Pediatric Dentistry Flashcards
max. conc. of nitrous should not exceed
flow rate is
50%
6 L/min
earliest symptom of conscious sedation is
light headedness
drug used for pediatric sedation by acting on CNS to induce sleep is
CHLORAL HYDRATE
-kids enter period of excitement and irritability before becoming sedated
short acting barbiturates include
secobarbital (seconal)
pentobarbital (nembutal)
sedatives by oral admin. but aren’t as good, non-analgesic, can cause hyper-excitability
standard prophylaxis for kids is
amox
50 mg/kg 1 hr before
pulpectomy (RCT) is indicated when
- periapical pathology
- canals filled with ZOE paste (min. tissue rxn)
pulpotomy
preserves radicular VITAL pulp when the entire coronal pulp is amputated; allows resorption and exfoliation of the primary tooth, but preserves its role as a natural space maintainer
-coronal pulp shows evidence of inflammation and degen. change
2 pulpotomy techniques
- Calcium hydroxide - tx PERMANENT teeth when there is a pathologic change in pulp at carious exposure site; indicated for peranent teeth with immature root development and healthy pulp tissue in canals
- Formocresol - tx PRIMARY teeth with carious exposure, success depends on VITAL root tip. Formecrosl causes surface fixation of pulp tissue and odontoblast degeneration.
indications and contraindications for Formecresol pulpotomy
indications - tooth sensitive to sweets, pulp exp during caries excavation, xray shows deep caries to pulp
contra - internal resorption on xray, tooth painful with swelling
direct pulp capping is used on
PERMANENT teeth (not primary cause of CaOH’s alkaline pH), tooth is ASYMPTOMATIC, there’s a small exposure
with mild irritation, resolves itself
with severe irritation, internal resorption can occur
contraindications of a direct pulp cap on primary teeth
spontaneous pain
large exposure
excessive bleeding
xray evidence of internal resorption
indirect pulp capping goals
preserve pulp vitality, prevent exposure, save tooth structure, arrest caries, promote reparative dentin formation
indications - permanent teeth with rampant caries, large caries close to pulp
contraindications - don’t use when spontaneous pain, furcation involvement, pulpal involvement, don’t do in KIDS
adolescents with rampant caries may need caries control before final restoration to arrest lesions. this involves __
removing gross caries, placing CaOH and an interim restoration like IRM (reinforced ZOE)
ER tx of fractures of permanent teeth with immature apices
Class I - smooth edges, restore
Class II - CaOH to exposed dentin and restore
Class III - CaOH, place temp, if exposure is big then perform CaOH pulpotomy -> pulpectomy eventually
Class IV - CaOH pulpotomy -> pulpectomy eventually
in a kid with a fully formed apex, if there is a pinpoint exposure and it has been a while (day) since it happened, what is tx?
what if it happened right away?
1 day - conventional RCT
imm - direct pulp cap with CaOH
MOST COMMON craniofacial malformations (50% of all defects)
cleft palate and cleft lip
Cleft lip
during 5th-6th week of embryonic life, from failure of maxillary and frontonasal processes to merge
- more common in males
- more common on left side
Class I - unilateral notch of vermillion NOT into lip
Class II - unilateral notch of vermillion extending into lip but not nasal floor
Class III - unilateral notch of vermillion but into lip and floor of nose
Class IV - bilateral clefting
-occurs during 4-6 wks of pregnancy
Cleft palate
opening in roof of mouth where 2 sides of palate did not unite, occurs in 6th-8th week of embryonic life
- fissure in midline
- isolated clefts more common in females
- impaired speech and swallowing
Class I - only soft palate
Class II - both palates but not alveolar process
Class III - both palates and alveolar process on one side of premaxilla
Class IV - soft palate and continues thru alveolus on both sides of premaxilla
Acute Necrotizing Ulcerative Gingivitis (ANUG, Vincent’s Angina, Trench Mouth)
clinical manifestations
tx
painful hyperemic gingiva, punched out papilla, covered by GRAY pseudomembrane with foul odor
- fusopirochetal infxn caused by FUSIFORM/FUSIBACTERIUM, SPIROCHETES, P. INTERMEDIA
- assoc. with poor OH, common in conditions with crowding and malnutrition, stress and smoking risk factors too
- YOUNG ADULTS 15-35 yrs.
