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297 Cards in this Set
- Front
- Back
A thorough examination should consist of what?
|
- CASE HISTORY
- Clinical Examination - Diagnosis - Treatment plan |
|
TRUE or FALSE: During history taking, have the parent in the room with the child unless suspicious of child abuse.
|
TRUE
|
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When is the normal development of WORDS?
|
1 to 2 years
|
|
When is the normal development of PHRASES?
|
21-24 months
|
|
When is the normal development of SENTENCES?
|
24-26 months
|
|
CLUBBING of fingers can occurs with what conditions?
|
- heart defects
- cystic fibrosis |
|
Spoon shaped nails result from what condition?
|
Iron-deficiency
|
|
What are some possible reasons for facial asymmetry?
|
- trauma
- fibrous dysplasia (Cherubism) - Cranial nerve palsy - Developmental disturbances: hemifacial microstomia, hypertrophy, hypotrophy - neoplasms |
|
Enlarged lymph nodes are common in which age groups?
|
4 years old
7-8 years old |
|
Which factors may contribute to bad breath in young child?
|
LOCAL:
- poor OH - food odor SYSTEMIC: - diabetes - sinusitis - GI infection / malignancies |
|
Macroglossia may be associated with which conditions?
|
- anatomic variation
- Down's syndrome - Neoplasm / cyst |
|
Which condition leads to "strawberry tongue" ?
|
Scarlet fever
|
|
Name some conditions that can cause DESQUAMATION of the tongue?
|
- vitamin deficiency
- anemia - stress disorder - geographic tongue |
|
What conditions are associated with HYPERDONTIA?
|
- Mesiodens
- Gardners syndrome ( autosomal dominant, multiple osteomas ) - Cleidocranial dysplasia |
|
What are some causes of INTRINSIC STAINING?
|
- blood dyscrasias
- amelogenesis and dentinogenesis - tetracycline - trauma |
|
What are some causes of EXTRINSIC STAINING?
|
- chromogenic bacteria
- foods - medications |
|
Describe HUTCHINSONS INCISORS:
|
tapered and notched incisor edges
(classical findings for prenatal syphilis infection) |
|
Define MULBERRY MOLARS:
|
Crenated occlusal patterns of posterior teeth
(classical findings for prenatal syphilis infection) |
|
Identify:
|
Hutchinson's incisors (associated with syphilis)
|
|
|
Hutchinson's incisors (associated with syphilis)
|
|
Idenfity:
|
Mulberry molars associated with prenatal syphilis infection
|
|
Why is early caries detection important in primary teeth?
|
They will be retained until normal exfoliation.
|
|
What are some critical organs that are vulnerable to developmental defects with radiation use?
|
- SKIN: cancer
- RED BONE MARROW: leukemia - GONADS: mutation, infertility - EYES: cataract - THROID: cancer - BREASTS: cancer - SALIVARY GLANDS: cancer |
|
What are some things done to protect us from getting too high of a radiation dose?
|
- Apron and collar
- Faster films: E and F - extraoral (pano) radiography - beam-positioning devices - cones with diff lengths and shapes - high KV technique - digital radiogarphy |
|
In what situations do we NEED a periapical view?
|
- tooth that may need PULP/ENDO THERAPY
- requires EXTRACTION - existing LARGE RESTORATIONS |
|
What is the biggest disadvantage of BITEWINGS?
|
doesn't show apical extent of primary teeth or the developing follicle of permanent tooth
|
|
What are the four main types of pediatric appointments?
|
1) Initial / new patient exam
2) Recall 3) Emergency 4) Treatmetn |
|
What would be the treatment plan for a child that is NO CARIES / LOW RISK?
|
- F toothpaste
- Diet counselling - OHI, sealants - 12mo recall |
|
What would be the treatment plan for NO CARIES / HIGH RISK?
|
- F toothpaste
- topical fluoride - diet counselling - OHI, sealants - xylitol - regular 6 mo recall |
|
What is the treatment for PRIMARY TOOTH ENAMEL CARIES / MOD-HIGH RISK?
|
- restore if visible on radiograph
- F toothpaste - topical fluoride - diet counselling - OHI, sealants - xylitol, MI paste - regular 3-6mo recall |
|
What is the treatment for ENAMEL CARIES / PERMANENT TEETH?
|
- f toothpaste
- topical fluoride - diet counselling - OHI, sealants - xylitol, MI paste - regular 6 mo recall |
|
What is the treatment for CAVITATION AND DENTIN CARIES / PRIMARY AND PERMANENT / MOD-HIGH RISK?
|
- Restore teeth
- F toothpaste - topical fluoride - diet counselling - OHI, sealants - Xylitol, MI paste - regular 3-6 mo recall |
|
The Golden Rule is NEVER LEAVE decay on a tooth expected to be in the mouth longer than ___ months?
|
3 months
|
|
Early appointments should be reserved for what?
|
- very young patients
- handicapped patients - behaviour management cases |
|
How apart should scheduling be for pedo patients?
|
- POSITVE: 2 weeks apart
- DIFFICULT: 4-6 weeks |
|
Children at HIGH RISK of developing caries should be seen how often?
