Paeds/Ortho Flashcards
what to include in paeds GA referral letter
1 - pt name and address
2- parent/guardian name
3 - contact telephone number
4 - your name,practice address, and telephone
5 - GMP name, practice address and telephone
6 - treatment plan/needs
7 - justification for GA (SIGN guidelines)
8 - Medical history
9 - any radiographs
elements of CRA
7
MHx
SHx
clinical evidence
saliva
plaque control
fluoride use
diet
caries prevention methods
8
toothbrushing technique - 2xdaily, modified bass, spit dont rinse
F varnish - 22600ppm 2xyearly or 4xyearly
F toothpaste - 1450ppm smear when over 3, above 6 pea
F suppliements (NaF mouthwash 5%)
Diet diary
fissure seals
radiographs
sugar free meds
reasons for delayed eruption of permanent tooth
7
- abnormal development position
- supernumerary tooth
- displacement of permenent teeth due to trauma to primary tooth
- dilaceration
- impaction
- eruption cyst
- early loss of primary tooth
signs of supernumerary
5
- delayed eruption
- midline diastema/discrepancy
- crowding of permanent teeth
- displacement of permanent teeth
- rotation of permanent teeth
standard prevention toothbrushing instruction
once yearly advise
brush as soon as first primary tooth erupts
2xdaily, 2mins, morning and last thing at night- no food or drink after
spit dont rinse
assist till 7years, supervise thereafter till child confident and able to do solely
enhanced prevetion toothbrushing
every 4 months give standard advice
+
3mins hands on brushing instruction
disclosing tablets
toothbrushing charts
free toothbrush/toothpaste
fluoride overdose
5.5mg/kg
need to know concentration toothpaste, weight of child and amount consumed
diet standard prevention
1xyearly
reduce frequency of sugars to meal times
be careful re hidden sugars - ketchup, baked beans, soy milk, fruit juice
limit fizzy/carbonated drinks to meal times
sugar free snacks - breadsticks, carrots, oatcakes, cucumbers
water only between meals and for bedtime bottle
diet enhanced prevetion
standard at every recall
+
diet diary - 2 weekdays and 1 weekend
action planning
fluoride varnish dose
5% NaF 22600ppmF 2xyearly
2-5=0.25ml
>5=0.4ml
enhanced- 4xyearly
fissure seals
permenant teeth
L6s buccal pits; U6s palatal pits
GI is pre-coop
check with probe if able to get them off
bitewings from when
around age 5
standard every 2 years
high risk - every 6-12months
how to manage a suspocious fissue in permanent molar
clean - pumice brush but no pumice
dry
good light
magnification
radiograph - see if dentinal caries present
tx
* microcavitation/shadowing in enamel - PRR and fissure seal
* if just stained, no radiographic evidence - FS
options caries management in primary dentition
1 - complete caries removal and restoration
2 - partial caries removal and restoration
3 - no caries removal and seal#
4 - no caries removal, prevention, make self cleansing
5 - XLA
index of suspicion for child neglect
could the injury been caused accidentally? how?
does explanation of injury fit age and clincal findings?
if explanation is consistent with injury, is this within normally acceptable limits of behvaiour?
is the story consistent? (changing details etc)
if there is delay in seeking advice, are there good reasosn for this?
general demnour
relationship between guardian and child
child’s reaction to people
child’s reaction to any med/dental exam
comments by child/guardian that raise concerns about upbringing
dental neglect markers
5
- nutrition - failure to thrive
- warmth, clothing, shelter - cold injury/sun burn
- hygiene+health care - dental caries, head lice
- stimulation+education - developmental delay
- affection - withdrawn/attention seeking behaviour
primary herpetic gingivostomatitis with systemic involvement
aciclovir only prescribed - immunocompromised or severe infection in the non-immunocompromised
primary response to herpes simplex
* sore mouth and throat, enlarged lymph nodes
* also period of malaise and fever (systemic)
* self limiting 7-10days
* fluid intake, bed rest, analgesia, CHX, nutritious diet
aciclovir 200mg tablets, 1tab 5xdaily for 5days (25 total)
Concerned mother with 2 year old in pain. Take a brief pain history then photo of decayed 52-62 (upper incisors) provided.
