Diploma of the Faculty of Dental Surgery (MFDS) Paediatric Dentistry and Orthodontics Syllabus

What is the difference between a pulpotomy and a pulpectomy in primary teeth?

Pulpotomy: removal of coronal pulp only, radicular pulp left vital. Pulpectomy: complete removal of coronal and radicular pulp, canals filled with a resorbable material (e.g. zinc oxide-eugenol or iodoform paste) — indicated for irreversible pulpitis or necrosis.

Why must non-resorbable materials (e.g. gutta-percha) be avoided in primary tooth root fillings?

Primary tooth roots physiologically resorb before exfoliation; the root filling must resorb with the root. Resorbable pastes (ZOE, iodoform-based) are used so they do not impede eruption of the permanent successor.

Define Early Childhood Caries (ECC) and Severe ECC (S-ECC).

ECC: presence of one or more decayed (cavitated or non-cavitated), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under 6. S-ECC: any smooth-surface caries under age 3, or specific dmfs thresholds at given ages.

What feeding habit is the classic cause of 'nursing/bottle caries' and which teeth are affected/spared?

Prolonged/nocturnal bottle feeding with sugary drinks or on-demand breastfeeding. Maxillary incisors are affected first; the mandibular incisors are typically spared (protected by the tongue and saliva from sublingual glands).

Outline the key prevention strategies (the 'evidence-based prevention' package) for children.

Twice-daily brushing with fluoride toothpaste (supervised, spit don't rinse), dietary advice to reduce sugar frequency, fluoride varnish application, fissure sealants on permanent molars, and regular recall based on risk.

What material and indication apply to fissure sealants in children?

Resin-based sealants (or GIC if moisture control is poor) applied to caries-free or early-lesion pits and fissures, particularly permanent first molars soon after eruption, to prevent occlusal caries.

In a child presenting with dental trauma, what are the key historical questions (the 'when, where, how')?

When the injury occurred (time elapsed affects prognosis), where (tetanus risk if contaminated), how it happened (mechanism, and whether the account is consistent — safeguarding concern), and whether there was loss of consciousness/other injury.

How is an avulsed PERMANENT tooth managed at the scene and why is primary tooth avulsion managed differently?

Permanent tooth: reimplant immediately, or store in milk/saliva/HBSS and seek urgent care; reimplantation is time-critical for periodontal ligament viability. Avulsed PRIMARY teeth are NOT reimplanted (risk of damage to the permanent successor).

What is the ideal storage medium ranking for an avulsed permanent tooth?

Best: replant immediately. Otherwise (in order): Hank's Balanced Salt Solution > cold milk > saliva (in mouth/buccal sulcus or container) > saline. Avoid water (hypotonic — lyses PDL cells) and dry storage.

Classify the main types of luxation injuries to teeth.

Concussion (no displacement, tender), subluxation (loosened, no displacement), extrusion (partial axial displacement out of socket), lateral luxation (displaced laterally, often with alveolar fracture), and intrusion (displaced into the socket/alveolar bone).

What is the main concern when a primary tooth is intruded, and what guides management?

The relationship of the intruded primary root to the developing permanent tooth germ. If the root is displaced toward the germ (apex palatally on radiograph appearing elongated), extraction is considered; if away (apex labially, foreshortened), spontaneous re-eruption is allowed.

What is amelogenesis imperfecta and its three main types?

An inherited defect of enamel formation affecting all/most teeth in both dentitions. Types: hypoplastic (thin/deficient enamel — reduced quantity), hypomineralised/hypocalcified (soft, normal-thickness enamel that wears), and hypomaturation (mottled, normal thickness but poorly matured).

What is dentinogenesis imperfecta and its hallmark clinical/radiographic features?

An inherited dentine defect (sometimes linked to osteogenesis imperfecta). Teeth appear opalescent/grey-brown, enamel chips off exposing soft dentine causing rapid wear. Radiographs show bulbous crowns, cervical constriction, and obliterated pulp chambers.

What is Molar Incisor Hypomineralisation (MIH)?

A qualitative, demarcated developmental defect of enamel of systemic origin affecting one or more first permanent molars, often with incisors. Lesions are demarcated white/cream/yellow-brown opacities; molars may show post-eruptive breakdown and hypersensitivity.

Define hypodontia, oligodontia, and anodontia.

Hypodontia: developmental absence of one or more (usually fewer than six) teeth excluding third molars. Oligodontia: absence of six or more teeth (excluding third molars). Anodontia: complete absence of all teeth.

Which teeth are most commonly congenitally absent (hypodontia) in the permanent dentition?

Excluding third molars (most commonly absent overall), the most commonly missing are the mandibular second premolars and the maxillary lateral incisors.

What is a supernumerary tooth, and name the common types by morphology and location.

