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BDS3 > Paeds (COH, Ortho & Endo) > Flashcards

Paeds (COH, Ortho & Endo) Flashcards

1
Q

What are 3 ways in which the increased width of permanent INCISORS are accommodated for?

A
  1. Primate Spacing (in deciduous dentition) 2. Proclination (permanent incisors erupt palatal/lingually) 3. Growth of maxilla/mandible
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2
Q

Outline the steps in Cveks’s Partial Pulpotomy…

(Include review times)

A
  • LA/Rubber Dam
  • Access cavity
  • Remove 2mm (1-3mm) infected pulp tissue
  • Control haemorrhage with saline cotton pleget
  • Cover pulp with non-setting CaOH
  • Seal with SETTING CaOH & GIC
  • Restore with composite
  • Review: 6-8 weeks and then 1 year after
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3
Q

Give an example of 1. Positive 2. Negative Reinforcement, used to reduce child anxieties

A
  1. POSITIVE = Stickers, Certificates or Positive encouragement
  2. NEGATIVE = Remove stimulus (e.g. if we don’t behave teddy/mummy will have to leave”)
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4
Q

What is meant by “Primate Spacing” in Deciduous dentition?

A

Space between: B+C (before C) in upper arch C+D (after C in lower arch Which then allows for more space upon eruption of permanent teeth

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5
Q

What are 3 requirements to do Pulpectomy on decidious teeth?

A
  1. “Irreversible Pulpitis” diagnosed - Clinical signs (including profuse bleeding after initial Pulpotomy stages)
  2. NON-Vital radicular pulp (+/- infection) - If infection on opening, temporise and do in 2 stages
  3. Good Px cooperation
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6
Q

According to 1989 Children’s Act, which adults have parental responsibility? (5)

A
  • Birth mothers
  • Birth fathers married to (or were married to) birth mother at time of childs birth
  • UNmarried birth fathers of children born after 01/12/2003 if name on birth certificate
  • Legal (Special) guardians - Court order
  • Local authorities - Child in care

N.B. Foster Carers do NOT have PR

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7
Q

How might the following patients require additional imput during GA:

  1. Diabetic?
  2. Bleeding disorders?
  3. Sickle-Cell disease?
A
  1. Insulin sliding scale & Glucose monitoring
  2. Factor replacement
  3. Pre-op hydration
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8
Q

In surface remodelling, does the anterior maxilla undergo APPOSITION or RESORPTION?

Explain this in reference to overall maxilla growth direction/translation…

A

RESORPTION

This goes AGAINST, the overall translation of the Maxilla in the downwards and forwards direction

This translation is achieved mainly through growth at (Cranomaxillary) Suture

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9
Q

What are 7 indications FOR Pulp Therapy (saving a carious tooth)?

A
  • MH Contra-indications to XLA (E.g. bleeding disorder)
  • Co-operative Px
  • Motivated Px
  • Regular attender
  • Previous Tx (LA experience)
  • Long time before tooth exfoliation
  • Strategic (e.g. maintain E’s)
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10
Q

What is the difference between PULPOTOMY and PULPECTOMY?

(Define both)

A

PULPOTOMY = Removal of Coronal Pulp

PULPECTOMY = Removal of Coronal AND Radicular Pulp

Pulpe_c_tomy = _C_omplete

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11
Q

What are the IDEAL properties of a conscious sedation agent? (7 - Think process of administering, action and recovery)

A
  • Comfortable and non-threatening method of administration
  • Rapid onset
  • Predictive sedative and anxiolytic action
  • Controllable duration of action
  • Analgesic (no LA/needles needed)
  • No side effects
  • Rapid and complete recovery
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12
Q

What are 2 aims of conscious sedation for the DENTIST?

A
  1. Safe completion of quality care (via minimising any disruptive behaviours of child)
  2. Leave child fit for discharge at end of treatment
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13
Q

What are some of the safety features on IHS machines?

A
  • Scavenger systems - ball should stay in middle
  • Nitrous Oxide “Shut off” - Minimum of 30% O2 delivery at all times, automatic shut off of NO2 if exceeds 70%
  • Pin index patterns - Different for O2 and NO2 to ensure no confusion
  • Pressure reducing valves - Reduce to 60psi
  • Colour Coded
  • Oxygen Flush button
  • Bodok Seal - gas tight seal betweeen cylinder and tubing
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14
Q

What are 2 contraindications to GA in children?

