Transcript Dr Carol Mason – dental features of RTS

Rubenstein Taybi Syndrome
Oral and Dental Features
Carol Mason
Consultant in Paediatric Dentistry
Great Ormond Street Hospital for Children
NHS Foundation Trust
Overview
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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
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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”