paeds dentistry Flashcards
A 2-year-old attends your surgery with his mother. She is concerned by the appearance of his upper teeth.
There is caries in the following teeth: 54 52 51 61 62 64 84 74
What diagnostic name would you give to this caries distribution?
early childhood or nursing bottle
(max incisors, 1st molars, mandibular canines)
Why are the specified teeth affected in this distribution of early childhood caries (ECC), and not others? (3 marks)
lower incisors are protected by tongue
affected teeth are first to erupt
position = get bathed during bottle feeding
difficulty cleaning posterior teeth
the lower incisors are spared from decay as they are physically protected by the nursing position of the child’s tongue.
if the habit continues, the other teeth (mandibular canines and all of the first primary molars) will be subjected to the cariogenic challenge in sequence with their eruption order.
List FOUR causes of the ECC. (2 marks)
prolonged bottle feeding
bottles at night
milk used as pacifier during the day
poor OH
high sugar/acid diet
transmission of streptococcus mutant from caregivers or family members
What fluoride regime could you follow in the dental surgery setting for this child?
(2 marks)
topical fluoride - duraphat - 22,600 ppm - 2.26% sodium fluoride
0.5 mg fluoride toothpaste - use a smear
silver diamine fluoride
ip discing
strip crowns for primary ants
List FOUR of the recommendations you would make regarding tooth brushing for this patient.
(2 marks)
brush twice a day, after breakfast and before bedtime
small headed toothbrush with soft bristles
supervised brushing until 7 years old at least
brush for at least 2 minutes
spit don’t rinse
use a smear of toothpaste
A very anxious 6-year-old child attends your surgery for the first time. The child is not in pain.
Following examination, you note a number of problems. The treatment items you decide on are listed in the table below in the WRONG order.
- Using the numbers 1 to 8 indicate your sequence of treatment.
Lower primary molar requiring pulp therapy
Occlusal restoration on an upper molar requiring local anaesthesia
Application of fluoride varnish
Extraction of upper primary molar
Small occlusal restoration requiring no local anaesthesia
Oral hygiene instruction and dietary advice
Interproximal restoration on a lower primary molar requiring local anaesthesia
Fissure sealants
Oral hygiene instruction and dietary advice
Application of fluoride varnish
Fissure sealant
Small occlusal restoration requiring no local anesthesia
Occlusal restoration on an upper molar requiring local anesthesia
Interproximal restoration on a lower primary molar requiring local anesthesia
Lower primary molar requiring pulp therapy
Extraction of upper primary molar
- Name TWO aspects of the child’s behaviour during treatment which would confirm they remain dentally anxious. (2 marks)
physical signs = trembling, sweating, fidgeting, increased heart rate
verbal cues = crying, whimpering, asking questions, telling you no, not opening mouth
A 4-year-old child is brought to your surgery complaining of severe pain and sleep loss for the last six weeks. The child is a new patient to your practice. On extraoral examination you notice that the child has bruising on their right cheek and a small abrasion on their right temple (see photograph above).
- What might you be concerned about as a result of seeing this child?
(1 mark)
child abuse and neglect
- Which TWO parts of this presentation led you to have concerns regarding this?
Severe pain and sleep loss lasting for six weeks, indicating chronic untreated dental issues.
Bruising on the right cheek and a small abrasion on the right temple, which could suggest physical trauma.
- Suggest TWO questions which you would ask next to further investigate your concerns? (2 marks)
“Can you tell me more about how your child sustained the bruising on their cheek and the abrasion on their temple?”
“Has your child experienced any other injuries or accidents recently?”
- You decide that some aspect of the response to these questions warrants further action. Who should you discuss this with?
(1 mark)
discuss them with the appropriate authorities, such as a designated child protection officer or social services.
refer by phone, then follow up in writing
facts statements of concerns
- As a result of this onward discussion what THREE different courses of action may take place?
(3 marks)
If immediate danger = child protection order by sheriff order
exclusion order
child assessment order
removal by police
otherwise = investigation, initial assessment, discussion
decide the risk
then no action or joint investigation
- You establish the only concern is regarding dental caries. After ensuring the painful tooth is treated you tell the parent that the child has a number of other carious teeth requiring attention and make two appointments for them to come back. The parent fails to bring the child back for either of these appointments. What should you do next?
(1 mark)
it’s important to follow up with the parent to remind them of the importance of dental treatment for their child’s health.
this could involve sending reminders via phone call, text message, or mail, and offering support or assistance to address any barriers preventing them from attending appointments.
if repeated attempts to contact the parent are unsuccessful, it may be necessary to involve social services or other appropriate authorities to ensure the child receives necessary dental care and to address any underlying issues contributing to the lack of follow-through on appointments.
A 9-year-old poorly co-operative child attends your surgery with gross caries evident clinically in teeth 16, 36 and 46. The prognosis of these teeth is poor and they require extraction. All other teeth are caries free.
- What special investigation would be appropriate for this patient?
OPT radiograph
What information are you ideally looking for to establish the suitability of the timing of these extractions?
(2 marks)
dental development stage
MH
behavioural assessment - whether they will coop for LA or need GA
whether there is pain or infection associated
stage of eruption of 7s
stages of calcification of 7s
presence of 8s
degree of crowding
malocclusion type
condition of other teeth
hypodontia
List TWO advantages of extraction of first permanent molars of poor prognosis at this stage of development?
(2 marks)
prevent damage to neighbouring caries free teeth
creates space for future ortho treatment = sometimes 7’s erupt to take up the space and go into occlusion with second premolars
List TWO disadvantages of extraction of first permanent molars of poor prognosis at this stage of development?