|
Every 3-6 months
|
|
Chidlren with LOW CARIES risk should be seen how often?
|
6-12 months
|
|
By late adolescnece, what percentage of children have had caries?
|
80%
|
|
What are the THREE PEAKS described by Lewis and ISmail 1993 of dental caries?
|
AGE 7: coronal decay of primary
AGE 14: coronal decay of perm AGE 30-40: root decay |
|
What is the KEYES MODEL of CARIES ETIOLOGY?
|
1. Host
2. Substrate 3. Bacteria 4. Time |
|
What is the ANDERSON MODEL of caries etiology?
|
1. Environment
2. Genetics 3. Infectious agents |
|
How can we assess caries risk?
|
1. Case history
2. Clinical and Radiographic Exam 3. Special diagnostic tests |
|
TRUE or FALSE: Enamel hypoplasia strongly correlated with caries.
|
TRUE
|
|
TRUE or FALSE: Low Birth Weight / Premature babies had high counts of enamel hypoplasia (~95%).
|
TRUE
|
|
What is the best indicator of future caries experiences?
|
PAST EXPERIENCE (presence of restored/active lesions)
|
|
What is hte purpose of the DIET ANALYSIS?
|
DETERMINE:
- amount - consistency - frequency - duration - timing |
|
What are three methods for DIET ANALYSIS?
|
1. QUESTIONNAIRE
2. INTERVIEW 3. THREE DAY DAILY RECORD |
|
What does DMFS stand for?
|
Decayed
Missing Filled Surfaces |
|
Which are the MOST CARIOGENIC bacteria?
|
Mutans streptococci
|
|
Mutans streptococci counts of > 100,000 cfu/ml indicates what?
|
Caries risk
|
|
Mutans streptococci counts of > 500,000 cfu/ml indicates what?
|
Smooth surface caries risk
|
|
TRUE or FALSE: Lactobacilli on their own are cariogenic.
|
TRUE
|
|
What are the normal values for STIMULATED and UNSTIMULATED SALIVARY FLOW?
|
USF: 0.1ml/min
SSF: >1.0ml/min |
|
Caries risk increases with what salivary flors?
|
SSF < 0.7ml/min
USF < 0.3 ml/min |
|
What is the healthy salivary pH?
|
>6.5 pH
|
|
Development of a child is intimately related to maturation of which system
|
NERVOUS SYSTEM
|
|
What age is INFANCY?
|
0-2 years
|
|
What age is TODDLER?
|
2-3 years
|
|
What age is CHILDHOOD?
|
4-10 years girls
4-12 years boys |
|
What age is ADOLESCNECE?
|
10-18 years girls
12-20 years boys |
|
NEONATE is what period of time?
|
0-4 weeks
|
|
At what stage during prenatal life do motor organs appear?
|
EMBRYO (2-8 weeks)
|
|
At what stage does all differentiation occur?
|
EMBRYO (2-8 weeks)
|
|
When is the "FETUS" stage/
|
8 weeks - 4 months
|
|
When does the FACE form?
|
4 weeks
|
|
When do the TEETH begin to form?
|
6 weeks
|
|
The fetus has all neural cells for the rest of its life by what time?
|
8 months in utero
|
|
when does the primary palate begin to form?
|
WEEK 7
|
|
When does the secondary palate begin to fuse?
|
Weeks 8-10, complete by weeks 11-14
|
|
What is the average weight of a baby?
|
3.4kg (7.5lbs)
|
|
Babies lose 6% of their body weight in the first few days from what?
|
Fluid loss
|
|
What is the weight of a baby at 6 months?
|
2x birth weight
|
|
What is the weight of a baby at 12 months?
|
3x birth weight
|
|
What is the HR and BP at birth?
|
HR: 140-150bpm
BP: 75/50 mmHg |
|
At what stage do emotions such as fear, anger, jealousy, frustration, sadness, excitement develop?
|
INFANCY
|
|
What are the vital signs of a TODDLER?
|
HR: 105+/- 35 bpm
BP 85/55 mmHg TEMP: 37.2'C RR: 20-30/min |
|
When does personality become more evident?
|
TODDLER STAGE
|
|
When does independence emerge in children?
|
TODDLER
|
|
What are hte vital signs of a CHILD?
|
HR: 95 +/- 35bpm
TEMP: 37'C BP: 100/60mmHg RR: 20-30/min |
|
When are the three main growth spurts?
|
4, 12, 16
|
|
What are the fastest growing body parts in PRENATAL to BIRTH stage?
|
Head
|
|
What are the fastest growing body parts in BIRTH-1YEAR?
|
trunk
|
|
What are the fastest growing body parts 1YR - ADOLESCENCE?
|
LEGS
|
|
STANDARD DEVIATION CURVE:
|
68% within 1 standard dev
95% within 2 97.7% within 3 |
|
What is the MAIN DETERMINANT of growth potential?
|
Genetic endowment
|
|
What is the cranial growth order of HEIGHT?
|
CRANIAL GROWTH IN HEIGHT > Width > Length
HWL |
|
What is the facial growth order?
