Midterm Flashcards
If the pH falls below __ a dysbiotic microbiome categorized by and increase in the acidic biofilm species
5
Normal mouth pH = 7
Demineralization starts at pH 5.5
Presence of 1+ decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in child under age 6
Early childhood caries (ECC)
Describe severe early childhood caries (S-ECC)
<3 yr : any sign of smooth surface caries
3-5 yr: 1+ cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth
decayed, missing or filled score of greater than or equal to:
4 (age 3), 5 (age 4), 6 (age 5)
establish dental home within __ months of first tooth or __
6
12 months of age
Primary
Secondary
Tertiary preventative measures for ECC
Primary: needs to begin before disease occurs, education, limited sugar intake, avoid nighttime bottles, avoid baby bottle/breastfeeding past 12 months, brushing x2 day, topical fluoride treatment, fluoridated water
Secondary: prevent progression of/remineralization of caries before cavitation stage, early detection, sealants, more frequent fluoride varnish
Tertiary: SDF, restoration
Crown structure of a pediatric patient
Onion shaped
converging towards the occlusal
In a pediatric tooth, Enamel rods in cervical area are directed to the
occlusal (change class II prep shape)
Is enamel and dentin thinner or thicker in a pediatric tooth
Thinner (1-1.5 max width to ADJ)
Contact on a pediatric tooth are
broad and flat
Color of a pediatric tooth
Lighter (B2-A1)
Root shape of a pediatric tooth
narrower and longer compared to their crown length (permanent teeth have shorter thicker roots)
Resorption begins when __ of root is formed
Tooth is shed when __ of root is formed
1/3
1/2
Furcations on primary teeth
Closer to the crown (more susceptible to damage)
Pulp structure of pediatric teeth
larger chambers
pulp horns closer to outer surface
mesial pulp horn is higher
__ teeth should be erupted before age 3
20
Primary molars are replaced by
permanent premolars
2nd primary molars resemble __ , maxillary 1st primary molars resemble __ , mandibular 1st molars resemble __
1st permanent molars
1st permanent premolars
none (milk man)
Teeth present at birth
natal teeth
Neonatal teeth
Teeth that erupt within 30 days of birth
when the developing tooth moves inside the alveolar bone but cannot yet be seen clinically
Pre Emergent eruption
(begins once the root formation has started)
Emergence: when a cusp or an incisal edge of a tooth first penetrates the gingiva. Occurs when __ is established.
75% of the final root length
This must exist to move the tooth
eruption force
When does eruption occur
Follows a circadian rhythm, occurs mainly during early hours of sleep or after meals
Post emerging eruption
continuous movement until it reaches occlusion (faster during this stage)
Eruption does not stop once the tooth is in occlusion- continues to equal the rate of the vertical growth of the face
On average a molar erupts about 10 mm after occlusion
Primary teeth eruption
Mandibular incisors
maxillary incisors
Maxillary lateral incisors
mandibular lateral incisors
Maxillary 1st molars
mandibular 1st molars
Maxillary canines
Mandibular canines
Mandibular 2nd molars
maxillary 2nd molars
Comp exam care pathway
Interview
Oral exam
Detection
Images
Occlusion
Susceptibility
What is used to asses pain
FLACC
Probing primary teeth should be done after __ as tolerated by the child
eruption of 1st permanent molars and incisors
What do the colors of plaque tablets mean
Pink = 24 hour plaque
Purple = 48 hour plaque
Blue = 1 week plaque (pH = 3)
Biofilm removal: teach the parent to __
when should cleaning first occur?
Lift the lip
Clean baby gums using damp washcloth day after home
1 yr soft toothbrush and fluoride smear
Caries risk assessment tool (CAT-AAPD) should be performed as soon as
first primary tooth erupts
04HIP
PEDBEH
03HIP
01HIP
general consent
Pediatric behavior management
auth for use imaging
notice of privacy
D0150
D0120
D0140
Comprehensive exam
recall exam
emergency exam
Non-nutrutive sucking habit >3yr =
malocclusion (class II)
Sugar consumption is higher among children whose mothers were
younger
had less schooling
smoked
Babies breastfed in the 1st hour of life
consume less sugar during first 6 months
Acidic foods =
Alkaline foods =
demineralize
remineralize
(cows milk contains calcium, phosphorus, casein to stabilize plaque pH)
Appearance of occlusal surfaces (pit and fissure)
ICDAS 0
ICDAS 1
ICDAS 2
ICDAS 3
ICDAS 4
ICDAS 5
ICDAS 6
0 = sound
1 and 2 = initial
3 and 4 = moderate
5 and 6 = advanced
This should not be used to detect disease before clinical examination
radiographs
used for diagnosis of pulp status, decay depth, root development/resorption, furcation
PA
used for diagnosis of proximal caries, measure bone loss, pulp status
BWX
If there is an interproximal lesion on one side of the mouth it is usually mirrored on the other side of the mouth
used for diagnosis of crowding, extra or missing teeth, after dental trauma, any other pathology
Pano
No root formation of permanent tooth + extraction of primary tooth =
Permanent tooth will not erupt
½ to 2/3 root formation of permanent tooth + extraction of primary tooth =
Permanent tooth will erupt faster
Radiographs on a new pediatric patient
2-4 BWXs capture D of 2nd primary molar to D of canine (size 0-1 sensor)
(Pano if mixed dentition)
Recall pediatric patient and radiographs
