Paeds Tutorials Flashcards
- 10 year old patient
- unhappy with front teeth appearance
- Sensitivity while brushing
- Asthamtic
- brushes twice daily with 1450ppm
What is your diagnosis? (4)
- MIH in upper and lower molars permanent molars
- Anterior tooth wear (NCTSL)
- Upper moderate crowding
- Lower mild crowding
- 10 year old patient
- unhappy with front teeth appearance
- Sensitivity while brushing
- Asthamtic
- brushes twice daily with 1450ppm
What is their caries risk assessment? and what further investigations would you do ? (2)
- High risk due to
Asthma = xerostomia - Diet diary to analyse diet and assess risk
- Ask about asthma inhalers ; nature of asthma and triggers , medications
- 10 year old patient
- unhappy with front teeth appearance
- Sensitivity while brushing
- Asthamtic
- brushes twice daily with 1450ppm
What are the favourable signs of extraction of permanent first molars? (4)
- Patient age is 8-10
- Calcification of the bifurcation of the 7s
- Calcification of the 8s
- Class I incisor relationship
- 10 year old patient
- unhappy with front teeth appearance
- Sensitivity while brushing
- Asthamtic
- brushes twice daily with 1450ppm
When would you compensate an extraction of a permanent first molar?
- when the upper 6 will by unopposed for a long time - to avoid over eruption
- when there is a clear occlusal requirement ( not aligned teeth interfering with the occlusion)
What is molar incisor hypo-mineralisation?
Hypo-mineralisation of systemic origin affecting 1-4 permanent molars usually associated with affected molars.
What is the suggested etiological factors of MIH? (pre-natal)
- Pre-eclampsia
- gestational diabetes
- general health in 3rd trimester
What is the suggested etiological factors in MIH? (natal)
- Prolonged delivery ( may cause trauma during birth
- Early delivery ( immature)
What is the suggested etiological factors in MIH? (post-natal)
- Infections to child - measles , rubella , chicken pox
- Prolonged breast feeding
- Medications while breastfeeding (mother and child)
- Socioeconomic status
( First year in the child’s life)
What are the symptoms of MIH? (2)
- Tooth sensitivity
- Aesthetic concerns
What are the signs of MIH? (4)
- Demarcated opacities with varied translucency in enamel (molars ± incisors)
- Tooth discolourations (brown/yellow)
- Severe NCTSL
- Secondary caries
What important medical history information should you gather for a child with asthma? (5)
- Nature of asthma
- History of hospital addmissions due to asthma
- Triggers and exacerbating factors
- Record FEV1 / PEFR values if known
- Medication doses and frequency of use
What does FEV1 / PEFR values tell you about an asthmatic patient?
- Measurements to assess lung function
- Degree of airway obstruction and severity of asthma
- important in monitoring asthma
What can suggest for a patient who is on high doses of corticosteroid for asthma for a prolonged time ?
- consider steroid cover
What triggers can exacerbate asthma? (3)
- Anxiety
- Colophony
- Local anaesthesia - sulphites (presevatives)
- Dust/debris
How can the nature of asthma affect a child’s dental management plan? (7)
- Educate patient about their increased risk of oral disease due to asthma
- OHI for prevention and the use of FV (consider colophony free)
- Diet advice - sugar free drinks
- Rinse after inhaler use
- Use spacer after inhaler use
- Make appropriate referrals for the increased risk of erosion
- There are many possible triggers of acute asthma attacks - try to minimise these
What can be the triggers of asthma in the dental setting? (6)
- Colophony in fluoride varnish
- Debris from enamel
- Prolonged supine position
- NSAIDs and Opiods
- Anxiety
- Aerosols
Where might you seek assistance from for the management of asthmatic patients?
- Consult with patient GP or special care dentist
- John 6 years old with dental anxiety
- Intermittent pain (right side of mouth)
- Mom wrote Cleft in MH form
- Drinks juice throughout the day and does not like water
- Today came for a clinical examination , OPT taken
What further information (excluding MH) would you want from john history? (3)
- Social history - impact of CLP
- Visits to hospital
- Patient GP details
What medical history is important to gather for a CLP patient? (3)
- Type of cleft condition
- Cardiac conditions (defects?)
