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paeds need to know Flashcards

1
Q

name the 5 possible injuries to dental hard tissues and pulp

A
  • enamel fracture
  • enamel and dentine fracture
  • enamel, dentine, pulp fracture
  • crown-root fracture
  • root fracture
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2
Q

describe a concussion injury

A
  • tooth tender to touch
  • tooth NOT displaced
  • normal mobility
  • no bleeding into gingival sulcus
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3
Q

describe a subluxation injury

A
  • tooth tneder to touch
  • increased mobility
  • tooth NOT displaced
  • may have bleeding from gingival crevis
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4
Q

describe a luxation injury

A
  • tooth displaced
  • usually in a palatal/lingual/labial direction
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5
Q

describe an intrusion injury

A
  • tooth usually displaced through the labial bone plate
  • may impinge on the permanent tooth bud
  • into alveolar bone with fracture of the alveolar socket
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6
Q

describe an extrusion injury

A

partial displacement of the tooth out its socket

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7
Q

describe an avulsion injury

A
  • tooth is completely out the socket
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8
Q

describe an alveolar fracture

A
  • fracture involves the alveolar bone (labial and lingual)
  • fracture may extend to adjacent bone
  • mobility and dislocation of the segment are common
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9
Q

what is the most common injury to supporting tissues of the teeth?

A

luxation

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10
Q

what extra-oral examinations would you carry out on a patient who has presented with trauma?

A
  • lacerations
  • haematoma
  • haemorrhage/CSF
  • subconjunctival haemorrhage
  • bony step deformities
  • mouth opening
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11
Q

describe the intra-oral examination you would carry out on a patient presenting with trauma

A
  • soft tissue damage
  • tooth mobility
  • transillumination
  • tactile test with probe
  • percussion
  • occlusion
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12
Q

describe a trauma stamp

A
  • special investigation for pt with trauma
  • includes;
    mobility, colour, TTP, sinus, percussion note, radiograph
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13
Q

when is observation not an appropriate response to trauma?

A

when there is risk of aspiration, ingestion or occlusal interference

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14
Q

what do you advise a parent of a child who has experienced trauma to a tooth?

A
  • analgesia
  • soft diet for 10-14 days
  • chew on molars
  • brush teeth with soft toothbrush after every meal
  • topical chlorhexidine gluconate 0.12% mouth rinse applied topically twice daily for a week
  • warn re signs of infection
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15
Q

how do you initially manage an enamel fracture?

A
  • smooth sharp edges with a small soft flex disc
  • take 2 periapicals to rule out root fracture or luxation
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16
Q

how would you initially manage an enamel-dentine fracture?

A
  • cover exposed dentine with glass ionomer/composite
  • consider placing a composite bandage
  • take 2 periapicals to rule out root fracture or luxation
  • radiograph any cheeck/lip lacerations
  • sensibility test to evaluate tooth maturity
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17
Q

how would you initially manage an enamel-dentine-pulp fracture?

A
  • partial pulpectomy- part of the coronal pulp removed
  • full pulpotomy
  • extraction
  • evaluate the exposure- size, time since injury, associated PDL injuries
  • pulp cap
  • open apices= preserve pulp to secure further root development
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18
Q

how would you manage a crown-root fracture?

A

remove loose fragment and determine if crown can be restored
if restorable:
* no exposed pulp- cover dentine w glass ionomer
* exposed pulp- pulpotomy or endo
if unrestorable;
* extract the tooth
* do not dig for fragments that are not easily accessible

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19
Q

how would you initially manage a root fracture?

A
  • if coronal fragment not displaced-no treatment
  • coronal fragment displaced but not excessively mobile- leave coronal fragment to spontaneously reposition even if some occlusal interference
  • coronal fracment displaced, excessive mobility, occlusion interference- extract loose coronal fragment, reposition loose coronal fragment, consider splint
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20
Q

how would you manage concussion trauma?

A
  • no treatment -observe
  • clinical and radiographic follow up at 4 weeks and 1 year
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21
Q

how would you manage an extrusion trauma?