clinical manifestations - inflamed, painful, bleeding gingiva, poor appetite, fever, malaise, odor
tx - debridement, H2O2, abx therapy
Primary (Acute) Herpetic Gingivostomatitis
viral infection
- characterized by: inflamed gingiva, sore throat, fever, malaise, lymphadenopathy, small fluid filled vesicles on mucosa of the lips/tongue/gingiva
- round ulcers with RED AREOLAE on CHEEKS
- self limiting, lasts 7-10 days
- tx: oral fluids
- common in PRESCHOOL kids
Atrophic Gingivitis
gingival recession without bone loss
Acute Lymphocytic/Lymphoblastic Leukemia (ALL)
most common pediatric cancer, form of acute leukemia most responsive to therapy
signs - fatigue, pallor, weight loss, easy bruising -> fever, hemorrhages, weak, bone/joint pain, repeated infxns
oral features - gingival oozing, petechiae, hematoma, ecchymosis, oral ulceration, pharyngitis, gingival infxn unresponse to therapy, submandibular lymphadenopathy
-susceptible to candida infxns (Nystatin)
most common type of leukemia in kids is
lymphoblastic leukemia
Apert Syndrome
cranial-limb anomaly
- malformations of skull, midface, hands, feet (NOT blindness)
- assoc. with supernumerary teeth, crowding, Class III
major features - prematurely fused cranial sutures, retruded midface, fused fingers and toes
Autism
appears in first 3 yrs, 4x more common in boys
- difficult to tx autistic pt cause of impaired communication
- can use sedatives and reduce loud sonds
Attention Deficit Disorder (ADD)
what tx?
short attention span, hyperactivity, impulsive behavior
- cause unknown
- 10x more common in males
Methylphenidate (ritalin) - mild CNS stimulant
Amphetamines (dextroamphetamine)
Achondroplasia
short-limb dwarfism
-most kids die before 1
clinical features - disproportionate short stature, prominent forehead, depressed bridge of nose, small maxilla causing overcrowding of teeth, Class III malocclusion
Gigantism oral features
- enlarged tongue
- teeth tipped buccal or lingual
- mand prognathism
- long roots
Pituitary dwarfism oral features
- delayed eruption and exfoliation
- short clinical crowns, smaller roots
- smaller dental arch -> malocclusion
- mandible underdeveloped
Cellulitis
acute spreading infxn of dermis and subcutaneous tissues, causing pain, erythema, edema, warmth
caused by - Group A streptococci & Staph Aureus
-harder to tx in kid cause dehydration
Ludwig’s Angina
cellulitis that affects submandibular, sublingual, submental spaces
- causes elevation of tongue and mouth -> obstruction of airway
- hospital immediately
Cretinism (child hypothyroidism) is a
deficiency caused by congenital absence of THYROXINE
- severe HYPOthyroidism in a kid characterized by defective mental and physical development
- dwarfed body with curved spine and pendulous abdomen
- distorted limbs
- severe mental retardation
dental findings - underdeveloped mandible, overdeveloped maxilla, enlarged tongue causing malocclusion, delayed tooth eruption, longer retention of deciduous teeth
Cystic Fibrosis
INHERITED disease of exocrine glands
- sticky mucus from faulty transport of Na+ and Cl in cells lining organs
- glands most affected are in pancreas, respiratory system, sweat glands
- inherit defective copy of CF gene
- dx tool is sweat test (elevated Na and Cl)
- dark teeth
combo of steatorrhea, chronic resp. infxn, functional disturbances in secretory mechanisms of various glands
Cleidocranial Dysplasia (dDysostosis)
INHERITED disorder of bony development
- absent or incompletely formed clavicles
- characteristic facial appearance, dental abnormalities
- supernumerary teeth, delayed eruption, peg-shaped teeth, missing teeth
Ectodermal Dysplasia
HEREDITARY condition caused by abnormal development of skin, hair, nails, teeth, sweat glands
- different types but X-linked anhidrotic is most common
- anodontia or oligodontia, conical shaped anteriors
- atrophic skin, defective hair, hypoplastic sweat glands
Anhidrotic ectodermal dysplasia
most common, only affects males, characterized by lack of perspiration
retained primary teeth are an oral manifestation of what 2 conditions
Ectodermal and
Cleidocranial Dysplasia
Diabetes
what is the triad?
oral complications?
