Outcome 1 - Pediatric Dentistry

Question 1

What are Primary Teeth important for?

Answer 1

Not only Biting & Chewing - they play an important role in the development of permanent teeth as well as in the development of the jaw bones and facial muscles

Question 2

How long must primary teeth last to allow for proper development of the mouth?

Answer 2

5-10 years

Question 3

It is important to retain the primary teeth for the following reasons:

Answer 3

Nutrition - intact primary dentition is essential for proper nutrional intake duing this period of active growth

Muscle growth - primary teeth along with the chewing process help stimulate the growth of the maxilla and mandbile

Speech - primary teeth are essential to the development of sound production and speech development. tongue uses teeth and roof of mouth to make many sounds

Mouth Structure - primary teeth retain space in the dental arch for their permanent successors . When primary teeth are lost prematurely, permanent teeth may be impacted or erupt out of alignment

Esthetics - encourage a positive self image - missing teeth that should normally be there could lead to teasing/bullying

Question 4

Pediatric patients experience many disturbances in tooth development and eruption. Three of the common disturbances are..

Answer 4

-Supernumerary teeth (hyperdontia)
-Unerupted (impacted) maxillary cuspids
-Frenum induced diastema

Question 5

How supernumerary teeth affect pediatric patients ?

Answer 5

Supernumerary teeth frequently cause a delay in eruption of the normal permanent teeth or anomalies of position such as a diastema or rotations. They may cause the development of cysts that can damage or resorb roots of adjacent teeth. Supernumerary teeth are generally removed to prevent crowding and shifting of the dentition. If they are left in place, the patient may require orthodontic treatment to align them with the other teeth.

Question 6

What are supernumerary teeth found at the midline called?

Answer 6

If they are found at the midline they are called mesiodens.

Question 7

Where are supernumerary teeth most often found in pediatric patients?

Answer 7

They are most often found in the region of the upper anterior teeth, especially the central incisors.

Question 8

What does an impaction mean?

Answer 8

an impaction means the tooth is not able to erupt fully into place in the mouth

Question 9

What tooth is most often associated with impaction?

Answer 9

The third molar / wisdom tooth

Question 10

What is the second most common teeth to become impacted?

Answer 10

the maxillary cuspids - which are considered the cornerstones of the dental arch so every effort is made to bring them into proper occlusion

Question 11

What is done to bring cuspids into proper occlusion?

Answer 11

To move them into position, they may have to be surgically exposed, followed by orthodontic treatment.

Question 12

What is a frenum induced diastema?

Answer 12

an abnormally large maxillary labial frenum which is often seen in children. It is associated with a diastema between the primary central incisors or the erupting or erupted permanent central incisors.

Question 13

Why is there often space between the primary central incisors?

Answer 13

A space between the uper primary central incisors is common and normal. It is oweing to the growth of the anterior segment of the maxilla and should cause no concern. This seperation may be absolutly normal in the time before the upper lateral inciros and cuspids erupt - cuspids will often push the centrals together as they move into position

Question 14

What if a child’s diastema does not close?

Answer 14

If the diastema does not close when all teeth have erupted into position, it may be due to the thickness of the frenum tissue. A frenectomy may need to be preformed to remove the tissue allowing the central incisors to come together in a normal contact position.

Question 15

What is the objective of preventive dentistry for pediatric patients?

Answer 15

Is to maintain the tooth in the mouth, in a health condition to fulfull its role as a useful component of primary dentition. The importance of oral hygiene, use of fluoride, diet and other preventive measures play a vital role.

Question 16

What is the objective of retorative dentistry for pediatric patients?

Answer 16

Is to maintain the tooth in the moouth, in a healthy condition. The same goals are appleid as those for permanent teeth. The dental assistant role will be to adapt to smaller dention, and techniques.

Question 17

Examples of dental traumas are…

Answer 17

-anterior teeth fracture
-intrusion (apical displacement of a tooth into the alveolar bone)
-extrusion (tooth is displaced from its socket)
-lateral luxation (tooth positioned forward or backward from gumline)
-avulsed teeth (knocked out) (replanting)

Question 18

Why do pulp exposures occur frequentl in primary teeth?

Answer 18

Because of the small area between the pulp and the calcified tooth structures

Question 19

What is the objective of pulp therapy?

Answer 19

To maintain the tooth in the mouth, in a healthy condition to fulful its role as a useful component of primary dentition. A tooth successfully treated will not only fulfill its role in mastication, but it will act as the best space maintainer for the developing permanent dentition.

