SDCEP Paeds Flashcards
problems with MIH molars (6)
prone to breakdown
poor quality enamel so sensitive to temp
can be painful on brushing
increased caries susceptibility
abnormal etching & bonding pattern that compromises restorative outcomes
more difficult to anaesthetise
caries risk assessment factors (7)
- clinical evidence of previous disease
- dietary habits i.e. frequency of sugar consumption
- social history esp socioeconomic status
- use of fluoride
- plaque control
- saliva
- medical history
can someone feed my overweight sausage dog
behaviour management strategies for children (8)
- communication
- enhancing control
- tell show do
- behaviour shaping & positive reinforcement
- structured time
- distraction
- relaxation
- systemic desensitisation
route map of health behaviour change using motivational interviewing
step 1 - explore current practice & attitudes using a motivational interviewing approach; develop discrepancy, roll with resistance, elicit talk change
step 2 - educational intervention; improve knowledge & skills
step 3 - action planning; set time, date, place to start
step 4 - encouraging habit formation; achieve sufficient repetition
step 5 - repeat; at each recall visit
motivational interviewing approach
SOARS
S - seek permission
O - open questions
A - affirmations
R - reflective listening
S - summarising
when to consider placing FS in GIC
- when child is pre cooperative
- when resin sealant is indicated but there are concerns about moisture control
- on a PE tooth
xla of FPM of poor prognosis at what age and why
8-10 years of age
factors influencing optimal outcome:
1. bifurcation of 2nd PM
2. 2nd premolars & 3rd molars are present
3. mild buccal segment crowding present
4. class I incisor relationship present
suitable tx for primary tooth with advanced lesion in occlusal / proximal surface
no caries removal & seal using hall technique
when is the hall technique suitable
when there is unaffected dentine between the lesion & pulp and its success is dependent on the quality of the seal; if seal fails caries will progress
benefits of the hall technique (3)
- no LA
- no tooth prep / caries removal
- no risk of iatrogenic damage
suitable tx for primary or permanent tooth with initial occlusal / proximal lesion
no caries removal and seal with FS
proximal surface using icon
alternative method for placing resin infiltration into proximal enamel lesions to stop demineralisation from progressing is to use Icon (specially designed kit) which involved isolating, etching, using ethanol to dry out the pores that have been created and then flowing unfilled low viscosity resin into the pores blocking them
tx for primary / perm anterior tooth with advanced lesion, primary posterior tooth with advanced occlusal or proximal lesion, permanent tooth with moderate occlusal / proximal lesion
selective caries removal & restoration
tx for primary tooth with single surface lesion
ART - atraumatic restorative technique
ART
may not require LA as sound dentine not removed
uses hand instrumentation i.e. excavator to prep cavity then place rest using GI
clean cavity using wet cotton pellet as 3 in 1 will overly dry dentine
high viscosity GI used as conventional has a high failure rate
tx of permanent tooth with extensive lesion in occlusal / proximal surfaces
stepwise caries removal & restoration
stepwise caries removal
used if risk of pulpal involvement
step 1 -> gain access, remove superficial caries (enough to allow effective marginal seal to be obtained with bonded adhesive restoration)
temp rest will inhibit further progression of residual caries whilst allowing reactionary dentine to be laid down
step 2 -> typically carried out 6-12mths later by accessing the cavity & restoring the tooth; increased distance of the pulp from the carious lesion reduced chance of pulpal exposure when removing all the caries & providing permanent rest
tx for primary tooth with arrested caries / unrestorable / close to exfoliation / advanced lesion but alt methods not feasible
non restorative cavity control
tx for advanced lesions in primary / permanent teeth
complete caries removal & restoration
when to do a pulpotomy of a primary molar
pulpitis with irreversible symptoms
primary molar with advanced carious lesion with no clear band of dentine visible radiographically that separates the lesion & the pulp
technique for primary molar pulpotomy
- LA & rubber dam
- large access cavity & removal of entire roof of pulp chamber
- remove contents of pulp chamber using slow speed / sharp excavator
- irrigate with water from 3in1; avoid use of compressed air which could cause surgical emphysema
- identify entrances to root canals:
- maxillary 1o molars have 3 canals (2 buccal 1 palatal)
- mandibular 1o molars have 2 canals (mesial & distal) - if still bleeding arrest via soaked CW pellet in ferric sulfate
- if cannot be arrested or canals found to be necrotic consider pulpectomy / xla
- remove CW & place MTA or similar material in pulp chamber. alternatively, ZOE cement may be placed on pulp stumps & floor of pulp chamber
- fill with ZOE cement & place PMC
tx for non vital primary and perm teeth with dental abscess or periapical / peri radicular periodontitis
local measures for control of infection i.e. incise & drain, hand excavation etc
why consider balancing xla
to minimise centreline shift & maintain symmetry of developing occlusion
consider balancing xla when (3)
- one C to be xla
- one C exfoliated prematurely due to eruption of permanent lateral incisor
- centre line shift is developing following xla of one D
to reduce discomfort of LA use (4)
- topical anaesthesia
- distraction technique
- very slow injection technique i.e. taking at least 60secs for infiltration
- intra papillary injection rather than palatal
normal healthy enamel visually
> 98% mineralised so almost transparent
caries affected enamel visually
white appearance - acidic solutions from cariogenic plaque biofilm / acid etching solution preferentially dissolve prism sheaths in enamel creating pores which refract the light reflecting it back instead of letting it pass through