What is 1 extra (only applies to adults)?

A
  • MH comorbidities (e.g. cardiac problems)
  • Allergies to drugs used in GA

Adult only: No suitable escort available

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15
Q

What are the 3 aims of PULPOTOMY?

(Think process)

A
  1. Remove inflammed coronal pulp
  2. Preserve /fix remaining radicular pulp
  3. Maintain tooth viability
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16
Q

What are 3 main safety considerations during conscious sedation, which should be monitored?

A
  1. Px is conscious (duh)
  2. Px retains protective reflexes
  3. Px can understand and respond to verbal stimulus throughout
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17
Q

What are the advantages (1) and disadvantages (3) of endodontic treatment on an IMMATURE tooth?

A

ADVANTAGES: Good prognosis as better blood supply

DISADVANTAGES:

  • Shorter root (less favourable crown to root ratio)
  • Difficult to obturate (open apex!)
  • Weak root (increased risk of fracture
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18
Q

What are 3 aims of conscious sedation for the CHILD?

A
  1. Prevent/reduce anxiety-related dental fear and pain
  2. Improve cooperation
  3. Promote positive attitude & response to treatment
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19
Q

What are 7 signs of OVER Sedation with IHS?

A
  • Nausea/Vomiting
  • Headaches
  • Px complains of feeling “unpleasant”
  • Laughing or giddiness
  • Decreased cooperation (e.g. persistant mouth closing)
  • Irregular respiratory rate
  • Loss of consciousness
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20
Q

What are the advantages of Nitrous Oxide use in Inhalation Sedation? (10)

A
  • Colourless, slightly sweet gas at RT
  • Anxiolysis (via GABA)
  • Mild analgesia - Opioid (N.B. Only mild, LA needed & Benzodiazepines are NOT analgesic)
  • Low blood gas solubility → Rapid induction & recovery
  • Haemodynamic stability
  • Minimal metabolism (less than 0.01%)
  • Weak anaesthetic (MAC 105%) → Difficult to make Px unconscious
  • Non irritant to mucosa
  • Hypnosis & Euphoria
  • Flexible depth and duration of anaesthesia
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21
Q

Outline the pre-operative checks for IHS…

A
  • Px MH (especially no airway blockages, if temporary e.g. hayfever → Delay Tx)
  • Eaten
  • Escort present (responsible parent/guardian with no other children present)
  • Consent
  • Chaperone (trained dental nurse) present through entire procedure
  • Pre-procedural machine checks
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22
Q

What are 5 indications of Inhalation Sedation use in child?

A
  1. Dental Anxiety
  2. Long procedures
  3. Traumatic procedure (e.g. XLA)
  4. Gag reflex
  5. Medically compromised patient (e.g. cardiac problems where GA CI)
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23
Q

In absence of an adult with PR, who can consent for a child’s life-saving treatment? (2)

A
  • School teachers in loco parentis
  • 2 Consultants
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24
Q

What are 3 anatomical differences between Immature and Mature Permanent teeth?

A
  1. Shorter roots
  2. Open root apex
  3. Thinner dentine
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25
Q

How should suspected child abuse be reported in the dental practice?

A
  • Take detailed history & examination, talk to parent/carer and child about injury causes
  • Consult with colleagues
  • Explain concerns to parent/carer (unless suspect risk to child)
  • Report to social services or safeguarding team within hospital trust
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26
Q

What is the difference between APEXOGENESIS and APEXIFICATION?

N.B. Both done on IMMATURE PERMANENT teeth (not deciduous)

(Define both)

A

APEXOGENESIS = Pulp therapy on VITAL tooth, performed to encourage physiological development of root

APEXIFICATION = Pulp therapy on NON-VITAL tooth, performed to induce a calcified barrier at open apex of incomplete root formation, through use of CaOH (natural barrier) or MTA (artificial barrier)

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27
Q

Outline the clinical procedure when administering IHS for Px

A
  • Pre-op checks
  • Machine turned on and set to: 100% O2 at 6L/min for 1 min
  • Incremental increases in NO2:
  1. 10% increase per min till 20% NO2
  2. 5% increase per minute after
  • Gradually increase NO2 concentration till adequate sedation is achieved
  • Pharmacological assistance given to Px: Calm voice, Story-telling & Reassurance
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28
Q

What are the 5 options for Pulp Therapy in decidious teeth?

