Flashcards
Paediatrics - Clinical
Cards in this deck (38)
- 1What is molar incisor hypomineralisation?Hypomineralised 1st permanent molars (1-4)
Often ass.w/incisors
White/yellow/brown opacities - 'cheese molars'
Systemic origin - 2What is the difference between hypomineralised and hypoplastic enamel?Hypomineralised -> decreased MINERAL CONTENT - due to disturbed enamel formation
Hypoplastic - decreased BULK/THICKNESS
True - never formed
Acquired - post eruptive - 3How can maternal/natal events cause MIH?3rd trimester illness of mother∴ during enamel development
/OR/ baby -> premature, forceps delivery, foetal distress
Potential O2 loss to ameloblasts - 4Name 3 aetiologies for MIH other than maternal/natal diseaseChildhood illnesses <2 years
Varicella - most linked to MIH
Measles
Rubella - 5What clinical problems does MIH present?Loss of tooth tissue ∴ 2ndry caries, tooth wear and enamel breakdown
Sensitivity - TB can be sore
LA not always successful
Aesthetics - esp.incisors
Anxiety? More traumatic visits
Bonding difficulties - poor enamel quality - 6How is MIH managed?ALL Pts -> Prevention
OHI, F-, Diet, Reg.Att
MOLARS -> Restore - FS/comp/GIC/SSC
Poss. planned XLA
INCISORS -> Microabrasion?
Restore - composite/veneers - 7What are the indications for SSCs?Primary molars
Loss of marginal ridge
After pulpotomy/pulpectomy
Space maintenance
Hypoplastic teeth (inc.permanent teeth) - 8How is a tooth prepared for a SSC?LA and rubber dam
Occ height reduction ≈ 1mm
Maintain cuspal outline
Clear contact pts w/tapered bur
No buccal reduction unless large cusp e.g. Ds - 9What is the Hall technique?No LA or tooth preparation
Remove gross caries if possible
Seat crown directly - 10How is a SSC size chosen?Measure MD width
Adjust if needed w/scissors
Can test size but do not 'snap' on
Can use contralateral if no correct SSC available - 11How is a SSC fitted?LA and rubber dam
Tooth prep/Hall technique
Correct size chosen
Dry area
GIC in crown
Place L and seat B
Pt can bite on CWR
Gingival blanching is normal
Remove excess cement and floss contacts
Check occ -> small changes will adapt
POIG - 12What are the signs of SSC failure?Rocking - poor fit
2ndry caries
Crown lost/broken
Ireeversible pulpitis
Abscess
Interradicular/PA radiolucency - 13Name 2 space maintainersBand/crown & loop
Distal shoe - 14What is a fissure sealant?Protective coating applied to fissures
Prevents food/bacteria reaching fissure depths ∴ stops caries
Can be BISGMA or GIC (if moisture control poor) - 15What are the indications for a fissure sealant?High caries risk pts
Caries in primary dentition -> seal all permanent molars
Caries in secondary dentition -> seal all permanent molars
Medically compromised/special needs pts - 16What are the contraindications for fissure sealants?Low caries risk pts -> monitor only
Poor coop/moisture control e.g. ++ young ∴ wait - 17What factors are considered for planned XLA of 6s?Poor prognosis of 6
Bifurcation of 7 forming ≈ 8-9yrs
5s and 8s in good position
Class I occlusion
Check all radiographically - 18What are the risk factors for caries in children?LOCAL
Poor oral hygiene
Diet
Fluoride access
GENERAL
Socioeconomic status
Breast vs. bottle fed
Medically compromised
Parental OH status
SMK parents - 19Outline dietary advice for young childrenBreastfeeding is best
Begin cup drinking ≈ 6/12
Milk/Water to drink
Sugary drinks only @ meals and w/straw
No feeder in bed
Sugar free medication
Fruit/veg snacks - 20What makes up a caries risk assessment?1. Clinical evidence
2. Diet
3. SH
4. F-
5. Plaque control
6. Saliva
7. Medical history
NB any 1 = high risk - 21What are the SIGN guidelines for a prevention plan?1. Radiographs - freq varies w/risk
2. TBI
3. F- TP
4. F- varnish
5. F- supplements
6. Diet
7. Fissure sealants
8. Sugar free medicines - 22Detail fluoride toothpaste use for 0-16yrs0-2 -> 1000ppm smear
2-6 -> 1000ppm pea/1450ppm if high risk
6+ -> 1450ppm
HIGH RISK
10+ -> 2800ppm (0.619%)
16+ -> 5000ppm (1.1%) - 23Detail fluoride supplement useNB only if <0.3ppm in water
0-6mnths -> nil
6mnths-3yrs -> 0.25mg/day
3-6yrs -> 0.5mg/day
6+yrs -> 1mg/day - 24When can mouthwash be used? What strength?From 8+yrs
225-450ppm - 25Detail the use of fluoride varnish22600ppm (2.26%)
From 2+yrs
Up to 4x yearly
NB caution w/colophony allergy - 26What possible problems can occur with fluoride?Fluorosis -> excessive ingestion during development
Mottling, staining, pitting
Toxicity -> toxic dose 5mg/kg
Rx - milk or calcium - 27How may a child's anxiety be assessed?History - esp. PDH
Modern Child Dental Anxiety Scale - MCDAS -> 1-5 smiles-tears - 28Name some techniques of behaviour management NB be able to detail at least 1 of thesePositive reinforcement
Tell-show-do
Acclimatisation
Desensitisation
Distraction
Modelling
Relaxation -> progressive muscle relaxation
Hypnotherapy - 29How should a paediatric treatment plan be orderedPain
Behaviour management
Acclimatisation
Prevention
Progressive Rx
Rads w/caries risk
Long term Rx planning - 30What are the indications for primary molar endodontics?Good cooperation
Avoid GA
MH precludes XLA e.g. bleeding disorder
Missing secondary tooth
Space maintenance
Age appropriate - 31What are the contraindications for primary molar endodontics?Poor cooperation
MH precludes endodontics
Recurrent/severe pain/swelling
Unrestorable tooth
Exfoliation soon
Multiple carious teeth - 32What are the indications for a vital pulpotomy?Reversible pulpitis
Marginal ridge broken down
Caries 2/3 into dentine
Exposure - 33How is a vital pulpotomy carried out?Pre-op radiograph
LA and dental dam
Access -> remove caries and unroof pulp chamber
Remove coronal pulp w/sterile excavator/s.speed
Control bleeding -> ferric sulphate on CWR 20s
Assess pulp ->
inflamed = bright red blood, haemorrhagic ∴ pulpectomy/XLA
uninflamed = deep red, no bleeding ∴ continue
CaOH/MTA @stumps
GIC core
SSC - 34What are the indications for a pulpectomy?Hyperaemic pulp following pulpotomy
Non-vital tooth
Necrosis
Irreversible pulpitis
Furcation involvement
NB swelling or systemically ill = XLA - 35Describe a non-vital pulpectomyRadiograph
LA and dental dam
Access and caries removal
Pulp extirpation
Assess bleeding
Root canal prep to 2mm short of apex
Fill canals w/CaOH & iodoform e.g. Vitapex
Restore GIC and SSC - 36How is primary molar endodontics failure seen clinically?Mobility
Fistula
Pain
Swelling - 37How is primary molar endodontics failure seen radiographically?Radiolucency
Resorption
Furcation bone loss - 38—
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- Flashcards on Paediatrics - Clinical, created by Michael Brown on 01/12/2015.
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- Michael Brown
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