Explain diagnosis toparent, prevention and management options
brief hx
* how long pain there for? any analgesia/calpol? how much?
* feeding bottle to bed? what is in it?
pattern of decay - upper incisors, Ds and lower canines (lower incisors protected by tongue)
advice
* feeder cup replacing bottle from 6months
* no feeding at night - lactose in milk, dec saliva flow
* no sweetened milk/soy milk (unless medically advised)
* water between meal times
* sugar free meds (calpol)
* safe snacks - cheese, breadsticks, veg
toothbrushing - assist till age of 7, 2xdaily, spit dont rinse, smear of 1450ppm
management
* extraction carious teeth under GA due to pain - risks: small risk of brain damage, not waking up. benefit - only way out of pain
* GIC remaining teeth and review
* F varnsih
trauma stamp
colour
EPT
ECl
TTP
percusive note
mobility
displacement
radiograph
sinus
trauma complications to primary tooth
pain
swelling
dark discolouration
inc mobility
delayed exfoliation
infection - look out for gum swelling
trauma complications to permanent tooth
preamature or delayed eruption
enamel hypoplasia/hypomineralisation
crown/root dilaceration
failure to erupt
failure to form
odontome formation
how to deal with complaint regarding prev dentist
‘I can’t give comment because I don’t know the full story’
‘I can only offer you this treatment at this present time’
‘Whatever was offered previously, will not change what treatment is required now’
‘It will be unhelpful for me to be involved in this matter as I don’t know the
background behind’
Tell mum if she is intended to complain, she can go back to the practice, they will
have a standard complaint procedure = only if the patient asks (do not offer!)
separator and hall crown placement
Place separators between medial and distal contacts
* Floss 2 pieces of floss through the orthodontic separator
* Pull tight and move down between contacts of the tooth (not subgingival)
Leave in place for 2-7 days
Remove with a BLUNT probe
Sit child upright
* Place gauze swab to protect the airway
Choose the crown: aim to fit smallest size of crown that will seat (use sticky stick)
* Select one that covers all the cusps and approaches the contact points with slight
* springiness
* Do not fully seat the crown!
Dry the crown, fill with GIC (Aquacem)
Dry the tooth
* If cavity large: place some GIC in the cavity
Place the crown over the tooth
Seat the crown with finger pressure - first method
* Child can seat the crown by biting on it over gauze - second method
Remove excess cement with CWR
Get pt to bite down for 2-3mins or finger pressure
Make sure all excess cement has been removed
Floss between contacts
process and risks for GA referral
DWP and paretn of GA risks/benefits and all other alternative options
* Referral to hospital for specialist to assess - if any other teeth of poor prognosis
* they will be added to this plan to avoid future GA
* GA will involve day in hospital - need to monitor for full recovery
* Need of chaperone throughout.
Very common minor risks:
* Headache, nausea, vomiting, drowsiness
* Sore throat or sore nose/nose bleed from intubation
Risks from treatment:
* Pain, bleeding, swelling, bruising, infection, loss of space, stitches
Rare major risks:
* Brain damage
* Death - 3 in a million. Need a machine to breathe during op and there is a
* very small risk that you will not be able to breathe independently
* again on waking - ie never waking again.
