Paeds - revision notes Flashcards
Fluoride mouth wash
> 8 years old
225ppm
10ml a day
Lee way space
is the mesio distal space between primary molars that is bigger than the distance that the permanent pre molars will replace
1.5m = upper
2.5mm = loweer
High risk children
no fluoride
consumption of high sugarary snacks
unstimulatated saliva flow <0.7ml/min
new carious lessions
existing restorationss
early loss of primary teeth
Rx for durphat
22800ppm - 0.619% sodium fluoride)
BPE in children
7-11 = 16,11,26,36,41,46
codes 0-2
Plq levels
10/10 = clean tooth
8/10 = plq cervical margin
6/10 = ple cervical 1/3
4/10 = plq on middle 1/3
Radiographs
high = 6-12months
low = 12-18 months
Sequence of restiorations
fluroide varnish
fissure sealatns
preventative restorations
simple fillings
fillings involoing la bunt not into pulp
pulpotomie/pulpectomies
XLA
elements of caries risk assessment
dietary advice
saliva
Medical history
fluoride use
plq control
clincial evidence
socail hisotry
Preventative programme
fissure sealants
fluoride varnish
fluoride supplmentation
radiographs
toothburshing insturction
diet advice
sugar free meds
fluoride tp
Ramptant caires
10 or more carious lesions
Flurodie varnish
22600ppm applied either 2 or 4 times a year
contra - ulcerative stomatitis, allergy to elastoplast, colophony, sevre asthma, gingivitis
Fluoride varnish advice after placement
avoid eating and drinking for 1 hr
brush teeth as normal at night
might have temp yellow staining
avoid fluoride suplments for rest of day
soft diet
Causes of nursing bottle caries
surgary drinks in bottles
swirling of jucies in mouth
inapporparate feeding bootles
poor oh
prolonged brest feeding
not using straw with fizzy drinks
SDF
44,800ppm
used in asymptomatic carious lesions teeth
MIH sens
meidcally hx risks XLA
carious lesions that are cleansable
root caries
delay in GA or sedation
Contra of SDF
allergy to silver, ammounium or fluoride
allergy to potassium oriodine
stomatitis, mucositits,
caries to pulp or infection
SDF risks
decay continues to develop
stains clothing
leaves metallic taste
temp stains soft tissues
can discolour cavitated lesions black
discolouration of tooth fillings
when would you not carry out endo
pt has cardiac defect
immunocompromised
poor healing potential
Vital pulpotomy aim
to remove the infected cornal part of the radicular pulp, stop bleeding and main the apical portion of pulp
Steps in vital pulpotomy
LA, rubber dam and gain acces to carious lesion
remove carious lesion and gain acees to the roof of bulb chamber with diamond bur
remove the cornoal pulp with steel bur or excavator
establisht ehextent of bleeding apply a ferric sulphate soaked pellet over the pulp and gain haemharrage control, if bleeding continues then reapply and wait till control achieved
resotre with ZOE paste and GIC core adn then restroation
Ferric sulphate
only used in primary teeth as casues staining and darkenin in adults
use nsCAOH or CaOH in adults
follow up for vital pulpotomy
6months clincally
12months radiographically looking for furcaiton involvement, pa path, internal and external resoorption
Pulp capping
mainins the vitatility of the tooth <24hrs exposure
arrest heammrahge with pressure and damp cotton wool rool
apply CaOH over the site and then resotre
Non vital pulpectomy
the only option to save a non vital tooth
pulp necrosis, chronic sinus, pa perio, bleeding pulp or inflammed pulp
Apexification
induces a calcified barrier in the root of incomplete or open apices with a necrotic pulp
