Pediatric Dentistry Test 1
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| components of patient history? | identifying data, chief complaint, present illness, past history, illness, operations, current health status, dental history, family history
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| where do we see early childhood caries most often? | upper front and upper and lower posterior teeth
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| what teeth usually come in first? | anteriors, upper and lower
canines and then posterior
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| what are the most common operations kids have? | tonsillectomy/ adenoidectomy or placement of ear tubes
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| what are the most comment current or chronic illnesses | asthma, cardia, seizure disorders, bleeding disorders, behavior disorders
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| what are fordyce granules? | sebaceous glands more commonly seen in hairy patients
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| what is a mucocele? | due to trauma to salivary gland
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| what is geographic tongue? | loss of filliform papillae
changes periodically tends to be chronic condition
may have some pain or sensitivity
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| what do we look at when classifying occlusion on primary teeth? | Molar relationship looking at the most distal portion of our lower second primary molar
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| class I in primary dentition | flush terminal plane (upper and lower distal portion end to end), canine end to end
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| class II in primary dentition | mesial step (distal of lower primary molar is in front of the upper primary molar), canine class I
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| class III in primary dentition | Distal step (lower secondary primary molar is distal to the second primary molar on maxillary), class II canine
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| what is over jet? | facial aspect of the lower incisors to the facial aspect of the upper incisors
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| what is over bite? | how much the upper incisors are overlying the lower incisors (percentage or mm)
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| what is child development? | biological, physiological and emotional changes that occur in human beings between birth and the end of adolescences
continuous process with a predictable sequence but has unique course for every child
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| what is growth? | predictable and orderly process that results in increase in size
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| what is development? | increase in complexity of form and function in an orderly sequence
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| what are the principles of child development? | proceeds in head to toe direction
center of the body outward
depends on maturation and learning
proceeds from simple to complex
continuous process
proceeds from general to specific
individual rates of growth and development
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| what is cephalocaudle principle? | development proceeds from head to toe direction
child gains control of the head first, then the arms and legs
crawling
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| what is proximodistal development? | development proceeds from the center of the body outward
spinal cord develops before outer parts of the body
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| how can growth be evaluated? | height, weight, head circumference, BMI
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| what is cognitive development? | construction of through processes including remembering, problem solving and decision making from childhood through adolescence to adulthood
how children come to think, know and solve problems
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| what is piaget's theory of cognitive development | the thinking process develops in sequential stages, each stage different from the others
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| what are the stages according to piaget? | sensorimotor: birth to 2 years
preoperational: 2 to 7 years
concrete operational: 7 to 11 years
formal operational: 12 to adult
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| how long does sensorimotor last? | birth to 2 years
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| how long does pre operational last? | 2 to 7 years
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| how long does concrete operational last? | 7 to 11 years
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| how long does formal operational last? | 12 to adult
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| what is skinner's theory on cognitive development | behavior can be modified through experience
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| what are the early years of language? | 2 months cooing
3 months babbling
9 months imitation of sounds
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| what is 12-18 months language development? | 10-20 words, understands more than speaks
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| what is 18-24 months language development? | combine words, bye bye stage, points at body parts
50 or more words
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| what is 3-4 years language development? | carries conversations, three word sentences, count to 3, names 1-3 colors
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| what is 4-5 years language development? | sentence length 4-5 words, tells stories, count to 10 names 5-6 colors
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| what is receptive language? | when a person has trouble understanding others
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| what is expressive language? | sharing thoughts ideas and feelings completely
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| what is a speech disorder? | unable to produce speech sounds correctly or fluently or has problems with his or her voice
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| what makes up neurodevelopment development? | gross motor, self help, fine motor
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| at 12 months what are the neurological developments? | sit unsupported, crawl, walk two or three steps