body can’t properly use and store glucose
triad - polydipsia (thirst), polyphagia (hunger), polyuria (freq. urination)
Type I Diabetes (insulin dependent, juvenile-onset) - body stops making insulin, prone to ketoacidosis, blindness may develop
oral complications - xerostomia, infection, poor healing, perio disease, burning mouth syndrome
Diphtheria
acute, contagious disease caused by bacterium CORYNEBACTERIUM DIPHTHERIA
-production of a systemic toxin damaging to heart and CNS
Down Syndrome (Trisomy 21)
CONGENITAL, chromosomal abnormality
low caries rate high prevalence perio disease delayed eruption malocclusion enamel dysplasia delayed mental and physical development short, stocky build, broad, flat face, slanty eyes prominent, thick tongue **heart defects common, SBE prophylaxis is required for dental tx** reduced resistance to infxn
Gingivostomatitis
sores on mouth and gingiva caused by HERPES (HSV-1), characterized by inflammation of gingiva and mucosa, common esp. in kids
Acute (Primary) Herpetic Gingivostomatitis
kids <3 (1-5 yrs) with prodromal symptoms (fever, malaise, irritability, headache, dysphagia, vomiting, lymphadenopathy)
- tx by mild topical (ex. Dyclone) for pain
- virus that causes this is closely related to herpes that causes chickenpox (varicella zoster)
common sequelae of Acute Herpetic Gingivostomatitis
- recurrent herpes labialis (cold sores)
- spherical vesicles
- kid will have circulating anti-herpes antibodies (HSV-1 antibodies)
Herpangina
viral infection (strain of coxsackie A)
- young kid
- oral ulcers (white to whitish gray base and red border on roof of mouth and throat)
- fever, sore throat, headache
- goes away in a week, tx is palliative
Hemangioma
most COMMON BENIGN TUMOR of INFANTS
- vascular birthmarks, biologically active
- 5x more common in girls
- common on lips, tongue, buccal mucosa, flat or raised, deep red or blushish
- removed surgically
ex. asymptomatic blue lesion on tongue, minimal increase in size 5 yrs
Lymphangioma
well circumscribed nodule or mass of lymphatic vessels, often in neck and axilla
-compressible and spongy red to blue translucent lesions
tx by excisional biopsy
Neurofibroma
firm, encapsulated tumor by proliferation of SCHWANN CELLS
- on tongue, buccal mucosa, vestibule, palate
- can become malignant (5-15%)
MULT. LESIONS are assoc. with NEUROFIBROMATOSIS (Von Recklinghausen’s Disease)
Nursing Bottle Caries (Baby Bottle Tooth Decay/Bottle Mouth Syndrome)
widespread caries, most commonly affecting MAXILLARY INCISORS
-in combo with Strep mutans
max incisors > max and mand 1st molars > mand. canines
Pierre Robin Syndrome
HEREDITARY disorder
-presents micrognathia, glossoptois (down displacement/retraction of tongue), high arch or cleft palate
Porphyria
3 major findings?
dx?
INHERITED disorders, abnormalities in production of heme pigments, myoglobin, ctyochromas
-can cause discoloration of teeth
3 major findings
- Photodermatitis (light sensitivity causing rash)
- Neuropsychiatric complaints
- Visceral complains (ab pain, cramping)
Dx - red urine, purple brown teeth, sensitive to sunlight, gets blisters and swelling on face/hands in sunlight
Causes of tooth discolration (4 conditions)
- Porphyria
- Cystic Fibrosis - dark
- Erythroblastosis Fetalis - destruction of erythrocytes, blue-green
- Tetracycline therapy - yellow to brown, gray to black
Rieger’s Syndrome
delayed sexual development, hypothyroidism, dental features like hypodontia, underdeveloped premaxilla, cleft palate, protruding lower lip
Recurrent Aphthous Ulcers (Canker sores)
unknown cause, triggered by stress, dietary deficiencies (iron, folic acid, vit B12), periods, hormonal changes, etc.
- painful white or yellow ulcers with red halo on NON-KERATINIZED oral mucosa
- RAS and intra-oral herps are distinguished on location
- more in women
RAS occur on __ whereas intra-oral herpes occur on __
RAS - mobile mucosa
intra-oral herps - tissue bound to periosteum
3 classes of Recurrent Aphthous Ulcers
- Recurrent minor < 1 cm
- Recurrent major > 1 cm, lasts > 2 wks, scars
- Recurrent herpetiform - clusters and ulcers
pts with __ ulcers should be screened for diabetes mellitus or Behcet’s syndrome
Recurrent herpetiform
Grand Mal Epilepsy (Tonic Clonic)
most common seizure disorder (90% of epileptics)
- tonic-clonic, 2-5 min.
