adapted from quizlet jessiebeedmd Pediatric SSCE Exam Flashcards

What two factors are considered moderate risk for 0-5 yo pt?

• Child is a recent immigrant

• Child has special health care needs

⭐️What five factors are considered moderate risk for pts 6 yrs or older?

• child is a recent immigrant

• pt uses hypo-salivary medication(s)

• pt has special healthcare needs

• pt wears intraoral appliance

• pt has defective restorations

⭐️Guidelines for prescribing radiograph initial exam primary dentition:

• 2 posterior BW (#0)

• 2 occlusal (#2)

• If proximal surfaces cannot be visualized or probed

• Selected PA (#0)

⭐Guidelines for prescribing radiograph initial exam mixed dentition:

• 2 posterior BW (#1,2)

• 1 panoramic

• Selected PA (#1,2)

⭐Guidelines for prescribing radiograph initial exam permanent dentition:

• 4 posterior BW (#2)

• 1 panoramic

• Selected PA (#2)

⭐Guidelines for prescribing radiograph recall for clinical caries, increased risk:

Repeat BW every 6-12 months or until no caries evident for primary, mixed, and permanent dentition

⭐Guidelines for prescribing radiograph recall for no clinical caries or increased risk:

Repeat BW every 12-24 months for primary and mixed dentition

⭐Guidelines for prescribing radiograph recall for clinical caries, increased risk:

Repeat BW every 18-36 months for permanent dentition

⭐Guidelines for prescribing radiograph recall for perio disease or hx of perio tx

Individualized radio graphic examination PA and BW

what are disease indicators for caries in a child who is 0-5yrs old? (3)

• noncavitated caries lesions (incipient/white spot)

• visible caries lesions

• recent restorations or missing teeth due to caries

• these pts are high caries risk

what are the disease factors against caries for children >6yrs old (4)?

• presence of interproximal caries lesion(s)

• new noncavitated lesions (white spot lesions)

• patient has new cavitated lesions or lesions into dentin radiographically

• patient has restorations that were placed in the last 3 years (new patient) or in the last 12 months (pt of record)

what are the oral hygien instructions for an infant or child with no teeth?

wipe with clean cloth & water

the following are the oral hygiene instructions for what age group?

• brush 2x/day

• smear layer of toothpaste

• supervise child

• brush tongue

less than 3 yrs old

the following are the oral hygiene instructions for what age group?

• brush 3x/day

• pea size of fluoridated toothpaste

• supervise child

• brush tongue

3-6 yrs old

A child should be supervised when brushing until what age?

10 - 11 years old

when should a child begin flossing (or when should the caregiver begin flossing a child's teeth)?

as soon as you see contact between the teeth

⭐what are the post op instructions for fluoride varnish? (4)

• can eat & drink immediately

• no crunchy or sticky foods

• no hot beverages

• no brushing for at least 6 hours

what is a proactive, developmentally based counseling that focuses on the needs of patient at a particular stage of life.

anticipatory guidance

what does anticipatory guidance include? (6)

-diet

-oral hygiene

-fluoride exposure

-non-nutritive habits

-injury prevention

-dental & oral development

the following are the dietary recommendations for an infant of which age?

-avoid allowing the infant to sleep or nap with a bottle

-avoid frequent, on-demand breastfeeding at night --> develop a feeding schedule so the infant takes several ounces every few hours rather than feeding continuously

birth to 6 months

the following are the dietary recommendations for an infant of which age?

• avoid putting to sleep with the bottle

• wean off the bottle by 12 months, & introduce a regular cup

• no carbonated beverages

• learn about appropriate snacks to avoid cariogenic foods between

6 -12 months

the following are the dietary recommendations for an infant of which age?

• discontinue bottle-feeding, revisit the use of a sippy cup

• avoid constant sipping from a cup unless it contains only water

• limit cariogenic snacks between meals

12-24 months

the following are the dietary recommendations for an infant of which age?

• consume cariogenic foods with meals, not as snacks

• revisit sippy-cup

• evaluate juice exposure & carbohydrates

24-36 months

the following are the oral hygiene recommendations for an infant of which age?

• after each feeding & before bed, clean gums & newly erupted teeth with wet, soft, clean washcloth/gauze pad/water-soaked toothbrush

• no fluoride supplementation

birth - 6months

the following are the oral hygiene recommendations for an infant of which age?

-clean teeth with a soft child's toothbrush & smear amount of toothpaste

-teething-place a damp, cold washcloth

-fluoride supplementation after a fluoride assessment done by pediatric dentist or pediatrician

6 -12 months

the following are the oral hygiene recommendations for an infant of which age?

