paeds scenarios Flashcards
A mother brings her 2 year old son for his first appoint, unsure of whether she should give him fluoride supplements as they live in a non-fluoridated area.
Please give fluoride advice and explain the reasons for the advice given.
Explain that:
- fluoride has been shown to reduce caries prevalence by 50%.
- has a beneficial impact on the teeth that have already erupted but also impacts developing teeth.
- there is an optimum intake of fluoride and exceeding this could lead to fluorosis causing tooth discolouration and toxicity.
- for a low-risk child of 2, a smear of toothpaste containing 500ppm is appropriate.
- high risk would need 1000ppm.
spit after brushing otherwise this could be toxic and don’t give F rinses for the same reason
If the ANB angle is greater than 4º, what skeletal class will the patient have?
Class II
If the ANB angle is less than 2º, which skeletal class will the patient have?
Class III
If a healthy 15 year old girl with a Class I skeletal pattern and occlusion attends with a retained URC and an impacted 3, what would treatment options be?
- Leave the impacted 3 where it is - but this could leave a gap needing to be filled by a partial denture if the URC comes out.
- Surgically remove the 3 and leave the C in position - possibility of adjacent tooth damage during the procedure.
- Transplant the permanent tooth into the socket - only if there is enough room to do so.
- Orthodontically Repositioning - means the pt will have to wear a fixed ortho appliance, best long term solution.
Name the potential causes of an unerupted central incisor.
- Extracted or Avulsed
- Ectopic position of the tooth germ.
- Crowding
- Supernumerary
- Dilacerated Root
- Pathology (e.g: cyst or odontome)
- Congenitally absent tooth.
If a 9 year old boy presents with delayed eruption of his UL1, what would 4 treatment options be for this?
- No Treatment - although not suitable as it has already delayed the eruption of the permanent incisor.
- Await the eruption of the supernumerary and then XLA - explain this is not suitable as the child is 9 and this is unlikely to happen when the central hasn’t come through already by itself.
- Surgical Removal of the Supernumerary and allow central to erupt - may need ortho alongside if there isn’t enough space.
- Surgical Removal of supernumerary and put a bracket on the central to pull it down
A mother attends with her 3 year old daughter having fallen and avulsed her ULA. They have brought it in milk.
Explain how you would manage this.
- History of the accident (how, when, where etc).
- Check for any other injuries.
- Ask about dental/medical history and tetanus status.
A mother attends with her 3 year old daughter who has fallen and avulsed her ULA. They have brought it in milk.
Explain the complications to warn the mum of.
- Discolouration to the adjacent primary tooth which may potentially lead to/indicate pulp death.
- Potential XLA of the adjacent tooth.
A mother attends with her 3 year old daughter who has fallen and avulsed her ULA. They have brought it in milk.
How would management differ if the pt had been 10 years old?
The tooth would be a permanent incisor and so require re-implantation and splinting.
- be careful as splinting for too long could cause ankylosis *
How would you manage an apical 1/3 root fracture?
No treatment would be required unless the coronal fragment is mobile or displaced.
if required, splint for 3-6 weeks and keep under observation for pulp necrosis.
If a 14 year old attends with an enamel fracture following being hit with a hockey ball, how would you manage this?
- Take a history.
- RMH including vaccination status.
- Detailed IO and EO examination.
- Radiographs to rule out a root or dentoalveolar fracture.
- Smooth off the sharp edge.
How would a enamel-dentine fracture be managed following the conduction of a history and clinical examination?
Use a calcium hydroxide lining to protect the exposed dentine and cover with an acid-etch retained composite restoration.
How would an enamel-dentine-pulp fracture be managed following the conduction of a history and clinical examination?
Tiny Exposure: direct pulp cap with biodentine/calcium hydroxide and cover with composite.
Large Exposure: explain the tooth will need some form of pulpal treatment - cvek/partial pulpotomy to try maintain vitality, coronal pulpectomy or total pulpotomy as last resort.
How would a Cvek pulpotomy be carried out and managed?
- Exposed pulp removed with high-speed.
- Calcium hydroxide/biodentine placed after achieving haemostasis.
- GIC placed in the remainder of the cavity and then composite placed.
- Follow-up at 1, 3 and 6 months.
- 96% success rate *
A mother attends with her child who has rampant bottle caries.
What is the likely cause and how would you manage this patient in the short and long term?
- Introduce yourself.
- Take a history (SOCRATES).
- RMH incl. any sugary medications.
- Confirm the cause and amount of sugar intake (can be done with a diet sheet).
- Provide diet advice re. sugar intake - 4 sugar tax per day, water only at night.
- Discuss fluoride supplementation either as a 1000ppm paste or fluoride supplements.
- Consider XLA of poor prognosis primary teeth/painful teeth.
- Consider restoring saveable teeth with PMCs.
- advise the mother brings her son regularly for further checkups. *