Non vital tooth on xray
Pa radioluency
external or internal root resoprtion
widening of PDL
loss of lamina dura
anklyosis
Contraindications to inhaltion sedation
can’t breathe through nose
common cold
severe asthma
tonsillar enlargement
severe copd
Reasons good for inhaltion sedation
rapid onset
quick recovery
no needles/cannulation
no amnesia
drug is not metabolised in liver
adults do not need cahperone
matinance of protective reflexes
Contraindications of GA
allergy to the Ga drug
liver function issues
renal issues
ECG abnormalities - long QT syndrome
Cystic fibrosis
Severe astham - class ASA 3 and 4
resp disease
cogential heart defects
sickle cell anemia
Fasting for GA
6 hrs - no solids
4 hrs - no milk
2hrs - no clear fluids
GA recommendations
stop smoking 12 hrs before GA
Alcohol - if regular the liver enzymes can be reduced which has an affected on absorbing the anesthetitc
need escort home and someone to monitor them for 12 hrs
Extrinsic staining
tea/coffee/drinks
poor OH
smoking
drugs - iron = black, CHX = brown/ blakc
Intrinsic local staining
infection/path present
internal resoprtion
caries
injury/infection
Systemic staining
flurosis
amelgeogensis imprefect
dentitignsisi imprefecta
drus - tetracycline
bilirubim
10% carbamide peroxide brown down to
3% hydrogen peroixde
7% urea
When are composite veneers not apporpriate
in children the pulp horns and chambers and stillll quite large
the gingival contour is still immature
Causes of toothwear in children
parafunctional habits
gastric probs
dietary issues
Objective of resotring tooth wear
improve senstiivity
to have a balanced occlusion
to resotre function
to presevre remaining tooth tissue
support remaining tooth struture
When is microabrasion indicated
flurosis
trauma to teeth
MIH
post ortho demineralisation
white/brown surface staiing
Advantages of microabrasion
quick and easy
non invasive
conservative of tooth structure
no LA required
effective
not expensive
Disadvatanges of microabrasion
HCl caustic
has to be carried out at GDP
unpredicatble outcome
removes enmale so can lead to sens
Steps in microabrsion
apply rubber dam and pumice and water to tooth to clean
then apply petreleum jelly to soft tissues
then apply sodium bicarbonate to gingivae
apply Hcl slurry for 5secs on each tooth and rinse
repeat 10 times and review
wash and polish with flexi discs and apply flurodie varnish to help with reminerlisaiton and sens
review in 4-6weeks
** advise not to consume dark fluids and food for 24hrs
Other types of tx for disclouration
resin infiltration
bleaching - vital bleaching e.g chairside bleaching, non vital bleaching
Types of non vital bleaching
walking tech - which creates cavity into pulp chamber and bleach applied directly in and sealed over and reapplied at intervals
inside out tech - where cavity cut into pulp and pt then applies bleaching gel in tray and into mouth and over the area with pulp cavity
Hypomineralisation
where there is reduced enamel formed or the ennamle mineral content is reduced
Hypoplastic
enamel bulkl, thickness is reduced
enamel morophology is not right
Questions to ask for MIH
pre natal - mum in 3rd trimester, pre-elampsia, gestational diabetes
peri natal - traumatic birth, baby full term or premature
post natal - prolonged breast feeding >6months, fever, meds, resp issues, chickenpox, mumps
Clincal issues with MIH
sens
tooth wear
appearance
breakdown of enamel
secondary caries
Traumatic injuries what toask
how the injury occured?
