PAEDS OSCE PREP Flashcards
What generalised toothbrushing advice would you give to all paediatric patients and their carers?
- Start brushing from the eruption of first tooth
- Children should be assisted or supervised once dexterity gained
- 2x a day, for a minimum of 2 minutes, spit don’t rinse
What fluoride toothpaste would be used in a standard risk child under 3 years old?
a SMEAR of 1000-1500ppmF
What fluoride toothpaste would be used in a high risk child under 3 years old?
a SMEAR of 1350-1500ppmF
What fluoride toothpaste would be used in a standard risk child 3+ years old?
a PEA-SIZED amount of 1000-1500ppmF
What fluoride toothpaste would be used in a high risk child 3+ years old?
a PEA SIZED amount of 1350-1500ppmF
What fluoride toothpaste would be used in a high risk child 10+ years old?
2800ppmF toothpaste
What is the pneumonic that is involved in motivational interviewing?
SOARS
- seek permission
- open questions
- affirmations
- reflective listening
- summarising
What is involved in step one of health behaviour change using motivational interviewing?
Explore current practise and attitudes using a motivational interviewing approach
- SOARS
What is involved in step two of health behaviour change using motivational interviewing?
educational intervention
- improve knowledge and skills
What is involved in step three of health behaviour change using motivational interviewing?
Action planning
- set time, date and place to start
What is involved in step four of health behaviour change using motivational interviewing?
Encourage habit formation
- achieve sufficient repetition
What is involved in step five of health behaviour change using motivational interviewing?
REPEAT EVERYTHING at each visit to maintain behaviour change
How can action planning be used to encourage toothbrushing in paediatric patients?
Ask what routine habits exist each day (e.g getting changed in the morning and night) that could be used as a reminder to brush teeth immediately afterwards
- good way to make toothbrushing a habit
How often should hands-on brushing instruction be given to high risk paediatric patients?
At each recall visit for at least 3 minutes
What are the steps in toothbrushing instruction technique given to paediatric patients and their carers? *brief
- Decide if parent/carer is going to brush all surfaces of teeth in one section of mouth OR the same surface of each complete arch before moving on
- Carer can decide to stand behind/in front of child
- Dentist shows how to do it and then gets patient/carer to try
- Short scrubbing motion
- Should take 2 minutes
- Don’t drink or eat acidic things 30 mins before brushing
- Ensure to brush partially erupted teeth
What is diet advice for paediatric patients?
- limit consumption of sugary foods/drinks and confine to meal times
- drink only water or milk between meals
- have healthy snacks
- do not put sugary drinks in feeding bottles
- do not eat or drink (apart from tap water) after brushing teeth at night
- be aware of hidden sugars in food
- be aware of acid content in fizzy drinks
What are examples of healthy foods/snacks to recommend to paediatric patients?
- fresh fruit (sugary be careful!)
- carrot
- peppers
- breadsticks
- oatcakes
- low fat cheese
In higher risk paediatric patients, how would you assess their diet and provide advice?
Diet diary (3-5 days and at least one of the days is a weekend)
- advise based on diary
What are the standards for fissure sealant placement in paediatric patients?
Place sealants in all pits and fissures of permanent molars ASAP after eruption
- ensure buccal pits of lower FPM and palatal fissures of upper FPMs are sealed
- use Bis-GMA if cooperative (first choice)
- use GI if uncooperative
How would you check that a fissure sealant has be placed correctly?
- Try to dislodge sealant with a sharp probe
- Check with probe for blow holes/ledges
What is the gold standard for moisture control when placing fissure sealants? What can be used if this is unacceptable?
Gold standard = dental dam
Used instead = cotton wool rolls, saliva ejector, dry guards
Explain the steps of GI use as a fissure sealant option:
- Place a small amount of GI on one finger tip and petroleum jelly on the adjacent finger
- If able to wipe the tooth with cotton wool roll to dry
- Firmly apply the finger tip with glass ionomer to the tooth surface to be sealed, keep in place for 2 minutes
- Place the second finger in mouth and rapidly switch fingers to cover GI with petroleum jelly
What is the minimum age for fluoride varnish application?
2 years old
How often should fluoride varnish be applied to children’s teeth?
Minimum 2x per year BUT up to 4x per year for high risk patients
What is the concentration of fluoride varnish used in practise?
22,600ppmF (5%)
When is use of fluoride varnish contraindicated?
- Severe asthma
- Allergy to colophony
What amount of fluoride varnish should be used for children aged 2-5 years old?
0.25ml
What amount of fluoride varnish should be used for children aged 5+ years old?
0.4ml
After application of fluoride varnish, what instructions do you give to the patient and carer?
- Avoid eating and drinking for at least 30mins (longer better)
- Eat soft foods for the rest of day
- Brush teeth as usual that night
- Teeth may appear yellow but this will fade with eating and brushing
What is the safely tolerated dose of fluoride?
