SCR - Ortho/Paeds Question Flashcards
What problems are associated with leaving anterior crossbites untreated ?
Toothwear, gingival recession, displacement on closure.
What problems are associated with leaving posterior crossbites untreated ?
Displacement on closure, toothwear, facial asymmetry, eruption of permanent dentition into displaced ICP position, TMJ problems.
What problems are associated with leaving an increased OJ untreated ?
Increased risk of trauma, aesthetics (psychosocial problems and teasing).
What problems are associated with leaving a reverse OJ untreated ?
Displacement on closure, incisal edge wear, difficulty incising foods, speech.
What problems are associated with leaving a deep OB untreated ?
Gingival stripping, palatal ulceration.
What problems are associated with leaving digit sucking habits untreated ?
AOB, reduced OB, proclined uppers, retroclined lowers, increased OJ, posterior crossbite.
What problems are associated with leaving supernumerary teeth untreated ?
Impede eruption of associated teeth, displaced eruption of adjacent teeth, poor aesthetics, damage to adjacent teeth.
What problems are associated with early loss of primary teeth ?
Space loss, upper and lower inherent crowding, impaction of permanent successor.
What problems are associated with impacted FPMs ?
Pulpitis of E and premature exfoliation of E.
What are the management options for correcting an anterior crossbite ?
URA - Adams clasps on 6s and 4s and Z-spring and posterior bite plane.
2x4 fixed appliance.
What occlusal features are favourable for correcting an anterior crossbite ?
Palatal tipped tooth in crossbite, good OB, adequate space to move forward.
What are the management options for correcting a posterior crossbite ?
URA.
Rapid maxillary expansion screw.
Quad helix (fixed appliance).
What are the skeletal, dental and soft tissue aetiological features of an increased OJ ?
Skeletal - Class II SB, mandibular deficiency.
Dental - U incisor proclination, L incisor retroclination.
Soft tissue - lower lip trap, hyperactive lower lip.
Digit sucking habit.
What are the management options for correcting an increased OJ ?
URA - Adams clasps on 6s and Robert’s retractor.
Growth modification - headgear, twinblock, Frankel II.
What is the aim of growth modification in the correction of an increased OJ ?
Enhance mandibular growth, restrain maxillary growth, remodel glenoid fossa, retrocline upper incisors, distalise upper molars, mesialise lower molars.
What are the skeletal and dental aetiological features of a reverse OJ ?
Skeletal - Class III, hypoplastic maxilla, prognathic mandible.
Dental - mandibular displacement, retained upper deciduous incisors.
What are the management options for correcting a reverse OJ ?
URA - proclined upper incisors.
Growth modification - chin cup, reverse twin block, protraction headgear.
What are the aetiological features of the malocclusion developed from a digit sucking habit ?
Prevention of eruption of incisors, lowering tongue position, unopposed buccinator pressure on upper buccal surfaces.
What are the management options for correcting a digit sucking habit ?
Positive reinforcement.
Encourage cessation at home - nail varnish, plasters, gloves.
Habit breaker appliance - removable or fixed - expansion screw, goal post.
What is the management option for managing a deep OB ?
URA with FABP - allows passive eruption of molars and increase in OVD.
What are the features of a conical supernumerary tooth ?
Close to midline, usually 1 or 2 in number, don’t prevent eruption but can displace centrals.
How are conical supernumerary teeth usually managed ?
If erupt or impede tooth eruption - extract.
Wait 12 months if spontaneous eruption of permanent tooth.
If not, +/- surgical exposure of central with orthodontic traction.
How are tuberculate supernumerary teeth usually managed ?
Extraction - wait 12 months if spontaneous eruption of permanent tooth.
If not, +/- surgical exposure of central with orthodontic traction.
How are supplemental supernumerary teeth usually managed ?
Extract either supplemental or tooth - depending on tooth form, quality and position.
How are odontome supernumerary teeth usually managed ?
Left in situ.