when the injury occured
where the injury occured - to establish if tetnus is required
crown framgments lost etc
amensia, concussion, vomiting, headaches
have they had previous dental trauma
Mh - allergies - for antibiotics
Tetanus in last 5 years
bleeeding disorders
congientia lheart defect, immunosuppresion or rhemuatic fever as don’t want to carry out endo
Avulsions more successful when
minimal damadge to the pulp and perio ligament
the correct sotrage medium and the extra avlolar time small
When not to reimplant a tooth
if child is immunocomporomised
if the child has other medically issues that take priorioty
pt lacks co-operation
Public advice for avulsion
hold the tooth by the crown
remove debris with cold running water and a plug in the sink
try and reimplant into the socket
if can’t store in milk or saliva
seek dental advice
Avulsion
complete removal of the tooth from the socket
sepration of PDL and exposure of root surface
Concussion
there is no rupture of the perio ligament
limited ging bleeding, some swelling
no increase in mobility
TTP yes
tx - soft diet, good oh, chex and gentle brushing
Subluxation
rupture to some PDL and some mobility present
Tooth is ttp
no displacmeent present
Tx - clean area with saline, water and chx and fleible splint for 2 weeks
Extrusion
rupture of the PDL and pulp
tooth appears to be elongated and out of socket
TTP and mobile
Tx - La with vaso, clean area and saline
flexible splint for 2weeks
Lateral luxation
rupture of the perio ligament and pulp and damage to the aveloar plate
high metallic sound present
not mobile
axial and apical impaction
Pulpal necrosis is high especially if closed apex and resoprtion and ankylosis present
Tx reposition under LA and clean area with ater and saline, reposition with flexible splint for 4 weeks
Lateral luxation
rupture of the perio ligament and pulp and damage to the aveloar plate
high metallic sound present
not mobile
Tx reposition under LA and clean area with ater and saline, reposition with flexible splint for 4 weeks
Intrusion injury
rupture of perio ligament, pulp and the alveolar plate and driving axially and apically
Pulpal necrosis is high especially if closed apex and resoprtion and ankylosis present
Flexible splint for 2weeks and start endo after 2 weeks placiing CaOh
Dental alveolar fracture
flexible splint for 4 weeks
Trauma stamp
colour
notation
displacement
sinus
sens
TTP
mobility
radiograph
Prognosis of tooth depends on
type of injury
time between innjury and tx
the extent of damge to PDL
presence of infection
stge of root development
Flexible splint
don’t brush for 1st day
sfot diet
Chx mw for 7 days
use a soft bristle brush
avoid contact sports
Enamel fracture
smooth down sharp fragment or bond back to tooth
2PA’s to rule out root fracture or lateral luxaiton
Enamel dentine fracture
bond fragment back to tooth or place comp bandage
2pa’s to rule out root fracture or lateral luxation
Enamel dentine pulp fracture
partial pulpotomy or pulp capping
Crown root fracture with no pulp exposure
then remove the fragment with forceps
may need to suture ging margins and laceration
clean area with water, saline and chx
apply gi or comp on exposed area and restore with comp
Crown root fracture with pulp exposure
the same but could require xla, gingivectomy, surgical extrusion
Coronal root fracture
flexible splint for 4months
apical or middle 1/3 fracture
flexible splint for 4 weeks
Pulpan necrosis
pink colour means intrapulpal bleeding, pulp still vital
Pulpal obliteration
yellow or opqaue colour (normally exfoliates)
Root resorption
external = intrusive
internal - subluxation
Traumatised primary tooth complications
delayed exfoliation
loss of vitality
abscess risk
dilcaeration of permanent
Permanenet tooth trauma following
hypoplasia
hypominaerlasation
delayed eruption
delayed exofliation
ectopical eruption
damage to crown/root development
Child abuse categories
sexual
emtional
neglect
physical
failure to thrive
Index of suspicion for child abuse
a vague story
the story does not add up with the injuries
the child and parents behavious is odd
the child will not interact with you
delay in seeking help
parents mood abnormal
