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61 Cards in this Set
- Front
- Back
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What is the main cause for early childhood caries?
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Sleeping with a bottle
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Which teeth are commonly affected by ECC?
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Maxillary anteriors
First molars U + L Lower canine due to eruption |
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What are the treatment options for ECC?
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1.Leave
2. Restore 3. Extract |
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Why are primary teeth restored?
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1. Limit the damage of dental caries
2. Ensure adequate function 3. Restore aesthetics 4. Maintain the natural space available for developing permanent dentition. |
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What dental factors affect restoration of primary teeth?
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Signs and symptoms
Tooth close to exfoliation (stage of root development) Hypodontia Early loss of other primary teeth Number of carious teeth |
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What social factors affect restoration?
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Pt and parent compliance
Regular attender Positive parental attitude Co-operation |
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What are the signs and symptoms of pulpal involvement in primary teeth?
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- spontaneous severe pain (awake at night)
- reporter pain on biting - need for analgesics -clinical extent of caries (presence of marginal ridge breakdown) - IO swelling or sinus -EO swelling |
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What special investigations can be done for pulpal involvement in primary teeth?
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- Gentle finger pressure to determineif tooth is mobile or tender
- NO pulpal sensibility tests -NO tapping of teeth - Radiographs usually mandatory: - extent of caries - presence of pathological or physiological root resorption - presence of successor |
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What are the pulp therapy options?
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Vital pulp:
-indirect pulp treatment -pulpotomy -desensitizing pulp therapy *NO direct pulp capping coz contact of CaOH with pulp causes root resorption in primary tooth. If you expose a pulp then pulpotomy. Non-vital pulp: - pulpectomy |
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When is indirect pulp treatment done?
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- Deep carious lesion
- no signs or symptoms (no pulp exposure) |
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Why is indirect pulp treatment done?
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To arrest carious process
To maintain pulp vitality |
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What is the clinical technique for IPT?
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1.LA
2.Good isolation (rubber dam) 3. Removal of all caries at ED junction 4. Hand removal (excavation) of soft deep carious dentine over pulp region to avoid exposure. 5. Lining material e.g. GIC, CA(OH)2 6. Definitive restoration (SS crown) |
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When is a pulpotomy done?
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- Mechanical caries exposure of vital coronal pulp tissue
- asymptomatic tooth or only in transient pain |
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What is a pulpotomy?
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Removal of a clinicall diagnosed irreversibly inflamed coronal pulp and maintenance of the healthy or reversibly inflamed radicular pulp.
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What is the pulpotomy clinical technique?
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LA
Rubber dam Access Caries removal Remove roof of pulp chamber - sterile diamond fissure bur Remove coronal pulp (sterile excavator or large round bur in slow handpiece) Achieve haemostasis with gentle application of sterile cotton pledget moistened with saline (usually take 4 minutes) Evaluate pulp stumps: -Normal bleeding = non-inflamed pulp (bright red colour, good haemostasis) - Abnormal bleeding = inflamed pulp (deep crimson, continued bleeding after pressure) - Medication: -Place 15.5% ferric sulphate solution and cotton pledget over pulp stumps - 15 secs - Pulp stump evaluation: - dark brown/black with minimal oozing - Application of lining , reinforced GIC or ZnO eugenol -Definitive Restoration (SS Crown) |
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When is desensitising pulp therapy done?
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When adequate analgesia cannot be achieved.
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Why is DPT done?
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To reduce pulp inflammation and/or symptoms in order to facilitate further pulpotomy or pulpectomy.
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What is the clinical technique for DPT?
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- LA
- Good isolation, rubber dam - caries removal - cotton wool pledget loaded with steroidal antibiotic paste (Ledermix) directly over exposure site - Place well sealed temporary dressing - Recall after 7-14 days and proceed with pulp treatment depending on clinical findings. |
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What are the indications for a pulpectomy?
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- irreversible pulpitis on basis of reported symptoms &/or clinical findings (e.g. profuse haemorrage following pulpotomy procedure)
- non-vital tooth - good patient compliance |
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Why is a pulpectomy done?
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To remove irreversibly inflamed or necrotic radicular pulp tissue, clean the root canal system and obturate with a filling material that will resorb at the same rate as the primary tooth.
