Pediatric Dentistry Final Review (ksolman x ryanef123 collab🤩)

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which Brodsky grade:

Surgically removed tonsils

1

which Brodsky grade:

Tonsils hidden within tonsil pillars

2

which Brodsky grade:

Tonsils extending to the pillars

3

which Brodsky grade:

Tonsils beyond the pillars

4

which Brodsky grade:

Tonsils extend to midline

3, 4

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

1. minimal

2. moderate

3. deep

4. general anesthesia

4 levels of sedation

Minimal sedation

what type of sedation:

A drug-induced state where pts respond to verbal commands while maintaining stable breathing + heart function

Monitoring

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

Moderate sedation

what type of sedation:

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

cardiovascular

in moderate sedation:

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

Consciousness

in moderate sedation:

_____ is usually preserved, but precautions are necessary to prevent deeper sedation.

Deep sedation

what type of sedation:

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

ventilatory

in deep sedation:

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

airway protective reflexes

in deep sedation:

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

General anesthesia

Patients can transition from deep sedation to...

General anesthesia

what type of sedation:

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

breathe independently

in general anesthesia:

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

Cardiovascular

in general anesthesia:

______ function may be impaired.

1. Nitrous oxide

2. Benzodiazepines: diazepam, midazolam

3. Opioids (meperidine, morphine)

4. Antihistamines

5. Dexmedetomidine

List the 5 common sedation agents.

Depressant

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

5, 10

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

true

T/F: Nitrous oxide is an anxiolytic w/ minimal analgesia

20-70

Nitrous oxide: __% concentration w/ an open system + nasal hood

Peripheral neuropathies

Chronic nitrous oxide exposure/abuse can occur in dental professionals and may result in ________ ___________.

1. lack of potency

2. dependent on psychological reassurance

3. interference of nasal hood w/ injection of anterior max

4. pt must be able to breathe through nose

5. NO2 pollution + potential occupational exposure hazards

5 disadvantages of nitrous oxide

1. Midazolam (Versed)

2. Diazepam (Valium)

CNS depression, minimal CV effects occurs with which 2 sedation agents?

respiratory depression

There is risk of ______ with Midazolam (Versed) and Diazepam (Valium).

Anterograde

_________ amnesia occurs with Midazolam (Versed).

15 min onset; 20-30 min working time

Onset vs. working time for Midazolam (Versed)

0.5-1 mg/kg to 20 mg max dose

Oral dose of Midazolam (Versed)

0.2-0.3 mg/kg to 10 mg max dose

Intranasal dose of Midazolam (Versed)

3-4

Midazolam (Versed) has _x potency of diazepam (valium).

Paradoxical negativism "angry child"

What condition:

• 2% of patients

• Agitated and combative

• Screaming and flailing

Midazolam (Versed)

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

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

Onset vs. working time for 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

Dose of Diazepam (Valium)

Narrow-angle glaucoma

Contraindication for Diazepam (Valium)

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

Diazepam (Valium) half life = ?

Flumazenil (benzodiazepine)

What pediatric reversal agent do we use?

IV: 0.01 mg/kg to 1 mg max

IN: 0.04 mg/kg to 0.2 mg max

Typical pediatric dose of Flumazenil (reversal agent benzodiazepine)

1. pulse oximetry

2. ECG

3. capnography

4. noninvasive BP

4 monitoring modalities used for pt safety

Pulse oximetry

Which modality:

Oxygenation (SpO2)

Late indicator of ventilatory problems

ECG

Which modality:

Heart rhythm

Detects arrhythmias

Capnography

Which modality:

Ventilation (EtCO2)

Early indicator of hypoventilation/apnea

Noninvasive BP

Which modality:

Perfusion trend

Cuff size matters

Less

The younger the age, the ____ accepting of sedation.