|
WIDTH > length > height
WLH |
|
TRUE or FALSE: Facial profile flattens with age (decreasing facial convexity)
|
TRUE
|
|
Define INTERSTITIAL GROWTH:
|
Increase in size by expansion from within
|
|
Define APPOSITIONAL GROWTH:
|
Increase in size by surface addition
|
|
Define SUTURAL APPOSITION:
|
increase in size of bone by addition at the sutural interface
|
|
Define DRIFT:
|
Process of new bone deposited on one side of a cortical plate and bone resorbed on the opposite side
|
|
TRUE or FALSE: Anterior OB and OJ increase slightly with age.
|
FALSE: decrease
|
|
What is the percentage of MESIAL STEP?
|
49%
|
|
What is the percentage of DISTAL STEP?
|
14%
|
|
What is the step of FLUSH TERMINAL PLANE?
|
37%
|
|
What percentage of END-to-END terminal relationship will shift into a CLASS I final occlusion?
|
75%
|
|
When is a LOWER HOLDING ARCH essential?
|
When PRIMARY CUSPIDS lost prematurely
|
|
When do teeth generally erupt?
|
After root is 3/4 developed
|
|
Bicuspids take how long to erupt through 1mm of overlying bone
|
4-5 months
|
|
TRUE or FALSE: Permanent incisors erupt lingually to primary laterals and centrals.
|
TRUE
|
|
When is the UGLY DUCKLING STAGE?
|
7-14 years
|
|
What is the best topical anaesthetic agent?
|
20% Ethyl p-aminobenzoate (Benzocaine)
|
|
In what cases should BENZOCAINE be used with caution?
|
Patients with pseudocholinesterase deficiencies
|
|
Generally, what is the depth of anaesthesia achieved with TOPICAL?
|
2-3 mm
|
|
WHat is the percentage of LIDOCAINE used?
|
2% lidocaine 1:100,000 epi (DRUG OF CHOICE)
|
|
What is the percentage used of ARTICAINE?
|
4% ARTICAINE (not recommended for use in small children under age 4)
- greater risk of overdose and risk of methemoglobinemia |
|
What is the percentage of mepivacaine?
|
3% mepi
|
|
What are the max allowed doseages for LIDOCAINE?
|
WITHOUT VASO = 4.4mg/kg
WITH VASO = 7mg/kg |
|
TRUE or FALSE: In children, mandibular foramen is lower and more posterior than in adults.
|
TRUE
- children its at junction of middle nad cervical 1/3 of lower teeth |
|
What is the depth of insertion for IAN block?
|
15 mm
|
|
What is the indication for doing a LONG BUCCAL NERVE BLOCK?
|
- always do this when doing IAN
- rubber dam placement on permanent molars |
|
Why should PDL injections not be used in young children?
|
- may cause enamel hypoplasia in underlying mature permanent teeth
|
|
What is hte maximum dose of epinephrine recommended for use in children on Ritalin/amphetamines for ADHD?
|
0.04mg epi
|
|
What are the LOW TO MODERATE BLOOD LEVELS signs of overdose of LA?
|
CNS stimulation - tremor, tinnitis, excited or talkative
CV signs - elevated BP, HR, RR |
|
What are the MODERATE TO HIGH BLOOD LEVELS of LA overdose signs?
|
CNS Depression - confusion/drowsy/unresponsive/seizures
Depressed BP, HR Respiratory symptoms, slow rate or resp arrest Cardiac arrest |
|
How much lidocaine is in 2% carpule?
|
20mg/ml
1 carp = 1.8ml 36mg |
|
How much epinephrine in 2% lido 1:100k epi?
|
1000mg / 100,000 ml = 0.01mg/ml
0.018 mg in carpule |
|
CALCULATE THE MAX DOSE of lido for a 4yr old that weighs 17kg.
|
4.4mg/kg x 17 kg = 74.8mg / 36mg/carp = 2 carps
|
|
At what age is premolar eruption greatly accelerated?
|
8-10
|
|
What situations can arise in delayed eruption of premolars?
|
Children who have lost primary molars at or before 4-5 years of age
|
|
What are some signs of TEETHING?
|
- extensive drooling
- gum rubbing - elevated temperature - refusing food - watery eyes - disturbed sleep |
|
ERUPTION HEMATOMA is most commonly seen where?
|
Primary second molar
|
|
What are some factors that influence ectopic eruption?
|
1) larger than normal mean sizes of all max primary and perm teeth
2) larger affected first permanent molars and 2nd primary molars 3) smaller maxilla 4) posterior position of maxilla in relation to cranial base 5) abnormal angulation of eruption of the max first perm molars 6) delayed calcification of some affected first perm molars 7) trauma |
|
TRUE or FALSE: There is a causal relationship between ankylosed precursors and congenital absence of their successors.
|
FALSE - no causal relationship
|
|
Eruption can be DELAYED in what conditions?
|
- Down's syndrome
- Cleidocranial - Hypothyroidism - Hypopituitary - Achondroplastic dwarfism - Gardner syndrome - Ellis van Creveld Syndrome - Vit D deficient rickets |
|
Eruption can be accelerated by which systemic factors?
