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paediatrics > restorative management of the primary dentition > Flashcards

restorative management of the primary dentition Flashcards

1
Q

why is it important to restore the primary dentition?

A

-dental health affects general wellbeing and health
-dental infections have a detrimental effect on health
-can cause physical, mental and emotional effects
-especially in those with learning difficulties
-dental pain can be detrimental to health of child

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2
Q

why would you restore a tooth?

A

-prevent pain
-prevent irriversible pulpitis
-restore form
-restore function- speech/eating
-restore aesthetics
-acclimatisation- anxious or behavioural problems- best to get them used to it early
-maintain space- teeth may end up erupting at unusual angle e.g lower 5s erupting lingually
-untreated dental infections could cause sepsis or infections of permanent tooth germs leading to deformities such as turners teeth (enamel hypoplasia)
-avoid GA- traumatic and costly
-avoid GA in medically compromised pts eg bleeding disorders

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3
Q

how does primary morphology affect caries and restorations?

A

-dentine and enamel are less mineralised than permanent dentition- so caries progressive more quickly
-pulp horns are relatively larger compared with permanent- risk pulp exposure during restorations- higher on mesial aspect

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4
Q

how do primary teeth differ to permanent?

A

-smaller
-enamel and dentine is less mineralised
-enamel is thinner
-dentine is relatively thinner
-pulp is relatively larger
-pulp horns closer to surface
-contact points are flater and wider

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5
Q

why does caries progress quicker?

A

-thinner enamel
-relatively thinner dentine
-less mineralised enamel and dentine
-pulp is relative larger- closer to surface

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6
Q

how does primary pulp respond to caries progression?

A

-can produce secondary dentine- but progression is often to rapid

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7
Q

how many root canals do primary molars have?

A

usually 3 but can vary

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8
Q

where are the root canals positioned in lower primary molars?

A

MB ML D

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9
Q

where are the root canals positioned in upper primary molars?

A

MB DB P

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10
Q

how would you compose a tx plan?

A

-relieve pain
-prevention at home- OH and diet
-professional prevention- fluoride/FS
-stabalise caries
-restore
-pulp therapy
-extractions

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11
Q

discuss consent for tx

A

under 16s require parental consent - explain to parents in a way they understand using clinical and radiographic aids
-however, gillicks competence principal states that if a child understand pros/cons of procedure and is competent to consent- that can be accepted

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12
Q

what is needed to diagnose reversible and irreversible pulpits?

A

-take history of pain
-full examination
-radiographs

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13
Q

what is the likely history for reversible pulpits?

A

-pain from sweet/hot/cold
-pain relieved when stimulus removed
-short duration
-often occurs when eating/drinking

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14
Q

what is the likely history for irreversible pulpitis?

A

-pain remaining after stimulus removed
-prolonged and constant pain
-pain keeping you awake at night
-pain removed with analgesics

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15
Q

what would be seen upon exam with reversible pulpits?

A

-early carious lesion

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16
Q

what would be seen upon exam with irreversible pulpitis?

A

-extensively broken down marginal ridge
-sinus
-intr-oral swelling
-lymphadenopathy
-raised temp

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17
Q

what would be seen on radiograph for reversible pulpits?

A

-caries into dentine

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18
Q

what would be seen on radiograph for irreversible pulpits?

A

-caries into/close to pulp

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19
Q

restore or extract?

A

-enough tooth tissue- restore
-type of pulpits
-prev extractions?- restore as may affect function- hypodontia
-avoid GA- restore
-compliance of pt
-maintain space- avoid drifting eg lingual 5s

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20
Q

when should you extract?

A

-balancing for function
-poor compliance for long appts
-poor parental support
-poor attendance- may end up in pain

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21
Q

when would you temporise a tooth?

A

-to relieve pain asap and arrange for further restoration/extraction
-relive sharp edge

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22
Q

what should a temporary filling do?

A

-relive pain
-not be detrimental to pulp
-not affect future restoration
-provide a good seal
-used for one or two teeth at a time

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23
Q

describe stabilisation of teeth

A

-when poor OH and high amounts of active caries
-remove as much disease as poss round ADJ
-temporary filling to all necessary teeth until careful consideration is made on restoring/extracting
-buys time for cooperation/restore restorable teeth before extracting others
-prevents progression in other teeth when focusing on one

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24
Q

where is a good starting pt for treatment of children/

A

buccal maxillary- as painless LA can be given

25
Q

when is it ok to give idb/more painful injection?

A

-when compliance has improved and pt is cooperative
-when pt confidence/trust and understanding has improved

26
Q

what should be integrated before and throughout tx? and why?

A

-prevention or new lesions will form during tx

27
Q

what is the typical sequence for caries tx for children?