What are the features of a tuberculate supernumerary tooth ?
Barrel shaped, causes failure of eruption of dental incisors, develop palatal to incisors.
What are the features of a supplemental supernumerary tooth ?
Normal tooth morphology, normally erupt.
What are the two forms of odontome ?
Where are they most common ?
Compound - normal organisation of dental tissue, anterior maxilla.
Complex - disorganised mass, posterior mandible.
What jaw are supernumeraries more commonly found ?
Maxilla 2% incidence in permanent dentition.
What gender are supernumeraries more common in ?
Males.
What medical conditions are associated with supernumeraries ?
CLP and cleidocranial dysotosis.
What is the most common cause of failure of eruption of U1 and 10% of diastemas ?
Supernumeraries.
Also - trauma to primary dentition causing dilaceration of permanent tooth or pathology.
Congenital absence of central incisors is rare.
How should you manage early loss of A’s and B’s as a result of caries ?
Do not require compensation or balancing - rarely affect midline.
How should you manage early loss of C’s as a result of caries ?
Balance to maintain centre line, do not require compensation.
How should you manage early loss of D’s and E’s as a result of caries ?
Space maintainence, little effect on centreline and no need to balance (only if under GA).
When is the best time to extract FPMs for spontaneous closure of 5-7’s ?
Calcification of bifurcation of 7s (8-9 years old).
You have to extract a patient’s upper FPM - do you balance or compensate ?
No.
You have to extract a patient’s lower FPM - do you balance or compensate ?
Compensate and balance if crowded.
Can balance with premolar on opposite side of the arch depending on requirement of space.
What guidelines are available for management of extractions of FPMs ?
RCS (2009) Clinical Effectiveness Committee
What is the consequence of early loss of mandibular FPMs ?
Distal migration of second premolar.
What is the consequence of late loss of mandibular FPMs ?
Poor spontaneous closure, mesial tipping and lingual rolling of 7.
What is the consequence of early loss of maxillary FPMs ?
Better space closure.
Use space maintainer or delay XLA if space required for ortho.
What are the aetiological features of impacted FPMs ?
Angle of eruption, ectopic crypt, morphology of E crown, small maxilla.
What are the treatment options for managing impacted FPMs ?
Active observation - 66% disimpact.
XLA of E - regain space for premolar and treat crowding at later stage.
Disimpact - separators, band E and bracket with open coil.
Distal disking of e.
URA with finger spring.
What is the cause of infraocclusion of primary molars ?
Temporary ankylosis.
What teeth are most commonly affected by primary molar infraocclusion ?
D
What are the signs of ankylosis of a primary molar ?
Percussion note, blurring or absence of PDL on radiograph.
What two factors will influence the management of an infraoccluding primary molar ?
Presence of permanent successor and degree of infraocclusion.
What teeth are most commonly affected by hypodontia ?
Lower 5s, upper 2s, upper 5s.
How should a patient with hypodontia be managed ?
Refer as soon as possible.
Restorative treatment alone - composite build ups.
Early orthodontics to improve aesthetics - diastema.
Extraction of b’s.
Define interceptive orthodontics.
Any procedure that will reduce or eliminate severity of developing malocclusion.
How many mm diastema should close spontaneously ?
2.5mm
On intra-oral assessment of a patient with delayed eruption of central incisors - what should you check ?
Palpate labially and palatally.
Is primary mobile ?
Is primary discoloured ?
What is a balancing extraction ? What is the aim of this ?
Removal of tooth from the opposite side of the arch.
Aims to maintain position of centreline and symmetry.
What is a compensating extraction ? What is the aim of this ?
Removal of tooth in opposing quadrant.
Aims to maintain buccal occlusion.
Describe a removal space maintainer.
Adams clasp UR6 and UL6 (0.7mm HSSW).
Labial bow UR3 to UL3 (0.7mm HSSW) OR Southend clasp.
Baseplate - extend acrylic around teeth to prevent drift.
