Pediatrics

CAMBRA considers caries as? (3)

- medical changes can affect an individuals caries risk level

- dietary habits

- individual risk can change over time

when is it appropriate to take a posterior bitewing on a pediatric patient prior to eruption of the first permanent tooth?

when you cannot see interproximal

how is a stainless steel crown seated?

lingual to buccal

(T/F) primary molars are wider mesiodistally than their permanent successors

true

(T/F) permanent crowns are less bulbous than primary crowns

true

(T/F) primary molar roots are longer in proportion to the crown than the corresponding permanent teeth

true

(T/F) pulp horns are more pointed in permanent teeth than in primary teeth

false

what is a distal shoe used for?

to maintain the space of a primary second molar that has been lost prior to the eruption of the first permanent molar

In a 4 y/o when proximal or interproximal caries are visible clinically and involve the marginal ridge of the first primary molar what restoration should you place?

stainless steel crown

at what age should non-nutritive sucking habits be discontinued?

3 years

how is the enamel in primary teeth compared to in permanent teeth?

primary tooth enamel is about 1/2 as thick as permanent teeth

if a primary tooth is intruded what is the treatment initially?

if the crown is 1/2 visible, leave it and allow it to fully re-erupt

according to the guideline of behavior guidance, a dentist's responsibility during an exam with a family is to? (4)

- use lay terminology

- educate parents or caregivers

- assess the child's developmental level

- predict the child's reaction to dental treatment

Describe the Frankl Classification:

Frankl 1:

Frankl 2:

Frankl 3:

Frankl 4:

Frankl 1: definitely negative refusal of treatment, crying and fearful

Frankl 2: negative reluctance to accept treatment, uncooperative, withdrawn, sullen

Frankl 3: positive acceptance of treatment, cautious, shy, reluctant behavior at times, compliance

Frankl 4: definitely positive rapport with the dentist, shows interest, laughing, enjoyment

is there a reliable method to determine pulp vitality in a pediatric patient?

no - best way to assess if pulp is vital or not is to drill in and see if pulp bleeds

(T/F) early childhood caries are also called "baby bottle syndrome" or "baby bottle caries"

true

(T/F) early childhood caries typically affect the first primary molars first

false - usually start on incisors because they erupt first

(T/F) newly erupted teeth may be at a higher risk of caries

true

(T/F) in early childhood caries mandibular anterior teeth are affected when the disease becomes severe

true

(T/F) childhood caries is an infectious disease

true

ectopic eruption commonly involves what teeth? (3)

- maxillary first permanent molars

- maxillary canines

- mandibular incisors that erupt lingual to lower primary incisors

the purpose of anticipatory guidance includes preparing to educate parents regarding _____ (4)

- speech and language development

- substance abuse

- oral hygiene and dietary habits

- I/O and perioral piercings

what are the basic skills of motivational interviewing (OARS)?

- open ended questions

- affirmations

- reflective listening

- summarizing

(T/F) Pt mother is extremely nervous about her first child's dental visit. There is a direct correlation between the mother's anxiety and the child's negative behavior in the dental office

true

how many carpules of lidocaine should be used per 20 pounds?

1 carp

how many carpules of septocaine should be used per 40 pounds?

1 carp

what is the behavior management technique characterized by strengthening the occurrence of desired behaviors by providing a reward?

positive reinforcement

(T/F) dental caries risk assessment based on age, biological factors, protective factors and clinical findings should be a routine component of new and periodic exams

true

which primary tooth DOES NOT resemble any other tooth in the mouth?

primary mandibular first molar

what is the preferred approach for an infant exam?

knee to knee exam

(T/F) the sequence of eruption of primary teeth is more important than the time of eruption

true

(T/F) a patient's history of cavities and abscessed teeth is NOT a good predictor for treatment of early childhood caries

false

what is a caries risk assessment? (4)

- fosters the treatment of the disease process instead of focusing on the outcome

- gives an understanding of disease risk factors for specific patients

- individualized preventative and restorative treatments for patients

- anticipates caries progression and stabilization

what are signs of irreversible pulpitis or necrosis that may indicate the need for a non-vital pulp therapy or extraction? (6)

- spontaneous pain

- sinus tract or fistula

- soft tissue inflammation

- excessive mobility

- furcation or apical radiolucency

- radiographic evidence of internal or external root resorption

(T/F) timing of initial radiographic exam should be based on the patients age

false - based on needs not age

(T/F) evidence indicates that sealants are effective at preventing caries in teeth with deep pits and fissures

true

(T/F) Sealants should be placed on pits and fissure surfaces judged to be at risk for dental caries and sealants should be placed on surfaces that already exhibit incipient non-cavitated carious lesions to inhibit progression

true

which offers better isolation a pediatric split dam technique or the individually isolated technique?

individually isolated technique

what are the advantages of using the pediatric split dam technique? (3)

- used in primary and mixed dentition

- easier and faster to place

- no rubber dam material between the teeth

Although smaller, the primary maxillary 2nd molar resembles what permanent tooth?