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| at 1-2 years what is the neurological developments? | walk unsupported, climbs on chair, self feeds with a spoon
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| at 2-3 years what is the neurological developments? | walk upstairs, pedal a tricycle, turn pages on a book
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| what is temperament? | describe the way that he or she approaches and reacts to the world, it is their personals style
appears heritable and stable across time
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| what is personality? | outcome of genetic predisposition to certain behaviors paired with effects of the social and family environment
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| what is 0-3 child development? | babies learn to walk, crawl, stand, talk
lap exams in dental office with oral sedation or IV sedation for work
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| at what age should the child be able to sit in the dental chair by themselves? | age 3
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| what are luxation injuries? | any injury to the tooth other than fracture
usually involves displacement of the tooth
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| what is more common in primary dentition than permanent and also more common than fractures? | luxation injuries
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| what is a concussion? | tooth is hit but not displaced of loosened, no bleeding, bruised PDL, sore to touch or pressure
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| what is the treatment for a concussion? | no treatment other than palliative, soft diet
unlikely to have negative sequelae especially if isolated injury
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| what is a subluxation | tooth is loosened but not displaced, little or no bleeding, sore to the touch or pressure
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| what is the treatment for a subluxation? | no treatment other than palliative, unlikely to have negative sequelae
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| what is a lateral luxation? | tooth is loosened and displaced in any direction other than the long axis, may interfere with occlusion, bleeding from gingival crevice and sore to touch or pressure
radiographs show medial distal widening of PDM space on one side
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| what is the treatment for a lateral luxation? | if not too mobile, reposition with gentle finger pressure
if very mobile extract
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| what is the likely sequelae for a lateral luxation? | abscess is most likely
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| what is an intrusive luxation? intrusion | tooth is displaced deeper into the alveolus along the long axis, tooth is displaced such that the crown appears shorter than adjacent teeth, tooth will not be loose, bleeding from gingival crevice but no soreness, no mobility
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| what does the radiographic exam look like in intrusive luxation? | absence of PDM space
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| what is the treatment for intrusive luxation? | choose to watch for re-eruption if not pushed into permanent tooth bud forming at it's root end or extract
if no movement within 2-3 weeks: extract
if severely intruded extract
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| what is the most common adverse seqelae for intrusive luxation? | abscess then ankylosis
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| what is extrusive luxation? extrusion | tooth is loosened and displaced along its long axis farther out of the bone so crown appears longer than adjacent teeth, bleeding from gingival crevice and sore to touch or pressure with mobility
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| what does the radiographs looks like in extrusive luxation? | widening of PDM space at apex
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| what is the treatment of extrusive luxation? | if not too mobile, reposition with gentle finger pressure
if very mobile, extract
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| what is the most common sequelae for extrusive luxation? | abscess
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| what is an avulsion or exarticulation? | tooth is missing, bleeding empty socket
radiographic shows empty socket
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| what is more common in permanent dentition than primary and more common than laxations in permanent dentition trauma? | tooth fractures
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| what is the treatment for enamel only uncomplicated fractures? | smooth rough edges
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| what is the treatment for enamel and dentin uncomplicated fractures? | composite bonding over area of bond tooth fragment back on tooth
may do ssc on primary teeth
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| what is the treatment for a complicated fracture? | pulp treatment, pulpotomy/ectomy
SSC or esthetic crown
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| how much does pulp necrosis increase if the dentin is left unexposed for greater than 24 hours? | 5% to 10%
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| what is the treatment for apical 1/3 root fracture? | usually not mobile so seldom requires splinting, good prognosis
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| what is the treatment for middle 1/3 root fracture? | fair prognosis if coronal segment not too mobile or separated too much, may be able to reposition and splint but if that mobile will probably extract
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| what is the treatment for coronal 1/3 root fracture? | poor prognosis, extract
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| what does immediate grey color of a tooth mean? | may be like bruise and return to normal but merits close supervision
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| what does delayed grey color of a tooth mean? | almost always indicates pulp necrosis
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| what is the treatment for grey tooth? | pulpectomy or extraction
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| what does yellowing of the tooth mean? | pulp obliteration, calcific metamorphosis
indicates excess dentin is being formed, rarely continues to pulp necrosis