-child participation in oral hygiene

-a smear amount of fluoride toothpaste

12-24 months

the following are the oral hygiene recommendations for an infant of which age?

-use pea-sized amount of Fluoride toothpaste

-use dental floss

-continuation of parental supervision

24-36 months

⭐which teeth grow in 30 days after birth?

neo-natal teeth

⭐which teeth are present at birth?

natal teeth

⭐what does the following describe?

whitish-yellow nodules located on the gums or roof of mouth (Found along the midline of the hard palate)

epstein pearls

⭐Found along the gum line (the alveolar ridges, on the cheek-side or tongue-side) rather than the center of the palate

bohn’s nodules

⭐what does the following describe?

• dentinal union of 2 embryologically developing teeth

• more common primary dentition 0.5%

• 2 separate pulpal chambers & separate or fused canals

• clinical diagnosis = missing tooth

fusion

⭐what does the following describe?

• division of single tooth germ during the proliferation stage

• common in primary dentition 0.5 - 2.5%

• the tooth appears as a bifid crown

• single root & pulp chamber

• clinical diagnosis = extra crown

germination

⭐which primary tooth molar relationship?

straight

⭐which primary tooth relationship?

distal

⭐which primary tooth relationship? (right side)

mesial

In Class I molar occlusion, the MB cusp of maxillary 1st molar contacts the _____________ of the 1st mandibular molar

anterior buccal groove

class II MB cusp is more M

class III MB is more D

the following are the indications of which restorative treatment?

• deep retentive pits & fissures

• stained pits & fissures w/ decalcification or opacification

• no radiographic/clinical caries interproximally

• good isolation can be achievable

pit & fissure sealants

what is to be considered for treatment planning pit & fissure sealants?

• caries risk → high caries risk is a good indication

• age at placement → not based on how long ago tooth was erupted, but whether or not a sealant is necessary to prevent caries

• teeth to be sealed = tooth at risk of developing caries

• patient's cooperation

the following are the indications for what treatment?

• all surfaces of anterior teeth, including those with developmental or acquired defects

• up to 2 surfaces of posterior primary or permanent teeth

restorations w/ adhesive materials

the following are the contraindications of what treatment?

• where the tooth cannot be isolated to obtain moisture control

• in patients needing large multiple surface restorations in the posterior primary dentition

• in high caries risk patients

restorations w/ adhesive materials

⭐indications for stainless steel crown (ssc)

• extensive carious lesion that involves a cusp or part of a cusp is missing

• extensive carious lesion where more than 2 surfaces are connected

• interproximal caries extending beyond line angles

• following a pulpectomy or pulpotomy

• patients w/ increased risk who' s cooperation is affected by age, behavior, medical hx, or require general anesthesia for treatment

• intermediate restoration of fractures tooth

• restoration of hypoplastic or hypocalcified primary or permanent tooth

• restoration of teeth w/ hereditary anomalies

• failure of available restorative materials

True or False: Stainless steel crowns cannot be used to restore hypoplastic, hypocalicified, or teeth w/ hereditary anomalies

False ==> SSC can restore all of these

what are the objectives of a pulpotomy of a primary tooth?

• preserve the vitality of radicular pulp w/o adverse signs & symptoms

• no radiographic evidence of pathologic external root resorption or canal calcification / internal root resorption should be self-limited and stable

• no harm to succedaneous tooth

what are the indications for a pulpotomy on a primary tooth? (2)

• mechanical or carious exposure in a primary tooth w/ normal pulp or reversible pulpitis

• exposure due to trauma

the following are contraindications of what treatment?

• hx of unprovoked/spontaneous pain

• presence of a fistula or swelling

• evidence of necrotic pulp

• uncontrolled pulpal hemorrhage

• periapical or bifurcation radiolucency

• pathological resorption of the pulp

• dystrophic calcification

• more than 1/3 external root resorption, internal root resorption

pulpotomy

what are the steps for a pulpotomy on primary teeth?

1) local anesthesia

2) rubber dam isolation

3) caries removal

4) access to pulp chamber and evaluate bleeding (bleeding clinical indication of pulp status)

5) amputation of coronal pulp tissues

6) achieve hemostasis w/ cotton pellet

7) apply selected medicament on remaining radicular pulp tissues

8) remove cotton pellet with medicament & fill chamber with ZOE (zinc oxide eugenol)

9) restore tooth w/ SSC = most effective long-term

which restoration is most effective longterm following a pulpotomy?

stainless steel crown (SSC)

which medicament is used to fill the chamber during pulpotomy?

zinc oxide eugenol (ZOE)

What are the 3 medicaments used in vital pulp therapy? (3)

• formocresol

• ferric sulfate

• mineral trioxide aggregate (MTA)

which medicament for vital pulp therapy?

