SAQs Child Dental Health and Ortho

What is MIH?
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Terms in this set (81)
What is MIH?
MIH is a developmentally derived dental defect that involves hypomineralisation of one to four first perm molars frequently associated with similarly affected perm incisors
Clinically you note: mild enamel opacities with minimal enamel breakdown on his mandibular 6s, and mild enamel opacities without enamel breakdown on his maxillary 6s. How would you manage the permanant posterior molars?
Prevention: Flouride toothpaste 1450ppm. FS 6s. FV 4 times a year. Consider supplements. Diet diary.
Stabilisation: GIC to stabilise dentiton and consider ortho referral.
Sensitivity: Tooth mousse can also seal with GIC or SSC
Composite restoration
Maxillary canines are commonly impacted. What signs might a GDP see in a pts mouth that would make them suspicious that a maxillary canine was impacted in a 13 yr old?
Absence of max. canine in the appropriate position.
Absence of a canine bulge palpable in the buccal sulcus.
Deciduous upper canine still in place and firm.
Protrusion of the lateral incisor.
Other associated dental anomalies- hypodontia, malformed teeth, delayed eruption, enamel hypoplasia.
What special investigations would be warranted?
Radiograph- Anterior occlusal or Periapical. Cone beam CT.
In what circumstances would you consider the surgical removal of an impacted 3?
When the tooth has associated pathology- such as a dentigerous cyst or root resorption.
Root resorption of adjacent teeth.
When would you decide to leave the 3?
No pathology.
Risk of damage to adjacent teeth.
Pt declines.
MH contraindicates XLA
What are the various components of a removable orthodontic appliance and what function does each one perform?
Active component- Site of delivery of the force to move a tooth/teeth
Retentive Component- Keeps appliance in the mouth
Anchorage Component- Provides resistance to unwanted teeth/ tooth movement. Every action has an equal and opposite reaction and hence there is always a raction from active components and anchorage is the source of resistance.
Baseplate- Holds the components together.
What are the advantages of the adams clasp design?
Provides retention and anchorage.
Easy to ajust.
Versatile: auxilary fittings unclude double clasps, hooks for elastics an tubes for headgear.
What other designs of such components are used to keep an appliance in place?
Southend clasps on the incisors
When would you use an anterior biteplane and when would you use a posterior biteplane?
anterior bite planes open the bite to allow the posterior teeth to erupt while preventing the anterior teeth from erupting anymore. As the posterior teeth erupt there is vertical development of the alvelous and the conyles grow.
A posterior bitep lane is almost the reverse where the anterior teeth are allowed to erupt while the posterior teeth are prevented from further eruption by the bite plane. This will cause a reduced overbite to increase. Both can only be used in Pts who are still actively growing.
What are the advantages of removable appliances?Effective for simple tipping of favourably inclined teeth over short distances. Easy to clean. Cheap.Name two conditions that may result in delayed eruption of primary teeth.Pre term birth. Chromosomal abnormalities eg Downs syndrome, turner syndrome. Nutritional deficiency Hereditary gingival fibromatosisName two local conditions and a systemic condition that may delay permanent tooth eruption.Local Conditions- Supernumerary teeth, Crowding, cystic change around the tooth follicle, Ectopic position of tooth germ. Systemic- Cleidocranial dystosis, Hypothyroidism and hypopituitarismWhat gender is hypodontia most common in?FemalesWhat do you understand by the term "infraocclusion" and how is it graded?Teeth that fail to maintain their occlusal relationship with opposing or adjacent teeth. Previosously called submerged or ankylosed teeth. Most commonly affects the deciduous mandibular molars. Graded as follows: Grade 1- the occlusal surface of the tooth is above the contact point of the adjacent tooth Grade 2- the occlusal surface of the tooth is at the contact point of the adjacent tooth. Grade 3- the occlusal surface of the tooth is below the contact point of the adjacent tooth.An 11 y.o boy presents with an infraoccluded lower second deciduous molar. What percentage of primary molars are affected by this condition?8-14%How would you manage this problem?Take a radiograph to see if there is a permanent successor. If there is one, it is likely that the infra-occluded 2nd deciduous molar will exfoliate at the same time as the contralateral tooth, when the permanent successor starts to erupt.If there is a permanent successor and the second deciduous molar is still infraoccluded and is below the ginigval tissue, what could have happened to the second deciduous molar? What will you