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Stewart Flashcards

1
Q

Communication with children

A

Actual words, tone and non verbal

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2
Q

Positive reinforcement

A

Break everything in small steps
Give positive feedback throughout the session
Immediately after good behavior-verbal praise, positive tone modification

Ignore negative -avoid negative reinforcement

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3
Q

Tell, show do

A

Backbone of paediatric dentistry
Most useful in low anxiety pt
Tell- age appropriate explanation of the procedures, appropriate terminology
Show- demonstrate and let pt feel and touch things we will use, avoid unsheathed needs and high speed
Do-perform the action, positive reinforcement, communication techniques

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4
Q

Treatment planning in children

A

They have short attention span
Treatment to be broken down in manageable elements
Let them know what are you doing
Prevention
Acclimtisaion
Stabilisation
Reassess
Restore

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5
Q

Features of primary dentation

A

Incisor spacing
Anthropoid spaces- upper BC, lower CD
Mesio buccal cusp of upper E is in the buccal groove of lower E
Increased MID width of lower E
flush distal plane-both upper an flower Es finish at the same place

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6
Q

Leeway space

A

Permanent successors to EDC are smaller than the primary teeth
Upper arch- 1.5 mm
Lower arch- 2.5 mm
This space allows first permanent molars to drift mesially and adopt class I occlusion

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7
Q

Difference between primary and permanent teeth

A

Primary are smaller, whiter, thinner enamel, more bubous molars, wider contact points, bigger pulp to crown ratio, large pulp horns, bigger root to crown ratio, roots splayed

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8
Q

Hypodontia

A

In primary dentition- Equal in F and M, up to 1%
Permanent dentition - 3.5-6.5%, 4 times more in F than M, bigger chance is hypodontia in primary
Most common- 8,2,5
Associated with cleft, Down, ectodermal dysplasia (fine hair, dry skin, no sweat glands, perioral pigmentation, teeth small and conical and hypodontia)

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9
Q

Supernumerary

A

In primary dentition -0.2-0.8%
In permanent dentition - 1.5-3%
2 times more in male than female
5times more in maxilla than mandible
75% in upper anterior region
As ca. Be retained
Types: conical (in shape, round roots and mainly in midline), tuberculate (rarely erupt, more than one cusp, need surgical removal), supplemental(duplication of permanent tooth, most common laterals, 5s, 3rd molars), odontome( tumours of odontogenic origin, made of odontogenic tissue, can develop is other areas of the body, compound odontomes-resamble the tooth, can be diffuse mass of disorganized tissue- complex odontome)

Problems arising from supernumerary -no eruption, delayed eruption, rotation or displacement, dilaceration of the root, resorption of surrounding teethz formation of cysts)

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10
Q

Microdontia

A

Primary dentition -0.2-0.5%
Permanent dentition -2%
More in female than male
Usually upper lateral incisor
Can be linked with hypodontia
Treatment is usually crown or xla

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11
Q

Accessory cusp

A

Unknown frequency in primary dentition
Permanent dentition -10-60%
Usually on upper 1 and 2-palatal
Or D-mb cusp
E-mp cusp
Or 6-mp cusp
Treatment options:
Nil
Fissure sealants
If in occlusal interference -selective grinding or section and pulpotomy

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12
Q

Invagination (dens in dente)

A

Primary dentition -1%
Permanent dentition -1-5%
Twice more in male than female
Treatment options:
Fissure sealants, RCT, XLA

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13
Q

Tauradontism

A

Permanent molars-6% frequency
Features
Increased pulp chamber vertically
Long crown, short roots
Treatment -nil

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14
Q

MIH

A

6-60%frequency
Mainly 6s and 1s

Treatment -
Incisors- microabrasion and composite
6s-Seal/ PMC/onlays or XLA

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15
Q

Fluorosis

A

Due to high F- in water (more than 1-2 ppm) or F- ingestion
Presentation- mottling and hypoplasia
Treatment - nil or microabrasion

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16
Q

Amelogenesis imperfecta

A

Genetic origin
Affects both primary and permanent dentition
1:14000 prevelance
Different types -hypoplastic, hypomineralised or mixed

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17
Q

Dentinogenesis imperfecta

A

Genetic origin alone or in association with osteogenesis imperfecta
1:18 000 prevelance
Presentation- blue/gray enamel, enamel loss, dentine attrition, pulp exposure