- tx: pt in supine position, prevent injury, basic life support (head tilt), oxygen if cyanosis
Petit Mal Epilepsy (Absence)
- in childhood under 16 yrs., 5-10 sec.
- mgmgt is protective, little or no danger
Measles (Rubeola)
from PARAMYXOVIRUS
- fever, cough, rash
- KOPLIK’S SPOTS 1-2 mm yellow white oral lesions, looks like necrotic ulcers with bright red margin
German Measles (Rubella)
benign viral disease
- red, bumpy rash, swollen lymph nodes, mild fever
- PETECHIAE spots on soft palate
- hypoplastic primary incisors from maternal rubella
Mumps
uni or bilateral swelling of salivary glands, usually PAROTID (parotitis)
-papilla on opening of parotid duct on buccal mucosa is puffy and red
Smallpox (Variola)
viral disease, high fever, nausea, vomiting, chills, headache
oral manifestations - ulceration of mucosa and pharynx, sometimes swollen tongue
Scarlet Fever
exotoxin mediated, from group A beta hemolytic strep infxn
symptoms - strep throat, fever, sore throat, headache, STRAWBERRY TONGUE
-enlargement of FUNGIFORM PAPILLAE above level of white desquamating filiform papilla -> looks like strawberry
tx by penicillin
Amelogenesis Imperfecta
INHERITED, dominant trait
-thin, soft enamel
Dentinogenesis Imperfecta
INHERITED, dominant
- undermineralized dentin
- bulbous crowns with short roots, opalescent dentin obliterates pulp cavity
- teeth wear rapidly
Type I: assoc. with OSTEOGENESIS IMPERFECTA, kids have blue schlera, fragile bones, hearing loss
Type II: most common
Type III: Brandywine, multiple pulpal exposures
Dens-in-Dente (Dens Invaginatus)
tooth within tooth from invagination of all enamel organ layers into DENTAL PAPILLA
- most involves MAX LATERAL incisor
- pulp usually exposed, so should be RCT
Enamel hypocalcification
HEREDITARY
- enamel is soft and undercalcified, but normal in quantity
- defective maturation of ameloblasts
Enamel hypoplasia
DEVELOPMENTAL
- enamel is hard, but thin and deficient cause of defective enamel matrix formation with deficiency in cementing substance
- common sequelae in kid with hx of generalized growth failure in first 6 mo. of life
- manifestation of HYPOPARATHYROIDISM (prevent with Vit D)
Concrescence
Gemination
Fusion
C - joined by cementum, after roots complete
G - single tooth germ splits to form 2 separate crowns
F - 2 tooth buds joined and appear as a large crown
Fusion or gemination occurs during INITIATION and PROLIFERATION stages
Anodontia
- Complete True
- Partial
- Complete true - usually assoc. with hereditary ectodermal dysplasia
- Partial - common and affects max 3rds, max laterals, mand 2nd PMs`
Conditions that cause DELAYED EXFOLIATION and DELAYED ERUPTION
Systemic
-Cleidocranial dysostosis, Down’s, Ectodermal dysplasia, Gardner’s, Osteogenesis imperfecta, Rickets, Severe congenital heart disease, MR
Localized - abscess, ankylosis
Hypothyroidism, Hypopituitarism, Hypoparathyroidism
Child vs. Adult Periodontium
- Child periodontium has greater blood and lymph supply
- alveolar crest is flatter and bone is thinner
- gingival pockets are larger, attached gingiva is narrower
- tissues are redder
- lack of stippling
- round and rolled gingival margins
- cementum is thinner
- PDL fibers run parallel to tooth
primary teeth begin to form at __ weeks in utero and calcify at __ months in utero
6 wks
4 months
Stages in tooth development (life cycle)
- Initiation (Bud) - formation of dental lamina [fusion, gemination]
- Proliferation (Cap) - enamel organ formed [fusion, gemination]
- Differentiation (Bell, Histodifferentiation) - final shaping of tooth, cells become tissue forming cells in enamel organ [dentinogenesis and amelogenesis imperfecta]
- Apposition - deposit dental tissues, most cells of pulp are fibroplasts
- Calcification (Mineralization) - primary teeth calcify in 2nd trimester of pregnancy (14 wks/4 mo. in utero)
- at birth, 20 deciduous and 4 1st molars calcified
- in a 2 yr. old 40 teeth have calcified
- cariostatic effect of fluoride
- tetracycline stain incorporated
- roots done by 3-4 yrs. - Eruption - through gingiva
- Attrition - loss of tooth structure
enamel is derived from what germ layer
ECTODERM - determine crown root and shape
All other tooth structures come from mesenchyme (MESODERM)
Stages of Tooth Histogenesis (5)
- Elongation of inner enamel epithelial cells of enamel organ
- Differentiation of odontoblasts
- Deposit of 1st layer of DENTIN
- Deposit of 1st layer of ENAMEL
- Deposit of root dentin and CEMENTUM
Korff’s fibers
rope-like fibers in pulp periphery, help form dentin matrix
Hertwig’s Epithelial Root Sheath (HERS)
from joining of inner and outer enamel epithelium of enamel organ
-uniform growth causes single rooted tooth, medial outgrowths cause multi-rooted teeth
when a tooth erupts, how much of the root has formed?
