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Paediatrics (Trauma (Concussion
Confirm w/ rx, may be TTP
review in…
Paediatrics
Trauma
Concussion
- Confirm w/ rx, may be TTP
- review in few weeks & 6yrs
Subluxation
- Increased mobility?
- discolouration common
- Rx and review + soft brush
Intrusive Luxation
- highest risk to permanents
(hypomin, hypoplas)
Extrusive/Lateral Luxation
- Occlusal interference/ mobility
- Exo asap or spontaneous realignment
- Review at 3 months
Crown Fracture
- complicated or non-complicated
- Sensitive to cold
- GIC/Comp
- Strip crown for Anterior (BEST!)
- SSC for Posterior
-
Non-accidental Injuries
(50% of children will suffer orofacial injuries w/ child abuse)
- brusining
- abrasions
- fractures
- teeth injuries
Consequences to the developing permanent dentition
- Tooth malformation
- Impacted teeth
- Ectopic eruption
- Discolouration/hypolplasia
- Dilaceration
Oral Medicine
Developmental Conditions
Gingival Cysts
Ae: residual epithelium of the dental lamina, 65-90% of newborns
feats: true cysts w/ epithelial lining
Tx: No Tx, disappears w/n several weeks
Congenital Epulis
Ae: rare tumor of new borns (granular cell tumor), unknown
feats: pink-red, smooth surface mass
Tx: Surgical excision
Ankyoglossia
Ae: Unusually short, thick lingual frenulum
feats: known as tongue tied, affects eating, speech, OH
Tx: Non-surgical or surgical release
-
Infectious Conditions
Bacterial
Impetigo
Ae: Staphylococcus aureus (bullous) and/or Streptocossus pyogenes (non-bullous)
feats: itchy sores, yellow complexion
tx: antiseptic, or Oral Ab
Scarlet Fever
Ae: Group A streptococcal bacteria, spread airborne
feats: sore throat, strawberry tongue, fever
Tx: Penicliian/erythromycin for upto 10 days
Viral
-
Herpes Labalis
Ae: HSV, trauma, stress, sun exposure, hormones
feats: clustering vesicles on a red base on lip
-
Varicella
Ae: VSV
feats: rash, fever, malase, vesicles, shingles is 2ndry
Tx: antivirals within 24hrs, good OH
Hepangia
Ae: coxsackie virus
feats: low grade fever, malaise
tx: pallative care
Glandular Fever
Ae: Infectious mononucleosis, HSV/EBV
feats: malaise, acute phayngitis, ulcers and petechiae on soft palate
Tx: self-limiting?!, palative care
Fungal
Oral Candidosis
Ae: Candida infect due to immunosuppression of some sorts
feats: white lesions that can be scraped off, bleeding
Tx: topical antifungals
Ulcerations
Recurrent Aphthous Ulcer
Ae: unclear, F>M, common in developed world. can be predisposed
feats: Minor vs Major or Herptiform
Tx: treta predisposing factors, topicals, then systemics if no change
Minor <1cm , 10-14 days duration, No scarring, Non-keratinized mobile mucosae (Lip, buccal mucosa, floor of mouth, sulci or ventral tongue).
Major
1 cm, >14 days duration, Yes scarring, Anywhere, including keratinized mucosae (Dorsum of the tongue and hard palate).
Neoplasma
Infantile Haemangioma
Ae: Most common benign soft tissue tumours, endothelial cell neoplasm
feats: blue or pink macules or patches.
tx: self-limiting, topical therapies (B-blockers +corticosteroids)
Lymphangioma
Ae: benign lesion of the tongue, present at birth
feats: reddish, blue soft, compressible
Tx: surgical resection
Traumatic Overgrowth
Fibro-epithelial polyp
- Reactive connective tissue hyperplasia
- Tongue, lip, palate, or buccal mucosa
- Surgically removed.
-
Pyogenic Granuloma
- Cause is unknown-? Trauma, F> M
- Benign vascular tumors of the skin or mucous membranes
- Red lip and gingival mucosa
-
Pediatric Leukemia
Ae: Acute Lymphoblastic leukaemia (ALL) + Leukemia 30% of all childhood cancers
feats: Oral ulcers, Gingival enlargement, Anemia
Tx: Chemo, Stem Cell Ther
Syndromes
Trisomy 21 (Down's)
Associated Symptoms: physical growth delays, characteristic facial features, and mild-moderate intellectual disability
Oral feats:
Supernumary teeth
Enamel hypoplasia
Macroglossia/fissured tongue
Reduction of salivary flow/Aplsiasia of parotid
-
Prevention
Concentrations of fluoride recommended in NZ toothpaste
- 1000ppm: 0.22%
- 1450ppm: 0.312%
Clinpro varnish/ duraphat: 22,600ppm fluoride
-
-
Dental restorative materials containing fluoride: GIC, alginate
Fluoride formulations in NZ:
Sodium fluoride and sodium monofluorophosphate
- Given to pts: One week before strip crowns under GA to improve gingival health prior to surgery
-
Restorative Materials
Amalgams
Advantages
– Effective
– Cheap
– Durable
– Simple to use
– Long track record with safety
Disadvantages
– Unaesthetic
– Requires mechanical retention
– Toxicity concerns
Composite
Advantages
– Aesthetic
– Adhesive (with bond agent)
– Controlled set
– Reasonable wear resistance
Disadvantages
– Technique sensitive
– Expensive
– Polymerization shrinkage
Compomers
Advantages
– Aesthetic
– Command set
– Available in colours (Twinky Star)
Disadvantages
– Cost
– Technique sensitive
RMGIC
Advantages
– Aesthetic
– Adhesive
– Controlled set
Disadvantages
– Technique sensitive
– Cost
– Polymerization shrinkage
GIC
Advantages
– Tooth coloured
– Chemical bond to dentine
Disadvantages
– Technique sensitive
– Setting time
– Poor wear resistance
– Poor compressive strength
– Poor track record in pediatric interproximal restoration
SSC
-
Hall Crown Technique
- No caries removal, no L.A, no tooth prep
- Not for anxious children or adv. carious lesions
Behavior Management
TELL
SHOW
DO
- Perform immediately without delay
Reinforcement
- behaviour that follows a stimulus & is reinforced, is strengthened, and is more likely to recur in a similar circumstances
Voice Control
- creates a positive/calming environement
Music
- Lowered stress/anxiety/pain perception
- distraction, emotional stimulus
-
Diagnosis and Tx Plan
- Understanding developmental stages
- Recognition of normal
- Systematic Approach
- Understanding caries
- Degree of suspicion
- Actue --> manage immediately
- Dental Age --> stage of dentition
- Caries Risk --> L/M/H, do not prolong
- Perio health --> Y/N?
- OH/Prevention --> distribution, age, conttributing
- Behavior Manag --> anxiety/stress, issue?
- Occlusion --> development
- Trauma --> Hx, tx, follow up
- Establishes a preventive program
- Addresses all oral conditions, dental diseases & injuries
Holistic
- Treating a child not a tooth
- Not a list of procedures
- Behavior shaping
- Prevention
- Growth and development (Interceptive orthodontics?)
Sequenced
- gradual introduction
- simple/least invasive