On radiographs- bulbous crowns, short thin roots, large pulps

Treatment options -PMC or XLA

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18
Q

Premature eruption

A

Natal teeth-present at birth
Neo natal- erupt in first month of life
Treatment -leave and reassure/if risk of inhalation-XLA

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19
Q

Reasons for delayed eruption

A

Supernumerary
Dilaceration
Cyst
Impaction
Premature loss of primary precursor
Downs syndrome
Endocrine
Treatment

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20
Q

Infra occluded primary molars

A

Often associated with missing primary premolars
Primary molars ankylose and fail to alter position

If successor is present- leave to exfoliate
If no permanent successor-composite onlay

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21
Q

National dental inspection programme

A

In P1 and P7 (5,12 years)
They will check dmft as well

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22
Q

Care index in paeds

A

The care index is a measure of the percentage of decay that has been treated

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23
Q

SIMD-

A

Scottish index of multiple deprivation
1-most deproved
5-least deprived

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24
Q

Benefits of diagnosing early caries

A

First-prevention is key (standard and enhanced)
To arrest the caries and to have smaller restorations

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25
Visual diagnosis
Lighting Clean and dry Exam all surfaces Probe-not pits and fissures Remove debris only Record ICDAS
26
ICDAS caries codes
0 sound 1 first visual changes in enamel 2 distinct visual change in ename 3 enamel breakdown, no dentine visible 4 underlying dental shadow (not cavitated in dentine) 5 distinct cavity with visible dentine 6 extensive distinct cavity with visible dentine
27
Frequently of radiographs
High caries risk in both dentition-6-12 months Low caries risk in primary dentition -every 12-18 months Low caries in permanent dentition -every 24 months
28
Caries risk assessment
Depends on- Siblings caries Dietary habits Brushing habits SIMD It should include prevention regime, radiograph review and recall period
29
4elements of prevention
TB with F- toothpaste Diet advice Fissure sealants Topical fluoride
30
Standard prevention
Twice a day for 2 min Am and pm Nil after pm brushing Toothpaste-under age of 3-smear of 1000-1500 ppm Above 3years.old-pea size (1450-1500 ppm) Spit don't rinse Parent brushing until 7years old, then supervision Small headed brush and soft Circular movement Topical fluoride - twice a year (2+years olds) 22600 ppmF 2-5 y old- o.25 ml Above 5-0.4 ml Duraphat has colophony- can exacerbate asthma and plaster allergy (Teeth need to be isolated and dried, no food for 30 min, no brushing for 2 h)
31
Enhanced prevention
Hands on advice Disclosing (at surgery and at home) Toothbrushing charts Free brush and paste Flossing Toothpaste Less than 3 y -1450-1500 ppm smear 3-6 y- 1450-1500 pea Above 6-same but can also go higher 3 day diet diary-2 week and one weekend day Topical fluoride - 4 times a year Alcohol free mouthwash in 7+ age, at a separate time from brushing! Fissure sealants- if there is a caries in primary dentition; if deep pits /fissures present; if any enamel defects. Usually 6s,7s or Es Fissure sealants can be used as a good acclimatised for forther treatment
32
Different caries removal options
Complete caries removal Partial caries removal No caries removal -hall, seal or prevention/self-clensing Xla
33
What to consider when deciding on the option to restore
Extent, site and activity of the lesion Time to exfoliation Co operation-both child and carer Your abilities as practicioner
34
4 outcomes with tooth restorability
Manage caries-restore Prevention and review Pulpal therapy XLA
35
Active disease management
It is unethical to leave active caries or abscess We can leave asymptomatic abscess or active caries for up to 3 months until the child is being acclimatised
36
Complete caries removal na restore
Pros-evidence based, best results Cons- difficults-LA, isolation, use rotary instruments, need level of co operation- unpredictable, time consuming, high pulp exposure risk due to large pulp horns
37
Partial caries removal
Removal of the worst soft caries first and then removing caries around the margins Pros- evidence based, no need for LA, reduced prep time, reduced risk of pulp exposure Cons-marginal seal needs to be effective Monitoring and record keeping essential Gic- only class I, so only single surface If multisurface-composite (amalgam no longer permitted) Need good moisture control as seal is crucial Monitor with radiograph Inform and document
