpes zoster
trigeminal nerve
immunodeficiency
signs of shingles?
complication of shingles?
pain, rash, mouth ulcers
ramsay hunt syndrome - genilculate zoster - rash in ear, facial palsy and ulcers on ipsilateral soft palate
tx of shingles?
analgesics and aciclovir
PHG is a disease caused by?
systemic features?
oral features?
herpes simplex
fever, malaise, lymphadenopathy
painful erythematous and swollen gingiva with tiny vesicles on perioral skin and vermillion border on lips and OM
PHG most common between?
commonly mistaken for?
lesions heal when?
how are they treated?
6m to 6 years
teething
1-2 weeks
symptomatic tx
what are complications of PHG?
recurrent
herpes labialis
intra oral
herpetic whitlow
what is Hand foot and mouth caused by? occurs how? oral lesions tend to be? oral signs? systemic signs? lesions resolve when?
coxackie epidemics under 5 years painful lesions vesicles and ulcers anywhere orally macules, papules on feet hands and toes 2 weeks
what is mumps?
incubation period?
signs?
differnetiate from what before diagnosing?
viral infection of salivary glands
14-21 days
bilateral swelling of parotid glands
obstructive/ bacterial sialadenitis
what are signs of measles?
incubation period?
high risk of?
highly contagious
systemic symptopms and skin rash
10-14 days
bacterial complications
what are oral signs of measles?
kopliks spots
small red macules with white necrotic centres
what is rubella?
how is it spread?
incubation period?
signs?
mild viral disease
droplet infection
14-21 days
rash on face, behind ears, mild fever, sore throat, enlarged lymph nodes
what is herpangina caused by?
signs?
resolves when?
vesicles on soft palate with fever, malaise, sore throat, hard to swallow
resolves in a week
what can febrile illness cause?
enamel hypoplasia
measles/chickenpox
what is enamel hypoplasia?
how is it caused?
incomplete or defective formation of enamel = alteration in form or colour
- results bc disturbance or damage to ameloblasts during enamel matrix formation
appearance of hypoplasia?
perm centrals/laterals/first molars
horizontal rows of pits transversing the tooth surface
varies with severity and extend of injury to ameloblasts
categories of impairment?
intellectual
physical
sensory
what is downs syndrome caused by?
susceptible to?
signs?
oral risks?
chromosomal disorder
caridac problems
large tongue, large fingers/hands
- delayed primary exfoliation, hypodontia, hypoplastic teeth, susceptible to perio
what is often the main problem impeding OH in downs syndrome pt?
access/ability to brush
what is fragile x syndrome?
commonly affects who?
effects?
genetic disorder
males
mental impairment/learning disabilities
what is the main issue with treating fragile x pt?
problems understanding or tolerating tx
what are common problems found with tx of autistic or schizophrenic pt?
communication/probs with relationship formation
ensure what re tx for autism or schizophrenia?
prevention
limit tx to what is tolerated
not too long a wait
short sessions
what is dyslexia?
what is the main problem faced by the pt?
what is the management?
usually causes problems with cognition
does not fully understand what is happening
rx at slow pace, explain in easy terms
what is the tx of an ADHD pt?
keep apps short
easy and short tasks
take lots of breaks
challenges faced with a physically impaired pt dentally?
gag and cough reflex hypoplastic teeth - sensitivity access to mouth manouvering wheelchair lifting pt excessive saliva flow self inflicted intra oral wounds
how to manage physically impaired pt?
aggressive prevention operative intervention early modify tx plan if necessary pts may need sedation/GA TB modification/electric TB
how to manage blind pt?
tell then do
low reassuring voice
relay info on how brush feels in mouth etc
how to manage a deaf pt?
visual aids where necessary
sit directly in front of
no masks obscuring face
how may tooth formation be affected?
genetically determined
local/systemic factors
both
what teeth are commonly missing?
8’s, 5’s, 2’s
missing perm teeth are seen in what % of pts with missing primary teeth?
30-50%`
patients with supernumerary teeth have what chance of being followed by SN in perm dentition?
30-50%
mesioden is?
paramolar/distomolar is?
maxilla:mandible ratio?
what can SN’s be associated with?
ant maxilla SN
molar region SN
5:1
cleidocranial dysplasia
what is megadontia?
teeth larger than normal
pituitary gigantism
what is microdontia?
lateral incisors affected called?
other teeth commonly affected?
more common in?
teeth smaller than normal
peg shaped
max third molars
females
short roots common in?
long roots common in?
also poss caused by?
oriental
african
irradiation of jaws, chemo during root formation
poss ortho tx
what are double teeth/gemination?
developmental seperation of a single tooth germ to produce 2 seperate teeth
unknown cause
rare
ants and deciduous commonly affected
what are double teeth/fusion?
union of two normally separated adjacent tooth germs
poss hereditary
primary dentition common
what is concresence?
joining of two teeth one of which could be a SN by cementum
trauma/crowding/root surfaces in close proximity
max molars commonly affected
tooth formation disorders tend not to be treated in the primary dentition, tx in permanent?
tx dependent on
space available in arch
morphology of pulp chamber/canals
degree of attachment between tooth
what is an invaginated tooth?
infolding on palatal surface of the crown of the tooth and lined with enamel, sometimes extending into root
aka dens in dente
normal tooth tissue in abnormal form
deepened pit or crevice in cingulum
tx of invaginated teeth?
