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BDS4 > Paeds Tutorials > Flashcards

Paeds Tutorials Flashcards

1
Q
  • 10 year old patient
  • unhappy with front teeth appearance
  • Sensitivity while brushing
  • Asthamtic
  • brushes twice daily with 1450ppm

What is your diagnosis? (4)

A
  • MIH in upper and lower molars permanent molars
  • Anterior tooth wear (NCTSL)
  • Upper moderate crowding
  • Lower mild crowding
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2
Q
  • 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)

A
  • High risk due to
    Asthma = xerostomia
  • Diet diary to analyse diet and assess risk
  • Ask about asthma inhalers ; nature of asthma and triggers , medications
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3
Q
  • 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)

A
  • Patient age is 8-10
  • Calcification of the bifurcation of the 7s
  • Calcification of the 8s
  • Class I incisor relationship
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4
Q
  • 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?

A
  • 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)
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5
Q

What is molar incisor hypo-mineralisation?

A

Hypo-mineralisation of systemic origin affecting 1-4 permanent molars usually associated with affected molars.

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6
Q

What is the suggested etiological factors of MIH? (pre-natal)

A
  • Pre-eclampsia
  • gestational diabetes
  • general health in 3rd trimester
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7
Q

What is the suggested etiological factors in MIH? (natal)

A
  • Prolonged delivery ( may cause trauma during birth
  • Early delivery ( immature)
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8
Q

What is the suggested etiological factors in MIH? (post-natal)

A
  • 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)
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9
Q

What are the symptoms of MIH? (2)

A
  • Tooth sensitivity
  • Aesthetic concerns
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10
Q

What are the signs of MIH? (4)

A
  • Demarcated opacities with varied translucency in enamel (molars ± incisors)
  • Tooth discolourations (brown/yellow)
  • Severe NCTSL
  • Secondary caries
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11
Q

What important medical history information should you gather for a child with asthma? (5)

A
  • 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
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12
Q

What does FEV1 / PEFR values tell you about an asthmatic patient?

A
  • Measurements to assess lung function
  • Degree of airway obstruction and severity of asthma
  • important in monitoring asthma
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13
Q

What can suggest for a patient who is on high doses of corticosteroid for asthma for a prolonged time ?

A
  • consider steroid cover
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14
Q

What triggers can exacerbate asthma? (3)

A
  • Anxiety
  • Colophony
  • Local anaesthesia - sulphites (presevatives)
  • Dust/debris
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15
Q

How can the nature of asthma affect a child’s dental management plan? (7)

A
  • 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
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16
Q

What can be the triggers of asthma in the dental setting? (6)

A
  • Colophony in fluoride varnish
  • Debris from enamel
  • Prolonged supine position
  • NSAIDs and Opiods
  • Anxiety
  • Aerosols
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17
Q

Where might you seek assistance from for the management of asthmatic patients?

A
  • Consult with patient GP or special care dentist
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18
Q
  • 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)

A
  • Social history - impact of CLP
  • Visits to hospital
  • Patient GP details
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19
Q

What medical history is important to gather for a CLP patient? (3)

A
  • Type of cleft condition
  • Cardiac conditions (defects?)
  • History of cleft-related surgery undertaken
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20
Q

What are the extra-oral findings in a cleft lip and palate patient? (3)

A
  • Class III skeletal presentation
  • Maxillary Hypoplasia ( or non if only palate)
  • Communication between upper lip and nostrils
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21
Q

What are the intraoral findings of a CLP patient? (9)

A
  • Hypodontia
  • Hypoplastic teeth
  • Hypomineralised teeth
  • Microdontia
  • Macrodontia
  • Crowding
  • Misaligned upper arch
  • Communication between nasal and oral cavity
  • Caries and periodontal involvement
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22
Q

Which practitioners are involved in the CLP patients management? (7)

A
  • Special cleft nurse
  • Orthodontist
  • Paediatric dentist
  • GP
  • GDP
  • Speech therapist
  • Psychologist
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23
Q

What is the treatment timeline for a CLP patient? (5)

A
  • 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
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24
Q

What supportive resources are available for CLP patients and parents?

A

CLAPA ( cleft and lip palate association)

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25
Q

What is the aetiology of CLP?