Which has the lowest success rate?

A
  1. Indirect Pulp Capping (CaOH)
  2. Direct Pulp Capping - NOT RECOMMENDED, LOWEST SUCCESS RATE
  3. Cvek’s Partial Pulpotomy (1-3mm coronal pulp)
  4. Conventional Pulpotomy
  5. Pulpectomy
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29
Q

Where are growth rotations most common?

In terms of Facial height, Overbite and Space closure…What are the outcomes of:

  1. Forward rotation?
  2. Backward rotation?
A

Mandible (but can also occur in maxilla)

FORWARD

  • DECREASED facial height (short face)
  • INCREASED overbite
  • Space closure = DIFFICULT

BACKWARD

  • INCREASED facial height
  • DECREASED overbite OR an openbite
  • Space closure = Easier
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30
Q

When is “Two Stage Pulpotomy” / “Desensitisation” done? (2)

What are the stages?

A

If uncooperative Px or inadequate analgesia

  1. Remove as much coronal pulp as possible
  2. Place Ledermix/ Odontopaste on pulp and cover with Temp filling (IRM/GIC)
  3. Px returns 7-10 days later
  4. Remove filling and assess (Continue with Pulpotomy OR Pulpectomy)

Ledermix → Tooth devitalisation

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31
Q
A
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32
Q

What is meant by “Flush Terminal Plane” in Deciduous dentition? When and how is this later lost?

A

Straight line of occlusion between E’s on upper and lower jaw, leading to Class II occlusion Lost through “Leeway Space” as combined messy-distal width of C,D and E is LARGER than that of 3,4 and5 (By 1mm/quadrant on upper and 2mm/quadrant on lower jaw)

Erupting teeth guided into Class I (perfect) occlusion upon loss of E’s

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33
Q

Outline the POST-operative procedure & checks after IHS (3)

A
  • Give Px oxygen flush: 100% O2 for 2-3 mins to prevent diffusion hypoxia
  • Slowly sit Px up, give POIG (verbal & written) and discharge with responsible parent/guardian
  • Fill in Tx record form and rate sedation level with “Ramsey Scale”
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34
Q

What are the eruption dates for Permanent dentition? In general, do upper or lower teeth erupt first?

A

In general, lower teeth will erupt first. (General: 6-8 = Incisors and 6s 10-12 = Rest) 6 YEARS: U+L6, L1 7 YEARS: U1, L2 8 YEARS: U2 11 YEARS: L3, U+L4 12 YEARS: U3, U+L5, U+L7 (All +/- 18 months) 17-21 YEARS = U+L8

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35
Q

What are the 4 types of abuse a child may encounter?

A
  1. Emotional
  2. Physical
  3. Sexual
  4. Neglect
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36
Q

What is the best type of consent for IHS?

A

2 Stage Consent

1st at Tx appt (given written leaflet to take home and mask to practice with)

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37
Q

What are 3 medical conditions with signs that may be confused with abuse?

A
  • Impetigo - Similar to cigarette burns
  • Birthmarks - Bruising
  • Facial infcetion - Trauma

N.B. Also consider CLUMSY children!

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38
Q

What are 4 SIGNS adequate sedation has been achieved with IHS?

A
  • Normal, smooth respiration (12-20 breaths/min)
  • Decreased muscle tone → Relaxed arms and legs
  • Peripheral vasodilation (slight flushing of extremeties and face)
  • Slight increase in BP & HR (SNS activity)
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39
Q

When is Ledermix or Odontopaste used in endo?

What do they do?

A

Steroid/Antibiotic Paste used in “2 step technique”/ “Desensitisation” in cases of uncooperative Px or inadequate analgesia.

Placed after coronal pulp removal and Ledermix causes Tooth devitalisation

Temporary restoration placed on top, Px returns 7-10 days later (remove and continue with treatment)

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40
Q

Outline the initial stages of Pulpotomy in a deciduous tooth. How do you dictate whether to continue pulpotomy or change treatment?