• Fixative Agent with progressive fibrosis

• Bactericidal

• Calcific changes evident , no dentinal bridging

• Preserves the cell detail

• Inhibits autolytic changes and bacterial growth

formocresol

which medicament for vital pulp therapy?

• Hemostatic Pulpotomy agent

• Blood reacts with Ferric and Sulfate Ions within the acidic PH of the solution

• Agglutination of proteins forms plugs that occlude the capillary orifices

• No antibacterial action (must assume the radicular pulp is healthy) Concentration 15-20%

• Low Toxicity

ferric sulfate

which medicament for vital pulp therapy?

• Root end fillings

• Direct pulp caps

• Furcation

• Apexification

• Pulpotomies

• Properties: Excellent biocompatibility, Antimicrobial, Alkaline ph -Radiopacity, High Sealing Capacity, Ability to induce Dentin formation, cement, bone

MTA (mineral trioxide aggregate)

what are the two therapies for non-vital primary teeth?

pulpectomy (necrotic and abscessed) and extraction

what are the indications for pulpectomy of primary teeth?

• Restorable Tooth (contraindicated when damaged beyond restoration or mobile)

• Non-Vital Pulp diagnosed with irreversible pulpitis or necrosis

• Tooth planned for a Pulpotomy, but the radicular pulp clinically shows signs of irreversible pulpitis or necrosis

• Adequate Root Remaining, minimal to no root resorption (contraindicated when more than 2/3 resorption)

• Cooperative Patient

contraindication to pulpectomy of primary teeth?

pt severely immunocompromised

objectives of pulpectomy of primary teeth

• Resolution of Infective Process

• No Signs or Symptoms

• Radiographic Success

pounds to kg

/2.2

⭐how to calculate max dose amoxicillin suspension?

40mgs x kg x day → gives you mg per dose given every 8 hours for 7 days

then choose which approximates your dose better 125 mg/5ml or 250mg/5ml (see pic) = sig aka directions

then calculate x3/day and 7 days for disp aka dispense

what constitutes space loss?

w/in first 6 mo or days premature primary tooth loss due to mesial drift of perm 1st M and maybe distal drift of teeth mesial to an extraction site (especially the mandibular cuspids when incisors erupting)

what does LLHA stand for?

lower lingula holding arch

indications of which space maintenance appliance?

• To preserve space created by loss of one tooth in a single quadrant

• Unilateral/ Bilateral loss of a 1st or 2nd primary molar

• After the eruption of permanent lateral incisors replace with LHA

band and loop

which space maintenance appliance?

band and loop

which space maintenance appliance?

• A distal extension with horizontal and vertical components, cantilevered from the first primary molar

• Indication: loss of 2nd primary molar BEFORE eruption of permanent first molar

• Disadvantages:

  • Difficulty in the construction of the appliance needs a couple of radiographs and precise placement into the tissue

  • Presence of constant foreign body in a sensitive area of mouth

  • Possible route of infection between oral and submucosal areas where it enters the tissue due to incomplete epithelialization

  • Periodic re-evaluations for correct positioning needed

  • Breakage of appliance can result in trauma or infection

  • Must remove and place other appliance upon eruption of 1st permanent molar

distal shoe

which space maintenance appliance?

distal shoe

which space maintenance appliance?

• Stabilizes mandibular arch

• Unilateral and bilateral space loss

• Prevents mesial tipping of the molars and lingual tipping of the incisors while maintaining the arch length

• Permanent first molars, central and lateral incisors must be present

• Rests on the cingulum of the lower anterior teeth

LLHA

which space maintenance appliance?

INDICATIONS:

• Premature loss of a mandibular first primary molar (prevents loss of arch dimension and permits disto-lateral movement of primary canine)

• Premature loss of a mandibular second primary molar (prevents loss of arch dimension and prevents mesial tipping of first primary molar)

ADVANTAGES

• Incorporate resistance of several teeth (good anchorage)

• Allows free individual movement of teeth while maintaining space in the desired areas

• Causes little or no inconvenience to the patient

• Less bulky than a removable appliance

• SM for more than one succedaneous tooth in the arch

LLHA

indications of which space maintenance appliance?