A
  • Genetic - syndromes , family history or ethnicity
  • Environmental - smoking, alcohol, SIMD, antiepileptics, multivitamins
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26
Q

During what developmental period and week does CLP arise?

A
  • Embryonic stage : 0-8 weeks
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27
Q

What other facial syndromes occur during embryonic stage of developnent (0-8 weeks )

A
  • Foetal alcohol syndrome
  • Hemifacial microsomia
  • Treacher collins syndrome
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28
Q

What is the main system for classifying CLP patients?

A

LAHSHAL classification
Describe type, size and extent of clefting

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29
Q

Give classifications of the following cleft presentations?

A
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30
Q

What is the most common missing tooth in CLP?

A

Upper lateral incisor

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31
Q

What is the most common skeletal base pattern in CLP?

A

Class III

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32
Q

What is the most common cause of CLP?

A

SIMD - low socioeconomic status

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33
Q
  • 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?

A

Increased risk of complications following invasive dental treatment ( prolonged bleeding and difficulty in achieving haemostasis) due to missing clotting factors (8,9)

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34
Q

What prevention advice would you provide for a haemophilic patient? (7)

A
  • 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
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35
Q

What dental treatment can be permitted for haemophilia patients? (5)

A
  • 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)
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36
Q

What dental treatment required extra management steps for haemophiliacs ? (3)

A
  • IDB
  • Lingual infiltration
  • XLA - contact haemophilia centre
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37
Q

How would you manage an emergency haemophilia patient presenting with ** dental pain ** ? (6)

A
  • 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
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38
Q

How would you manage an emergency haemophilia patient presenting with ** Trauma ** ? (6)

A
  • 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
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39
Q

What is the minimum coagulation factor concentration allowing for invasive dental treatment to be undertaken?

A

50%

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40
Q

What platelet count is considered to be safe for dental treatment?

A
  • Primary care - 100x10^9 / L
  • Secondary care - 50x 10^9 / L
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41
Q

What LA administration techniques require haemostatic cover in haemophilias?

A

IDB , lingual infiltration

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42
Q

What are recommended local haemostatic methods for surgical extraction for haemophiliacs ? (4)

A
  • Apply pressure with damp gauze
  • LA with vasoconstrictor
  • Pack socket with surgicel
  • Suturing
  • Surgical splints ?? not sure
43
Q

What are recommended systemic haemostatic methods for surgical extractions for hemophilias?

A
  • Coagulation factor replacement
  • DDAVP (desmopressin)
  • Tranexamic acid
44
Q

What clotting factor deficiency found in Haemophilia A?

A

8

45
Q

What clotting factor deficiency found in Haemophilia B?

A

9

46
Q

What clotting factor deficiency found in von willebrand’s disease?

A

vW factor = 8

47
Q

What are the clotting factor percentage found in different severities of haemophilia? (4)

A
  • Carrier = >50%
  • Mild = 6-40%
  • Moderate = 2-5%
  • Severe = <1%
48
Q
  • New 12 year old patient with **down’s syndrome and asthma **
  • Difficulty brushing because he ** hates the taste of toothpaste **
  • Takes salbutamol ( infrequently as doesn’t need it)
  • Moderate learning difficulty
  • Cracked lower lip that sometimes bleed
  • What is down’s syndrome?
A

It is a genetic disorder associated with trisomy of chromosome 21

49
Q

What dental risk factors does a down syndrome child have? (3)

A
  • Predisposition to periodontitis
  • NCTSL - due to bruxism
  • Orthodontic problems : hypodontia, malocclusion
  • High caries risk
50
Q

What medical risk factors does down syndrome child have? (9)

A
  • Learning disability
    High risk of :
  • Cardiac defects (ASD, VSD, PDA)
  • Immunosuppression
  • Vision problems
  • Hearing problems
  • Sleep apnea
  • Hypothyroidism
  • GORD
  • coeliac disease
51
Q

What are the oral manifestations of down syndrome? (12)

A
  • Hypodontia
  • Microdontia
  • Maxillary hypoplasia
  • Macroglossia
  • Fissured tongue
  • AOB
  • Class III malocclusion
  • NCTSL
  • High arched palate
  • Delayed development
  • Ectopic eruption
  • Impaction
52
Q
  • New 12 year old patient with **down’s syndrome and asthma **
  • Difficulty brushing because he ** hates the taste of toothpaste **
  • Takes salbutamol ( infrequently as doesn’t need it)
  • Moderate learning difficulty
  • lower lip that cracked sometimes and bleeds

