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What is the most prevalent infectious disease in children?
Caries 40% by kindergarten
What is the dental home?
- Dentist & patient all inclusive for comprehensive continuously accessible coordinated and family centered way.
- Begin no later than 12 months
When should dental home be established?
Early as 6 months, 6 months after 1st tooth, no later than 12 months
Describe the different craniofacial dimensions at birth.
- Transverse(width): close to adult
- Ant-post: diff growth rates for max and mand
- Vert: lease developed (40% adult)
- Cranial Vault: closer than face, mirror neural growth (8th month all nerve cells developed)
- Cephalocaudal growth gradient: cranial vault->max->mand
What does Scammon’s growth curve predict?
- Assumption: 20 years growth is complete
- Lymphoid: exceeds 100% peaks at 200% around 10 years
- Neural: gets to 90% by around 6 years
- Maxillary: always above mandibular (more accelerated than mand)
- Mandibular: below flattens 8-9
- General: flattens 5-9 (s-shaped)
- Genital: flattens 2-12 then spurts
What are the 3 phases of tooth eruption?
- Preeruptive: root formation begins and tooth is moving toward bony surface
- Eruptive(prefunctional): root dev through gingival emergence, most are ½ to 2/3 dev on ginvgival emergence
- Eruptive(functional): from gingival emergence to the point where the tooth meets its antagonist
What are some of the causes of tooth eruption?
- Root formation
- Hertwig’s epithelial root sheath proliferation
- Dental papilla CT proliferation
- Simultaneous jaw growth
- Muscular pressure
- Apposition and resorption
What are the developmental milestones of primary teeth?
- Tooth formation begins 7 weeks in utero
- Calcification evident at birth
- Enamel complete by 1 year
- Primary should erupt by 24-36 months
- Roots complete by 3
What are the developmental milestones of permanent teeth?
- Formation: begins between 3.5-6 months in utero
- Calcification of 1st molars by birth
- Calcification of all teeth except 3rds by 3 years
- Enamel of incisors and 1sts complete by 5 years
Where is primate space?
- Max: lateral & canines
- Mand: canine & 1st molar
When is bottle discontinued?
What are piaget’s spectrum of cognitive development?
- Sensorimotor: 0-2 years
- Preoperational: 2-6/7
- Concrete operation: 6/7-12
- Formal operations: 12-16
What are the language capacities of 0-3 months?
- Receptive >> expressive
- 18 months: 10 words
- 3 yr old: 1000 words
What are the (behavioral) cognitive development classifications?
- Pre-cooperative: lacking ability to cooperate (usually 0-3)
- Uncooperative: potentially cooperative
- Appropriate vs inappropriate
What areas are significant for dental hx?
- Feeding: frequency, habits, bottle
What areas are examined of the face for ortho status?
- Profile: convex, concave, straight
- Facial pattern: upper, middle, lower 3rds, lower(1/3 upper lip, 2/3) lower lip)
- Lip position: retrusive, normal protrusive. Jaw:head relation, tissue thickness
- Facial symmetry
What are the skeletal classes?
- Class II: max prognathia, mand retrognathia (convex)
- Class III: max retro, mand pro (concave)
What are the terms to describe facial patterns and what techniques used to assess?
- Mesofacial: avg, mandible line should extend to lowest occipital
- Brachyfacial: short, wide. Shallow mandibular incline, below occipital plane, usually has long upper face height
- Dolichofacial: long, narrow. Steep mandibular, intersects above occipital plane
- (Lateral cephalograph)
What factors affect lip position?
- Jaw relation to head
- Tissue thickness
What are the areas to examine for occlusion?
- AP: Angle classes, overjet, anterior crossbite, incistor angulation, AP incisor position
- Transverse: midline, posterior crossbite, arch width/symmetry, curve of wilson
- Vertical: overbite, incisor display, gingival display, curve of spee, occlusal cant
- Alignment (over arches) crowding, missing, supernumery impacted, transposed, ankylosed, diastema, bolton analysis
What are Angle malocclusion classes?
