paeds case Flashcards
how to describe clinical findings of a photo
extraoral:
-swelling/erythema/soft tissue lesions
-temperature
-lymph node involvement
intraoral:
-soft tissue-modified BPE >7 yrs
-OH
-type of dentition
-hard tissue: charting, caries, hypomin/TSL/mobility
-orthodontic: occlusion, molar and incisal, midline shift, spacing, crowding
when a patient attends, what further information do you want?
history taking:
-who have they attended with? who has parental responsibility?
-SOCRATES assessment for pain and sensitivity
-PDH: who has referred them, previous treatment history, attendance
-MH: diagnoses, medication, previous GA/hospital, allergies, details of health care professionals
-SH: social services/safeguarding concerns
medical questions:
-check diagnosis
-when diagnosed
-who is managing them? does the child see any medical specialists?
how does it affect their daily life?
taking any medications: name, dose, frequency
allergies?
hospitalised?
previous operations?
how would you alter SOCRATES for a child?
site: Can you point to the tooth or area that feels funny or is sore?
onset: When did you first notice the funny feeling in your teeth?
character: What does it feel like?
radiation: is the feeling just in one place or can you feel it in other teeth?
allievating factors: Does anything make it feel better?
timing: Does it come and go, or is it always there? Does it happen more at certain times, like when you’re eating or drinking?
exacerbating factors: What makes it worse?
severity: How bad does it feel if 0 is no pain and 10 is the worse pain? What number would you give it?
questions to ask when finding out about a medical condition
-check diagnosis
-when diagnosed
-who is managing them? does the child see any medical specialists?
how does it affect their daily life?
taking any medications: name, dose, frequency
allergies?
hospitalised?
previous operations?
what further investigations would you do?
-choose appropriate radiographs
-sensibility testing
-percussion
-trauma checks
how to do a radiographic report of OPG
type of radiograph
grade
alveolar bone levels
teeth present/eruption/development
radiolucent areas
radiopacities
pathology
other:
crowding
signs of supernumerary teeth
primary teeth close to exfoliation
impacted teeth
resorption
list of diagnoses
soft tissue: include gingival health, plaque induced gingivitis?
oral hygiene
caries risk status
type of dentition
hard tissue: radiographic findings and pathology, MIH, caries, TSL
orthodontic: spacing, crowding, centreline shift, occlusion if possible
how to determine prognosis of a tooth? specifically first permanent molar
tooth factors:
-caries/enamel quality/evidence of post eruptive breakdown
-colour and extent of lesion/caries
-plaque levels
-restorability
-timing
-presence /position of 3rd molars
-teeth present/developing
patient factors:
-ability to maintain oral hygiene/diet
-symptoms
-behavioural/anxiety
-medical
-social including parental expectations
how to present a paeds patient
age and gender of patient
who they attended with and do they have parental responsibility?
PCO: any concerns raised
HPC: docrates assessment re pain/sensitivity
PDH: who has referred them. previous treatment history, attendance
diet and oral hygiene and caries risk status
MH: diagnosis, medication, previous GA/hospital. allergies, details of health care professionals
SH: social services/safeguarding concerns
clinical findings:
soft tossie: include gingival health and plaque
hard tissue: type of dentition, include radiographic findings and pathology and orthodontic findings
management plan of paeds patient + considerations
considerations: age, consent, MH, caries risk, anxiety
- emergency management/advice as priority
- prevention plan tailored to individual risk factors:
-diet, OH, fluoride, fissure sealants - comprehensive treatment planning based on the clinical and radiographic findings
medical history: management
considerations
does the medical condition affect their oral health?
-dry mouth
-gingival health
-increased caries risk
any concerns re bleeding?
concerns re infection/healing?
any special precautions for dental treatment?
consider do I need to contact any health professionals?
management plan: dental emergency
considerations
cooperation/age of child
signs and symtoms: temperature, lymph involvement, mouth opening, eating/drinking
pain relief/antibiotics and/or
definitive care (consent)
management for acute abscess
airway, spreading infection? referral
antibiotics
management of reversible pulpitis
temporary dressing
resoring affect tooth +/- pulp therapy
managmement of irreversible pulpitis
first stage endodontics (permanent teeth)
extraction
consider GA if multiple teeth are of poor prognosis
antibiotic prescribing:
options
which is the most appropriate and why?
what are alternatives?
first line: phenoxymethylpenicillin
preferred due to its narrower spectrum of activity, which is less likely to drive antibiotic resistance
amoxicillin may be used when compliance is more challenging (phenoxymethylpenicillin QDS but amoxicillin TDS) easier for parents to adhere to schedule
absorption: amoxicillin=more acid stable so better efficient absorption from the GI tract. phenoxymethylpenicillin is more effective on empty stomach
metronidazole: narrow spectrum for anaerobic bacteria. used in cases of penicillin allergy
caries management in primary teeth
different management options
- prevention only: flupride, diet, OH, sealants
- biological approach: SDF, hall crowns (primary teeth only), sealants consider resin vs GIC
- restorative/surgical approach: treatment under LA: composite restorations, SSC +/- pulpotomies (primary teeth only), removal of any unrestorable teeth and/or teeth with pathology
MIH management of 6s
monitor/temporise: fuji triage, maintain until ideal timing
good prognosis (no minimal/post op breakdown): fissure sealant or direct composite restoration
moderate prognosis (post-op breakdown, generalised yellow/brown discolouration): restore- direct composite restoration or indirect composite/metal onlay or extract
poor prognosis: extract- consider compensating extraction
first molar extraction: predictors of success with second permanent molar eruption
Radiographic evidence SPM bifurcation mineralisation
Mesio-angulation SPM
TPM presence (usually evident radiographically by 8yrs
Expectation of 2 molars in each quadrant
compensating and balancing extractions of FPMs: RCS guidelines
compensating: not routinely carried out unless clear occlusal requirement or likelihood of upper FPM being unopposed for a significant period of time
anxiety management in paeds patient
options
what are they anxious about?
age of patient?
severity of anxiety?
non-pharmacological management:
-communication
-tell show do
-distraction
-positive reinforcement
pharmacological management:
-LA
-inhalational sedation
-general anaesthetic
how to explain a diagnosis to a patient/parent?
acknowledge concerns
explain diagnosis: aetiology, appearance, outcome, potential impact on QOL
reassure: management options available
agree action plan: what can you do as a dentist and what can they do at home?
encourage questions
