MD PEDIATRIC Flashcards
what are stages of tooth development and time?
initation stage ( 6 weeks )
bud stage ( 8 weeks)
Cap stage (9 weeks)
Bell stage ( 11 weeks)
Maturation ( 14+ week)
eruption
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all primary teeth and permanent molars arise from what tissue ?
DENTINAL LAMINA !!
BUD STAGE
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what stage does enamel begin to develop? how long does it take to get to this stage?
CAP STAGE ( after bud stage): enamel organ that makes enamel
- dentinal papilla: rest of tooth bud creates dentin and pulp
- Dental follicle: surrounding sac surrounds dentinal papilla and enamil organ
9 weeks
what is the dental follicle?
Sac of cells surrounds both the enamel organ and the dental papilla (creates dentin and pulp)
what stage follows cap stage and what is being created?
Inner cell layer (IEE) : ameloblasts
Dental Papilla: odontoblasts (dentin making)
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what are the stages of BELL stage?
Histodifferntiation: IEE -> ameloblasts ; Dental papilla -> odontoblasts
Morphodifferntiation: shape and size of crown determined during this process
Apposition: odontoblasts: deposit dentin matrix (collagen) ; ameloblasts: deposit enamel matrix; Cervical Loop: IEE and OEE join (HERS and epi rests of Malassez)
IEE + OEE = REE ( functional epithelium)
Maturation : depsit enamel and dentin; calcification begins at cusp tips and goes down
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what is the longestr stage of tooth development?
maturation ( bell stage)
how long does it take to complete maturation of primary tooth crown?
2 years
how long does it take to complete permanent tooth crown ?
4-5 years
SUMMARY OF ERUPTED TOOTH
Enamel organ: emloblasts -> enamel
Dental Papilla: odontoblasts -> dentin; central cells-> pulp
Dental Follicle: cementoblsts -> cementum; osteoblasts -> alveolar bone ; fibroblasts -> PDL
calcification order :
central incisors
lateral incisors
canines
first molars
second molars
central Incisors : 14 weeks
First molar: 15 weeks
Lateral incisors: 16 weeks
Canines: 17
second molars: 18 weeks
development order
calcification order :
central incisors
lateral incisors
canines
first molars
second molars
central inciros ( mandibular first) : 6-7
lateral incisors ( max first) : 7-8
first molars: 9-11
canine: 10-12
second molars : 10-12
primary tooth development?
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permanent tooth development
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most common supernumery teeth?
mesiodens ( middle ebtween 8 and 9)
most common missing teeth order?
3rd molars
mandibular 2nd PM
maxillary Laterals
Maxillary second PM
most common congenitally missing primary tooth?
Maxillary Lateral Incisor
which one affects cap stage/ bell stage?
microdontia
fusion
gemination
macrodontia
Bell: Micro and Macro
Cap: FUsion and Gemination
patient walks in count was one less than normal. what do they have?
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FUSION
always anterior
2 buds merge into 1 tooth
patient comes in with normal count of teeth. what is this called? what happens during it?
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gemination !
- 2 crown 1 root
tooth count normal
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patient has tooth with extra cusp. what is this ?
dens invaginatus
dens evaginatus
tauradontism
dilaceration
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dens Evaginatus :
talon cusp, has pulp, dentin , enamel ( dont extract)
patient walks in and radiographs shows a tooth growing inside anotherl . what does this patient have? what causes this ? what tooth mostly found in?
dens invaginatus
dens evaginatus
tauradontism
dilaceration
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dens invaginatus ( dens in dente)
caused by invagination of IEE
permanent maxillary lateral
what does this radiograph show an image of ?
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taurodotism
elongated pulp chamber and short roots
what does this show an image of and what causes it ?
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DILACERATION
traumatic injury to primary tooth
patient walks in with this radiograph. what do they have?
amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
enamel hypoplasia
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dentinogenesis imperfects ( no pulp)
a patient walks in with blue scelera in her eye. this is a feature of what?
amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
enamel hypoplasia
dentinogenesis imperfecta
what does this patient have?
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amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
enamel hypoplasia
amelogenesis imperfecta :
alteration of enamel
what does this patient have?
amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
dentin dysplasia
concreasence
enamel hypoplasia
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dentin dysplasia !!
chevron pup;s, short roots, messed up dentin
short roots: type 1
Chevron pulps: type 2
what does this patient have?
