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BDS3 paeds > Prep for clinic > Flashcards

Prep for clinic Flashcards

1
Q

primary eruption sequence

A
  • lower centrals
  • upper centrals
  • upper laterals
  • lower laterals
  • upper 1st molars
  • lower 1st molars
  • upper canines
  • lower canines
  • lower 2nd molars
  • upper 2nd molars
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2
Q

primary lower centrals erupt

A

6 months

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3
Q

primary upper centrals erupts

A

8-12months

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4
Q

primary upper laterals erupt

A

9-13 months

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5
Q

primary lower laterals erupt

A

10-16 months

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6
Q

primary upper 1st molars erupt

A

13-19 months

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7
Q

primary lower 1st molars erupt

A

14-18 months

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8
Q

primary lower canines erupt

A

17-23 months

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9
Q

primary upper canines

A

16-22 months

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10
Q

primary lower 2nd molars

A

21-23 months

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11
Q

primary upper 2nd molars

A

25-33 months

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12
Q

general rule of eruption

A

lowers before uppers (except primary canines)

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13
Q

permanent eruption sequence:

A

6 years - all 6s, lower centrals
7 years - upper centrals, lower laterals
8 years - upper laterals
11 years - lower canines, all first premolars
12 years - rest - upper canines, all second premolars and second molars

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14
Q

4 functions of primary dentition

A
  • reserve space for permanent
  • development speech
  • ease mastication
  • healthy start to permanent dentition
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15
Q

contraindications to duraphat

A

ulcerative gingivitis or stomatitis or known sensitivity to colophony (1-7%)

not for ingestion during application

not for systemic Tx

on day of application other F preparations should not be used (e.g. gels) and routine regiments of F tablets should be suspended for several days after Tx

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16
Q

adverse reactions to duraphat

A
  • oedematous swellings reported in rare instances
  • attacks of dyspnoea in extremely rare asthmatics
  • nausea in sensitive stomachs

remove by brushing and rinsing in cases of intolerance

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17
Q

duraphat is

A

5% sodium fluoride solution

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18
Q

indication for F varish

A

hypersensitiy Tx

caries prevention

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19
Q

most beneficial caries prevention

A

topical F application /varnish (more than systemic ingestion)

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20
Q

F varnish works in 3 ways

A

slows down development of carious lesions by stopping demineralisation - SLOWS CARIES PROGRESSION

makes enamel more resistant to acid attack from plaque bacteria and speeds up remineralisation, does so with F so more strong/less soluble - CARIES ARRESTING

stops bacteria metabolism at high concentrations - CARIES INHIBITING

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21
Q

4 properties of topical fluoride

A

desensitising

water tolerant

adherent

sets in presence of saliva

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22
Q

method of application of topical fluoride

A

remove gross plaque

remove excess moisture from teeth with cotton wool roll or air syringe

apply first to lower arch where saliva collects more rapidly

dispense correct amount of duraphat into dappens dish (0.25-0.5ml per application/mouth)
apply sparingly in thin layer - do not need to use all

paint varnish onto dry, isolated teeth with microbrush

dental floss can be used to ensure varnish reaches interproximal areas

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23
Q

advice to parents after topical fluoride application

A

avoid eating or drinking for at least one hour (longer period more beneficial)

eat soft foods for rest of day

brush teeth as normal

do not take F supplement on day of application

makes teeth appear yellow but will wear off with eating and brushing

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24
Q

safely tolerated F dose STD

A

STD

dose below which symptoms fo F toxicity are unlikely to occur

1mg/kg

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25
Q

potentially lethal F Dose PLD

A

PLD

lowest dose associated with fatalisty

5mg/kg

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26
Q

certainly lethal F dose CLD

A

CLD

survival after consuming is unlikely

32-64mg/kg

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27
Q

how many application per cartidge of childsmile duraphat

A

cartridge = 1.6ml

recommend 0.25-0.5ml per application

so 6 applications of 0.25ml for 3-5 year olds in cartridge

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28
Q

F in 0.5ml duraphat

A

11.3mg

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29
Q

F in 0.25ml duraphat

A

5.65mg

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30
Q

F in 1.6ml cartridge duraphat

A

35.84mg

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31
Q

estimated F toxic dose

A

5.15mg/kg

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32
Q

estimated F toxic dose for 10kg child

A

50mg F

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33
Q

estimated F toxic dose for 15kg child

A

75mg F

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34
Q

estimated F toxic dose for 20kg child

A

100mg F

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35
Q

symptoms and signs of F overdose

A

F fast absorbed from stomach

nausea and vomitting, diarrhoea and abdominal pain

excessive salivation, abnormal taste, tremors, weakness and convulsions

shallow breathing and nervous system shock

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36
Q

management of F toxicity

<5mg/kg

A

Give calcium orally (milk) and observe for a few hours

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37
Q

management of F toxicity

5-15mg/kg

A

Give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital

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38
Q

management of F toxicity

>15mg/kg

A

Admit to hospital immediately, cardiac monitoring and like support, intravenous calcium gluconate

