PAEDS OSCE PREP

Question 1

What generalised toothbrushing advice would you give to all paediatric patients and their carers?

Answer 1

• 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

Question 2

What fluoride toothpaste would be used in a standard risk child under 3 years old?

Answer 2

a SMEAR of 1000-1500ppmF

Question 3

What fluoride toothpaste would be used in a high risk child under 3 years old?

Answer 3

a SMEAR of 1350-1500ppmF

Question 4

What fluoride toothpaste would be used in a standard risk child 3+ years old?

Answer 4

a PEA-SIZED amount of 1000-1500ppmF

Question 5

What fluoride toothpaste would be used in a high risk child 3+ years old?

Answer 5

a PEA SIZED amount of 1350-1500ppmF

Question 6

What fluoride toothpaste would be used in a high risk child 10+ years old?

Answer 6

2800ppmF toothpaste

Question 7

What is the pneumonic that is involved in motivational interviewing?

Answer 7

SOARS
- seek permission
- open questions
- affirmations
- reflective listening
- summarising

Question 8

What is involved in step one of health behaviour change using motivational interviewing?

Answer 8

Explore current practise and attitudes using a motivational interviewing approach
- SOARS

Question 9

What is involved in step two of health behaviour change using motivational interviewing?

Answer 9

educational intervention
- improve knowledge and skills

Question 10

What is involved in step three of health behaviour change using motivational interviewing?

Answer 10

Action planning
- set time, date and place to start

Question 11

What is involved in step four of health behaviour change using motivational interviewing?

Answer 11

Encourage habit formation
- achieve sufficient repetition

Question 12

What is involved in step five of health behaviour change using motivational interviewing?

Answer 12

REPEAT EVERYTHING at each visit to maintain behaviour change

Question 13

How can action planning be used to encourage toothbrushing in paediatric patients?

Answer 13

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

Question 14

How often should hands-on brushing instruction be given to high risk paediatric patients?

Answer 14

At each recall visit for at least 3 minutes

Question 15

What are the steps in toothbrushing instruction technique given to paediatric patients and their carers? *brief

Answer 15

• 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

Question 16

What is diet advice for paediatric patients?

Answer 16

• 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

Question 17

What are examples of healthy foods/snacks to recommend to paediatric patients?

Answer 17

• fresh fruit (sugary be careful!)
• carrot
• peppers
• breadsticks
• oatcakes
• low fat cheese

Question 18

In higher risk paediatric patients, how would you assess their diet and provide advice?

Answer 18

Diet diary (3-5 days and at least one of the days is a weekend)
- advise based on diary

Question 19

What are the standards for fissure sealant placement in paediatric patients?

Answer 19

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

Question 20

How would you check that a fissure sealant has be placed correctly?

Answer 20

• Try to dislodge sealant with a sharp probe
• Check with probe for blow holes/ledges

Question 21

What is the gold standard for moisture control when placing fissure sealants? What can be used if this is unacceptable?

Answer 21

Gold standard = dental dam

Used instead = cotton wool rolls, saliva ejector, dry guards

Question 22

Explain the steps of GI use as a fissure sealant option:

Answer 22

• 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

Question 23

What is the minimum age for fluoride varnish application?

Answer 23

2 years old

Question 24

How often should fluoride varnish be applied to children’s teeth?

Answer 24

Minimum 2x per year BUT up to 4x per year for high risk patients

Question 25

What is the concentration of fluoride varnish used in practise?

Answer 25

22,600ppmF (5%)

Question 26

When is use of fluoride varnish contraindicated?

Answer 26

- Severe asthma - Allergy to colophony

Question 27

What amount of fluoride varnish should be used for children aged 2-5 years old?

Answer 27

0.25ml

Question 28

What amount of fluoride varnish should be used for children aged 5+ years old?

Answer 28

0.4ml

Question 29

After application of fluoride varnish, what instructions do you give to the patient and carer?

Answer 29

- 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

Question 30

What is the safely tolerated dose of fluoride?

Answer 30

1mg/kg

Question 31

What is a potentially lethal dose of fluoride?

Answer 31

5mg/kg

Question 32

What is in a trauma stamp?

Answer 32

- colour - TTP - mobility - sinus - percussion note - radiograph - sensibility testing

Question 33

A child patient has knocked out their front tooth, what advice do you give to the parent over the phone?

