Paeds Revision Flashcards
What are the stages of tooth development?
Morphogenesis
Cytodifferentiation
Matrix secretion
What is MIH
A multifactorial condition resulting in decreased enamel mineralisation of the permanent molars and incisors.
Normal amount of enamel but decreased quality.
When does enamel develop?
In 3rd trimester of pregnancy until 3 years old
In MIH, what phase of amelogenesis is affected?
Mineralisation phase
When are the enamel matrices of FPM and incisors developed by?
FPM during 1st year of life
incisors by age 2
How does MIH present?
Asymmetrical, chalky white/ yellow/ brown marks on permanent molars / incisors
What questions to ask mum regarding MIH?
Pre natal - any illnesses during third trimester of pregnancy eg gestational diabetes, pre-eclampsia
Peri natal - was the birth traumatic eg c section
Post natal - any illnesses in the first 3 years of life
What are the clinical problems of MIH? (6)
Post eruptive breakdown (dentine exposure and pulp at risk)
Sensitivity (may lead to poor oral hygiene)
Difficulty with bonding due to poor mineralisation
Local anaesthesia problems as pulp is chronically irritated
Behaviour management problems
Aesthetic problems
What are the treatment options for MIH?
Enhanced caries prevention
Composite / GIC restorations
Micro-abrasion/ resin infiltration
Crowns / onlays / veneers
What is enhanced prevention?
Fluoride varnish 4 x yearly
Toothbrush demonstration at every appointment
Fissure sealant of molars and premolars
Diet advice at every appointment
High fluoride toothpaste (<10 years- 1500ppm / 10-16 years- 2800ppm / >16 years - 5000ppm)
Review every 3 months
Utilise any community/ home support
When is best timing for extraction of FPMs?
Calcification of bifurcation of lower 7s
8s present
Mild to moderate crowding
What is fluorosis?
Diffuse white opacities without clear boundary associated with the ingestion of fluoride during enamel development
Symmetrical, bilateral pattern
Caries resistant teeth
What is the purpose of fluoride varnish?
Minimally invasive treatment in which fluoride varnish is placed on the tooth to promote remineralsiation (hardening of the tooth) and to prevent demineralisation (softening of the tooth)
Involves drying the tooth and place a gel over tooth
Can be applied up to 4 x yearly
Contraindications- severe asthma, colophony allergy
Post op- no eating or drinking for 30 mins
What is the management for fluoride toxicity?
5mg/ kg - milk
5-15 mg/ kg - ipecac syrup, milk
>15mg/ kg - hospital referral
What is tooth mousse?
Can provide relief of sensitivity
Topical cream (CPP-ACP) - milk derived protein - to strengthen teeth and promote remineralisation of enamel
What is primary herpetic gingivostomatitis?
Contagious primary infection caused by herpes simplex virus.
Very common condition, self limiting and will resolve in 7-10 days.
Often presents as blisters on lips/ tongue/ gums/ roof of mouth - after blister pops, ulcers will form.
This can make it sore to swallow/ eat.
What is the management of primary herpetic gingivostomatits?
Reassure parents and child
Encourage fluid intake
Analgesia to control pain / fever (calpol)
Suck on ice cubes
Clean teeth with damp cotton roll
Dilute CHX as mouthwash
Antibiotics only recommended if systemically unwell / immunocompromised
Review patient in 2 weeks
What antibiotics are prescribed for primary herpetic gingivostomatits ?
Aciclovir 200mg tablets, 1 tablet 5 x daily for 5 days (25 tablets)
What is nursing bottle caries?
Pattern of caries associated with baby having bottle of milk over night - affects lingual of upper incisors and lower canines.
What is the diet advice for child with nursing bottle caries?
Feeder cup replacing bottle from 6 months old
No on demand breastfeeding
Be aware of hidden sugars in oat milk/ almond milk
Milk and water only between meals
Only water overnight
Assist with toothbrushing
What is the management of nursing bottle caries?
Extraction of various teeth (under GA) warn of risks of GA
Fluoride - topical
What are the risks of GA?
Common minor risks:
- headache, nausea, vomitting, drowsiness, sore throat from intubation, child upset when waking
Risks from treatment:
- pain, bleeding, bruising, swelling, infection, loss of space, stitches may need to be placed
Major risks:
- 3 in 1 million adverse effects - machine used to help breathe during operation, very small risk wont be able to breathe independently afterwards
What is involved in GA assessment appointment?
Treatment planning- with knowledge that this may change on day- any required treatment carried out
Consent- written:
- all options give
- side effects and complications
- pre-op fasting
- post op arrangements- adult escort with no other children
- post op care and pain management
What is included in caries risk assessment? (7)
Clinical evidence
Diet
MH
SH
Saliva
Plaque control
Fluoride exposure
What are the key elements of prevention? (8)
Radiographs (6 months)
Diet advice
Tooth brushing
Fluoride toothpaste
Fluoride supplement
Fluoride varnish
Fissure sealant
Sugar free medication
What is included on a trauma stamp?
Colour
Sinus
TTP
Percussion
Mobility
Radiograph
EPT
Ethyl chloride
What are the indications for hall crown placement?
Early to moderate proximal lesions involving dentine of primary molars with no signs of symptoms of pulpal involvement
Radiographically- visible band of normal dentine between lesion and pulp on bite wing
What are the contraindications for hallcrown?
Clinical / radio graphic signs of pulpal involvement
Insufficient tooth tissue for crown retention
Aesthetic concerns
Patient cooperation
Risk of bacterial endocarditis
What are the steps of hall crown placement?
Place separator for 2-7 days
Size crown- should cover all cusps, approaches contact point with springiness (almost always size 3/4), do not fully seat
Fill with GIC (aquacem)
Dry tooth, place crown, ask patient to bite
Remove excess cement
Ask pt to continue to bite until set
What are post op instructions for hall crown?
Tooth and gum may feel uncomfortable when you go home, this will settle
Analgesia if necessary