- History of cleft-related surgery undertaken
What are the extra-oral findings in a cleft lip and palate patient? (3)
- Class III skeletal presentation
- Maxillary Hypoplasia ( or non if only palate)
- Communication between upper lip and nostrils
What are the intraoral findings of a CLP patient? (9)
- Hypodontia
- Hypoplastic teeth
- Hypomineralised teeth
- Microdontia
- Macrodontia
- Crowding
- Misaligned upper arch
- Communication between nasal and oral cavity
- Caries and periodontal involvement
Which practitioners are involved in the CLP patients management? (7)
- Special cleft nurse
- Orthodontist
- Paediatric dentist
- GP
- GDP
- Speech therapist
- Psychologist
What is the treatment timeline for a CLP patient? (5)
- 3-6 months - lip closure
- 6-12 months - palate closure
- 8-10 years - alveolar bone graft
- 12-15 years - definitive orthodontics
- 18-20 years - orthognathic surgery
What supportive resources are available for CLP patients and parents?
CLAPA ( cleft and lip palate association)
What is the aetiology of CLP?
- Genetic - syndromes , family history or ethnicity
- Environmental - smoking, alcohol, SIMD, antiepileptics, multivitamins
During what developmental period and week does CLP arise?
- Embryonic stage : 0-8 weeks
What other facial syndromes occur during embryonic stage of developnent (0-8 weeks )
- Foetal alcohol syndrome
- Hemifacial microsomia
- Treacher collins syndrome
What is the main system for classifying CLP patients?
LAHSHAL classification
Describe type, size and extent of clefting
Give classifications of the following cleft presentations?
What is the most common missing tooth in CLP?
Upper lateral incisor
What is the most common skeletal base pattern in CLP?
Class III
What is the most common cause of CLP?
SIMD - low socioeconomic status
- New patient attends to practice with Haemophilia type A (mild)
- NB . photos taken at a later date to radiograph
What is the risks of tooth decay in haemophilic patients?
Increased risk of complications following invasive dental treatment ( prolonged bleeding and difficulty in achieving haemostasis) due to missing clotting factors (8,9)
What prevention advice would you provide for a haemophilic patient? (7)
- Education on regular attendance for early caries detection
- Avoid invasive procedure
- x4 FV per year
- FS occlusal and palatal bits of D/E/FPM/SPM
- Diet advice
- OHI with hands on brushing at every visit
- Consider community and home support
What dental treatment can be permitted for haemophilia patients? (5)
- LA techniques : buccal infiltration, intraligamentary and intra-papillary injections
- Routine PMPR - supra and sub
- Prosthodontics (moderate to severe cases in hospital setting with specialist)
- Endodontics
- Orthodontic treatment ( modified so not possible for soft tissue trauma)
What dental treatment required extra management steps for haemophiliacs ? (3)
- IDB
- Lingual infiltration
- XLA - contact haemophilia centre
How would you manage an emergency haemophilia patient presenting with ** dental pain ** ? (6)
- Assess cause of pain and take pain history
- If spreading infection or systemic symptoms prescribe ABS
- Analgesics - Avoid aspirin , discuss NSAIDs use with haemophilia centre
- Take care with intra-oral x-ray films
- Endodontics are permitted
- Avoid XLA in primary care
How would you manage an emergency haemophilia patient presenting with ** Trauma ** ? (6)
- Assess need for invasive procedure based on trauma type and presentation
- Endodontic treatment is permitted
- Avoid XLA in primary care
- Suture gingival lacerations
- Provide factor replacement therapy if excessive bleeding
What is the minimum coagulation factor concentration allowing for invasive dental treatment to be undertaken?
50%
What platelet count is considered to be safe for dental treatment?
- Primary care - 100x10^9 / L
- Secondary care - 50x 10^9 / L
What LA administration techniques require haemostatic cover in haemophilias?
IDB , lingual infiltration