+/- mesial stop (0.6mm HSSW).
Describe a fixed space maintainer.
Band and loop.
Palatal and lingual arches.
At what age should you refer a patient if you have any doubts about the prognosis of the 6s ?
8-9 years old.
On extraction of permanent 6s, what is the most ideal occlusion for successful eruption ?
Calcification of bifurcation of 7s.
8s present.
Class 1 average/reduced OB.
Moderate lower crowding.
Mild/moderate upper crowding.
Your patient has an anterior Xbite, what should you check on oral examination ?
Mandibular displacement, mobility of lowers, toothwear, gingival recession.
What is the risk of relapse of a posterior Xbite ?
50%
What two factors will reduce the risk of relapse of a anterior Xbite ?
OB and growth.
At what age of stopping a digit sucking habit, do you have the greatest degree of spontaneous correction of malocclusion ?
9-10 years old.
When does calcification of permanent maxillary and mandibular central incisor occur ?
3-4 months.
When does calcification of permanent lateral incisors occur ?
Maxilla 1 year.
Mandible 3-4 months.
When does calcification of permanent maxillary and mandibular canine occur ?
4-5 months.
When does calcification of permanent first premolars occur ?
6 months to 2 years - maxilla before mandible.
When does calcification of permanent second premolar occur ?
2-3 years old - maxilla before mandible.
When does calcification of permanent maxillary and mandibular first molar occur ?
0-1 months.
When does calcification of permanent maxillary and mandibular second molar occur ?
2.5-3 years old.
What is the prime age for interceptive extraction of the c for an ectopic canine is ?
10-13 years old.
By what age if the dental follicle of the third molars is not present are you unlikely to have them ?
11 years old.
How long after tooth eruption should completion of root formation occur in permanent dentition ?
3 years.
How long after tooth eruption should completion of root formation occur in primary dentition ?
1.5 years.
By what age should primary dentition be fully erupted by ?
2.5-3 years old.
What is the sequence of eruption of maxillary permanent teeth ?
6 1 2 4 5 3 7 8
What is the sequence of eruption of mandibular permanent teeth ?
6 1 2 3 4 5 7 8
Between what ages is your mixed dentition phase ?
6-11 years old.
How to manage reversible pulpitis in a child ?
Restore - restoration or MCC.
How to manage irreversible pulpitis in pre-cooperative child ?
Temporise with ZOE (Odontopaste - corticosteroid and antibiotic).
If primary tooth - refer for XLA.
If permanent tooth - RCT or XLA referral for specialist.
How to manage irreversible pulpitis in cooperative child ?
If primary tooth - XLA or pulp therapy.
If permanent tooth - XLA or RCT in GP.
Temporise with ZOE (Odontopaste - corticosteroid and antibiotic) if required.
How to manage PA periodontitis or PA abscess in pre-cooperative child ?
Primary - refer for XLA.
Permanent - refer for XLA or RCT.
How to manage PA periodontitis or PA abscess in cooperative child ?
Primary - XLA or pulp therapy.
Permanent - XLA or RCT in GP.
What antibiotic can be prescribed to child for management of spreading odontogenic infection ?
PenV -
6-12 years old - 250mg 4x daily 5 days.
12+ years old - 500mg 4x daily 5 days.
What are the five components of caries prevention for low caries risk children ?
1450ppmF toothpaste - smear <3s and pea-sized amount >3s.
Fluoride varnish application 2x annually.
3 min toothbrushing OHI annually + diet advice.
FS on all molars (RMGI) once fully erupted.
Recall period - 6 monthly.
What are the five components of caries prevention for high caries risk children ?
1450ppmF toothpaste - smear <3s and pea-sized amount >3s.
Consider 2800ppmF toothpaste for over 10 years old.
Fluoride varnish application 4x annually.
3 min toothbrushing OHI and diet advice at every recall appt.
Temp GI FS on erupting teeth, RMGI on fully erupted teeth.
Recall period - 3 monthly.