need to consider after removal of the second deciduous molar?The second deciduous molar may have ankylosed. Space maintenance will need to be considered after the extraction to allow eruption of the permanent molar.A fit and healthy 12 y.o girl attends with her mother following an accident in which she fell off the apparatus at her gym club. She has banged both her upper anterior teeth. Examination reveals no extra oral injuries, but both the upper central incisors are mobile and the crowns are palatally displaced. What special tests would you carry out and why?Trauma Stamp- EPT, Ethyl Chloride, TTP, Mobility, Sinus/Tender sulcus, Colour PA radiograph or anterior occlusal to see if their roots are fractured.The upper central incisors are fractured in the mid third of the roots. What tx would you carry out and how long must that tx be done for?Flexible splint for 4 weeks, bonded to injured tooth and one healthy tooth on either side of it.If the coronal portion of the tooth became non-vital what tx would you carry out?Pulp should be extirpated up to the fracture line. Root canal is filled with non-setting CaOH to encourage barrier formation coronal to the fracture line. The CaOH should be chnaged every 3 months until the barrier forms at which point the coronal portion can be filled GP and tooth kept under review.If there were no root fractures, would your management have changed?The teeth are mobile and palatally displaced so they must have undergone some type of displacement injury. These would still require flexible splinting for 2-3 weeks.If a dentoalveolar fracture had been diagnosed, would your management have changed and if so how?Alveolar injuries require repositioning and splint for 4 weeks using a hard wire rather than a flexible splint.What do you understand by the term "behaviour management"?Way of encouraging a child to have a positive attitude oral health an healthcare so that tx can be carried out. It is based on establishing communication while allieviating anxiety and fear, as well has building up a positive rapport between dentist/dentsitry and child.Name three types of communication management.Non-verbal communication Tell, show, do Voice control Distraction Positive reinforcementIf a child is unable to tolerate dental tx, drugs may be administered to help the child cope with the procedure. One way of drug delivery is inhalation sedation. What drug is commonly used with this method?Nitrous OxideGive two contraindications for this drugSickle cell disease Severe emotional disturbances COPD Cooperative ptName another sedative drug that may be used and the possible routes of deliveryMidazolam- intranasal, IVA fit and healthy 15 y.o girl complains of a wobbly upper tooth. Exam reveals that the tooth is a deciduous upper left canine and the permanent canine is not visible. Describe how you would determine whether there in an unerupted permanent canine.Clinical exam- angulation of lateral incisors nay give a clue. Palpation of the buccal sulcus or their might be bulge on the palate. Radiographs - PA or anterior occlusalYou have a panoramic radiogrpah and a PA view. Describe how you could use these images to determine the exact position of the unerupted tooth.By using parallax technique. When two views are taken with different angulations, any object that is further away from the tube will move in the same direction of the tube. This can be carried out in either the vertical or horizontal plane. With these two radiographs the tube has shifted from a near horizontal position in the panoramic radiograph to a much higher angulation in the P. If the canine tooth appears lower on the panoramic than it does on the PA then its is palatally situated and if it appears higher it is buccally placed.Name two other combinations of radiographs that could be used to localise the tooth.Two PAs taken at different anglulations A PA and an anterior occlusal An anterior occlusal and a panoramicWhat other imaging technique could be used to determine whether the tooth is buccally or palatally placed?Cone beam CTWhat are the tx options for impacted permanent canines when the deciduous predecessor has been lost? Give and advantage and disadvantage of each option.No intervention and monitor impacted canine tooth. Adv- easy Dis- would leave a gap consider prothesis Removal of impacted tooth. Adv- No possibiltiy of cystic change Dis- Surgical procedure; damage to adjacent teeth/structures; leave a gap prosthesis. Surgical exposure with orthodontically assisted eruption. Adv- Tooth ends up in proper position with an intact PDL Dis- Surgery; pt needs to wear a fixed ortho appliance; prolonged tx; tooth may still not erupt Transplantation of canine. Adv- Quick, tooth immediately put into place Dis- Surgery; tooth may become ankylosed; loss of vitality; long term prognosis not as goo as teeth that erupt normallyWhat types of appliance are the Andresen