Paeds pbl
This presentation is the property of its rightful owner.
Sponsored Links
1 / 15

Paeds – PBL PowerPoint PPT Presentation


  • 62 Views
  • Uploaded on
  • Presentation posted in: General

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:

Download Presentation

Paeds – PBL

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Paeds pbl

Paeds – PBL

Group 4


Trigger

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


History taking

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


History taking1

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


Paeds pbl

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.


Paeds pbl

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


History taking2

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


Clinical examination

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


Clinical examination1

Clinical Examination

  • PE 11, 21

  • UE 12,22


Differential diagnoses

Differential diagnoses

  • Irreversible pulpitis

  • Acute periapicalabscess

  • Acute periapicalperiodontitis

  • Pulp necrosis


Investigations

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


Definitive diagnosis

Definitive diagnosis

  • Irreversible pulpitis


Treatment options

Treatment Options

  • Pulpotomy+/- ssc

  • Partial pulpotomy+/- ssc

  • Pulpectomy+/- ssc

  • Extraction (balancing & compensating) space maintainer


Treatment plan

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


  • Login