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BDS4 Exam Perp > Paeds questions > Flashcards

Paeds questions Flashcards

1
Q

What does a BPE score of 3 mean?

A
  • pocket depth 3.5-5.5 mm
  • black band partially visible
  • plaque retentive factors present (calculus, overhangs)
  • bleeding on probing
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2
Q

What teeth should be probed in a 13 year old to obtain BPE?

A

16,11,26
46,31,36
* simplified BPE until the age of 17

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3
Q

What is the normal depth from ECJ to alveolar bone crest?

A

This is the biological width - 2mm

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4
Q

What medications conditions might cause a 13 year old to have BPE of 3?

A
  • anti-epileptics - phenytoin
  • Calcium channel blockers - amlodipine - CVD
  • immunosuppression - cyclosporine
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5
Q

What medical conditions might cause BPE of 3? (not medication related)

A
  • diabetes
  • Leukaemia
  • puberty
  • aggressive periodontitis?
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6
Q

Special investigations for BPE of 3 in children?

A
  • 6PPC
  • Plaque free and marginal bleeding chart
  • Radiographs (BW, PA)
  • Diet diary
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7
Q

When to start periodontal assessment in children and why?

A

*7 and above
* unlikely to have periodontal disease before this age + index teeth are still not erupted

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8
Q

What is the treatment plan for BPE scores of 3 in children?

A
  • initial periodontal therapy (step1) : OHI, PMPR and prevention
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9
Q

When to refer a child with periodontitis to specialist?

A
  • stage 2,3,4
  • Grade C
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10
Q

What 2 questions to ask parent when a child presents with a fractured tooth?

A
  • when, how and where did it happen?
  • If they can account for the missing fragment
  • any other symptoms or injuries due to trauma?
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11
Q

What things determine the prognosis of a traumatised tooth when discussing with patient?

A
  • Size of exposure
  • Stage of root development
  • Type of injury
  • If PDL is damaged
  • time between injury and treatment
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12
Q

Where do you suspect a missing tooth fragment to be and how to manage this?

A
  • inhaled in the lungs - chest x-ray A&E referral
  • swallowed in the stomach - stomach scan A&E referral
  • Embedded in soft tissues - radiograph to confirm then remove and suture / refer to OS
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13
Q

Tooth have an enamel dentine fracture what is your management?

A
  • account for fragment
  • take 2PA to rule out root fracture or luxation
  • radiograph any lip or cheek lacerations to rule out embedded fragments
  • Sensibility test and evaluate root maturity
  • bond fragment to tooth or place composite bondage with lining if close to the pulp
  • review within 6-8 weeks and one year
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14
Q

What to check at review after trauma ?

A
  • check with radiographs for root development (compare with contralateral tooth)
  • Check for internal or external root resorption
  • check for any periapical pathologies
  • ask patient if they have any symptoms
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15
Q

What to discuss with parent regarding the treatment of a traumatised tooth?

A
  • inform of any complications : discolouration, pain, sinus, infection, damage to adjacent teeth
  • prognosis of tooth
  • inform about treatment options to gain valid consent
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16
Q

List 8 questions you would ask mother when child is presenting with white/yellow/brown stains on teeth?

A
  • during pregnancy - natural birth?
  • any severe illness during pregnancy such as anaemia or gestational diabetes
  • any problems in 3rd trimester such as pre-eclampsia
  • any birth trauma, anoxia or hypokalaemia?
  • what is a pre-term birth?
  • how long did the child breast feed for? any fever or medication during this time?
  • socioeconomic status
    *any infections during childhood such as measles/chicken pox or rubella?
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17
Q

What is the condition that affect the 1st molars and incisors causing tooth discolourations?

A

MIH (molar incisor hypo-mineralisation)

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18
Q

Questions to rule out fluorosis from MIH?

A
  • does the patient use fluoridated toothpaste and how often?
  • what fluoride concentration the patient use?
  • does the patient drink fluoridated water?
  • fluoride supplement use and why?
  • does the patient have any siblings who use high strength toothpaste? does the child use that?
  • what is the child oral hygiene regime?
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19
Q

What is MIH?

A

Hypo-mineralisation of systemic origin affecting the first permanent molars frequently associated with affected incisors

disturbance of enamel formation resulting in a reduced mineral content

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20
Q

List potential problems associated with MIH teeth in the future?

A
  • loss of tooth substance (enamel breakdown, caries, toothwear)
  • teeth sensitivity
  • poor long term prognosis
  • poor aesthetics
  • difficult to restore due to poor bonding capability
  • problems with orthodontic treatment
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21
Q

Treatment options for MIH incisors?

A
  • micro-abrasion
  • resin infiltration
  • localised composite restoration
  • composite/porcelain veneers
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22
Q

MIH molars treatment options?

A
  • composite/GIC restoration
  • SSC
  • Extractions
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23
Q

What diagnostic test to carry out to check vitality of a tooth?

A
  • EPT
  • ECT
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24
Q

What are the treatment options for a subluxation trauma?

