2 Components of anxiety and implications
- COGNITIVE - An inability to concentrate, poor memory function
- BEHAVIOURAL - Avoidance, disruptiveness
Features of an abscess
- swelling
- tender to palpation around tissues
- TTP
- Reddening of mucosa
- Pus discharge
- Sinus tract
- Fever & Malaise
- High in occlusion
- Mobility
- Radiograph shows PA changes
Difference between Periapical & Lateral abscess
• LATERAL PERIO ABSCESS:
- Deep pocket
- Vital
- Pus in pocket
- Radiographic bone loss
• PERIAPICAL ABSCESS:
- Non vital
- Pus in tissue
- Radiographic apical change
History Taking in Paeds
• Pt. details • Who pt. attended with • Pt. complaint • Hx of complaint (when, where, how) If tooth kept how was it stores and how long. If not chest x-ray
• Head injury - if suspected concussion or head injury, send to A&E
- MH
- DH
Non-Accidental Incident
- Delay in seeking tmt
- Inconsistent Hx
- Withdrawn child
- Multiple lesions of different sizes
- Frenum tears
- Bite marks
- 50% injuries found in orofacial region and burns account for 10%
Uses of Composite over GIC
- Where aesthetics important (class IV)
- Heavy occlusion
- Temporary veneer
- Temporary crowns
- Wear similar to tooth tissue
- Permanent restorations
7 uses of GIC
- Primary teeth restorations
- Class V restorations
- Abrasion lesions
- ART
- Luting cements
- Cavity bases
- Caries risk - F- releasing
- Fissure sealants
4 adhesion systems in dentine bonding
Type of acid etch and %
- TYPE 1: etch/bond/prime (All Bond 2)
- TYPE 2: etch/prime & bond (Scotch bond 1)
- TYPE 3: etch & prime/bond (Clearfil SE)
- TYPE 4: etch & prime & bond (scotch bond universal)
- 37% phosphoric acid
3 materials used for high strength ceramic core
- Zirconia
- Alumina
- Glass infiltrated
Loose temporary management
- Assess cause of failure
- Alleviate pain/sensitivity
- Assess prep:
- ensure no damage to preparation
- new impression
- Clean tooth of cement
- Fabricate new crown and cement
- May consider using different technique/stronger cement
Reasons why temporary may be loose
- Inadequate technique for cementation
- Inadequate quantity/quality of cement
- Unsuitable occlusion
- Poor placement technique
- Poor retention form poorly formed prep
Types of temporary for posterior
- DIRECT - RMGIC
- Aluminium shell crowns
- Pre-recorded matrix w/ protemp
6 functions of temporary
- Protect dentine & pulp
- Maintain and restore occlusion
- Maintain marginal integrity
- Maintain aesthetics
- Identify under prepared areas or undercuts
- Easy removal - no damage to prep
3 types of ceramics and how substructure affects
• DENTINE BONDED CROWN:
- Minimal tooth prep. Translucent material - very aesthetic.
• PREFORMED METAL CROWN:
- Metal supported with sintered ceramic veneer (1mm) - often opaque appearance and metal margin showing through - least aesthetic
• ALL CERAMIC:
- High strength ceramic substructure often opaque with a sintered ceramic veneer. Heaviest prep of all crowns. Less aesthetic than DBC but more so than PFM, especially with more translucent ceramic sub structures
Dentine bonding precautions
- Moisture control - rubber dam
- Dry do not desiccate tooth
- Air dry 5 seconds for even spread of bond
- Etch for 10 seconds (if on natural tooth)
- Light cure 15 seconds
Optimum outcome after XLA
- Mesial movement of 7 to close the gap and replace 6
- No distal drifting of the 5
- No overreaction of opposing 6
- Normal eruption of 8s with no impaction
- Control of disease, increase in OH and no caries
- Positive attitude towards dentistry
Problems with early XLA of 6
- Mesial tilting of the 7
- Mesio-lingual rotation of 7
- Disturbing of occlsuion (if lower 6 la then upper 6 may overerupt)
- Loss of anchorage for URA
How management changed in Class 2 Div 1
Aim = Class 1 molar
2 options: • Correct class II with XLA and then fit functional appliance • Retain and incorporate into ortho tmt plan
- Don’t extract in lower unless xla in upper otherwise will increase discrepancy
- If lower molar:
- Crowded lower arch
- Not crowded lower arch
- XLA when bifurcation of the 7s to close space, consider removing upper 6s during tmt
• If upper molar:
- Retain so can be extracted and space can be used during orthodontics
RPD - 5 clinical examination features
- Occlusal relationship - guidance
- FWS
- Centre line
- Lip line
- Restorative and vitality status of teeth
- Position of teeth present
- Shape and position of potential abutments
Reason for SDA
- No evidence for TMJ problems
- No detriment from prostheses
- No need for immaculate OH
Chronic atrophic candidosis Causes & Symptoms
CAUSES:
• Poor OH
- Leaving denture in at night
- Systemic disease - diabetes, xerostomia
- Excessive FWS - unretentive
SYMPTOMS:
• Red palate in denture bearing areas
- Some hyper plastic tissue
- Angular cheilitis
- Mostly asymptomatic
