tys shen ti Flashcards
patient is considered to be moderate risk for caries by virtue of MH - trisomy 21, VSD, epilepsy, GDD
what is the rationale for this risk assessment
- poor OH
- poor diet control
factors:
1) caregiver
- oral neglect: dental care is low priority
- poor diet control: tend to use sweets as rewards
- lack of OH knowledge
2) GDD
- cannot OH
3) meds
- chronic paeds meds are often in the form of sweetened syrups
4) habits
- diet: food pouching
- oral: self injurious behaviour like picking of gums
5) oral hypersensitivity
- cannot tolerate toothbursh in mouth
6) dental manifestations
- malocclusion and anomlies: crowding makes OH difficult
what further qns would you wanna ask about down syndrome kid before starting examination
1) severity of mental retardation
- what is the level of cooperation: behaviour management strat
- is he prone to violence/ self injury -> may require restraint
2) heart condition
- may need ab prophy
3) taking any meds?
- cariogenic meds might be taken between meals
4) dental hx
- OH practices? so we know what to reinforce
5) diet?
- frequency and amount of sugar consumed
- tendency to use sweets as reward
- pouching habits?
6) damaging oral habits?
what circumstances will severe perio disease occur in childhood
SYSTEMIC RISK FACTORS ASSC W GINGIVAL MANIFESTATIONS
1) hormones - increased progesterone, estrogen will lead to increased permeability of gingival exudate and altered plaque composition. so onset of puberty might have gingi
2) drugs
- anticonvulsants, immunosuppressants, nifedipine will all give DIGO
3) HIV
- reduction in T helper cells adversely affects immune functioning. will have band of intense marginal gingival erythema
4) leukemia (AML, ALL)
- leukemic infiltrate will give gingival swelling
SYS RISK FACTROS ASSC W PERIO
1) Type I DM
- diabeters causing perio
GENETIC CONDITIONS
1) leukocyte disorders
- neutropenia
2) Papillon lefevre syndrome
- severe perio can start as early as age 2-3
3) downs syndrome
- ct disorder
- immunodeficiency
4) ehler danlos
- collagen disorder
what clinical and radiographic findings will you need to make a decision whether atooth with large cavity needs pulpot, pulpect, exo
1) MH
- any contra for exo?
2) DH of child - is he cooperative to tx
- if very very uncooperative, just one time exo instead of bringing for pulpot then if it fails have to pulpect or exo anyway
3) signs and symptoms (PAIN HX)
- to see if irreversible then likely need pulpect
4) clinically, i/o, is the tooth restorable? enough tooth structure left?
5) i/o - how is the OH, if need exo, is it possible to put a space maintainer
also if very severe gingival inflammation, SSC may worsen the prio condition so might choose to exo
RADIOGRAPHIC
- is there PA involvement - but can still heal if pulpect? so wont really affect our tx choice?