A
  • not interfering with occlusion- spontaneous repositioning
  • reposition tooth by gently pushing it into socket under LA
  • splint
  • excessive mobility/extruded >3mm- extract
  • follow up at 2 weeks (remove splint), 4 weeks, 2 months, 3 months, 6 months, 1 year, annually for at least 5 years
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22
Q

how would you manage a lateral luxation trauma?

A

minimal/no occlusal interference- allow to reposition spontaneously
severe displacement- extraction/ resposition and flexible splint (4 weeks)
endo evaluation 2 weeks post op
follow uo 2 weeks, 4 weeks, 2 months, 3 monhts, 6 months, 1 year, annually for at least 5 years

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23
Q

how would you manage an avulsion?

A
  • radiograph to confirm avulsion
  • do not replant
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24
Q

how would you manage an alveolar fracture?

A
  • reposition segment
  • stabilise with flexible splint to adjacent, uninjured teeth for 4 weeks
  • suture any gingival lacerations
  • monitor pulp condition of all teeth involved
  • teeth may need to be extracted after alveolar stability has been achieved
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25
what guidelines whould you refer to when following up on a truama patient?
international association of dental traumaology guidelines
26
describe direct complications of dental trauma to a primary tooth
* discolouration mild grey- may still be vital opaque/yellow- pulp obliteration if no signs of pulp necrosis or infection, no treatment required- review * discolouration and infection sinus, gingival swelling, abscess increased mobility radiographic evidence of periapical pathology extract or endo * delayed exfoliation ectopic eruption, delayed eruption, stop eruption
27
what can injury to developing permanent teeth result in?
* enamel defects (44%) * abnormal crown/root morphology (8%) * delayed eruption (1%) * ecropic tooth position * arrested development * complete failure of tooth to form * odontome formation
28
name 2 types of enamel defect
* enamel hypomineralisation * enamel hypoplasia
29
describe enamel hypomineralisation and its treatment
* qualitative defect of enamel i.e. normal thickness but poorly mineralised * enamel appears white/yellow * no treatment * composite masking +/- localised removal * tooth whitening
30
describe enamel hypoplasia and its treatment
* quantitative defect of enamel i.e. reduced thickness but normal mineralisation * yellow/brown defects * no treatment * composite masking
31
define tooth dilaceration
abrupt deviation of the long axis of the crown or root portion of the tooth
32
how would you manage crown dilcaeration?
* surgical exposure and orthodontic realignment * improve aesthetics restoratively
33
how would you manage root dilaceration/angulation/ duplication?
combined surgical and orthodontic approach
34
how can premature loss of a primary tooth affect eruption of the permanent tooth?
can delay eruption up to 1 year due to thickened mucosa
35
how would you manage a permanent tooth that is delayed in eruption?
* radiograph if >6 month delay compared to contralateral tooth * surgical exposure and orthodontic alignment may be required
36
how would you manage an ectopic tooth?
* surgical exposure and orthodontic realignment * extraction
37
how would you manage a tooth that has arrested development?
* endodontic treatment * extraction
38
how would you manage a tooth that has completely failed to form?
tooth germ may sequestrate spontaneouly or require removal
39
why does a tooth with a wide open apex have a higher chance of vitality than a closed apex?
due to neurovasculature bundle at apex and regeneration of nerves in the tooth
40
how often should you follow up on an enamel or enamel-dentine fracture injury?
* 6-8 weeks * 6 months * 1 year
41
what shuld you do at a follow up appointment for an enamel/enamel-dentine injury?
* use trauma stamp * check radiographs for; root development- width of canal and length comparison with other side internal and external inflammatory resorption periapical pathology
42
how do you place a direct pulp cap?
* trauma stamp and radiographic assessment * LA and rubber dam * clean area with water then disinfect with sodium hypoclorite * apply calcium hydroxide (Dycal) * restore tooth with quality composite restoration * review at 6-8 weeks, 6 months, 1 year
43
how do you perform a partial pulpotomy?
* trauma stamp and radiographic assessment * LA and dental dam * clean with saline then disinfect with sodium hypochlorite * remove 2mm of pulp with high spped, round diamond bur * place saline soaked CW pellet over exposure until haemostasis achieved * apply CaOH then GI then restore with composite resin
