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: 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

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

Chief complaint Hx of complaint

History taking

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

Hx of admission

Cause, when, where & Tx received

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

PMH PDH

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 occurs within six months after the procedure.

Dental procedure requiring antibiotic prophylaxisAll dental procedures involving

manipulation of gingival tissue or the apical region of teeth or perforation or oral mucosa

includingExtraction

Routine cleaning

Scaling and root planing

Periapical root canal treatment

Fitting orthodontic bands

placing subgingival medications

Biopsy

Suture removal

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

Regimen: Single Dose 30 to 60 minutes before procedure

SITUATION AGENT ADULTS CHILDREN

ORAL amoxicillin 2g 50mg/kg

UNABLE TO TAKE ORALLY

Ampicillin OR Cefazolin or ceftriaxone

2g IM or IV

1g IM or IV

50mg/kg IM or IV

50mg/kg IM or IV

ALLERGIC TO PENICILLINS OR AMPICILLIN-ORAL

Cephalexin*ORClindamycinORAzithromycin or clarithromycin

2g

600mg

500mg

50mg/kg

20mg/kg

15mg/kg

ALLERGIC TO PENICILLINS OR AMPICILLIN-UNABLE TO TAKE ORALLY

Cefazolin or ceftriaxoneOR Clindamycin

1g IM or IV

600mg

50mg/kg IM or IV

20mg/kg IM or IV

History taking

congenital heart disease

significant hereditary disease

sibling with the same disease

Diet hx sweet food

consumption, bottle feeding (frequency, amount, type)

Habit thumb sucking Parafunctional habit

Family History Social History

Clinical 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

Extraoral examination Intraoral examination

6 o E op C m E mp 6 o

E ol(f) E mo

Clinical Examination

PE 11, 21 UE 12,22

Differential diagnoses

Irreversible pulpitis Acute periapical abscess Acute periapical periodontitis Pulp necrosis

Investigations

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

radiolucency on 55 caries (enamel+dentin+pulp)

radiopaque on 85 restoration (enamel+dentin+pulp)

radiolucency on 26 caries (enamel+dentin)

radiolucency on 16 caries (enamel+dentin)

radiolucency on 46 caries (enamel+dentin)

widening of PDL space dm of 85

OPG Periapical xray

Definitive diagnosis

Irreversible pulpitis

Treatment Options

Pulpotomy +/- ssc Partial pulpotomy +/- ssc Pulpectomy +/- ssc Extraction (balancing & compensating)

space maintainer

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