LLHA

which space maintenance appliance?

• Designed to retain maxillary molar position

• Acrylic button rests on the palatal rugae (serves as a brace against anterior wall of palatal vault)

• Prevents mesial movement/tipping and rotation over the palatal root

INDICATIONS

• Either primary/mixed dentition, as it does not interfere with eruption of permanent maxillary incisors

• For premature loss of:

  • Unilateral 1st/2nd or both primary molars

  • Bilateral primary molars

nance

indications of which space maintenance appliance?

nance

true or false: Space loss not critical after premature loss of primary incisors

True!

There may be rearrangement of space between remaining incisors, but no net loss of space

If primary canine lost and no space maintainer placed, a midline shift to affected side (and lingual shift of mandibular incisors) will occur when permanent incisors erupt

what are the indications for anterior space maintenance?

• Space maintenance (loss of primary canine)

• Esthetics

• Speech (if child has not acquired speech skills)

• Masticatory function (feeding usually not a problem)

• Prevents tongue habit

• Emotional development

• More than six months before eruption of permanent central incisors

• Acceptable behavior

what makes something an uncomplicated trauma to permanent dentition? complicated?

uncomplicated if it’s in only E and/or D

complicated if there is pulp involvement

treatment for uncomplicated trauma to permanent dentition

resin restoration (if exposed dentin w/in 0.5mm of pulp place CaOH₂ and GI)

⭐treatment for complicated trauma to permanent dentition

Evaluate apical development

Treatment:

• Open apex: Preserve pulp vitality (Pulp Cap/Pulpotomy) CaOh2 Mature apical development – RCT

• Apexogenesis (vital)⭐

• Apexification (non vital)⭐

⭐what is a root fracture?

• Coronal segment mobile and displaced

• Tender to percussion

• Bleeding from gingival sulcus

• False negative (initially)

• Monitor pulp Status

• Crown discoloration (red,gray)

⭐radiographic findings for root fracture

Horizontal plane fracture → Cervical Third fractures → Radiograph: PA 90

Oblique plane Fracture → Apical third fractures (common) → Radiograph: occlusal

⭐root fracture treatment

• Reposition if displaced ASAP

• Verify position with radiographs

• Stabilization flexible splint 4 weeks (apical third and middle third)

• Root fracture near cervical area (up to 4 months) longer period is beneficial

• Monitor healing (up to 1 year)

• RCT if necrosis

On mature teeth optimal repositioning of fragment increases frequency of hard tissue healing

On immature teeth, favorable pulp revascularization, high repair for young cells, healed even sub-optimal repositioning

⭐what are some findings for concussed tooth? treatment?

• Tender to touch or tapping

• No displacement

• No mobility

• Sensibility test: +

• no radiographic findings

tx: monitor pulp for a year

minor traumatic injury where a blow to the mouth damages the supporting periodontal ligaments and bruises the inner dental pulp, without knocking, loosening, or displacing the tooth

⭐what are some findings for subluxated tooth? treatment?

• Tender to touch or tapping

• No displacement

• Increased mobility

• Bleeding from gingival crevice

• Sensibility test: -

• Radiographs: no findings

tx: No treatment normally Stabilization for patient comfort if excessive mobility, Monitor normal pulpal response

⭐what are some findings for extrusive luxation? treatment?

• Tooth appears elongated Excessively mobile

• Sensibility test: (-)

• Radiographic Findings: Increased PDL space apically

tx: Reposition gently into socket Stabilization: 2 weeks, In mature teeth where pulp necrosis is anticipated or if signs and symptoms indicate that pulp (immature or mature teeth) became necrotic RCT is indicated

⭐what are some findings for lateral luxation? treatment?

• Tooth is displaced in palatal/lingual or labial direction

• Non-Mobile

• Percussion (high metallic sound)

• Alveolar process fracture

• Sensibility test: (-)

• Radiographic Finding: Widening of PDL space (occlusal)

tx: Reposition tooth digitally or with forceps to disengage from bony lock, Stabilization 4 weeks, Monitor pulpal condition If pulp becomes necrotic RCT indicated to prevent resorption

⭐what are some findings for intrusive luxation? treatment?

