Paeds MCQs Flashcards
Define concussion
Injury to tooth supporting tissues without abnormal loosening or displacement of the tooth with or without pulpal damage
What is the main treatment option for a primary tooth whose crown has luxated palatally?
Leave only if not in traumatic occlusion
What is the prevalence of non-accidental injury in the UK?
0.1-10%
9yo boy comes to see you with frank caries in a first permanent molar. How would you manage this patient? (3)
Tooth isn’t saveable in long term, what would be optimum outcome after extraction (5)
1. Take a history Clinical examination Radiographs if required Orthodontic opinion 2. Space closure, no crowding, class I occlusion, no more caries
What may be unfavourable about extractions of 6s?
Caries present in other teeth Occlusion disturbed Space - little relief at front of mouth Treatment planning is more difficult Anchorage loss for URAs Lengthy ortho tx - pt unsuitable due to poor OH
If patient has a carious upper 6 and is class 2 div 1 how would you manage
Preserve 6s until 7s erupt
Fit removable appliance before doing extractions, otherwise 2nd molars will drift forward
Space provided by XLA 6s can be used to reduce overjet and align teeth
Alternatively XLA 6s, then XLA 4s if required
Use headgear with URA after XLA 6s to move back buccal segments before 7 erupts
Name 4 adhesive systems to bond resin to enamel and dentine and 4 commercially available brands (12)
UNSURE
- light activated e.g. Porcelite for veneers
- dual cure e.g. Mirage FLC for ceramic crowns, onlays, inlays
- HF etch + silane for resin bonded ceramics
Child caries + radiograph: explain to mum and child
- Introduce yourself
- Ask relationship of guardian and establish rapport
- Show what you see on rad OR chart teeth
-identify obvious radiolucencies
-explain which ones will need restorative/ pulp tx / extraction and why
-give diet advice
-exposure to fluoride
-assess motivation of mother and family
4 pillars: OHI, diet, fluoride, fissure sealants
Giving diet analysis and advice
3 days including one weekend
Explain need to record time, content and amount of food and drink consumed
Assess nutritional value of main meals
Highlight all sugar intake
Highlight between meal snacks
Keep advice short and simple
Explain relationship between sugary snacks & drinks between meals and decay
relationship between sugary snacks & drinks between meals and decay
In the mouth, the bacteria living on the teeth convert sugar into acid
-it is this acid that dissolves tooth enamel (the white bit you can see)
The more sugar you have, the more the tooth is dissolved –> can break down tooth causing a hole which can go inside of the teeth where the soft pulp is
The pulp contains sensitive nerve fibres which can make you feel pain
If the decay gets really deep, we may need to remove the pulp by performing RCT and put a crown (cap) on it or it may need extraction.
It’s important to reduce the amount and frequency of sugary food, so try and keep it to meal times - should not be consumed more than 4x/ day
“Saliva washes away the acid between meals, but if your child is always eating, there may not be time for this acid to get washed away.”
Crisps and nuts are although more dentally healthy are high in fat and salt and should not be substituted for sweets
Chewing gum and cheese will stimulate saliva flow and may help after eating sugary snacks
Only drink plain milk or water between meals
Fruit contains natural sugars but does not increase risk of caries therefore should increase amount of fruit and vegetable in your diet.
Explaining action of fluoride
Has been shown to reduce tooth decay by 50%
Protects teeth from acid damage and can help stop breakdown of teeth by bacteria
Child must spit after brushing
-rinsing will remove some fluoride
Brush twice a day with smear 1350-1500ppm (0-3 with concern)
Fluoride varnish at least 2x yearly
Primary eruption dates
A, B, D, C, E A: Lower 8 months, upper 10 B: Upper 11, lower 13 D: 16 months C: Upper 19, lower 20 months E: lower 27, upper 29 months
Mouthwash recommendation
Sodium fluoride 0.05% 250ml, once daily with 10ml, 1 min and spit out at different time to brushing
For those 8yrs and upwards with active caries prescribe daily fluoride toothpaste
Patient with root caries - what ppm toothpaste?
If adult (16+) - 5000ppm If 10+ - 2800ppm
Which toothpaste to prescribe for a 12yo autistic child
Oranurse - non-flavoured and does not contain sodium lauryl sulphate (foaming agent)
-choose 1450ppm conc.