appliance, Frankel appliance and twin block appliance? How do they work?They are all functional appliances. A functional appliance is an orthodontic appliance that uses, guides or eliminates the forces generated by the orofacial musculature, tooth eruption and facial growth to correct malocclusion.What age group of pts are they most effective in?Growing children, preferably before the pubertal growth spurt as they use the forces of growth to correct the malocclusion. Around 11-12Which type of malocclusion is most successfully tx with these appliances? What skeletal effects are thought to occur?Their main use is to tx class 2 malocclusions, especially class 2 div 1. However, they can also be used to tx anterior open bites and class 3 malocclusions. Mandible is stimulated to grow and the glenoid fossa remodels forwards as the appliances pull the condylar cartilage forwards, beyond the gleniod fossa.Name two skeletal and two dental changes that are reported to occur with the use of these appliancesSkeletal changes- Restraint or redirection of forward maxillary growth. Optimisation of mandibular growth. Forward movement of glenoid fossa. Inc in lower face height. Dental changes- Palatal tipping of upper incisors. Labial tipping of lower incisors. Inhibition of forward movement of maxillary molars. Mesial and vertical eruption of mandibular molars.What determines the response of a tooth when force is applied to it?The magnitude and duration of the forceWhat changes are seen in the periodontal ligament when orthodontic forces are applied to teeth?Depending on the side: Tension side- Stretching of the periodontal ligament fibres and stimulation of the the osteoblasts on the bone surface leading to bone deposition Compression side- Compression of blood vessels, osteoclast accumulation which result inn resorption of bone and formation of Howship lacunae into which fibrous tissue is deposited.Give five complications of orthodontic txRoot resorption, enamel decalcification, ginigivitis, trauma/ulceration, allergy, relapse, incomplete tx, loss of vitality, pt dissatisfactionWhat force is usually used for orthodontic tx?Tipping 50-75g Translation 100-150g Rotational 50-100g Extrusion 50g Intrusion 15-25gName a commonly ortho index that categorises the urgency and need for orthodontic tx.IOTNHow many components are there in the index and what grades does this index incorporated?IOTN- Dental health and aesthetic component Dental health 1-5 inc in tx need aesthetic component 1-10 photographs 10 being the least aesthetically pleasingA 12 y.o girl complains of a "gap between her upper central incisors" that she is getting teased about at school. Name four causes of a midline diastema.Physiological- central incisors erupt first and a diastema may be present until the upper canines erupt Small teeth in large jaw- including peg laterals Missing teeth Midline supernumerary, odontome Proclination of upper labial segment Prominent frenumHow would you determine the cause of the diastema?History and exam. In particular, look for: A prominent frenum. Pull the lip to put the frenum under tension and look for blanching of the incisive papilla Proclination of upper incisors Size of the teeth in the upper labial segment Radiograph will help confrim if there are any teeth missing or presence of supernumeraries.Once the potential cause of the diastema has been identified how should the pt be managed?If the upper canines are unerupted and the diastema is <3 mm and then reassess after eruption of the canines. If the upper canines are unerupted and the diastema >3mm ortho tx may be required when the canines erupt to approximate the incisors. If the upper canines are erupted then the incisors will require orthodontic approximation or restorative tx to reduce the gap. If there is a prominent frenum, the pt should be referred for an opinion/tx of the frenum. Surgical tx woul involve a frenectomy. If a supernumerary or odontome is present then refer for surgical removal. If teeth are missing, consider closing the midline diastema and a restorative option for the space further created laterally. If the upper labial segment is proclined, a full orthodontic assessment is needed to determine if it is treatable by orthodontics alone or may require surgical intervention at a later date. If the upper central and lateral incisors are very narrow with spacing then it may be possible to refer for restorative tx to restore the teeth with composite, porcelain veneers or corwns to inc width and minimise gaps.How common is cleft lip and palate in western Europe?1:700 birthsAt what age do most units carry out closure of the cleft lip?3 monthsat what age do most units carry out closure of the cleft palate?Between 9 and 18 monthsName two dental anomalies that often occur in cleft patientsHypodontia, supernumerary teeth, delayed eruption, hypoplasiaAt what stage may ortho tx be needed?Mixed