Theme 6- Paediatric dentistry Flashcards
1
Q
What are pit and fissure sealants ?
A
materials which obliterate pits and fissures to remove the sheltered environment that careis can thrive in
2
Q
What do fissure sealants do ?
A
remove anatomical plaque retentive areas
3
Q
Where do F/S have the greatest benefit ?
A
the occlusal surfaces of 6s and 7s
4
Q
Which teeth are suitable for a F/S ?
A
recently erupted crowns
no evidence of caries into dentine
caries free
5
Q
If there is occlusal caries in one 6 what should we do ?
A
seal all the 6s
6
Q
What should we do if there is caries in more than one 6?
A
seal the 7s when they erupt
7
Q
In which types of teeth are F/S useful ?
A
hypominerlaised
hypoplastic teeth
8
Q
How far should a F/S extend ?
A
buccal pits
palatal pits
cingulum pits of incisors
if necessary
9
Q
What are the pillars of prevention ?
A
diet control OHI F/S regular recall Fluoride
10
Q
When is the active caries age range ?
A
5-15 years
11
Q
In which patients would you place a F/S ?
A
medically physically mentally compromised socially disadvantaged previous caries experience in the primary dentition anatomically deep pits and fissures poor dietary control and OH
12
Q
What are the 2 types of sealant materials?
A
Bis-GMA resin
GIC
13
Q
How is Bis-GMA resin used as a F/S ?
A
its the gold standard and preferred choice good retention can be autopolymerising or light cured opaque or clear technique sensitive placement
14
Q
What is required for an effective resin F/S ?
A
good isolation and moisture control
15
Q
How is GIC used as a F/S ?
A
2nd choice used in anxious/uncooperative patient cant get adequate moisture control or if its a partially erupted tooth poor retention fluoride releasing can be self cure or light cured
16
Q
What is the main cause of F/S failure ?
A
salivary contamination
saliva can remineralise the etched enamel so the resin isn’t retained well
17
Q
Why do we need to isolate teeth for a F/S ?
A
protect the patient from the acid etch
18
Q
What is the equipment for a moisuture control ?
A
cotton wool rolls saliva ejector aspirator dry tips rubber dam
19
Q
How do you use a dry tip ?
A
point backwards
rough absorbent surface goes onto the mucosa
place over the opening of the parotid duct– opp the maxillary 6/7
20
Q
Give the steps for the placement of a resin based fissure sealant ?
A
- prophylaxis- clean any plaque with dry brush
- isolation and moisture control
- etch for 15 secs
- wash for 15 secs
- dry for 15 secs- reveal frosty appearance
- replace any cotton wools if needed
- place resin into fissures with pear shaped burnished up to one third of the cusp height
- Cure for 20 secs
- Evaluate
21
Q
Are sealants permenant ?
A
no they can be lost need to monitor loose bulk annually a partial loss can allow bacteria to ingress need to top up or replace
22
Q
How do you place a GIC F/S ?
A
Clean tooth isolate apply GIC self cure (4/5 mins)with green wax or light cure apply fluoride varnish on top
don’t need to etch
23
Q
Can you use a bonding resin with Fissure sealants ?
A
yes - it will aid bond strenght
advantageous as you don’t need to apply the bonding resin to a dry surface- can use if you cant get adequate moisture control
recommended for hypominerlised or hypolastic teeth
24
Q
What are the options for pit and fissure caries ?
A
leave and monitor enamel biopsy seal and monitor PRR conventional class I restoration
25
What is an enamel biopsy ?
a small dubious investigative pit into enamel with a half small stainless steel bur held perpendicular to 1mm
26
WHat shoudl you do after an enamel biopsy ?
if non carious- F/S
if caries confined to enamel- F/S and monitor
if caries into dentine- PRR
27
What is a preventive resin restoration ?
```
a restoration that is confined to the pits and fissures and does not involve cusps (if cusps are involved- conventional class I restoration)
must remove caries before hand, bond, composite then FS on top
```
28
Describe the method for a PRR ?
