paeds Flashcards by Elena Kit

advantages of Hall technique

Allows pre formed metal crown to be placed over carious primary molars to be placed
Non-invasive & quick
Requires no LA; requires no tooth preparation
Requires patient compliance & trust in operator ability

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What instruments are used for Hall technique?

Mirror
Straight probe
Excavator
Flat plastic
Cotton wool
Gauze for airway/elastoplast to secure crown
Band forming pliers (convex-concave)

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what teeth are suitable for hall technique?

primary molars (Es and Ds)

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How would you choose the SS crown for Hall technique?

Choose smallest crown that will cover all cusps. Partially seat the crown until it engages all contact points
Adjustments may have to be made using Adams pliers-right way/wrong way
Where distal marginal ridge of D is missing and E has drifted mesially, use separators
If unsuitable, remove crown using excavator before cement sets

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Indications for Hall technique

No radiographical sign of pulpal involvement (asymptomatic tooth)
Sufficient amount of sound tooth tissue

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procedure steps of hall technique

Place ortho separator 3-5 days, use floss to help place it

Sit child upright: gauze swab to protect airway
Smallest crown that covers all cusps. DO NOT SEAT. Should “spring back”
Dry crown, fill with luting cement-no air inclusions
Only prep is drying tooth first if possible
Cement placed in cavity if it is large
Place crown over tooth. Partially seat until contacts are engaged.
* Either sit crown with finger pressure or
* ask child to bite for 2-3 minutes (cotton wool)
Remove excess cement, floss contacts and give child a sticker

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paeds prevention and patient advice

Brushing
Topical DURAPHAT F- varnish
Fissure seal
Dietary advice
Reassure that patient will be used to the feeling within 24hrs
Even bite within weeks

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why would you avoid Hall technique

if no sufficient tissue and pulpal involvement
poor cooperation from a child
risk of endocarditis

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why would SS crowns fail?

Minor - secondary caries, reversible pulp inflammation, loss of restoration but tooth restorable

Major- irreviersible pulpitis, tooth unrestorable

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conventional stainless steel paeds crown prep

require prep, remove marginal ridges and break contact points, occlusal reduction

problems - rock, canting, loss of space (don’t get ideal prep)

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What type of treatment is hall technique?

biological, conservative and preventative

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Minor failure in hall technique

new or secondary caries
crown becomes worn
lost crown but able to replace it
reversible pulpitis

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major failure in hall technique

irreversible pulpits with access that requires pulpotomy or extraction
inter-radicular radiolucency was seen on radiographs; the restoration was lost and tooth was now unrestorable.

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What changes would be seen in the lower dentition when patient is 7 years old

central upper and lower incisors will erupt
lower lateral incisors

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Principle of Hall Technique to arrest caries.

it is to create sealed environment around the decayed tooth, prevent bacteria to enter it and arrest progression of decay

provides a suitable environment for the body to lay down a new layer of dentin, which helps to protect the underlying pulp.

can be used in anxious patients

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Requirements to place a Hall crown on a selected tooth.

caries shouldn’t spread to the root of the pulp
no symptoms of inflammation
structurally sound
good OH
cooperative patient

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Instruments required for Hall Technique

pre-formed crown
mirror
straight probe
excavator
flat plastic
cotton wool
gauze for airway
band forming pliers
floss
rubber dam

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Stainless Steel Crowns are cold worked. Describe work hardening and its effect on material

made of staineless steel alloy that undergoes cold working during the manufacturing process

the work hardening process occurs when the metal is deformed by BENDING, TWISTING, COMPRESSING it, causing dislocations in the metal’s atomic structure. These dislocations make it more difficult for the metal to deform further, making the material stronger and more resistant to bending or other types of deformation.

IT INCREASES STRENGTH BUT CAN MAKE IT MORE BRITTLE

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Under what circumstances would you consider a pulp therapy in paediatric patients?

deep caries - that reached the pulp
trauma
developmental anomalies
large restoration
pain or infection
cooperative child
medical history precludes extraction
missing permanent successor
over-riding necessity to preserve the tooth
* e.g. space maintainer
child under 9 years of age

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Your patient’s mother asks what the long-term complications of having the tooth removed would be. How would you respond? (5 marks)

malocclusion/misalignment due to gaps
loss of space causing increased risk of malocclusion
bone loss
if happened too early, will cause impacted permanent teeth
aesthetic concerns if anterior
impeded speech problems
psychological disturbance
trauma from anaesthesia/ surgery
decreased masticatory function

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The mother then asks about the potential complications of primary molar pulp therapy. What do you tell her?

Early resorption leading to early exfoliation
Over-preparation

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contra-indications for Pulp Treatment

poor co-operation
poor dental attendance
CARDIAC DEFECT
multiple grossly carious teeth
advanced root resorption
severe/ recurrent PAIN OR INFECTION

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If you were to provide pulp therapy for this patient what would the definitive coronal restoration be and why?

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pulpectomy - calcium hydroxide and iodoform where are roots are, GIC in the core and preformed metal crown on top

high success rate, provide protection against decay, easy to place, require minimum preparation

Picture of primary dentition, sinus on lower left D. What would be your treatment options?

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antibiotics
pulpectomy
extraction if not successful
drainage

when would you consider pulp therapy?

when caries extended to the pulp cooperative child mh excludes extraction missing permanent successor for space maintenance child under 9 years of age

long term complications of primary tooth extraction?

unwanted gaps that can lead to malocclusion speech problems mastication function deficiencies psychological disturbance trauma from anaesthesia / surgery

complications of pulp therapy?

early resorption that leads to early exfoliation over-preparation

parent calls your practice and tell that 9 yo daughter knocked her front tooth the term is?

trauma - avulsion

what instructions would you give to parent if child has a knocked out tooth?

