Paedodontics

Question 1

What is the most important thing to find out about a paediatric patient during first session?

Answer 1

Have they had any previous treatment - other than that it is just like a standard exam with taking of bitewings at around 3-4 years old

Question 2

What is the essence of paediatric dentistry?

Answer 2

TIME - always be mindful of the time - time is money but in this case - time for the kid to be sick of you is not long

Question 3

Why does caries progress rapidly in decidious teeth?

Answer 3

1. Thinner enamel and dentine
2. Wider dentine tubules
3. Large pulp chambers
4. Extensive pulp horns

Question 4

What is the best practice for paedeatric dentistry?

Answer 4

Always - early diagnosis. Always - prevention, fluoride introduction, CPP-ACP therapy. Early restorative treatment.

Question 5

What are some of the contraindications for extraction for a child?

Answer 5

1. Haemophilia
2. Von Willebrands disease
3. Platelet disorder

Question 6

What are some of the medical contraindications for pulpotomy?

Answer 6

1. Congenetial heath disease
2. Immuno-compromised
3. Poor healing potential
4. Special needs/ or sever disability

Question 7

What are some of the tooth specific factors for tooth extraction/pulpotomy?

Answer 7

1. Stage of dental development
2. Pulpal status
3. Restorable or not
4. Space management

Question 8

What would you except the abscess to come out for the infected primary dentition first?

Answer 8

Around the buccal or palatal and lingual area due to large forcassion of the deciduous molars and premolars

Question 9

What are some of the steps to coming to a pulpal diagnosis for deciduous teeth?

Answer 9

1. History of pain
2. Clinical examination - extent of caries, mobility, swelling/fistula
3. Investigation - pulp test and radiographs

Question 10

What is important to know before prescribing anti-biotics for a child?

Answer 10

Make sure you are planning to extract the cause of the infection very very VERY soon

Question 11

What are some of the contraindications for primary pulp therapy?

Answer 11

1. Presence of radiolucency/caries in the furcation
2. Internal or external root resorption including physiological root resorption
3. Furcation or periapical bone lesions

Question 12

What is the aim of pulp treatment?

Answer 12

1. Remove the diseased and bacterially contaminated tissue
2. Establish an environment that will prevent any further and future bacterial contamination

Question 13

What are the 4 levels of endodontic treatment?

Answer 13

1. Indirect pulp cap
2. Direct pulp cap
3. Vital pulpotomy
4. Pulpectomy

Question 14

What is the important pre-requisite for utalisation of vital pulpotomy?

Answer 14

Reticular tissue of the pulp (in roots) should be vital. In children - the pulpotomy should be covered by a stainless steal crown!!!

Question 15

What are the objective of pulpotomy?

Answer 15

1. Preserve vital pulp
2. Resolve existing reversible pulpitis
3. Maintain tooth symptom free
4. Permit normal exfoliation
5. Cause no harm to secondary successor
6. Cause no internal resorption or canal calcification

Question 16

What is a big contraindication for a vital pulpotomy?

Answer 16

1. Extra-pulpal pathology
2. Irreversible pulpitis
3. Complex medical history - think infective endocarditis

Question 17

What are the steps for pulpotomy?

Answer 17

1. LA and isolation
2. Prepare access to remove caries - may start occlusal reduction here aswell
3. Remove caries
4. Gain access to pulp chamber
5. Remove entire roof of pulp chamber - do not forget about corners - use large bur (no perforations)
6. Achieve haemostasis with dry cotton pellet
7. Place medicament over radicular pulp stumps - MTA for example or Feeric Sulphate
8. Condense IRM into the chamber
9. Restore with GIC
10. Restore with a stainless steel crown

Question 18

What is Formocresol?

Answer 18

It is a material containing formaldehyde which a potent tissue fixative. It is bactericidal and devitalising to the tissue.

It has a success rate of above 90% but highly depends on the coronal seal.

Controversy: formaldehyde is a carcinogen but there is no study that shows formocresol causes carcinomas.

Question 19

What are the different Zones of inlammed pulp?

Question 20

What is Ferric Sulpahte?

Answer 20

It is a haemostatic agent but it is not bactericidal. It is also signifcantly less toxic.

Because it essentially acts a sealant for the vital tissue - it is less forgiving than formocresol.

Success rate is around 90% again.

Question 21

What is MTA?

Answer 21

Mineral Trioxide Aggregate - portland cement. Excelent sealant, has anti-bacteria effect.

Very high success rates but it is quite expensive.

Question 22

Why should we restore primary teeth?

Answer 22

1. Eliviate pain
2. Eleviate infections
3. Impact on quality of life
4. Impact on self esteem
5. Potential development of fear and anxiety
6. Effect on permanent dentition
7. Occlusion trouble
8. Medical implications

Question 23

What is something to consider in the context of contact area in the decidous teeth?

Answer 23

The contact areas are quite broad and flattened thus it is harder to restore the tooth and replicate an appropriate contact point

Question 24

What is the aim in deciduous restorations?

Answer 24

Only restore the tooth ONCE until exfoliation

Question 25

What are the factors to consider when selecting the material for tooth restoration for decidous tooth?