- Max 1st MB cusp w buccal groove of mand 1st
- I: malocclusion-malopposed teeth
- II: end-to-end or end on, overjet
- III: distal to groove, underjet (underbite)
What do you key off for primary occlusion?
- Posterior surface of primary 2nd molars
- Flush terminal plane: end to end
- Mesial step: mandibular mesial (underbite mayebe)
- Distal step: mandibular distal (overjet maybe)
What is overjet and its normal ranges?
- Horizontal overlap of incisors from labial surface of lower to incisal tip of upper
- Normal 2-3mm
- Can have negative mand in front of max (underbite) anterior crossbite
- End on incisors = 0 overjet
What are the incisor divisions?
- Div 1: flared incisors
- Div 2: retroclined incisors
- -trusive: position
- -clined: angulation
What is overbite?
- Vertical overlap of incisors
- Normal:1-2mm or 20-30%
- Excessive=deep bite w/ possible palatal impingement
- None = open bite
What is a good landmark for facial midline?
What is posterior crossbite?
- Max arch narrower, involves AP and transverse
- Look at canines for transition point
What is a brodie bite?
Mandibular teeth completely lingual to maxillary
What are the criteria for using radiographs with children?
- 1. Cooperative
- 2. Posterior interproximal surfaces cannot be evaluated
- Freq: based on risk
What are some classes of misbehaving children?
- Emotionally compromised
- Shy, introverted
- Authority averse
Risk factors of sucking?
- What, frequency, duration
- ⇒ Caries, othrodontic
Where do ECC usually present?
- Max incisors (not mand bc Whartons duct)
- Max & mand 1st molars
- Mand canines
What is night-time bottle use associated with?
- Max anterior caries in 24-36 month old children
- No association with younger or posterior caries
What is the age pattern and presentations of ECC?
- 10-12 months: max anteriors
- 13-15 months: molar fissures
- 19-21 months: posterior proximal in conjunction with other patterns
What are ECC risk factors?
- Excessively frequent bottle (sleeping)
- Prolonged bottle or breast (beyone 18 months)
What are the factors of oral habits affecting occlusion?
- Intensity, frequency, duration
- DURATION most important: 4-6 hrs of force/day causes tooth movement
What is AAP stance on pacifier use?
Advocates use in infants to reduce SIDS, but SIDS risk decreases at 9 months
What are the drives to suck?
- Inherent biological: nutritive, non-nutritive
- Non-nutritive sucking beyond oral phase (3yrs) reflects psychological disturbance suggestive of inability to manage stress & anxiety
- Conversely, learning theory suggests that non-nutritive is adaptive response that is often rewarded and becomes a learned habit w/o psych abnormality
What are the stats and factors on oral habits?
- 90% during 1st year
- Most stop by 24-36 months
- Prolonged factors: old maternal age, higher maternal education, no older siblings
What are the prevalence patterns of non-nutritive sucking?
- both: decrease fast to 36 months
- pacifier: almost 0 by 72 (social)
- thumb/digit: decreases at slow rate after 36 months
What are dental problems associated with non-nutritive sucking?
- Anterior open bite
- Posterior cross bite (needs intervention)
- Excessive overjet
- Class II canine relationship
When and why should intervene w/sucking habit?
Allow for spontaneous cessation, but intervene prior to eruption of permanent teeth, (intervene 3-4 y/o)
Do lip, toungue habits cause malocclusion?
- Not really, sucking & biting may maintain problem though
- Tongue thrust may maintain open bite.
What age is treatment of open bite recommended?
10, 90% spontaneously close by then
What is the impact of mouth breating?
- Long lower face
- Maxillary constriction
- “adenoid facies”
What is the treatment of mouth breathing?
If airway is abstructed, turbinectomy, adenoidectomy
What is the impact of nail biting?
No malocclusion but possible enamel fractures
What are the impact, causes and tx of bruxism?
