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Paeds – PBL

Paeds – PBL. Group 4. Trigger . Trigger 1: A 7 year old girl is seeking your help because of toothache on her lower right teeth. She came with her mother. According to her mother, at birth she was diagnosed to have “hole on her heart” Trigger 2:

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Paeds – PBL

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  1. Paeds – PBL Group 4

  2. Trigger • Trigger 1: • A 7 year old girl is seeking your help because of toothache on her lower right teeth. She came with her mother. According to her mother, at birth she was diagnosed to have “hole on her heart” • Trigger 2: • During history taking, mother claimed that the daughter had: • No sleep for the last 3 nights due to pain • Been treated by antibiotics and analgesics previously • She went to a dentist and the dentist filled the tooth with ‘temporary’ filling. The mother claimed that the daughter was reasonably cooperative during previous treatment. The mothe wanted you to fix her daughter’s problem

  3. History taking Chief complaint Hx of complaint • toothache on her lower right teeth • ‘hole on her heart’ • No sleep for the last 3 days • Been treated by antibiotics and analgesics • History of pain: • site • onset • characteristics • type of pain • severity • radiation • Alleviating factors • Aggravating factors • recurrence • assoc symptom (swelling, LOA, discharge) • Treatment received: • Type of treatment • Efficacy of the treatment

  4. History taking PMH PDH • hole on heart • tx done • surgery (prosthetic heart valve) • med (eg. Anticoagulant)  refer guidelines (AHA) • Follow up • Frequency & Location • medication • symptom • SOB, Cyanosis, Lethargy, Fever, Malaise • IE • Other disease • Blood, Kidney • Allergy • Medication, Food, Material • Hxof admission • Cause, when, where & Txreceived • Other types of medication • Last visit and tx done (when, where, what) • Temporary filling, reasonably cooperative • Restoration  duration, • History of extraction • Complication (prolong, bleeding, infection) • Plaque control

  5. Cardiac conditions associated with highest risk of adverse effect from endocarditis for which prophylaxis with dental procedures is reasonable • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair • Previous IE • Certain specific, serious Congenital Heart Disease (CHD) • Unrepaired cyanotic congenital heart defect with prosthetic heart material or device whether placed by surgery or by catheter intervention, during first 6 month after the procedure.* • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device(which inhibit endothelialization) • Cardiac transplantation recipients who develop cardiac valvulopathy *Prophylaxis is reasonable because endothelialization of prosthetic material occurswithin six months after the procedure.

  6. Situation Agent Regimen—Single Dose(30-60 minutes before procedure)

  7. History taking Family History Social History • congenital heart disease • significant hereditary disease • sibling with the same disease • Diet hx • sweet food consumption, bottle feeding (frequency, amount, type) • Habit • thumb sucking • Parafunctionalhabit

  8. Clinical Examination Extraoral examination Intraoral examination • face, TMJ, lip, mouth opening • lymph node (palpable) + neck • skin (cyanosis) • swelling (fluctuant etc) • site of complaint (85 OL) • presence of temporary restoration (intact) • condition of adjacent structure • presence of sinus tract • TTP, tender to palpation, pocket, mobility, vitality, bleeding • Caries • charting

  9. Clinical Examination • PE 11, 21 • UE 12,22

  10. Differential diagnoses • Irreversible pulpitis • Acute periapicalabscess • Acute periapicalperiodontitis • Pulp necrosis

  11. Investigations OPG Periapicalxray • all developing permanent teeth present except 8’s • all 6’s erupted • all 1’s and lower 2’s erupted • other permanent teeth still not erupt • radiolucencyon 55  caries (enamel+dentin+pulp) • radiopaqueon 85  restoration (enamel+dentin+pulp) • radiolucencyon 26  caries (enamel+dentin) • radiolucencyon 16  caries (enamel+dentin) • radiolucencyon 46  caries (enamel+dentin) • widening of PDL space dm of 85

  12. Definitive diagnosis • Irreversible pulpitis

  13. Treatment Options • Pulpotomy+/- ssc • Partial pulpotomy+/- ssc • Pulpectomy+/- ssc • Extraction (balancing & compensating) space maintainer

  14. Treatment plan • Emergency • behavior mx (non pharmaco) • prphyab • pulpotomy &ssc • Preventive • OHI • scaling + prophy • diet counseling • FS & PRR • Restorative • restoration of carious tooth • Extraction  nil • Review  fluoride application • Maintenance – r/v

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