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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
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:
Identify:
Hutchinson's incisors (associated with syphilis)
Hutchinson's incisors (associated with syphilis)
Idenfity:
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?
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?
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?
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:
IDENTIFY THE APPLIANCE:
Nance holding arch
Identify the appliance:
Identify the appliance:
Transpalatal arch
What is the problem?
What is the cause?
What is the treatment?
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) 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) 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?
What type of space maintainer is this?
Lingual holding arch
What is the treatment for this?
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) 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?
- impaired wound healing
- xerostomia
- altered sense of taste or smell
- reduced appetite
- increased risk for dental caries
- risk of oral infections
What are the clinical manifestations of calcium deficiency?
- osteoporosis
- disturbances in dental development
What are the clinical manifestations of Vit D deficiency?
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
Premature closure of sutures is called:
SYNOSTOSIS
Define ALOPECIA:
Loss of hair
Alopecia can occur in what conditions?
- chemotherapy
- ringworm
- ectodermal dysplasia
- hormonal disturbances
Treatment planning starts with what?
INFORMATION GATHERING
In treatment planning, what should always be addressed first?
- chief complaint
- acute pain / infection
- problems which may soon develop into emerg situations
- large carious lesions can be temporized until able to treat definitively
FIRST PRIORITY IN TREATMENT: Ant or post teeth?
Posterior
Children with HIGH CARIES risk should be seen how often?
3-6 months
Children with LOW CARIES risk should be seen how often?
6-12 months
Face is derived from which processes?
- frontonasal prominence
- paired maxillary prominences
- paired mandibular prominences
What are the three types of toxicity associated with fluoride?
- acute toxicity (death)
- chronic toxicity
- dental fluorosis
What are the four mechanisms of aciton of FLUORIDE?
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
What are the 5 main considerations for PEDIATRIC ORAL SURGERY?
- preoperative evaluation (medical, dental)
- behavioural consideration
- growth and development
- pathology
- perioperative care
Why is surgery involving mandible and maxilla of young patients complicated?
- developing tooth follicles
Why is prompt treatment of odontogenic infection important in children?
- prone to dehydration
- upper face infections
- lower face infections (twismus)
Primariy molar roots are LARGER / SMALLER ? in diameter and MORE DIVERGENT / LESS DIVERGENT than permanent molars?
- smaller
- more divergent
A 12 year old boy is getting his 75 and 85 extracted. What kind of space maintainer should be placed?
None
A boy is getting his max anterior primary teeth extracted, what kind of a space maintainer should be used?
Nance appliance WITH anterior teeth
Missing teeth in primary dentition can result in what?
- improper mastication
- malposition of teeth
- alteration in growth and developmental patterns
- speech problems
- psychological trauma
Define NATAL TEETH:
- born with the teeth
Define NEO-NATAL TEETH:
- within 30 days of birth
- DONT REMOVE unless very mobile and risk of aspiration
When does the germ form for the primary teeth generally?
6-8 weeks IU
When does the enamel generally form for primary teeth?
4-6 months IU
How long does root formation generally take for PERMANENT teeth after eruption?
2-3 years
What is the INCISOR LIABILITY generally (numbers)?
- Max = 7.6 mm total
- Mand = 6.0 mm
When is the ARCH CIRCUMFERENCE greatest?
Age three
What is the LEEWAY SPACE for max and mandible?
MAX 0.9 mm per side
MAND 1.7 mm per side
WHen does the MID-PALATAL SUTURE fuse?
13- 16 years old (early teens)
What is the TWEED variation of serial extraction of primary teeth?
- D's , C's and then 4's
What is the "NORMAL" extraction sequence for primary teeth?
- C's then D's and then 4's
What are the INDICATIONS for serial extraction in mixed dentition phase?
- Class I molars and canines
- severe crowding (greater than 6mm per quad)
- normal OB and OJ (2mm each)
- 7-8 years old
- full profile
When does the PRIMARY PALATE form?
4-6 weeks IU
Puberty in boys lasts on average how long?
5 years
When is the CRITICAL PERIOD to avoid fluorosis occuring in permanent incisors?
2-3 years
What is the CERTAIN LETHAL DOSE of fluoride?
- 32-64 mg / kg in one source
- death has been reported at 17 mg / kg
What is the SAFELY TOLERATED DOSE of fluoride?
8- 16 mg/ kg
What is the TREATMENT for overdose of Fluoride?
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
What are some COMMON signs and symptoms of ACUTE FLUORIDE TOXICITIY?
LOW DOSAGE:
- nausea
- vomiting
- hypersalivation
- abdominal pain
- diarrhea

