pedo final review

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pedo final review
2013-12-10 23:30:11
pedo final review
pedo final review
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  1. Brodsky Scale
    • assess tonsil size
    • 0: Tonsils entirely within tonsillar fossa
    • 1+:Tonsils occupy less than 25% of oropharynx
    • 2+:Tonsils occupy less than 50% of oropharynx
    • 3+:Tonsils occupy less than 75% of oropharynx
    • 4+:Tonsils occupy 75% or more of oropharynx
  2. Malampatti Score
    • predict ease of intubation
    • Class 1: Tonsillar pilllars, soft palate, and
    • uvula visible
    • Class 2: Tonsillar pillars and soft palate
    • visible, upper portion of uvula
    • Class 3: Base of uvula, soft palate visible
    • Class 4: Only hard palate visible
  3. first examination is recommended:
    at the time of the eruption of the first tooth and no later than 12 months of age
  4. Dental explorer usage:
    • Tip of explorer can be moved gently across surface
    • of any non-cavitated area
    • Used to determine the presence or absence of
    • roughness as an indication of whether the underlying demineralized area reflects an active lesion
  5. major differences in tooth morphology between primary and permanent teeth?
    • Thin, even enamel (about 1mm)
    • Pulp horns closer to outer surface of tooth
    • Bulbous crowns with distinct cervical constriction
    • Short root trunks
    • Large pulp horns and pulp chambers
  6. Glass ionomers
    • •chemical bonding to both enamel and dentin
    • •thermal expansion similar to that of tooth structure
    • •biocompatibility
    • •uptake and release of fluoride
    • •decreased moisture sensitivity when compared to resins
    • Resin-modified glass ionomers have improved wear resistance compared to conventional glass ionomers and are appropriate restorative materials for primary teeth
  7. composite contraindications
    • isolation problems
    • large, multiple surface restorations (cusp coverage)
    • high-risk paitents who have muliple caries or demineralization and poor compliance
  8. Sealants should be placed on pits and fissures of primary and permanent teeth of children and adults when it is determined that:
    the tooth, or the patient, is at risk of experiencing caries
  9. Pit-and-fissure sealants should be placed on ______ in children, adolescents and adults to reduce the percentage of lesions that progress
    early (noncavitated) carious lesions
  10. ____ sealants are the first choice of material
  11. Routine mechanical preparation of enamel before acid etching is
    NOT recommended, BUT tooth should be CLEAN
  12. Pit & Fissure Sealant: Procedure
    • • Clean the tooth surface with toothbrush, prophy angle +/- pumice, or strong burst of air + water (last option)
    • • Isolate the quadrant and utilize a bite block
    • • Determine if need to open grooves (not usually)
    • • Etch enamel (20-60 sec) and rinse
    • • Dry thoroughly - surface should be frosty
    • • Apply hydrophilic dentin bonding agent (1 bottle system)
    • • Place sealant on the mesial-occlusal surface and drag the sealant into the grooves....
    • • THINK: Rivers, not Lakes
    • • Polymerize (20-40 sec)
    • • Evaluate surface coverage, retention and occlusion
    • • Floss the contacts
  13. Other areas to seal
    • OL groove of upper molars
    • buccal pit & grooves of lower molars
  14. Amalgam Indications or contraindications:
    • • Limited to one surface and small two
    • surface restorations (Class I, Class II)
    • contraindications:
    • • Small carious lesions where a conservative adhesive restoration is more appropriate
    • • Class II amalgams in primary molars when the preparation extends beyond proximal line angles
  15. Common errors with class I amalgam
    • (A) Preparing cavity too deep
    • (B) Undercutting marginal ridges
    • (C)Carving the anatomy of amalgam too deep
    • (D) Not removing amalgam flash from cavosurface margins
    • (E) Undercarving, leading to fracture from hyperocclusion
    • (F) Not including all susceptible fissures
  16. Common errors with class II amalgam
    • (A) Failure to extend occlusal outline into all susceptible pits and fissures
    • (B) Failure to follow outline of the cusps
    • (C) Isthmus cut too wide
    • (D)Flare of proximal walls too great
    • (E) Angle formed by the axial, buccal and lingual walls too great
    • (F) Gingival contact with adjacent tooth not broken
    • (G)Axial wall not conforming to proximal contour of tooth & mesiodistal width of gingival floor >1mm
    • Class II amalgams contraindicated in primary
    • molars when the preparation extends beyond proximal line angles
  17. high caries risk
    • decayed/missing/filled surfaces greater than the child’s age
    • numerous white spot lesions
    • high levels of mutans streptococci
    • low socioeconomic status
    • high caries rate in siblings/parents
    • diet high in sugar
    • presence of dental appliances
  18. interim therapeutic restorations (ITR) vs. atraumatic/alternative restorative technique (ART).
