ORE Part 2 Paediatric Dentistry 4 — Questions and Answers
Question 1: What is the recommended treatment for a pulp-exposed primary molar in a symptom-free child with a carious exposure?
- Pulpotomy with Biodentine or formocresol, followed by stainless steel crown (Correct answer)
- Direct pulp cap only
- Extraction always
- Root canal treatment (pulpectomy) as first choice
Correct answer: Pulpotomy with Biodentine or formocresol, followed by stainless steel crown
Pulpotomy (amputation of coronal pulp with placement of a medicament and SSC) is the first-line treatment for carious pulp exposure in symptom-free primary molars in cooperative children.
Question 2: What is the rationale for using a stainless steel crown (SSC) following pulpotomy in a primary molar?
- Protect the structurally weakened tooth and seal the pulpotomy medicament (Correct answer)
- Purely aesthetic
- Prevent root resorption only
- Because composite cannot be used on primary teeth
Correct answer: Protect the structurally weakened tooth and seal the pulpotomy medicament
SSCs provide full coronal coverage and a durable seal following pulpotomy, protecting against fracture of the weakened tooth and microleakage that could compromise the pulpotomy.
Question 3: According to the BSPD clinical guidelines, what is the recommended age to consider extractions under general anaesthesia (GA) as a last resort in children?
- GA should always be a last resort at any age after failing all other options (Correct answer)
- Under 3 years as first choice
- At age 6 routinely
- For all anxious children regardless of prior management
Correct answer: GA should always be a last resort at any age after failing all other options
BSPD and NHS guidelines emphasise GA as an absolute last resort at any age, after exhausting behaviour management, inhalation sedation, and conscious sedation options.
Question 4: What is the 'ectopic eruption' of a first permanent molar and what is its clinical significance?
- Eruption path leading to resorption of the distal root of the second primary molar (Correct answer)
- Eruption of the molar on the opposite side of the arch
- Delayed eruption without complications
- Early eruption of a molar above the occlusal plane
Correct answer: Eruption path leading to resorption of the distal root of the second primary molar
Ectopic eruption of the first permanent molar involves it impacting on the distal surface of the second primary molar, causing root resorption and potential loss of space.
Question 5: What is the recommended topical fluoride regime for a high-caries-risk child aged 3–6 years in England?
- Fluoride varnish (22,600 ppm) applied by a professional at least twice per year plus 1,000 ppm toothpaste twice daily (Correct answer)
- Fluoride tablets alone
- 2,800 ppm toothpaste twice daily
- No additional fluoride beyond water fluoridation
Correct answer: Fluoride varnish (22,600 ppm) applied by a professional at least twice per year plus 1,000 ppm toothpaste twice daily
NICE and 'Delivering Better Oral Health' recommend professional fluoride varnish (≥22,600 ppm) at minimum twice yearly combined with twice-daily brushing with age-appropriate 1,000 ppm fluoride toothpaste.
Question 6: What is the clinical presentation of a dentigerous cyst in a child and what is its most common associated tooth?
- Radiolucency around the crown of an unerupted tooth, most commonly the lower third molar or canine (Correct answer)
- Multilocular radiolucency only
- Always symptomatic with pain
- Associated with primary teeth only
Correct answer: Radiolucency around the crown of an unerupted tooth, most commonly the lower third molar or canine
A dentigerous cyst envelops the crown of an unerupted tooth (>3 mm pericoronal space) and is most frequently found associated with lower third molars, upper canines, or lower premolars.
ORE Part 2 Paediatric Dentistry 4
What is the recommended treatment for a pulp-exposed primary molar in a symptom-free child with a carious exposure?