first permanent maxillary molar

(T/F) Direct pulp capping is indicated on a primary tooth with normal pulp following a small mechanical and traumatic exposure. Direct pulp capping of a carious and pulp exposure of a primary tooth is not recommended

true

(T/F) radiographic evidence of internal or external resorption indicates that a tooth would be a candidate for vital pulp therapy

false

(T/F) provoked pain of a short duration relieved with or without OTC analgesics would indicate a tooth being a candidate for vital pulp therapy

true

(T/F) no signs or symptoms and able to clean out the tooth with brushing would indicate a tooth being a candidate for vital pulp therapy

true

what are the indications for a full coverage stainless steel crown on a primary tooth? (4)

- extensive caries

- following pulp therapy

- rampant caries with high caries risk

- large and multiple surface lesions

when would indirect pulp therapy in primary teeth be appropriate?

as long as the tooth remains sealed from bacterial contamination the prognosis is good for caries to arrest and reparative dentin to form and protect the pulp

Whichprofessionally applied fluoride delivery system is recommended for pediatric patients younger than 6 with an elevated risk of caries?

2.26% fluoride varnish

Which agents are used for indirect pulp caps of primary teeth? (2)

- calcium hydroxide (CaOH) since it has a high pH that bacteria cannot survive in

- MTA

(T/F) In primary teeth, indirect pulp capping is shown to have a higher success rate than pulpotomies in long-term studies

true

(T/F) A pulpectomy should be performed on a primary tooth that has moderate to significant root resorption

false

when can partial pulpotomies (CVEK) be used? (3)

- anterior traumatized immature permanent teeth

- molar where you have carious pulp exposure on immature permanent teeth

- partial pulpotomy for a molar with a carious pulp exposure

what are 3 advantages of using a glass ionomer in restorative material?

- minor fluoride release

- complete moisture control is not critical

- fast and easy to place

what 4 things are critical to have documented in a post-trauma SOAP note?

- medical and injury history

- diagnosis

- time of injury and time of dental visit since injury

- consent form

Parent comes to your office with a 9-year-old with a #9 completely avulsed. The injury occurred 30 min ago. Patient is healthy. What is the correct treatment for #9?

reposition tooth and splint it in place

A4-year-old presents to your office. The mother is concerned that the child's tooth is turning dark. The child's tooth had trauma 8 weeks ago. The child does not complain about the tooth. The tooth is now mobile, and the soft tissue is healthy. What do you recommend for mothers?

observe and monitor for symptoms

Anextraoral radiograph for a child's traumatized tooth with a fragment possibly located in the oral tissue is taken by?

- hold sensory externally, lateral to the face

- aim through the lip

- reduce to 1/4 of voltage (setting for a PA)

(T/F) Anticipatory guidance is the process of providing practical developmentally appropriate information about a child to prepare parents for all that they need to do

true

According to AAPD, the purposed behavior guidance techniques, both non-pharmacological and pharmacological, for infants, adolescents, and persons with special healthcare needs (SHCN) include (3)

- alleviate anxiety

- nurture positive dental attitude

- perform quality healthcare safely and efficiently

Incipient interproximal decay seen on radiograph is an indicator that ____

caries process is occurring

(T/F) A 1-year-old child whose primary water supply is fluoridated at 0.07 ppm and is at high risk for dental caries is recommended a 0.25 mg fluoride supplementation

false - they have optimal fluoride water supply

What are the characteristics of an active caries lesion? (5)

- lesions in a plaque stagnation area

- color is matte or opaque, has a loss of luster

- color is white and yellow

- rough enamel or soft mushy dentin

- radiographic change over time

What are NOT characteristics of an active caries lesion? (5)

- lesion is not in a plaque stagnation area

- shiny enamel

- color is brown-black

- hard enamel or dentin

- plaque is thin and not sticky

when would use of SDF be indicated? (2)

- cavitated lesions not approaching the pulp

- cavitated lesion that has any surface accessible with a brush for applying SDF

when would use of SDF NOT be indicated? (3)

- unsolicited or spontaneous pain

- signs of pulpal inflammation

- furcation or periapical radiolucency

Expert panel suggest the following for non-surgical treatment options for non-cavitated lesions on the facial or lingual surfaces of primary teeth (2)

- 5% sodium fluoride (NaF) varnish

- 1.23% APF gel

(T/F) A partial pulpectomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1-3 mm to reach deeper healthy tissue. While CaOH has been demonstrated to have long-term success, MTA results are more predictable forming a dentin bridge in pulpal health

true

(T/F) When performing a pulpotomy, excessive hemorrhage in the pulp tissue that is not controlled with a damp cotton pellet applied several times is a clinical sign of irreversible pulpitis and indicates that a pulpectomy or an extraction may need to be performed on the tooth

true

(T/F) Following pulpectomy in a primary molar, the tooth should be restored w/a restoration that seals the tooth from leakage. Appropriate restorations would include:

- a stainless steel crown

- if there is sufficient supporting enamel, amalgam or composite resin can be a functional alternative of a primary tooth that has a lifespan of less than 2 years

both are true