paeds chapter Flashcards
what information should you obtain through history and exam
medical history - conditions that may impair oral hygiene; medications that are sugar based or cause dry mouth
social history - living arrangements
dental history - last visit, brushing habits, F use
diet - quantity and frequency of sugar intake
exam - clean and dry teeth to inspect for early signs of decay; set appropriate recall based on risk factors
what OHI should be given once a year
<3 = smear 1000ppm as soon as first teeth erupt
3-6 = >1000ppm pea sized
>7 = 1450 ppm
brush twice a day for two mins, spit don’t rinse, assisted/supervised until age 7
>10 = 2800ppm F
>16 = 5000ppm F
what diet advice should be given once a year
promote a balanced diet
drink milk or water
reduce consumption of sugar containing food and drink to a max of 4x a day, ideally during during mealtimes
promote non cariogenic snack choices (cheese or vegetable sticks)
do not eat or drink after brushing at night
be aware of hidden sugars and acid content
what is the method for applying fluoride varnish
apply from the age of 3
low risk 2x a year; high risk 4x a year
0.25ml for ages 2-5; 0.4ml for >6
instructions - don’t eat or drink for 30 mins after application
contraindications - allergy to colophony, have been hospitalised due to asthma or ulcerative gingivitis
what are the basic management techniques for caries in the primary dentition
complete caries removal and restoration - considered best practice, suitable for all types of restorable carious lesions
partial caries removal and restoration - suitable for all types of restorable carious lesions; dependent on good marginal seal as not all caries removed; clear superficial caries and any obvious caries from the EDJ
no caries removal and restoration - fissure sealant, hall crown
no caries removal and self cleansing lesion and prevention advice - only if no alternative treatment is feasible; caveatted/ advanced cavities can be made self cleansing if no other measures are feasible; no LA required (remove undermined enamel and place F)
what are the indications for vital pulpotomy
indications - patient is able to tolerate all stages (LA, dam, radiographs); vital restorable molar tooth with caries >2/3 into dentine, carious or mechanical exposure of vital coronal pulp, no radicular pulpitis (no spontaneous pain, haemorrhage from radicular tissues is controlled), no abscess/fistula, extraction contraindicated
what is the operative procedure for vital pulpotomy of a primary molar
assess patient compliance, check medical history and re-obtain consent
administer LA and dam
remove caries present and access pulp chamber with a high speed
remove roof of pulp chamber - endo-z but or safe ended access burs are appropriate
large excavator or slow speed round bur to remove coronal pulp
rinse the chamber and apply ferric sulphate on cotton wool for 15s; if no haemostasis re-apply for a further 15s (if no haemostasis then radicular pulp is inflamed indicating extraction of pulpectomy)
fill pulp chamber with MTA, ZOE or BioDentine
remove dam
size PMC and seal with GIC while pt bites down on CWR
remove excess and floss inter proximally
carry out annual radiographic reviews
what are the indications for hall crown technique
inter proximal caries
caries on two or more surfaces
pulp treated teeth
what are the contra indications for hall crown technique
pulpal symptoms or caries close to pulp
patients at risk of infective endocarditis
insufficient tooth remaining to retain crown
what is the method for hall crown technique
obtain consent
place separators in contact point - not necessary in open contact points
remove separators 3-5 days later
place gauze to protect the airway
select the appropriate crown size but do not fully seat - look for spring back
dry the crown and place glass ionomer cement
dry the tooth and seat the crown with a combination of finger pressure and the child biting onto cotton wool - make the child aware of clicking sound and salt and vinegar taste
remove excess cement, floss interproximally
remove the gauze
ask the patient to maintain firm pressure until fully set
reassure patient that high bite will settle and advise POI if pain relief needed (paracetamol)
recall in 3 months