44
what should you do if there is no bleeding/you cannot arrest bleeding during a partial pulpotomy?
proceed to full coronal pulpotomy
45
how do you carry out a full coronal pulpotomy?
* begin with partial pulptomy * assess for haemostasis after application of saline soaked cotton wool * proceed if tooth is hyperaemic or necrotic * place calcium hydroxide in pulp chamber * seal with GIC lining and quality coronal restoration
46
what is the aim of a pulpotomy?
to keep vital pulp tissue within the canal to allow normal root growth (apexogenesis) both in the length of the root and the thickness of the dentine
47
how would you perform a pulectomy on an open apex?
* ubber dam, access * haemorrhage control- LA/sterile water * diagnostic radiograph for WL * dry canal, non-setting CaOH2, CW in pulp chamber * glass ionomer temporary cement in access cavity and evaluate calcium hydroxide fill level with radiograph
48
how would you overcome an open apex in a tooth requiring a pulpectomy?
* place CaOH in the canal to induce hard-tissue barrier * regenerative endodontic technique to encourage hard tissue formation at apex
49
how would you treat a corwn-root fracture with no pulp exposure?
* fragment removal and restore * fragment removal and gingivetomy * surgical extrusion * extraction
50
when is fragment removal and gingivectomy indicated in a tooth with a crown-root fracture and no pulp exposure?
indicated in crown-root fractures with palatal subgingival extension
51
how would you treat a crown-root fracture with pulp exposure?
* can be temporised with composite for up to 2 weeks * fragment removal and gingivectomy * surgical extrusion * extraction
52
how would you manage a subluxation
* usually just observe * may need splint if mobility is excessive or tenderness on biting * clinical and radiographic follow up at 2 weeks (when removing splint), 3 months, 6 months, 1 year
53
**lateral luxation of tooth with incomplete root formation** describe possible findings at 2 week endo follow up
* spontaneous revascularisation may occur * if pulp becomes necrotic and signs of inflammatory external resoprtion commence- endo
54
**lateral luxation of tooth with complete root formation** describe possible findings at 2 week endo follow up
* pulp likely necrotic * commence endo * corticosteroid-antibiotic or calcium hydroxide as intra-canal medicament to prevent the development of inflammatory (infection-related) external resorption
55
how would you treat an intrusion injury on a tooth with immature root formation?
* spontaneous repositioning independent of degree of intrusion * if no re-eruption within 4 weeks- ortho * monitor pulp conditin * spontaneous pulp revascularistaion may occur * if pulp becomes necrotic and infected- endo
56
how would you treat an intrusion injury on a tooth with mature root formation?
* <3mm- spontaneous repositioning if no re-eruption within 8 weeks- resposition surgically and splint for 4 weeks or ortho before ankylosis develops * 3-7mm- reposition surigcally or ortho * >7mm- reposition surgically
57
how would you treat an intrusion injury on a tooth with complete root formation?
* pulp almost always becomes necrotic * endo at 2 weeks or as soon as tooth allows * aim to prevent development of inflammatory external resorption
58
how often should you follow up on an intrusion injury?
* 2 weeks * 4 weeks (splint removal) * 2 months * 3 months * 6 months * 1 year * annually for at least 5 years
59
why is an avulsed permanent tooth consider an emergency?
successful healing can occur if there is only minimal damage to the pulp and the PDL
60
what critical factors should you consider when presented with an avulsed tooth?
* extra alveolar dry time (EADT) * extra alveolar time (EAT) * storage medium
61
what emergency advice do you give to a patient with an avulsed permanent tooth?
* ensure tooth is permanent * hold by crown * encourage to place tooth immediately back into socket * rinse tooth gently in milk, saline or pt saliva if dirty * bite on gauze/tissue to hold in place once replanted * if replantation not possible- place tooth in milk/saline/saliva * seek immediate dental advice
62
how would you manage an avulsed tooth with a closed apex that a patient has already replanted?
* clean injured area * verifiy position and apical status- clincially and radiographically * place splint * suture any gingival laceratins * consider antibiotics * check tetanus status * provide post-op instructions * follow up
63
what is the emergency management of an avulsed tooth with a closed apex?
* remove debris * replant under LA * splint * suture any gingival lacerations * consider antibiotics * check tetanus status * provide post op instructions * follow up