A
  1. Give LA
  2. Apply Rubber dam
  3. Access cavity and caries removal
  4. Remove pulp chamber roof → Canal visualisation
  5. Irrigate
  6. Remove coronal pulp with EXCAVATOR
  7. Control haemorrhage with saline-soaked Cotton Plegit (apply with pressure for 4 mins)

HAEMOSTASIS ⇒ Pulpotomy

NO HAEMOSTASIS ⇒ Pulpectomy or XLA

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41
Q

What are 4 features of the nasal mask used for IHS?

A
  • One way breathing valve
  • Active scavenger system
  • Inner & Outer lining
  • Hose connectors
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42
Q

What is meant by the “Ugly Duckling Phase”? How does it often present?

A

During Mixed Dentition: Impact of unerupted canine crown on roots of neighbouring 2 –> Splaying of incisors (Often resolved upon eruption of the canine!) May present as midline diastema

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43
Q

What is the difference between Cranial Base and Cranial Vault?

(Hint: Start by describing them and give examples)

A

CRANIAL VAULT

  • Flat bones of skull (e.g. frontal, parietal, occipital and squamous part of temporal)
  • Separated by sutures (or “fontanelles” at birth)
  • Growth: INTRAMEMBRANOUS

CRANIAL BASE

  • Inner bones of skull (e.g. ethmoid, sphenoid, basioccipital and petrous part of temporal)
  • Growth: Endochondral & “Spheno-occipital Synchondrosis”)
44
Q

[Think Endo]

What are 5 anatomical differences between decidious and permanent teeth?

(Hint: Where does bone loss occur? How large is the pulp? Where are accessory canals?)

A

DECIDUOUS:

  • Larger pulp chamber with more pronounced pulp horns
  • Thinner enamel
  • More divergent roots and longer in comparison to crown
  • Accessory canals present at root bifurcation (→ difficult radiograph detection of pulp necrosis)
  • Bone loss occurs at root furcation (vs. root apex of permanent molars)
45
Q

What type of CaOH (setting/non setting) is used in:

  1. Indirect Pulp Capping?
  2. Direct Pulp Capping?
  3. Cvek’s (Partial Pulpotomy)?
  4. Conventional Pulpotomy?
  5. Pulpectomy? (as an alternative for GP)
  6. Apexogenesis? (Immature permanent tooth)
  7. Apexification? (Immature permanent tooth)

What are 2 other uses?

A
  1. Setting
  2. Setting
  3. BOTH (Non-setting first →then Setting CaOH and GIC → Then Composite restoration)
  4. None (15.5% Ferric Sulphate)
  5. Non-setting
  6. TRICK Q (Apexogenesis = Pulp therapy on a immature permanent tooth and can include all of 1-4)
  7. Non-setting
  • Sealer
  • Intra-Canal Medicament - Non-setting
46
Q

What are the 2 main aims of Pulp Therapy (in deciduous teeth)?

A
  1. Maintain vitality of tooth and supporting structures
  2. Maintain the dental arch

ESPECIALLY imporant in retaining E’s. Loss of E’s → Mesial drifting of erupting 6’s (leading to space loss and possible impaction or lingual eruption of 5’s)

47
Q

What 3 cells are involved in Ossification? (& their function)

A
  1. OSTEOBLASTS = New bone formation
  2. OSTEOCLASTS - Bone resorption
  3. OSTEOCYTES = Mature permanent bone cell
48
Q

What type of growth occurs at the Cranial Base?

A
  1. Endochondrial Ossification - Develops from “Primary Cartilagenous Chondrocranium”
  2. Spheno-Occipital Synchondrosis - Growth between 2 bones → main impact on anterio-posterior relationship of maxilla to the mandible
  3. Surface Remodelling
49
Q

What does the Cephalocaudal Gradient of Growth tell us?

A

After 3rd month of foetal life, proportion of total body size contributed by the head/face steadily declines 50% (2 month foetus) 30% (Birth) 6% (25 years)

50
Q

What is meant by the Parent-Child-Operator triangle? Who is at the apex? Who has control?

A

3 way interaction between parent, dentist & child - with CHILD at the APEX of the triangle. - Parent provides physical support and verbal consent - Give child some control (e.g. “put you hand up if you want to stop” “shall we do filling on left or right first?”) - Avoid 3 way conversation during procedures: 1 person (dentist) talking

51
Q

What is the PRE and POST operative advice for children undergoing GA?