dentition- proclination of upper inciosrs may be necessary if they erupt in lingual occlusion, otherwise ortho tx is better deffered until just prior to alveolar bone grafting. Ortho expansion of the collapsed arch and alignment of upper incisors is required prior to alveolar bone grafting. Permanent dentition- fixed appliances are usually required for alignment and space closure. Orthognathic surgery and associated ortho tx is carried out when growth is completed. Pts classically have a hypoplastic maxilla with a class 3 malocclusion, and orthognathic surgery is considered for improvement in aesthetics and function.What may need to be carried out to aid eruption of the maxillary canine on the cleft side and when would this be done?Alveolar bone grafting It is carried out to make a one-piece maxilla. The grafting is usually done between the ages of 8-11 yrs, when the canine root is 2/3 formed. It provides bone for the canine to erupt into. It provides bone as support for the alar base of the nose. It provides an intact arch to allow tooth orthodontic movement . It aids closure of any oronasal fistula.How would you advise pts to administer an apppropriate fluride regime for children in the following age groups: up to 3 yrs, 3-6 yrs, 7 to young adult, from 7 to young adult but HCR.Up to 3: Parents should brush teeth. 1000ppm and a smear. As soon as they erupt brush them. 3-6: Still brushed by parents or supervised. Pea sized amount of fluoride toothpaste 1350-1500 ppm 7-16: 1450ppm pea sized. Spit dont rinse Above 10 yrs of age can prescribe 2800ppm toothpaste Above 16 yrs can prescribe duraphat 5000ppmWhat is the recommended professional intervention regarding fluoride for children in the following age groups: 3-6 yrs, 7-16 yrs3-6 yrs FV 2x a year 7-16 yrs FV 2-4 x a year. $x for HCR. Ensure sugar free medications to minimise cariogenic effect. FS permanent molars when they erupt. Investigate diet and give advice Above 10yrs 2800pm toothpaste, above 16 5000ppm toothpaste for HCRTeeth start forming before the age of 6 months so why are fluoride supplements not given to younger children?Infants < 6 months of age do not have adequate renal function to excrete fluoride. Hence why fluoride is contraindicated until children are atleast 6 months.What are factors that would put a child a high risk for developing caries?Social factors: Lower socioeconomic group, irregular dental attendance, poor knowledge of dental disease, siblings with HCR. Dietary factors: Easily available sugary snacks and drinks, frequent sugar intake. OH factors: Poor plaque control, No fluoride MH factors: reduced salivary flow, medically compromised, physical disability, cariogenic medicine taken long termHow would you carry out a diet analysis for a child?You need to ask the parents (carer) to record on a sheet the time, the food and the amount of everything that is eaten over a 3-4 day period. Try to include one day from the weekend as dietary habits often differ then.List 4 pieces of dietary advice that you would give to a parent/pt."Safe Snacks"- nuts, fruits, bread, cheese "Safe drinks"- Water, milk, tea no sugar Toothbrushing OHI Limit; the frequency sugar containing food and drinks. Sweets to mealtimes or one day a week. Avoid; Chewy sweets in particular, sweetened drinks in a bottle. Discourage; on demand breast feeding . Always try to be positive don't make the parent feel guiltyWhat is meant by the terms balancing and compensating extractions?A balancing extraction is the extraction of the same or adjacent tooth on the opposite side of the same arch. A compensating extraction of same or adjacent tooth is the opposing arch on the same side.What is the likely effect of premature loss of a deciduous canine?Primary effect of early loss of deciduous teeth in a crowded mouth is localised crowding. The extent will depend on several factors, including the pts age, extent of existing crowding and the site of the early tooth loss. In crowding, adjacent teeth will move into the space hence a centreline shift will occur with the unilateral loss of a deciduous canine.Is the effect greater or less with the premature loss of a deciduous first molar than with a canine?A centreline shift will occur to a lesser degree with a unilateral loss of a deciduous first molar compared with a deciduous canine.What would you recommend in a crowded mouth requiring the unilateral loss of an upper canine?The unilateral loss of a canine should be balanced as the correction of a centreline discrepancy is likely to need a fixed appliance and prevention preferable to dealing with the problem.What is the effect of a premature loss of deciduous second molar?the premature loss of a deciduous second molar is associated with forward migration of the first permanent molars. This is greater if the deciduous second molars are lost before eruption of the first permanent molars, so if possible, delay extraction