* Upset when coming round - can make underlying anxiety worse
* Malignant hyperpyrexia (v. rare - important to ask for FH)
Conditions requiring special care (can be contraindications)
* Sickle cell disease (or any hypoxia)
* Diabetes - can’t fast in same way
* Down’s syndrome
* Malignant hyperpyrexia
* CF or Severe asthma
* Bleeding disorders
* Cardiac or Renal conditions
* Epilepsy
* Long QT syndrome
GA referral
- Patient name
- Patient address
- Patient/Parent contact numbers (landline and mobile)
- Patient medical history
- Patient GP details
- Parental responsibility
- Justification for GA
- Proposed treatment plan
- Previous treatment details
Letter must include:
Recent radiographs or if not available an explanation of why (e.g. pt
uncooperative)
talk through parents concerns re F varnish
Reassure the patient
* Fluoride varnish is placed on the tooth and is minimally invasive
* Promotes remineralisation (hardening of tooth) and prevents demineralisation (softening of tooth)
* It involves dry the teeth and painting a gel on to the tooth
Contraindicated in:
* Severe uncontrolled asthma (hospitalised in the last 12 months)
* Allergy to colophony (sticking plasters) - We can use a colophony free version if needed
instructions afterwards
* Don’t eat/drink for 1 hour
* Soft diet for the rest of the day
* No dark coloured foods
* Avoid fluoride supplements today
Fluoride toxicity:
* Very small risk and technically relevant if small child consumes a quantity of toothpaste
* 5mg/kg: milk
* 5-15mg/kg: ipecac syrup, milk and possible referral
* >15mg/kg: hospital referral
Patient asks - I’m wondering why my younger child needs fluoride varnish?
* Clear justification regarding caries – prevention of tooth decay (fluoride effective), evidence of additional benefit over and above daily tooth brushing
* Recommended for all not just those at risk (universal process)
* Recommended that children get it atleast 2x a year
* Recommendations are evidence based e.g. refer to guidance such as SDCEP,
sign etc
Patient asks I’ve heard that too much fluoride can be harmful, is that true?
* Details know minimal risk with use of fluoride varnish and twice daily use of fluoride toothpaste provided used as recommended
* Fluoride varnish quantity carefully controlled
* Guidance given regarding toothpaste quantity and Supervised brushing
* posible side effects - fluorosis and mottling
11 EDP# immature apex - 8 yr old - Outline procedure to parent of
anxious child (6 mins)
Explain nature of injury in simple terms
* Enamel dentine pulp fracture or complicated pulp fracture
Explain treatment : PULPOTOMY (open apex)
* As this is a large exposure the tx of choice is called a pulpotomy
* Explain partial removal of pulp
* Explain that aim is to keep undamaged pulp tissue alive
* Explain that this is so the tooth stays alive and continues to grow
Baseline sensibility tests
* Tests required to see how the nerve in the injured and adjacent teeth respond
* Tests required as baseline reading for long term monitoring
LA required
* Parent informed that LA is required
* Required to keep patient numb and comfortable
* Describe that LA involves injection in the gum
Dental Dam
* What this is - rubber sheet over tooth acts like mask
* Why dam is placed - moisture control, protects airway
Drilling/use of handpiece
* Drill will be used to remove some pulp tissue
* Aim is to leave only good tissue
Dressing
* Indicate that the tooth will be dressed; Setting CaOH, MTA
Composite restoration
* Indicate that a white filling will be placed to regain aesthetics
Actor marks: Describing tx in an understandable manner, supportive and empathetic
regarding injury
18-month old knee to knee
Introduce self and designation
Reassure father everything will be ok
Knee-to-knee examination
* Explain to the parent what you intend to do
* Sit across from the parent with your knees touching theirs
* Bring your knees together and ask the parent to do the same
* Ask the parent to sit the child with their legs round the parents waist
* Lower the child down into your knees and ask the parent to hold the child’s arms
18month old subluxation explain to father tx and possible consequences
Trauma stamp:
* Colour, EPT, EC, TTP/percussive note, mobility, displacement, radiograph, sinus
Subluxation signs:
* TTP, mobile, bleeding from gum, no displacement
Explain nature of injury in simple terms
* Subluxation of the upper central baby teeth
* This is an injury to the supporting structures of the tooth
Explain treatment: JUST OBSERVATION
* No treatment required
* Only that can be done today is clean tooth with saline or CHX wipe with gauze due to age
Explain home care
* Instruct soft food for 1 week
* Important to keep the area clean and plaque free for good healing
* OHI - Brush with a soft brush after every meal
* CHX 0.2% with cotton swab to area x2 per day for 1 week
Explain possible complications to primary tooth:
* Pain, swelling, dark discolouration, increased mobility, delayed exfoliation,
* infection
* Child may not complain of pain, however, infection may be present and
* parent should watch for signs of swelling on the gums and bring the child
in for treatment.
