Pediatric Dentistry Final Review (ksolman x ryanef123 collab🤩)

Brodsky:

Surgically removed tonsils

0

Brodsky:

Tonsils hidden within tonsil pillars

1

Brodsky:

Tonsils extending to the pillars

2

Brodsky:

Tonsils beyond the pillars

3

Brodsky:

Tonsils extend to midline

4

Brodsky grades (_ and _) suggest a narrower airway, which increases the risk of airway obstruction during sedation.

3, 4

Sedation:

A drug-induced state where patients respond to verbal

commands while maintaining stable breathing and heart

function

Minimal sedation

In minimal sedation, children usually only need _________, but if they become moderately sedated, moderate sedation guidelines should be followed.

Monitoring

Sedation:

A drug-induced state where patients can respond to verbal commands or light tactile stimulation.

Moderate sedation

Sedation:

Patients maintain their own airway, and cardiovascular function is typically preserved.

Moderate sedation

Sedation:

Consciousness is usually preserved, but precautions are necessary to prevent deeper

sedation.

Moderate sedation

Sedation:

A drug-induced depression of consciousness where patients are difficult to arouse but respond purposefully after repeated verbal or painful stimulation.

Deep sedation

Sedation:

Patients may have impaired ability to maintain ventilatory function and might need help with airway maintenance, and spontaneous ventilation can be inadequate.

Deep sedation

Sedation:

Cardiovascular function is typically preserved, but there may be a partial or complete loss of airway protective reflexes.

Deep sedation

Patients can transition from deep sedation to...

General anesthesia

A drug-induced loss of consciousness occurs when patients cannot be awakened, even with painful stimulation.

General anesthesia

Sedation:

Their ability to breathe independently is often impaired, requiring assistance to maintain an open airway and possibly the use of positive-pressure ventilation.

General anesthesia

Sedation:

Cardiovascular function may be impaired.

General anesthesia

List the common sedation agents.

Nitrous oxide

Benzodiazepines (diazepam, midazolam)

Opioids (meperidine, morphine)

Antihistamines

Dexmedetomidine

Nitrous oxide is a CNS _________ (minimal CV or respiratory effect).

Depressant

Nitrous oxide has induction time of _ minutes and recovery __ minutes.

5, 10

Anxiolytic, minimal analgesia

Nitrous oxide

Nitrous oxide: __% concentration - open system; nasal hood

20-70

Chronic nitrous oxide exposure/abuse can

occur in dental professionals and may result in ________ ___________.

Peripheral neuropathies

What are these disadvantages of?

Nitrous oxide

Sedative/Hypnotic (Benzodiazepine)

Midazolam (Versed)

Diazepam (Valium)

CNS depression, minimal CV effects occurs with which sedation agent?

Midazolam (Versed)

Diazepam (Valium)

T/F: There is risk of respiratory depression with Midazolam (Versed) and Diazepam (Valium).

True

_________ amnesia occurs with Midazolam (Versed).

Anterograde

Onset vs. working time for Midazolam (Versed)

15 min onset; 20-30 min working time

Oral dose of Midazolam (Versed)

0.5-1 mg/kg to 20 mg max dose

Intranasal dose of Midazolam (Versed)

0.2-0.3 mg/kg to 10 mg max dose

Midazolam (Versed) has _x potency of diazepam.

3-4

What condition:

2% of patients

Agitated and combative

Screaming and flailing

Paradoxical negativism "angry child"

Paradoxical negativism "angry child" is associated with which sedative?

Midazolam (Versed)

Onset vs. working time for Diazepam (Valium)

45-50 min onset; peak 60 min with 45-60 min working time

Dose of Diazepam (Valium)

0.2-0.3 mg/kg orally with max dose 15 mg as single agent or 10 mg in combo with other agents

Contraindication for Diazepam (Valium)

Narrow-angle glaucome

Diazepam (Valium) half life = ?

20-40 hours but can be extended in some patients because of an active metabolite

What pediatric reversal agent do we use?

Flumazenil (benzodiazepine)

Typical pediatric dose of Flumazenil (reversal agent benzodiazepine)

IV: 0.01 mg/kg to 1 mg max

IN: 0.04 mg/kg to 0.2 mg max

Which modality:

Oxygenation (SpO2)

Late indicator of ventilatory

problems

Pulse oximetry

Which modality:

Heart rhythm

Detects arrhythmias

ECG

Which modality:

Ventilation (EtCO2)

Early indicator of hypoventilation/apnea

Capnography

Which modality:

Perfusion trend

Cuff size matters

Noninvasive BP

The younger the age, the ____ accepting of sedation.

Less

Sedation is ____ likely to be successful for child with cognitive impairment.

Less

#1 factor influencing sedation outcome

Child's behavior (temperament)

Socialization: child with few limits or boundaries can be "_______" = not a good candidate for sedation

Difficult

A powerful indicator of a child's response to dental treatment

Temperament

Behavioral style of an individual while interacting with the surroundings

Temperament

Both ___ and ___________ seem to act as predictors of child behavior in the dental setting.