in primary teeth, root is formed in __ months
in permanent, it takes __ yrs
2/3
18 months
3 yrs
Lobes
primary centers of ossification, separated by developmental grooves
min # of lobes from which a tooth develops is 4
anteriors = 4 (3 labial, 1 lingual) premolars = 4 (3 buccal, 1 lingual) cept md 2nd (3 buccal, 2 lingual) 1st molars = 5 2nd molars = 4 3rd molars = 4
Primary Tooth Eruption
Rule of Four
7 mo. - 4 teeth erupted - 4 mand centrals
11 mo. - 8 teeth erupted - 4 max laterals
15 mo. - 12 teeth erupted - 4 1st molars
19 mo. - 16 teeth erupted - 4 canines
23 mo. - 20 teeth erupted - 4 second molars
Periods of dentition
- Primary 6 mo. - 6 yr.
- Mixed 6-12 yr.
- Permanent 12+
Primary vs. Permanent Teeth
- primary are lighter in color
- primary pulps are bigger
- primary crowns are bulbous, constricted
- primary crowns smoother
- primary anteriors roots taper more
- enamel ends abruptly at cervical line instead of getting thinner
Primary vs. Permanent Molars
- crowns shorter with pronounced B & L cervical ridges, constricted cervical area
- occlusal table is narrow F-L
- anatom is shallower
- prominent mesial cervical ridge
- longer roots, more slender, divergent, less curved
sum of M-D widths of primary molars in a quadrant is 2-5 mm > permanent teeth that follow them (premolars)
-enamel on occlusal is 1 mm thick (perm = 2.5 mm)
permanent tooth most likely malposed in cases of mand arch space discrepancy
permanent mand 2nd premolar
primary tooth most likely to be crowded out of the arch
primary maxillary canine
primary tooth that does not look like any other primary or permanent tooth
primary mandibular 1st molar
- oval occlusal surface, wider M-D > B-L
- occlusal table rhomboid shape
- transverse ridge btw MB and ML
- MB cusp largest and longest
primary mandibular 2nd molar looks like
permanent mandibular 1st molar
-this primary tooth has the greatest F-L diameter of all primary teeth
most atypical tooth of all the molars (primary and perm)
primary maxillary 1st molar
- smallest molar in all dimensions except labiolingual
- bicuspid
- H shaped occlusal pit-groove pattern
- has THREE ROOTS
primary tooth that looks like permanent max 1st molar
primary max 2nd molar
- can have 5th cusp of carabelli
- prominent MB cervical and oblique ridge
when do permanent 1st molars calcify
at birth
at 6, a child’s head is __ % of adult size
90%
-brain and cranial base are fully developed
human development facts at birth
- jaw large enough to accomodate all primary teeth
- width of face reached its adult size
- palate is flat
from ages __ to __ body’s lymph tissue is 200% of normal adult
6-12
fissure sealants succeed by
altering host susceptibility
caries activity is directly proportional to
consistency, frequency, oral retention of fermentable carbs
to prevent caries, CDC recommends __ ppm of fluoride in drinking water, and the max is __
0.7 ppm
max = 1.2
optimal conc. of fluoride for water depends on
air temp
fluorides often added to water are (3)
sodium fluoride
sodium silicofluoride
hydrofluosilic acid
deposits of fluoride happens on SMOOTH SURFACES
professional applied topical fluorides (3)
- Sodium Fluoride (NaF) - basic, good taste, no effect on materials
- Stannous Fluoride (SnF2) - does not etch porcelain, tastes bad, ACIDIC, STAINS demin enamel and porcelain, not used in US, advantage is single tx can be given
- Acidulated Phosphate Fluoride - tastes better, but can damage prcelain, ACIDIC, contraindicated on porcelain and composite, can corrode surface of titanium implants
most stable reaction product of a topical app of F- is
fluoroapatite
beneficial effects of fluoride
- interferes with plaque (plaque sticks to teeth cause DEXTRANS are insoluble and sticky)
- antibacterial
- enhances enamel remin
- decreases enamel solubility
- inhibits glycolysis
mechanisms of fluoride to inhibit caries
- topical effect - enamel remin
- F- converts hydroxyapatite by substituting OH for F- (F- is smaller and has greater affinity for HA)
- F- inhibits glycolysis (inhibits production of glucosyltransferase)
F- mouth rinses have greatest effect on
newly erupted teeth
greatest conc. of F- exist on
outermost layer of enamel (so be careful in prophy)
the toothpaste/dentrifice component most likely to inactive F- is
dicalcium phosphate
ER tx for kid who ate a lot of F- is
acute F- toxicity symptoms may appear within __ min and persist up to __ hrs
induce vomiting, have them drink a lot of milk or something with calcium to decrease acidity and form complexes with fluoride
DON’T have them drink sodium bicarb or do ammonia under nose
Acute F- toxicity appears in 30 min, lasts up to 24 hrs
F- is mainly eliminated from body via
most F- absorption happens where?