A

PRE

  • Fasting (1-4-6 rule, light meal no less than 8 hours before)
  • Parent escort (unaccompanied with no other children)
  • Consent

POST

  • 4hr in hospital - Eat, drink & pass urine
  • Necessary Transport
  • 1-2 day recovery
52
Q

Why do we use CaOH in pulp therapy?

What is a disadvantage to its use?

What is a better alternative? Why dont we use this?

A
  • High pH (12.5 - 12.8) → BACTERIOSTATIC
  • Initiates formation of Cementum-like hard tissue barrier
  • Cheap and easy to use

Disadvantages = LT use → Dentine wall weakening and increased risk of root fracture

Alternative = MTA (Expensive & can undergo discolouration)

53
Q

Which areas of the maxilla undergo Appositon and Resporption in Surface Remodelling?

A

APPOSITION

  • ANS
  • Hard palate
  • Tuberosity
  • Sutures (Posterior & Superior)

RESORPTION

  • Anterior Maxilla - goes against translation
  • Floor of nose
  • Anterior alveolar process
  • Antrum walls
54
Q

Why are decidious teeth not obturated with Gutta Percha?

What 3 materials can be used instead?

A

Gutta Percha doesnt resorb (need material which resorbs with decidious teeth upon exfoliation)

ALTERNATIVE = RESORBABLE PASTE

  • Non-setting CaOH
  • CaOH & Iodoform Paste (e.g. VitapexTM or EndoflasTM)
  • Slow-Setting Pure ZOE
55
Q

What type of growth occurs at the Mandible?

A
  1. Intramembranous Ossification (mainly)
  2. Endochondral Ossification (at CONDYLES) → Elongation of Mandible downwards and forwards
  3. Surface Remodelling
56
Q

What is meant by “Neglect”?

What are 6 signs of Neglect?

A

Neglect = Persistant failure to meet a child’s basic physical and/or psychological needs

  1. Lack of nutrition → Stunted growth
  2. Inappropriate clothing
  3. Lack of hygiene
  4. Frequent injuries (unsafe environment)
  5. Developmental delays
  6. Withdrawn or attention-seeking behaviour
57
Q

What are the 2 aims of PULPECTOMY?

A
  1. Remove irreversibly inflammed coronal and radicular pulp
  2. Obturate canals with material that resorbs at same rate as deciduous tooth and will be rapidly eliminated if accidentally extruded through apex
58
Q

What is the definition of: 1. Class I Molar Relationship? 2. Class I Incisal Relationship?

A
  1. Mesio-Buccal cusp of upper 6 occluded with mid-buccal groove of lower 6 2. Lower incisal edge occlude with the cingulum plateau of upper incisors
59
Q

According to Childrens Act 1989, who is classified as a child? (3)

A
  • Anyone who hasnt reached their 18th birthday
  • OR up to 19th birthday if disabled
  • Unborn children
60
Q

What are the 4 main types of pharmacological agents used for Conscious Sedation?

Which is first time for children below 12 years?

A
  1. Inhalation Sedation (Nitrous Oxide & Oxygen) = FIRST LINE!!!
  2. Oral Sedation (Benzodiazepines, e.g. Midazolam)
  3. Transmucosal Sedation (as above)
  4. Intravenous Sedation (as above)
61
Q

What are oro-facial signs of Physical abuse? (3)

A
  • Bruising
  • Tooth trauma
  • Abrasions/Lacerations

N.B. Abused (mainly Neglected) children are moe likely to have carious teeth

62
Q

What are the disadvantages of Nitrous Oxide in Inhalation Sedation? (6)

A
  • ST Side Effects → Nausea, Headache or Loss of consciousness (rare)
  • LT Exposure Side Effects → B12 def. Anaemia, Bone marrow suppression, Liver disease or Increased miscarriage/Reduced fertility risk
  • Environmental damage
  • Expensive
  • Bulky equiptment
  • Route of administration close to oprating side → Reduced access to oral cavity for Tx
63
Q

What are 9 non-pharmalogical techniques to treat an anxious child?