A

flexible splint for 2 weeks

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25
What advice would you give when splinting a tooth for trauma?
* OHI ; CHX mouthwash + gentle brushing * Eat soft diet * Avoid contact sports
26
At what age should you be able to palpate the canine in the buccal sulcus for a child?
* Palpate maxillary canines at 9-11 years
27
What method would you use to locate the position of an ectopic canine?
* Vertical parallax technique * PA + upper anterior occlusal * upper anterior occlusal and OPT
28
What age range is ideal for interceptive orthodontics?
* 7-11 years, mixed dentition stage
29
How long after extracting the Cs you should review ectopic canines?
6 months
30
What syndromes can be associated with hypodontia? (4)
* Down's syndrome * Pierre robin syndrome * Cleft lip and palate patients * ectodermal dysplasia
31
How may hypodontia present to GDP? (6)
* missing primary teeth * delayed exfoliation of primary teeth * delayed or asymmetrical pattern of eruption * infra-occlusion * Cleft lip and palate * Ectopic canines
32
What are 4 options to replace missing teeth in hypodontia? (general)
* accept and monitor * restorative management * orthodontic management * restorative and orthodontic management : Close space Open space - Implant, RBB ,autotransplantation, rpd
33
Name people involved in the care of a child with hypodontia? (8)
* restorative dentist * paediatric dentist * orthodontist * Prosthodontist * oral surgeon * GDP * Clinical psychologist * Speech and language therapist
34
what is the incidence of missing primary teeth?
less than 1%
35
What is the incidence of missing permanent teeth?
6% excluding the 8s
36
What are the most teeth affected by hypodontia in order?
Lower 5 Upper 2 Upper 5 Lower incisors
37
What 4 things would make you suspect a non accidental injury in a child?
* delays in presentation and untreated injuries * injuries that does not fit explanation * injuries that are in the triangle of safety * injuries to both side of the body
38
What is the triangle of safety?
* the area between the ears, side of face, the neck and top of shoulders * injuries in this area are most likely to be non-accidental
39
Give 2 effects of trauma on primary teeth?
* discolourations * delayed exfoliation of primary tooth ( may not resorb normally)
40
Give 5 effects of trauma on permanent dentition?
* enamel defects * ectopic tooth position * abnormal tooth or root morphology * delayed eruption * Ankylosis
41
What 4 conditions are down's syndrome children predisposed to?
* Cardiac defects ; ventricular septal defect, tetralogy of Fallot * Leukaemia * Epilepsy * Dementia ( alzheimer's)
42
What are 7 extra-oral features of down's syndrome?
* eye's that slant upwards and outwards (almond shaped) * Small mouth and tongue may stick out * Small ears (dysplastic) * Flat nasal bridge and small nose * Flat back of head * Flat face * fissured lips
43
6 intra-oral features of down's syndrome?
* Predisposition to periodontal disease * Macroglossia * Hypodontia * Microdontia * Maxillary hypoplasia - the underdevelopment of bones in the upper jaw * Class III malocclusion
44
How would you alter the prevention treatment plan for children with down's syndrome?
* Fluoride varnish x4 22,600 ppm * Recall every 3-6 months * Radiographs every 6-12 months * Stronger toothpaste strength ex. 2800 * Fluoride supplements * CHX mouthwash
45
What 8 things are assessed in a clinical trauma review?
* Sinus * Colour * ECT * EPT * TTP * Percussion note * Radiographs * Mobility
46
What is lateral luxation?
* displacement of the tooth in a direction other than apically * accompanied alveolar bone fracture (labial/palatal/lingual) * The tooth is forced into alveolar bone which results in the tooth being non-mobile * Totall or partial PDL separation
47
How long are lateral luxation injuries splinted for?
* Flexible splint for 4 weeks - due to alveolar bone fracture
48
What kind of root resorption might occur with lateral luxation trauma?
External inflammatory resorption
49
What is the cause of root resorption?
* Trauma (luxation , avulsion) * necrotic pulp -> root canal system necrosis -> periapical periodontitis -> osteoclasts osteoclasts to resorb bone * Prolonged stimuli to areas of damaged root allowing progressing of the root resorption * Orthodontic treatment
50
What is the stimulation molecule in root resorption?
RANKL which is a signalling molecules that regulate osteoclast activity
51
What is the initial management of root resorption (children)?
* symptomatic management * infective cause - remove stimulus , orthograde endodontics with CaOH dressing * pressure cause - stop orthodontic treatment * extraction in some cases
52
What is the short term management of root resorption (children)?
Monitor and review
53
What is the long term management of root resorption (children)?
* radiographic review * replace of CaOH dressing
54
How would external root resorption appear clinically?
* positive to ECT * Negative to EPT * pain on percussion * may be mobile
55
What are the radiographic signs of external root resorption?
* Widening of the PDL with loss of surrounding lamina dura * Shortening and blunting of root apices * Tramlines of root canal are still intact
56
What are the children caries risk assessment criteria? (7)
* clinical evidence * dietary habits * saliva * plaque levels * medical history * social history/ socioeconomic status * fluoride use
57
What 8 factors make up the prevention plan of a child?
* fluoride varnish * fissure sealants * diet diary * fluoride supplements * Toothbrushing instructions * Strength of fluoride toothpaste * Sugar free medicines * Radiographs
58
How often should you take bitewings for high risk and low risk children?
- high : 6 months - low : 12-18 months
59
What toothpaste strengths are used in children? (normal risk)
up to 3 years - 1000 ppm - smear 0.1ml 3-6 years - 1000ppm - pea 0.25 ml 7+ = 1350-1500 ppm - pea 0.25 ml
60
What toothpaste strengths for high risk caries in children?
Under 10 - 1500ppm 10 -16 = 2800ppm 16+ = 5000ppm
61
What is the time interval for fluoride varnishes in high risk vs low risk children?
* x4 a year in high risk / medically compromised and special needs * x2 a year for normal risk * should not be placed within 24h
62