kidneys
(but fluoride in body mostly in skeletal tissue)
absorption in stomach
acute fluoride poisoning
-causes of death are cardiac failure and respiratory paralysis
15 mg/kg for kid can be lethal
4-5 g for adult is lethal
range of lethal dose is 20- 50 mg/kg
dental fluorosis
irreversible diffuse symmetric hypomineralization disorder of ameloblasts
- only when exposure when enamel is developing
- from chronic (low dose long term) intake, NOT topical
pit and fissure sealants are best retained on what teeth?
which teeth benefit the most?
retained on max and mand. premolars
max and mand 1st molars benefit the most
principal feature of a sealant req for success is
adequate retention
caries protection is 100% in pits and fissures that remain sealed
components of pit and fissure sealants
- bis-GMA - monomer
- initiator - benzoyl peroxide
- accelerator - amine is self cured
- opaque filler - titanium oxide added to make it look diff than occlual enamel
H&N cancer pts can benefit by using what 2 kinds of fluoride at home?
NaF
Stannous F-
daily use of F- gels at home is indicated in
- rampant enamel or root caries
- xerostomia
- H&N radiation therapy
- use on abutment teeth under overdenture
- hypersensitive roots
components of NaF paste used to treat root sensitivity
sodium fluoride
kaolin
glycerin
__ ppm is optimum F- conc. in drinking water
1.0 ppm
US public health sets optimum at 0.7-1.2
How much F- is in a 8.2 oz tube of toothpaste? mg? ppm?
232 mg
1100 ppm
NaF or sodium monofluorophosphate contain 1.0 mg/g toothpaste
F- conc. increases or decreases in external layer of enamel through life
increases
Ellis Crown Fracture Classification
Class I - simple, involves little or no dentin -> enameloplasty
Class II - involves considerable dentin, no pulp -> CaOH or GI
Class III - with pulpal exposure -> pulp therapy and restore, then RCT with ZOE
Class IV - entire crown lost -> pulpectomy and SSC
Root fractures in primary teeth
uncommon cause pliable bone lets the teeth fall out
- in apical third usually heals itself
- use heavy wires to stabilize (splinting NOT recommended in kids teeth)
most reliable vitality test
thermal esp. in incisors (if it doesnt respond -> necrosis)
EPT not reliable
shine light to see pulpal hyperemia
why don’t you need gingival bevel in Class II for primary teeth
enamel rods in gingival third extend occlusally from DEJ
indications for SSCs
extensive caries, hypocalcified teeth, teeth with dentinogenesis or amelogenesis imperfecta, after pulpal tx, abutment for a space maintainer, or fractured tooth
SSC Tooth Prep
cusps reduced 1.0 - 1.5 mm
break contact
where is mandibular foramen in relation to occlusal plane compared to adults
it’s LOWER
girls reach puberty __ yrs earlier than boys
2 yrs
contraindications to rubber dam
if they have fixed ortho, congested nose, recently erupted tooth that won’t hold clamp
most common premed prior to general anesthesia for kids is
VERSED
premed with barbiturate can cause paradoxical excitement
how to manage angry child
separate parent, with permission use HOME technique, display authority
how to manage fearful child
parent stand behind chair, allow child to express fear, change focus, use sedaiton
how to manage mentally retarded child
short appts, morning, give tour, only 1 instruction at a time, reward