64
how often should you follow up on an avulsed tooth?
* 2 weeks (remove splint) * 4 weeks * 3 months * 6 months * 1 year * annually for at least 5 years
65
what is the long term prognosis of an avulsed tooth with delayed replantation?
poor- ankylosis related root resorption likely to occur
66
when should you not replant an avulsed tooth?
* child immunocompromised * other serious injuries requiring preferential emergency treatment * very immaure apex and EAT >90 mins * very immature lower incisors in young children finding it difficult to cope
67
how would you follow up on a dento-alveolar fracture?
* monitor clinically and radiographically * monitor root development including canal width and length- compare with neighbouring unaffected tooth * 4 weeks- splint removal * 6-8 weeks * 4 months * 6 months * 1 year * annually for at least 5 years
68
what advice do you give for a dento-alveolar fracture?
* soft diet for 7 days * avoid contact sport whilst splint is in place * careful oral hygiene with use of chlorhexidine gluconate mouthwash 0.12%
69
what special investigation can you carry out on a pre-cooperative child?
OPT on deciduous dentition setting 4
70
give examples of behaviour management strategies
* communication * enhanced control * tell show do * behaviour shaping and positive reinforcement * structure time * distraction * relaxation * systematic desensitisation
71
how can you manage a child's dental anxiety?
the modified child dental anxiety scale (MCDAS)
72
what is the aim of behavious management?
to promote a positive attitude to dental care and facilitate ongoing prevention and care
73
at what age are the effects of dental anxiety most apparent?
<4 years
74
why might a child be anxious about attending the dentist?
* the way dentists are portrayed in media * dental anxiety of parent can induce dental anxiety in child * children with high caries are more likely to havbe dental anxiety * lack of knowledge of what you are going to do * association of dentist with pain
75
a child presents with unrestorable 16,36,46 what is the treatment plan for the 26?
compensating extraction to prevent over-eruption
76
when is the best time to extract permanent first molars?
* when bifurcation of 7s can be seen * when permanent second premolars are present * usually around age 8.5-9.5 years
77
what are the advatages of extracting permanent first molars at the preferred time?
* allows for mesial drift of second permanent molars * gives a caries free dentition
78
what are the disadvantages of extracting permanent first molars at the perferred time?
* associated risk of GA * procedure can be overwhelming for a child this age and can affect future appointments
79
what are the possible affects of trauma on permanent teeth?
* fails to form * ectopic eruption * dilaceration * hypomineralisation * odontoma formation * delayed eruption * enamel defects * abnormal tooth/root morphology * delayed eruption * ectopic tooth position * arrest in tooth formation * complete failure of tooth to form * odontome formation
80
what are indications that injury to a child is non-accidental?
* injuries to both sides of the body * injuries to soft tissue * injuroes with particular patterns * any injury that doesn’t fit the explaination * delay in presentation * untreated injury
81
how do you treat an anxious child?
* positive reinforcement * tell-show-do * acclimatisation * desensitisation * voice control * distraction * role modelling * relaxtion technique/hypnosis
82
define child protection
activity undertaken to protect specific children who are suffering or at risk of suffering significant harm
83
define safeguarding children
measures taken to minimise the risks of harm to children
84
which 3 elements must be present to prove child abuse?
significant harm to child carer has some responsibilty for that harm significant connection between carer's responsibility for child and harm to child
85
what are the 4 major themes of the children and young peoples act 2014?
* children's rights * getting it right for every child * early learning anf childcare * looked after children
86
what are the UN rights of the child?
the right to; * respect * information about yourself * have a say in your life * a good start in life * be protected from harm * be and feel secure
87
what children are classed as 'vulnerable'?
* under 5s * irregular attenders * medical problems and disabilities * looked after children
88
what are the short term effects of neglect?
damage to; * physical health * emotional health * social development * cognitive development
89
what are the long term effects of neglect?