(2 marks)
in non-cooperative child it might require GA -> own risks
opposing arch can over erupt
can distrust eruption sequence -> crowding, misalignment, spacing issues
can be difficult to chew if 7’s are still not there
What might this child require to enable these extractions?
(2 marks)
behaviour management techniques - e.g positive reinforcement, distraction, desensitisation, tell-show-do
sedation or GA
Name 3 potential storage mediums for an avulsed tooth.
milk
saline solution
saliva
HBSS (hank’s balanced salt solution)
water
what is EADT and EAT
critical factors for prognosis
Extra-alveolar dry time (EADT)
Extra-alveolar time (EAT)
Give another 2 points of information you would give to someone phoning up about an avulsion.
hold by crown only
encourage attempt to place tooth immediately into socket (if dirty, rinse gently in milk, saliva and replant)
bite on gauze/handkerchief to hold in place
seek immediate dental advice
What form of splint is used a subluxation? And what is the minimum time the splint should be in place for?
flexible = one tooth on either side
2 weeks
What is the fluoride regime for a high-risk 4 year old?
enhanced prevention
use 1350-1500 ppm F - pea sized amount
fluoride varnish 4x times a year - duraphat 22600 ppm 50 mg/ml
At what age is it suitable to deliver mouthwash to a paediatric patient?
from 7 years old
Toxic dose to patients and how to treat a specific amount
ingestion of fluoride at levels higher than 5 mg/kg body weight
give calcium
contact 999
monitor vital signs
activated charcoal
supportive care - hydration, electrolytes, nausea, vomiting
Before prescribing F- mouth rinse for kids what should you check before prescribing?
age - over 6 years - because of risk of swallowing
assess other fluoride deliveries
ability to follow instructions
ask to show if they know how to spit
Daily strength of F- mouth rinse
Sodium Fluoride Mouthwash, 0.05%
how can dental trauma impact primary and permanent dentition?
disruption normal eruption patterns
speech development
ability to chew
pain and discomfort
infection/abcess
permanent teeth = fractures/cracks / tooth germ
pulp exposure
aesthetics = discoloured teeth
root resorption
need for severe restorative work
signs paediatric patient is anxious
Physical signs:
Increased heart rate
Rapid breathing
Sweating
Clammy hands
Trembling or shaking
Pupil dilation
Behavioral signs:
Crying or tearfulness
Clinging to parent or caregiver
Withdrawal or avoidance behaviors
Restlessness or fidgeting
Difficulty sitting still
Excessive talking or silence
Agitation or irritability
Verbal signs:
Expressing fear or worry about the dental visit
Asking repetitive questions
Expressing reluctance or refusal to cooperate with the dentist or dental procedures
Vocalizing discomfort or pain
Non-verbal cues:
Facial expressions of fear or distress (e.g., wide eyes, furrowed brows)
Body language indicating tension or discomfort (e.g., crossed arms, tensed muscles)
Avoiding eye contact
Looking around nervously
4 reasons for child to be anxious in dental setting
fear of pain
fear of unknown
previous negative experience
mirroring parents anxieties
sensory sensitivity
loss of control
developmental stage = lack of ability to understand and cope with their fears and anxieties
2 ways to treat anxious child
Use pre-cooperative and co-operative terms
4-5 years
Really important labelled praise - “Scott well done for sitting in the chair”
“Scott please sit in the chair”
6-8 years
Increased fear responses
More independent
8-12 years
Growing concerns of embarrassment
Intellect becomes important
Communication in Paeds
Using their names can assist in developing rapport
Lowering chair so we are on the same level
Dental jargon is avoided
Younger children can only concentrate on one adult per time
Body language is so important as we are wearing masks
7% words, 38% voice, tone and 55% body language
behaviour techniques
Preparatory Information - welcome letters, dental widgits, social stories, acclimatisation
MODASF - modified child dental anxiety scale
“would you like to fill in a questionnaire for me”
Non-verbal Role Modelling - smiling, eye contact, “you are alright, you are okay”
Modelling it on a sibling, family or a toy
Voice control - young children responds to tone well
Establish authority - “schoolteacher voice”
Tell-show-do = age appropriate, demonstration, perform with minimal
Enhanced control - stop signals
Allows degree of control
Ask to show thumbs up and down
“I will use this for 5s”
Behaviour shaping and positive reinforcement - “They way you kept your mouth open today was better than rest of kids on clinics”
Magic nose, magic light - ask them to press their nose and move chair then
Motivation interviewing
Tug of war when putting a crown - gamification
4 radiographic signs tooth became non vital in paeds
root resorption
periapical radiolucencies
treatment of ED and EDP fractures
ED = cover exposed dentine with GI/comp
lost structure can be restored immediately with comp or at later visit
EDP = partial pulpotomy or extraction
An 8-year-old boy presents to you with a dentine/enamel fracture of tooth 11 sustained during a school rugby match.
- Describe your emergency treatment of this dentine/enamel fracture.
(1 mark)
GI to cover exposed area
- List FOUR signs and/or symptoms (excluding radiographic) which you would look for in longitudinal monitoring of this patient.
(4 marks)
colour
pain
mobility
sensitivity
- What FOUR radiographic signs might be present if tooth 11 becomes non-vital?
(4 marks)
external root resorption
periapical pathology such as an apical abscess
empty pulp chamber or root canals
widening of PDL
- The patient has another rugby match in 2 weeks time. How might you help prevent further injury to the anterior teeth?
(1 mark)
mouth guard - specially constructed in the lab for this patient