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39
Q

rule for toothbrushing

A

spit don’t rinse

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40
Q

toothpaste for less than 3 years old

A

smear

1000ppmF

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41
Q

toothpaste for 3-9 years old

A

pea size

1350-1500ppmF
1450ppmF for high risk - any age

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42
Q

toothpaste for 10 years+

A

2800ppmF (less likely to swallow)

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43
Q

toothpaste for 16+ high risk

A

5000ppmF

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44
Q

fluoride varnish strength

A

22600ppmF

roughly 20x stronger than toothpaste

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45
Q

Silver diamine fluoride strength

A

44,000ppmF (double F varnish)

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46
Q

periodontal status

plaque scores

A

10/10 perfectly clean tooth

8/10 line plaque around cervical region

6/10 cervical 1/3 of crown covered

4/10 middle third of crown covered

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47
Q

periodontal status

BPE

A

0 healthy

1 bleeding on probing

2 calculus or other plaque retention factors

3 shallow pocket 4/5mm

4 deep pocket 6mm+

  • furcation involvement
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48
Q

ramjford’s 6 index teeth

A

16, 11, 26 and 36, 31, 46

49
Q

BPE score options in children 7-12

A

0, 1, 2

50
Q

when are full range BPE scores used?

A

13-17 years

- record if not done due to poor co-op

51
Q

probe for BPE

A

WHO 612 probe

  • 0.5mm ball ended
  • black band 3.5-5.5mm, 8.5mm - 11.5mm
52
Q

black bands on BPE probe

A

3.5-5.5mm, 8.5mm - 11.5mm

53
Q

refer to periodontal specialist for child if

A

agressive periodontitis diagnosis

incipient chronic periodontitis not responding to Tx

systemic medial condition associated with periodontal destruction

medial Hx that significantly affects periodontal treatment or requiring multi-disciplinary care

genetic conditions predisposing to perio destruction

root morphology adversely affecting prognosis

non-plaque induced conditions requiring complex specialist care

cases requiring diagnosis/ management of rare complex clinical pathology

drug induced gingival overgrowth

cases requiring evaluation for periodontal surgery

54
Q

SIGN 47

primary prevention

A

keeping children’s teeth healthy before disease/caries occur

55
Q

clinical evidence of high risk caries

A

new lesions

premature extractions

anterior caries/restorations

multiple restorations

No FS

fixed appliances/ortho

partial dentures

56
Q

clinical evidence for low risk caries

A

no new lesions

no extractions for caries

sounds anterior teeth

no/few restorations

restorations present are old

FS

no appliances

57
Q

dietary habits for high caries risk

A

frequent sugars

58
Q

dietary habits for low caries risk

A

infrequent sugars

59
Q

social history for high caries risk

A

deprivation

high caries risk siblings

low knowledge of dental disease

irregular attender

ready available snacks

low dental aspirations

60
Q

social history for low caries risk

A

advantaged

low caries risk family

dentally aware

regular attender

limited snacks

high dental aspirations

61
Q

use of F for high caries risk

A

wanter not fluoridated

no F supplements

no F toothpaste

62
Q

use of F for low caries risk

A

water fluoridated

F supplements

F toothpaste

63
Q

plaque control for high caries risk

A

infrequent, ineffective cleaning

poor manual control

64
Q

plaque control for low caries risk

A

frequent and effective cleaning

good manual control

65
Q

saliva for high caries risk

A

low flow rate

low buffering capacity

high S mutans and lactobacillus counts

66
Q

saliva for low caries risk

A

good manual control

normal flow rate

high buffering

low S mutans and lactobacillus counts

67
Q

medical history for high caries risk

A

medically compromised

physical disability

xerostomia

long term cariogenic medicine

68
Q

medical history for low caries risk

A

no medical issues

no physical issues

normal salivary flow

no long term cariogenic medicines

69
Q

what caries risk if not clear fit low or high

A

moderate

70
Q

primary prevention in children of high caries risk involves

A

behaviour modifications

tooth protection

consistent preventative message reinforced by dental practice team and other HCP

71
Q

behaviour modifications as primary prevention in children of high caries risk

A

dental health education advice provided to individual at chair-side

brush teeth twice daily using toothpaste (at least 1000ppmF)