BWXs every 6, 12, 24 months depending on CRA
Transitional dentition (6-7 years) radiographs
bitewings, panoramic
Panoramic - growth and development problems
Panoramic every 5 years
Adolescent radiographs
every 5 years panoramic, bitewings (2-4 depending on caries risk)
When to take a PA on a child
Pulp status
Decay depth
Root development / resorption
Furcation
distal of max and mand 2nd primary molars are in same vertical plane
flush terminal plane (develops into Class 1)
distal of mand 2nd primary molar is more distal than max 2nd primary molar
distal step
(develops into Class 2)
distal of mand 2nd primary molar is more mesial than max 2nd primary molar
mesial step (develops into Class 3)
Mixed dentition: __ used to classify occlusion when 1st molars are missing
canines
Primate spaces:
large spaces found mesial to maxillary primary canines and distal to mandibular canines
(helps molars erupt into class I occlusion)
(no space = crowding)
Caries risk assessment
High risk:
Moderate risk:
Low risk:
disease indicators present or risk factors outweigh protective factors
no disease indicators, risk and protective factors balanced
no disease indicators, very few risk factors
Disease indicator (High caries risk) (7)
White spots
decalcification enamel defects
obvious decay
Restoration present
Plaque obvious
gums bleed easily
Inadequate saliva flow
Mother active dental decay
Bottle other than water, milk or formula
Continued bottle use
Child sleeps with bottle
Frequent >3x/day snacks
Saliva reducing factors (meds, cancer treatment, genetics)
Incr risk of infection and decay
Developmental problems
Caregiver low health literacy
Drug use
Orthodontic appliance
Deep pit and fissures
intra and extra oral Risk factors (moderate risk if equal to protective factors, high risk if outweighs)
pH indicating paper place __
blue/green = __, yellow = __
lingual of mandibular molars
basic
acidic
Saliva check: Bite wax for 3-5 minutes spit saliva into cup
Stimulated flow rate: measured in mL (should be above __)
1mL/min
divided into different age groups (0-3, 3-5) risk divided by feeding patterns
CAMBRA
What caries risk assessment do we find in axium
AAPD-CRA
Chlorhexidine is effective against __ but __ is resistant
S. mutans
Lactobacilli
(opposite charges attract)
Explain 1X1X1
Chlorhexidine can lowe bacterial challenge by using daily one week each month
Understand the relevance of systemic fluorides on tooth formation
Ameloblasts secrete enamel matrix proteins (amelogenin) mineralized in 2nd stage to form enamel
External factors (fluoride) can stop development/mineralization of enamel (ameloblast stop secreting)
= Enamel Defects
ability to influence processes by facilitating calcium and phosphate precipitation
FLuoride
= drinking water
= mouthwash
= pediatric toothpaste used to be
= toothpaste
0.1 – 1 ppm
50-250ppm
500-600ppm
1000-1450ppm
When the pH in the mouth falls below 5.5 the teeth demineralize
-Ca and PO4 minerals are removed from the tooth –> saliva is hyper mineralized
-formation of white spot lesions
-When the pH is reestablished at 7.0 the Ca and PO4 minerals are incorporated from the saliva back into the tooth structure
-Fluoride helps Ca and PO4 be incorporated faster and more efficiently
-forms calcium fluorate (CaF) : accumulates in smooth enamel and dental plaque
Pediatric Fluorides
Brush x2 day with >__
Smear (__) for kids under 3yr that cant spit, pea sized (__) for kids over 3yr that can spit
1,000ppmF
0.1mg F
0.25mg F
Varnishes
__ (5% NaF)
Can be used to reduce tooth sensitivity
22,600 ppm
Turns tooth black, arrests lesion without having to numb or drill tooth
Silver Diamine Fluoride (SDF)
%NaF / 2.2 = %F
%F x 10,000 = ppm
Ex: 5% NaF / 2.2 = 2.26%F x 10,000 = 22,600 ppm
caries reduction after 5 yr (reduced 70% compared to chlorhexidine or fluoride
varnish)
Xylitol
Pericoronitis:
inflammation of gums around wisdom teeth, happens when don’t brush properly
38% (44,800ppm), changes microbiome (kills some bacteria, allows other bacteria to grow)
Arrests carious lesions
Stains tooth black (put Vaseline on gums to prevent from staining)
High caries risk pt
Used for very young pt who otherwise would have to be under anesthesia to do restoration
SDF
remove carious tissue using hand instruments only, restore with material that sticks to tooth (glass ionomer)
atraumatic restorative treatment (ART)
(Should not be used when: abscess, fistula, pulp exposed, chronic inflammation of
pulp, inaccessible to hand instrument)
restore, arrest or prevent progression of caries when traditional cavity prep is not feasible
interim therapeutic restorations (ITR)
use separators to create space in between teeth, remove separators after 15mins, choose prefabricated crown of appropriate height, fill with GI, cement onto tooth, clean excess
-decay is sealed under preformed metal crown (PMC) without LA, tooth preparation or caries removal
Hall technique
Lesion in a permanent vs primary tooth
Lesion in permanent tooth: cavitation follows single canal (enamel rods/dentinal tubules) into dentin towards the pulp
Lesion in primary tooth: lesion is bigger, spreads faster and over larger area
(Gets to pulp faster)
5 dentin types
Destroyed
Infected (bacteria, soft)
Affected (demineralized)
Sclerotic
Normal
__ single most important factor in protecting pulp against injury
Remaining dental thickness