adults neglected as children have higher incidence of; * arrest * suidcide attempts * major depression * diabetes * heart disease
90
what are the 3 stages of managing dental neglect?
* preventative dental team management * preventative multi-agency management * child protection referral
91
describe preventative dental team management
* raise concerns with parents * offer support * set targets * keep records * monitor progress
92
describe preventive multi-agency management
* liase with other professionals * child may be subject of a CAF (common assessment framework) at this level * check if child is subject to child protection plan * agree joint plan of action * letter to health visitor of child
93
what should you do if a child presents with facial trauma which you think is deliberate?
* record in notes * refer to child protection advisor * after referral if child is in immediate danger- child protection order, removal by police or authority of a JP
94
what are the signs of an anxious child?
* avoidance e.g. asks to go to toilet etc. * avoids eye contact * crying * wanting to be by parent's side
95
what do you need to carry out treatment on a 3 year old?
GA/inhalation sedation ascertain who has parental responsibility gain informed consent write referral letter for GA
96
what toothbrushing advice do you give to parents?
* brush for 2 minutes twice daily - one of these times should be at bedtime * <2- a smear of toothpaste , >2 pea-sized amount of toothpaste * use a small/medium (dependant on age) sized brush with soft bristles and brush in circular motions * spit dont rinse * dont use mouthwash * fluoride concentration advice * adult should be helping child to brush until around age 7/8
97
what causes nursing bottle caries?
going to bed with a bottle prolonged breastfeeding baby using bottle as a comforter rather than a dummy innapropriate use of feeding bottles and cups
98
explain the distribution of decay in nursing bottle caries
lower incisors protected by tongue maxillary incisors are affected the worst as they eruptic first if habit continues, mandibular canines and all 6s will be subjected to cariogenic challenge in sequence with their eruption order
99
what is the toothpaste fluoride concentration recommendations for standard risk children?
* eruption- age 3= 1000ppm * 4-16 years- 1000-1500ppm
100
what is the toothpaste fluoride concentration recommendations for high risk children?
* <10 years= 1500ppm * 10-15 years= 2800ppm * 16+yrs= 5000ppm
101
what is a toxic dose of fluoride?
5mg/kg body weight
102
how do you treat fluoride toxicity in children?
* <5mg/kg=milk and observe * 5-15mg/kg= milk and hospital * >15mg/kg= hopsital immediately, cardiac monitoring, life support, intravenous calcium glucanate given
103
what is nursing bottle caries?
caries caused by excessive use of a bottle by infants e.g. going to bed with a bottle at night
104
what advice would you give to a parent of a child with nursing bottle caries?
* no bottle after teeth are brushed * dont take. abottle to bed * dont drink juice out of. asippy cup- water only * juice should be drank out of a cup or with a straw * general toothbrushing advice
105
what is an appropriate fluoride regime for a child at high risk of caries?
* increased fluoride toothpaste * fluoride varnish application 4 times per year
106
at what ages do the permanent maxillary teeth erupt?
7 8 11 10 10 6 12
107
at what ages do the permanent mandibular teeth erupt?
6 7 9 10 10 6 12
108
how can you help a child stop a digit sucking habit?
positive reinforcement to persuade behaviour change identify triggers and provide comfort in other ways offer gentle reminders provide removable appliance with rake nail polish with a bad taste
109
give occlusal presentations of a digit sucking habit
proclined upper incisors retroclined lower incisors anterior open bite/incomplete open bite posterior crossbite narrower upper arch
110
how is the posterior dentition affected by a digit sucking habit?
narrow arch created by masster muscle constantly pushing upper posterior teeth palatally posterior crossbite can then be observed when narrowed upper arch meets lower arch
111
what is the name given to the space between primary central incisors, usually caused by a low frenal attachment?
midline diastema
112
what causes fluorosis?
excess ingestion of fluoride during development of the teeth
113
how would you treat fluorosis?
* microabrasion * composite restoration * strip crowns
114
why does caries affected enamel have a white appearance?
acidic solutions preferentially dissolve prism sheaths in enamel, creating pores these pres refect light, relfecting it back instead of letting it pass through

paediatrics (5 decks)

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