Answer 25

1. Caries risk and rate 2. Size and type of lesion 3. Pulp status 4. Age 5. Stage of root development 6. Overall developmental status 7. Tooth anomalies 8. Level of cooperation 9. Material properties 10. Moisture control 11. Oral hygiene 12. Motivation for regular attendance 13. Longevity

Question 26

What are the advantages of stainless steel crowns?

Answer 26

Durable, longevity is greate, relatively inexpensive, minimal technique sensitivity and is very conservative.

Question 27

What are the disadvantages of stainless steel crown?

Answer 27

Poorer aesthetics and impaction of erupting 6's

Question 28

What are indication for stainless steel crowns?

Answer 28

1. Pulp therapy 2. Multisurface caries 3. Developmental defects 4. Early wear and loss of occlusal height 5. Failure of other restoration 6. Space maintenance 7. Fractured teeth 8. High caries risk 9. Young children undergoing general anaesthesia

Question 29

What are the step-by-step procedures in administration of a stainless steal crown for a child?

Answer 29

1. Consent, LA, Rubber dam - always consider quadrant care 2. Do occlusal reuciton first - just remove 1mm - Remove caries and do the pulpotomy steps 3. prep the crown normally 4. Trial and error size selection - consider mesial-distal width as the main guide - if that fails try the contra-lateral upper molar 5. Flex the crown and snap it into the undercut areas of the tooth - make sure you snap it into subgingival area on the buccal 6. Ensure it can not be removed with rocking or come loose 7. Remember Size 4 is better for first molar and size 5 for second molars

Question 30

What is Hall Technique?

Answer 30

It is when you place stainless steel crown on carious primary molars without carious excavation or tooth preparation BUT THIS TECHNIQUE IS VERY CASE SPECIFIC

Question 31

What are the recommendations for use of amalgam in children?

Answer 31

Not recommended in Australia because it is just hard to manipulate but you can still do it with consent

Question 32

What is the failure rate of stainless steel crowns comparing to other restorative materials?

Answer 32

Stainless steel crowns are better comparing to other materials in children

Question 33

What is a compomer?

Answer 33

It is a combination between composite and GIC but more of a composite

Question 34

What kind of restorations could you offer your kid-patients for their anterior teeth?

Answer 34

Composite strip crowns or full metal crowns but both technique are quite difficult and require a lot of moisture control so maybe stick to normal composite technique for now.

Question 35

What is chronological hyperplasia?

Answer 35

It is when there is hyperplasia only in certain areas of the decidous teeth

Question 36

What is important to understand with general anaesthesia?

Answer 36

1. It is very expensive 2. A lot of treatment will be done 3. There rate of children coming back with caries is high - behaviour change is needed

Question 37

What do we do with posterior teeth in very young kids with high caries risk?

Answer 37

Stainless steal crown

Question 38

What do we do with posterior teeth in not-so-young children with low caries risk?

Answer 38

Try to use CR or RMGIC in small slots - consider sandwich techniques

Question 39

What is essential for a long lasting fissuer sealing?

Answer 39

MOISTURE CONTROL

Question 40

What are some of the options we have for children with mild or moderate anxiety levels?

Answer 40

1. Conscious sedation 2. General anesthesia

Question 41

When should you consolidate a treatment plan?

Answer 41

Try to get it done by the end of the first appoitment to allow for advanced planning thus increasing compliance

Question 42

What patient qualify for conscious sedation in SA dental?

Answer 42

Only ASA I and ASA II patient - so healthy patient or patient with mild controlled conditions ASA III and above need to be treated in a hospital environment

Question 43

What is a good indication of cooperation for children in a dental chair?

Answer 43

If we can take bitewings on a kid it is a good indication of behaviour

Question 44

Why is important to provide children with good experience of dental treatment?

Answer 44

To give them less dental anxiety

Question 45

What is dental fatigue?

Answer 45

It occurs in children due to multiple repeated visits for dental treatments is associated with decrease in cooperation and increase in behaviour problems in chair

Question 46

In paediatrics, what does an exam appointment include?

Answer 46

1. Exam 2. Removal of plaque 3. Diet counselling 4. Fluoride application 5. Child and parent education 6. Discussion of treatment option

Question 47

What kind of approach we should ideally utilise with paediatric patients?

Answer 47

Quadrant dentistry

Question 48

What should we tell the patient when treatment planning for a paediatric patient?

Answer 48

Always assume the worsts and always set expectations right

Question 49

What is important with sim clinic teeth in terms of pulp removal?

Answer 49

Do not chase red - you will have no tooth left.

Question 50

What kind of technique we use on deciduous teeth in terms of rubber dam?

Answer 50

Cuff technique

Question 51

What kind of sealant we use in deciduous teeth in sim clinic?

Answer 51

IRM

Question 52

What kind of clamp could you use for deciduous preparations?

Answer 52

12A clam with floss

Question 53

What kind of bur could you use for occlusal reductionfor deciduous teeth?

Answer 53

Use diamond of flat fissure

Question 54

How do you a stainless steel crown?

Answer 54

First put it on the lingual/palat than stretch it over (roll) the buccal buldge

Question 55

What do we cement stainless steel crowns with?

Answer 55

RMGIC

Question 56

What is crimping?

Answer 56

It is the slight bending of the crown margins in order to achieve better fit!