What is the most appropriate fluoride supplements?
* FV 22,600 at least twice a year * Sodium fluoride mouthwash - 225ppm for 7+ * Oral fluoride tablets 1mg/ml
63
How does fluoride work?
* slows down the development of caries by stopping demineralisation * speeds up enamel remineralisation * can stop bacterial metabolism to produce acid attack * make enamel more resistant to acid attack
64
What other than fluoride varnish can be carries out to protect a high risk caries?
* Place fissure sealants in all pits and fissures of permanent teeth * Diet advice including sugar free medicines * Tooth brushing instructions and increased fluoride toothpaste strength
65
Describe the appearance of dental fluorosis ?
* Opaque white spots and streaks on the teeth ( chalky) * mottled patches on teeth in mild cases * brown staining and pitting on the teeth in severe cases
66
What fluoride concentration is optimum in drinking water?
* 1ppm
67
Where can fluoride be found in food?
* Tea * Beer * Bony fish * Cucumber and pickles * Spinach, asparagus and carrots * Potatoes and white rice
68
Give 2 treatment options for fluorosis and the advantages of this treatment?
* Micro-abrasion - easily performed, conservative, fast acting , permanent results * Vital bleaching - allow patient to achieve desired color, simple, can be carried out at home , tooth conserving * Composite restoration over defect - tooth tissue conservation, simple and inexpensive
69
10 year old boy present with bad taste and on examination you note generalised white plaque that scraps off easily and leaves an erythematous base , what is your diagnosis?
Pseudomembranous candidiasis
70
Name 4 pre-disposing factors for pseudomembranous candidiasis?
Local * steroid inhaler use * oral steroids * nutritional deficiencies * broad spectrum antibiotic use Medical * Diabetes * Immunocompromised : HIV
71
Give an advantage and a disadvantage of an oral swab?
* Simple and site specific * can be easily contaminated and uncomfortable
72
Give an advantage and a disadvantage of an oral rinse?
* Records whole mouth and can separate healthy organisms * not site specific and some patient find it hard to do the rinse process * difficult to standardise
73
What is the first line medication for pseudomembranous candidosis?
* Miconazole cream first * Fluconazole capsules - systemic if severe * Can interact with warfarin and statins
74
What other medications than fluconazole can be used for oral candidosis?
* miconazole oro mucosal gel * Nystatin oral suspension
75
What 3 questions would you ask mother about child who ingested fluoride?
* How old is the child? * What is the strength of the toothpaste (fluoride concentration) * How much toothpaste have they swallowed? * The child weight? | age dose, weight and amount
76
If a child ingested a possible toxic dose of fluoride, what would be your advice?
* less than 5mg/kg = give calcium orally (milk) and observe for few hours * 5-15 mg/kg = give calcium orally (milk) and admit to hospital * more than 15mg/kg = admit to hospital immediately for cardiac monitoring and life support and give IV calcium gluconate
77
What 3 calcium forms can be given to a child who swallowed fluoride toothpaste?
* milk * calcium gluconate * calcium lactate
78
What is the most common cause of fluorosis in the UK?
* fluoride in the public water supply 1ppm
79
What is your first line treatment for a 10 year child with fluorosis?
Enamel micro-abrasion or leave and monitor
80
Flouride supplements values for patients ages 1 , 4 , 7
1 - 0.25mg drops 4 - 0.5 mg tablets 7 - 225ppm mouthwash
81
Diagnostic features of subluxation injury?
* Increased mobility and TTP * No displacement of the tooth * Bleeding from gingival sulcus
82
What type of splint would you use for subluxation?
2 weeks flexible splint
83
When would you review a patient with subluxation?
2,4,8 and 1 year
84
Define root resorption
the non bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells
85
What 2 features would you assess radiographically when reviewing a lateral luxation injury? (3)
* root development * internal and external root inflammatory resorption * comparing with opposite tooth
86
How does internal inflammatory root resorption present clinically? (6)
* Pink spot on crown * Radiographically oval translucency in canal * Initially positive to sensibility testing * Not mobile * Sinus may be present at late stage * early stages asymptomatic or mild discomfort * Tooth discolouration *
87
How would internal inflammatory root resorption present radiographically?
* round to oval radiolucent enlargement to pulp canal * Outline of root canal is distorted * continuous with root canal walls * mottled appearance (radiopacities) due to replacement resorption
88
What is the mechanism of internal root resorption?
* Outermost odontoblast layer and pre-dentine of the canal damaged * Exposure of underlying mineralised dentine to odontoclasts * this can lead to necrosis and apical periodontitis if left untreated
89
What is the management of internal root resorption?
* CaOH in canal * RCT * remove cause if present
90
6 year old child resents with pain in lower right quadrant due to grossly carious 85, and a buccal swelling , the patient. also suffers from haemophilia A * what is your diagnosis?
periapical abscess due to gross caries
91
6 year old child presents with pain in lower right quadrant due to grossly carious 85, and a buccal swelling , the patient. also suffers from haemophilia A What is the treatment choice for this patient? and why?
* Caries excavation and sedative dressing * Pulp therapy - pulpectomy or pulpotomy * Drainage of pus - ABS for systemic involvement * Extractions as last resort as need to lialise with haematologists for coagulation factor replacement / use of transexamic acid
92
6 year old child presents with pain in lower right quadrant due to grossly carious 85, and a buccal swelling , the patient. also suffers from haemophilia A List 8 stages in this treatment
Pulp therapy * LA and dental dam * Clean area with water/CHX * remove 2mm of pulp and check haemostasis with saline cotton pledge * If no bleeding / hyperaemic continue with full pulpotomy * If haemostasis achieved place CaOH in pulp chamber and seal with GIC and SCC Antiobiotic for systemic involvement XLA - lialise with haematologist as patient might require transexamic acid or factor VIII replacement / DDAVP (desmopressin)
