Membership of the Joint Dental Faculties (MJDF) Paediatric Dentistry and Orthodontics Syllabus

Paediatric Dentistry and Orthodontics syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Paediatric Dentistry and Orthodontics in Membership of the Joint Dental Faculties (MJDF), not a summary of it.

1. 1

   Child Patient Management

   4 topics

   • Behaviour management and acclimatisation
   • Age-appropriate communication and consent
   • Dental anxiety and use of sedation in children
   • Safeguarding and recognition of dental neglect and abuse
2. 2

   Management of Caries in Children

   4 topics

   • Caries risk assessment and prevention in children
     • Delivering Better Oral Health toolkit guidance
     • Fluoride varnish and fissure sealants
   • Restoration of primary teeth and Hall technique
   • Pulp therapy in primary teeth
   • Management of the unrestorable primary tooth
3. 3

   Developmental and Eruption Disorders

   4 topics

   • Tooth eruption sequence and disturbances
   • Molar incisor hypomineralisation and enamel defects
   • Hypodontia and supernumerary teeth
   • Management of the first permanent molar of poor prognosis
4. 4

   Orthodontic Assessment and Interceptive Care

   4 topics

   • Malocclusion classification
     • Incisor and molar relationships
     • IOTN and treatment need
   • Recognition and timing of orthodontic referral
   • Interceptive measures including space maintenance
   • Management of ectopic and impacted teeth

Paediatric Dentistry and Orthodontics flashcards for Membership of the Joint Dental Faculties (MJDF)

25 of 50 cards from the Paediatric Dentistry and Orthodontics deck — real questions with worked answers.

1. What is the recommended order of behaviour management techniques when introducing a child to dental treatment?

   Use a graded, non-pharmacological approach first: tell-show-do, acclimatisation/desensitisation, positive reinforcement, modelling, distraction and voice control. Pharmacological methods (sedation, GA) are reserved for when these fail or are inappropriate.

2. Describe the tell-show-do technique.

   Tell: explain the procedure in age-appropriate language. Show: demonstrate the procedure (e.g. on a finger, model or the child's nail). Do: carry out the procedure exactly as demonstrated. It reduces uncertainty and builds trust/acclimatisation.

3. What is the purpose of acclimatisation (systematic desensitisation) visits in paediatric dentistry?

   To gradually expose an anxious child to the dental environment and stimuli in small, non-threatening steps, allowing them to build coping skills and trust so that treatment can later be carried out without distress.

4. At what age is a child in the UK generally presumed competent to consent to their own dental treatment, and on what basis?

   At 16 a young person is presumed to have capacity to consent (Family Law Reform Act 1969). Under 16, a child may consent if assessed as Gillick competent — able to understand, retain and weigh the relevant information.

5. Who can give valid consent for dental treatment of a young child in the UK?

   A person with parental responsibility (or the Gillick-competent child themselves). Consent must be informed, given voluntarily, and the person must have capacity.

6. What is meant by age-appropriate communication when consenting a child?

   Tailoring language, explanation and choices to the child's developmental stage — using simple concrete terms for young children, involving them in decisions, and ensuring both child and parent understand the procedure, risks, benefits and alternatives.

7. Which forms of conscious sedation are most commonly used for children in UK dental practice?

   Inhalation sedation with nitrous oxide/oxygen ($\ce{N2O/O2}$, relative analgesia) is first-line. Intravenous and oral sedation (e.g. midazolam) are used in specialist settings; multi-drug techniques require a hospital environment.

8. What is the definition of conscious sedation?

   A technique producing a depressed level of consciousness that enables treatment, while verbal contact with the patient is maintained throughout. The drugs/techniques used must carry a margin of safety wide enough to make loss of consciousness unlikely.

9. What are the main advantages of inhalation (nitrous oxide) sedation in children?

   Rapid onset and recovery, easily titratable, provides analgesia and anxiolysis, no injection needed, and maintains protective reflexes and verbal contact. It is the safest sedation technique for children.

10. List key alerting signs that should raise suspicion of dental neglect.

    Obvious untreated dental disease causing pain/sepsis, failure to attend or complete treatment, repeated DNAs, parent ignoring advice, and dental disease out of keeping with the level of care provided — particularly when it affects the child's wellbeing.