```
once caries free
etch
wash
dry
bond and air dry
cure
composite and cure
seal with FS
cure for 40 secs
check for occlusion problems
```
29
What is the stabilisation approach for treatment?
minimal tissue removal
application of a temporary dressing - reduce bacterial load and stops caries progression
allows time for implementation of prevention and acclimitisation
30
Why is recall faster in children compared to adults ?
faster caries progression
faster erosive wear
detection of occlusion
31
Which radiographs would you use for caries diagnosis ?
bitewings
| lateral oblique radiograph- if they cant tolerate intraoral films
32
What should you consider in treatment planning ?
stage and activity of caries
progression to dentine ?
pulp status- necrotic or pulpitis ?
successor ?
33
In comparison to permenant teeth primary teeth are ?
```
primary teeth are
thinner enamel and whiter enamel- can enter dentine easily
higher pulp horns
more bulbous teeth
molar roots are divergent
underlying successor
broader contact points- more interproximal caries
narrow and twisted root canals
```
34
What does loss of the marginal ridge in primary molars due to Caries indicate ?
pulpal involvement
35
Is amalgam used in primary dentition ?
contra indicated in under 15 years
36
When are stainless steel crowns indicated ?
when 2 or more surfaces on a primary molar are carious
hypomineralised/hypoplastic teeth
grossly carious 6
37
What are the characteristics of GIC ?
```
needs a dry field to apply
fluoride releasing
no etching needed
no polymerisation shrinkage
seen as a stabilisation material
```
38
When is GIC use not recommended ?
proximal cavities in primary molars
39
What are Resin modified GIC ?
resin system added to GIC allows it to set with LCU or chemically
Acid/base reaction still happens
Can use as fissure sealants
40
What is compomer ?
```
poly acid modified composite resin
high resin component
no acid/base reaction
needs etch and bonding
premixed in capsules
```
41
GIC RMGIC Compomer composite ...
```
fluoride release decreases
strength increases
ease of placement decreases
polymerisation shrinkage increases
decreasing roughness
increasing roughness
```
42
Why is pit and fissure caries not as problematic in the primary dentition ?
pits and fissures are shallower- less susceptible to decay
43
What does presence of pit and fissure caries in a priamary molar indicate ?
high carious activity
44
How would you manage pit and fissure caries ?
use a small stainless steel bur in a high speed
drill to depth of 1..-1.5mm
ensure big enough to pack material
if needed follow the fissures to remove caries
45
What are buccal or labial lesions a result of ?
nursing bottle caries
C to C
crescent shaped
46
How would you tackle buccal or labial lesions -prep?
```
direct access
high speed diamond or slow speed steel
work perpendicular
remove soft caries wth slow handpiece
join any small cavities
```
47
What is the preferred method for treating approximal caries without pit and fissure caries ?
PFMC but might not be possible so need to prep as normal approximal caries
48
How would you tackle approximal caries ?
use pear shaped bur
perpendicular for 1mm keeping enamel slither
extend Bucco lingually
make U shaped box
clear contact points by removal of slither
restore with matrix and wedge and composite
49
How do you deal with approximal caries with pit and fissure caries ?
small diamoond bur along the fissures- follow the caries
tackle approximal- keep enamel slither and deepen 1-2mm
create step between approxomal floor and fissure floor
removal of slither
90 degree carvo surface angles
round angles
restore with composites
50
What is the longevity of primary molar restorations ?
8-9 years
51
What does the longevity of a restoration depend on ?
material used- might be more user friendly as long lasting retention not needed
retention affected by compliance- was it easy to place ?
was there adequate isolation and moisture control ?
52
When are children most accident prone ?
2-4 yrs for the priamry dentition
| 7-10 yrs for the permanent dentistion
53
What are common methods of incisor fracture ?