An extra tooth beyond the normal complement. Types: conical (peg-shaped, e.g. mesiodens between upper centrals), tuberculate (barrel-shaped, often paired, palatal, prevent incisor eruption), supplemental (normal morphology), and odontome.

What is a mesiodens and a key clinical consequence?

A supernumerary tooth located in the midline of the maxilla between the central incisors. It can cause failure of eruption of permanent incisors, midline diastema, or displacement, and often requires removal.

List clinical features that should raise suspicion of non-accidental injury (NAI) in a child.

Injury inconsistent with the history given, delay in seeking treatment, changing/vague accounts, injuries of varying ages, bilateral/symmetrical injuries, torn labial frenum (esp. pre-walking), bruising in unusual sites, bite marks, and burns.

What proportion of physical child abuse involves the head, face, and neck, and why is this relevant to dentists?

Approximately 50-65% of physical abuse injuries involve the head, face, mouth, or neck (orofacial region), placing dental professionals in a key position to detect signs of abuse.

What is the dentist's duty if child abuse/neglect is suspected (UK safeguarding)?

Dentists have a professional and statutory duty to safeguard children: document findings carefully, follow local safeguarding procedures, discuss with the safeguarding lead, and refer/share concerns with social services — the child's welfare is paramount (Children Act 1989/2004).

Describe Angle's classification of malocclusion.

Based on first molar relationship. Class I: mesiobuccal cusp of upper first molar occludes in the buccal groove of lower first molar (normal AP). Class II: lower molar distal to this (overjet increased). Class III: lower molar mesial to this (lower teeth/jaw protrusive).

Distinguish Class II division 1 from Class II division 2 malocclusion.

Both have a Class II molar/skeletal tendency. Division 1: upper central incisors proclined or average, increased overjet. Division 2: upper central incisors retroclined, often with increased overbite and reduced/normal overjet.

How is incisor relationship classified (British Standards Institute)?

Based on the lower incisor edge relative to the cingulum plateau of the upper central incisors. Class I: lower edge occludes on/below cingulum. Class II: lower edge posterior to cingulum (div 1 = proclined uppers/inc overjet; div 2 = retroclined uppers). Class III: lower edge anterior to cingulum.

Define overjet and overbite.

Overjet: the horizontal (anteroposterior) distance between the upper and lower incisor edges (normal $\approx 2$-$4\,\text{mm}$). Overbite: the vertical overlap of the lower incisors by the upper incisors (normal $\approx$ one third to one half of lower incisor crown).

What records are typically taken for an orthodontic assessment?

Study models (or digital scans), clinical photographs (extra- and intra-oral), radiographs (OPT/panoramic and lateral cephalogram), and an assessment of the index of orthodontic treatment need (IOTN).

What is the IOTN and its two components?

Index of Orthodontic Treatment Need — used to assess need for treatment. Two components: the Dental Health Component (DHC, grades 1-5, scored on worst feature) and the Aesthetic Component (AC, a 10-point photographic scale). Grade 4-5 DHC indicates definite need.

What is serial extraction / interceptive management of crowding in the developing dentition?

A planned sequence of extractions (e.g. primary canines, then primary first molars, then first premolars) to relieve anterior crowding and guide eruption. More commonly, balancing and compensating extractions are used to maintain symmetry and midline.

Differentiate a 'balancing' extraction from a 'compensating' extraction.

Balancing extraction: removing a tooth (often the contralateral tooth in the same arch) to preserve the dental midline/symmetry. Compensating extraction: removing the equivalent tooth in the opposing arch to maintain the occlusal relationship.

What features of a developing malocclusion warrant referral to an orthodontist?

Anterior or posterior crossbites with displacement, increased overjet (>$6\,\text{mm}$, trauma risk), impacted/ectopic teeth (esp. canines), unerupted teeth/supernumeraries, severe crowding or spacing, hypodontia, and significant skeletal discrepancies.

Why is early detection of an ectopic/palatally displaced maxillary canine important, and how is it assessed?

Early detection allows interceptive extraction of the primary canine (around age 10-13) which may redirect the permanent canine and avoid surgery. Assessed by palpation of the buccal sulcus from ~age 9-10; if not palpable, radiographs (parallax) localise it.

State the principle of retention and why it is needed after orthodontic treatment.

Teeth tend to relapse toward their original positions because periodontal/gingival fibres remodel slowly and growth continues. Retainers (fixed bonded or removable, e.g. vacuum-formed/Hawley) hold teeth until tissues stabilise; certain results require lifelong retention.

Which orthodontic results are most prone to relapse and may require permanent retention?

Corrected rotations, closed median diastemas, instanding/proclined lower incisors and any case where lower incisor position was changed, and expanded arches. These often need indefinite (lifelong) retention to maintain stability.