Paul Ashley

Paul Ashley

Paediatric Dentist working at the UCL Eastman

Location London, UK

Activity

  • To get a certificate you need to pay for the course

  • Well for that you should probably consider our MSc. However we are probably going to set-up a different course for dentists who want to know how to look out for orthodontic problems and when to refer

  • Yes - there is some evidence to suggest dentists are more nervous about it than children are!

  • do you mean pulpotomy/pulpectomy for primary teeth? Or permanent

  • Yes - I like to give them the mirror to hold whilst I put on my gloves etc

  • Agree - but I wouldn't overestimate the impact of fluoride release from GICs

  • I guess it depends on what you see? So if there is obvious contamination with soil or something you really want to get that out. But I would still start with rinsing.

  • Perfect

  • It should be somewhere - let me check

  • Yes - that's why I prefer the term primary teeth, rather than deciduous teeth

  • No agree - you might even go straight for the extraction. But better to start off small if you can

  • Of course - but changing behaviour is really difficult to do

  • Definitely

  • so diet and toothbrushing advice are definitely important. But fluoride advice is the big one - make sure you do that first

  • It's a tricky one because fluoride is important. I think it's probably best if you can convince them to use it. If not then you I guess you throw everything else at them - tooth mousse, hydroxyapatite toothpastes, fissure sealants etc etc

  • Sterile saline or sterile water

  • It's tricky to make a denture for a three year old and you need to ask yourself who you are making it for. Is it the child or the parents! I find it hard to believe that a three year old would be bullied meaningfully by their peers

  • I think that with the new IADT guidelines they are keen for you to get the tooth back in the mouth as soon as possible. So maybe reimplant first and then do the endo

  • Always a difficult problem to manage. Do you leap in with something difficult eg extraction? Or do you try and build cooperation by doing something simpler. I think it depends very much case by case. If the pain is manageable I prefer to usually try and build up cooperation

  • Yes this has always interested me. I agree that the evidence for sealing primary molars is not as good as for permanent molars.

  • I don't think anyone knows really. We tend to just place SDF and not put anything else on top

  • That is definitely a viable option

  • So in terms of caries really the most important thing we can do is to make sure they are using a fluoride toothpaste

  • we tend to use duraphat but I'm not sure it's better or worse than anything else

  • If the seal is good yes - modern concepts of caries removal are moving towards this approach

  • You can put a crown on using the Hall technique

  • If they follow it!

  • There is (potassium nitrate I think?). Doesn't seem to work for me

  • What like a consent? There are examples on the BSPD website if you would like to do that

  • Futurelearn handles all of this - I think if you want a certificate you need to pay

  • It was probably already non-vital. Did you have a pre-op radiograph?

  • So antibiotic requirement is as dictated by the IADT guidelines. Yes - tetanus is their GP

  • NHS. I think 4-6 months?

  • In the UK it's from 10

  • I'm not aware of SSCs causing pulp inflammation

  • I think that's no longer recommended

  • Actually I think soaking in fluoride has been removed from the guidelines now

  • Oranurse

  • Hi - when I've looked at it I wasn't convinced by the evidence so we don't tend to bother with the KI

  • Hello Hangama - I am sorry the video doesn't work. Unfortunately I think this is probably a problem with your computer or connection, I am not aware of problems with other users. Is it just the one video or all of them?

  • Interesting point re the ceiling picture. Yes - chatty nurse is very helpful!

  • I don't think it makes any difference and not aware of any evidence

  • I think we would normally replant the tooth and then do more comprehensive planning once the immediate emergency is over. This might mean decoronation later.

  • Yes consent is important. Though what do you do if the this is not possible! Tricky. Sometimes we are happy with agreement over the phone as the outcome is so much poorer if treatment is delayed

  • You could use double sided tape - but is it something you are happy to have in the dental surgery? In our experience children with metal crowns are rarely teased as a result.

  • So I'm not sure. But I wouldn't use SDF where pulp involvement is likely because it's the wrong treatment. If pulp involvement is likely then you need strategies to manage the pulp such as indirect pulp capping, pulpectomy or extraction

  • Nice tip - I might try it!

  • Well it depends on the avulsion - the IADT guidelines are helpful with regard to the right treatment plan

  • so with regard to fluorosis and varnish or rinses, I don't think there is any evidence of a link between them and fluorosis. These are topically applied so the risk is very low.

  • I don't think there is any evidence to support the use of CHX mouthrinse to control caries - and obviously using mouthrinses in young children who can't rinse and spit can be problematic

  • Yes - tetanus status is important. I take your point re antibiotics. I question the benefit though.