- check that the successor is present because if not then we are likely to save this tooth as long s possible
- see if there are pathological changes like external or internal root resorption, pulp calcifications
when parent wants to leave carious tooth alone since its a baby tooth. discuss pros and cons
pros:
- no cost, no extensive tx
- can leave in temporarily as space maintainer
cons:
- active source of infection, might incite pain in the future then end up having to exo and space loss, might affect permanent dentition in the future
MOST IMPORTANTLY:
TURNERS TOOTH: damage to perm successor, or if the primary tooth has pathological root resorption, it can impede eruption of permanent successor bc the primary tooth becomes ankylosed
3 medicaments used for primary tooth pulpot and what is their moa
1) 1/5 dilution of formocresol solution
- works by TISSUE FIXATION
concerns with tissue toxicity, mutagenecity
2) ferric sulphate
- achieves mechanical hemostasis by sealing cut blood vessels in pulp VIA FERRIC ION COMPLEX
3) MTA
- stimulate HARD TISSUE FORMATION via cytokine release from pulp fibroblsats
- biocompatible, promotes tissue healing
what sort of preventive advice would you give (in general)
1) OH
- twice daily brushing
- parents supervise for some younger kids
2) diet conselling
- diet diary
- limit to 5 meal moments a day
- choose less cariogenic snacks
3) fluoride exposure
- switch toothpaste
- 6 monthly fluoride varnish
4) recalls
causes of discoloration of teeth
EXTRINSIC
- stains from iron rich foods like spinach, broccoli
- chromogenic bacteria
- bile pigments in jaundice
INTRINSIC (localised)
- developmental defects eg MIH, turners tooth
- caries
- AR
- devitalisation of tooth
- internal resorption
INTRINSIC (generalised)
- amelogenesis imperfecta
- dentinogenesis imperfecta
- fluorosis
CHRONOLOGIC
- tetracycline stains
- systemic illness
what are the factors that would influence a childs behaviour at the dental office
child, parent, clinician, envt
1) CHILD
- age/ cognitive development = sensorimotor, preoperational, concrete operational, formal operational
- personality (easy, slow to warm up, difficult)
- attachment to caregiver, up to 5 years old
2) PARENT
- whether parent has a negative or positive attitude towards things
- parental anxiety can be transferred to the child
- parenting practices can influence child’s behaviour and coping skills
3) CLINICIAN
- personality (warm and welcoming vs not)
- appearance
-aptitude (eg delivery of LA can be more painless)
4) ENVT
- sounds like dental drill will scare child
detail steps taken to ensure successful delivery of buccal infiltration to a child who is receiving LA for the first time
two aspects to delivering LA - technique and behaviour mx
can split answer into before, during, after
BEFORE LA:
- tell show do, explain numbing using childrenese
- profound topical anesthesia (benzocaine 20%) ideally flavoured
- do not show needle
DURING
- technique, slow controlled infusion
- distraction: talk a lot, count to 10, breathe in and out
- positive reinforcement: praise them for being brave
AFTER:
- positive reinforcement
- POI to parent: what to do when LA has worn off
discuss possible causes for deciduous teeth exfoliating prematurely, no caries, fair OH with mild mod plaque accumulation
taken xray, BL seen
1) hypophosphotasia
- serum alkaline phosphatase deficiency
- cementum hypoplasia, PDL dont attach
- characterised by early exfoliation of primary teeth
2) ehlers danlos syndrome (defective pdl, collagen disorder)
3) diabetes
- attachment loss, leads to early exfoliation of primary dentition
4) leukocyte disorders like neutropenia
5) Downs syndrome
6) Papillon Lefevre syndrome
- palmar-plantar hyperkeratosis
- mutation of gene for cathepsin C (lysosome proteinase)
- early exfoliation of primary teeth by 4yo
7) aggressive perio
- associated with highly virulent strains of AA
ddx for smooth opaque white patch on labial surface of incisors
1) MIH
- unknown etiopathogenesis but its because of hypomineralisation when there is a disturbance between enamel crystal growth, due to inhibition of resorption by ameloblasts and proteolytic enzymes
- isolated areas of white/yellow/brown discoloration which remain glossy even when dried
2) fluorosis
- upper CI begin calcification at 3-4 months, complete crown formation at 2.5-3 years old
- isolated white/yellow/brown discolorations
3) localised enamel hypoplasia
- there was a disturbance in development of enamel organ, during differentiation of ameloblasts
- can be due to malnutrition, downs syndrome
4) turners tooth
- trauma to primary predecessor, affected developing tooth germs
5) incipient smooth surface caries
- decalcification of enamel, loss of enamel prisms and translucency
indications for splinting, type and duration of splinting for various types of injuries
rationale:
- maintain repositioned teeth in desired position otherwise displacements can cause further injury to PDL or neurovascular bundle (eg crushing injury)
- if dont splint, can cause occlusal interferences
- for patient comfort
- for improved function eg mastication, deglutition
duration of splint
- extrusion 2 weeks
- lateral luxaton 4 weeks
- intrusion 4 weeks
- avulsion: if eodt is more than 60 mins, just splitn 4 weeks but if its less than 60 mins, splint only 2 weeks because we want to avoid risk of ankylosis
