Paediatric
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what is the pattern of eruption of primary dentition
generally lowers before uppers except upper later a,b,d,c,e
when is primary dentition complete by
2.5 to 3 years
what are some differences between primary and permanent teeth
primary has more narrow roots which tend to flare out to make way for permanent primary enamel and dentine is much thinner pulp is much larger and more easily exposed in a restoration
what can be seen in first primary molars
large mesiobuccal tubercle
what is in a second upper primary molar
transverse ridge
what is in a second lower primary molar
3 cusps
how is space created for permanent dentition
anthroid space - infront of upper canine and behind lower canine primary molars are much bigger than the permanent premolars to come - leeway space also incisors are more tilted in permanent
what is the pattern of eruption in permanent teeth
first molar, central incisor, lateral incisor then upper - first premolar, second premolar, canine, 2nd and 3rd molars lower - canine, 1st and 2nd premolar, 2nd and 3rd molar
why is orthodontics not given until canine is through
canine pushes the incisors together
what is the ugly duckling phase
when the roots of incisors are displaced ditsally, creating a gap midline
what is the sequence of restorations in paeds
prevention, fissure sealant, preventative restoration, shallow restoration, restoration requiring LA, pulpotomy
what should be the depth of occlusal cavity
no deeper than 1.5mm, risk pulpal exposure
what are the indications to use a crown
no radiographic evidence of caries into pulp, enough sound tissue for a crown to bond to
what are the benefits of using a crown
lasts much longer, less likely to get secondary caries, doesnt require LA or tooth prep so child doesnt have to co-ordinate too much
what other restorative materials are available and how do they compare to one another
amalgam (but not now), composite, compomer, RMGI, GI amalgam lasts longer than all compomer lasts longer than composite and RMGI RMGI is better than GI composite is not ideal - requires good moisture control - rubberdam, need LA
what instruments are required for placement of stainless steel crown
fissure bur, crown climper pliers, GI cement
what factors influence caries management in children
compliance, extent of caries, OH, space maintainer
what are the indications and contraindications for a pulpotomy
indications - reversible pulpitis, good haemostasis, good co-operation, space maintainer, medical history prevents exraction, hypodontia contraindications - poor co-operation, poor dental attendance, multiple grossly carious teeth,
what are some disadvantages of extraction of primary teeth
allows for drifting, especially permanent molar, traumatic, impeeded speech and masticatory
what is used in pulpotomy for controlling bleeding, calming pulp and cement
ferric sulphate held on for 20 seconds to stop bleeding, the calcium hydroxide or zinc oxide eugenol, then GIC cement for crown
what are the indications for a pulpectomy
irreversible pulpitis, cannot achieve haemostasis, periapical absess, pulp necrosis
briefly describe steps in a pulpectomy
remove roof of pulp chamber, remove coronal pulp, try ferric sulphate to reduce bleeding, use filers to remove pulpal tissue, then rinse pulp chambers with chlorhexidine, fill with CaOH, and over coronal, can then place GI cement for crown
why should the files be stopped 2mm from working length
to prevent damage to developing tooth, apices are open so can go through to permanent tooth
what is the first thing that should be done when a tooth is fractured
prevent bacterial ingress as this causes pulpal death