Paeds textbook Flashcards
Contains fc from: BDS3- Special needs Fissure sealants Fluoride use Prevention Treatment planning. Paeds behaviour BDS4- treatment of discolouration
Compare dental fear/ anxiety and phobia?
Anxiety- a reaction due to a previous negative experience.
Fear- Emotional response to a specific threat
Phobia- Persistent and extreme fear of objects or situations which interfere with daily life.
Discuss the physiological changes common in a child experiencing anxiety?
Breathlessness
Perspiration
Palpitations
Fealing of unease.
Discuss the cognitive changes in a child experiencing anxiety.
Interference in concentration
Hypervigilance
Inability to remember certain events
Imaging the worst that could happen.
Discuss the behavioural reactions of a child experiencing anxiety.
Avoidance- Postponing appointments/ constantly speaking/ closing thir mouth/ asking lots of quesitions/ asking to go to the toliet frequently. Older children may complain of headaches/dizziness/ or can’t be bothered.
Running away
Aggresive behaviour( will need to discuss these feelings)
The patient’s eyes are screwed up and their eyebrows are lowered.
What is this a sign of?
Pain.
The patient’s eyes are wide and their eyebrows are raised.
What is this a sign of?
Fear
What is the letter to dentist?
This collects the worry and pain expectations of the child’s dental treatment.
It also decides on the stop signal that is vital for patient control .
How do we assess dental fear and anxiety (DFA)
- Assess the patient’s desire to influence the course of treatment (give back control e.g. rest breaks/ stop signals)
- Find out the relevant health history questions.
- Use the MCDAS- modified child dental anxiety scale.
Why do we restore upper teeth before lowers?
Because it is easier to anaesthetise upper teeth & it is more comfortable.
What do we start with for child patients.
We start with the painless treatment to get the child used to the dental environment.
Compare social and non-social re-inforcers
Social reinforcers are facial expressions/ verbal praise/ appropriate physical contact.
Non social reinforcers are stickers or certificates.
e.g. a brave certificate or a clever certificate.
What is acclimitisation?
Gradually introducing children to the dental environment such as:
- showing the child on a stuffed animal
- introducing suction by letting the child suck water from a cup.
What is systematic desensitisation?
The idea that repeated non distressing exposure to a stimulus will reduce anxiety
e.g. systematic needle desensitisation (when the patient is calm show them a needle)
How does role modelling work to manage behaviour?
If a patient sees someone else doing a similar proedure and mastering it, they will imitate them
How does hypnosis work for behaviour management?
The patient is relaxed and asked to concetrate on ideas and images. The hypnotist communicates with the patient to get their subconcious brain more open to the ideas.
Describe the fight or flight response for a child
We have calm (p/s) and panic (S) mode.
Panic mode would be switched on if someone steps infront of you while you are riding a bike.
Your imagination can also switch panic mode on. (i.e. worrying about the dentist)
What is the applied tension relaxation technique?
You raise blood pressure to prevent fainting by:
- Tensing the muscles of the arms/ chest and keeping them tense until they feel the heat rising in their face.
- Releasing the tension (goes back to normal)
- Repeat 5 times.
When do we use the applied tension technique and why?
Used for patients with a fainting tendency and blood injury related phobia.
As fainting is caused by a rapid drop in blood pressure and blood injury injection related phobia is characteristic of causing fainting.
Discuss the relaxation technique of matching and pacing
You match your breathing with your patients so that you can begin to lead the pace yourself.
This ensures the pace is as slow as you want it to be.
Discuss progressive muscle relaxation.
You relax the body starting from the top and working down.
Through tensing the area, holding the tension and then releasing to relax.
How do you relax a child using the space exercise?
Breathe in for 3, hold and breathe out for 5.
Then ask the patient to repeat each phrase that you say in their head while they are breathing out.
How do you relax the child using controlled breathing?
- breathe in for 3
- hold
- Breathe out for 5.
This gets the child to focus on their breathing.
List the caries risk factors
Clinical evidence
Diet
Fluoride use
Plaque control
Saliva
Social history
Medical history.
What must your treatment plan include?
Prevention
Behaviour management/ Acclimatisation
Operative procedures
Regular reassessment.
How do we use the knee to knee examination?
- You need the parents to help
- Have all equipment ready before starting.