    • ITR may be used in very young patients uncooperative patients, or patients with special health care needs for whom traditional cavity preparation and/or placement of traditional dental restorations are not feasible or need to be postponed
    • ITR may be used for caries control in children with multiple open carious lesions, prior to definitive restoration of the teeth
    • ART is a means of restoring and preventing caries in populations that have little access to traditional dental care and functions as definitive treatment.
  19. Glass ionomers can be recommended as:
    • 1. luting cements;
    • 2. cavity base and liner;
    • 3. Class I, II, III, and V restorations in primary teeth;
    • 4. Class III and V restorations in permanent teeth in high
    • risk patients or teeth that cannot be isolated;
    • 5. caries control with:
    • a. high-risk patients;
    • b. restoration repair;
    • c. ITR;
    • d. ART
  20. The objective of resin infiltration is
    to halt progression of small proximal carious lesions by surrounding them with polymerized unfilled resin
  21. The smaller filler particle size allows greater polishability and esthetics, while larger size
    provides strength
  22. SSCs have been indicated for
    • restoration of primary and permanent teeth with caries
    • cervical decalcification
    • developmental defects (eg, hypoplasia, hypocalcification)
    • when failure of other available restorative materials is likely (eg, interproximal caries extending beyond line angles, patients with bruxism)
    • following pulpotomy or pulpectomy
    • for restoring a primary tooth that is to be used as an abutment for a space maintainer
    • for the intermediate restoration of fractured teeth
    • patients under GA or sedation
  23. In high caries-risk children, definitive treatment of primary teeth with SSCs is better over time than
    multisurface intracoronal restorations
  24. extractions behavior mgt
    • topical & profound LA
    • consider N2O, oral sedation, GA
    • TSD: Pressure vs Pain
    • Distraction is a must
  25. ped extraction armamentarium
    • Curette or periosteal elevator (Miller)
    • Smaller pediatric forceps
    • # 150S maxillary molars
    • # 151S mandibular molars
    • # 1 maxillary anterior
    • # 44 mandibular anterior
    • Tooth elevator #301
    • Reduced size allows easier placement in
    • the small oral cavity
    • Small end adapts better to the primary
    • tooth anatomy
  26. ped ext technique
    • Dental curette or periosteal elevator separates
    • epithelial attachment
    • Appropriate elevators used to luxate tooth, great
    • care must be taken not to luxate adjacent teeth or
    • damage developing tooth
    • Appropriate forceps seated with lingual/palatal
    • beak first, then rotation of buccal beak into
    • position (at CEJ)
    • Throughout extraction, firm apical pressure applied
    • with forceps
    • Molars: palatal/lingual movement first, following by
    • buccal and palatal/lingual motion
    • Incisors/canines: rotational movement towards the
    • midline
  27. root tip should be left if it is:
    • Small
    • Located deep in socket
    • In close proximity to permanent successor
    • Unable to be retrieved after several attempts
    • inform parents of complications
  28. Postoperative Instructions:
    • verbal & written
    • 1) Bite on gauze for 30 minutes, don’t chew gauze
    • 2) Do not use straw for 24 hours
    • 3) Brush remaining teeth daily, but do not rinse or use mouthwash today
    • 4) Take pain medication as directed
    • 5) If increased pain after 48 hours or abnormal bleeding, call the office
    • 6) Do not spit. Spitting will cause bleeding. (Excess saliva and a little blood looks like a lot of bleeding).
    • 7) If bleeding starts again, place new gauze and bite firmly for one hour, do not chew gauze
    • 8) Ice pack can be used immediately after surgery and for first 24 hours to decrease swelling. Keep ice on for 10 min, off for 10 min.