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What is the clinical procedure for a pulpectomy?
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LA
Rubber dam Access Coronal pulp extirpation Root canal preparation (2mm short of apex), irrigation with normal saline or chlorhexidine. Obturation (pure ZnO eugenol , Vitapex- CaOH) GIC core Stainless steel |
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What material can be used to obturate in a pulpectomy?
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- pure ZnO eugenol
- Vitapex >CaOH >Iodoform (bacteriostatic, radiopacity) |
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What are the properties of CaOH in Vitapex?
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- high pH neutralises endotoxins produced by anaerobic bacteria
- stimulates 'blast' cells aiding apexigenesis |
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What problems can be encountered with pulpectomy?
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-Complicated primary molar radicular morphology
-physiological root resorption - proximity to permanent successor - need excellent patient cooperation |
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Pulpally treated teeth need to be reviewed ever 6 months. List clinical and radiographic failures that are possible.
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Clinical failure:
- pathological mobility - fistula/chronic sinus - pain Radiographic - increased radiolucency - external and internal resorption -furcation bone loss |
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What are stainless steel crowns?
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Prefabricated crown forms which can be fitted to individual primary molars and cemented in place to provide a definitive restoration.
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Why use SSCs?
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Long term failure is less than amalgam.
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When are SSCs used?
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-Carious primary teeth when more than 2 surfaces affected, extensive lesions
-Following pulpotomy/pulpectomy procedure -high caries, impaired OH -restorative treatment under GA -developmental defects -fractured primary molars -extensive tooth surface loss -infra-occlusion - maintain mesio-distal space -space maintainer |
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When are SSCs not used?
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- tooth close to exfoliation
- known nickel allergy/sensitivity |
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What is the clinical technique for SSCs?
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LA
Isolation (rubber dam) Caries removal/appropriate pulp treatment Occlusal reduction Approximal reduction crown selection Cementation Check occlusion |
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When are composite resin strip crowns used?
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-Primary incisors
-Caries on multiple surfaces - Incisal edge is involved - extensive cervical decalcification -pulpal therapy is indicated -dental anomalies |
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What is the clinical technique for SSCs?
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LA + Rubber dam
Correct Celluloid crown depending on mesio-distal width of the teeth Caries removal Reduce incisal height by 2mm protect exposed dentine with GIC Trim the crown and make two holes in the incisal corners Etch for 20s , wash and dry Apply Prime and bond and cure dor 20s Fill the crown with appropriate shade of composite and seat with gentle, even pressure, allowing excess to exit freely Light cure each aspect (labially etc) equally Remove celluloid crown, adjust and polish Check occlusion |
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What are the reasons for extracting primary and permanent teeth in children?
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-Extensive caries
-infection (swelling,sinus) - dental trauma -orthodontic extraction - retained primary teeth - to facilitate orthodontic treatment - to help restore dental development (balancing and compensating) - Dental anomalies: =enamel hypoplasia = supernumerary = fusion/gemenation = natal and neonatal teeth - Infraocclusion /submerged teeth -periodontal disease |
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Which teeth are left when considering extraction?
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-asymptomatic teeth close to exfoliation (>2/3 root resorption)
- Arrested caries with no signs of infection (clinical or radiographical) |
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What are the sequelae of early loss of primary teeth?
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-space loss
- crowding/impaction of permanent teeth -early or late eruption of permanent dentition depending on stage of development -damage to permanent teeth (very rare if wrong extraction technique used) |
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Differences in technique when extracting primary and permanent teeth in children.
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-Behaviour problem
-Size of teeth -Shape:more bulbous crown -Physiology: root resorption -Support: elastic bone - Presence of permanent teeth - leave small fragment insitu, avoid blind elevation. *easier to extract teeth in chn coz of elastic bone and root resorption |
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Which two pathologies commonly affect first permanent molars?
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1. Caries- most affected teeth in permanent dentition
2. Molar incisor hypomineralisation - cheesy molars |
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What are the effects of early loss of upper 6's?
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If before complete eruption of 7> rotation and mesial drift of 7 and distal drift of 5
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What are the effects of early loss of lower 6's?