Explain possible complications to permanent tooth:
* Premature or delayed eruption, enamel hypoplasia/ hypomineralization,
* crown/root dilaceration, failure to erupt, failure to form, odontome formation
Follow up: 1wk and 6-8wks
Actor marks for describing tx in an understandable manner, supportive and empathetic
regarding injury
class II div 1 skeletal +malocclusion (IOTN 5a - sheet provided)
referral - is it urgent?
Skeletal classification
* Class 2 – maxilla more than 2-3mm infringe of mandible; increased OJ; ANB >4o
Incisor classification:
* Class II div 1 = lower incisor edge lie posterior to the cingulum plateau of the upper central incisors. The upper central incisors are Proclined or of averageinclination and there is an increased OJ
Dental factors of class II div 1 malocclusion
* Increased OJ – incisors Proclined or average
* Variable of OB
* Can have good alignment, crowding or spacing in dentition
* Habitually parted lips may lead to drying of the gingivae and exacerbation of any pre existing gingivitis
Reason for treatment:
* Concerns regarding aesthetics
* Concerns regarding dental health
* Prominent incisors are at risk of trauma especially with incompetent lips
* OJ >9mm 2x likely to suffer trauma – IOTN 5A
class II div 1 skeletal +malocclusion (IOTN 5a - sheet provided)
management
1- Accept – leave and monitor
* When there is mildly increased OJ and if patient isn’t concerned
* Can give advice and use of mouth guard for trauma protection
2- Attempt growth modification
* Headgear – try and restrain growth of maxilla horizontally and/or vertically
* Functional appliance (twin bloc, medium opening activator)– utilise, eliminate or guide the forces of muscle function, tooth eruption and growth to correct the malocclusion. These should be used during growth and coincide with pubertal growth spurt.
URA
* Limited role unless there is very mild class II, when overjet is due to incisor proclination and favourable OB
* Only after specialist assessment
Orthognathic surgery
* Should be carried out when growth is complete and only when there is severe skeletal A/P discrepancy or vertical direction,
* Usually involved mandibular surgery but may include maxilla
* Fixed appliances will be required before, during and after surgery.
URA Design
basics
A – Active component (moves the teeth, 0.5mm)
R – Retention (holds the brace in, 0.7mm in permanent, 0.6mm in deciduous)
A – Anchorage (resists unwanted tooth movement)
B – Baseplate (plus any modifications)
* Provides anchorage, retention, connector
Self-cure PMMA over Heat-cure PMMA
* Advantages: quicker and easier fabrication - 14mins vs 14hrs
* Disadvantages: residual monomer can be an irritant
URA for overbite
In order to REDUCE an overbite we must make a baseplate modification by using a FLAT ANTERIOR BITE PLANE which is made by taking measurement of OJ + 3mm. We add 3mm to minimise the risk of lowers going behind uppers and prevents the lower teeth retroclining which makes overbite even worse. A FABP creates POSTERIOR OPEN BITE. We then want to start closing the posterior open bite happens as the lower teeth move to occlude with upper teeth and close then open bite - only happens when teeth are erupting and bone and soft tissues are forming (cant be done in adults or will end up with over eruption and roots exposed so teeth become mobile). We then take out the appliance and have a gap that allow us to force the overjet closed
Aim: Please construct a URA to reduce OJ 22,21,22,12 and reduce OB (done after 4s extracted and canines moved back)
Active components
- 22,21,11,12 Robert’s retract 0.5mm HSSW + 0.5mm ID tubing
Retention
- Posterior retention
o 16+26 Adam’s clasps 0.7mm HSSW
Stops
- 13+ 23 mesial stops 0.7mm HSSW flattened (stops canines relapsing these are passive components)
Anchorage
- Good and bad moving 4 teeth but all have small roots and moving same direction
Base plate
- Self cure PMMA with flat anterior bite plane OJ+3mm