- Sit opposite your parent with your legs together (knee to knee)
- Patient should face the parent with legs on either side of their waist.
- Get the parent to hold the child’s hand
- Lay the patient back on your lap and have a look.
What are we using radiographs to check in the primary dentition?
If trauma to primary incisors has damaged the permanent successors.
For foreign bodies in the lips/cheeks.
Developmental status
Caries.
How often do we complete radiographs in the mixed dentition?
Bitewings :
every 6 months for high risk
Every 1-2 years for low risk.
What are the additional considerations for permanent dentition patients?
Increased awareness of appearance.
3rd molar development
Eating disorders and non carious tooth substance loss.
What is review and recall and why is it needed?
Review is an assessment with intent to change if neccesary e.g reviewing clinical treatments and radiographic findings.
Recall- patient’s are brought back in after primary care for a checkup.
Normal patients every 6 months
High risk caries patients- every 4 months.
WHY? All behavioural changes need re-iteration and encouragement.
What are the aims for each visit?
- Establish the caries risk level of each child
- Decide the treatment goals.
- Devise a preventative programme
- Decide the appropriate recall interview
What are the arrows pointing to?
The Dentine layer showing through non-carious enamel
The bluish- grey colour due to dentine thinning towards the incisal edge. This colour is due to the shadow at the back of the mouth.
Compare the appearance of the enamel lesion on the surface and in transmitted light.
Enamel lesion on the surface will appear matte/ opaque and chawky white.
In transmitted light- the lesion will appear darker than healthy enamel.
What clinical feature indicates dentinal involvement?
Opalescent enamel beside stained fissures.
What are we looking for in a radiograph ?
If the carious lesion extends into the dentine and if so, what part of the dentine (outer/ middle/ inner)
Where does the colour of the tooth come from?
dentine
Why does a caries cause the tooth to appear more matte?
Caries dissolves the prisms sheaths, creating pores- these pores refract light back instead of letting it through.
How do we prevent via recall appointments?
Provide oral hygiene advice
Provide diet advice
Closely monitor any lesions you are treating with prevention.
Check fissure sealants are still intact
Your patient is deemed normal caries risk, How often should you book a checkup?
Every 6 months
Your patient is deemed high caries risk, How often should you book a checkup?
Every 3 months
Your patient is deemed normal caries risk, How often should take radiographs?
Every 2 years
Your patient is deemed high caries risk, How often should take radiographs?
Every 6-12 months
Your patient is deemed normal caries risk, How often should you provide toothbrushing instruction.
Every year
Your patient is deemed high caries risk, How often should you provide toothbrushing instruction.
At every recall appointment
Your patient is deemed normal caries risk, what strength of toothpaste should you advise?
1350-1500ppm
Your patient is deemed high caries risk and aged >10 what strength of toothpaste should you advise?
2800ppm
Your patient is deemed normal caries risk, how often should you apply fluoride varnish?
Twice a year
Your patient is deemed high caries risk, how often should you apply fluoride varnish?
4 times a year
What fluoride supplements would you give high risk patients?
Alcohol free fluoride mouthwash.
(for patients over the age of 7)
Your patient is deemed normal caries risk, how often should you provide diet advice?
Once a year
Your patient is deemed high caries risk, how often should you provide diet advice?
At every recall visit.
Use food and drink diaries
Your patient is deemed normal caries risk, which teeth should you fissure sealant
1st permanent molars after eruption.
Buccal pits of lower 1st permanent molars
Palatal fissures of upper 1st permanent molars
Your patient is deemed high caries risk, which teeth should you fissure seal.
All permanent molars and premolars sealed on eruption.
palatal pits on upper lateral incisiors
Occlusal and palatal surfaces of the D/E.
What does the fluoride varnish consist of?
5% sodium fluoride.
What children are at risk of an allergy to duraphat and why?
Those who :
- have recently been hospitalised due to asthma or an allergy
- are allergic to sticking plaster.
Because duraphat contains colophony.
Discuss the cocentration of duraphat varnish and the volume used.
22,600 ppm.
We use 0.25ml on children aged 2-5 (nursery & P1)
We use 0.4ml on primary 2 and above
How much fluoride needs to be ingested to cause toxicity and what factors impact this?
5mg/kg for toxicity.
The concentration of the toothpaste and the weight of the child affect this
How do you manage a child who has swallowed <5mg/kg of toothpaste?