- Cause: occlusal interference(local), systemic, psychological, medical
- Wear of primary canines and molars (rarely pulp)
- Muscle soreness and TMJ pain
- TX: ID and equilibrate occlusal interference, rule out systemic problems, mouthguard, stainless steel crowns, psych referral
Which main oral habits directly impact occlusion?
- Others maintain: lip habits, tongue thrust, mouth breathing
- Teeth integrity: nail biting, bruxism
Describe the physical changes between 3-6.
Head slow, limb rapid, 4” & 5lbs(muscle bulk & calcification) / year
Describe the craniofacial growth changes.
- Remodeling of cranial vault bones (increased size apposition at sutures)
- Ossification of synchondroses in cranial base
- Describe the maxillary and mandibular changes (3-6).
- Maxilla apposition in up & back direction(superior & posterior sutures) leading to down and forward displacement /translation. Anterior maxilla resporbtion. Apposition on palatal and resporption on nasal, net downward translation
- Mandible, remodeling throughout, resorption on anterior ramus, apposition on posterior, net translation down & forward.
What age does relative growth of face & cranium diverge?
Around 5, more facial changes after.
What is the relation of max and mandible from 3-6 from scammon’s curve?
Max still ahead, mandible S flattens after 6
Where does most growth from 3-6 occur in facial diagrams?
- Vertical vs. transverse
- Mandible/facial vs cranial
What is early mesial shift?
Closing of interproximal space of primary dentition on eruption of first permanent molars. -> bitewings may be necessary
What is 3x3+3&3?
- 3 components: facial, skeletal, dental
- 3 planes: A/P, transverse, vertical
- 3 factors: space/crowding, alignment, tooth mass
- 3 variables: growth, cooperation, interdisciplinary
What are some appliances for maxillary transverse deficiency?
- Quad helix
- Banded hyrax expander
What are Blains classifications of parental personality?
- Appropriate: nurturing, transfer authority
- Compensatory: super parents, many Qs
- Overprotective: high risk child, older parents
- Manipulative: demanding, controlling
- Hostile: noncompliant, avoiding, questioning
- Neglectful: chaotic, careless, unappreciative
- Overindulgent: overlaps compensatory, overprotective
What are the dimensions (classifications) of parenting style?
- Responsiveness: extent of intentional fostering of individuality (supportive)
- Predicts social competence and psychosocial functioning
- Demandingness: behavior control, claims parents make on children to become integrated into the family whole by demands, supervision and willingness to confront the child who obeys
- Associated with instrumental competence and behavioral control
What are the features of authoritarian parenting?
- High demandingness, low responsiveness
- Obedience, status oriented expect obedience with no explaination
- Well ordered, structured w clear rules
What are the features of authoritative parenting?
- High demandingness, high responsiveness
- Monitor and impart clear standards for their childrens conduct.
- Assertive but not intrusive and restrictive.
- Supportive not punitive.
- Want assertive, socially responsible self-regulated cooperative children
What are the features of uninvolved parenting?
- Low demandingness, low responsiveness
- Rejecting neglectful
- Children perform most poorly across the board
What are the features of indulgent parenting?
- Low demandingness, high responsiveness
- Nontraditional and lenient, do not require mature behavior, allow self-regulation and avoid confrontation
- Democratic vs nondirective
What is classical conditioning and how does it relate to pediatric dentistry?
- Unassociated stimuli could produce reflexive behavior
- Associative learing
- Goal: extinction of conditioned response, develop discrimination
What is operant conditioning?
- Unconscious determined behavior overrides conscious determination
- The consequence of a behavior is a stimulus that can affect future behavior
- Pleasant stim, response increase: positive reinforcement (PS presented)
- Pleasant stimulus, response decrease: time-out (PS withdrawn)
- Unpleasant, response increase: negative reinforcement (US withdrawn)
- Unpleasant, response decreased: punishment (US presented)
mWhat is modeling?
Observational learning, imitation of behavior in social context