FS after eruption
vitality test/radiograph
endo tx if pulp involved
small tuberlce on occlusal surface of premolar in central part of fissure
what a talon cusp?
a horn like projection of the cingulum of the maxillary incisor teeth which may reach and contact the incisal edge of the tooth
what is the tx of talon cusp?
FS margins
poss pulpotomy
no tx if no interfernece with occlusion
tx of a evagninated teeth?
xrays to determine any pulpal involvement
remove tubercle and limited pulpotomy may be required
what is taurodontism?
bull like teeth where pulp chamber of teeth is vertically enlarged at expense of roots
what is amelogenesis imperfecta?
generalized enamel defects affecting all of teeth of primary and secondary dentitions
genetic or inherited
what are the classifications of amelogenesis imperfecta?
hypoplasia or hypomineralisation?
describe hypoplasia?
deficient enamel matrix resulting in: thinner enamel grooved or pitted glossy hard or translucent
describe hypomineralisation?
defect in mineralisation norm thickness but v soft discoloured yellow brown opaque/chalky prone to caries/weak enamel enamel chips easy
what is the management of amelogenesis imperfecta? - localised
generalised?
localised - preformed crowns
generalised - aesthetics, senstive to thermal and mechanical stimuli
poor oh and staining
what is dentinogenesis imperfecta?
inherited disorder of dentine which may not be associated with osteogenesis
- primary and perm teeth affected
- opalescent/grey or brown
- enamel flakes off because poor adhesion
- pulpal exposure likely
molars have short roots and canal obliteration
perm dentition generally less affected
how can syphillis affect deciduous teeth?
treponema pallidium in the dental follicle transmited via the placenta, associated with blindness deafness or paralysis
what anomalies occur with congenital syphillis?
hutchinsons incisors
mulberry molars
moons molars
describe hutchinsons incisors?
affects upper central incisors
notch in incisal edge
MD narrowing of incisal portion of the crown
may lead to ant open bite
what are mulberry molars?
first perm molars affected
occlusal surfaces rough and pitted
compressed nodules instead of cusps
similar in appearance to a raspberry or mulberry
what are moons molars?
affects perm molars
round or dome shaped
what is an enameloma?
small spherical projection on a root surface
abnormal displacement of ameloblasts abnormally dispalced during tooth formation
max molars commonly affected
attached to cementum near root bifurcation area
how does primary tooth pulp therapy differ to RCT?
- increased no of accessory canals foramina and porosity increased
- canals more ribbon like
- fine filamentous pulp system
- more difficult canal debridement
- complete extirpation of pulp remnants
- increased perforation
causes of irriversible pulpitis?
caries
trauma
wear
if the marginal ridge is broken down even if the radiograph is relatively unaffected what is likely to be happening?
irriversible pulptitis
what is a carious exposure?
point where communication exists between pulp and oral cavity
symptoms similar to irriverisible pulpitis
could be symptom free/pulp polyp
contraindications to pulp therapy?
unrestorable tooth long term
pt un cooperative
medically compromised
ortho xla
tx options for vital primary teeth?
pulp capping
pulpotomy
desensitising pulp therapy
what type of pulp capping is unsuitable for primary teeth?
direct
what is a pulpotomy?
removing the diseased coronal portion of pulp only and applying medicaments to the remaining pulp tissues = continued function
- greater success than pulp capping
contraindications to pulpotomy?
abscess - infected/inflamed radicular pulp
excessive bleeding upon access to pulp chamber
no bleeding on access to pulp chamber
describe formocresol?
tricesol - antiseptic
formalin - tissue fixative
binds bacterial and pulp tissue proteins
bacteriocidal and devitalising agent
tissue fixed and rendered inert and resistant to breakdown by bacterial enzymes
side effetcs of formocresol?
mutagenic and carcinogenic fast absorption in kidneys/liver local soft tissue damage if formocresol passes through foramen superficial tissue devitalisation 80-90% of pulps become non vital
how to use formocresol?
small amount on blotted cotton pledget
isolation of tooth
well sealed restoration margins to prevent leakages
describe ferric sulphate?
excellent haemostatic agent
not a fixative
antimicrobial qualitites unknown
15% to pulp stiumps for 15 secs
describe gluteraldehyde?
aqueous sol 2-4%
powerful fixative agent
toxic effects
describe calcium hydroxide?
internal resorption = problem
equal efficacy with formocresol when used in pure powder form - analytical grade
encourages new dentine formation from pulp
dentine bridge formed remaining pulp tissue now has an effective barrier against bacterial invasion
allows pulp to heal rather than fixing
clinical technique of pulpotomy?