URA for overjet
Active components
- 22,21,11,12 Robert’s retract 0.5mm HSSW + 0.5mm ID tubing
Retention
- Posterior retention
o 16+26 Adam’s clasps 0.7mm HSSW
Stops
- 13+ 23 mesial stops 0.7mm HSSW flattened (stops canines relapsing these are passive components)
Anchorage
- Good and bad moving 4 teeth but all have small roots and moving same direction
Base plate
- Self cure PMMA with flat anterior bite plane OJ+3mm
URA for retracting canines
Aim: please construct a URA to retract 13 + 23
Active components
- 13 + 23 palatal finger springs + guards 0.5mm HSSW
Retention
- Posterior retention
o 16 + 26 Adam’s clasp 0.7mm HSSW
- Anterior retention
o 11 + 21 southend clasp 0.7mm HSSW
Anchorage
- Good as only moving 2 teeth
Base plate
- Self cure PMMA
URA for retracting buccally placed canines
Aim: please construct a URA to retract buccally placed 13 and bring 23 in the line of arch and reduce OB
Active components
- 13 buccal canine retractor 0.5mm HSSW with 0.5mm ID tubing
- 23 palatal finger spring and guard 0.5mm HSSW
Retention
- Posterior retention
o 16+26 Adam’s clasps 0.7mm HSSW
- Anterior retention
o 11+21 southend clasp 0.7mm HSSW
Anchorage
- Good only moving 2 teeth
Base plate
- Self cure PMMA with flat anterior bite plane OJ+3mm
URA to fix anterior crossbite
Aim:Please construct URA to correct anterior cross bite
Active components
- 12 Z spring (or T spring) 0.5mm HSSW
Retention
- Posterior retention
o 16+26 Adam’s clasps 0.7mm HSSW
o 14+24 Adam’s clasps 0.7mm HSSW
Anchorage
- Good only moving 1 tooth
Base plate
- Self cure PMMA with flat posterior bite plane
URA to fix posterior cross bite
Aim: Please construct a URA to expand the upper arch
Active components
- Midline palatal screw
Retention
- Posterior retention
o 16+26 Adam’s clasps 0.7mm HSSW
o 14+24 Adam’s clasps 0.7mm HSSW
Anchorage
- Good only moving 1 tooth
Base plate
- Self cure PMMA with flat posterior bite plane
Required to fit upper removable appliance to a 9-year old. Examine the prescription and the appliance, look for defects and answer the examiners question
FABP, show how to make adjustments to adams clasps and activate palatal finger spring. Prior checks before delivery and care instructions.
Component faults:
* Z-spring encased in acrylic, UR6 adam’s clasp arrowhead fault, UL6 adam’s clasp flyover fault
Prescription faults:
* Southend clasp included meaning appliance won’t work, Adam’s clasp on ULC not ULD, FABP instead of PBP.
How would you rectify these errors?
* Re-make appliance by taking new impressions
Activating palatal finger spring:
* Using spring former pliers – 1-2mm activation
Fitting a URA
* Check that the appliance if for the correct patient o Check the appliance is asked for
* Run finger over all surfaces to check for protruding wires and sharp acrylic
* Check wirework integrity (if overworked)
* Fit the appliance
* Check for any blanching or trauma
* Check posterior retention - Flyovers (first as influence the arrowheads);Arrowheads:Activation
* Activate to produce 1mm movement per month: spring formers
* Demonstrate to patient about insertion and removal
* Ask patient to demonstrate insertion and removal
* Review: 4-6 weekly
Instructions to patient
* Will feel big and bulky
* Likely to impinge on speech -Start reading a book aloud to prevent this
* May have ‘mild discomfort’ - particularly on teeth being moved - but this is a sign that the appliance is working
* Initial increase in saliva – 24-48 hours
* Wear 24 hours/day including meal times
* Can remove the appliance to clean with a soft brush after each meal or when
taking part in active/contact sport – store in a safe place
* Avoid hard and sticky foods
* Be cautious with hot food and drinks as base plate acts as an insulator
* Non- compliance will lengthen treatment
* Give an emergency contact number – do not wait till next appt. if there is a problem
Patient wants you to go back over advice on how to avoid
decal.