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amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
dentin dysplasia
concreasence
enamel hypoplasia
REGIONAL ODONTODYSPLASIA
ghost teeth
after extraction. adjacent teeth look as though fused together by cementum. what is this
concreascance
fusion
gemination
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concreascene
difference between
gemination
fusion
concreascence
fusion: 2 buds / 1 tooth ( one less)
gemination (one root 2 crown ( normal)
concr: adjacent fuse togehter
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patient walks in with this. what is this condition?
amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
dentin dysplasia
concreasence
enamel hypoplasia
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ENAMEL HYPOPLASIA
turners hypoplasia
patient walks in with this. what is this condition?
amelogenesis imperfects
dentinogenesis imperfects
regional odontodysplashia
dentin dysplasia
concreasence
enamel hypoplasia
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enamel hypoplasia
congenital syphilis ( hutchinsons incisors and mulberry molars)
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difference between primary and secondary mandibular first enamel in terms of
- enamel
- pulp
- rootsa
primary:
thinner enamel
bigger pulp
more divergent roots
this tooth is widest anterior tooth M->D direction and only ant tooth where width is bigger than height
primary maxillary central inciros
this tooth is widest anterior tooth FL direction
primary maxillary canine
what has longer and sharper cusps
- primary maxillary canine
- permanent maxillary canine
- primary mandibular canine
PRIMARY MAX CANINE
this tooth resemebles oermanent maxillary 1st premolar
primary max 1st molar
this tooth has most prominent MF cervical ridge of max primary teeth
primary maxillary 1st molar ( resembles perm max 1st PM)
wides FL of ALL primary teeth and what does it resemble?
PRIMARY MAX 2ND MOLAR
resembles perm max 1st molar
last primary tooth to erupt
onlyp rimary tooth with cusp of carabelli, oblique ridge, and DL groove
this is the only primary tooth with cusp of carabelli, Oblique Rirdge , and DL groove
primary max 2nd molar
this primary tooth has smallest FL
primary mandivular central incisor
this tooth is the most symmetrical tooth !
Primary Mand Central Incis.
this is the most unique tooth in dentition.
has ML ice cream cone cusp which is highest and sharpest, 4 cusps and 4 pulp horns, CEJdips more on mesial half resulting in S shape cervical
Primary mand 1st molar ***
which cusp is the largest and highest on primary 1st mandibular molar ?
MB : LARGEST
ML: HIGHEST AND SHARPEST
this tooth has widest MD in whole dentition
prim. mand. 2nd molar
how many cusps and roots of primary mandibular 2nd molar
2 roots and 2 canals
prim mand 1st: 4 cusps 3 pulp horns
this tooth crown resembles perm mand 1st molar
primary mand second molar
primary tooth amalgam depth and isthmus width
depth: 1.5 mm
isthmus width: 1/3
area of primary tooth where composite rstoration most common failure
gingival margin
stainless steel crown for teeth affected by caries that extend where?
direction youre suppose to seat SSC?
past axial line angles
lingual to buccal
patient walks in and has caries on primary incisors is worried about ESTHETICS. what rsetorative procedure should be done?
strip crown
for primary incisors w/ proximal caries
1 mm incisal reduction !!
child walks in with R/L under tooth with pain, mobiity. what does this mean?
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furcation r/l sign of necrosis for a primary pulp
what material should you use for Indirect pulp cap
CaOH or RMGI
when doing a procedure, accidentily have pinpoint pulp exposure on primary tooth. how shouls this be fixed and what is complication that could happen?
CaOH directly on pulp
RMGI placed over as restoration
INTERNAL ROOT RESORPTION
PULPOTOMY is for what type of pulp and what material should be used ?
VITAL and restorable primary tooth with exposure
Formocresol: coagulation
ZOE for BU
SSC for coverage
formecrosl -> ZOE -> SSC
PELPECTOMY PROCEDURE:
what type of pulp? what tooth to not do on? material
NECROTIC and RESTORABLE teeth ( non resotrable= extraction)
Primary first molars: acessory canals
basically RCT but using ZOE
under what circumstance to EXT primary tooth
necrotic 1st molar
nonresotrable
root resorption ( except secondary primary molar so acts as space maintaner)
procedure for primary first molar with furcation ?
extraction
procedure for primary second molar with furcation ?
pulpectomy
procedure for tooth with no furcation involvement but endo sympms
pulpotomy
WHAT IS THE PRIMATE SPACE ON MAND AND MAX?? ***
WHEN IS IT GONE?