11. What does the dental safeguarding mnemonic 'preventive dental team management → preventive multi-agency management' escalation describe?

    A staged response to suspected neglect: raise concern with parents and offer support/preventive care; if no improvement, liaise with other professionals (multi-agency); and if the child remains at risk, refer to children's social care following local safeguarding procedures.

12. Which orofacial injuries in a child are particularly suspicious of physical abuse?

    Injuries to the head, face, ears and neck; torn labial frenum (especially in a non-mobile infant); bruising of soft tissues; bite marks; and injuries whose pattern or history is inconsistent or changing.

13. Name the high-risk caries indicators used in a child's caries risk assessment.

    Past caries experience, high/frequent sugar intake, poor oral hygiene/plaque, low fluoride exposure, medical conditions, special needs, low socioeconomic status, and infrequent dental attendance.

14. What fluoride toothpaste concentration does Delivering Better Oral Health recommend for children up to 3 years and for high-risk children?

    All children up to 3 years: at least 1000 ppm fluoride, smear amount. Children 3–6: 1000+ ppm, pea-sized. Children giving concern/high caries risk: prescribe higher-concentration paste (e.g. 1350–1500 ppm, or 2800 ppm from age 10).

15. How often should fluoride varnish ($\ce{NaF}$ 22600 ppm, 5%) be applied to children, and from what age?

    Apply at least twice yearly from age 2 (2 to 3 times a year). High-risk children may receive applications up to 4 times per year.

16. What is the Hall technique?

    A biological (non-restorative) method of managing carious primary molars by cementing a preformed metal crown over the tooth with glass ionomer cement, sealing the caries in without local anaesthetic, caries removal or tooth preparation.

17. On what principle does the Hall technique work?

    Sealing carious dentine from the oral biofilm arrests lesion progression by depriving cariogenic bacteria of substrate, so the caries becomes inactive even though it is not removed.

18. What are the contraindications to the Hall technique?

    Signs of irreversible pulpitis or dental sepsis (abscess, sinus, non-physiological mobility), clinical/radiographic pulpal involvement, and inability to achieve a seated crown. Also caution where there is risk of nickel allergy or where occlusal space is inadequate.

19. What materials are preferred for restoring primary teeth, and why?

    Preformed (stainless steel) crowns for multi-surface/extensive caries (most durable); glass ionomer/resin-modified GIC and compomers for fluoride release and ease of placement; composite for anterior aesthetics. SSCs have the highest success rate for multi-surface lesions.

20. Compare pulpotomy and pulpectomy in primary teeth.

    Pulpotomy: removal of the coronal pulp only, leaving vital radicular pulp, used for reversible/coronal pulpitis. Pulpectomy: removal of the entire (coronal and radicular) pulp and canal filling with a resorbable material, used for irreversible pulpitis or necrosis.

21. Which medicament is now most commonly recommended for primary molar pulpotomy, and what historically used agent has been abandoned?

    Ferric sulfate or MTA/Biodentine are recommended for vital pulpotomy. Formocresol is being phased out due to concerns over formaldehyde toxicity/carcinogenicity.

22. What canal-filling material is used in primary tooth pulpectomy and why must it be resorbable?

    A resorbable paste such as zinc oxide eugenol, iodoform-based (e.g. Vitapex/Metapex, $\ce{Ca(OH)2}$+iodoform) is used so it resorbs in step with the physiological root resorption, avoiding interference with the succedaneous permanent tooth.

23. What are the management options for an unrestorable primary tooth?

    Extraction (under LA, sedation or GA as appropriate), with consideration of balancing/compensating extractions and space maintenance. The decision weighs the child's cooperation, symptoms, and the position relating to the developing permanent dentition.

24. Define balancing and compensating extractions.

    Balancing extraction: removal of the contralateral tooth in the same arch to prevent a centreline shift. Compensating extraction: removal of the equivalent opposing-arch tooth to prevent over-eruption. Used mainly with primary canines/first molars to maintain symmetry.

25. State the eruption sequence of the primary dentition.

    A (central incisor) ~6 months, B (lateral incisor) ~7–9 months, D (first molar) ~12–18 months, C (canine) ~16–22 months, E (second molar) ~24–33 months. All 20 primary teeth are usually present by ~3 years.

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