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Transcript
Rubenstein Taybi Syndrome Oral and Dental Features Carol Mason Consultant in Paediatric Dentistry Great Ormond Street Hospital for Children NHS Foundation Trust Overview • • • • • • Oral and Dental Features Problems Management Prevention of Dental Disease Practical Tips for Oral Hygiene Hospital Passport Oral and Dental Features a/b: c: high arched, narrow palate wide alveolar ridges extra cusps d: e: extra tooth (mesiodens) extra tooth Oro-Dental Features as Useful Diagnostic Tool in Rubinstein–Taybi Syndrome A. Bloch-Zupan et al Am J of Med Gen Part A 143A:570–573 (2007) Oral and Dental Features Oro-Dental Features as Useful Diagnostic Tool in Rubinstein–Taybi Syndrome A. Bloch-Zupan et al Am J of Med Gen Part A 143A:570–573 (2007) f: screw-driver incisors, opacities g-i: talon cusps Also – crowding, wear Problems • Difficulties with oral hygiene – Crowded teeth – Shape of teeth – Manual dexterity – Learning disability • Increased risk of caries – As above (+ dietary influences) Problems • High, narrow palate food trapping difficult denture • Extra cusps / teeth • Crowding difficult hygiene • Wear sensitivity Management • Talon Cusps: – Sealing – Sequential grinding – Reduction (with or without pulp exposure) Management • Crowding: – Extractions and “driftodontics” – Simple orthodontic treatment – Complex orthodontic treatment Dental Caries (Decay) For dental caries to develop, need • Susceptible tooth surface • Fermentable carbohydrate • Bacteria • Time The Acid “See-Saw” www.oralanswers.com Prolonged / Frequent Sugar Exposure Drinks and Snacks Choose Safer Snacks Prevention of Dental Disease • Evidence-based toolkit AVOID DENTAL DISEASE Summary Guidance Tables Summary Guidance Tables Amount of toothpaste “Smear” “Pea” Summary Guidance Tables Summary Guidance Tables Summary Guidance Tables Summary Guidance Tables Summary Guidance Tables Main Messages • • • • Breast feeding best nutrition for babies Brush 2x day (last thing at night + one other) Parents/carers brush or supervise Fluoride toothpaste: – 0-3 yrs smear of no less than 1000ppm F – 3-6 yrs pea-sized 1000-1500ppm F • Spit don’t rinse • Frequency + amount of sugary foods and drinks • Sugar free medicines • Do not smoke • Alcohol, Fruit and Veg Oral Hygiene Difficulties Common Complaints • “Toothbrush is difficult to hold….” • “He / She doesn’t like the taste…” • “I only have a short time….” • “He / she clamps down on the brush…..” “Toothbrush is difficult to hold….” Electric toothbrush Modified handles “He / She doesn’t like the taste…” Try……. Also useful in - Oral aversion / nil by mouth - Unsafe swallow - Autism (add flavour/colour) - Sore mouth / ulcers “I only have a short time….” Dr Barman’s Super Brush Electric toothbrush “He / she clamps down on the brush…..” Two–side / Two-brush technique Mouth “props” “He / she clamps down on the brush…..” Two–side / Two-brush technique Mouth “props” “He / she clamps down on the brush…..” Thimbles Positioning for Oral Hygiene Joanna Douglass Fun Toothbrushes Musical Lighting up Hi-Tec Oral Hygiene Many Apps available Electric brushes with timers and smiley faces Oral Hygiene Aids • Soft post surgical brush (TePe) • Collis-Curve toothbrush • Chemical adjuncts (chlorhexidine / triclosan) TePe Special Care Toothbrush www.colliscurve.co.uk Chlorhexidine and fluoride Oral Hygiene Aids Cleaning between teeth / crowded teeth Aspirating tooth-brush – fits onto suction machine Parents Central members of MDTs “Experts by Experience”