A
  1. Gradual Exposure 2. Acclimatisation 3. Tell-Show-Do 4. Behavioural Shaping 5. Modelling 6. Positive Reinforcement 7. Negative Reinforcement 8. Distraction 9. Desensitisation
64
Q

Why can’t we do RCT on non-vital immature tooth? (2)

A
  • Open apex = No seal for obturation
  • Wide funnel shaped canals = difficulty obturation (often higher MAF needed)
65
Q

How does Pulpectomy in deciduous tooth differ to RCT in permanent tooth? (4)

A
  • Irrigation in deciduous = 0.1% Sodium Hypochlorite, 0.9% Saline or 0.4% Chlorhexidine
  • WL = 2mm (vs. 1mm) from root apex
  • Maximum file size = 30 (vs. 80)
  • Obturation with: CaOH, Iodoform paste (e.g. VitapexTM) or slow-set ZOE (vs. GP)
66
Q

What is the main material used to achieve haemostsasis in Pulpotomy?

How is this achieved?

What are 6 alternative materials?

A

15.5% Ferric Sulphate

Forms “Ferric Ion Complex” when in contact with blood via protein binding → Mechanical vessel seal → Haemostasis

Does NOT induce healing or reparative dentine!!

Alternatives:

  • MTA (best but expensive)
  • CaOH
  • Electro-surgery
  • Laser
  • Gluteraldehyde
  • Bone morphogenic/osteogenic protein
67
Q

What are the 2 aims of pulp therapy on IMMATURE PERMANENT teeth if pulp is:

  1. Vital?
  2. Non-Vital?
A

VITAL:

  1. Preserve pulp vitality
  2. Allow continued root development (including apex formation)

NON-VITAL

  1. Create natural apical barrier (CaOH)
  2. Create artificial apical barrier (MTA)
68
Q

What is the purpose of a “Scavenger System” in IHS?

A

Removes excess gas allowing for good Px ventilation

Prevents exhailed NO2 release to operator

69
Q

What is the difference between Graded Experience and Acclimatisation (non-pharmacological techniques to treat an anxious patient)?

A

Graded Experience = Gradual introduction to the dental environment (e.g. non-invasive procedures first) Acclimatisation = Repeating of simple interventions to build familiarity (adding new procedures one at a time)

70
Q

Once Haemostasis achieved (healthy clotted radicular pulp stumps seen) how is Pulpotomy continued?

A
  1. 15.5% Ferric Sulphate applied with microbrush and left for 15 seconds
  2. Rinse and Dry
  3. Restore with IRM(ZOE) or GIC
  4. Coronal seal restoration (ideally SSC/PMC)
71
Q

What is the MAXIMUM exposure limit to Nitrous Oxide in IHS?

A

100ppm over 8 hours

72
Q

What are 4 possible reasons for IHS failure?

How can these be rectified?

A
  1. Px not breathing adequately through nose ⇒ Encourage nose breathing and ensure no blockages
  2. Ineffective seal on mask ⇒ Ensure tight seal
  3. Px too anxious, cannot cooperate ⇒ Stop Tx and reconsider options (e.g. GA)
  4. Faulty IHS machine ⇒ Stop Tx and have checked by trained engineer
73
Q

What are 6 indications for GA in children?

A
  • Failed sedation attempts - severe dental anxiety
  • Pre-cooperative child
  • UNcooperative child (e.g. Special Care)
  • Multiple extractions in more than 1 quadrant
  • Complex Tx
  • LA allergies (rare)
74
Q

Outline process of APEXIFICATION on non-vital immature permanent tooth…

How often should this be repeated?

What are the outcomes if:

  1. An apical barrier forms?
  2. No apical barrier forms?
A

* LA/Rubber Dam

  • Access cavity
  • Irrigate with Chlorhexidine or Sodium Hypochlorite (0.5%)
  • Clear canal
  • Fill with Non-setting CaOH then compres apically with wet cotton pellet
  • Temp restoration

Repeat every 3 months for 18 months - 2 years

  1. Apical barrier forms → Obturate (GP)
  2. No Apical barrier forms after above time → Artificial barrier formed using MTA
75
Q

What are the 4 main types of pulp treatment on VITAL IMMATURE teeth (“Apexogenesis”)?

Why do we not do Pulpectomy?

