Paeds: treatment planning of the carious dentition

Question 1

How can you allow a child to feel in control during the appointment?

Answer 1

Child responsible for saying “stop” and “go”. Rehearse a signal to stop i.e. hand raise.

Tell, show, do approach: explain what you are going to do, trial it out (praise the patient if they do well), then proceed with procedure

Question 2

How can you get a child to behave in the chair?

Answer 2

Reinforce positive behaviours “that helps me when you do this”

Ignore negative behaviours.

Question 3

How could you encourage a child to endure a potentially upsetting procedure?

Answer 3

Structured time: break down what you are doing into timed sections the child can comprehend.

“I’ll buzz your tooth while I count to three, then stop. Is that Ok? 1…2…3…. Well done!”

Question 4

What is silver diamine fluoride treatment?

Answer 4

SDF is a topical medicaments that can manage and prevent dental caries, as well as relieving dentinal hypersensitivity.

Question 5

Why can silver diamine fluoride compounds prevent caries?

Answer 5

Silver —> antimicrobial
Fluoride —> remineralisation of enamel

Question 6

Why might you be cautious with SDF?

Answer 6

Formation of a silver oxide layer (black) will stain most oxidisable surfaces.

Question 7

Orthodontic separators

Answer 7

Useful to open proximal contacts and create space (can aid Hall technique, caries diagnosis, placing of proximal sealants).

Question 8

How long should orthodontic separators be placed on the tooth for? before treatment

Answer 8

3-7days

Question 9

Describe the purpose of the Hall technique

Answer 9

a method of “sealing in” caries within a primary molar tooth.

Question 10

What are the requirements to place a preformed metal crown on a tooth?

Answer 10

1. No clinical or radiographic signs of pulpal pathology.
2. CLEAR band of dentine between cavity and pulp.

Question 11

What would you put into a preformed metal crown before placing it over the tooth?

Answer 11

Glass ionomer luting cement

Question 12

How could you tell the preformed metal crown is seated properly?

Answer 12

The surrounding gingiva will often blanche.

Question 13

What measurement is important to document in the notes when doing the hall technique?

Answer 13

OVD - occlusal vertical dimension —> has it changed significantly post-procedure (~2mm is normal).

Can be taken using probe.

Question 14

What would you reassure the patient of after performing the Hall technique?

Answer 14

Advise the patient that the bit will feel high but this will resolve in a week or two.

Question 15

What chemical would you use on a soaked cotton pellet to achieve haemostasis when doing a pulpotomy?

Answer 15

Ferric sulphate (for 1-2minutes)

Question 16

What would you place on exposed pulp after achieving haemostatsis during a pulpotomy?

Answer 16

Mineral Trioxide Aggregate (MTA)

Question 17

What would you fill the cavity with once completion of a pulpotomy?

Answer 17

Zince oxide eugenol material

Question 18

When would you avoid using silver diamine fluoride?

Answer 18

Silver allergy, irreversible pulpitis or periapical periodontitis, infection

Question 19

What could this be?
- Clinical signs of caries
- Not TTP
- No abnormal mobility
- No signs of infection (i.e swelling, sinus or suppuration)
- Pain is short and doesn’t linger
- Pain only in direct response to stimuli

Answer 19

Reversible pulpitis

Question 20

What could this be?
- Clinical signs of caries
- Not TTP
- No abnormal mobility
- No signs of infection (swelling sinus suppuration)
- Spontaneous pain
- Prolongered and lingers after removal of stimuli
- Wakes up in the night

Answer 20

Irreversible pulpitis

Question 21

What could this be?
- Clinical signs of caries
- Increased motility
- TTP
- Signs of infection (swelling, suppuration and sinus tract)
- Often acute symptoms gone
- dull throbbing pain
- can be assymptomatic

Answer 21

Periradicular/apical periodontitis