Max: M to canine ( lat incisor and canine)
Mand: D to canine ( 1st molar and canine)
WHAT IS LEEWAY SPACE
difference in size of the mesiodistal crown widths of the primary canines and molars compared with that of their permanent successors (canine, first and second premolars
primary = more
upper: 2.5 mm
lower : 1.5 ,,
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interdental space is caused by what? **
growth of dental arches !!! ( Board ?)
what is the ugly duckling stage? age? **
preceeds eruption of max canines ( 7-11 y/o)
match the terms:
space management
Space maintanence
Space Regaining
Reactive, Retroactive, Proactive
mange: proactive ( manage and hold leeway space)
maint: reactive
regaining: retro (want 3 mm max)
primary incisor loss causes what? and how to fix it?
localized space loss
kiddie partial for speech and esthetics
primary canine loss? how to fix it?
cause lingual collapse of incisors and loss of arch ength
LOWER LINGIAL ARCH or NANCE from perm first molars
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when to use LLHA? and what teeth do they wrap around?
PRIMARY CANINE LOSS
permanent first molars !
what to use for primary first molar loss ?
BAND AND LOOP
LLHA or NANCE
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what to use when primary second molar is lost?
DISTAL SHOE : from primary first molar to unerupted permanent 1st molar
LLHA or NANCE: if permanent first molar is already erupted
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when do we use :
LLHA? NANCE? Distal Shoe? band and loop
LLHA or nance: if Perm first molar erupted
BAND AND LOOP : primary fitst molar loss
DISTAL SHOE : primary second molar loss
average tooth pierces bone with how much root formation?
2/3
average tooth pierces gingiva with how much root formation?
3/4
rule of 7 with primary molar lost?
lost before 7: eruption of PM delayyed
Lost after 7: PM accelerated
space closure accours within ____ months after tooth loss
first 6 months
lingual eruption of teeth. how to treat?
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double row of teeth: resolve on their own
(ectopic eruption) patient walks in with their teeth erupting laterally. what procedure should be done?
extract contralateral primary lateral teeth asap to avoid midline deviation
patient walks in. his molars are out of occlusion and have a hollow sound when tapped. what does patient have and treatment?
ANKYLOSED PRIMARY MOLARS
no tmnt necessary
healthy gingiva in children vs adults color?
children: reddish due to thinner epithelium less keratinization, grater vascularity
Adults: coral pink
children vs adults healthy gingiva features:
contour
kids: rounded and rolled margins due to edema
adults: knife edged
children vs adults healthy gingiva features:
texture
kids: flabby
adults: firm and resilient
children vs adults healthy gingiva features:
sulcus
kids: deeper
Adults: less deep
gingivits in children is induced by what?
plaque!!!!!
parents should participate in kids oral hygiene until what age
8 !!! b/c manual dexterity
what is ANUG? tmnt?
acute necrotizing ulverative gingivitis
A; painful fever
N: dying tissue
U: pseudomembrane
G: bleeding, inflammed gums, blunted papilla
tx: Debridement, oxidizing mouth rinse, AB
what is RAG?
reduced attached gingiva
atached gingiva: best gingiva
most common cause of inadequate attached gingiva?
labial eruption path
kid walks in with bump on crest of alveolar ridge. what is this and tx?
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eruption cyst
txx: nothing, simple surgical excision if symptomatic
tx for this high frenum?
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CLOSE SPACE FIRST!
THEN FRNECTOMY !
PREPUBERTAL PERIODONTITIS INVOLVES WHAT TEETH FIRST?
tx?
PRIMARY MOLARS
tx: debridement and AB
most common teeth for trauma in children?
overjet in children?
maxillary anteriors
> 6 mm ( usually)
concussion or subluxation of teeth.
what is it and what is tx?
mobility of tooth but no displacement ( luxators loosen teeth)
no tmnt
child walks in tooth pushed in. what is this?
tx?
issue with this?