Give them milk and monitor them for a few hours.
How do you manage a child who has swallowed 5-15mg/ kg of toothpaste?
Give them calcium orally and take them to hospital.
How do you manage a child who has swallowed >15mg/ kg.
Admit them to hopsital immediately
For: cardiac monitoring
Life support
Intravenous Calcium glucon
What is a fissure sealant?
It is a protective plastic coating that is used to seal fissures and pits of a tooth to prevent food or bacteria getting stuck.
Why are fissures more vulnerable to caries?
- They are less protected by fluoride than other tooth surfaces.
- A toothbrush cannot reach the whole way into a fissure.
What material is a fissure sealant made of?
Normally BIS gma resin
sometimes RMGIC
What teeth do we fissure seal for children with disabilities,
All teeth.
What teeth do we fissure seal for high risk children with learning difficulties
all teeth
What teeth do we fissure seal for high risk children who are medically compromised.
All teeth
What preventative action should you take if a child presents with caries in 1 permanent molar?
Fissure seal the other 3 1st permanent molars.
If the caries is occlusal- seal the 2nd permanent molars on erruption.
What are the SDCEP guidelines for all children no matter their risk.
All permanent molars should be sealed as soon as possible after eruption.
What surfaces should you ensure to seal on upper molars?
Occlusal surface and palatal pits.
What surfaces should you ensure to seal on lower molars?
Occlusal surface and buccal pits.
What surfaces should you ensure to fissure seal on the upper incisors.
Cingulum pits.
Why do we not want to overfill the fissure sealant?
overfilling decreases long term retention.
How should you check a fissure sealant after application?
Check for:
- adhesion
- air bubbles
- Material interproximally
- Excess material distal to the tooth.
- for opaqueness.
How often do we review fissure sealants?
Every 4-6 months.
What should we look for when checking the fissure sealant at recall meetings?
Visual check- Is there opalescence visible- this indicates leaking and demineralisation.
Physical check- use a probe to try and lift away the fissure sealant.
When do we chose a glass ionomer fissure sealant?
When good moisture control cannot be achieved.
If the patient has very sensitive teeth (so drying would be painful)
As a temporary sealant on primary and secondary molars until they fully erupt.
Covid- this doesn’t require an AGP.
Discuss glass ionomer cement as a fissure sealant.
adv- they release fluoride
Disadv- they are poorly retained
they require regular re-application.
What barriers can children with special needs have to attending appointments?
- Challenging behaviour & anxiety (so acclimitisation is crucial)
- Access/ parking
- Other appointments- collaborate and plan
- Parental attitudes- we want to promote good knowledge.
List some of the aids that can be used for toothbrushing.
Two sided toothbrush
Finger prop
open wide disposable mouth rest.
Oronurse toothpaste
Duraphat.
2 toothbrush technique
What are some barriers for changing the diet of a child with special needs.
May have atypical food clearance/ food holding/ regurgitation.
Diet is already restricted (may only eat certain things)
Sweet treats may be given for good behaviour
Medicines containing sugar .
Compare the surgical options for children with additional support needs.
Sedation- not everyone can have it ( avoid for patients with muscloskeletal disorders)
GA- for uncooperative patients or when extensive treatment is needed.
List some dental features of cerebral palsy.
- Access
- Drooling
- Poor oral hygiene
- trauma
- Uncontrollable movements.
- Gingival hyperplasia
- Enamel hypoplasia.
- Bruxism
- Malocclusion
- Enhanced gag reflex.
What are the different types of disability we can have.
Physical
Medical
Mental
Sensory.
What communication aids can help visual impairment?
Braille
What communication aids can help a hearing impairment?
BSL and hearing loops
What communication aids can be used for patients with Autisim spectrum disorder.
Makatron
board maker pictures
widget symbols.
What are the 3 main characteristics of a child with autism?
They don’t like change
Struggle forming new relationships
Struggle to commmunicate.
What information should be asked in the ASD questionaire prior to treatment.
- Child’s likes and dislikes (for rapport)
- Do they have any sensory issues?
- What treatment has been possible previously.
- How they communicate
- Any trigger signs to show that they are done.
If the child with ASD has sensory problems, with sound how do you prepare the practice?
Turn off the radio
Turn off the aspirator.