|
- Histiocytosis X
- Cherubism - Hypophosphatasia - Acrodynia - Papillon-Lefevre Syndrome - Hyperthyroidism - Cyclic neutropenia - Congenital agranulocytosis - Chediak-Higashi Syndrome - Leukemia - Acatalesemia - Juvenile Diabetes - Progeria |
|
Define GROWTH:
|
Increase in size
|
|
Define DEVELOPMENT:
|
increase in complexity
|
|
What should be done before any treatment?
|
GET TO KNOW THE CHILD
|
|
What was JOHN LOCKE's view of development?
|
TABULA RASA
- mind of newborn is like a blank slate with nothing written on it |
|
What are WRIGHT's CLINICAL CLASSIFICATIONS?
|
1) Cooperative
2) Lacking cooperative ability 3) Potentially cooperative |
|
What are the SUB-CLASSES of POTENTIALLY COOPERATIVE PATIENTS?
|
1) uncontrolled behaviour
2) defiant behaviour 3) timid 4) tense-cooperative 5) whining |
|
UNCONTROLLED BEHAVIOUR is usually in what age group?
|
Under 6 years
|
|
DEFIANT BEHAVIOUR is usually seen in what age group?
|
Primary school age
- saying I don't want to, I don't have to, I won't, |
|
WHat is the FRANKL Behaviour Rating scale?
|
= Definitely negative: refuses treatment, forceful crying, fear,
- Negative: reluctant to accept treatment, uncooperativeness, + Positive: accepts treatment, at times with reservation ++ Deff positive: enjoys the treatment, good rapport with dental team, interest in dental procedures |
|
Separation anxiety is more common in children under which age?
|
Under 6 years old
|
|
Mother's anxiety has the greatest effect on a child of what age?
|
under 4 years old
|
|
TRUE or FALSE: Fear lowers the pain threshold for all other procedures.
|
True
|
|
What is one of the greatest management problems that the practitioner must face when dealing with children?
|
OVERCOMING THE CHILDS FEARS
|
|
What is the best NON-PHARMACOLOGICAL technique to get children to do treatment?
|
MODELING
|
|
What are some methods of NON-PHARMACOLOGICAL TECHNIQUES of behaviour management?
|
- modelling
- distraction / suggestion - positive reinforcement - voice control - tell-show-do |
|
At what age can children understand basic grammar?
|
Age 4
|
|
At what age can children follow and participate in different conversations?
|
Age 4
|
|
What are the five types of parents?
|
1) vulnerable: rely on you
2) Responsible: in charge of childs well being 3) protective: 4) guilt 5) angry |
|
What are some ANTICIPATORY guidelines for children?
|
1) bacteria transmission
2) teething 3) nursing/diet 4) prevention of trauma 5) oral hygeine |
|
What are some anticipatory guidelines for toddlers?
|
1) diet
2) hygeine 3) trauma prevention 4) habits 5) drinking from cup 6) fluoride |
|
Where does most child abuse occur?
|
HOME
|
|
What are the stats for infants in the US that are victims of non-fatal neglect and abuse?
|
1 in 50
|
|
SEXUAL ABUSE was mostly associated with what kind of symptoms?
|
- anxiety
- depression - dissociation |
|
VERBAL ABUSE had a strong association with what?
|
anger-hostility
|
|
Approx how much demineralization is required for radiographic detection of a lesion?
|
50%
|
|
What are the peaks for childhood trauma (injuries to teeth)?
|
First at 2 years then 8-10 years
|
|
What are the factors that determine the extent of the injury to a tooth/
|
- energy of impact
- resiliency of impacting object - shape of object - direction of force - direct traum - indirect trauma |
|
What are the most important factors in oral habits?
|
DURATION and INTENSITY
|
|
ACCORDING TO PINKHAM, majority of oral habits stop by what age?
|
5 years old
|
|
According to TRAISMAN, what was the average age that an oral habit was stopped?
|
3.8 years (some as late as 12-15
|
|
According to POPOVICH and THOMSPON, what specific association was made, and if the habit was stopped before what age would the effects on occlusion be transistory?
|
- Class II malocclusion and digit sucking were significantly associated
- If stopped before SIX years |
|
What percentage of patients with an early habit tend to develop chronic habits extending past 8 years?
|
20%
|
|
Posterior crossbites are how much more common in thumb/finger sucking habits?
|
Five times more common
|
|
What are some treatment techniques for digit sucking habits?
|
- counselling
- reminder therapy - reward system - psychological treatment - appliance treatment |
|
An oral habit appliance must be in place for how long?
|
minimum of 6 months: 3 to break habit, 3 to prevent relapse
|
|
How often should follow-up be for HABIT APPLIANCES?
|
every month
|
|
Perioral burns are what type of burn?
|
THIRD DEGREE
|
|
How long does edema last in PERIORAL BURN>
|
7-10 days
|
|
When should commisure therapy be started in perioral burn victims?
|
Day 5-10
Topical bacitracin on extraoral wounds |
|
What is the treatment for PERIORAL BURN?
|
Measure commissure, oral opening.