What is the likely cause of his lower lip issues? (4)

A

This can be due
* Mouth breathing from anterior open bite
* Class II malocclusion
* Xerostomia from inhaler
* Drooling

53
Q
  • New 12 year old patient with **down’s syndrome and asthma **
  • Difficulty brushing because he ** hates the taste of toothpaste **
  • Takes salbutamol ( infrequently as doesn’t need it)
  • Moderate learning difficulty
  • Cracked lower lip that sometimes bleed

How can you manage his lower lip issue? (4)

A
  • Educate parents about the cause and give advice
  • Suggest frequent sips of water
  • Suggest Salivary stimulants ( glycerine + lemon or sugar free gum)
  • Rehydrate lower lip with petroleum jelly or lip balm
54
Q
  • 4 year old sustained trauma , went to A&E, with no other injuries
  • Sent urgently to paediatrics dental department for review
  • Discomfort from his teeth and difficulty biting his teeth together
  • MH = Ventricular septal defect

What is infective endocarditis?

A

Infective endocarditis is a serious infection of the inner lining of the heart chambers and heart valves. It is typically caused by bacteria.

55
Q

What is the incidence of infective endocarditis in the general population?

A
  • Incidence = less than 1/10,000 per year
56
Q

Which patients are at risk of developing IE?

A
  • Acquired valvular heart disease
  • Hypertrophic cardiomyopathy
  • Previous infective endocarditis
  • Congenital heart disease ( cyanotic or repaired with prosthetic material)
  • Prosthetic heart valve patients
57
Q

What are the clinical features of a patient presenting with IE? (8)

A
  • Fever > 38C
  • Night sweats and chills
  • Breathlessness
  • Weight loss
  • Fatigue
  • Muscle pain
  • Back pain
  • Joint pain
58
Q
  • 4 year old sustained trauma , went to A&E, with no other injuries
  • Sent urgently to paediatrics dental department for review
  • Discomfort from his teeth and difficulty biting his teeth together
  • MH = Ventricular septal defect

Mathew patients think he may require ABs prophylaxis for IE management , who you must seek advice from to provide best treatment for this patient? (3)

A
  • Patient’s cardiology consultant
  • Cardiac surgeon
  • Local cardiology centre
59
Q

What guidelines are available for IE management?

A
  • NICE clinical guidelines 64
  • SDCEP guidelines - Dental advice for patients at increased risk of infective endocarditis
60
Q

What is the recommendations for IE management according to SDCEP and NICE?

A
  • AB prophylaxis is not routinely given to patients at increased risk of infective endocarditis
  • Consult with patient cardiology consultant before invasive denture procedure
61
Q

Explain how NICE and SDCEP guidelines history in relation to the recommendation of infective endocarditis?

A
  • NICE published guidelines in 2008 recommended antibiotic prophylaxis for anyone having a dental procedure
  • NICE then in 2018 changed their guidelines to align with SDCEP guidelines : not recommending ABs prophylaxis for routine dental procedures and discuss with patient cardiology consultant if undergoing an invasive dental procedure
62
Q

What are the features of a preventative plan for the management of a patient at risk of IE?

A
  • Inform the patient about the risks of IE with invasive treatment ( 1 in 10,000 per year)
  • Effectiveness and risks of AB prophylaxis and current guidelines recommendations
  • Advice about the importance of maintaining good oral hygiene and regular visits to reduce the risk of invasive treatment
  • Reduce frequency of sugar intake
  • Risks of non medical procedures (pirecings and tattoos)
63
Q

What would you say to a patient at high risk of developing endocarditis? (5)

A
  • Endocarditis is an infection in the heart, its caused by bacteria entering from the outside of your body
  • Usually the risk is about 1 in 10,000 per year (rare), and you are at high risk of developing this
  • Dental procedure such as extractions increase the risk of bacteria to enter into your body
  • The guidelines do not recommend ABs prophylaxis for non invasive dental procedures for people at high risk
  • Good oral hygiene and regular dental visits are important in reducing oral bacteria
64
Q

What would you tell a patient at high risk of IE when discussing ABs prophylaxis? (5)

A
  • Dental procedures are not thought to be the main cause of infective endocarditis
  • It is unclear if antibiotic prophylaxis would prevent infective endocarditis and it may still occur with it
  • Antibiotics can cause side effects such as nausea, diarrhea, allergic reactions and rarely
  • Maintaining good oral hygiene and regular dental visits effectively reduce oral bacteria and prevent oral disease = less risk of invasive procedure
  • Reduce sugary drinks and snacks to prevent tooth decay
65
Q

What are congenital cardiac defects?