38
No caries removal and seal
Pros-no LA, no prep Cons-weak evidence,quality of seal or caries progression is questionable In pre complaint PT this is advisable Remove the debris and clean it GIC on one finger, and then vaseline on other. Monitor and inform and document This technique used to temporarily halt the spread of the caries or minimalise reversible pulpitis or sensitivity
39
Hall PMC
Pros: no LA, no prep, no iatrogenic damage Cons: partial fitting/leakage, aesthetics No caries removal and seal by the crown 1. Assess the tooth shape, contact point,assess marginal ridge breakdown occlusion (measure OB prior to PMC placement and after) 2. Radiographs 3. Airway protection- PT sitting upright and gauze placed 4. PMC selection (smallest PMC, need spring back, do not fully seat on try in, try lingual to buccal 5. Crown loading with cement (3/4 full, bad taste, GIC luting cement-runnyy mix, 1 scoop powder:2 scoops liquid) 6. Crown fit and seating (place lingual to buccalz apply pressure with a thumb, then PT bites on dry cotton roll 7. Wipe down excess cement with damp cotton roll 8. Final seal and check (cotton roll biting for 2-3 roll, check occlusion and contact points with the floss) If same arch needs more than one PMC-can fit on same appointments If opposing teeth-leave 2-3 months between PT preparation- explain how it will look, feel high, taste of cement, practice biting on cotton roll
40
No caries removal and prevention
Pros- no prep, no LA etc Cons- limited evidence based, depends on habits and shape of cavities Need enhanced prevention-reduced sugar consumption, improved OH, change of oral environment so active caries becomes arrested Regular check ups and documentation Diet diary as it is enhanced prevention
41
Pulpal pain
Managing pain should be a priority If pulpal involvement -pulpal therapy or XLA (not recommended at the first visit) Refer for GA/IHS- if pre cooperative, if very young or with multiple abscess or have additional needs Pain can be coming due to reversible or irreversible pulpitis or dental abscess
42
Reversible pulpitis
Sharp pain, transient, pain on stimulus-hot and cold, sweet. Resolves when stimulus is removed. Pain is not localised/hard to localise and tooth is not TTP Management - caries removal and sedative dressing placed (eg. Zinc oxide eugenol) and then replace at next visit with permanent restoration. Review and record.
43
Irreversible pulpitis
Throbbing pain Spontaneous Can be intermittent or continuous-lingers Easy to localise Pain on hot, cold as well but spontaneous Disturbs sleep Management - if co-opetative- do pulpal therapy or XLA, or steroid/antibiotic dressing (Ledermix, Odontopaste) plus analgesia and pulpal therapy If pre cooperative -odontopaste and analgesia and consider referral for HA/IHS
44
Dental abscess
Severe pain, disturbs sleep, TTP, mobile, swelling, malaise On X ray- widening of PDL and radicular radiolucency Vitality in molars are non reliable Management - if co operative- pulp therapy, or XLA Pre cooperative - analgesia, antibiotics, referral
45
Pulpotomy
Removal of inflamed coronal pulp and retention of healthy radicular pulp tissue Pulpotomy would be a choice if we created vital exposure or tooth has early irreversible pulpitis, traumatic exposure, various exposure Contraindications -close to exfoliation, unreasonable, multiple pulp treatment, pre cooperation
46
Pulpectomy
Removal of irreversibly inflamed coronal and radicular pulp, needs to be obturated with resorbable material (non setting CaOH) and tooth willed with zinc oxide eugenol Indications: irreversible pulpitis, dental abscess Contra indications: close to exfoliation, unrestorable, multiple pulp treatments , pre co operative Every primary molar that has pulp therapy needs to be restored with PMC- gives best seal and best chance of success
47
What can supernumerary teeth cause?
Prevent eruption, displace or rotate teeth above them, dilaceration of roots, resorption of surrounding teeth, develop cyst
48
Factors to consider in caries management
Time to exfoliation, site and extent of the lesion, the risk of pain/infection, absence/presence of infection, number of teeth affected, preservation of tooth structure, avoidance of treatment-induced anxiety
49
Assessment of a child need to include:
Parent motivation and responsibility Patient history Clinical examination Caries risk assessment
50
Fluorosis and severity causing enamel defects depends on
