Pediatric Dentition - Kleppinger

Question 2

Tooth Anatomy - Cliff’s Note’s Edition

Answer 2

Enamel - hard outer covering, brittle, thin

Dentin - has dentinal tubules and odontoblastic processes, continues to form throughout life

Cementum - covers only the root has Sharpey’s fibers in it

Peridontal Ligament - attach tooth, cushion force, made of collagen-rich Sharpey’s fibers

Dental Pulp - contains blood vessels, lymphatic vessels, myelenated and unmyelanated nerve fibers

Question 3

Primary Dentition

(baby teeth)

Answer 3

20 teeth - 10 in each arch

4 incisors, 2 canines, 4 molars

Question 4

Adult Dentition

Answer 4

32 teeth total, 16 per arch

each arch: 4 incisors, 2 canines, 2 pre-molars, 3 molars

Question 5

Eruption Milestones:

age 1st tooth appears:

completion of primary dentition:

age 1st permanent tooth appears:

completion of permanent dentition:

Answer 5

Eruption Milestones:

1st tooth: roughly 6 months (mandibular, central)

completion of primary dentition: 2-2.5 years

1st permanent tooth: 6 years (mandibular 1st molar)

completion of permanent dentition: 12-13 years (no 3rd molars)

*from ages 8-10 “classic mixed dentition” 1/2 primary, 1/2 permanent

Question 6

Identify the condition and describe the management:

pt is a newborn presenting for a 2 week check up

exam: you note 2 teeth, and ulceration of the lower lip

Answer 6

Neonatal Teeth ->

Riga Fede Disease (ulceration)

seen at birth or within 30 days

prematurely erupted portion of deciduous dentition can interfere with nursing

tx: if supernumerary remove the tooth, if not smoother it

Question 7

Hyperdontia

Supernumerary Teeth

Answer 7

extra tooth in addtion to the 20 primary or 32 permanent teeth

can impede eruption of other teeth

most common:

• anterior maxillary incisor region
• 4th molar

Question 8

Hypodontia

Answer 8

Congenitally Missing Teeth - alveolar housing is deficient locally

more common in females

multiple missing teeth can be a component of several syndromes

most likely

1. 3rd molar
2. lateral incisior
3. 2nd premolar

Question 9

Identify this condition and describe the management:

pt is a 7 year old and is pretty pumped to be getting his adult teeth and money from the tooth fairy

mom however is worried about this vesicle that has appeared:

Answer 9

Eruption Cyst

• remnant of developmental dental follicle
• occurs after the erupting tooth has emerged through bone

tx: once the tooth penetrates the gingiva, cyst drains and heals uneventfully - may require enucleation

Eruption Hematoma

blood filled cyst (see below)

tx: same

Question 10

Enameloblast Insult

Answer 10

causes: fever, medications (TETRACYCLINES), trauma

imperfect enamel “hypoplastic” can be localized or generalized

active: 14 weeks I.U. to approx 8 (2nd molars), 14 (3rd molars)

Question 11

Describe the dentition changes that can occur from thumb sucking and pacifiers.

Answer 11

anterior maxillary teeth flare outward & mandibular retroclination - open bite

if it continues past eruption of permanent teeth, may permanently change skeletal form of anterior maxilla

Question 12

What is tooth decay?

Answer 12

demineralization of tooth structure by lactic acid

dental plaque: biofilm of bacteria, proteins, and glycoproteins

normal flora: streptococcus mutans and lactobacillus

Question 13

Baby Bottle Decay

Early Childhood Caries

Answer 13

typically seen 1-3 year olds

due to having control of drinks throughout day and or night - bottle at bedtime, sippy cups - child holding fluid for extended period of time against teeth

Question 14

Differentiate between:

Pit and Fissure Decay

&

Smooth Surface Decay

Answer 14

Pit and Fissure Decay -

• pits and fissures can be too narrow for toothbrush bristles to clean
• usually develops 0-3 years after eruption of tooth

Smooth Surface Decay

• between teeth (interproximal surfaces) or near gingival margin on the buccal surface
• 2-5 years after eruption of tooth

Question 15

Gingivitis

Answer 15

marginal gingiva swells due to irritation from normal flora bacteria in dental plaque and calculus

REVERSIBLE but can progress to periodontitis

increased probing depth in gingival sulcus

Question 16

Periodontitis

Answer 16

begins as gingivitis

deepest part of gingival sulcus has less oxygen and nutrients

anaerobic bacteria: Actinobacillus actinmycetemcomitans; Porphymonas gingivalis, Bacteroides forsythus - produce* *collagenase

collagenase: breaks down peridontal ligament

affects hard and soft tissue

without treatment: tooth loss

Question 17

Describe the managment and complications of tooth displacement:

Answer 17

damage to peridontal ligament - stabilization for 2 weeks

if pulpal tissues damaged or severed: root canal

time out of correct position is critical, if more than 2 hours reimplantation will fail

can have resorption

• external destroy tooth from PDL
• internal destroy tooth from nerve chamber

Question 18

Dentoalveolar Fracture

Answer 18

requires replacement and stabilization for 2-8 weeks

pulpal tissue damages requries treatment (root canal)

Question 19

Dental Trauma Management:

if the tooth is chipped and patient has no pain, blood, mobility

Answer 19

no hurry

Question 20

Dental Trauma Management:

if tooth is fractured with sensitivity

Answer 20

go to dentist

Question 21

Dental Trauma Management:

if tooth avulsed

Answer 21

replace the tooth NOW and refer to dentist ASAP