    • 9) Black and blue bruises can occur after surgery
    • 10) Drink lots of liquids and eat soft foods
    • Call office with any concerns
  29. Primary spacing
    • Baume Type I: generalized spacing in primary dentition (2/3 of patients)
    • Baume Type II: non-spaced primary dentition (1/3 of patients)
    • Spacing 3-6mm -> No transitional crowding
    • Spacing less than 3mm -> 20% with incisor crowding
    • No spacing -> 50% with incisor crowding
    • Crowded primary teeth -> 100% with incisor crowding
  30. Primate space
    • Maxillary: Between lateral incisor and canine
    • Mandible: Between canine and first primary molar
  31. Leeway space
    • The difference in the mesiodistal dimension of C-D-E segment and the 3-4-5 segment
    • 0.9 mm of space per quadrant for maxilla
    • 1.7mm of space per quadrant for mandible
  32. E-space
    • (a subset of the leeway space)
    • difference in the mesiodistal dimension of the primary second molars (“Es”) & the permanent second premolars
  33. Incisor liability
    • The difference between amount of space needed and the amount of space availalbe for the permanent incisors
    • - Due to permanent incisors being larger then primary incisors
    • Maxillary incisors size differential: 7.1mm > for permanent
    • Mandible incisors size differential: 5.1mm > for permanent
  34. Early mesial shift
    • During eruption of 1st permanent molars some of the primary spacing
    • closes, shifting the primary molars mesially
  35. Late mesial shift
    Forward movement of 1st permanent molars after exfoliation of the primary molars, leading to closure of the leeway space
  36. Early loss of incisors Minimal loss of arch length, unless ..
    • Lost before primary canines erupt
    • Class II tendency
    • No primary spacing
    • Deep overbite
  37. Groper appliance
    • - esthetic (not functional)-
    • early loss of incisors and canines have minimal impact on function
  38. Most critical tooth for space:
    Primary 2nd molar before eruption of permanent 1st molar
  39. Which space maintainer is the best?
    • well-maintained primary tooth
    • All space maintainer appliances are plaque retentive
    • Increasing caries risk and gingival inflammation
    • Appliances may:Impinge on the soft tissues
    • Interfere with the eruption of adjacent teeth
    • Fracture
    • Become dislodged or lost
    • Therefore, every effort should be made to retain primarymolars until they are naturally exfoliated
  40. Band and loop
    • For loss of primary 1st molar prior to eruption of permanent 1st molars
    • Limited to single unit spaces as the loop has limited strength
    • Well adapted to the gingival tissue and adjacent tooth
  41. Distal shoe
    loss of primary 2nd molar prior to eruption of permanent 1st molars
  42. Lower Lingual Holding Arch
    • For unilateral or bilateral loss of mandibular primary 1st or 2nd molars
    • Band and loop
    • Prevents mesial tipping of permanent 1st permanent molar
    • Prevents loss in arch dimension
    • ONLY utilized if permanent mandibular incisors have already erupted-
    • Bands on permanent 1st molars-
    • Wire contacts cingulae of incisors & stays 1-1.5mm away from tissues-
    • Omega loops placed bilaterally to allow for future adjustment
  43. Transpalatal Arch (TPA) & Nance appliance
    • For unilateral or bilateral loss of maxillary primary 1st or 2nd molar since the permanent 1st molars have erupted
    • Follows palate curvature- Lies 2-3mm AWAY from mucosa
    • Nance appliance has an acrylic button that increases anchorage by pressing on palatal vault
  44. Removable space maintainer
    • For unilateral or bilateral loss of primary 1st molar prior to eruption ofpermanent 1st molars (alternative to the distal shoe)
    • Fill the saddle with acrylic to encourage eruption behind the acrylic
  45. space maintenance contraindicated
    • poor oral hygiene
    • high caries rate
    • Uncooperative children
    • irregular attendance
    • *gingival tissues may grow over the space maintainer
    • bands get loose leading to plaque and decay
  46. Primary dentition - Maxilla and Mandible
  47. mixed maxilla
  48. mixed mand
  49. After permanent first molars erupt completely, must transition to a
    • fixed bilateral space maintainer (LLHA, TPA or Nance)
    • Eruption sequence dictates the need for a fixed bilateral space maintainer in order to maintain arch perimeter
  50. high risk caries factors 0-5
    • mother + caries
    • Low SES
    • frequent snacking
    • bottle
    • DMF
    • white spots
    • S. Mutans
  51. Moderate CAMBRA 0-5
    • special needs
    • immigrant
    • plaque
    • >6 defective restorations, intraoral appliance
  52. protective CAMBRA 0-5
    • Fl H20
    • Fl toothpast
    • Fl topical
    • dental home
  53. High CAMBRA > 6
    • low SES
    • freq snacks
    • IP lesions
    • white spots
    • xerostomia
  54. asthma risk
    • candidiasis (steriod)
    • xerostomia (B2 agonist)
    • gingivitis, mouth breathing, inc myeloperoxidase
    • doubles caries risk
    • prevention: drink, rinse after inhaler, good OHI
  55. AP primary molar class
    • fixed reference: distal max 2nd molar
    • variable: distal mand 2nd molar
    • distal, mesial step, flush terminal plane
  56. class II
    • div 1: proclined max incisors
    • div 2: retroclined max incisors
  57. non-nutritive sucking sequelae
    • anterior openbite
    • posterior crossbite
    • increased OJ
    • proclined upper incisors
    • linguoversion of lower incisors
    • distorted incisor eruption
    • class II
  58. 2% lido 1:100k epi
    • max dosage: 4.4mg/kg or 2mg/lb
    • max total: 300mg
    • 34mg/carpule
    • duration pulp (1hr max, 1.5 mand), soft tissue (3hrs)