LA, isolate
outline form to access caries - remove all caries prior to pulp access
large access cavity - remove entire roof of pulp chamber with SS bur + care not to damage floor of pulp chamber
remove contents of chamber
saline irrigation
apply medicaments
if after medicament stage in pulpotomy there is still uncontrolled bleeding what could be the next step?
desensitising pulp therapy
pulpectomy
what is a tooth having undergone a pulpotomy restored with?
hard setting calcium hydroxide
backfill with zinc oxide and eugenol
perm SSC
what is desensitising pulp therapy?
used in order to reduce pulpal inflammation/or symptoms in order to facilitate pulpotomy or pulpectomy
indications for desensitising pulp therapy?
carious pulp exposure - no signs or symptoms of vitality loss
hyperaemic pulp during attempted pulpotomy
hyperalgesic pulp
technique of desensitising pulp therapy?
open and gain access to pulp chamber
cotton pledget with ledermix over exposure site
well sealed temp dressing
rev 2 weeks, proceed with pulpotomy or pulpectomy
what is the tx for non vital pulp tx?
how does it differ to pulp amputation?
pulpectomy
aim is not to preserve viable tissue but not to remove necrotic tissue and obturate canals
differs in pulpectomy to RCT?
apical foramina wider = damage to perm tooth germ easy
root canals rbbon shaped harder instrument
root canal walls thin = prone to perforate
teeth resorb = material must be resorbable
phases of pulpectomy?
1 - canal debridement
2 - obturation
phase 1 of pulpectomy?
LA
isolate
large access cavity
necrotic tissue removed from pulp chamber
irrigate with sodium hypochlorite
canal instrumentation
files kept short of apex
file canal walls, remove debris, irrigate
dry canal walls with paper points or cotton pledget
place temp dressing - l=kalzinol/ledermix, non setting caoh
review 7-10 days
phase 2 of pulpectomy?
remove temp dressing irrigate and dry canals place resorbable root filler zinc oxide eugenol/caoh pack densly but take care around foramen fill zinc oxide and eugenol perm restoration
what reviews should be done following pulp therapy?
rev at 6 monthly interviews
follow up radiographs taken at yearly interviews
reasons to restore deciduous teeth?
restore form restore aesthetics restore function maintain space acclimatisation avoid sepsis and infection avoid extraction
important differences in structure of deciduous teeth?
smaller enamel is thinner pulp relatively larger horns nearer surface aprismatic ename flatter and wider contact points
stages of deciduous tx planning?
relief of pain, prevention at home, prevention professioanlly
- stabilisation of caries
- restorations
- pulp therapy
- extractions
- behaviour management
- reinforce prevention
if a child presents with toothache, check for what?
abscesses caries trauma toothwear infection soft tissue lesions exfolliation or eruption
signs of reversible pulpitis?
o/e?
radiographically?
- sweet, hot, cold
- pains stops when stimuli removed
- short duration
- occurs when eating mainly
- early carious lesion
- caries into dentine
signs of irriversible pulpitis?
o/e?
radiographically?
constant relieved by analgesics kept awake lymphadenopathy, raised temp, extensive marg reduction, sinus, intra oral swelling caries close to pulp/radiolucency
what to consider when deciding to restore/extract>
type of pulpitis
likelihood of pulpotomy to restore
quality and quantity of tooth tissue to restore
prev xla or edentuluous spces
reasons to extract?
balancing extractions
non compliance
no parental support
no attendance beyond pain relief
what is temporisation?
temp dressing is effective in relieving pain until restoration can be completed, extracted or arranged to be kept under observation
material should not be detrimental to the pulp, good seal and not conflict with final restoration
what is stabilisation?
managing the child with continual poor OH with active high amounts of caries needs to be thought and should be stabilised first before definitive restorations provided
how is stabilisation achieved?
remove caries from cavity margins and dress to buy time for cooperation to improve and tx of restorable teeth
what is the value of stabilisation?
in the pre cooperative pt - prevents lesion progression
multiple carious lesions - arrests caries in a long plan
prevent sensitivity in teeth close to the tooth to be restored that day and out with the range of LA
how does thinner enamel affect cavity prep?
caries penetration distance is more rapid = less distance
cracking/fractures are more common
small burs used
pulp horns nearer surface
how does the cervical bulge with gingiva constriction affect cavity prep?
floor of box tends to be too deep
re establish floor by moving axial wall towards pulp - exposure risk
how does the narrow occlusal table affect cavity prep?
cusps weakened by overextension of cavity prep in bucco lingual direction
how do the broad contact areas located gingivally affect cavity prep?
difficulties in clearing box in a buccal/lingual direction
how do large pulp horns seated below cusps affect cavity prep?
isthmus must be narrow to avoid pulpal exposure
to reduce failure of material the pulpoaxial line angle may be deepened to increase material bulk
what is the aim of a restoration?
remove caries and prepare a cavity with minimal invasion of tooth tissue and with little/no discomfort for the pt
how is pulp exposure risk increased when deepening a box?
removal of dentine adjacent to pulp horn = exposure
what is hall crown technique?
method of managing carious primary molars using PMC’s but wihout tooth prep, caries removal or use of LA