93
What precautions should you take when extracting a tooth in a patient with haemophilia? (5)
* Use infiltrations instead of blocks * Atraumatic procedure * Consult with haematologist * Suturing and haemostatic agents should be used * Give transexamic acid and review within one week
94
Name 4 local haemostatic agents?
* Surgicel - oxidised cellulose * Haemocollagen sponge * ferric sulphate * saline
95
List possible treatment options for impacted molars on a 7 year old child? (7)
* Accept and monitor - might correct once other teeth exfoliate and erupt * Orthodontic separator use * Orthodontic appliance attached to 6 to bring into position * Remove distal of E * XLA of E * URA to create space
96
Why might a first molar be impacted? (5)
* angle of path of eruption * Crowding * Small maxilla/mandible * Morphology of surrounding teeth * Ectopic crypt
97
What complications are associated with impacted molars? (7)
* Pain and discomfort * Difficulty maintaining oral hygiene * Tipping and tilting of adjacent teeth causing crowding and misalignment * Periodontal disease - bone loss * Root resorption * may interfere with orthodontic treatment * tooth loss
98
What features of permanent dentition allow for replacement of primary teeth without crowding? (3)
* Slightly proclined permanent teeth * Interdental spacing between primary teeth allow for space for permanent * Mandibular and maxillary growth during puberty * Leeway space ( in primary dentition)
99
What is leeway space and why does it relieve crowding?
Leeway space is the extra mesial-buccal-distal space that is occupied by the primary molars which are wider than the premolars that are going to replace them allowing space for the premolars and molars
100
How much is the leeway space?
- 1.5mm per side on upper - 2.5mm per side on lower
101
What is extrusion?
* Partial displacement of a tooth out of its alveolar socket
102
What are the characteristics of extrusion?
* Partial or total separation of PDL * loosening of the tooth - mobility * alveolar socket bone is intact * tooth may be protruded or retruded
103
What materials would you use in a flexible splint? and how?
* flexible stainless steel wire 0.6mm * Acid etch 37% phosphoric acid ; prime and bone ; composite * Sink contoured; passive wire into composite * Shape and light cure composite * Smooth any rough composite and wire ends
104
What aesthetic problems in missing 23 and 22 in a 17 year old patient?
* teeth in smile line so patient may be more aware of this when smiling * Patient may be teased due to the gap in teeth * Patient may be psychologically affected by having missing teeth
105
What problems with function of missing 23 and 23 in a 17 year old?
* Difficulty with incising food * Problems with speech (whistling) * Teeth may not occlude properly
106
What are the types of dentinogenesis imperfecta?
Type 1 : associated with osteogenesis imperfecta Type 2 : not associated with OI but autosomal dominant Type 3 : brandywine isolate
107
What are the clinical signs of dentinogenesis imperfecta
* loss of enamel ( more susceptible to fracture/wear) * discolouration * both primary and permanent dentine affected * Amber appearance of affected teeth (translucent) * Multiple periapical abscess due to pulpal obliteration * malocclusion * increased sensitivity
108
What are the clinical signs of osteogenesis imperfecta? (5)
* blue eye sclera * bone fractures * hearing loss * bone deformities * Bruise easily
109
What are the radiographic signs of dentinogenesis imperfecta?
* bulbous crown with apparent cervical constriction * Periapical radiolucencies * Obliterated pulp chamber and canals due to deposition of dentine ( erupts large and sclerosis occur) * Reduced root length with rounded apices
110
4 restorative options for dentinogenesis imperfecta?
* SCC * Composite/porcelain veneers * Over dentures *Removable prosthesis
111
Which type of dentinogenesis imperfecta present with obliterated pulps?
Type 1 and 2
112
Cooperative 10 year old attends with moderate crowding requesting othrotreatment , he has poor oral hygiene and caries into dentine in first molars Describe you management
# deal with pain first - analgesia * Assessment : History, E/O , I/O and caries risk assessment , radiographs , sensibility testing * Treatment : # Treat caries # Prevention : FS, OHI , radiographs , fluoride varnish/toothpaste , diet diary # Ortho treatment : explain OH importance before ortho , explain it is not appropriate at this time due to caries/OH and age/development # Asess child protection for neglect due to caries on 6s ## Footnote - also find out why patient wants orthodontic treatment and explain risks and benefits
113
Cooperative 10 year old attends with moderate crowding requesting othrotreatment , he has poor oral hygiene and caries into dentine in first molars Describe the risk/benefit discussion with parent and child? Regarding : ortho, GA , extraction of 6s
* Risks of orthodontic treatment Root resorption Relapse Gingival recession Decalcification Trauma * Risk of extracting 6s Pain, bleeding, bruising, infection, damage to adjacent structures, mesial tipping of 7 , distal migration of 5's * Benefits of extracting 6s caries free dentition * Risks of GA Nausea, drowsiness, vomiting , slow recovery, hypoxia, brain injury, death, anaphylactic shock
114
When should you extract the 6s in a child?
When the bifurcation of the 7 is developing or if 8s are present
115
* 5 year old presenting with mums boyfriend * did not sleep due to dental pain * never been to dentist due to mum fear * She is pyrexic, in pain and had swollen left side of face associated with gross caries in all primary teeth * you provisionally diagnose acute peripapical abscess What should you establish prior to examination ?
- History - pain history, MH, DH and allergies - Consent for any treatment - Determine if airway is compromised due to pyrexia (chest infection) ## Footnote If a patient is unable to swallow or they are unable to push their tongue forward in their mouth send to emergency via NHS 24 or call 999
116