  59. 4% articaine 1:100k epi
    • parathesia: more common
    • max dosage 7mg/kg or 3.2mglb
    • max total: 500mg
    • 68mg/carpule
  60. Nitrous oxide can be used for patient with mild or moderate asthma
  61. Always use rubber dam with asthma pt?
  62. Acyanotic CHD
    • L->R (skips body)
    • ASD, VSD, PDA
    • AV canal
    • Aortic or pumonary stenosis
  63. Cyanotic
    • Truncus Arteriosus
    • Transposition of the Great Vessels
    • Tricuspid Atresia
    • Tetralogy of Fallot
    • Total Anomalous Pulmonary Venous Return
  64. Prophy AB needed for:
    • prosthetic cardiac valves
    • previous IE
    • CHD: unrepaired cyanotic CHD, within 6 months of repair, repaired CHD w/ residual
  65. Prophy AB dosage
    • amoxicillin/cephalexin: 50mg/kg (2g adult)
    • clindamycin: 20mg/kg (600mg adult)
    • do not use cephalosporin if hx of anaphylaxis, angioedema or urticari to penicillin
    • ex 44lb: 44lb/2.2 lb/kg * 50mg/kg = 1000mg
    • 1 bottle 250mg/5ml amoxicillin
    • take 20ml (4 teaspoons) 1 hour before visit
  66. Frankl Behavior Rating Scale
    • 1 - Definitely negative
    • Refusal of treatment, crying forcefully, fearful, or any other overt evidence of extreme negativism.
    • 2 - Negative
    • Reluctance to accept treatment, uncooperative, some evidence of negative attitude but not pronounced (sullen, withdrawn).
    • 3 - Positive
    • Acceptance of treatment; cautious behavior at times; willingness to comply with the dentist, at time with reservation, but patient follows dentist’s directions cooperatively.
    • 4 - Definitely positive
    • Good rapport with dentist; interested in the dental procedures; laughing and enjoying the situation.
  67. Behavior Guidance Techniques:
    • • Tell Show Do
    • • Voice control
    • • Nonverbal communication
    • • Positive reinforcement
    • • Distraction
    • • Parent presence absence
    • • Nitrous oxide/oxygen inhalation
    • Advanced Behavior Guidance Techniques(require training):
    • • Protective stabilization
    • • Oral conscious sedation
    • • General anesthesia
  68. N2O precautions
    • diffusion hypoxia:34 times more soluble than nitrogen in blood
    • • Must administer 100% oxygen to the patient for 3 to 5 minutes after nitrous oxide is terminated
  69. N20 Contraindications
    • • COPD
    • • First trimester of pregnancy
    • • Tx with bleomycin sulfate
    • • Methylenetetrahydrofolate reductase deficiency
    • • Severe emotional disturbances or drug-related dependencies
  70. Indications for oral conscious sedation:
    • • Fearful, anxious patients for whom basic behavior guidance techniques have not been successful
    • • Midazolam: sedative/hypnotic + amnestic properties - 30-40 minutes of working time
    • • Patients who cannot cooperate due to a lack of psychological or emotional maturity and/or mental, physical, or medical disability
    • • Patients for whom the use of sedation may protect the developing psyche and/or reduce medical risk
    • • Contraindications for oral conscious sedation:
    • • The cooperative patient with minimal dental needs
    • • Predisposing medical and/or physical conditions which would make sedation
    • inadvisable
  71. Chronic periodontitis
    • Slow to moderate rate of progression that may include periods of rapid destruction of attachment and bone levels
    • Used to be grouped with aggressive periodontitis; lack of published data for chronic
    • periodontitis in children
  72. Localized aggressive periodontitis
    • Etiologic bacteria:✦ Agregatibacter(actinomycetemcomitans
    • ✦ Interproximal attachment loss on at least two permanent first molars and incisors (with attachment loss on no more than two teeth other than first molars and incisors)
    • tx: debridement(surgeical), amoxicillin, metronidazole, tetracyclines
