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Paeds and Trauma Flashcards

1
Q

an 8yo child attends with an enamel dentine pulp fracture. You are happy the patient is medically fit with no other injuries.

What two things do you need to know about the injury before you decide whether or not a dirct pulp cap or pulpotomy is the most appropriate treatment?

A

When did the injury occur? Even if pinpoint exposure, if it had been 24hrs plus, high chance of bacterial ingress

Size of the exposure; more than 1mm pulpotomy is best choice

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2
Q

19yo patient attends on Monday morning having sustained trauma to 11, 12 on Saturday. 12 crown missing and sub alveolar fracture. 11 pulpal exposure of 2mm. Both teeth sensitive. Four steps in management of 11?

A

*Locate the missing fragment of tooth
*Give LA and apply rubber dam
*Pulpotomy; Access pulp chamber, remove coronal pulp, achieve haemostasis with CWP and water/ferric sulphate, place CaOH, seal with GIC, composite bandage
*If unable to achieve haemostasis, pulpectomy.

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3
Q

19yo patient attends on Monday morning having sustained trauma to 11, 12 on Saturday. 12 crown missing and sub alveolar fracture. 11 pulpal exposure of 2mm. Both teeth sensitive.
Why would a subalveolar fracture 12 deem the tooth unrestorable?

A

*Lack of coronal tissue to bond to/support/retain restoration.
*Inability to achieve moisture control
*Inability to take impression for indirect restoration.
*Hard to establish marginal integrity/difficulty cleaning

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4
Q

Explain the stages of a pulpotomy for tooth 11

A

* Apply dental dam

* Remove pulp tissue at 2-3mm radius around the exposed area

* Assess bleeding - if no bleeding, remove more tissue

* Gain heamorrhage control using CWP and saline (NOT ferric sulphate in a permanent tooth as it stains!)

* If hyperaemic, remove more tissue

* Once normal bleeding has stopped, apply non setting calcium hydroxide

* Seal with GI

* Restore with composite restoration

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5
Q

Following a pulpotomy, the patient remains asymptomatic and you are now about to take a 6 month post op radiograph. The pulp has remained vital, what favourable sighs would you expect to see on the radiograph?

A

* Continued root development

* Continued thickening of dentine in the root walls

* No signs of pathology

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6
Q

Name 4 fluoride supplements and their doses you would give a patient to prevent decalcification

A

Toothpaste 1450ppmF 2 x daily

Fluoride varnish 22,600ppmF 4 x yearly

Mouthwash 450ppmF 1 x daily

Fluoride tablets, 1mg 1 x daily

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7
Q

Name two methods of preventing decalcifications besides fluoride

A

OH and diet advice

Fissure sealants

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8
Q

5yo Jodie has been brought in by her mothers boyfriend. She has not been sleeping due to pain. Has never been to dentist before. Facial swelling. Boyfriend vague about MH.

What should you establish prior to examination?

A

Severity of condition. Thorough MH. Consent - record everything that is said and carried out in notes

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9
Q

5yo Jodie has been brought in by her mothers boyfriend. She has not been sleeping due to pain. Has never been to dentist before. Facial swelling. Boyfriend vague about MH.

Describe in detail one behavioural management technique to get cooperation

A

Tell. Show. Do

Explain to Jodie what she can expect. Show her the instruments, 3 in 1, medicaments you plan to use. Demonstrate carrying out exam/treatment, get Jodie to help hold mirror etc

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10
Q

5yo Jodie has been brought in by her mothers boyfriend. She has not been sleeping due to pain. Has never been to dentist before. Facial swelling. Boyfriend vague about MH.

Jodie has been uncooperative, what would short term management be?

A

Drainage

Pain reliefe

ABs (amoxicillin 500mg 3 x daily 5 days)

Tell parent she must be brought back

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11
Q

5 year old child brought to practice with pain and swelling by mums bf. Has never attended dentist before. How would you address previous non attendance?

A

Ensure up to date contact details

Take accurate and detailed notes

Contact mum by phone (or other guardians)

Discuss with mother the necessity of child attending appts

Inform mum of possibility of child protection involvement if non compliant

Set appt over the phone and arrange appropriate escort

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12
Q

What evidence based brushing advice would you give for a 5yo to prevent caries?

A

Brush 2 x daily with fluoried TP 1450ppm

Modified bass technique

Brush 2-5 minutes

Use a pea sized amount of toothpaste

Spit dont rinse

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13
Q

What does a BPE score of 3 indicate?

A

Probing depth of 3.5-5.5mm

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14
Q

What teeth should be probed to obtain a BPE score in a 13yo?

A

Modified BPE until 17yo. Ramjfords teeth. 16, 11, 24, 36, 31, 44

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15
Q

What is the normal depth from CEJ to crestal bone?

A

2mm

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16
Q

13yo presents with BPE scores of 3, what medical condition may they have?