Impressions Decide on appropriate appliance. Deliver appliance within 14 days of burn. Generally splint appliances worn 24hours a day for 6-12 months (except when eating or cleaning), Must see patient every 4 weeks to make adjustments. |
|
What is the most effective method of systemic fluoride administration?
|
Communal water fluoridation
|
|
What is the optimum concentration of fluoride for communal fluoridation?
|
1 ppm
|
|
KNOW THE FLUORIDE CHART:
AGE GROUPS: Birth to 6 months 6 mo to 3 years 3 - 6 years > 6 years |
Birth to 6 month = none
6 mo to 3 years = 0.25 mg / day [[<0.3 ppm ]] 3-6 years = 0.50mg/day [[<0.3 ppm ]] 0.25 mg / day [[ 0.3-0.6 ppm ]] > 6 years = 1.0 mg/day [[<0.3 ppm ]] 0.50 mg / day [[ 0.3-0.6 ppm ]] |
|
Why is the gingival colour of young child more REDDISH?
|
- increased vascularity
- thinner epithelium |
|
How is YOUNG CHILD gingiva different than adults?
|
- MORE REDDISH
- LESS STIPPLED - ROUNDED MARGINS |
|
Define ERUPTION GINGIVITIS:
|
- transistory
- eruption of primary teeth - eruption of perm teeth - subsides after teeth emerge into oral cavity |
|
What is the treatment for MILD ERUPTION GINGIVITS?
|
no treatment other than OHI
|
|
What is the treatment for PAINFUL PERICORONITIS?
|
- OHI
- irrigation with counter-irritant such as Peroxyl |
|
What is the treatment for PERICORONITIS accompanied by swelling and lymph node involvement?
|
- OHI
- Irrigation - Antibiotic therapy |
|
What is the most frequent acute viral infection of the oral mucosa?
|
Herpes simplex
Primary herpetic gingivostomatitis |
|
Approx. what percentage of primary herpes infections are sublicnical?
|
99%
|
|
What is the peak prevalence of Primary Herpetic Gingivostomatitis?
|
2-3 years of age
|
|
What is the treatment for PRIMARY HERPETIC GINGIVOSTOMATITIS?
|
- Palliative
- Bed rest and isolation from others - Good hydration - BLand foods - Good oral hygeine: moist gauze - oral fluid, nutritional intake, vitamin supplements - analgesics and antipyretics |
|
What is the pediatric dose for ACETAMINOPHEN?
|
10-15mg/kg q4h
MAX = 65mg/kg |
|
What is the pediatric dose for IBUPROFEN?
|
10 mg/ kg q6-8h
MAX = 1200mg |
|
What is the peak age for RECURRENT APHTHOUS STOMATITIS?
|
10-19 years of age
|
|
What is the treatment of NECROTIZING ULCERATIVE PERIODONTITIS?
|
- mechanical debridement
- OHI - antibiotic therapy if needed (metronidazole and pen V) |
|
Neonate candidiasis occurs when?
|
First 2 weeks of life
|
|
What is the treatment of infant / young children with oral CANDIDIASIS?
|
1 ml of Nystatin dropped into mouth 4 times a day (q6h)
|
|
What is the treatment for GENERALIZED AGGRESSIVE PERIODONTITIS?
|
- OHI
- Surgery - Tetracycline - Metronidazole |
|
Which primary teeth have the LEAST retention?
|
C's
|
|
Which primary teeth have the MOST retention?
|
E's
|
|
What are some ways one can gain retention in primary teeth?
|
1. SSC's
2. Bands 3. Adam's Clasps 4. Ball clasps 5. Bonded resin areas on buccal surfaces and C-clasps (canines) |
|
What is the anomaly?
What is the cause? When did it happen? What is/are the consequences of such a problem? What is hte treatment? |
Turner's hypoplasia
Trauma to primary tooth 3-4 months after birth Predisposing factor for caries Composite restoration |
|
How long does it take to see the dentinal bridge after direct pulp capping using CaOH?
|
6-8 weeks
|
|
5 year old child, asymptomatic
What is the treatment plan for 54? |
Tx is to extract (less than 2/3 root left) and space maintainer (unilateral BAND AND LOOP)
|
|
How old is the patient?
What are the problems that you see in this radiograph? What is the treatment plan? |
5-6 years old
Root tip / space loss / ectopic eruption Extraction and distal shoe space maintainer |
|
IDENTIFY THE APPLIANCE:
|
Nance holding arch
|
|
Identify the appliance:
|
Transpalatal arch
|
|
What is the problem?
What is the cause? What is the treatment? |
1) Anterior open bite, unilateral cross bite, midlines off
2) Thumbsucking, tongue thrust, premature contact 3) Palatal crib, RPE, Quad helix, selective grinding if premature contact |
|
1) What is/are the anomalies presnet?
2) The cause? |
1) Anterior open bite, unilateral crossbite, max anterior caries
2) baby bottle syndrome, maxillary constriction, tongue thrust, thumb sucking |
|
1) How old is the patient?
2) Does she/he need any treatment? |
1) 7-8 years old
2) Slicing, lingual bar |
|
What type of space maintainer is this?
|
Lingual holding arch
|
|
What is the treatment for this?
|
Extract and space maintainer
|
|
1) how old is this patient
2) What problem do you see? 3) What are consequences of these problems? |
1) 11ish
2) ankylosis and space loss 3) eruption of upper e and space loss due to mesial migration of lower 6 |
|
What are some oral manifestations of IRON DEFICIENCY?
|
- glossitis
- angular cheilitis - pallor of oral mucosa and lips - fungal infections such as candida |
|
What are some clinical manifestations of Zinc deficiency?
|
- stunted growth
- immune responses - decreased reproductive development and function - skeletal abnormalities |
|
What are some ORAL manifestations of zinc deficiency?