of deciduous second molars until the first permanent molars are in occlusionDo you compensate or balance the premature loss of deciduous second molars?NeitherAn anterior open bite can occur with which types of malocclusionIt can occur in a class 1, 2 or 3 malocclusionGive a simple classification of an AOBSkeletal causes: Inc in lower anterior face height, inc MMPA Soft tissue causes: Endogenous tongue thrust Habits: Digit suckingAn AOB caused by one fcator is relatively straightforward to tx. Which factor is this?Digit suckingWhat other occlusal features may you see in this situation?Retroclined lower incisors, Proclined upper incisors, unilateral buccal segment crossbite with mandibular displacement.Name 5 ways in which fluoride is administered to children.Water supply, Milk, Salt, Toothpaste, VarnishAdvantage and disadvantage of methods you've just givenWater- Adv- V. cheap, available to everyone, doesn't rely on pt compliance. Dis- Not readily available to everyone, opposition to fluoride. Toothpaste- Adv- Daily delivery Dis- relys on pt brushing teeth FV- High Fluoride content; may result in early arrest of lesions, can be used to introduce children to dental care. Dis- Relys on dental professionala fit and helathy 6 y.o girl attends your practice with her mother complaining of intermittent pain from the mandibular, right second premolare. The pain is set off by cold drinks, it does not disturb her sleep and has not required pain relief. What is your diagnosis?Reversible Pulpitis; provoked pain of short duration relieved with over the counter analgesics, by brushing or on the removal of the stimulus.What are your tx options because the child's mother is keen to save the tooth?Pulpotomy or Indirect pulp therapy IPT- arrests the carious process and provides conditions conducive to the formation of reactionary dentine beneath the stained dentine, with remineralisation of remaining carious dentine ; this promotes pulpal healing and preserves/maintains vitality of the pulp tissue. Pulpotomy; involves removal of the coronally inflamed pulp and maintenance of the radicular pulp, which is reversibly inflamed or healthy.What different medications could you use?IPT- hard setting CaOH or reinforced GIC Pulpotomy- in posterior teeth 15.5% ferric sulphate solution (will stain coronal portion orange so not suitable for incisal pulpotomies use saline), MTA, CaOHWhat would be your definitive restoration of choice?Stainless Steel CrownWhat are the signs of irreversible pulpitis and what would your tx options be?Irreversible pulpitis; a history of spontaneous unprovoked toothache, a sinus tract, excessive mobility not associated with trauma or exfoliation, furcation/apical radiolucency or raiographic evidence of internal/external resorption Pulpectomy oe XLADescribe the development of the mandible and maxilla.The maxilla is derived from the first phjaryngeal arch and undergoes intramembranous ossification. Maxillary growth ceases earlier in girls (15 y.o in girls, 17 y.o in boys). The mandible is derived from the first pharyngeal arch and is a membranous bone. The mandible elongates with growth at the condylar cartilage, at the same time bone is laid down at the posterior vertical ramus and reabsorbed on the anterior margin. Mandibular grown ceases later than maxillary growth and is earlier in girls (17 in girls, 19 in boys)What is the difference between endochrondral and intramembranous ossification? Give an example of where it occurs in the headEndochondral ossification occurs at cartilaginous growth centres where chondroblasts lay down a matrix of cartilage within which ossification occurs. This occurs at the synchondroses of the cranial base. Intramemebranous ossification is the process in which bone is both laid down within fibrous tissue; there is no cartilaginous precursor. This occurs in the bones of the vault of the skull and face.List two localised and three general causes of abnormalities in the structure of enamel.Local- Trauma, infection, irradiation General- Amelogenesis imperfecta, Infection; pre natal or postnatal Birth; prolonged labour, premature Fluoride Nutrional deficiencies Downs syndrome IdiopathicWhat do you understand by the term enamel hypoplasia and how does it differ from hypocalcification?Hypoplasia is a disturbance in the formation of the matrix of enamel which gives rise to pitted and grooved enamel. Hypocalcification is a disturbance in the mineralisation of the enamel and gives rise to opaque white enamel.Name three disturbances of dentine formationDentinogenesis imperfecta, Dentinal hypoplasia type 1 and 2. Fibrous dysplasia of dentine, regional odontoplasia, Ehlers Danlos syndrome, Vit D resistant/dependant rickets, HypophosphatasiaWhat do you understand by the term turner teeth?Caused by infection from a deciduous tooth affecting the developing underlying permenant tooth. Results in abnormal enamel and dentine.