1mg/kg
What is a potentially lethal dose of fluoride?
5mg/kg
What is in a trauma stamp?
- colour
- TTP
- mobility
- sinus
- percussion note
- radiograph
- sensibility testing
A child patient has knocked out their front tooth, what advice do you give to the parent over the phone?
- Reassure patient/parent and calm them down
- Is the patient awake or exhibiting any signs of concussion/confusion/sickness.. if so send to A&E
- Pick up tooth via CROWN not root
- If visibly soiled run under water for 10s
- Replace into socket if possible, if not store tooth in saliva/milk/saline
- Get to dentist ASAP (<45 mins best)
What aftercare should be advised after trauma to primary teeth such as avulsion/luxation?
- Use analgesia
- Soft diet for 10-14 days
- Brush teeth with soft toothbrush after every meal be careful
- Topical chlorhexidine 0.12% mouthrinse if able
- Look for signs of infection
A child experiences an enamel fracture, what is the follow-up regime?
Review appointments at:
- 6-8 weeks
- 6 months
- 1 years
*Take radiograph and complete trauma stamp
A child experiences an enamel-dentine fracture, what is the follow-up regime?
Review appointments at:
- 6-8 weeks
- 6 months
- 1 years
*Take radiograph and complete trauma stamp
A child experiences an enamel-dentine-pulp fracture, what treatment options do you have?
- pulp cap
- partial pulpotomy
A child experiences an enamel-dentine fracture and you place a direct pulp cap, what is the follow-up regime?
- clinical follow up after 1 week
- clinical and radiographic follow up after 6-8 weeks
- clinical and radiographic follow up 6 months
- clinical and radiographic follow up after 1 year
A child experiences an enamel-dentine fracture and you complete a partial pulpotomy, what is the follow-up regime?
- clinical follow up after 1 week
- 6-8weeks
- 6 months
- 1 year
What % of all school children experience dental trauma?
25%
What is the most common injury in the primary dentition?
Luxation
What is the follow up regime for a paediatric patient who has suffered concussion to a permanent tooth?
Clinical and radiographic follow up
- 4 weeks
- 1 year
What is the follow up regime for a paediatric patient who has suffered subluxation to a permanent tooth?
Clinical and radiographic follow ups
- 2 weeks (including splint removal)
- 12 weeks
- 6 months
- 1 year
What are you checking at a follow up review of concussion/subluxation?
- trauma stamp
- sensibility tests
- radiographs = root development, comparison with contralateral tooth, resorption
What is the follow up regime for a paediatric patient who has suffered extrusion to a permanent tooth?
Clinical and radiographic follow ups
- 2 weeks (including splint removal)
- 4 weeks
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- Annually for 5 years
What is the follow up regime for a paediatric patient who has suffered lateral luxation to a permanent tooth?
Clinical, radiographic and endodontic check
- 2 weeks
Clinical and radiographic follow ups
- 4 weeks (splint removal)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- Annually for 5 years
What is the follow up regime for a paediatric patient who has suffered intrusion to a permanent tooth?
Clinical and radiographic follow ups
- 2 weeks
- 4 weeks (including splint removal)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- Annually for 5 years
What is the follow up regime for a paediatric patient who has suffered avulsion to a permanent tooth with closed apex?
Follow up:
- 2 weeks (splint removal too)
- 4 weeks
- 3 months
- 6 months
- 1 year
- Annually for 5 years
What is the follow up regime for a paediatric patient who has suffered avulsion to a permanent tooth with open apex?
Follow ups
- 2 weeks (splint removal)
- 1 month
- 2 months
- 3 months
- 6 months
- 1 year
- annually for 5 years
When would you decide NOT to replant a permanent tooth that has suffered avulsion?
- child immunocompromised
- other serious injuries require priority emergency treatment
- very immature apex and extended EAT (>90 mins)
What is the follow up regime for a paediatric patient who has suffered dento-alveolar fracture to permanent teeth?
Follow ups
- 4 weeks (splint removal)
- 6-8 weeks
- 4 months
- 6 months
- 1 year
- annually for 5 years
What advice would you give to a patient that has experienced dento-alveolar fracture?
- soft diet for 7 days
- avoid contact sport
- brush teeth but be careful
- use Chlorhexidine 0.12%
What types of splint can be used in paediatric patients chair side?
- composite and wire
- titanium trauma splint
- composite***
- orthodontic brackets & wire
- acrylic
What types of splint can be used in paediatric patients lab made?
- vacuum-formed splint
- acrylic
What are the most common post-trauma complications of permanent teeth?
- pulp necrosis and infection
- pulp canal obliteration
- root resorption
- breakdown of marginal gingiva and bone