Close the door to reduce noise.
If the child with ASD has problems, with taste- how do you prepare the practice?
Note that duraphat tastes of banannas.
Chose oronurse- it is a tasteless foamless toothpaste.
If the child with ASD has visual issues, how do you prepare the practice?
Turn off the dental light and use sunlight to look in the child’s mouth.
If the child with ASD has problems with movement, how do you prepare the practice?
Set the dental chair at the correct height so that you don’t have to move the child once they are seated.
What diet advice would you provide for a parent of a child with ASD?
To reduce fizzy drinks or juice, the child will need to be weaned off over a few months. This would be done by diluting the drink down over that time period.
What treatments would you provide for a child with ASD?
Fluoride varnish every 4 months
GIC fissure sealants- if the patient doesn’t like the taste of salt and vinegar crisps- cover it with oronurse)
Wait until they are acclimatised before any more treatments
What are the dental features of down Syndrome.
- Increased risk of periodontal disease.
- Class III occlusion
- Macroglossia (large tongue)
- Anterior open bite)
- Maxillary hypoplasia
- Hypodontia/ microdontia.
Identify and describe this clinical image?
This is primary herpetic gingivostomatitis.
This results in fluid filled vesicles found on the gingiva, lips, tongue, buccal and palatal mucosa.
These vesicles can rupture causing ulceration.
This will normally last 10-14 days.
identify and describe this clinical image.
This is a herpangioma.
This is when there are fluid filled vesicles in the tonsillar area or the pharyngeal regions.
This normally lasts 7-10 days.
These vesicles can rupture to cause ulceration.
Identify and describe this clinical image?
This is hand foot and mouth.
It is characterised by ulceration on the gingivae/tounge/cheeks/palate and a maculopapular rash on the hands and feet.
It commonly lasts 7-10 days.
What are the symptoms of primary herpetic gingivostomatitis?
Fever
Headache
Severe oedematous marginal gingivitis
Vesicles/ulceration.
How do we treat:
Primary herpes
Herpangina
Hand foot and mouth.
Bed rest
soft diet
Paracetamol
Antimicrobial gel or mouthwash.
What is Herpes labialis?
What triggers it?
How do we manage it?
This is a secondary herpes infection.
It can be triggered by stress, sunlight or other causes of ill health.
We manage it with a topical acylovir cream.
What is oral ulceration ?
an inflamed and exposed area of connective tissue due to destruction of the epithelium (covering)of the oral mucosa.
list some causes of oral ulceration?
Trauma
Infection (e.g. hand, foot and mouth)
Immune deficiencies
Vitamin deficiencies (e.g. Iron/ folate/ vitamin B12)
Systemic diseases (e.g. chrons disease)
Neoplastic
Recurrent apthous stomatitis- no underlying cause.
What information do we want to know for an ulcer history?
Onset
Frequency
Number
Size
Site
Duration
Exacerbating factors
Lesions in other areas
Any treatments? (what did and didn’t work)
How do we describe an ulcer?
Border
Shape
Colour
Size
Location
Lesion characteristics.
What investigations should we consider after diagnosing an ulcer?
Full blood count
Diet diary
Haematinics
Coeliac screening (looking for anti-transglutaminase antibodies. )
How do we manage ulcers?
Deal with the exacerbating factors
- Nutritional deficiencies (iron supplements or refer)
- Traumatic factors.
- Avoid sharp or spicy foods
- Avoid allergic reactions.
Pharamceutical
- Prevent superinfection infection- Corsodyl 0.2% mouthwash
- Provide a barrier- (Hyaluronate) Gengigel topical gel or Gelcair mouthwash
- Symptomatic relief- Difflam or LA spray.
List the clinical features of Orofacial granulomatosis and oral chron’s
- Swelling:
- Lips
- Gingiva
- Non-labial facial surfaces
- Peri-oral erythema
- Cobblestoning of the buccal mucosa
- Linear oral Ulceration.
- Mucosal tags
- Lip/tongue fissuring/ angular cheilitis
How do we manage OFG?
Oral hygiene support
Symptomatic relief for the oral ulceration
Dietary exclusion to reduce the infammation.
Topical steroids
Topical Tacrolimus (immunosuppressants)
Discuss this clinical image?
This is geographical tongue.
We have red inflamed areas surrounded by white margins.