What are the three contraindications for fluoride varnish application (Duraphat) ?
Severe asthma hospitalised in past 12 months.
Severe allergy hospitalised in past 12 months.
Under 2s.
When would it be appropriate to opt for non-restorative cavity control as a treatment option for a primary tooth ?
Unrestorable or asymptomatic.
Close to exfoliation.
What are contraindications for Hall technique ?
Pulpal involvement or PA radiolucency.
Why are MIH teeth more difficult to anaesthetise ?
Chronic inflammation of pulp due to presence of bacterial ingress due to poor enamel quality.
What are the six possible differential diagnoses for enamel defects ?
Fluorosis - diffuse.
Amelogenesis imperfecta - genetic, both dentitions.
Caries - clear primaries ? Unlikely.
Trauma to primary predecessor - history,
Tetracycline staining - history.
Enamel hypoplasia - localised enamel quantity defect.
What are physical signs of dental fear and anxiety ?
Breathlessness, sweating, palpitations, nausea.
What are cognitive signs of dental fear and anxiety ?
Poor concentration, hypervigilance, worry, amnesia.
What are behavioural signs of dental fear and anxiety ?
Avoidance, aggression.
What are some non-pharmalogical behaviour management techniques ?
Enhanced control - rest breaks, stop signals.
Preparatory information.
Acclimatisation - staging tx.
Positive non-verbal communication.
Role modelling.
Voice control.
Tell show do.
Positive reinforcement.
Distraction.
CBT.
Hypnosis.
What are some pharmalogical behaviour management techniques ?
Topical LA - 5% lidocaine gel.
LA - chasing technique, wand.
IV sedation with Propofol - targeted controlled infusion (anaesthetist lead.
IH sedation with nitrous oxide - titration, combined with CBT and hypnotic suggestion.
What are the preventative measures for orthodontic decal ?
Case selection, fluoridated mouthwash, personalised OHI inc ID brushes, diet advice, regular GDP visits (now HCR so 3 monthly), F varnish application.
What are the treatment options for orthodontic decal ?
Acid pumice (18% HCl) microabrasion.
Localised composite restorations if cavitated.
Composite wash or veneer.
Vital bleaching.
Porcelain veneer.
What are the three options for orthodontic retention ?
Thermoplastic retainer.
Fixed retained (HSSW bonded with composite 3-3).
URA - Adams clasp on 6s and labial bow 3-3s.
What are two acts which relate to child protection ?
Child Protection Scotland 2014.
Children & Young Peoples Act 2014.
What are the three types of vulnerable children ?
Under 5s, those with medical conditions/disabilities, irregular attenders.
Define dental neglect according to British Society of Paediatric Dentistry.
Persistent failure to meet child’s OH needs, likely to result in significant impairment of oral/general health and development.
What are signs of dental neglect ?
Repeated cancellation or FTAs to appointments.
Repeated pain on presentation.
Repeated requirement for GA.
Failure to complete tx or adhere to patient specific dental plan.
What is the first stage of handling dental neglect suspicion ?
PREVENTATIVE DENTAL TEAM MANAGEMENT
- Raise concerns with parent and offer support.
- Raise concerns with colleague.
- Set targets for parent/child for self care plan.
- Record in notes and monitor progress.
What is the second stage of handling dental neglect suspicion ?
PREVENTATIVE MULTIAGENCY MANAGEMENT
- Check if child is on child protection register.
- Liaise with school, GP, social worker, nurse.
- Common Assessment Framework used for MDT approach.
- Agree plan of action and review.
- Write letter to health visitor if FTA >5.
What is the third stage of handling dental neglect suspicion ?
CHILD PROTECTION REFERRAL
- To social services via local guidelines.
- For joint investigation OR nothing with additional support.
- Immediate harm ? Child protection order.
You have concerns regarding possible child neglect, who can you speak to for advice on how to manage the situation ?
Named person, experienced colleague, child protection adviser, social services, children’s service department.