* store in fresh cold milk or saliva * do not allow to dry out * Can wash for 10s under cold water while holding only the crown if obvious debris * do not touch the root

if patient has fully erupted lateral incisors, what splint would you consider

flexible splint

ideal material for splint

0.6 mm stainless steel wire, using bond and etch and composite to hold in place

how long should splint be left in situ ?

- FLEXIBLE SPLINT (covering 1adj tooth either side of avulsed tooth) = 2 weeks - RIGID SPLINT (covering 2x adj teeth either side of avulsed tooth) = 2-4 weeks

diet and oh instructions with splint

avoid sugary foods, ensure good OH, low sugar snacks 1- Continue to brush teeth as normal (2x daily for 2 mins) using a SOFT BRISTLED toothbrush (brush even if bleeding occurs) 2- Use a fluoride-containing toothpaste: 1400-1500 ppm 3- Continue GENTLE inter-dental cleaning (pt may have to change floss to an inter-dental brush/ wand to fit through splint wire) 4- Recommend rinsing 2x daily with chlorohexidine mouthwash (anti-microbial effects)

when necrotic pulp is extirpated, what material should be used to fill the canal?

CaOH + iodoform = vitapex

role of vitapex (CaOH + iodoform)

save the tooth and prevent spread of infection

Mum brings tooth in tissue, what would you do with tooth?

CLOSED APEX: - Rinse tooth in saline solution - Re-implant and splint for 2 weeks (carry out RCT after 1 week) OPEN APEX: - Remove PDL fibres (any attached necrotic tissue) with gauze - Soak tooth in fluoride solution - Re-implant and splint for 4 weeks

Two questions that you would ask the mum about accident?

- Was the accident a result of a sporting injury? - Did your child lose consciousness or feel faint/ dizzy after accident? - Was there any bleeding? - Childs tetanus status??

MIH what teeth are affected?

First permanent molars and also sometimes permanent incisors

questions you would ask mum about MIH

- Prenatal period: did you suffer from any illness in your pregnancy or have any known nutritional deficiencies? - Natal: Was the birth complicated, requiring c-section or assisted delivery? Was the child kept in a baby care unit after birth? - Post natal: Did the child suffer from any illnesses in the first 2 years? Or measles, mumps, rubella, chicken pox? How long was the baby breastfed and when was the child weaned?

why do we ask about time period for MIH

first permanent molars calcify by the age of one

what MIH patient might complain of

- hypersensitivity - molars look very yellow - loss of tooth substance – breakdown of tooth enamel, tooth wear, secondary caries.

is dentine affected in MIH?

Outline the formation of enamel and dentine

Dental papilla cells adjacent to the IEE differentiate into odontoblasts which lay down a dentine matrix (mainly collagen) which is later mineralised (unmineralised = predentine). Once dentine formation has begun, IEE cells differentiate into ameloblasts. They deposit a protein matrix (enamel matrix protein = amelogenins) which is partially mineralised (30%) and once this framework is established, the organic part is removed and mineralisation is completed (maturation). Ameloblasts regress and form a protective layer over the enamel: the reduced enamel epithelium.

With regards to amelogenesis what are the differences between hypomineralisation and amelogenesis imperfecta hypoplasia (5)

In summary, hypomineralisation affects the quality of enamel, whereas AI hypoplasia affects the quantity of enamel formed during amelogenesis. Both conditions can lead to tooth sensitivity and early tooth decay. Hypomineralisation can be caused by nutritional deficiencies, infection or systemic illnesses Imperfecta is a genetic condition Hypo is 1st molars and incisor Amelogenesis can be any teeth

With regards to Nerves and vessels why is the child experiencing sensitivity (3)

exposed dentine nerve irritation vascular changes Dentine hypersensitivity: porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate A nerve fibres (hydrodynamic theory) Peripheral sensitisation: underlying pulpal inflammation leads to sensitisation of C-fibres

What are the immediate and intermediate treatment (3)

fluoride treatment - high fluoride varnish and toothpaste dental sealants restorative - fillings and steel crowns

what advice would you give the girl about brushing with molar hyporminelarisation (1)

regularly and properly with soft bristled toothbrush

In an attempt to find an aetiological factor for the MIH condition you ask a series of questions. a.) Write down one question you might ask the mother about the patient’s antenatal period. (1 mark)

did you suffer from any illness in your pregnancy or have any known nutritional deficiencies?

Write down two questions you might ask the mother about the time of the patient’s birth. (2 marks)

- Did the baby need oxygen at birth? - Was the baby born prematurely?

Write down two questions you might ask the mother about the patient’s first two years of life. (2 marks)

- Did the child suffer from any illnesses in the first 2 years? Or measles, mumps, rubella, chicken pox? - How long was the baby breastfed and when was the child weaned?

Approximately how much of the crown of the first permanent molars is calcified at birth? (1 mark)

cusps only

When is crown formation complete for the: a) First permanent molars

2-3 years

When is crown formation complete for the: b) Permanent maxillary central incisors

3-4 years

When is crown formation complete for the: c) Permanent mandibular central incisors

3-4 years

What complaints may the patient herself have about the teeth affected by molar incisor hypomineralisation? (2 marks)

sensitivity aesthetics

how would you stop bleeding in pulpotomy?

ferric sulphate

paeds Flashcards

(56 cards)