This caused by a loss of filiform papillae.
It can cause intense discomfort especially with spicy food, tomato and citrus fruits.
This managed by: a bland diet during flare ups.
Discuss this clinical image
This is a fibro-epithelial polyp.
A firm pink lump found mainly in the cheeks/lips or tongue.
This remains constant in size and is caused by minor trauma.
This is treated by surgical excision.
Discuss this clinical image?
Congential epulis.
This is found on the anterior maxilla of neonates.
It is benign and is treated by excision.
Discuss this clinical image?
This presents with pedunculated cauliflower like lesion. That is caused by HPV.
-HPV6&11- Squamous cell papilloma
HPV2&4- Verruca Vulgaris (also associated with skin warts)
What are epiludes?
Soft tissue swellings in the gingivae in response to chronic inflammation or trauma.
Discuss this clinical image?
This is a fibrous epulis.
The lesion is a similar colour as the gingivae.
It is a pedunculated or sessile mass with a firm consistency
Discuss this clinical image?
Pyogenic granuloma.
This is a soft, deep red/ purple swelling that is often ulcerated.
It can haemorrhage spontaneously or with mild trauma.
If found in a pregnant women we call it a pregnancy epulis.
Discuss this clinical image?
This is a peripheral giant cell granuloma.
This is a dark red and ulcerated swelling.
It is interproximal with an hourglass shape- buccal and lingual swellings joined by a narrow middle section between the teeth.
Discuss this clinical image?
This is a mucocele.
It is a cyst originating from a minor salivary gland.
This is normally related to trauma.
Most will rupture spontaneously.
Discuss this clinical image?
This is a ranula- which is a mucocele from a minor or major salivary gland in the floor of the mouth.
We need to do an MRI to exclude a plunging ranula (the ranula goes submandibular or submental)
Discuss this clinical image?
Bohn’s nodules-
Gingival cysts seen on the alveolar ridge.
This usually disapears in the first few months of life.
Discuss this clinical image?
Epstein’s pearls.
Small cystic lesions found along the palatal midline.
They disappear in the 1st few weeks.
What is characteristic of temporomandibular joint dysfunction syndrome
Pain when opening the mouth
Restricted mouth opening.
Mastigatory muscle spasm.
How do we manage temporomandibular joint dysfunction syndrome?
Reduction of exasterbating factors :
- Habits ( clenching/ grinding/ chewing gum/ nail biting/leaning on the jaw)
- Manage stress
- A bite raising device (if nocturnal grinding/ clenching)
Rest the overworked muscles
- Avoid wide mouth opening
- Soft diet
Symptomatic relief
- Analgesic
- Alternating hot and cold packs.
Name and discuss this anomalie
Hypodontia- Patient has not developed all of their teeth.
Name syndromes associated with hypodontia?
Down’s syndrome. Cleft palate. Ectodermal dysplasia
What problems are caused by hypodontia
Overerruption Abnormal shape/form Spacing Submergence Deep overbite Reduced LFH.
How can we manage hypodontia?
* Removable prosthesis * Crowns and Bridge * Implants * Porcelain veneers * orthodontics.
Compare the 4 types of supernumerary teeth in hypodontia
Conical- cone shaped. Tuberculate- barrel shaped Supplemental- looks like a normal tooth Odontome- irregular mass of tooth tissue.
What is the most common cause of delayed eruption of lateral incisor teeth
Supernumerary teeth.
What anomalie of shape is shown here.
Accessory cusp e.g. talon cusp.
Name this anomalie of shape?
Dens in dente- tooth inside a tooth.
What is tayurodontism?
Bull horn shaped pulp chamber (pulp is much larger than normal)
What is the incidence of short root anomaly?
2.5%
What can cause the short root anomaly?
Radiotherapy Dentine dysplasia Accessory root.
What do you want to ask the patient if they present with localised enamel hypoplasia?
Did they suffer from any infection or trauma to their primary teeth?
What is enamel hypomineralisation?
A disturbance in enamel formation Secretory stage is fine (tooth is the right shape) but there is a problem with mineralisation.
What is enamel hypoplasia ?
There is reduced bulk or thickness of enamel. When there is a problem with the secretory stage (the tooth is not the right shape) The mineralisation is fine.
Compare true and acquired hypoplasia.