Concentration of fluorides period of using it/consuming and the age of the patient
51
Common complications following the dental trauma?
Pulpal necrosis Resorption Ankylosis Canal obliteration Discolouration Pulpal concussion
52
Splinting times
Subluxation- 2 weeks Lateral luxation - 4 weeks Intrusion- 4 weeks Extrusion-2 weeks Avulsion-2 weeks Root fracture- 4-4 months D-A fracture- 4 weeks All are flexible splints
53
Pulpal necrosis in trauma
Diagnosis is important Causation -take history Know the indications Necrosis diagnosed if: Colour change No response to EPT after 3 months Swelling Radiographically periapical radiolucency
54
Observations/tests needed if suspecting trauma
Percussion Tenderness Percussion note Transillumination Examination of soft tissues Mobility
55
Sensibility Vs sensitivity Vs vitality
Pulp sensibility - assessment of the pulps sensory response Sensibility - ability to respond to stimulus- thermal, EPT- they do not detect /measure blood supply to the dental pulp E.g. ethyl chloride soaked cotton pledget on the dry tooth and check response-normal, no response or ++response EPT- dry tooth, tip of EPC to have toothpaste and hold on the tooth- pt to say when can they feel and document the reading Sensitivity - condition of the pulp being very responsive to a stimulus
56
Resorption due to trauma
Happening as there is reaction of the osteoclasts to a stimulus Can happen due to trauma to PDL, bacteria, trauma to the pulp
57
Resorption types
Internal External inflammatory External cervical External replacement
58
Ankylosis
Follows PDL injury Can be due to extra long dry time following the trauma; due to intrusion injury Diagnosis made depending on: -P note - radiograph evidence of loss of PDL
59
Canal obliteration
Due to pulpal repair and deposition of hard tissue in the canal causing yellow teeth 25% of traumatized incisors develop pulp canal obliteration 75% of these remain symptom free RCT can be very difficult
60
Discolouration
Can be caused by: Medicaments from RCT Degraded pulp tissue on dentinal tubules Pulpal obliteration Treatment: Composite masking Veneers Bleaching
61
Concussion
Need vitality testing EPT At least 2 separate signs of pulpal necrosis for diagnosis - reliability problem
62
Transient apical breakdown
Colour change Loss of vitality TTP If open apex monitor for: return of colour, return of vitality, healing of apical area
63
Conscious sedation
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out but during which verbal contact with the pt is maintained throughout the period of sedation. PT is conscious and co operative, protective reflexes are intact Risk is very low Available in primary care environment Dental operators can perform sedation May be ineffective in some pt May be used freely on multiple occasions Gives opportunity to provide timely and more constructive dental care
64
Conscious sedation idications
Learning difficulty Involuntary movements Medically compromised with increased GA risk Exaggerated gag reflex Unusual traumatic procedure Released financing/failed LA Anxiety Needle phobia Excessive gag reflex Liver/kidney disease or preclusion to benzodiazapime
65
Medical nitrous oxide
Colourless gas's Pleasant sweet smell Weak anaesthetic agent Analgesic properties Minimal depression effect on respiration and myocardium Presented in blue cylinders 30% oxygen is minimum!
66
Why is nitrous oxide good sedation agent?
Smooth induction Titrated easily Rapid induction/recovery Non pungent, non irritant Low blood gas solubility Relatively wide margin between sedative and anaesthetic dose Analgesic properties No needles Wide age spread Easily discontinued Level of sedation maintained Administration and excretion through lungs-no metabolic demands It does not enter the blood stream so it wears off quickly
67
Disadvantages of nitrous oxide
Lack of petency- needs psychological reassurance Nasal hood may not be tolerated Bulky equipment and scavenging needed Clear nasal airway needed Chronic exposure/abuse Relative amount of pt compliance required Can be occupational health hazard- active scavenging and ventilation needed when in use! Implication in bone marrow depression Love, renal, neurological disease Carcinoma of cervix
68
Contraindications for conscious sedation
Nasal obstruction PT un-cooperative to whole dental environment 1st trimester pregnancy Pt with some psychiatric disorders Inability to communicate to provide necessary reassurance due to age or understanding

PAEDIATRIC DENTISTRY (3 decks)

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