```
playground accidents
contact sports
bicycles
road traffic accidents
assaults
child abuse- NAI
```
54
What is the main concern with fracturing primary incisors ?
damage to the tooth germ of the 1
55
What do mouth guards do and why are they problematic ?
mouth guards dissipate force only
| problematic as often used during time of the mixed dentition so they don't fit permanently
56
Where is the first permenant tooth germ located ?
palatally and apically to the A
57
What is the role of overjet in trauma ?
increased overjet with protruding maxillary incisors can predispose to traumatic dental injuries
58
What is another predisposing factor to traumatic dental injuries ?
insufficient lip closure
59
What should the dental history comprise of when treating dental injuries?
when- this can effect prognosis
where- might need tetanus prophylaxis
how- might give clues about injury or might indicate NAI
lost fragments ?- if loss of consciousness was it inhaled ? might be stuck in laceration
medical complications- loss of consciousness will take priority, headache, vomiting and amensia - need to rule out brain injury
previous traumatic injuries- pulp recuperative ability
60
What are the contraindications for endodontic treatment in a traumatic dental injury ?
congenital heart disease
history of rheumatic fever
severe immunosupression
there is a risk of bacterial endocarditis
61
What aspects of medical history should we take into account when considering treatment of injuries ?
bleeding disorders
penicillin allergies
tetanus immunisation status- if soil contamination or no booster
62
What should we look for in an extra oral examination of a traumatic dental injury ?
signs of shock- pallor, cold skin, hypotension, irregular pulse
facial swelling, lacerations and bruising
limited mandibular movement or deviation of the mandible
swollen lips - might be holding fragments
63
What should we look for in an intra oral examination of a traumatic dental injury ?
lacerations- for tongue and lips might need to suture, lacerations of the oral mucosa heal very quickly
haemorrhage
swelling
occlusion problems, tooth displacement, fractures
64
What is avulsion ?
complete displacement of the tooth from its socket in the alveolar bone
65
What should we do in the case of an avulsion ?
reimplantation of incisors not recommended as it can damage the 1 tooth term
space maintenance not needed there is minor dirfiting
eruption of the 1 might be delayed for year
66
What is an enamel infarction ?
crack in the enamel that involves no loss of tooth substance
67
What is an enamel fracture ?
loss of tooth substance confined to enamel
68
What is an enamel/dentine fracture ?
loss of enamel and dnetine
| no pulpal exposure
69
What is a complicated crown fracture ?
fracture of the enamel/dentine and pulpal exposure
70
What is an uncomplicated crown-root fracture ?
fracture involving enamel/dentine and cementum
71
What is a root fracture ?
fracture involving dentine, cementum and pulp
| classified as - mid third, apical third or coronal third
72
What can happen when dentine is exposed ?
can lead to hypersensitivity
73
What is a subluxation ?
abnormal loosening of the teeth with no displacement
74
How is a subluxation indicated and treated ?
indicated by gingival bleeding
mobility tests
advice soft diet for 1-2 weeks
if marked mobility- extra
75
How do you treat an uncomplicated crown fracture ?
remove sharp edges
| if compliant enough- composite restoration
76
How do you treat a complicated crown fracture ?
extraction usually
treatment of the pulp with calcium hydroxide/zinc oxide
and restoration might be possible
77
What is extrusion ?
a partial avulsion
| partial displacmeent of a tooth out of its socket
78
how do we deal with an extrusion ?
extraction
79
What is an intrusuion ?
displacement of the tooth into the alveolar bone
| accompanied by comminution or fracture of alveoalr socket
80
What is the most common type of traumatic dental injury ?
intrusion
81
How do we manage an intrusion ?
first need to determine the direction of the intrusion radiographically
if displaced palatally - can risk damage to the tooth germ of the 1- extract
if intruded bucally- review
82
What is the prognosis of an intrusion ?
re eruption is likely with 6 months
| if no eruption- possibly ankylosed- need to extract to allow eruption of the 1
83
What are the possible injuries to the alveolar bone ?
comminution of mandibular/maxillary wall of socket
fracture of mandibular/maxillary socket wall- buccal or palatal/lingual
fracture of maxillary process
fracture of mandible/maxilla
84
What are the aims of trating fractured incisors ?
promote normal development
aesthetics
maintain space
to protect pulp vitality
85
What is the method for treating fractured incisors ?