True- Enamel didn’t form Acquired- Hypomineralised tooth that loses bulk after eruption
Compare the presentation of enamel hypomineralisation& enamel hypoplasia
Hypomineralisation- Marks. Hypoplasia- marks and chunks missing.
What is MIH?
Molar incisor Hypomineralisation. When there is reduced mineralisation of molars and sometimes associated incisor teeth
What is the effect of MIH?
Increased sensitivity (more nerve tissues) Increased blood supply to area. Immune cell accumulation Loss of tooth substance.
How do we treat MIH molars?
* Restore- composite/ GIC/SSC * Adhesive retained copings (gold) * Extraction
How do we treat MIH incisors?
* Acid pumice micro-abrasion * External bleaching * Localised composite placement * veneers (when patient is older) .
What is fluorosis?
Hypomineralisation due to excess fluoride ingestion during development.
How do we treat fluorosis?
Microabrasion Veneers Vital bleaching
List some prenatal causes of generalised enamel defects.
Rubella/congenital syphilis/ thalidomide/ Fluoride/ maternal A&D
List some neonatal causes of generalised enamel defects.
Premature/ meningitis
List some postnatal causes of generalised enamel defects.
Otitis media/ Measles/ chickenpox/TB/ pneumonia/ Diphtheria/ deficiency of vit A/C/D / Heart disease/ Long temr health problem e.g. organ failure.
What condition is shown in this image?
Amelogenesis imperfecta- where there is abnormal enamel production
What do you see in radiographs of patients with amelogenesis imperfecta?
There is no obvious change in the radiolucency between enamel and dentine.
What is hypoplastic amelogenesis imperfecta?
Enamel crystals incompletely grow in length
What is hypocalcified amelogenesis imperfecta?
Incomplete growth in thickness/width
What is hypomaturational amelogenesis imperfecta?
Normal growth in length. Incomplete growth in thickness Incomplete mineralisation
Name the forms of amelogenesis imperfecta?
Hypoplastic Hypocalcified Hypomaturational Mixed forms with taurodontism
How common is amelogenesis imperfecta?
1:1400
what dental problems are associated with amelogenesis imperfecta?
Sensitivity Caries/acid susceptibility Poor aesthetic Poor oral hygeine Delayed eruption Anterior open bite
How do we treat patients with amelogenesis imperfecta?
Composite bonding Veneers Fissure sealant metal onlays SSC Orthodontics
What condition is shown in this image?
Dentine imperfecta
Describe dentine imperfecta?
Abnormality in the development of dentine. There is a bulbous crown and obliterated pulp leaving no space for the pulp. Type 1- dentine and enamel type 2 just affects dentine
What problems are caused by dentine imperfecta?
Aesthetic Caries/ acid susceptibilty Spontaneosu abscess.
How do we treat patients with dentine imperfecta?
Cover the teeth before they can be damaged e.g. * Composite veneer * Overdenture * Removable prosthesis * SSC * Prevention
What is dentine dysplasia?
Normal crown morphology Obliterated canal Amber discolouration Short constricted roots.
What is odontodysplasia?
Localised arrest in tooth development Thin layers of enamel and dentine large pulp chambers (tooth is blurry in radiographs- ghost teeth)
How do we treat odontodysplasia?
Prevention and pain control
Restoration of lost tissue.
Harness the growth
Compare type 1 and Type 2 amelogenesis imperfecta?
Type 1- associated osteogenesis imperfecta. Loss of enamel aswell
type 2- no underlying medical conditions. No loss of enamel.
What is cleidocranial dysplasia?
hypoplasia of cellular component of cementum. ## Footnote stranger things
What is hypophosphatasia?
Hypoplasia or aplasia of cementum (early loss of primary teeth because there is nothing holding them in place)
What causes premature eruption?
* Overweight child \
* Precocious puberty
* You can also get natal or neonatal teeth.
What causes delayed eruption?
Malnutrition Prematurity / low birth weight
Associated general conditions (Downs/ Hpothyroid/ Cleidocranial dysplasia)
Gingival hyerplasia/ overgrowth (The teeth don’t look like they are erupting)
What causes premature exfoliation?
Trauma Following pulpotomy Hypophosphatasia.
What causes delayed exfoliation?