Answer 33

- 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)

Question 34

What aftercare should be advised after trauma to primary teeth such as avulsion/luxation?

Answer 34

- 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

Question 35

A child experiences an enamel fracture, what is the follow-up regime?

Answer 35

Review appointments at: - 6-8 weeks - 6 months - 1 years *Take radiograph and complete trauma stamp

Question 36

A child experiences an enamel-dentine fracture, what is the follow-up regime?

Answer 36

Review appointments at: - 6-8 weeks - 6 months - 1 years *Take radiograph and complete trauma stamp

Question 37

A child experiences an enamel-dentine-pulp fracture, what treatment options do you have?

Answer 37

- pulp cap - partial pulpotomy

Question 38

A child experiences an enamel-dentine fracture and you place a direct pulp cap, what is the follow-up regime?

Answer 38

- 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

Question 39

A child experiences an enamel-dentine fracture and you complete a partial pulpotomy, what is the follow-up regime?

Answer 39

- clinical follow up after 1 week - 6-8weeks - 6 months - 1 year

Question 40

What % of all school children experience dental trauma?

Answer 40

25%

Question 41

What is the most common injury in the primary dentition?

Answer 41

Luxation

Question 42

What is the follow up regime for a paediatric patient who has suffered concussion to a permanent tooth?

Answer 42

Clinical and radiographic follow up - 4 weeks - 1 year

Question 43

What is the follow up regime for a paediatric patient who has suffered subluxation to a permanent tooth?

Answer 43

Clinical and radiographic follow ups - 2 weeks (including splint removal) - 12 weeks - 6 months - 1 year

Question 44

What are you checking at a follow up review of concussion/subluxation?

Answer 44

- trauma stamp - sensibility tests - radiographs = root development, comparison with contralateral tooth, resorption

Question 45

What is the follow up regime for a paediatric patient who has suffered extrusion to a permanent tooth?

Answer 45

Clinical and radiographic follow ups - 2 weeks (including splint removal) - 4 weeks - 8 weeks - 12 weeks - 6 months - 1 year - Annually for 5 years

Question 46

What is the follow up regime for a paediatric patient who has suffered lateral luxation to a permanent tooth?

Answer 46

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

Question 47

What is the follow up regime for a paediatric patient who has suffered intrusion to a permanent tooth?

Answer 47

Clinical and radiographic follow ups - 2 weeks - 4 weeks (including splint removal) - 8 weeks - 12 weeks - 6 months - 1 year - Annually for 5 years

Question 48

What is the follow up regime for a paediatric patient who has suffered avulsion to a permanent tooth with closed apex?

Answer 48

Follow up: - 2 weeks (splint removal too) - 4 weeks - 3 months - 6 months - 1 year - Annually for 5 years

Question 49

What is the follow up regime for a paediatric patient who has suffered avulsion to a permanent tooth with open apex?

Answer 49

Follow ups - 2 weeks (splint removal) - 1 month - 2 months - 3 months - 6 months - 1 year - annually for 5 years

Question 50

When would you decide NOT to replant a permanent tooth that has suffered avulsion?

Answer 50

- child immunocompromised - other serious injuries require priority emergency treatment - very immature apex and extended EAT (>90 mins)

Question 51

What is the follow up regime for a paediatric patient who has suffered dento-alveolar fracture to permanent teeth?

Answer 51

Follow ups - 4 weeks (splint removal) - 6-8 weeks - 4 months - 6 months - 1 year - annually for 5 years

Question 52

What advice would you give to a patient that has experienced dento-alveolar fracture?

Answer 52

- soft diet for 7 days - avoid contact sport - brush teeth but be careful - use Chlorhexidine 0.12%

Question 53

What types of splint can be used in paediatric patients chair side?

Answer 53

- composite and wire - titanium trauma splint - composite*** - orthodontic brackets & wire - acrylic

Question 54

What types of splint can be used in paediatric patients lab made?

Answer 54

- vacuum-formed splint - acrylic

Question 55

What are the most common post-trauma complications of permanent teeth?

Answer 55

- pulp necrosis and infection - pulp canal obliteration - root resorption - breakdown of marginal gingiva and bone