A

A birth defect associated with the structure of the heart and the way it work.

66
Q

What to prescribe if ABs prophylaxis indicated? (3)

A
  • Amoxicillin 3g (oral powder)
  • Clindamycin Capsule (200mg)
  • Azithromycin oral suspension 200mg/5l
    60 hours before procedure
67
Q

What are congenital cardiac defects?

A

A birth defect associated with the structure of the heart and the way it work

68
Q

What are the categories of congenital cardiac defects?

A

Cyanotic and Non-cyanotic

69
Q

Examples of Cyanotic heart defects? (right to left shunt)

A
  • Tetralogy of fallot
  • Tricuspid Atresia

less oxygen in the blood

70
Q

Examples of Acyanotic cardiac defects? (left to right shunt) -

A
  • Atrial septal defect
  • Ventricular septal defect
  • Patent ductus arteriosus

normal levels of oxygen in the blood

71
Q

What syndromes can be associated with congenital cardiac defects? (4)

A
  • Down’s syndrome
  • Turner syndrome
  • Hemifacial microsomia
  • Cleft lip and palate
  • William’s syndrome
72
Q

What is a ventricular septal defect?

A
  • A cardiac birth defect associated with a connection between the ventricles, causing mixed blood to enter pulmonary circulation instead of deoxygenated blood.
73
Q

What features of a VSD makes it more severe?

A
  • Size of defect
74
Q

How can VSD be managed? (2)

A
  • Do nothing as may shrink by time
  • Open heart surgery + direct closure
75
Q

What 2 types of primary intrusive luxation injuries exist? (2)

A
  • Intrusive luxation into labial bone
  • Intrusive luxation into permanent tooth germ
76
Q

What are the signs of favourable outcomes of primary intrusive luxation Trauma? (4)

A
  • Root apex visible
  • Root appears shorter than contralateral
  • Displaced into the labial bone plate = tooth erupting
  • No significant Discolouration
77
Q

What are unfavourable signs of primary intrusive luxation injuries (5)

A
  • Root apex not visible
  • Root appears elongated - displaced into permanent tooth germ
  • Ankylosis
  • Severe discolouration
  • Peri-apical periodontitis
78
Q

How do you manage primary intrusion injury? (4)

A
  • Allow spontaneous re-eruption (6-12 months)
  • Suture gingival lacerations
  • Provide post-op instructions
  • Review
79
Q

When would you review a primary tooth intrusion?

A
  • 1 weeks , 6-8 weeks, 6 months, 1 year
80
Q

What advice would you give to parent’s who’s child was just treated for primary intrusion? (3)

A
  • Be careful when the child is eating to not further traumatise intruded tooth
  • Clean area with soft toothbrush
  • Use CHX mouthwash twice daily - 0.12% for 7 days
  • Review in 1 week
81
Q

How to chart a supernumerary on a dental chart?

A

S

82
Q
  • 8 year old patient
  • Mom concerned about the extra tooth and child concerned about her teeth appearance
  • She has type 1 diabetes takes insulin injections (well controlled)
    From radiograph - caries present
    What management options can you provide for this patient? (4)
A
  • Attempt caries removal for carious lesions on 55,54,64,74,85 and restore with composite, GI , RMGI (need compliance)
  • If not cooperative enough = SCC of 5’s and 4’s
  • If still not cooperative = SDF or non-restorative cavity control to make lesions cleansable
  • If not cooperative at all = Provide OHI and monitor or sedation under IS or GA
83
Q
  • 8 year old patient
  • Mom concerned about the extra tooth and child concerned about her teeth appearance
  • She has type 1 diabetes takes insulin injections (well controlled)
    From radiograph - caries present on primary teeth

What treatment can you provide under LA?