  • Yes - I was taught the same. Up to the individual I think. I do this.

  • Good question. I think it depends on how far out you are. If the tooth is miles away then you probably need to remove the splint and reposition. I don't think you need to remove the whole splint, just release the traumatised tooth

  • @REZARAZEQY There's not a lot of evidence for reattachment, a lot more for composite. I think composite probably gives a more predictable outcome

  • With regard to caries I'm not sure there is any evidence flossing makes any difference.

  • It also promotes the remineralisation process

  • Yes I think that's a good point re seeing the eye. In an ideal world maybe we all need ceiling mounted TVs.

  • I think pulpectomy is tricky in Ds and I'd really challenge the notion that removing a D is going to make any difference to chewing function. In terms of psychological impact, well it's a balance isn't it. Taking a tooth out isn't a lot of fun for sure. But having complex restorative treatment with a less predictable outcome may not be the answer.

  • Thanks for this Jonathan - obviously everyone has to practice dentistry in a way they are comfortable with. But the evidence really is nowadays in favour of selective caries removal and I don't see that changing.

  • Don't we all

  • Agree - tho' I would challenge you on pulpotomy. Why not indirect pulp cap?

  • Important. But. Do patients always listen to us?

  • It's a shame about Hall crowns - they make life a lot easier

  • This is definitely important. But be realistic about the changes you can achieve

  • We tend to go with milk because it's everywhere and saliva is trickier to get in enough volume. Imps and an essix retainer for space maintenance. Or make a temp bridge with some wire and an acrylic tooth.

  • Difficult patients. Re-attaching incisal fragments looks lovely when it's done. But they don't often last long.

  • Nasty. Obviously there is a whole safeguarding side to this as well

  • You can if you want. Though I understand the desire to get them back in asap

  • Good question. It's there until the decay is removed or covered over

  • Amalgam is largely banned now following the Minamata agreement. Different countries have different timelines for this. It's largely banned for use in children in Europe and the UK

  • Yes of course it's OK!

  • Cost depends where you live, it's quite widely used in the UK now. It's meant for carious lesions

  • Thanks Georgina - I'll see if we can do that. There are some limits as to how we can structure some of the assessments

  • It's in the course somewhere

  • I don't like it myself - i find it's tricky to remove

  • So there is evidence to show that you can use it after brushing and it still works. But I prefer to suggest at another time if that is feasible for the family

  • No you need a cement to fill in the gaps

  • Good point Georgina - I need to go back to my notes! I think it was a scale

  • So the actual clinical impact of the fluoride release is a little bit questionable. Otherwise GICs are of course OK but important to use resin modified GICs as they are stronger

  • Ok so hopefully sorted it now!

  • Yep-but only if you can change it which is tricky

  • Without seeing it I can't say. I guess if you know how flexible wire is then use that as a comparator?

  • The IADT guidelines give specific advice on this.

  • @JennyPage Also I think Yoda had similar feelings about the word Try

  • 699? it needs to be
    1. Short
    2. Pointy
    3 Fast

  • Depends on cooperation

  • I also get triggered when parents ask children to be 'brave'. If I'm doing my job properly they won't need to be

  • Nice example Jenny

  • Definitely important to be reading subtle signs/body language etc. It's a shame that these sorts of measurements aren't more reliable.

  • 0.4mm is usually recommended

  • You don't want to go into the pulp. So if the patient has symptoms of reversible pulpitis then stop before you go into the pulp

  • Fixed the link - thanks for spotting that

  • yes

  • You'd always want to restore if you can to try and make the biofilm easier to access. But in very young children sometimes that is impossible. In those cases you may adopt an interim strategy of prevention eg SDF until they are cooperative now for restorations

  • Evidence suggests that if BWs confirm caries has not progressed significantly into dentine then a sealant is OK

  • With experience but also understanding that radiographs are an imperfect tool so you won't always get it right

  • Use a fast hand piece to cut a vertical line along the buccal surface of the crown from the gingival margin up to the occlusal plane. Then you can usually use an excavator to pry it off

  • I don’t think there is an upper limit. In fact some people believe it has benefit for elderly patients who may not be able to access care@EstherAdeyemi

  • You managed this nicely. Yes - it is stressful!

  • Thank-you for this. I think this sort of insight from the wider team is invaluable and it shows that behaviour management starts the minute the child walks into the building, not just when they sit on the dental chair