* 5 year old presenting with mums boyfriend * did not sleep due to dental pain * never been to dentist due to mum fear * She is pyrexic, in pain and had swollen left side of face associated with gross caries in all primary teeth * you provisionally diagnose acute peripapical abscess Discuss one behavioral management technique you could use to maximise patient cooperation?
Tell - Show - Do * tell patient what you are going to do * show them how you are going to do it * Do the action - initiate treatment with a minimum delay
117
* 5 year old presenting with mums boyfriend * did not sleep due to dental pain * never been to dentist due to mum fear * She is pyrexic, in pain and had swollen left side of face associated with gross caries in all primary teeth * you provisionally diagnose acute peripapical abscess Patient is classed as pre-cooperative before treatment, what would be your short term management?
* pain relief - ibuprofen * drain the abscess * antibiotic use due to systemic involvement ( amoxicillin capsules) * review patient within 5 days * explain that if swelling or pain gets worse go to A&E
118
* 5 year old presenting with mums boyfriend * did not sleep due to dental pain * never been to dentist due to mum fear * She is pyrexic, in pain and had swollen left side of face associated with gross caries in all primary teeth * you provisionally diagnose acute peripapical abscess How would you address the issue of the child non -attendance?
* ensure you have patient correct details * record visit in notes * contact mum to discuss what has happened today and the importance of jodi attendance and issues regarding consent when she is not present * inform mum of possibility of child protection involvement due to non-attendance and non-compliance * Set up next appointment that is suitable for all | Keep in mind that she presented with mum boyfriend - not guardian
119
* 5 year old presenting with mums boyfriend * did not sleep due to dental pain * never been to dentist due to mum fear * She is pyrexic, in pain and had swollen left side of face associated with gross caries in all primary teeth * you provisionally diagnose acute peripapical abscess What evidence based advice would you give?
* Modifies bass technique : hold brush at 45 degree angle between the gums and tooth and brush with back/forward motion covering all surfaces of the tooth * Brush at least for 2min twice daily (morning and night) * Use 1350-1500 fluoridated toothpaste (pea size) * Use soft multi-tufted toothbrush * Spit do not rinse after brushing * supervise child
120
Until what age you should supervise child while toothbrushing?
Age of 7-8 * by standing behind the child infront of the mirror
121
What are the indications for a pulpotomy?
** general indications ** * Preserving tooth is necessary * medical history contraindicated extractions * Good cooperation * Missing permanent successor * Child under 9 ** clinical indications** * reversible pulpitis * marginal ridge destroyed * caries extending 2/3 into dentine radiographically
122
Describe primary incisor pulpotomy vs primary molar pulpotomy?
**Primary incisor** * Don't use ferric sulphate as it may stain the teeth * use more aesthetic restoration such as composite or MCC ** Primary molar** * Can use ferric sulphate * restoration can be SSC cause aesthetics not important
123
Why is generally pulpectomy is carried out on primary incisors instead of pulpotomy?
Due to small amount of pulp tissue
124
How does failure of pulpotomy monitored radiographically and clinically?
**Clinically** * mobility * Pain * Sinus * Abscess **radiographically** * root resorption * furcation bone loss * radiolucency (PA)
125
When is a full coronal pulpotomy used and what does it follow on from and what treatment can be used afterwards?
* After a partial pulpotomy where 2-3mm of pulp is removed until reaching healthy pulp * pulpectomy can be carried out after a full pulpotomy which include removing all pulp tissue -> RCT
126
What are the indications for a pulpectomy? (4)
* Exposure of non bleeding or hyperaemic pulp * Irreversible pulpitis * Periapical periodontitis * acute abscess
127
What is the process of a pulpectomy?
- Access and remove caries and remove contents of pulp chamber - Coronal pulp extirpation - Root canal prep 2mm short of radiographic apex using K-files to remove pulp tissue from canal - Obturate with vitapex = CaOH and iodoform paste - GIC cement / SCC - Post op radiograph essential to make sure no pulp obliteration
128
What are the advantages of non vital bleaching?
* simple to perform * conservative of tooth tissue * Keeps original tooth morphology * gingival tissues not irritated by material * no lab assistance required for walking bleach technique * adolescent gingival level is not a restorative consideration
129
Describe the outside-inside non vital bleaching technique?
* open access cavity ( root filling removed to below gingival level) * Custom mouthgaurd is made ( cut areas of teeth no being bleached from tray) * Patient applies gel to back of teeth and tray * gel should be changed every 2 hours / except for night * worn all the time except when eating or cleaning * patient should ensure the access cavity is clean and remove any food debris etc... ## Footnote To allow rebleaching CaOH placed and sealed with GIC then after two weeks white GP is applied with composite If no rebleaching required : Place composite + white GP
130
What are the total number of changes in walking bleach technique?
6-10 changes
131
Describe the walking bleach technique
* remove GP to below CEJ * clean with ultrasonic * place cotton pledge with bleaching agent then cover with dry cotton pledge * Seal with GI
132
What are the disadvantages of non vital bleaching? (5)
* cervical resorption * brittleness of tooth crown * can over bleach the teeth * risk of spillage of bleaching agent * may fail to bleach teeth
133
What to do if regression occurs after non vital bleaching?
Composite or porcelain veneers
134
What are the eruption dates of the primary dentition?
A : 4-6 m B : 7-16 m D : 13-19 m C : 16 - 22 m E : 15-33 m
135
What are the eruption dates for permanent dentition?
6 yrs - upper and lower 6s , lower 1s 7 yrs - upper 1s , lower 2s 8 yrs - upper 2s 9 yrs - lower 3s 10 yrs - 4s , 5s 11 yrs - upper 3s 12 yrs - 7s | Upper - 6124537 Lower - 6123457
136
When does eruption of primary dentition begins and when does it complete?
* begins at 6 months * completes in 2.5 - 3 years * lower teeth erupt before uppers except Bs
137
How long does it take for primary tooth root to complete apexogenesis?
1.5 years
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How long does it take for permanent tooth root to complete apexogenesis?
3 yrs
139
What are the types of amelogenesis imperfecta?
1 - hypoplastic - does not grow to complete length 2- hypomineralised - does not grow to complete thickness and width 3- hypomaturational - incomplete mineralisation, thickness and width 4- mixed with taurodontism
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Incidence of amelogenesis imperfecta
1:14000
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What causes amelogenesis imperfecta?
An inherited gene mutation in the genes AMELX, ENAM or MMP20 which are responsible for for making the proteins needed for normal formation of enamel extracellular matrix proteins | different mutations depend on the type of amelogenesis imperfecta
142
Examples of enamel extracellular matrix molecules
* enamelin * amelogenin * Kallikrein 4
143
What problems may occur with amelogenesis imperfecta? (6)
* anterior open bite * delayed eruption * sensitivity * more susceptible to acid > caries * poor OH * poor aesthetics
144
How is amelogensis imperfecta managed?
* Preventive therapy * Fissure sealants * composite veneers or restoration * SCC * orthodontics
145
What can cause enamel defects other than amelogenesis imperfecta?
* fluorosis * MIH * Trauma
146
What are in your index of suspicion for child abuse?
* Delay in seeking help * explanation and injury is incompatible * explanation changes and vague * child appearance and interaction with parent is abnormal * child may say something contradictory * parent mood is abnormal * parent aggressive towards staff and refuse treatment * history of previous injury of abuse
147
What orofacial injuries are suspicious ?
* E/O bruising on face - slap, punch , pinch bruising on ears - pinch and pulling lacerations burns and bites neck marks - choking fractures - nose , mandible and zygoma * I/O bruises burns tooth trauma frenal injuries lacerations
148
What major clinical lesions might an abused child present with?
* Skin lesions - bruises, burns , bites * bone lesions - fractures * intracranial lesions - shaking * viscera lesions - blunt trauma to abdomen
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Describe the process of referring a child who is suspected to be abused?
* Observe - assess , take history and examine (can take photographs * Record in notes * communicate with patient and parent regarding concerns * Communicate with senior colleague for advice * Refer to child protection service for assessment * Refer to social work services and inform relevant professionals, this is by phone then confirm in writing * Contact police if you feel that child is in immediate danger | Advice from collegue> child protection assessment >social work services
150
Child with blister on gums, what is your diagnosis?
Primary herpatic gingivostomatitis
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How might primary herpatic gingivostomatitis appear?
* numerous pin head vesicles * rupture rapidly to form ulceration covered by yellow-grey membranes
152
What are the signs and symptoms of primary herpatic gingivostomatitis? (7)
* sore mouth with no desire to eat, swallow or chew * Painful ertyhmatous gingivae * Halitosis * Ulcers in lip, ginigvae and extraoral mucosa * fever * malaise * cervical lymphadenopathy
153
What is the cause of primary herpetic gingivostomatitis?
Initial infection of primary herpes simplex virus type 1 HSV - 1
154
How to reassure regarding primary Herpatic Gingivostomatitis?
* Lesions heal spontaneously in 1 to 2 weeks acute phase lasting 7-10 days * Advice on infectious nature to patients eyes and other people who may be immunocompromised
155
What is the treatment you would offer apart from reassurance for primary herpatic gingivostomatitis?
* Plenty of bed rest and fluid intake to keep hydrated * Use of analgesics and antipyretics - NSAIDs * Refer to specialist if concerned about ability to eat and drink and may require Aciclovir * OHI - brushing advice
156
What future issues may HSV-1 cause in the future
* reactivation causing herpes labialis (40% of patients affected) * Bell's palsy
157
4 year old child with gross caries across anteriors, including smooth surface What is the likely diagnosis?
* early childhood caries/ nursing bottle caries
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How does early childhood caries present?
* usually affect maxillary anteriors, lower canines and lower 1st molars * affect smooth surfaces near the gingival margin
159
Why are the lower incisors not affected by nursing bottle caries?
* They are protected by the tongue
160
How does nursing bottle caries occur?
* carcinogenic mild being fed to the child through a nursing bottle overnight or frequently during the day * meaning the sugar in the milk are inside the patient mouth for long periods of time
161
What would your advice for a child's parent who is presenting with early childhood caries?
* advise parent to not take milk bottle to bed * avoid allowing the child to drink the milk all day long * reduce intake of milk to meal times gradually * give water between meals * Do not use soya milk (insufficient nutrients) * Do not breastfeed on demand
162
What is the treatment for early childhood caries?
* toothbrushing instructions + fluoride use * fluoride varnish x4 year * fluoride supplements * Caries removal - complete/partial with GIC or hall technique SCC for posteriors * Consider GA for extraction if child uncooperative with gross caries
163
What is the indications for a SCC? (6)
* more than 2 surfaces affected with extensive lesions * impaired oral hygiene and high caries rate * space required to be maintained * poorly cooperating children * after pulpotomy/pulpectomy * In MIH and enamel defects
164
How is SCC placed conventionally?
* LA and dental dam * Tooth prepped by removing 1mm of occlusal surface and contacts removed * Select crown by measuring mesial-distal length and adjust as needed using pliers * Isolate and dry tooth * Apply GIC on crown and then seat lingually and snap on buccally * Gingival blanching should occur * Remove excess cement with probe and cotton wool roll * Check contacts and occlusion