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| what does immediate pink coloring of the tooth mean? | may be like a bruise and return to normal but merits close supervision
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| what does delayed pink coloring of the tooth mean? | almost always indicates extensive respiration
needs extraction
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| when does a posterior tooth not need space maintenance? | there are 2 teeth erupted into tight occlusion distal to the space
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| when do you use size 0 film? | for BW and PA's prior to eruption of the 1st permanent molars
less than 6 years old
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| when do you use size 1 film? | special views of maxillary and mandibular PA's
rarely used but with digital feeling large, good for small mouths
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| when do you use size 2 film? | all maxillary and mandibular occlusals
bitewings and PA's after the 1st permanent molars are in occlusion
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| when do you use size 4 film? | a large occlusal
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| what does a new patient exam consist of for primary dentition prior to eruption of 6 year molars and contacts closed? | 1 maxillary occlusal
1 mandibular occlusal
2BW
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| what does a mixed dentition new patient exam consist of after 1st permanent molars erupt, posterior contacts are closed and inter proximal cannot be visualized directly | 2 occlusals, if all 4 permanent incisors are erupted than change to PA
2 BW if no second permanent molars
4 BW if 2nd permanent molars erupted
panorex
4-8 PA
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| what does a permanent dentition new patient exam consist of? | 2 anterior PA's
4BW
panorex
8PA
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| when should a patient with increased risk for caries get x-rays? | every 6-12 months posterior BW
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| when should a mixed dentition child with low risk get x-rays? | 12-24 months
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| when should an adolescent low risk child get x-rays? | 18 to 36 months
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| why are occlusal or anterior PA taken? | baseline film due to high incidence of trauma to maxillary incisors
diagnosis caries, trauma or mesiodens
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| why are bitewings taken? | diagnosis of small inter proximal lesions in a patient with closed posterior contract
evaluation of furcation in teeth with deep carious lesions or abscesses
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| why are posterior periodical or panoramic films taken? | visualization of developing permanent teeth
determination of missing or extra teeth
determination of pathology
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| when is an occlusal film diagnostic? | all apices of all erupted anterior teeth clearly visible with a minimum of 1 mm bone showing past apices
all four permanent incisor buds visible
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| when is an occlusal film taken? | prior to eruption of permeant incisors
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| when is a anterior PA taken? | after eruption of permanent incisors
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| when is an anterior PA diagnostic? | apices of all four permanent incisors must be clearly visible with a minimum of 1 mm bone visible past apices
all periodical area suspected of pathological changes must show normal bone apical to the questionable area
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| when is a bitewing diagnostic? | each inter proximal area observed without overlap
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| what should be visible in primary dentition bitewings? | distal of canine and distal of 2nd primary molar should be visible in primary dentition
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| what should be visible in mixed dentition bitewings? | distal of canine and distal of permanent molar should be visible in mixed dentition
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| what should be visible in full permanent dentition? | distal of canine and medial of 2nd permanent molar
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| what is the technique for successful anterior PA's? | occlusal plane -25 degrees for mandibular
tube head +60 degrees over tip of nose for maxillary
tube head -30 degrees over tip of chin for mandibular
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| what is the technique for successful bitewings? | angle tube head at positive 10 degrees slightly above the occlusal plane
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| when is a posterior PA diagnostic? | apices of all erupted teeth must be visible with a minimum of 1 mm of bone past the apices
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| what is the technique for successful posterior PA? | maxillary posterior +40 degrees slightly below pupil centered on the tooth to be x-rayed
mandibular: -10 degrees below border of the mandible and centered on the tooth to be x-rayed
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| what surface is more susceptible on 1st primary molar? | distal surface because it is in firm contact with the 2nd primary molar
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| what surface is more susceptible on 2nd primary molar? | mesial surface
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| when is it recommended that the child is brought to the dentist for the first time? | no later than the eruption of the first tooth or first birthday
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| what is the number one chronic infectious disease of childhood? | caries
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| what is vertical transmission? | transmission of microbes from mother or caregiver to child
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| what is horizontal transmission? | transmission of microbes between members of a group like family members of a similar age or students in a classroom
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| what is anticipatory guidance? | proactive counseling of parents and patients about developmental changes that will occur in the interval between health supervision visits that includes information about daily care taking specific to that upcoming interval