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- impaired wound healing
- xerostomia - altered sense of taste or smell - reduced appetite - increased risk for dental caries - risk of oral infections |
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What are the clinical manifestations of calcium deficiency?
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- osteoporosis
- disturbances in dental development |
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What are the clinical manifestations of Vit D deficiency?
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RICKETS
- bone deformities - poor muscle development - spinal curvature - bowed legs - enlarged joints and delayed closing of the skull bone - enamel and dentin hypoplasia - incomplete development or delayed tooth eruption |
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Premature closure of sutures is called:
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SYNOSTOSIS
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Define ALOPECIA:
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Loss of hair
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Alopecia can occur in what conditions?
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- chemotherapy
- ringworm - ectodermal dysplasia - hormonal disturbances |
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Treatment planning starts with what?
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INFORMATION GATHERING
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In treatment planning, what should always be addressed first?
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- chief complaint
- acute pain / infection - problems which may soon develop into emerg situations - large carious lesions can be temporized until able to treat definitively |
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FIRST PRIORITY IN TREATMENT: Ant or post teeth?
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Posterior
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Children with HIGH CARIES risk should be seen how often?
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3-6 months
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Children with LOW CARIES risk should be seen how often?
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6-12 months
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Face is derived from which processes?
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- frontonasal prominence
- paired maxillary prominences - paired mandibular prominences |
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What are the three types of toxicity associated with fluoride?
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- acute toxicity (death)
- chronic toxicity - dental fluorosis |
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What are the four mechanisms of aciton of FLUORIDE?
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HYDROXYAPATITE CRYSTALS:
- decrease solubility of enamel - better crystalization - enhancing the remineralization TOOTH SURFACE: - decreasing free energy of surface enamel - microorganisms get away from surface enamel MICROORGANISMS / DENTAL PLAQUE - enolaze enzyme inhibition - bactericide MORPHOLOGY CHANGE` - Flouride effect on tooth surface - Fluoride effect on microorganisms of dental plaque - morphology change |
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What are the 5 main considerations for PEDIATRIC ORAL SURGERY?
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- preoperative evaluation (medical, dental)
- behavioural consideration - growth and development - pathology - perioperative care |
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Why is surgery involving mandible and maxilla of young patients complicated?
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- developing tooth follicles
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Why is prompt treatment of odontogenic infection important in children?
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- prone to dehydration
- upper face infections - lower face infections (twismus) |
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Primariy molar roots are LARGER / SMALLER ? in diameter and MORE DIVERGENT / LESS DIVERGENT than permanent molars?
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- smaller
- more divergent |
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A 12 year old boy is getting his 75 and 85 extracted. What kind of space maintainer should be placed?
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None
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A boy is getting his max anterior primary teeth extracted, what kind of a space maintainer should be used?
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Nance appliance WITH anterior teeth
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Missing teeth in primary dentition can result in what?
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- improper mastication
- malposition of teeth - alteration in growth and developmental patterns - speech problems - psychological trauma |
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Define NATAL TEETH:
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- born with the teeth
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Define NEO-NATAL TEETH:
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- within 30 days of birth
- DONT REMOVE unless very mobile and risk of aspiration |
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When does the germ form for the primary teeth generally?
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6-8 weeks IU
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When does the enamel generally form for primary teeth?
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4-6 months IU
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How long does root formation generally take for PERMANENT teeth after eruption?
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2-3 years
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What is the INCISOR LIABILITY generally (numbers)?
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- Max = 7.6 mm total
- Mand = 6.0 mm |
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When is the ARCH CIRCUMFERENCE greatest?
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Age three
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What is the LEEWAY SPACE for max and mandible?
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MAX 0.9 mm per side
MAND 1.7 mm per side |
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WHen does the MID-PALATAL SUTURE fuse?
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13- 16 years old (early teens)
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What is the TWEED variation of serial extraction of primary teeth?
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- D's , C's and then 4's
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What is the "NORMAL" extraction sequence for primary teeth?
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- C's then D's and then 4's
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What are the INDICATIONS for serial extraction in mixed dentition phase?
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- Class I molars and canines
- severe crowding (greater than 6mm per quad) - normal OB and OJ (2mm each) - 7-8 years old - full profile |
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When does the PRIMARY PALATE form?
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4-6 weeks IU
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Puberty in boys lasts on average how long?
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5 years
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When is the CRITICAL PERIOD to avoid fluorosis occuring in permanent incisors?
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2-3 years
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What is the CERTAIN LETHAL DOSE of fluoride?
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- 32-64 mg / kg in one source
- death has been reported at 17 mg / kg |
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What is the SAFELY TOLERATED DOSE of fluoride?
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8- 16 mg/ kg
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What is the TREATMENT for overdose of Fluoride?