- Lower 1st primary molar is most common
- Infra-occluded teeth (1-9%)
- Double primary teeth
- No successor to push out primary tooth
o Hypodontia
o Ectopic permanent successor - Following trauma
What is characteristic of chronic Enamel hypoplasia?
Impact on multiple teeth in symmetrical linear fashion.
(The hypoplasia has affected all the enamel growing on the teeth during a particular timeframe)
e.g. only half of central incisors with tips of canines and premolars.
Discuss the treatment options for enamel hypoplasia?
- Accepting- not a viable option (hypoplasia likely to lead to caries/ Sensitivity issues )
- Cover with RMGI
- Crowning teeth (If crowning- will have to recrown when patient reaches full permanent dentition
- Extraction- an option if molars.
*
Compare child protection to child safeguarding.
Child protection is protecting children who are (or are at risk) suffering .
Child safeguarding is the measures taken to minimise the risk of harm. e.g. school policies.
Define children in need.
Those who require additional support or services to achieve their full pottential.
What is the child protection plan?
This is a list of children who have been identifed as being at significant risk of harm.
What elements must be present for child abuse?
- Significant harm to the child
- carer has some responsibilty for that harm.
- Significant connection between the carer’s reponsibility for the harm and the harm to the child.
What 5 questions should we ask for GIRFEC
What is getting in the way of this child’s wellbeing.
Do I have everything I need to help this child or young person? (clinical notes/ records of attendance)
What can I do now to help this child or young person? (treatment/ OHI/DIET ADVICE)
What can my profession do to help this child? e.g. arrange recall appointments
What aditional help is needed?
e.g. home based dental support.
What are the SHANARRI indicators we look for?
Safe
Healthy
Achieving
Nurtured
Active
Respected
Responsible
Included
When can you share private information.
When the child’s safety is at risk.
But ensure you write in your notes your justifcation for sharing this information.
What are the 3 big concerns for parental capacity?
- Mental health
- Alcoholism/ drugs misuse
- Domestic violence.
What children are more likely to be vulnerable?
children <5 (as they are only with families)
Irregular dnetal patients or those who only attend in pain (their parents are not taking them)
Children with medical problems and disabilities
What situations are a red flag for child protection?
- A delay seeking dental advice (with no satisfactory explanation)
- The history changes over time (or not explain the injury or illness)
- Are there any unexplained injuires when you examine the child
- Is the child’s behaviour and interaction with the parent concerning?
List some markers of neglect.
short stature (nutrition)
Inappropriate clothing/ cold injuries/ sunburn
ingrained dirt (fingernails)/ headlice/ dental caries
Developmental delay
Withdrawn or attention seeking behaviour.
What are indicators of dental neglect?
Obvious dental disease
impact on the child
Practical care has been offered but the child has not returned for treatment.
Give examples of willfull dental neglect and what do you do if it continues?
This happens after dental problems have been pointed out:
Irregular attendance , repeated failed appointments or late cancellations.
Failure to complete treatment
Child returning in pain at repeated intervals.
Repeated GA for Dental extractions.
If it continues you Report it.
On extraoral examination you notice that the child has bruising on their right cheek and a small abrasion on their right temple.
How do we manage dental neglect?
first- Preventative dental team management (raise concerns with parent and offer support)
2nd-Preventative multiagency management (liaise with other professionals to see if the concerns are shared)
In complex or deterioriating situations Child protection referral.
Compare acute and chronic abuse.
Acute abuse- spontaneous and uncalculated reaction. The parent feels remorse and seeks help (e.g. A&E)
Chronic abuse- no remorse, the child’s needs are not a priority.
What is typical of an accidental injury?
Bony prominences are damaged.
e.g. the parts that stop you from falling.
What questions should you ask yourself about a child’s injury?
Could the injury be accidental?
Does the explanation fit the injury?
Is the explanation within normal accepted limits of behaviour?
If there is delay in seeking advice, are there good reasons for this?
Who do you contact if the child is in immediate danger?
The police.
How do we refer a patient that we are concerned of being abused or neglected?
Telephoning social services & then following up the referral with a notification of concern form.
After referal, what 3 courses of action can take place?
If the child is in immediate danger (removal by the police/child protection order/ exclusion order/ Child assessment order)
Deciding if the child is at significant harm through (investigation/initial assessment/ discussion
From this
- No further child protection action ( may get additional support)
- joint investigation (an interview with the child by a police officer and social worker)