A
  1. Indirect Pulp Capping
  2. Direct Pulp Capping
  3. Cvek’s Partial Pulpotomy
  4. Conventional Pulpotomy

Pulpectomy only done in NON-VITAL teeth

76
Q

What type of growth occurs at the Maxilla (Naso-Cranial Complex) ?

A
  1. Intramembranous Ossification
  2. Growth at sutures
  • Craniomaxillary suture → Downward & Forward
  • Sagittal (Median Palatal) → Increased maxilla width
  1. Surface Remodelling
77
Q

What is the SDCEP definition of Conscious Sedation?

A

“A technique in which use of a drug(s) produces a state of CNS depression, enabling treatment to be carried out, but during which : - verbal contact with the patient is maintained - drugs carry a wide enough margin of safety to render loss of consciousness unlikely

78
Q

What can be used to assess dental anxiety in patients: 1. Under 8 years? 2. Above 8 years?

A
  1. Facial imaging scale (1-5) 2. Modified Child Dental Anxiety Scale
79
Q

What communication techniques can be used to reduce child anxieties? 1. VERBAL (3) 2. NON VERBAL (3)

A
  1. VERBAL - Speed -Tone - Words (“Childrenese” and empathy) 2. NON-VERBAL - Pictures - Media (distraction) - Body language
80
Q

What is the difference between “Cvek’s Pulpotomy” and “Conventional Pulpotomy”?

A

Cvek’s Pulpotomy:

  • Partial pulpotomy - Removal of 1-3mm inflammed pulpal tissue to reach underlying healthy tissue (MI)
  • Better prognosis in Immature permanent teeth with OPEN apex (vs CLOSED)

Conventional Pulpotomy:

  • ALL Coronal pulp removed
81
Q

Is there more post-natal growth facially or cranially? How do the 2 differ?

A

FACIALLY At birth, face/jaws are UNDERDEVELOPED and take up 1/8th skull –> Increasing in volume to 1/2 skull in adulthood Volume of while body taken up by Cranial/Facial volume reduces from 50% (2 month foetus) to 6% (adult) - Still grows

82
Q
A
83
Q

What type of growth occurs in the Cranial Vault?

A
  1. Intramembranous Ossification
  2. Growth at sutures
  3. Surface remodelling (OUTWARDS growth as apposition on exterior bone and sutures, with resorption on inner surface)
84
Q

Name the following features on the IHS equiptment:

A

(a) NO2 flowmeter
(b) O2 flowmeter
(c) Gas mixture control
(d) Gas flow rate control
(e) Oxygen flush button
(f) Air entrapment valve
(g) Gas outlet

85
Q

What is the difference between a SIGN and SYMPTOM? (Define both)

A

SIGN = Objective evidence of disease, discovered by a clinician upon examination

SYMPTOM = Subjective evidence of disease, experienced and reported by the patient

86
Q

In IHS, what Colour cylinder, Pressure & Phase (Gas/Liquid/Solid) is present for:

  1. NITROUS OXIDE?
  2. OXYGEN?
A

NITROUS OXIDE

  • Blue cylinder
  • 800psi
  • Gas/Liquid Phase (heavier than air)

OXYGEN

  • White cylinder
  • 2000psi
  • Gas Phase only
87
Q

What are the 3 growth outcomes of Maxilla growth?

A
  1. Forwards
  2. Downwards
  3. Widening of palatal vault
88
Q

What is meant by “Leeway Space”?

A

The difference in combined mesio-distal width of C, D and E vs. 3, 4 and 5 (where C, D and E are WIDER!!)

By 1mm per quadrant - Upper jaw (2mm)

By 2mm per quadrant - Lower Jaw (4mm)

Results in loss of E’s “Flush Terminal Plane” and teeth are now guided into Class I relationship

89
Q

When is deciduous dentition established? (years)

A

2.5 years (+/-6 months)

90
Q

When analysing occlusion, what are “Andrew’s 6 Keys of Occlusion”?

A
  1. Molar relationship 2. Mesio-distal crown angulation 3. Labio-lingual crown inclination 4. Tooth rotations 5. Tight contacts +/- Spacing 6. “Curve of Spee” (occlusal plane curvature on the mandible, beginning at premolars and ending at terminal molar)
91
Q

What is the difference between Growth and Development? (Define each)

A

GROWTH = Anatomical phenomenon involved with increase in size (hypertrophy) or number (hyperplasia)

DEVELOPMENT = Physiological phenomenon involved with increase in complexity

92
Q

What are 5 SYMPTOMS of adequate sedation with IHS?