spit don’t risk

restrict sugary food and drink consumption

advise of non sugar sweeteners (esp Xylitol)

sugar free chewing gum (esp Xylitol) when can

sugar free medications when possible and sugar free forms of non prescription medicines recommended

72
Q

tooth protection as primary prevention in children of high caries risk

A

sealants applied and maintained in pits/fissures high risk

  • review at check ups condition
  • GI sealants when resin sealants unsuitable

F tablets (1mg daily) for sucking for considered high decay

F varnish - duraphat - every 4-6months in high risk

chlorohexidine varnish option for preventing caries

73
Q

secondary prevention of caries

A

limiting impact of caries at early stage

74
Q

tertiary prevention of caries

A

rehabilitation of decayed teeth with further preventative care

75
Q

diagnosis dental caries confirmed by

A

bitewing radiographs

  • essential adjunct to first exam
  • frequency further radiograph based on caries risk
76
Q

management of carious lesions needs to be

A

both operative and preventative

  • operative alone will fail to prevent future disease
  • primary preventative care needs to be continued
77
Q

re-restoration of lesion

A

secondary caries diagnosis hard and clear evidence of involvement of active disease needs ascertained before replacement restoration

if only part of restoration is judge to have failed consideration repairing rather than replacement

78
Q

management of carious lesions

  • occlusal
  • extends clinically to dentine
A

carious dentine removed and tooth restored

79
Q

management of carious lesions

  • occlusal
  • only part of fissure system involved
A

use composite sealant

80
Q

management of carious lesions
- occlusal

when to use amalgam

A

effective

but not permitted in under 16s

81
Q

management of carious lesions

- approximal

A

preventative care (e.g. topical F varnish) rather than operative recommended when confined to enamel

82
Q

management of carious lesions

  • smooth surface
  • non cavitated
A

manage like approximal - preventative - if confined to enamel

83
Q

DMFT/S

A

Decayed
Missing
Filled
Teeth/ Surfaces

dmft/s for primary

84
Q

SIGN 138

key recocomendations

A

oral health promotion intervention should be facilitate twice daily toothbrushing with F toothpaste

resin based fissure sealants should be applied to permanent molars of all children as early after eruption as possible

85
Q

standard risk F strength

up to 18

A

1000-1500ppmF

86
Q

increased risk F strength (10-16)

A

2800ppmF

87
Q

2 approaches to caries prevention

A

population based - water fluoridation

targeted - based on risk

88
Q

risk indicators for caries (5/6)

A

diet

oral hygiene

microbiological (step mutans)

sociodemographics (low economic)

previous caries exposure

saliva? - if reduced than increased caries risk

89
Q

7 things to consider when assessing caries risk

A

clinical evidence of previous disease

diet (esp frequency sugar)

social history

fluoride use

plaque control

saliva

medical history

90
Q

why should F toothpaste use by children be supervised

A

to reduce the risk of fluorosis

91
Q

behaviour management

A

continuum of interaction with a child/pt directed towards communication and education

92
Q

goals of paeds behaviour management

A

ease fear and anxiety

promoting an understanding of the need for good dental health

93
Q

normal childhood development

age 2

A

fear of unexpected movements, loud noises and strangers

dental situation can produce fear in child

94
Q

normal childhood development

age 3

A

reacts favourably to positive comments about clothes and behaviour

less fearful of separation from parents (due to nursery)

experience will dictate reaction to separation

95
Q

normal childhood development

age 4

A

more assertive - bossy/aggressive possible

fear of unknown and bodily harm is now at peak

fear of strangers can be slightly decreased

with firm, kind direction can be excellent pts

96
Q

normal childhood development

age 5

A

readily separated from parents

fears usually diminished

proud of possessions - use to engage and build rapport

comments on clothes - quickly establishes rapport

97
Q

normal childhood development

age 6

A

seeks acceptance

success in acceptance can affect self-esteem

if child develops feeling of inferiority or inadequacy at dentist then behaviour may regress to that of younger age