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INTRUSION
tx: none: spont erupt
can damage permanent teeth
- hypoplasia: during apposition
- hypocalc: during calcification
- dilaceration: during toot formation
child walks in and tooth pulling out. what does patient have?
tx?
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EXTRUSION of primary teeth
TX: extruded more than 3mm = extraction
if patient seen before PA blood clot then REPOSITION and FLEXIBLE splint 1-2 weeks
patient has avulsion of primary tooth.
tx > and < than 30 minutes?
<30: replant, flexible splint 1-2 weeks, soft diet, AB, endo tmnt
> 30: extract and space maint.
crown fracture of primary tooth. what to do if in enamel only?
enamel and dentin?
E and D and P ?
******
E: smooth
D: restore
EDP:
pulpotomy: if vital
Pulpectomy: non vital
extract: if pathologic root resorption
a child walks in with root fracture. what to do if its in the apical half?
coronal half?
apical: no tmnt
coronal: rigid splint or ext
what is damaged in internal root resorption?
External root resorption?
IRR: odontoblastic layer in pulp
ERR: cementoblastic layer in PDL
age of most common child abuse and neglect?
0-3
dentist suspect child is being abused or neglected. he has no proof. what should the dentist do? **
by law they have to report it !!!!
what is the frankl rating scale?
1: definitely negative
2= negative resistence
3= positive acceptance
4 = definitely positive
this is a no-tmnt dental visit to be introduced to dental setting
familiarization
the knee-toknee exam is for what patients?
where is the childs head?
infants <2 y/o
Head: in DENTISTS lap
when should reinforcement be ?
immediate and specific to desirable behavior !
punish with the purpose of extinguishing or imporving negative behavior is caleld what?
what patients does this not work on?
defiant
ucnontrolled
timid
tense cooperative
whining
Aversive Conditioning
not for timid and tense-cooperative
palce hand over mouth to gain attention of uncontrolled patient
ADHD more common in M or F?
age appears?
most common meds?
M
3-6
methylphenidate ( ritalin)
atomexetin (straterra)
aphetamine (aderall)
patient with repetitive behavior and heightened sense of light and sound usually has what?
autism
MAX RECOMMENDED DOSE OF ANESTHETIC? **
4.4 mg/kg
nitrous sedation in children steps
- fil bag w/ O2 and place on patients nose with flow rate 4-6 L/min
- inc 10% increments to about 30% for operative procedures
- after stopping lungs fill with nitrous so give patients 100% O2 3-5 minutes
MOST COMMON COMPLICATION OF NITROUS SEDATION?
nausea
what is minimum alveolar concentration ( MAC) ?
Mac of nitrous oxide?
conc required to render 50% of patients immobile
105%
is asthma a contraindication to nitrous ?
No !!! mild to moderate asthma is okay
3 contraindications to nitrous?
<2 y/o
uncooperative
wheezing episode (asthma is okay tho)
4 stages of anesthesia?
1 paresthesia
2 vasomotor (warm)
3 Drift
4 Dream” eyes closed, jaw sagging
how is fluoirde in children given?
prescription only
fluroide for children > 3 y/o?
fluoride tablets and lozenges !!!
lozenges only above 3
fluoride in children <3 y/o
fluroide drops !!!
children cant swallow tabs
fluoride children > 6
fluoride mouth rinse
thumbsucking very common in what age?
up to 3 !!
effects of thumbsucking?
overjet, ant teeth. max, posterior?
increased overjet
ant open bite
maxillary constriction
posterior crossbite
what age should appliance to intervene with thumbsucking be placed and what are 2 examples?
5 or 6
Crib
BLuegrass : roller on ant plate
crib: steel fixed appliance in anterior palate region
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teeth present at birth called?
natal teeth !
teeth that erup within first 30 days called?
neonatal teeth
most common natal and neonatal teeth?
primary mandibular incisors
baby walks in and teeth causing ulceration on ventral tongue. what is this and what is tx?
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riga-fede disease
smooth or extract
EARLY CHILDHOOD CARIES
also called what?
patient what age?
2 things that cause it?
- baby bottle syndrome
- younger than 6 years
- constipation -> fruit juice consumption
- ear infection -> AB with high sucrose
when should infants drink from a cup?
age of first dental visit?
1
by age 1
age infant should use pea size of toothpaste?
2-5
age patient should use smear of toothpaste?
before age 2