Less

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

Child's behavior (temperament)

#1 factor influencing sedation outcome

Difficult

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

Temperament

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

Behavioral style of an individual while interacting with the surroundings

definition of temperament

Age, temperament

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

4, ++

which Frankl classification:

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

3, +-

which Frankl classification:

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

2, -+

which Frankl classification:

Negative, reluctant, timid, uncooperative

1, --

which Frankl classification:

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

Tell-show-do

Most effective for children with communicative/interactive ability, can be used with any child

Hearing impaired

When is tell-show-do contraindicated?

Positive reinforcement

which behavior management technique:

• 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

Distraction

which behavior management technique:

• Attention is directed from dental procedure

• Affects pain perception

• Dental applications: videogames, headphones, storytelling

Voice control

which behavior management technique:

• Controlled alteration of voice to direct behavior

  • Volume

  • Tone

  • Pace

• Study of Loud Voice control punishment

• Highly effective in reducing disruptive behaviors

Unacceptable

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

Parental absence/presence

which behavior management technique:

Indicated in any pt who has the potential to be cooperative

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

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

1. Parents unwilling/unable to extend effective support

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

When is parental absence/presence contraindicated?

Direct observation/modeling

ID the basic behavior guidance technique:

• Patient observes another patient exhibiting cooperative behavior during tx

• Can be through live model or video

1. Protective stabilization

2. Sedation

3. General anesthesia

What are the 3 advanced behavior guidance techniques?

1. Risks

2. Benefits

3. Alternatives of behavior guidance

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

True

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

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

How do we prevent traumatic dental injuries?

1. Med hx

2. Neurological eval (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 are the thorough diagnostic steps for managing traumatic dental injuries? (3)

1. Battle sign

2. Raccoon sign

What 2 signs are indicators of cranial fracture?

Uncomplicated

Uncomplicated or complicated trauma to permanent dentition:

Enamel/dentin

Complicated

Uncomplicated or complicated trauma to permanent dentition:

Pulp involvement

Radiograph, resin restoration

Treatment for uncomplicated trauma

Open apex: preserve pulp vitality CaOH2

Matural apical development: RCT

Treatment for complicated trauma

Root fracture

Which trauma:

• Coronal segment mobile + displaced

• Tender to percussion

• Bleeding from gingival sulcus

• False negative initially

Root fracture

Which trauma:

Crown discoloration (red, gray)

Cervical

For root fracture:

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

Apical

For root fracture:

Oblique plane fracture: _______ third fractures (radiograph occlusal)

1. Reposition ASAP

2. Verify position with radiographs

3. Stabilization flexible splint 4 weeks (apical + middle third)

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

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 the root fracture is near the cervical area?

RCT

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

1 year

Monitor healing of root fractures for up to ...

Hard tissue healing

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

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

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

Concussion

Which trauma:

• Tender to touch or tapping

• No displacement or mobility

• Sensibility test +

None

Radiographic findings of concussion and subluxation

Monitor pulp condition for a year

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

Subluxation

Which trauma:

• Tender to touch or tapping

• No displacement

• Increased mobility

• Bleeding from gingival crevice

• Sensibility test -

1. No treatment normally

2. Stabilization for patient comfort if excessive mobility

3. Monitor normal pulpal response

How do you treat a patient with subluxation?

Subluxation has mobility

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

Extrusive luxation

Which trauma:

• Tooth appears elongated

• Excessively mobile

• Sensibility test -

• Increased PDL space apically

Extrusive luxation

Which trauma:

Reposition gently into socket, 2 weeks

A patient has an extrusive luxation and needs treatment. What do you do, and how long does stabilization take?

Lateral luxation

Which trauma:

• Tooth displaced in palatal/lingual or labial direction

• Nonmobile

• Sensibility test -

Lateral luxation

A patient presents with a tooth displaced lingually and on percussion, there is a high metallic sound. Which trauma is it?

Widened PDL occlusally

What would you find on the radiographs of a patient who experienced lateral luxation?

1. Reposition tooth digitally or with forceps to disengage from bony lock

2. Stabilization 4 weeks

3. Monitor pulp

How do you treat lateral luxation?