A

Diabetes

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17
Q

13yo patient presents with BPE scores of 3. No relavent MH, what could be the cause?

A

Aggressive periodontitis

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18
Q

13yo patient presents with BPE scores of 3s from modified BPE score. What other investigations would you want?

A

PGI.

6PPC

Radiographs

Diet diary

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19
Q

13 yo patient presents with BPE scores of 3s. What is your treatment plan?

A

Initial non surgical debridement and HPT. Refer to a specialist

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20
Q

A patient has fractured 11. What two questions would you want to ask about the traumatised tooth?

A

When and how did it happen? Can you account for lost fragments?

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21
Q

List four things that determine the prognosis of a traumatised tooth.

A

Type of fracture (complicated/not complicated)

Maturity of tooth

Open or closed apex

Tooth mobility

Vitality of the pulp

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22
Q

Following a traumatic tooth injury in a child, what should be discussed with the parents?

A

Inform them of complications; change in colour, loss of vitality, pain, sinus, infection, damage to adjacent teeth. Inform them of prognosis and treatment options

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23
Q

How would you treat and enamel dentine fracture?

A

Indirect pulp cap, GI or composite restoration

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24
Q

Patients parents complain about white/yellow/brown staining on teeth. What 8 questions would you want to ask patients mum?

A

Pregnancy; any illness, difficulties? Anaemia, gestational diabetes?

Perinatal; normal delivery? Complications? Preterm birth?

Postnatal; prolonged BF, medications, fevers.

Childhood infections; chickenpox, measles, rubella

25
Q

Patients parents complaining of white/yellow/brown spots on childs teeth. List 5 questions to rule out fluorosis.

A

Excessive use of fluoride toothpaste?

Flouride supplements?

Fluoridated water?

Sibling/parent using high F toothpaste

OH regimen

26
Q

List 3 potential future problems due to MIH

A

Caries susceptibility

Difficulty restoring; poor bonding

Poor long term prognosis

Potential requirement for more complex/extensive/expensive treatment

Orthodontic problems

27
Q

A co-operative 10 year old patient attends with moderate crowding requesting orthodontic treatment, but has poor oral hygiene and cavitated caries into dentine in the first permanent molars.
Describe your management of the case.

A

History - Full history, Assess if pain/history of pain, Ask the patient about their ortho concerns
Caries risk assessment - diet, fluoride exposure, socio-economic, oral hygiene, medication, saliva quality, MH
OPT & bitewings - other caries risk, Clinical examination, Special tests: vitality testing, Deal with pain first, Dealing with the caries in the 6’s, GA, sedation, LA (risks, benefits, alternatives), Review developing dentition
Prevention regime - 4x fluoride varnish a year, duraphat 2800ppm, OHI, fissure sealants, sugar free medicines
Tell the patient and the parents that ortho treatment is not appropriate at the moment
Why the patient wants ortho (parent/patient), Inform the patient of the risks, That this could be changed in the future with appropriate oral hygiene care. Ensure that the patient knows that this can be changed, Assess child protection/patient neglect

28
Q

Describe the risk-benefit discussion you would have with the patient and parent regarding ortho treatment with 6s of poor prognosis

A

Risks of ortho - Root resorption, Relapse, Decalcification, Gingival recession, Other: wear, gingival ulceration, non-completion
Risks of extracting 6’s - Mesial tipping of 7’s, Distal migration of 5’s, Extracting at the right time - Bifurcations of the 7’s, 8’s are present
Risks of GA - Nausea, drowsiness, vomiting, Slow recovery, Death, Permanent brain injury, Malignant hyperpyrexia

29
Q

7yo with impacted upper 6s, crowded upper 2s. Give 5 possible Tx options for 6s

A

* Leave and monitor

* Surgical extraction

* Coronectomy

* ABs and analgesics

* Operculotomy

* XLA Es

* Remove distal aspect of Es

* Ortho appliance to bring 6s into arch

* Ortho seperators

30
Q

What features of the permanent dentition allow for the replacement of primary teeth without crowding?

A

Growth of maxilla

Proclination of permanent teeth

Extension of dental arch

Presence of space between primary teeth (primate space)

31
Q

What is leeway space and how does it prevent crowding?

A
32
Q

10yo extrudes 11. What materials/splint would you use? How long would you splint for?

A

Flexible ss wire splint for 2 weeks

Flexible ss wire

Acid etch 37%

Composite resin

Water

33
Q

What 4 tests would you do at a check up following trauma besides a radidograph?

A

EPT

Ethyl chloride

TTP

Mobility

Check for displacement

Check for colour change

Check for sinus

34
Q

What advice should be given over the phone following avulsion of a permanent incisor?

A

Reassure the patient

Do not handle tooth by the root

Do not reimplant if it is a primary tooth

Gently rinse under slow running cold water for 10 seconds

Reimplant ASAP or store in saliva, milk, saline

Come to GDP ASAP

35
Q

Pt attends following trauma. What should you check upon arrival?