hx of violence
child says something
Dental neglect
is the persistent failure for a childs basic oral health needs to be meet and signficantly impacts on their overall oral and general health
Options for dental neglect referral
- preventative dental team response
- preventative multi agecny response - social workers, health care visitor, GP, may have a child protection plan or common assessment fraemwork)
- child proteiton referall
Behaviour management techniques
tell show do
positive reinforcement
desenstitisation
hyponosis
CBT
relaxation
role modelling
distraction
voice control
stop signals
aclimitsasation
tests for children anxiety
Picture tests
venham picture scale
facial image scale
Modificed dental anxiety scale
dental phobia
severe dental anxiety
dental anxiety
a sense of apprehension that something dreadful is going to happen coupled with a sense of losing control
dental fear
a normal emtional reaction to one or more stimuli in the dental environment
dental phobia
a severe form of dental anxiety
dental aniety
a serve state of apprehension that something dreadful is going to happen coupled with losing control
dental fear
a normal state of emotional reaction to one or mores timuli in the dental enviornment
Hypodontia
lower 2nd premolar and then upper lateral incisors
Casues of hypodontia
cleft paltae
down syndrome
ectodermal dysplasia
incontenti pigmenti
Hurler’s syndrome
Can cause overeuption
Causes of supernunmerary teeth
cleft palate
cleidocranial dysplasia
Gardner’s syndrome
Males more than femals and the mxialla more common
Types of supernunmerary
conical - cone shaped
supplemental - same tooth
tuberculate - barrel shaped
odontome - irregualr mass of dental hard tissue
Miicrdontia
pituaitry dwarfism
radio and chemo
Macrodontia
pituatiry giangtism
Double teeth
fusion of 2 teeth
gemination -1 tooth splits into 2
Talon cusp
a horn like shape projected from cingulum of upper maxialry incisor
Do nothing
file enamel down and place fs
pulpotomy or pulpectomy
Taurodontism
enlarged pulp chamber - CEJ to birfucation of roots longer than the root length
Occurs due to failure of hertwigs root sheath
Signs and symptoms of amleogensis imprefecta
small teeth
discoloured
yellow teeth
AOB
pitted and grooved
prone to wear
It is when the enamel fails to develop correctly
autosomal dominant or x linked recessive
Types of amlegoegenisis imprefecta
hypominealised
hypocalcificied - yellow opaque colouring, soft enamelm enamel dull, lifeless and honey coloured
hypoplasitc - enamel is strong but small quantitiy
hypomaturation - soft enamel especially at the cervical region
Dentiogensisi imprefecta
type 1 - odontgensis imperfecta
Type 2 - autosomal dominant
Bradywine
Dentingensis imperfecta symptoms
blue, grey, yellow, brown colour
roots short and thin
bulbous crown
pulp canals oblitereated
probs with imperfecta conditinos
poor aesthetics
exposure of dentine causing sens
poor oh, caries, ging
chipping and atrriton of enamel
Dealyed eruption of primary teeth
low brith weight, preterm birth
Conditions - down syndrome, turners syndrome, hypothyrodism, hypopiturism, clediocranial dysplasia
Dealyed eruption of permanent dentition
truma
supernumary
ectopic successor
odontoms
impaction
Hyoplasia
local - infection or trauma
generalised - liver probs, measeles, mumps TB, nutritional
Hand foot and mouth diseases
casued by coxsackie A16
Casues skin rashes on hands and feet
sores and blisters in the oral cavity
takes 7-10days to resolve
tends to occur in children<5yrs
Tx - NSAIDS, fluids, soft diet, bland diet, reassurance, bed rest
Herpangina
a viral infection casued by coxsackie A
Casues painful bliseters with ahlo vesicles on soft palate, uvula and tonsilar area
Less painful and shroter duration than HSV1
Gerernal malaise, raised lymph nodes, sore throat,
Tx - fluid intake, bland diet, soft diet, bed rest, analgesics avoid aspirin
Primary herpetic gingivostomatitis
a viral infection caused by the herpes simplex virus 1
casues painful ulcerations and blisters in the mouth
fiery red appearance
the tongue can appear white
takes 10-14 days to resolve
fever, general malasie, vomiting, loss of apetite