Question 20

What is a pulpotomy?

Answer 20

Is the removal of the coronal portion of the pulp, and the treatment of the remaining radicular pulp. It is completed in an attempt to maintain the toot hand its supporting structures in a state of health.

Question 21

When is a pulpotomy most often preformed in primary teeth?

Answer 21

when the pulp has been exposed during the removal of dental caries and wwhen the resultant chronic inflamation has affected only the coronal portion of the pulp.

Question 22

Two techniques used for pulpotomy treatment are:

Answer 22

1. Pulpotomy with formocresol
2. Pulpotomy ith calcium hydroxide

Question 23

What is a pulpotomy with formocresol indicated for?

Answer 23

For carious and accidental pulpal exposres, in primary teeth, when the pulp is still vital.

Question 24

What is formocresol?

Answer 24

A combination of formaldehyde and tricresol in glycerine, has a protein-binding effect in addition to being a strong bactericide

Question 25

How is a pulotomy with formocresol performed?

Answer 25

A small cotton pellet is immersed in the formocresol solution and placed in the pulp chamber. After five minutes the cotton is then removed and a Zinc Oxide Eugenol (ZOE) cement is used to seal the pulp cavity. The liquid for this cement should consist of equal parts of formocresol and eugenol.

A final restoration or stainless steel crown should be placed which should allow the tooth to remain in the arch to maintain space until exfoliation.

Question 26

When is a Pulpotomy with Calcium Hydroxide indicated?

Answer 26

Is used primarily in young permanent teeth with open apices and fractures that expose the pulp. The fractured tooth often has a significant pulp exposure. In this type of treatment, the pulp in the apical portion of the root canal is not disturbed and root development can continue

Question 27

How is a Pulpotomy with Calcium performed?

Answer 27

The coronal portion of the pulp is removed. Calcium hydroxide is applied to the pulp canals. Intermediary bases are appleid and a final restoration is then placed. Radiographs are taken at recall appointments to confirm when root development is complete.

Question 28

What is a Pulpectomy?

Answer 28

Often referred to as a baby root canal. The entire pulp is remvoed when the disease process has affected both the coronal and radicular areas. The procedure is the same as in an adult root canal, but instead of using an inert material to fill the pulp canals - the material chosen must be resorbable so no material is left in the site as the primary roots resorb and the permanent tooth erupts.

Question 29

What are the two kinds of pulp capping?

Answer 29

1. direct pulp capping
2. indirect pulp capping

Question 30

When is Direct Pulp Capping indicated?

Answer 30

This treatment is performed on teeth where the pulp has been slightly exposed while removing decay. On primary teeth the fine pulp horns are close to the surface but they are not often visible radiographically.

Question 31

How is Direct Pulp Capping performed?

Answer 31

Usually, bleeding occurs as the exposure is made, and the pulpal area must be immediately cleaned with hydrogen peroxide. A layer of calcium hydroxide is placed on the exposed pulpal tissue followed by a protective base of appropriate cement. A rstoration is placed and finished.

Question 32

Outcome of Direct Pulp Capping?

Answer 32

In most cases, the tooth will remain vital, however, the pulp may become infected and require additional treatment such as root canal therapy. The patient (child & parent) must be informed that problems may develop later and that periodic monitoring is necessary.

Question 33

When is Indirect Pulp Capping indicated?

Answer 33

It is often performed when the pulp has not yet been expoded but there is a chance that the pulp will be exposed when removing caries in the pulpal floor area.

Question 34

How is Indirect Pulp Capping performed?

Answer 34

An instrument, such as a spoon excavator is used to remove caries from the coronal portion of the tooth to a depth that will avoid penetration of the pulp. A thick layer calcium hydroxide is placed over the caries and a temporary restoration is placed. The calcium hydroxide will stimulate the production of reparative dentin. After two to six months, the temporary restoration will be removed as well as any remaining caries, and a final restoration will be placed.

Question 35

Pulp capping procedures can be performed on primary or permanent teeth - true of false?

Answer 35

TRUE

Question 36

What is the objective of prosthodontic dentistry for pediatric patients?

Answer 36

The objective is to maintain the tooth in the mouth, in a healthy condition. It is important to keep primary teeth throughout adolescent years. A stainless steel crown may be introduced as solution to treat the tooth without the cost & time of fixed prosthodontics

Question 37

What instruments are used for pediatric dentistry?

Answer 37

Many of the instruments used in pediatric dentistry are simply scaled-down versions of those used for adult patients. A few procedures require specific instruments.