  73. Generalized aggressive periodontitis
    • P. gingivalis
    • ✦ Generalized interproximal attachment loss including at least three teeth that are NOT permanent first molars and incisors
    • tx: not responsive
  74. Systemic disease periodontitis
    neutrophil+immune cell dysfunction
  75. Papillon-Lefevre Syndrome
    • auto-recessive
    • severe destructive perio
    • palmar/plantar hyperkeratosis
    • early primary/permanent tooth loss w/o root resorption
  76. hypophosphatasia
    • defective alkaline phosphatase
    • bone problems, osteomalacia
    • perio: delayed formation, eruption
    • early, spontaneous tooth loss
    • mild: 1st sign is early primary tooth loss
  77. necrotizing perio disease
    • Spirochetes and P. intermedia
    • IP necrosis, ulceration
    • rapid onset of gingival pain
    • Tx: pain med, mechanical debridement
    • metronidazole & penicillin if systemic
  78. Apthous ulcer/stomatitis
    • recurrent, painful ulcers on non-keratinized,
    • Tcell dysfunction, trauma initiated
    • unattached mucosa
    • buccal, labial mucosa
    • minor: 1-5
    • major: multiple->scars
    • Tx: CHX, chemical cauterization
    • major tx: topical, systemic steroids
  79. Primary herpetic gingivostomatitis
    • fever, irritibility, multiple vesicles, diffuse erythema
    • lasts 7-10 days
    • widespread especially gingiva (digit, ocular maybe)
    • HSV
    • Dehydration
    • tx: supportive antipyretics, analgesics, hydration
    • acyclovir
  80. secondary herpetic ulcers
    • reactivated HSV
    • multiple, recurrent, small clustered
    • painful preceded by vesicles
    • herpes labialis: vermillion border, tx: abreva
    • recurrent intraoral: hard palate, attached mucosa
    • witlow: fingers
    • tx: symptomatic relief or acyclovir
  81. coxsakie A
    • hand-foot-mouth
    • prodromal: fever, anorexia, malaise, ab pain, cough
    • intraoral vesicles before skin lesions
    • dehydration
    • tx: supportive
    • herpangina
    • small, vesicular lesions w white base on soft palate uvula tonsils
  82. zoster
    • chicken pox
    • prodromal
    • skin lesions trunk, extremities spared
    • tx: supportive
  83. Defer elective dental treatment until oral and/or skin lesions resolve for all viral infections
  84. Decay without exposure, No spontaneous symptoms
    • Healthy or reversible pulpitis
    • Restore tooth
  85. Decay with possible or near exposure, No spontaneous symptoms
    • Healthy or reversible pulpitis
    • Indirect pulp treatment
  86. Decay with possible or near exposure, Occasional pain on stimulation
    • Reversible pulpitis
    • Pulpotomy
  87. Decay with possible or near exposure, Close to exfoliation
    Consider elective extraction
  88. Iatrogenic/non-carious exposure, No spontaneous symptoms
    • Healthy
    • Pulpotomy
  89. Carious exposure, Minimal history of pain, No mobility No radiographic evidence of pathology
    • Reversible pulpitis
    • Pulpotomy
  90. Carious exposure, Spontaneous pain
    • Irreversible pulpitis
    • Pulpectomy
    • Extraction
  91. Carious exposure, Draining sinus, swelling, mobility, radiographic pathology
    • Necrotic pulp
    • Pulpectomy, Extraction
  92. Gross Decay, Extensive root resorption, Not restorable, Furcation/periapical pathology
    • Necrotic pulp
    • Extraction
  93. TP appointment #1:
    • Exam, Prophy, Fl varnish, BWX (etc), OHI, CAMBRA, Diet Analysis, Informed consent, Material Choices, N20
    • Every Person Flourishes By Open Communication, Dieting and Ignoring Constant Materialistic Needs
  94. Treatment plan contents
    • Rational for Behavior Guidance Strategy(3-4 sentences):
    • Caries Risk Assessment, rational:
    • Material Choices(5-8 sentences)
    • Treatment Plan, including pulpal dx: