Paeds questions Flashcards
What does a BPE score of 3 mean?
- pocket depth 3.5-5.5 mm
- black band partially visible
- plaque retentive factors present (calculus, overhangs)
- bleeding on probing
What teeth should be probed in a 13 year old to obtain BPE?
16,11,26
46,31,36
* simplified BPE until the age of 17
What is the normal depth from ECJ to alveolar bone crest?
This is the biological width - 2mm
What medications conditions might cause a 13 year old to have BPE of 3?
- anti-epileptics - phenytoin
- Calcium channel blockers - amlodipine - CVD
- immunosuppression - cyclosporine
What medical conditions might cause BPE of 3? (not medication related)
- diabetes
- Leukaemia
- puberty
- aggressive periodontitis?
Special investigations for BPE of 3 in children?
- 6PPC
- Plaque free and marginal bleeding chart
- Radiographs (BW, PA)
- Diet diary
When to start periodontal assessment in children and why?
*7 and above
* unlikely to have periodontal disease before this age + index teeth are still not erupted
What is the treatment plan for BPE scores of 3 in children?
- initial periodontal therapy (step1) : OHI, PMPR and prevention
When to refer a child with periodontitis to specialist?
- stage 2,3,4
- Grade C
What 2 questions to ask parent when a child presents with a fractured tooth?
- when, how and where did it happen?
- If they can account for the missing fragment
- any other symptoms or injuries due to trauma?
What things determine the prognosis of a traumatised tooth when discussing with patient?
- Size of exposure
- Stage of root development
- Type of injury
- If PDL is damaged
- time between injury and treatment
Where do you suspect a missing tooth fragment to be and how to manage this?
- 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
Tooth have an enamel dentine fracture what is your management?
- 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
What to check at review after trauma ?
- 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
What to discuss with parent regarding the treatment of a traumatised tooth?
- inform of any complications : discolouration, pain, sinus, infection, damage to adjacent teeth
- prognosis of tooth
- inform about treatment options to gain valid consent
List 8 questions you would ask mother when child is presenting with white/yellow/brown stains on teeth?
- 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?
What is the condition that affect the 1st molars and incisors causing tooth discolourations?
MIH (molar incisor hypo-mineralisation)
Questions to rule out fluorosis from MIH?
- 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?
What is MIH?
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
List potential problems associated with MIH teeth in the future?
- 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
Treatment options for MIH incisors?
- micro-abrasion
- resin infiltration
- localised composite restoration
- composite/porcelain veneers
MIH molars treatment options?
- composite/GIC restoration
- SSC
- Extractions
What diagnostic test to carry out to check vitality of a tooth?
- EPT
- ECT
What are the treatment options for a subluxation trauma?
flexible splint for 2 weeks
What advice would you give when splinting a tooth for trauma?
- OHI ; CHX mouthwash + gentle brushing
- Eat soft diet
- Avoid contact sports
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
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
What age range is ideal for interceptive orthodontics?
- 7-11 years, mixed dentition stage
How long after extracting the Cs you should review ectopic canines?
6 months
What syndromes can be associated with hypodontia? (4)
- Down’s syndrome
- Pierre robin syndrome
- Cleft lip and palate patients
- ectodermal dysplasia
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
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
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
what is the incidence of missing primary teeth?
less than 1%
What is the incidence of missing permanent teeth?
6% excluding the 8s
What are the most teeth affected by hypodontia in order?
Lower 5
Upper 2
Upper 5
Lower incisors
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
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
Give 2 effects of trauma on primary teeth?
- discolourations
- delayed exfoliation of primary tooth ( may not resorb normally)
Give 5 effects of trauma on permanent dentition?
- enamel defects
- ectopic tooth position
- abnormal tooth or root morphology
- delayed eruption
- Ankylosis
What 4 conditions are down’s syndrome children predisposed to?
- Cardiac defects ; ventricular septal defect, tetralogy of Fallot
- Leukaemia
- Epilepsy
- Dementia ( alzheimer’s)
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
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
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
What 8 things are assessed in a clinical trauma review?
- Sinus
- Colour
- ECT
- EPT
- TTP
- Percussion note
- Radiographs
- Mobility
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
How long are lateral luxation injuries splinted for?
- Flexible splint for 4 weeks - due to alveolar bone fracture
What kind of root resorption might occur with lateral luxation trauma?
External inflammatory resorption
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
What is the stimulation molecule in root resorption?
RANKL which is a signalling molecules that regulate osteoclast activity
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
What is the short term management of root resorption (children)?
Monitor and review
What is the long term management of root resorption (children)?
- radiographic review
- replace of CaOH dressing
How would external root resorption appear clinically?
- positive to ECT
- Negative to EPT
- pain on percussion
- may be mobile
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
What are the children caries risk assessment criteria? (7)
- clinical evidence
- dietary habits
- saliva
- plaque levels
- medical history
- social history/ socioeconomic status
- fluoride use
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
How often should you take bitewings for high risk and low risk children?
- high : 6 months
- low : 12-18 months
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
What toothpaste strengths for high risk caries in children?
Under 10 - 1500ppm
10 -16 = 2800ppm
16+ = 5000ppm
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
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
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
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
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
What fluoride concentration is optimum in drinking water?
- 1ppm
Where can fluoride be found in food?
- Tea
- Beer
- Bony fish
- Cucumber and pickles
- Spinach, asparagus and carrots
- Potatoes and white rice
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
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
Name 4 pre-disposing factors for pseudomembranous candidiasis?
Local
* steroid inhaler use
* oral steroids
* nutritional deficiencies
* broad spectrum antibiotic use
Medical
* Diabetes
* Immunocompromised : HIV
Give an advantage and a disadvantage of an oral swab?
- Simple and site specific
- can be easily contaminated and uncomfortable
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
What is the first line medication for pseudomembranous candidosis?
- Miconazole cream first
- Fluconazole capsules - systemic if severe
- Can interact with warfarin and statins
What other medications than fluconazole can be used for oral candidosis?
- miconazole oro mucosal gel
- Nystatin oral suspension
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
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
What 3 calcium forms can be given to a child who swallowed fluoride toothpaste?
- milk
- calcium gluconate
- calcium lactate
What is the most common cause of fluorosis in the UK?
- fluoride in the public water supply 1ppm
What is your first line treatment for a 10 year child with fluorosis?
Enamel micro-abrasion or leave and monitor
Flouride supplements values for patients ages 1 , 4 , 7
1 - 0.25mg drops
4 - 0.5 mg tablets
7 - 225ppm mouthwash
Diagnostic features of subluxation injury?
- Increased mobility and TTP
- No displacement of the tooth
- Bleeding from gingival sulcus
What type of splint would you use for subluxation?
2 weeks flexible splint
When would you review a patient with subluxation?
2,4,8 and 1 year
Define root resorption
the non bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells
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
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
*
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
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
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
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
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
Child with blister on gums, what is your diagnosis?
Primary herpatic gingivostomatitis
4 year old child with gross caries across anteriors, including smooth surface
What is the likely diagnosis?
- early childhood caries/ nursing bottle caries
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
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