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LESS THAN 5mg/kg: oral calcium (milk) and observe
15mg/kg > 5 mg/kg: induce vomiting, oral calcium, admit to hospital GREATER THAN 15mg/kg: admit to hospital immediately, induce vomiting, monitor cardiac function, monitor electrolytes |
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What are some COMMON signs and symptoms of ACUTE FLUORIDE TOXICITIY?
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LOW DOSAGE:
- nausea - vomiting - hypersalivation - abdominal pain - diarrhea HIGH DOSE: - convulsion - cardiac arrhytmia - comatose Patient becomes HYPOCALCEMIC due to binding with F |
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What are the mechanisms of action of FLUORIDES?
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- decreases enamel solubility
- improves crystalinity - promotes remineralization - decreases free surface energy of bacteria so it cannot stick on tooth - bacteriocidal or static - causes developing crystal to get bigger, less soluble |
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What are some of the FIRST things to looks for in PEDIATRIC DENTAL EMERGENCY?
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- Deep caries approaching pulp
- internal / external resorption - apical or furcal radiolucencies - trauma - check for mobility |
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What is the KEY to diagnosis of BABY BOTTLE TOOTH DECAY?
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- mandibular incisors are caries free because of tongue protection
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Why can there be very rapid spread of infections in children?
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Large marrow spaces
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What is the treatment for infections in children?
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Penicillin
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What are some important signs of CNS damage that take precendence over the dental trauma if there is a pediatric emergency?
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- amnesia
- loss of consciousness - not alert, not oriented to time, place - extreme lethargy - irritability - dramatic change in personality - muscle weakness of one side or one arm, leg, etc - pupillary differences - nausea vomiting |
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Where do the majority of pediatric fracture traumas occurs?
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Mandibular condyle
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Which systemic factors can cause DELAYED EXFOLIATION/ERUPTION?
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- HYPOthyroidism
- HYPOpituitarism - low levels of GROWTH HORMONE |
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WHich systemic factors can cause PREMATURE EXFOLIATION?
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- HYPERpituitarism
- HYPERthyroidism |
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What are the three types of AMELOGENESIS IMPERFECTA?
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HYPOPLASTIC
- matrix not formed properly - thin enamel, shovel shaped, pits and defects HYPOCALCIFIED - matrix ok, calcification not proper - shears, breaks - moth eaten xray HYPOMATURE - more radiolucent - defect in entire calcified area |
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What is the proper order of STAGES OF TOOTH DEVELOPMENT?
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- initiation
- proliferation - histodifferentiation - morphodifferentiation - apposition - maturation |
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What are the INDICATIONS of pulp capping in PRIMARY TEETH?
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- asymptomatic tooth
- small mechanical exposures - normal pulp response, - no prolonged hemorrhage - periphery of exposure consists of sound dentin |
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What are some CONTRAINDICATIONS of pulp capping in PRIMARY TEETH?
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- rarely indicated on primary teeth - pulpotomy has higher success rate
- radiographic changes - hemorrhage or pus at exposure site - carious exposure |
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TRUE or FALSE: pulp testing of primary teeth is unreliable
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TRUE
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What are the INDICATIONS for PULPOTOMTY on primary tooth?
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- Symptomatic or asymptomatic posterior primary teeth
- inflammation confined to coronal pulp not extending into root canals - no evidence of pathologic changes radiographically |
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What are the CONTRAINDICATIONS for PULPOTOMY on primary tooth?
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- evidence of furcal or periapical pathology
- HX of spontaneous unprovoked pain - inability to control hemorrhage from pulpal stumps - less than 2/3 root remains (exfoliation) - tooth non-restorable - internal resorption - pulp with serious or purulent hemorrhage - fistula |
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How can one achieve MODERATE CONSCIOUS SEDATION in child?
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CHLORAL HYDRATE:
- 25-50 mg/kg - MAX of 1 gram - 30 min onset - duration 5 hours - peak in 1 hour - HIGH DEGREE OF GASTRIC IRRITATION DEMEROL: - most common narcotic agent - 1.2 - 2 mg/kg NOT TO EXCEED 100mg alone - action reversed by NARCAN |
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An 8 year patient with a 3mm diastema between the erupting maxillary permanent central incisors is a result of what?
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- normal eruption pattern
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During routine examination it is noted that a premolar is erupting ectopically while the primary predecessor is still firmly in place. The most appropriate management is to do what?
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Remove the primary tooth
Place orthodontic appliance immediately |
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The greatest amount of space closure following pre-mature tooth loss occurs in which area?
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Maxillary second premolar area
Amount of closure. In a given unit of time, maxillary second deciduous molar spaces show the greatest closure, followed by lower second deciduous molar spaces, while upper and lower first deciduous molar spaces show almost equal amounts of closure. The longer the time available for closure, the greater the total closure, particularly for extraction before eruption of the first permanent molar. |
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Children receiving systemic fluoride will exhibit the highest fluoride concentration in which part of the tooth?
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ENAMEL MATRIX (not surface)
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The eruption of which tooth signals the beginning of the MIXED DENTITION STAGE?
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Mandibular first molar
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A 7 year old child complains of pain when eating, has a large carious lesion on a permanent molar. A radiograph reveals NO periapical change. What is your treatment?