98
Q

normal childhood development

age 7-12

A

question inconsistencies and conform to rules of society - engage

still have fears bit better at managing them
- ask obvious Qs to see if they can be addressed e.g. why do you dislike the chair? (maybe movement when in, so can move into position prior)

99
Q

when are anxiety, behaviour and compliance linked in development

A

ages 3-8

older children able to use assessment tools MCDAS

100
Q

dental anxiety

A

occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences

101
Q

dental fear

A

normal emotional response to objects or situations perceived as genuinely threatening

102
Q

phobia

A

clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviour and interference in daily life
- avoid going to dentist

103
Q

3 components of dental fear and anxiety

A
  1. physiological and somatic sensations
  2. cognitive features
  3. behavioural reactions
104
Q

physiological and somatic sensations components of DFA

A

breathlessness

perspiration

palpitations

feeling of unease

105
Q

cognitive features of DFA

A

how changes occur in thinking process

  • interference in concentration
  • hypervigilence (swivel heads)
  • inability to remember certain events when anxious (mind racing)
  • imagining worse that could happen
106
Q

behavioural reaction of DFA

A

avoidance i.e. postpone dental app, child disruptive behaviour

escape from situation which precipitates anxiety

anxiety may manifest as aggression - esp adolescents

  • feel not listened to
  • explain will not do anything until we know that they are comfortable and how they are - dentistry is 2nd to them

dentist should always ensure safety of pt and staff

107
Q

Signs of DFA

A

some easy

some subtle

  • time delay asking Qs
  • stomach aches/need to go to toilet
  • headaches, dizziness
  • fidget
  • stutter
  • ‘can’t be bothered’
108
Q

factors that influence DFA

A 
fear of choking 
fear of injection/drilling 
fear of unknown 
past medical/dental experience
dental experience of family/friends
attitudes of parents 
preparation at home before appt
child's perception that something is wrong with teeth

useful to know so can specifically reassure

109
Q

control related measure to assist DFA

A

rest breaks

stop signals

pt need for info

110
Q

MCDAS

A

modified child dental anxiety scale

can get faces version

8+

base line DFA established

111
Q

good dentist/pt communication allows (4)

A

improved information obtained from pt
- more you know the better the Tx as more adapted

enable dentist to communicate information with pt

increases likelihood pt compliance - feel safe, listened to

decrease pt anxiety

112
Q

behavioural management techniques (7)

A

positive reinforcement

tell show do

acclimatisation

voice control

distraction

role modelling

relaxation/hypnosis

113
Q

Building Tx plan for children - general guide

A

simple -> complex

OHI, FS, upper before lower for restorations

114
Q

Paeds Tx plan

A
  1. exam, Fluoirde varnish, diet sheet given, toothbrush to bring on next visit, explain/take radiographs
  2. brush teeth with their brush, invite on chair, check diet, radiographs
    polish teeth and dry (slow speed + air syringe),
    explain FS
  3. FS, introduce saliva injector
  4. remove carious tissue with hand excavator if immediate temporisation needed
    Use slow speed for small buccal and cervical carious lesions
    introduce topical and give rubber dam home
  5. restore uppers with LA (topical then injection)
  6. restore lower teeth with LA
  7. pulp Tx then extractions if pt pain free e.g. if pulpotomy needed, do before extractions
115
Q

F toxicity threshold dose

A

5mg/kg

  • depends on tooth paste strength and weight child
116
Q

F toxic dose for 2yo (average weight 12kg)

A

60mgF

2/3 (60g) of a 90g 1000ppmF tube (90mgF/tube)

1/4 (21g) of a 75g 2800ppmF tube (210mgF/tube)

117
Q

F toxic dose for 4 yo (average weight 15kg)

A

75mgF

5/6 (75g) of a 90g 1000ppmF tube (90mgF/tube)

1/3 (27g) of a 75g 2800ppmF tube (210mgF/tube)

118
Q

F toxic dose for a 6yo (average weight 20kg)

A

100mgF

more than a tube (100g) of a 90g 1000ppmF tube (90mgF/tube)

1/2 (36g) of a 75g 2800ppmF tube (210mgF/tube)

119
Q

biggest F toxicity risk

A

small children ingesting high strength toothpaste

so keep toothpastes out of young children’s reach esp high strength duraphat (2800ppmF or 5000ppmF)

BDS3 paeds (15 decks)

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