if enamel layer affected lesion is matt, opaque, chalky white
anterior carious lesions visually
when using transmitted light, lesions will appear dark compared to healthy adjacent enamel due to light being blocked
if caries in dentine visually
particularly in proximal lesions
surface layer of enamel may appear unaffected & still transparent
but lesion appears opalescent white (like mother of pearl / translucent plastic)
tends to be associated with underlying infected dentine & dentinal carious lesions
EO features of down’s syndrome
epicanthic eye fold
broad flat face
short nose
flat back of head
thick unstable neck
IO features of Down’s syndrome
hypersalivation
maxillary hypoplasia
AOB
class III malocclusion
microdontia
hypodontia
high arched palate
CLP
macroglossia (difficulty in access & speech impacted sometimes)
predispositions in Down’s Syndrome
angular cheilitis - AOB & mouth breather, hypersalivation & increased infection risk
cardiac defects - ventricular septal defect
leukaemia
epilepsy
diabetes
attrition & erosive toothwear - due to bruxism, GORD & in combination with enamel defects (hypomineralisation & hypoplasia)
3 conditions associated with hypodontia
- ectodermal dysplasia
- Down’s syndrome
- CLP
- hurler’s syndrome
solutions to hypodontia
- porcelain veneer
- fixed pros
- overdenture
- RPD
- composite
problems associated with hypodontia
abnormal shape & form
spacing
submergence
deep OB
reduced LFH
aetiology of hard tissue defects
- LOCALISED -> trauma or caries then abscess of primary incisors
- GENERALISED ->
- environmental i.e. fluorosis
- hereditary i.e. childhood illness
4 types of amelogenesis imperfecta
- hypoplastic - crystals do not grow to correct length
- hypomineralised - fail to grow in thickness & width
- hypomaturational - normal length but incomplete thickness and mineralisation
- mixed with taurodontism
to diagnose AI
family hx (ask re parents & cousins)
generally affects both dentitions
affects all teeth
tooth size / structure / colour
radiographically - will see difference in enamel and dentine
problems associated with AI
poor OH
caries & acid susceptibility
sensitivity
poor aesthetics
AOB
delayed eruption
solutions for AI
preventative therapy
comp veneers / wash
FS
metal onlays
SSC
ortho
4 anomalies of dentine structure
- dentine dysplasia -> normal crown morphology, amber radiolucency, pulpal obliteration, short constricted roots
- odonotodysplasia -> localised arrest in tooth development, thin layers of enamel & dentine, large pulp chambers , ‘ghost teeth’
- systemic disturbance -> nutritional / drugs
- dentiniogenesis imperfecta -> 3 types
3 types of DI
type I = osteogenesis imperfecta
type II = autosomal dominant
Brandywine
solutions for DI
prevention
comp veneers
overdentures / onlay denture
removeable pros
SSC
radiographic & clinical signs of DI
radiographic - occult abscess formation / pulp canal obliteration / large bulbous crowns
clinical - blue sclera / amber coloured teeth / both dentitions affected / enamel loss due to poor connection at ADJ `
behaviour management (8)
communication
enhancing control
tell show do (acclimitisation)
behaviour shaping & positive reinforcement
structured time
distraction
relaxation
systematic densensitisation
what is GIRFEC
getting it right for every child
what is MIH
common developmental condition defined as hypomineralisation of systemic origin of 1-4 permanent first molars frequently associated with affected incisors
problems with MIH molars
prone to breakdown
poor quality of enamel - difficult to bond to due to abnormal etching & bonding
sensitive
painful to brush
increased caries susceptibility
clinical presentation of MIH
small, demarcated discoloured areas (white opacities) with no breakdown to large, dark (yellow / brown) areas that can # off due to weakness of hypomineralised enamel exposing underlying dentine
to determine whether teeth affected by hypomineralisation are of poor prognosis inc
- enamel colour in order of severity & increasing likelihood of breakdown white/cream, yellow/brown
- location of defects in order of severity: smooth surface, occlusal surface/incisal edge, cuspal involvement
- sensitivity from brushing or to temperature
- atypically shaped restorations
- any patient reported symptoms
SDCEP standard prevention
FOR ALL CHILDREN
1. toothbrushing advice at least x1 yearly brush thoroughly x2 daily including last thing at night
2. 1000-1500ppmF (u3 = smear & >3 = pea size)
3. spit don’t rinse
4. supervised by parent
5. at least x1 yrly reminder on diet i.e. limit sugary food and drink & remind it is the frequency of which
6. drink plain water / cow’s milk between meals
7. low sugar snacks
8. no sugary drinks / fruit juices in feeding bottles
9. free flow spout
10. after brushing at night only plain water
11. FS in pits & fissures of all permanent molars following eruption (buccal pits of lowers and palatal pits of uppers)
12. NaF 5% varnish x2 yearly to children aged 2+
enhanced prevention
for children deemed HIGH CARIES RISK
1. standard prevention toothbrushing advice at every recall visit
2. hands on brushing instruction at each recall
3. 1350-1500ppmF for up to 10yrs and 10-16yrs 2800ppmF
4. provide standard prevention diet advice at every recall
5. potential diet diary inc 1 weekend day
6. FS same as standard but also aim to seal upper lateral permanent incisors, occlusal & palatal surfaces of Ds Es FPM & SPM. if p/e use GIC / poor cooperation / moisture control concerns
7. FV - apply x4 yearly once >2yrs
8. alcohol free NaF MW for children >7yrs
note - duraphat 22,6000ppmF 0.25ml for 2-5yrs and 0.4ml for 5+yrs
no duraphat for children who have been hospitalised due to severe asthma / allergy in last 12mths or who is allergic to sticky plasters due to colophony content
8 elements of caries prevention
- radiographs
- fluoride toothpaste
- fluoride supplementation
- fissure sealants
- toothbrushing
- fluoride varnish
- diet advice
- sugar free medication
radiographs for high risk
bitewings
every 6mths
max 2 in 1 year
radiographs for low risk
bitewings
every 12-18mths children
every 2yrs adults