165
What other techniques for placing a stainless steel crown other than conventional ?
Hall technique where the tooth is not required to be prepped
166
How to judge failure of SCC? (signs of failure)
* Abscess formation * Radiolucency on radiograph * Symptoms of pulpitis * Broken or cracked crown * Crown canting or rocking * Secondary caries under crown * Crown falls off
167
What are the advantages of planned extraction of the first permanent molar in children? (3)
* allow for spontaneous closure of space by the 7 * caries free dentition * reduce possible orthodontic needs
168
What signs are indicative for the suitability of extraction of the 6s?
* At age 8-9 check prognosis of any affected 6s by caries - if poor prognosis consider planned loss * Radiographically it is ideal at the start of calcification of the bifurcation of the 7 ; ideally all premolars and permanent 3rd molars should be present * when medical history rules out endodontic procedures
169
What are the disadvantages of planned extraction of the 6s?
* may require GA which has risks * can traumatise the child as it is a demanding procedure * Result in mesial drift and rotation of the 7 and distal drifting of the 5 in the upper arch * Result in mesial drifting of the 7 and distal drifting and rotation of the 5 in the lower arch
170
What is the most common cardiac defect in children?
* Ventricular septal defect
171
What conditioin is VSD most common associated with ?
* Down's syndrome ( atrioventricular septal defect)
172
Name 6 medical issues that can be associated with down's syndrome ( other than VSD)
* Leukaemia * Epilepsy * Hypothyroidism * Periodontitis * Coeliac disease * Dementia ( Alzheimer's disease)
173
How is cardiac defect patients with down's syndrome managed in the dental setting?
* Preventive advice to avoid dental treatment - OHI, toothbrushing, fluoride etc... * Always consult with cardiologist when carrying out high risk dental treatment * Take thorough history : medications interactions and MH * Avoid Sedation, XLA instead of endo , refer to special care dentist
174
Why should you avoid sedation with children with cardiac defects?
* reduced response to sedative drugs due to cardiac condition leading to more adverse effects * Cardiovascular complications and hemodynamic instability * Respiratory complications leading to hypoxia * May lead to complications with oxygenation to tissues
175
What are the indications of microabrasion?
* Intrinsic discolouration of permanent anterior teeth * Fluorosis * Trauma * decalcification after orthodontic treatment
176
What are the advantages of microabrasion? (6)
* simple to perform * conservative treatment and need minimal maintenance * not expensive * Fast acting * effective and results are permanent * can be used before or after bleaching
177
What are the disadvantages of enamel microabrasion? (6)
* need to be done in dental surgery * HCL can be corrosive * treatment outcomes difficult to predict- teeth may be yellow * remove of surface layer of opaque enamel - 100 microns with HCL/Pumice * sensitivity and tooth more prone to staining * requires protective appartus for patient/nurse/ dentist
178
How is enamel micro-abrasion is carried out?
* Pro-op photos, shade and sinsibility, diiagram of defect required * clean teeth and place petroleum jelly applied to gingivae and dental dam placed * Teeth are cleaned with HCL pumice and water 10x5 applications * sodium bicorbonate guard placed behind teeth for protection * FV applied to teeth * Polished with finest sand paper disc then with toothpaste
179
What advice would you give patient after performing enamel microabrasion?
* Do not eat or drink highly coloured food for at least 24h
180
Which fluoride varnish is used in enamel microabrasion?
Pro-fluorid
181
When should you review patient after enamel micro-abrasion and what to do?
* review after 4-6 weeks * take post op photographs to compare shade
182
Why do we use fine sandpaper disc in enamel micro-abrasion?
To change the optical properties of enamel leading to less noticeable discolouration by smoothing the prismless enamel layer
183
How many microns of enamel removed with prophy with toothpaste? Prophy with pumice? orthobracket bonding/debonding? acid etching? HCL pumice microabrasion?
5microns 5-50 microns 5-50 microns 10 microns 100 microns
184
Regarding autism , what is the triad of impairment?
A term to describe the main features people with autism find difficult * Social communication * Social interaction * Social imagination
185
What is autism?
Developmental disability caused by difference in the brain
186
What other featured does autism have?
* Sensory overstimulation or understimulation * Learning difficulties * Epilepsy * OCD
187
What changes would you to a prevention advice for a child with autism?
* Use unflavoured toothpaste such as oranurse * OHI - give specific method and timing * if high risk give FV x4 , fluoride MW 225ppm, F toothpaste
188
How would you manage a child with autism in the dental setting? (5)
* Plan visit in advance and use pictures, social story and leaflets * Suitable appointment time in the patient routine * Control the environment by reducing distractions to avoid overstimulation * understand patient preferred communication style eg. pictures, symbols * avoid using phrases that are not understood because people with autism take words for its literal meaning
189
What are the reasons for a child to be anxious before visiting the dentist? (5)
*Stage of emotional development * Previous traumatic experience * Family and friends experiences and attitudes towards dental treatment * Child psychological make up * Media
190
How may anxiety manifest in children? (7)
* Crying and hiding * Feeling ill and wanting to go to toilet * Clinging to parent * Nose picking, thumb sucking , nail biting * somatisation - produce symptoms with no illness * low pain threshold * stuttering / no speech
191
How may anxiety be measured in children ?
Using MCDASf modified child dental anxiety scale
192
What does the MCDASf consist of?
Questions regarding dental experience with smiley face to choose for each questions ranging from 1 - 5 as 5 being most distressed , the score is then added up and dental anxiety level determined