A
  • Lightheadedness/Dizziness
  • Peripheral tingling
  • Wave of warmth
  • Analgesia (mild) - Oral tissues, hands etc
  • Euphoria
93
Q

What is the definition of General Anaesthesia?

A

A drug induced state of reversible, controlled UNconsciousness; during which the patieny is not rousable.

94
Q

What are 5 signs of Sexual abuse?

A
  • Direct allegation
  • STI
  • Pregnancy
  • Trauma
  • Emotional (e.g. inappropriate sexual behaviours)
95
Q

What are the 3 main planes of sedation with Nitrous Oxide?

Which is ideal? (include NO2 concentrations)

A

PLANE I (10-25% NO2)

PLANE II (20-55% NO2) - IDEAL

PLANE III (50-70% NO2)

96
Q

What are 7 CONTRA-INDICATIONS for Pulp Therapy (to extract a carious deciduous tooth)?

A
  • MH contra-indications to Pulp therapy (e.g. debilitating illness or cardiac lesion)
  • Poor co-operation
  • Not motivated (child or parent)
  • Several teeth involved
  • Tooth close to exfoliation
  • Unrestorable tooth (insufficient tooth tissue)
  • Acute abscess with cellulitis
97
Q

What are the 4 main sites of Cranio-facial growth?

What type of Ossification occurs at each?

A
  1. Cranial Vault - Intramembrane
  2. Cranial Base - Endochondral
  3. Maxilla (Naso-cranial complex) - Intramembrane
  4. Mandible - Intramembrane (main) BUT Endrochondral at condyles
98
Q

What are 10 Contra-Indications for Inhalation Sedation use in child?

A
  1. Px refusal (inc. consent issues, e.g. language barrier)
  2. Nasal obstruction
  3. Respiratory infection
  4. COPD
  5. Pre-cooperative child
  6. Immunocompromised
  7. Increased intra-cranial pressure
  8. Ear/Eye pressure
  9. Multiple Sclerosis
  10. Bleomycin chemotherapy
99
Q

When does tooth calcification begin? When (& what tooth) is usually first deciduous tooth to erupt?

A

4-6 months in utero 6-9 months: Lower incisors

100
Q

What are some risk factors for abused children? (5)

A
  • Parent/carer drug or alcohol abuse
  • Parent/carer mental health issues
  • Family violence
  • Previous child or animal abuse
  • Disabled children
101
Q

What are 3 things the dentist should be monitoring during IHS?

A
  1. Breathing rate and depth
  2. Skin colour - Flushing normal but too much may be evidence of hypoxia 2º to respiratory depression and reddness localised to areas hand/rubber dam touched may be allergies
  3. Level of relaxation (Cooperation and Communication)
102
Q

What is “Ossification”?

What are the 2 main forms? (Explain difference/mechanism)

A

Ossification = Formation of new bone

  1. INTRAMEMBRANOUS (New cells formed at periosteum/outer bone, secete ECM and mineralise to form bone in layers)
  2. ENDOCHONDRAL (Begins & spreads from “Primary Ossification Centre” - Cartilage formed and then replaced by bone)
103
Q

What are the 2 main pulp treatments for a NON-VITAL IMMATURE tooth?

A
  1. APEXIFICATION (Either natural barrier with CaOH or artificial barrier with MTA)
  2. Pulp revasculisation (replacement of damaged pulp with viable pulp tissue - still under study)
104
Q

How does most growth of the mandible (forwards and downwards translation) occur?

A

Via Surface Remodelling

APPOSITION

  • Posterior ramus
  • Outer body of mandible
  • Chin
  • Condylar cartilage

RESORPTION

  • Anterior ramus
  • Inner body of mandible
  • Incisor roots (labial)
  • Anterior/Inferior Condyle aspect
105
Q

What is the difference between SIGNS and SYMPTOMS of IHS?

A

SIGNS = What the sedationist observes

SYMPTOMS = What the patient feels

BDS3 (7 decks)

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