• Tooth displaced axially into alveolar bone

• Immobile High metallic sound at percussion

• Sens: (-)

• Radiographic Findings: PDL space absent from all or part of root, CEJ located more apically

⭐tx for intrusive luxation w/incomplete root formation

Allow eruption w/o intervention. If no movement in 4 weeks, begin ortho repositioning

⭐tx for intrusive luxation w/complete root formation

• If intruded <3mm, allow to re-erupt with no intervention

• If no movement within 8 weeks, reposition surgically and splint for 4 weeks

• Alternatively, reposition orthodontically before ankylosis begins

• If the tooth is intruded 3-7mm, reposition surgically (preferably) or orthodontically before ankylosis develops

• If intruded >7mm, reposition surgically

• Pulp almost always becomes necrotic->start RCT at 2weeks using a corticosteroid-antibiotic or CaOH2 in the cana

⭐what are some considerations for avulsion management?

• Time elapsed to replantation

• Stage of root development

• Presence of crown or alveolar bone fractures

• Time and type of storage medium (Best is HBSS- Hanks Balanced Salt Solution)

• Contamination of PDL

• Splinting

• Occlusion

• Root canal therapy

which storage medium is best for avulsion?

HBSS (Hanks Balanced Salt Solution)

⭐⭐why is there NO replantation for avulsed primary teeth?

high risk of ankylosis

⭐what are some findings and treatment for avulsion for immature tooth with dry time less than 60 minutes?

• Change transport medium HBSS

• Clean root surface, apical foramen w/saline

• Administer anesthetic

• Irrigate socket with saline

• Replant and verify with radiographs

• Splint 7-10 days up to 2 weeks

• Monitor

• If no REVASCULARIZATION, RCT recommended

⭐what are some findings and treatment for avulsion for mature tooth with dry time less than 60 minutes?

• Change transport media HBSS

• Clean root surface, apical foramen w/saline

• Administer anesthetic

• Irrigate socket with saline

• Replant and verify with xray

• Splint 7-10 days up to 2 weeks

• Monitor

• Start RCT within 10 days w CaOH2

what makes something an uncomplicated trauma to permanent dentition? complicated? treatments?

Uncomplicated fracture: enamel/dentin Resin restoration

Complicated fracture: w/pulp involvement

• Radiographic evaluation

• Pulpotomy or pulpectomy

• EXT: if unrestorable or uncooperative patient

crown/root fracture trauma to primary dentition findings and tx?

Fragment Removal: only if fracture involves small part of root

Restoration: ONLY if fragment is stable and large enough for coronal restoration

EXT: In ALL other instances

findings and treatment for root fracture primary dentition?

• The coronal fragment might be mobile and displaced

• Fracture is usually located (mid root, apical third)

Treatment:

• No displacement: NO TREATMENT

• Coronal Displacement*

• Mild mobility → spontaneous reposition

• Excessive mobility and occlusal interference → EXT

• Gentle reposition and splint 4 weeks

findings and treatment for alveolar fracture primary dentition?

• Fracture involves alveolar bone and may extend to adjacent bone

• Segment mobility and dislocation are common findings

• Occlusal interference noted

Treatment

• Radiograph evaluation (horizontal line to the apices of primary teeth and the successors will be disclosed)

• Reposition displaced segments

• Stabilization for 4 weeks

• Monitor fracture line

findings and treatment for concussion and subluxation primary dentition?

• Similar clinical findings as in permanent dentition

• No treatment on primary dentition only observation and use of CHX

• Color change alone does not indicate need for pulp therapy or extraction

• Additional signs and symptoms of infection (mobility, radiolucency swelling, fistula) indicate further treatment

findings and treatment for extrusive luxation in primary dentition?

• Partial displacement of tooth out of the socket

• Tooth appears elongated

• Excess in mobility

• Increase PDL space

Treatment:

• No interference → allow spontaneous reposition

• Excessive mobility > 3mm EXT

⭐findings and treatment for lateral luxation in primary dentition?

• Tooth displaced palatal/lingual Or labial

• Immobile

• Radiograph: occlusal X-ray, Widening PDL space apically

Treatment:

• No Occlusal interference → allow to reposition spontaneously

• Severe Occlusal Interference → EXT

• Reposition tooth and splint 4 weeks

⭐findings and treatment for intrusive luxation in primary dentition?

Tooth displaced through buccal plate

Treatment:

• Radiographic evaluation according to the location of displacement of the tooth it can appear shorter or longer

• If apex displaced through buccal bone plate OR If apex is displaced into the developing tooth: allow spontaneous repositioning (takes up to 6 months)

⭐what are some complications on permanent tooth after primary tooth displacement?

hypoplasia, hypocalcification, crown root dilaceration, disruption in eruption sequence