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-Loss after optimum age > tilting 7s
-Loss before optimum age >5 drifts distally and rotates |
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When should first permanent molars be extracted?
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- ideally between 8.5 to 10 years old (furcating of the second permanent molars)
- balancing and compensating -presence of third molars -orthodontic consideration -long term prognosis |
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What are the reasons for extraction of permanent teeth?
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1. Orthodontic extraction
- to facilitate orthodontic treatment (premolars commonly) -balancing and compensating to ensure normal dental development 2. Supernumerary teeth - erupted = simple extraction - buried = surgical extraction |
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Which Act defines parental responsibility when giving consent?
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The Children Act of 1989
- it sets out who has parental responsibility (PR) |
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Who has parental responsibility to give consent?
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-Child's parents if married at time of conception
- After adoption birth mother loses PR and adoptive mother/parents are legal parents -If not married, mother but not father has PR except when: >father has acquired PR via a court order or PR agreement > couple subsequently marry > if birth is registered after 01/12/03 and father is named on BC *therefore if father named in BC b4 01/12/03 he does not automatically have PR. - Legally appointed guardian: >appointed by court > appointed by parent with PR in the event of their own death *this is not the same as a foster parent -A person in whose favour a court has made a Residence Order concerning the child. - LA or other authorised person holding an Emergency Protection Order - LA designated in care order (but not when child is looked after under Section 20 of the Children Act-"accommodated or in voluntary care". |
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Can a step-parent give consent?
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Only if they have a residency order or adopt the child
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What are the chances of dying under GA?
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1 in 250 000
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Does a divorced dad have PR?
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Yes unless a court of law removes the right
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What is a Gilick competent child?
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A child under 16 capable of giving informed consent.
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What are the 4 key messages of oral health education?
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- Diet - reduce frequency of sugar
-Toothbrushing bd with fluoride toothpaste - fluoride - water fluoridation -dental attendance - at least once a year |
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What are key messages for a good diet
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-base meals on starchy foods
-5 portions of fruit and veg a day - Eat more fish - Cut down on saturated fat and sugar - eat less salt -drink plenty of water |
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What is the diet advice for caries prevention?
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- reduce frequency and quantity of sugar. Restrict sugar foods to meal times
-Limit consumption of foods and drinks with added sugars to a max of 4 times a day. - sugars (excluding those in whole fruit) should provide <10% of energy intake (60g per person - 33g for young children) |
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What are the two types of erosion?
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Intrinsic- eating disorder, GORD
Extrinsic - dietary |
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What advice can u give to prevent erosion?
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- twice daily use of 1 450ppm fluoride toothpaste
- keep acidic food and drinks to mealtimes only - avoid brushing immediately after acidic foods or drinks -avoid brushing after vomiting |
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List some non-milk extrinsic sugars
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-glucose
-sucrose -fructose |
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List some non-cariogenic bulk sweeteners
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-sorbitol
-xylitol -malitol -hydrogenated glucose -lycasin |
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What is the minimum age for Duraphat 2800ppm (sodium fluoride 0.61950?
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10 years (no risk of fluorosis at 10)
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What is the minimum age for Duraphat 5000ppm?
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16
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What is the clinical technique for Duraphat vanish application?
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-Prophy not needed unless gross plaque present
- dry teeth with cotton wool rolls or air - small quantity of varnish applied with a microbrush - Instruct to avoid eating,drinking or brushing for 30 + minutes. |
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How are patients selected for fissure sealing?
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-special needs
-dmfs =2 or 2+ -no routine sealing for children with caries-free primary dentition (monitor) |
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How are teeth selected for fissure sealing?
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permanent teeth - remember cingulum pits
deep fissures - potentially caries susceptible - ASAP- but failure rates higher on newly erupted teeth - not only 1-2 years post-eruption - consider caries risk factors -caries in any permanent molar - seal others |
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How often do high caries risk children require bite-wings ?
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Every 12 months
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What is the technique for fissure sealants?
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-Pumice prophy
-Etch 30-50% orthophosphoric acid -20s fissures to cusp tip, 3-4mm around pits -rinse 20-30 seconds - dry thoroughly - isolation crucial -apply resin and cure - 30s -If surface contaminated - re-etch for 15 sec - - |