HIGH DOSE:
- convulsion
- cardiac arrhytmia
- comatose

Patient becomes HYPOCALCEMIC due to binding with F
What are the mechanisms of action of FLUORIDES?
- 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
What are some of the FIRST things to looks for in PEDIATRIC DENTAL EMERGENCY?
- Deep caries approaching pulp
- internal / external resorption
- apical or furcal radiolucencies
- trauma
- check for mobility
What is the KEY to diagnosis of BABY BOTTLE TOOTH DECAY?
- mandibular incisors are caries free because of tongue protection
Why can there be very rapid spread of infections in children?
Large marrow spaces
What is the treatment for infections in children?
Penicillin
What are some important signs of CNS damage that take precendence over the dental trauma if there is a pediatric emergency?
- 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
Where do the majority of pediatric fracture traumas occurs?
Mandibular condyle
Which systemic factors can cause DELAYED EXFOLIATION/ERUPTION?
- HYPOthyroidism
- HYPOpituitarism
- low levels of GROWTH HORMONE
WHich systemic factors can cause PREMATURE EXFOLIATION?
- HYPERpituitarism
- HYPERthyroidism
What are the three types of AMELOGENESIS IMPERFECTA?
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
What is the proper order of STAGES OF TOOTH DEVELOPMENT?
- initiation
- proliferation
- histodifferentiation
- morphodifferentiation
- apposition
- maturation
What are the INDICATIONS of pulp capping in PRIMARY TEETH?
- asymptomatic tooth
- small mechanical exposures
- normal pulp response,
- no prolonged hemorrhage
- periphery of exposure consists of sound dentin
What are some CONTRAINDICATIONS of pulp capping in PRIMARY TEETH?
- rarely indicated on primary teeth - pulpotomy has higher success rate
- radiographic changes
- hemorrhage or pus at exposure site
- carious exposure
TRUE or FALSE: pulp testing of primary teeth is unreliable
TRUE
What are the INDICATIONS for PULPOTOMTY on primary tooth?
- Symptomatic or asymptomatic posterior primary teeth
- inflammation confined to coronal pulp not extending into root canals
- no evidence of pathologic changes radiographically
What are the CONTRAINDICATIONS for PULPOTOMY on primary tooth?
- 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
How can one achieve MODERATE CONSCIOUS SEDATION in child?
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
An 8 year patient with a 3mm diastema between the erupting maxillary permanent central incisors is a result of what?
- normal eruption pattern
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?
Remove the primary tooth
Place orthodontic appliance immediately
The greatest amount of space closure following pre-mature tooth loss occurs in which area?
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.
Children receiving systemic fluoride will exhibit the highest fluoride concentration in which part of the tooth?
ENAMEL MATRIX (not surface)
The eruption of which tooth signals the beginning of the MIXED DENTITION STAGE?
Mandibular first molar
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?
Vital pulpotomy
In a 5 year old, a small mechanical exposure in a vital primary molar would be treated by what?
Pulp capping with CaOH
In an 8 year old patient the most appropriate treatment of a VITAL permanent molar with a large carious exposure is what?
PULPECTOMY
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?
Pulpectomy
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?
Pulpectomy
What is the management of UNCOMPLICATED CROWN FRACTURE / PRIMARY TOOTH?
- 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
UNCOMPLICATED CROWN FRACTURE / PRIMARY TOOTH / DENTIN EXPOSURE:
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
What is the management of COMPLICATED CROWN FRACTURE - pulp tissue is vital.
Cervical pulpotomy

FOLLOWUP:
CL: 1 week
CL/RD: 3-4 weeks, 6 months, 1 year, then annually
What is the management for COMPLICATED CROWN FRACTURE / young primary tooth with a wide open apex and thin root dentin walls?
- Partial pulpotomy

FOLLOWUP:
CL: 1 week
CL/RD: 3-4 weeks, 6 months, 1 year, then annually
What is the treatment of a COMPLICATED CROWN FRACTURE / Parulis, mobility, and external resorption?
EXTRACTION
What is the treatment of a complicated crown fracture / root resorbing?
EXTRACTION
What is the technique for CERVICAL PULPOTOMY?
- LA and RDI
- remove coronal pulp tissue
- hemostasis
- place FC and ZOE
- seal with coronal restoration
- post-op and follow up
What is the management for ROOT FRACTURE / Minimal displacement / Non-mobile / PRIMARY TOOTH:
- observe tooth, analgesics, and soft diet
- DO NOT SPLINT

FOLLOWUP:
CL: 1 week
CL/RD: 3 weeks, 8 weeks, 1 year, then annually
What is the management of ROOT FRACTURE / PRIMARY TOOTH/ Severe displacement or mobile:
- extract coronal segment

FOLLOWUP:
- apical segment annually should be followed up
What is the management of ALVEOLAR FRACTURE / PRIMARY TEETH?
- 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
What are some oral hygeine instructions following PRIMARY TOOTH TRAUMA?
- 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
What percentage of chlorhexidine should be used to clean the mouth?
0.12%
What is the management of a JAW FRACTURE / PRIMARY TEETH?
- try to stabilize jaws and keep from moving
- splint with towel, tie or handkerchief
- send child to hospital immediately
What are the injuries to supporting tissues?
Concussion
Subluxation
Extrusion
Intrusion
Lateral luxation
Avulsion
What are general instructions for trauma cases?
- 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
What is the frequency of developmental disturbances in permanent teeth after traumatic injuries to the primary teeth?
50-60%
80% of oral cavity injuries occur in which age group?
PRESCHOOL children
What age group is the HIGHEST incidence of disturbances to permanent tooth?
0-2 years old (63%)
Which injury has the greatest chance of disturbance to permanent tooth?
INTRUSION (70%)
What are some negative effects that may happen to an underlying permanent tooth from trauma to primary?
- 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
What are some SEQUELAE of TRAUMATIC INJURIES TO PRIMARY INCISORS?
- space loss
- crown discoloration
- pulpal necrosis
- pulpal obliteration
- pathologic root resorption
-
Identify the condition?
Identify the condition?
Turner's tooth
Identify the problem here?
Identify the problem here?
Turner's tooth (enamel hypoplasia)
For partial or complete arrest of root formation, what needs to be damaged?
Epithelial sheath of Hertwig
Pulp necrosis is first evident how long after injury?
6-8 weeks after injury
What is the treatment of INTERNAL / EXTERNAL resorption of primary tooth?
EXTRACTION