Paeds Op tech revision Flashcards
goal for child’s oral health
reach adulthood with intact permanent dentition
operative differences between children & adults
- maturity/behaviour
- Constant change - mouth size etc
- Developing dentition
- Operator access - little mouths
- Tooth size & shape
- Preventive care
- Choice of restoration
example questions for taking a pain history from a child
- Where is the pain
- What does the tooth feel like
- Does anything make it better or worse
- How long has it be painful for
- Kept awake/off school
- Relieved with analgesics/antibiotics - calpol
paediatric sequence of treatment planning & restorations
- Prevention
- Fissure sealants
- Preventive restorations
- Simple fillings eg. shallow cervical cavities
- Fillings requiring LA but not into pulp (in co-operative children)
- Pulpotomies (upper arch first)
when to use LA on children?
- Minimal cavities With hand excavation or limited caries removal with slow speed may not require LA
All others DO need LA
-Use Topical!!
when do you not use LA on paediatric restorations?
Minimal cavities With hand excavation or limited caries removal with slow speed may not require LA
what LAs should be used on children?
topical
Lignocaine max dose is 4.4mg/kg. (A 10th of a cartridge per kg). A 2.2ml cartridge of 2% lignocaine has 44 mg of active agent.
- Max number of cartridges for 20kg 3-5 y/o =
- Limit for 20 kg child is 88 mg = 2 cartridges
Prilocaine 3% (with Felypressin) max dose is 6 mg/kg. (Just less than a 10th of a cartridge per kg). A 2.2ml cartridge has 66 mg.
- Max number of cartridges for 20kg 3-5 y/o =
- Limit for 20 kg child is 120 mg = 1.8 cartridges
what is lignocaine max dose?
4.4mg/kg
what is prilocaine max dose?
6mg/kg
occlusal cavity design in primary molars
no greater than 1.5 mm deep and must include all pits and fissures
- but preserve transverse ridges unless undermined by caries
In upper 5’s - banana shape (distal) and kidney bean (mesial)
In lower 4’s and 5’s = straightened out S
upper 5s occlusal cavity shape
banana shape (distal) and kidney bean (mesial)
lower 4s and 5s occlusal cavity shape
straightened out S
cavity design for interproximal cavity in primary molars
- Isthmus should be ½ to ⅓ of the width of the occlusal surface
- Axial wall follows contour of tooth
- Rounded line angles
- Marginal ridge almost removed - then sink the box an create an axial wall and a gingival floor
what is box prep?
- Axial walls follow contour of the tooth
- Rounded line angles
- No occlusal extension
what burs should be used in primary molar cavity prep?
- Occlusal - round bur for plunge cut or/then fissure bur
- Interproximal - fissure bur
- Box - fissure bur
7 restorative materials used in paeds
- Fissure sealants
- Temporary & intermediate dressings (e.g. ZOE)
- Glass ionomer
- RMGI
- Compomer (cross between composite and GI)
- Composite
- Preformed metal crowns - best material for primary molars
what 3 factors help determine restorative material and LA usage in children?
- Caries extent
- Longevity of tooth
- Co-operation of child
advantage of preformed metal crowns
have lower replacement and failure rate than amalgam restorations
amalgam Vs compomer Vs GIC
amalgam and compomer have similar failure rates over 3 years
amalgam and compomer last longer than GIC
which is more successful RMGIC or GIC?
RMGIC
the Hall technique
a novel method of managing carious primary molars by cementing preformed metal crowns (also known as stainless steel crowns) over them without local anaesthesia, caries removal or tooth preparation of any kind.
how do you treat cervical caries in children?
- hand excavate caries or use a slow speed handpiece with a round bur
- wash & isolate (preferably with rubber dam)
- either glass ionomer cement covered with vaseline or compomer
how do you treat inter-proximal caries in children?
- hand excavate or use a slow-speed round bur
- wash & isolate (preferably with rubber dam)
- place an acetate strip into interproximal area and restore with compomer / composite (strip crown)
what are some key instruments in paeds op tech?
- Tapered diamond separating bur
- Preformed metal crowns
- GI luting cement
- Crown crimping pliers
- Curved crown scissors
how to select crown to use?
- Measure mesio-distal width of crown or space with dividers
- Trial and errors
- Impression and crown prep on model
how to carry out marginal ridge reduction?
- Start from occlusal portion of marginal ridge
- Break contact area and produce knife edge finish mesially and distally
- ensure no ledges as they will prevent crown from seating
how much should the occlusal surface be reduced by (if needed)?
1-2mm
should the buccal and lingual surfaces be reduced?
only to remove any sharp angles caused by occlusal or interproximal caries
how should the crown fit?
snap fit
number towards the buccal
3 potential problems when placing crown in child
- rocking
- canting to one side
- loss of space (extensive caries)
what is rocking due to crown?
- Cervical margin > 1 mm beyond max curvature
- Difficult to contour margins sufficiently to contact tooth throughout
- Open margins and an unstable crown will result
SOLUTION = adjust tooth prep
what is canting to one side due to crown placement?
- Uneven reduction of occlusal surface
SOLUTION = round occluso-buccal line angle
what is ideal situation to reduced loss of space in crown placement?
rectangular shape and not square shape
5 things to remember for of the Hall technique
- Separators can be used if contact areas are a problem
- Use GIC
- Ideally fit should be subgingival or at least below the margins of any cavitation
(Gingiva may blanche but will turn back to normal) - There should be NO clinical or radiographic signs of pulpal involvement
- Tooth should have sufficient sound tissue left to retain the crown
what are Separators used in the Hall technique?
- Two lengths of dental floss should be threaded through the separator.
- Stretch tight and “floss” through contact point.
- See patient 3-5 days later for removal of separator (if not already fallen out).