```
cellulose crown
treat pulp wit calcium hydroxide
choose the correct crown based on M-D width
cut the collar of the crown
place escape holes in the M and D edges
etch, wash and dry
bond on labial and palatal surfaces entirely
airdry and cure
place composite in crown
seat crown firmly
polymerise all surfaces for total of 40-50 secs
remove crown and polish
```
86
How does caries spread to the pulp ?
pulp horns
coronal pulp
radicualr pulp
87
Which produces more widespread inflammation ?
proximal caries compared to occlusal caries produces more widespread inflammation
88
Is marginal ridge collapse a sign of pulpal inflammation ?
originally marginal ridge collapse was thought to indicate irreversible pulpitis
now it is known that extensive inflammation is present even before marginal ridge collapse
89
What are the aims and indications for a pulpotemy ?
maintain an intact arch
extraction is medically contraindicated - eg.bleeding disorder
wanting to avoid the psychological trauma associated with extraction
space maintenance
no successor
crown is restorable and good seal can be made
90
What are the contraindications for a pulpotemy ?
poor cooperation with child/parents
acute infection
neglected dentition that needs 3 or more pulpotemies
child is immunocompromised/ risk of infective endocaridits
unrestorable crown- cant get good seal
internal root resorptiob
near to exfoliation
91
What are the types of vital pulp therapy ?
indirect pulp cap
direct pulp cap- not done in the primary dentition due to poor success rates
pulpotemy
vital pulpectomy
92
What is indirect pulp therapy ?
similar to stepwise excavation in permanent teeth
excavate most carious dentine and leave small amount of carious dentine at the base
apply calcium hydroxide to kill bacteria and encourage tertiary dentine deposition
leave and re enter several weeks later - should be sufficient tertiary dentine- can remove the remaining carious dentine now without risking a pulp exposure
sealed with PFMC
93
What is problematic about the indirect pulp cap method ?
not preferred for reversible/irreversible pulpitis- need to remove the pulp
94
What is a single visit pulpotemy ?
removal of the inflamed coronal pulp leaving the radicualr pulp
medicament placed on the radicular pulp to encourage healing
95
Is a pulpotemy indicated with irreversible pulpitis ?
no- you need a vital pulpectomy
96
Is a pulpotemy indicated when there is internal root resorption ?
no extraction or vital pulpectomy
97
How do you assess radicular pulp status after coronal pulp amputation ?
if the bleeding can be arrested with 1/2 applications of ferric sulphate- then reversibly inflamed/normal radicular pulp
if the bleeding is not arrested after 2 applications- radicualr pulp is irreversibly inflamed- consider vital pulpectomy or extraction
98
What happens when pulpotemy is carried out on a irreversibly inflamed radicular pulp ?
internal root resorption
99
Why was formocresol used as the haemostatic agent in pulpotemies ?
protein binding- tissue fixative
| bacteriostatic- heal the radicualr pulp
100
Why is formocresol no longer used in the UK ?
contains formeldahyde which is a arcinogenic vapour
local skin burns
concerns about tooth germ, PDL and bone
101
What are the alternatives to formocresol ?
ferric sulphate- common
| MTA- expensive
102
What is ferric sulphate used for ?
Gold standard for application to radicualr pulp in pulpotemy
103
What does ferric sulphate do ?
it is a haemostatic agent -
| makes a ferric- protein ion complex on contact with blood which mechanically seals blood vessels
104
How is ferric sulphate applied ?
sterile cotton wool or burnisher
15.5% solution applied for 15 secs
2nd application is possible
105
How is the coronal pulp amuptated ?
hand excavators
106
How do you build up the pulp in a pulpotemy ?
zinc oxide eugenol cemtn
| condensed into cavity after arrested bleeding
107
How is the coronal pulp sealed in a pulpotemy ?
preferred choice is a PFMC
108
Describe the method for a single visit pulpotemy ?