193
Which score in MCDASf determines dental anxiety?
9
194
What score determines severe anxiety in MCDASf scale?
over 27
195
What components are assessed in MCDASf scale for anxiety?
* cooperation * compliance * behaviour
196
Give 8 behavioral management techniques for children with anxiety?
* desensitisations * acclimatisation - tell show do * CBT * progressive relaxation * Distraction technique * modelling - learn about environment by observing others * Enhancing control - tell pt to raise hand when they want to stop * Positive reinforcement
197
What is the difference between acclimatisation and desensitisation ?
* Desensitisation is slowly exposing the child to the dental environment which can be done is several visits * Acclimatisation is exposing the child to the dental environment and procedure by telling them what to expect ( tell show do)
198
What are the indications for placing fissure sealants?
* High caries risk children * medically compromised children : learning disabilities/ physical * Deep fissure pattern interfering with OH * If one of the 6s have caries , all molars should be sealed * all permanent 1st molars
199
Where to place fissure sealants for high risk caries?
* Palatal pits of 12,22 * Palatal and occlusal pits and fissures of Ds, Es, 6s , 7s
200
What materials can be used for fissure sealants?
* GIC * Bis-GMA resin following acid etch
201
Describe the technique for placing fissure sealants?
* clean tooth with cotton roll or toothbrush * isolate tooth using cotton roll and can use dry guard * acid etch with 37% phosphoric acid 30 seconds , wash and dry * change cotton roll and make sure tooth is dry * apply resin sealant to fissure make sure it extends 2/3 in cusp incline * light cure * check for no bubbles and check it is intact with a probe , remove excess and check occlusion
202
What are the 4 types of cerebral palsy? (types of movement)
* Spastic - stiff and tight muscles * Ataxic - unorganised movements * Athetoid - involuntary movements * Mixed
203
How is cerebral palsy classified? (parts of body affected)
* hemiplegia - one side on part * Diplegia - both sides same part * paraplegia - one side two parts * Quadriplegia - paralysis of all 4 limbs
204
What is cerebral palsy?
It is an umbrella term that includes disorders that affect the person ability to move due to brain damage
205
What is cystic fibrosis?
It is an autosomal recessive condition caused by chromosome 7 mutation of the gene CFTR which causes excessive mucous in the lungs, pancreas and salivary glands
206
What are the general signs and symptoms of cystic fibrosis? (6)
* Recurrent chest infections * Cyanotic lips * Blue fingernails * Respiratory problems such as coughing, sneezing and shortness of breath * Underdevelopment * Thick salivary secretions * Tooth discolouration (grey/brown)
207
What are the dental considerations for a child with cystic fibrosis?
* increased caries risk due to high calorie diet to maintain weight * may have calculus build up due to saliva leading so regular PMPR may be required * Close monitoring every 3-6 months to detect any caries * Xerostomia may lead to caries and periodontal disease * Medications such as steroids may lead to higher risk of candidiasis | Prevention is key : OHI, FV , FS etc
208
What instructions is given to a parent when a child has avulsed their tooth?
* Reassure * Hold tooth by crown and avoid touching the root * Run the tooth under cold water for no more than 10s * Put the tooth back in the socket and bite on tissue if permanent tooth * If cannot reimplant the tooth place in a storage medium * Seek immediate dental advice | DO NOT RE IMPLANT A PRIMART TOOTH
209
What medium is best for storing an avulsed tooth?
* Milk * HBSS (hank balanced salt solution) * Saliva (or in buccal sulcus) * Saline * Water
210
What should you check when a patient with avulsed tooth arrives?
* How and when the incident occurred * Account for all tooth fragments * Was the patient unconscious for any period of time? * Any other oral injuries?
211
What type of splint is advised for an avulsion trauma?
EADT - less than 60 mins > 2 weeks flexible splint EADT - more than 60 mins > 4 weeks flexible splint
212
What is EADT?
* The time between the avulsion and placing it in a storage medium or reimplanting it * It is the critical time for survival of the PDL * the longer the EADT the longer the damage to PDL
213
What are the common outcomes of avulsion injuries?
* ankylosis * root resorption * discolouration * pulp necrosis * Mobility
214
What medical history information is significant in an avulsion injury?
* any cardiac defects * tetanus status * If pt is immunocompromised * any allergies * medications
215
Why is a coronal third root fracture have the poorest prognosis?
* difficult to stabilise * close to gingival margin so hard to restore due to poor moisture control * more prone to bacterial invasion due to poor oral hygiene
216
List 4 indications for a pulpotomy on a primary molar ?
* MH contraindicate extraction * Pulpal exposure more than 1mm * Good patient cooperation * Caries into 2/3 of dentine * Space maintainer as there is no permanent successor
217
Name 4 associated conditions that down syndrome have an increased chance of presenting with during their childhood?
* Epilepsy * Cataracts * Hearing loss * Leukaemia * VEntral septal defect
218
4 classical features extraorally of down's syndrome?
* Frontal bossing * Widely spaced eyes * White spots on iris * Small midface and nose * Class 3 profile
219
Name 6 possible intra-oral manifestations of Down Syndrome
* Class 3 incisors , molars and canines * Microdontia * hypodontia * anterior open bite * Increased caries risk * Increased periodontal disease risk * Tooth wear
220
Discuss the impact of the patient's condition on the preventive care and treatment that will be provided? give 6 examples
High caries risk * high fluoride tooth paste * Flouride varnish applications x4 a year * Oral hygiene instructions with demonstration at every visit * Fissure sealants applied using GIC due to hypersalivation * Take bitewings every 6 months * Diet diary and modifications * Increase number of review appointments
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BDS4 Exam Perp (72 decks)

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