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Vital pulpotomy
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In a 5 year old, a small mechanical exposure in a vital primary molar would be treated by what?
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Pulp capping with CaOH
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In an 8 year old patient the most appropriate treatment of a VITAL permanent molar with a large carious exposure is what?
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PULPECTOMY
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What would be the treatment for an 11 year old who has intermittent swelling and pain associated with a central incisor which was traumatized 6 months ago?
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Pulpectomy
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A 5 year old child presents with a toothache involving a mandibular deciduous second molar. The tooth has a large carious exposure. What would your treatment be?
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Pulpectomy
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What is the management of UNCOMPLICATED CROWN FRACTURE / PRIMARY TOOTH?
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- take one radiograph; check stage of root development and root resorption if present
- examine for pulp exposure - if wounded lip, take image of lip to rule out presence of tooth fragment |
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UNCOMPLICATED CROWN FRACTURE / PRIMARY TOOTH / DENTIN EXPOSURE:
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Small fracture: no restoration
Large fracture: restoration with glass-ionomer or composite, using strip crowns FOLLOW UP - 1 week clinically - 3-4 weeks clinically and radiographically |
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What is the management of COMPLICATED CROWN FRACTURE - pulp tissue is vital.
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Cervical pulpotomy
FOLLOWUP: CL: 1 week CL/RD: 3-4 weeks, 6 months, 1 year, then annually |
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What is the management for COMPLICATED CROWN FRACTURE / young primary tooth with a wide open apex and thin root dentin walls?
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- Partial pulpotomy
FOLLOWUP: CL: 1 week CL/RD: 3-4 weeks, 6 months, 1 year, then annually |
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What is the treatment of a COMPLICATED CROWN FRACTURE / Parulis, mobility, and external resorption?
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EXTRACTION
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What is the treatment of a complicated crown fracture / root resorbing?
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EXTRACTION
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What is the technique for CERVICAL PULPOTOMY?
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- LA and RDI
- remove coronal pulp tissue - hemostasis - place FC and ZOE - seal with coronal restoration - post-op and follow up |
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What is the management for ROOT FRACTURE / Minimal displacement / Non-mobile / PRIMARY TOOTH:
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- observe tooth, analgesics, and soft diet
- DO NOT SPLINT FOLLOWUP: CL: 1 week CL/RD: 3 weeks, 8 weeks, 1 year, then annually |
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What is the management of ROOT FRACTURE / PRIMARY TOOTH/ Severe displacement or mobile:
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- extract coronal segment
FOLLOWUP: - apical segment annually should be followed up |
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What is the management of ALVEOLAR FRACTURE / PRIMARY TEETH?
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- patient management, most likely general anaesthesia
- reposition segment - confirm radiographically - splint teeth for 4 WEEKS - if teeth mobile, extract teeth FOLLOW UP CL: 1 week CL/RD/Remove Splint: 4 weeks CL/RD: 6-8 weeks, 6 months, 1 year annually |
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What are some oral hygeine instructions following PRIMARY TOOTH TRAUMA?
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- brush with soft brush
- dip brush in CHX to clean teeth for first 2 weeks until soft tissues heal - dampen gauze in 0.012% CHX to clean mouth |
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What percentage of chlorhexidine should be used to clean the mouth?
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0.12%
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What is the management of a JAW FRACTURE / PRIMARY TEETH?
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- try to stabilize jaws and keep from moving
- splint with towel, tie or handkerchief - send child to hospital immediately |
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What are the injuries to supporting tissues?
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Concussion
Subluxation Extrusion Intrusion Lateral luxation Avulsion |
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What are general instructions for trauma cases?
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- soft food for 1-2 weeks
- good oral hygeine: brush with soft brush after every meal - apply CHX 0.12% topically to affected area twice a day for one week - parents advised about possible complications like: swelling, dark discoloration of crown, increased mobility, fistula |
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What is the frequency of developmental disturbances in permanent teeth after traumatic injuries to the primary teeth?
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50-60%
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80% of oral cavity injuries occur in which age group?
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PRESCHOOL children
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What age group is the HIGHEST incidence of disturbances to permanent tooth?
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0-2 years old (63%)
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Which injury has the greatest chance of disturbance to permanent tooth?
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INTRUSION (70%)
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What are some negative effects that may happen to an underlying permanent tooth from trauma to primary?
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- white or yellow-brown discoloration of enamel
- discoloration of enamel with circular enamel hypoplasia - crown dilaceration - gemination - odontoma-like formation - root duplication - root dilaceration - partial / complete arrest of root formation |
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What are some SEQUELAE of TRAUMATIC INJURIES TO PRIMARY INCISORS?
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- space loss
- crown discoloration - pulpal necrosis - pulpal obliteration - pathologic root resorption - |
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Identify the condition?
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Turner's tooth
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Identify the problem here?
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Turner's tooth (enamel hypoplasia)
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For partial or complete arrest of root formation, what needs to be damaged?
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Epithelial sheath of Hertwig
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Pulp necrosis is first evident how long after injury?
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6-8 weeks after injury
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What is the treatment of INTERNAL / EXTERNAL resorption of primary tooth?
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EXTRACTION
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