Decal - has the shape of backet
* Weakens the enamel to caries
* Unsightly staining
Pt selection
* High risk if caries history evidence of decal, NCTSL
Oral Hygiene
* Toothbrushing + single tufted TB for brackets
* Inter-dental brushes and superfloss
* O.H.I. should include minimum twice per day VERY thoroughly - Dry toothpaste, methodical: work from upper right clockwise to lower right, brush 1 tooth at a time, angling brush at 45 degrees between gum and tooth, brush in short scrubbing motion for a
* minimum of 2 minutes, spit don’t rinse
* brushing after meals as brackets trap food/plaque
* disclosing tablets to identify missed areas
Diet advice
* Limit sugar amount and frequency
* Avoid snacks between meals – limit sugar intake to <3 times daily
* Avoid hard/hot foods, fizzy drinks, sports drinks, sticky sweets, chewing gum
* Ideal drinks are water or milk, crackers, cheese, fruit is acceptable snack but be careful of fat in cheese and natural sugar/acid in fruit
* Watch out for hidden sugars in foods such as tomato soup and ketchup.
* Rinse mouth after eating
Fluoride
Toothpaste
* Duraphat – 2800 ppm (0.619%) – 5000 ppm (1.2%)
* Twice daily, ordinary toothpaste at other times
* Warn re overdose and children
Mouthwash
* Daily 0.05% fluoride mouthwash (225ppm)
* Use IN-BETWEEN brushing, NOT after
F Varnish
* Proflurid (22600ppm) - not duraphat (not for tx of decal as it seals it in), every 4 months
F prescriptions
toothpaste
Sodium Fluoride Toothpaste 0.619% (2800ppm)
Send: 75ml
Label: brush teeth for 1 minute after meals using 1cm before spitting out,
twice daily
Sodium Fluoride Toothpaste 1.1% (5000ppm)
Send: 51g
Label: brush teeth for 3 minute after meal using 2cm, before spitting, 3x
daily
Orthodontic problems - Ectopic canine, OJ, OB, Peg lateral
Problems
* Increased OJ (1 mark)
* Increased OB (1 mark)
* Peg Lateral (1 mark)
* Ectopic Canine (4 marks)
Dental Health Implication
* Risk of trauma from OJ (1 mark)
* Risk of trauma from OB (1 mark)
* Risk of root resorption (1 mark)
* Risk of cyst formation (1 mark)
Position determination from radiographs provided - detailed use of parallax and
explanation (4 marks)
Parallax – OPT and oblique occlusal radiograph views - had to explain how you
get your answer
* Vertical parallax - SLOB
* Explanation: The tube head shifted up from OPT to oblique occlusal, the
* canine moved together with the tubehead compared to the incisor.
According to SLOB rule, the canine is palatal to the incisor.
Retained ULA + Unerupted UL1 (6 mins).
Photos of discoloured 61 and labial/buccal segments of an 8 year old.
PA of a dilacerated floating 21 that could be anything.