A

-relieve pain-temp dressing
-at home prevention-OH and diet
-professional prevention-FS/FV
-acclimatise-simple rest-max first
-complicated rest, pulp therapy, extrcations
-IDB- whole q if poss
-anteriors

28
Q

how is restoring the primary dentition affected by morphology?

A

-thinner enamel-progresses quicker-closer to pulp
-pulp horns closer to surface

  • use small bur
29
Q

what two factors help make you choose a material for a restoration?

A

-tooth factors- extent of caries and shape of cavity-will material stay.
-pt factors- moisture control, compliance/cooperation, aesthetics expectations, stabilise caries to prevent fast progression

30
Q

what is the main method for restoring molar tooth but what is the downfall?

A

hall technique- not aesthetically pleasing

31
Q

discuss occlusal caries in children

A

-occlusal caries less common as shallow tissues/pits
-compomers, composites or GI
-dependent on moisture control/isolation

32
Q

what does the Minamata treaty state?

A

no amalgam in deciduous teeth since July 2018

33
Q

what are the most common types of caries in molars of primary teeth?

A

-proximal- use ssc

34
Q

where would drilling into a primary molar be less risky?

A

middle of fissure system as won’t contact pulp horns which are higher mesially

35
Q

why is proximal cavities less likely to be preformed using conventional restorative techniques?

A
  • likely to contact pulp horns
    -little room for deep boxes
    -July 2018- no primary amalgams allowed
36
Q

what is the gold standard for proximal caries in primary molars? and why?

A

hall technique-sec

-avoid LA
-avoid pulp exposure
-no moisture control needed
-maintains arch space
-avoid GA
-strength
-durability
-wear

37
Q

how is stainless steel crown maintained?

A

morphology- cervical constriction and gingival bulb

38
Q

what class are proximal caries?

A

class II

39
Q

when would you use ssc?

A

-large class II cavity
-badly broken down teeth
-dental anomalies
-following pulpotomoy

40
Q

what is the first stage of primary crown prep?

A

choose size- marked tooth and position on buccal of crown
-measure mesiodistal width to get correct size

41
Q

what are the two methods for crowns?

A

-conventional technique and prep
-halls technique

42
Q

what is the technique for conventional technique and prep?

A

-remove caries
-use crown prep bur and slice medial, distal and occlusal aspect to allow crown to fit.
-aqua cem into crown and place crown
-remove excess cement
-check occlusion

43
Q

what should you look our for when prepping for crown?

A

shoulders- crown won’t seat fully

44
Q

how do you know you have selected the correct crown?

A

-should bounce- tight to tooth but if finger removed crown would spring back

45
Q

why is hall technique ideal?

A

-no la
-no caries removal
-no prep
-easier for pt and operator

46
Q

what is the hall technique ?

A

-choose crown size
-prep child by practicing biting technique
-fill crown with GI cement
-place crown on tooth and ask child to bite down
-wipe excess cement
-check occlusion
-occlusion likely high- advise parent and pt that this will return to normal as child alveolar bone malleable

47
Q

what does anterior caries indicate in pre-school age?

A

bottle mouth caries- children going to bed with milk/juice which is washing over teeth throughout the night

48
Q

what does anterior caries indicate in >3 yo?

A

high caries risk

49
Q

in a pre-cooperative pt how would you treat anterior restoration?

A

-GI cement

50
Q

in a cooperative pt-what is the ideal material for anterior restorations?

A

composite resin

51
Q

what is discing in primary teeth?

A

self cleansing cavities- use disc to flatten edges of cavity to smooth it- no longer retentive- can arrest lesion

52
Q

what are the downsides for using composite in primary teeth?

A

-bonding to thinner/less enamel/dentine
-cooperation
-moisture control-will not bond

53
Q

what are the positive/negative for using glass ionomer cement?

A

pos
-good bonding- no moisture control
-good for stabilisation/temporisation

neg
-evidence of fluoride release are minimal
-little strength and not durable for proximal cavities
-poor aesthetics primary teeth

54
Q

discuss rubber dam use in children?

A

-preferred over cotton wool
-gold standard for isolation-conventional comp resin rest and pulpotomy
-protect from inhalation and intake of medicaments

55
Q

what are other methods of moisture control?

A

-cotton wool
-dry gaurds
-saliva ejector
-suction

56
Q

when can LIA not be used for primary teeth?

A

-always es and sometimes ds

57
Q

what needle is used for IDB?

A

short for <7s
long for >7s

58
Q

what is the max dosage for prilocaine with felypressin?

A

1/11th cartridge per kg

59
Q

what is the technique for IDB for children?

A

-angle of mandible is more obtuse to ID foramen is lower
-id foreamen is at or just above the occlusal plane
-barrel at opposing primary molars

paediatrics (13 decks)

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