A

How and where did the incident occur?

Was consciousness lost? Was there any nausea/vomitting? If yes - A&E!

Account for all tooth fragments

Check tetanus status

36
Q

What type of splint is advised following avulsion?

A

EADT <60mins flexible splint for 2 weeks

EADT >60mins flexible splint for 4 weeks

37
Q

What are some common outcomes following avulsion of a permanent incisor?

A

Discolouration

Mobility

Necrosis of the pulp

Ankylosis

Root resorption

38
Q

What are the clinical signs of osteogenisis imperfecta and dentinogenesis imperfecta?

A

OI Blue sclera, frequent/multiple fractures

DI Loss of enamel. Discolouration. Affects both dentitions. Amber appearance of affected teeth

39
Q

What are the radiographic signs of dentinogenesis imperfecta?

A

Occult abcsess

Bulbos crowns

Short and thin roots

Teeth erupt with large pulp chambers but obliterated soon after

40
Q

What is the clinical management of dentinogenesis imperfecta?

A

Prevention

Composite veneers

Over denture

RPD

SSC

41
Q

What are the two modes of action of SDF?

A
  1. Promotes arrest and remineralisation of active carious lesions, dentinal caries and teeth with exposed root surfaces causing hypersensitivity.
  2. Promotes reduced sensitivity in permanent molar teeth with MIH via occlusion of dentinal tubules.
42
Q

What is the patient selection criteria for SDF?

A
  1. Pericooperative children whose behaviour/medical conditions limit invasive treatment.
  2. Need to delay treatment with sedation/GA
  3. High caries risk with compromised MH
  4. Part of biological caries management plan where carious lesions are also brushed twice daily and diet modifications have been made.
43
Q

What are the contraindications for SDF?

A
  1. Signs/symptoms of pulpal involvement.
  2. Radiographic peri-radicular radiolucency
  3. Infection/pain from pulpal origin
  4. Active ulceration
  5. Pregnant/breastfeeding
  6. Undergoing thyroid treatment.
  7. Non compliance with TB/diet
44
Q

What is SDF?

A

Silver diamine fluoride.
A colourless, odourless solution of silver, fluoride and ammonium ions.

45
Q

What is the concentration of SDF?

A

38%, 44,800 ppm fluoride ions

46
Q

Give 4 extra oral features of Downs syndrome

A

Round skull

Atlanto-axial instability

Oblique palperal fissures

Brushfield spots

Cataracts

Thick fissured dry lips

Small midface

Thick neck

Obesity

MH - CLP, CVD, epilepsy, hearing problems

47
Q

Give 4 intra oral features of Downs syndrome

A

Large fissured tongue/macroglossia

Maxillery hyperplasia

High arched palate

AOB

Class III skeletal base

CLP

Hypodontia

Microdontia

Increased perio disease due to immunocompromised

Spacing

48
Q

Following a root fracture, what types of healing can occur

A

Calcified tissue union accross fracture line

Connective tissue healing

Calcified tissue and connective tissue healing

49
Q

Following a root fracture, what is considered non healing?

A

Granulation tissue

50
Q

How are root fractures managed?

A

If undisplaced and no mobility - soft diet and monitor

If displaced and mobile - reposition under LA and splint

51
Q

How would you manage a patient with a root fracture that has lost vitality?

A

RCT to fracture line (ns CaOH then MTA or extract

52
Q

What are some signs of fluorosis?

A

Varies with severity; symmetrical white spots/flecks, brown spots, mottling, pitting

Occlusal surfaces of 6s unaffected

53
Q

How can fluorosis be managed?

A

Accept

Microabraision

Composite veneers

Porcelain veneers (over 18)

Bleaching however this may also affect white spots making them more obvious

54
Q

What are the advantages of non vital bleaching?

A

Easy

Conservative

Safe

No lab involvement

55
Q

What are the disadvantages of non vital bleaching?

A

External cervical resorption

Relapse

May fail

Over bleaching

Crown brittleness

56
Q

Briefly describe the walking bleach technique

A

Take pretreatment shade

Take clinical photo

Take radiograph to asses RCT

Dental dam

Access and remove GP below gingival margin

Ensure good coronal seal

10% carbamide peroxide bleach on CWP

Cover with dry CWP and seal with GIC

Renew every 2 weeks up to 10 times until happy with result/shade

Then place temp ns CaOH for 2 weeks to reverse acidity

Definitive restoration

57
Q

What is the only splint used for primary teeth?

A

Flexible for 4 weeks for alveolar bone fracture

58
Q

What is the difference between a flexible and rigid splint?

A

Flexible 1 tooth either side of trauma

Rigid 2 teeth either side of trauma

Final Flashcards (13 decks)

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