Please identify the problem present for this patient and discuss its further investigation/management with your examiner
Causes of retained ULA/Unerupted 21
* Trauma to A - causing damage to the 1
* Complications: Ankylosis, arrested tooth (21) formation, dilaceration, displacement
* Lack of permanent successor/Hypodontia
* Ectopic tooth germ
* crowding
* supernumerary - tuberculate most common
signs
* Discolouration of A, retained A
* Radiographic
* Lateral erupted before central
investigations
* Radiographic localisation for ortho treatment
* Another PA or anterior occlusal, or alternatively OPT and occlusal, CBCT for 3D view
Management
Always palpate: usually U1 is buccal and central (high)
Options:
* Leave and monitor - inform of possible cyst or resorption
* Extract retained A (leave U1) and space maintenance (warn of cyst formation risk)
* Surgical removal of both teeth and space maintenance
* Refer for orthodontic opinion/Tx - Inform of possible ortho tx benefits/risks
* Auto-transplantation
Other options:
* Extract retained A and hope spontaneous eruption (very unlikely since dilacerated)
* Expose (closed or open) +/- bonding/traction (won’t work if dilacerated)
class 3 malocclusion in 20y
tx options
Accept and Monitor
Intercept with a URA – procline uppers
notice pt’s age in scenario – this not possible
Growth Modification: with functional appliance (reverse twin block) or (RME + protraction headgear)
notice pt’s age in scenario – this not possible
Camouflage with fixed appliances
* Accept underlying skeletal classification problem, move teeth with fixed ortho to hide it
* procline uppers and retrocline lowers
* Risks of ortho: decal, root resorption, relapse, gingival recession
* Usually together with XLA U5s & L4s (most likely lowers to reduce necessary tipping)
Orthognathic surgery with combined orthodontics
Surgical manipulation of the mandible and/or maxilla to produce optimal aesthetics/function
* Multidisciplinary team – careful planning - Orthodontist, maxillofacial surgeon, clinical psychologist etc
* Pre-surgical orthodontics – 12-18 months: arch alignment, arch coordination, de-compensation
* Post-surgical orthodontics – 12 months
TOTAL TIME = 36 months
possible damage to stainless steel
- mechanical abrasion
- crushed/marked
- damage
- work hardened
- fatigue - repeat strain in deep undercut
check flyover than arrowheads
child eaten fluoride what do you need to know
amount of toothpaste eaten
strength of F in toothpaste
weight of child
probable toxic dose F
5mg/kg
mg F in fluoride varnish for 2yo
2yo has 0.25ml 22,600ppmF 5% NaF varnish
= 5.65mg
mg F in F varnish for 6yo
0.5ml 22600ppmF 5%NaF varnish
= 11.3mg
if child has 5mg/kg F
give calcium orally and observe
if child has 5-15mg F
give calcium orally and take to hospital
if child has >15mg/kg F
admit to hospital ASAP for life monitoring and IV calcium gluconate
how to calculate probable toxic dose F for child
get their weight and x5
e.g. 20kg child can have 100mg F
active ingredient in external bleaching gels
carbamide peroxide
breaks down into hydrogen peroxide and urea
hydrogen peroxide then breaks into free radical which is active oxidising agent which breaks long chanin inorganic chromogenic molecules into shorter chains
factors affecting external vital bleaching success
time
cleanliness
concentration
temperature
prior to external vital bleaching need to
make sure dentally fit - no decay, good perio health
record inital shade with shade guide and photos
consent - gingival irriation, need to replace restorations, may not work, sensitivity, relapse, compliance dependent
max carbamide peroxide
16.7%
will break into 5% H2O2
prescription for lab for external vital bleaching
please construct trays for external vital bleaching
ensure trays 1mm short of ginigval margin
please put bleach wells on labial surface of X
instructions for pt for external vital bleaching
keep bleach in fridge
fill wells with 1mm2 (popcorn kernel) of bleach, wear for at least 2hours but ideally overnight
internal non vital bleaching
risks
external cervical resorption
how to external non vital bleaching
remove GP 1mm below ACJ, 1mm RMGIC over GP
remove dark dentine, etch enamel 35% phosphoric acid
10% carbamide peroxide
how to microabrasion
clean tooth througly
vaseline to soft tissues
rubber dam seal
bicarbonate gingival guard
wedgets bewtween teeth
mix 18% HCl and pumice - apply to teeth, 5secs/tooth
wash, repeat up to 10x
remove rubber dam
polish with F prophy paste
apply clear F gel or varnish
review after 1 month
can be repeated
resin infiltration
change refractive index of white area
masks white area and makes tooth look like surrounding area
trauma stamp
ECl (not on primary tooth)
EPT (not on primary tooth)
Colour
TTP
percussive note
mobility
sinus
radiograph
displacement (1st visit only)
test tooth nerve, see if any infection underlying
causes of unerupted central
trauma to primary causing damage to permanent - complications: ankylosis; arrested tooth developement (21) formation, dialcareation, displacement
lack of permenent successor - hypodontia
ectopic tooth germ
crowding
supernumerary: tuberculate most common
signs of missing upper central
discoloration of A, retained A
radiographc
lateral erupted before central