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| what is included in anticipatory guidance for ages 0-3 | oral hygiene, diet and fluoride
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| what is anticipatory guidance for mothers? | oral hygiene, diet, fluoride, caries removal,
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| what can be mistaken for child abuse? | accidental injuries, genetic diseases, acquired diseases, infections
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| what is the definition for child abuse? | any mistreatment or neglect of a child that results in non accidental harm or injury and which cannot be reasonably explained
genuine threat of substantial harm and failure to make a reasonable effort to prevent an action of another
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| what is the definition of child neglect? | leaving a child in a situation where the child would be exposed to a substantial risk of physical or mental harm
failure to provide food, shelter, clothing or adequate supervision
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| what are the most common types of maltreatment? | neglect 78%
physical abuse 19%
sexual abuse 10%
emotional maltreatment 9%
medical neglect 2%
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| who are the abusers? | 60% are female, 40% are male
80% are parents
10% other relatives
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| what is phase I of abuse? | increased tension, anger, blaming, arguing, verbal abuse
almost anything the abuser sees as negative can cause battering
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| what is phase II of abuse? | the beginning of abuse- physical and or verbal
may be a slap, push, shove, punch or worse
may either begin as a single incident or hours of repeated beatings
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| what is phase II of abuse? | a calm after the beatings or abuse occur
abuser may deny, try to minimize or rationalize it and offer explanation for the abuse
abuser may to try to make up for it by apology and gifts, saying it will never happen again
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| what is the definition of physical abuse? | any act which results in non accidental trauma or physical injury
most often unreasonable severe corporal punishment
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| sites of inflicted injury | cheek, ear, lips and labial frenum, neck, buttocks and lower back, genitals and inner thighs
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| what is the definition of emotional abuse? | systematic tearing own of another human being, pattern of behavior that can seriously interfere with a child's positive mental and psychological development
victim sees himself or herself as unworthy of love and affection
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| what is the definition of sexual abuse? | involvement of dependent developmentally immature children in sexual activities that they do not comprehend
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| what is the most common form of child maltreatment reported to CPS? | child neglect
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| what is medical/dental neglect? | failure ti provide health care although finically able to do so
withholding traditional care due to religious beliefs is not usually considered medical neglect
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| what are the three things that puts a 0-3 child in the moderate risk for caries risk assessment? | Child has plaque on their teeth
Child has special health care needs
Child is a recent immigrant
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| what does caries risk assessment according to AAPD do for parents? | treatment of the disease process instead of treatment of outcome
gives understanding of disease factors
individualizes, determines frequency of preventive and restorative treatment
anticipates caries progression
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| what are the three factors for the caries risk assessment? | biological, protective, clinical findings
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| what puts a child at a high risk? | the presence of a single risk indicator in any area of the high risk category
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| what puts a child at a moderate risk? | the presence of at least one moderate risk indicator and no high category
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| what puts a child at a low risk | no moderate or high risk indicator
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| what are the high biological risks for 0-3 or 0-5 year olds | mother has active decay
parent is of low socioeconomic status
child has more than 3 meals containing snack or bereaves per day
child is put to bed with bottle
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| what are the protective factors for 0-3 or 0-5 year olds | child receives optimally fluoridated drinking water or fluoride
child has teeth brushed daily with fluoridated toothpaste
child receives topical fluoride from health professional
child has dental home/regular dental care
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| what are the high clinical finding risk found in 0-3 or 0-5 children? | child has white spot lesions or enamel defects
child has visible cavities or fillings
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| what do you do with a low risk 1-2 year old | recall every 6-12 months, twice daily brushing, diet counseling
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| what do you do with a moderate risk 1-2 year old with parents engaging | recall every 6 months, twice daily brushing, fluoride supplements, professional topical fluoride
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| for a low risk 3-5 year old what is radiographic orders? | 12-24 months
recall every 6-12 months
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| for a moderate risk 3-5 year old what is radiographic orders | 6-12 months
recall every 6 months
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| for a high risk 3-5 year old what is radiographic orders | 6 months
recall every 3 months
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| what are the moderate risk levels for children greater than 6 years old? | patient has special health care needs
patient is a recent immigrant
patient has defective restorations
patient wearing an intraoral appliance
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