Age, temperament

Frankl:

Definitely positive, good rapport, interest in dental procedures, laughs and enjoys

4, ++

Frankl:

Positive, accepts treatment but may be cautious or reserved, follows directions

3, +-

Frankl:

Negative, reluctant, timid, uncooperative

2, -+

Frankl:

Definitely negative, refusal of treatment, defiant, unable to cooperate

1, --

Most effective for children with

communicative/interactive ability, can be used with any child

Tell-show-do

When is tell-show-do contraindicated?

Hearing impaired

Rewards desired behavior

Best when immediate-concept

Requires consistency and avoid rewarding undesirable behavior

Realization that the desired behavior may be less than totally desired but is still a positive step to be recognized

Positive reinforcement

Attention is directed from dental procedure

Affects pain perception

Dental applications: videogames, headphones, storytelling

Distraction

Controlled alteration of voice to direct behavior

-Volume

-Tone

-Pace

Study of Loud Voice control punishment

Highly effective in reducing disruptive behaviors

Voice control

Greenbaum et al 1990 - Rated voice control as __________ by parents.

Unacceptable

Indicated in any patient who has the potential to be cooperative

Parental absence/presence

Most common technique of parental absence/presence involves...

Previously cooperative child who becomes uncooperative and practitioner asks parents to leave operatory until child becomes compliant

When is parental absence/presence contraindicated?

Parents unwilling/unable to extend effective support

Child unable to understand that parent's presence is contingent on cooperation

ID the basic behavior guidance technique:

- Patient observes another patient exhibiting cooperative behavior during tx

- Can be through live model or video

Direct observation/modeling

What are the three advanced behavior guidance techniques?

1. Protective stabilization

2. Sedation

3. General anesthesia

Informed consent should be presented in a language easy for parents' understanding and should address: (3)

Risks

Benefits

Alternatives of behavior guidance

T/F: Advance Behavior Management requires a separate informed consent.

True

How do we prevent traumatic dental injuries?

Custom pressure-laminated mouthguards have the best protective qualities (multiple layers)

What are the thorough diagnostic steps for managing traumatic dental injuries? (3)

1. Medical history

2. Neurological evaluation (important to evaluate cranial nerves, nausea, loss of consciousness) they require immediate referral

3. Clinical Exam

• Radiographs and Photographs

• Indicators of Cranial Fracture (Battle Sign, Racoon Sign)

What signs are indicators of cranial fracture?

- Battle sign

- Raccoon sign

Uncomplicated or complicated:

Enamel/dentin

Uncomplicated

Uncomplicated or complicated:

Pulp involvement

Complicated

Treatment for uncomplicated trauma

Radiograph, resin restoration

Treatment for complicated trauma

Open apex: preserve pulp vitality CaOH2

Matural apical development: RCT

Which trauma:

Coronal segment mobile and displaced

Root fracture

Which trauma:

Tender to percussion

Bleeding from gingival sulcus

False negative initially

Root fracture

Which trauma:

Crown discoloration (red, gray)

Root fracture

Which trauma:

Root fracture

Which trauma:

Root fracture

Which trauma:

Root fracture

For root fracture:

Horizontal plane fracture: ________ third fractures (radiograph PA 90)

Cervical

For root fracture:

Oblique plane fracture: _______ third fractures (radiograph occlusal)

Apical

A patient presents with a root fracture. How do you go about treating them if it's displaced?

Reposition ASAP

Verify position with radiographs

Stabilization flexible splint 4 weeks (apical and middle third)

A patient presents with a root fracture. How do you go about treating them if the root fracture is near the cervical area?

Stabilization with flexible splint (up to 4 months) longer period is beneficial

A patient presents with a root fracture. How do you go about treating them if it's necrosed?

RCT

Monitor healing of root fractures for up to ...

1 year

On mature teeth with root fracture, repositioning of fragment increases frequency of...

Hard tissue healing

On immature teeth with root fracture, there is favorable...

Pulp revascularization, high repair for young cells, healed even sub-optimal repositioning

Which trauma:

Tender to touch or tapping

No displacement or mobility

Sensibility test +

Concussion

Radiographic findings of concussion and subluxation

None

A patient presents with concussion. How do you treat them?

Monitor pulp condition for a year

Which trauma:

Tender to touch or tapping

No displacement

Increased mobility

Bleeding from gingival crevice

Sensibility test -

Subluxation

How do you treat a patient with subluxation?

No treatment normally

Stabilization for patient comfort if excessive mobility

Monitor normal pulpal response

Both concussion and subluxation are tender to touch or tapping. How do you tell the difference?

Subluxation has mobility and negative sensibility testing

Which trauma:

Tooth appears elongated

Excessively mobile

Sensibility test -

Extrusive luxation

Which trauma:

Increased PDL space apically

Extrusive luxation

Which trauma:

Extrusive luxation

Which trauma:

Extrusive luxation