A
  • Selective caries removal (possible without)
84
Q
  • 8 year old patient
  • Mom concerned about the extra tooth and child concerned about her teeth appearance
  • She has type 1 diabetes takes insulin injections (well controlled)
    From radiograph - caries present

What treatment options should be considered for GA?

A
  • Surgical XLA of supernumeraries
85
Q
  • 8 year old patient
  • Mom concerned about the extra tooth and child concerned about her teeth appearance
  • She has type 1 diabetes takes insulin injections (well controlled)
    From radiograph - caries present

What information would you provide to the mother if GA is indicated? (2)

A
  • Risks associated with GA such anaphylaxis, brain damage, bladder problems, shivering and feeling cold, memory loss, confusion and vomiting
  • Advise that the first visit to the centre will be for assessment only and the final decision will be there
86
Q

What is the pathology of type 1 diabetes?

A
  • Autoimmune destruction of the beta cells in islets of Langerhans in the pancreas leading to less insulin secretion

Type 2 = insulin resistance leading due to genetic and environmental fac

87
Q

What medication is taken for type 1 diabetes? and its MOA?

A
  • Insulin injection
  • increase uptake of glucose be cells
88
Q

What medication is taken for type 2 diabetes? and its MOA?

A
  • Metformin (biguanide)
  • Enhances insulin sensitivity by cells
89
Q

What does HbA1c present?

A
  • Glycated haemoglobin
90
Q

Give the average values of Hb1Ac in normal, pre-diabetes and diabetes patients?

A
  • Normal - less than 6% (42mmol/mol)
  • Pre-diabetes - 6-6.4% ( 42-48 mmol/mol)
  • Diabetes- more than 6.5% 48mmol/mol
91
Q

Give other 2 tests for diabetes apart from hb1AC and diagnostic values for diabetes?

A
  • Random plasma glucose = >11.1 mmol/mol
  • Fasting plasma glucose = >7mmol/L
92
Q

What is the main complication of uncontrolled hypoglycaemia in T1DM and how does it occur?

A
  • Diabetic ketoacidosis (DKA)
  • Body cannot access glucose to metabolise it so metabolise fat instead which result in an acidic end product (ketones) resulting in an acidic blood PH.
93
Q

What are the signs and symptoms of ketoacidosis?

A
  • Nausea
  • Vomitting
  • Abdominal pain
  • Cerebral oerdema
  • Followed by coma
  • Followed by death
94
Q

What is the ABCDE for acute hypoglycaemia?

A

A - initially talking
B - initially increased
C - initially increased
D - initially alert
E - irritable confused and pale

95
Q

What is the management for a patient showing signs and symptoms of hypoglycaemia during dental treatment? (4)

A
  • Stop treatment
  • Offer 15-20mg glucose in oral form (glucotabs, glucoguice) if conscious
  • If unconscious/impaired swallowing call 999 and put in recovery position, inject glucagon (1mg) intramuscular injection
  • Once conscious give oral glucose 15-20mg
96
Q

What are possible reasons for delayed eruption of an upper central incisor? (4)

A
  • Supernumerary teeth
  • Trauma
  • Ectopic teeth
  • Failure of development
97
Q

When would be an appropriate time to investigate the delay eruption of a upper first incisor?

A

8 years old

98
Q

What are the 4 types of supernumerary teeth? (4)

A
  • Conical
  • Tuberculate
  • Supplemental
  • Odontome
99
Q

Which supernumerary is the most common cause of failed/delayed eruption of an upper permanent central incisor?

A
  • Tuberculate
100
Q

What conditions are associated with supernumerary teeth? (4)

A
  • CLP
  • Down’s syndrome
  • Cleidocranial dysplasia
  • Gardner’s syndrome
101
Q

How would you manage an unerupted 11 in an 8 year old patient with immature permanent incisor? (3)

A
  • Remove obstruction
  • Monitor for 12 months
  • If did not erupt by 12 months = surgical exposure and orthodontic traction using gold chain
102
Q

How would you manage an unerupted 11 in a 10 year old patient with mature permanent incisors? (2)

A
  • Remove obstruction
  • Surgical exposure and orthodontic traction using gold chain
103
Q
A

BDS4 (63 decks)

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