apply topical LA- inform
Apply LA
apply rubber dam
remove the caries with diamond bur
unroof pulp chamber with endo z bur non end cutting
you will feel a dip- now move sideways to fully unroof
amputate the coronal pulp with excavators till the canal orifices are visible
arrest bleeding with ferric sulphate cotton wool
fill chmaber with zinc oxide eugenol- condense well
restore with PFMC
109
Clinically, how should patients present after a pulpotemy ?
no symptoms- pain etc
absence of abscesses or drainage sinus tract
no mobility or tenderness
retention of the tooth till natural exfoliation
110
Radiogrpahically, how should a pulpotemy patient present ?
no evidence of bone loss in furcatio region
| no internal root resorption - if detected it is chronic inflammation - treat as irreversible pulpitis
111
What are the common endodontic symptoms in a primary tooth ?
furcation radiolucnecy- not a periapicla radiolucency
| root resorption
112
What is a PFMC made of ?
stainless steel
113
What are in PFMC you need to be aware of ?
nickel and chromium
114
When should you not use a PFMC ?
in the case of a nickel allergy and MRI
115
What is significant about the cervical regions of a PFMC ?
the are wor hardned and fit into the gingival sulcus
116
Are PFMC effective ?
they are superior to and last longer than amalgam restorations
they don'tneed to be replaced
117
What are the indications for a PFMC ?
restoration of teeth with 3 or more carious surfaces
large carious lesions
restorative care is usually under GA or sedation
restoration following vital pulp therapy - pulpotemy
restoration of teeth with developmental defects- primary or permanent, hypomineralosation, hypoplasia, amelogenesis imperfecta, dentinogenesis imperfecta
fractured Ds or Es
bruxism patients
support for space maintenance
children with rampant caries
118
What are the contraindications for a PFMC ?
MRi or nickel allergy
poor compliance
neglected dentition and extensive caries
tooth has completed more than 2/3 root resorption - close to exfoliation
untreated root pathology like a furcation radiolucency
119
What are the aims for a PFMC ?
restore occlusal height
restore function
reduce sensitivity and prevent further carious attack
120
What is the technique for PFMC tooth preparation?
OAP technique
| occlusal, approximal and peripheral technique
121
What must you do before PFMC tooth preparation ?
adminster topical and LA
however if non vital tooth probs only need topical LA for the gingival trauma
rubber dam and remove caries
122
What do you do in the occlusal reduction ?
use a flame shaped diamond bur- the side of it
remove 1-1.5 mm
follow the cuspal inclines and maintain them
use sweeping motion from MR to MR
after should have occlusal clearance
123
What is the approximal reduction ?
using the fine point tapered bur at a 10-15 degree angulation
start superficially and sweep bucco-lingually
you will end up more gingivally and clear the contact points
if done correctly there will be gingival bleeding
check clearance with probe
124
What is the peripheral reduction ?
using the flat surface of the tapered bur create a bevel on the buccal and lingual/palatal margins- do not touch the actual surface
this will increase the surface area of the occlusal table
125
How do you choose a pfmc ?
Measure the MD width using a peridontal probe
126
What must you ensure when crowning an E ?
ensure it doesnt encroach on the space of the 6 distally
127
How does a PFMC fit ?
when placed linguo-bucally
it should engage the cervical undercuts
and snap
sit within the gingival sulcus
Marginal ridges of adjacent teeth are confluent
not higher than the adjacent teeth and no anterior open bite
128
What should you do if the crown sits on the sulcus and not within ?
crimp the crown margins
129
What should you do in the case of gingival blanching with a PFMC fit ?
trim the margins
straight for the MD margin
contoured for the LB margin
use the BB scissors to cut cresecent shape in the mesial/distal walls and then recontour
and then polish with soflex disc to smooth
130
Where is the buccal label placed on a crown ?
on the bucal surface
131
How do you cement a PFMC ?
mix GIC- need 3/4 scoops of powder and ratio of liquid to powder is 2:1
place into crown fitting surface with flat plastic
leave any excess GIC- let it set then floss away