Tx - bed rest, fluid intake, NSAID, soft diet, viral drugs -acylovir
Cerebral Palsy
a learning disability which affects movement and posture
Mixed
Dyskienetic - involuntary movements
Ataxic - shaky movements which affect balance
Spastic - stiffness and difficulty moving limbs
Dental features of cerebral palsy
ging hyperplasia
enamel hyperplasia
poor OH
drooling
enhanced gag reflex
bruxism
malocclusion
Difficulty for dentists and cerbral palsy
involuntary movemetns
enhanced gag reflex
poor posture
diffuclty opening mouth and intential tremor
Down syndrome
a neurodevelopmental disroder that means there is an extra copy of chromsome 21
General health probs with down syndrome
aleziher’s/ dementia
hypothyroidism
cogential heart defects
eye problems
epilpsy
leukameia
Dental and down syndomre
hypodontia
Class 3 malocclsuion
AOB
small lips
posterior cross bite
fissured tongue
Autism
neurdovelopmental condition which affects the persons ability to communicate and language
diffuclty understainding open ended questions
poor fine motor skills
obbessive behavious
fixation
repetitive behaviour
Dental and autism
bruxism
dry mouth
can’t understand pain
limited diet
can’t brush
salivation
delayed eruption
Tech for autism appts
short appts
use persons name
same dentist
same time
same room
encourage parent to attend
tell show do
short commands
sunglasses for bright lights
earphones for noise
avoid contact
Congential bleeding disorders
Von willebrand
Heamophillia A
Heamophillia B
Acquired bleeding disorders
Vit K
clotting antibiodies
liver disease
anticogulants
Cystic fibrossi
autosomsomal recessive of long chromsome 7
casues theicked and excess mucous production
finger clubbing
delayer eruption
enamel defects
can’t have GA - resp failure
HIV
xerostomia
salivary gland enlgargment
Kaopsi’s sarcoma
ging and perio lesions
orla ulceration and candidiosis
Avoid GA as recurrent chest infections
Red cell disorders
ulcerations, pale mucosoa, angular chelitits, candida infections
Iron - microcytic, low serum and ferritin
Vit B12 - seen in vegans, chrons and coliac
Folate - macrocytic - renal dialsys, chron’s celiac
Ulcerative colitis
inflamation of the lining of the bowel
Crohns diseases
sens to alpha gliden in gluten
macrocytic anemia
apthous ulders
hypoplasia
depapillation of tongue
Crohns diseases
mucosa fissured, cobblstone, OFG
Jegunum - folate absoprtion
illieum - Vit B12 absorption
angular chelitis, mucosal tages, submental lyphadenopathy
Epilpsy
decreases GABA neurotransmitted which leads to abnormal cell to cell propagation
Clonic/tonic
absence (pettit mal)
atonin/myoclonic
Ging hyperplasia, cervical lyphadenopathy, delayed eruption, folate deficiency, bleeding issues
Asthma
excess mucous production
inflammation of the linining of the airways
increases smooth muscle tone
Dry cough, GORD casuing palatal erioson, dry mouth, ulcerations, caries
Avoid in ASA3 and 4
Can have inhalation sedation
Beta 2 agonsit decreases saliva and corotocsteriods can cause adrenal suppression
Avoid aspirin and NSAIDs as allergy to penciliin
Stress and anxiety can induce symptoms
Chronic renal failure
excessive plq accumulation
enamel hypoplasia
pulp obliteration
ging overgrown
Hyper in diabetes
acetone in breath
weak pulse
nasuea/vomiting
loss of consciousness
dry skin
rapid breathing
thrist increase
Oral issues with diabetes
oral ulcerations
angular chelitis
caries
perio
poor wound healing
bad taste/altered taste
burning mouth,
candidosis
Features of diabetes
lethargy
polyuria
polydipsia
weight loss
dehydration
muscle wasting
shock/coma
paraesthetsia
Thrombocytopenia
reduction in circulatory platelets
normal = 150x10^9-400x10^9
lowest dentsit can treat = 50 x10^9
What to avoid in renal diseases
paracetamol
tetracycline
penicillin
Partial pulptomy
3mm around exposure removed
Contro of pulpotomy
muliple carious lesions
poor pt co-operation
tooth is near exfoliation
unrestorable
abscess present
MH - caridac defect, immuno, RF
Indications for pulpotomy
avoids GA
Mh compromised XLA
space maintaner
normal pulp
reversible pulptitis
no radipgrahic signs of infection
caries 2/3rd into dentine
no permanenet successor
Triangle of safety
side of face
neck
shoulder
ear
