Pediatrics1 Flashcards
Radiographs of a preschool child with ? will show obliteration of the pulp chambers with secondary dentin, a characteristic finding. • amelogenesis imperfecta • dentinogenesis imperfecta • fluorosis • enamel hypoplasia
dentinogenesis imperfecta (Teeth are blue-gray or brown and abrade rapidly)
which dentitions are affected in dentinogenesis imperfecta?
Both the primary and permanent dentitions
Dentinogenesis imperfecta can be subdivided into three basic types?
- Shields Type I: occurs with osteogenesis imperfecta
- Shields Type II: also known as hereditary opalescent dentin
- Shields Type III, seen exclusively in a triracial isolated group in Maryland known as the Brandywine population.
Amelogenesis imperfecta types?
- Hypoplastic Type: occur in the histodifferentiation stage (insufficient quantity of enamel formed due to areas of the enamel organ that are devoid of inner enamel epithelium)
- Hypomaturation Type: defect in enamel matrix apposition and is characterized by teeth having normal enamel thickness but a low value of radiodensity and mineral content.
- Hypoplastic or Hypomaturation Type with Taurodontism: is an example of inherited defects in both apposition and histodifferentiation stages (mottled enamel mostly in molar teeth)
- Hypocalcification Type: in the calcification stage (qualitatively, the matrix is poorly calcified so enamel is soft)
? is a process in which a single tooth germ splits or shows an attempt at splitting to form two completely or partially separated crowns. • concrescence • gemination • fusion • dens in dente
gemination (bifid crown with a single pulp chamber)
? is a twinning anomaly involving the union of two teeth by cementum only
Concrescence
The term dens-in-dente (also called ?) results from?
- dens invaginatus
* the invagination of the inner enamel epithelium
? is a condition produced when two tooth buds are joined together
Fusion (A radiograph is needed to confirm whether there is fusion or gemination)
? are characterized by a significantly elongated pulp chamber with short stunted roots resulting from the failure of the proper level of horizontal invagination of Hertwig epithelial root sheath
Taurodont teeth
? refers to an abnormal bend of the root during its development; it is thought to result from a traumatic episode, usually to the primary dentition
Dilaceration
Enamel hypoplasia: qualitative or quantitative?
less quantity - apear white, yellow, or brownish in color with a rough or pitted surface
Rubella embryopathy has a high correlation with ?
enamel hypoplasia in the primary dentition.
amelogenesis imperfecta is the genetic factors for?
enamel hypoplasia
enamel hypoplasia treatment?
veneer or if not bonded due to the enamel nature then crown or even extraction and an implant
Excessive fluoride levels in drinking water are associated with fluorosis.
Fluoride levels in excess of ? begin to pose a risk for fluorosis.
• one part per million
• two parts per million
• three parts per million
• four parts per million
three parts per million
? is the bedrock strategy on which all of pediatric dental behavior management rests. • tell-show-do (TSD) • positive reinforcement • distraction • nonverbal communication
tell-show-do (TSD)
When treating a child who is obviously afraid, the dentist should:
• use restraint
• use the hand-over-mouth technique (HOME)
• permit the child to express his fear
• avoid all reference to the child’s fear
permit the child to express his fear - identify the fear
All behavioral patterns are motivated by ?
anger and fear
Fear is most likely to be exhibited by ?. This is related to the anxiety over?
- a young child on his first visit to the dentist
* being separated from a parent
? has the greatest influence on the child’s reaction to fear at the initial visit.
the parent, not the dentist
what to do with angry child?
- Separate the parent and the child
- Place the child in the chair abruptly and be firm
- Use the “hand-over-mouth” excercise (HOME) - get the parent’s permission !!!
- Display authority and command respect of the child by continuing with treatment if he/she is uncooperative
- Comfort parent at the end of the visit
- Compliment child at the end of the visit
what to do with fearful child?
- Have the parent stand quietly behind the chair
- Dentist must be consistent in tonal quality
- Permit the child to express his fears - identify the fear
- Change the child’s focus off fear
- Lastly, sedation
The process of shaping a patient's behavior through appropriately timed feedback is called: • tell-show-do • voice control • positive reinforcement • distraction • nonverbal communication
positive reinforcement
All of the following procedures have proved beneficial in treating a mentally retarded child EXCEPT one. Which one is the EXCEPTION?
• speak slowly and in very simple terms
• listen carefully to the patient
• schedule long appointments
• ask the patient if there are any questions about anything you will be doing
schedule long appointments
The management of a child who must undergo dental extractions is based on which of the following factors?
• the age and maturity of the child
• the past medical and dental experiences that might influence the behavior of the child
• the physical status of the child
• the length of time and amount of manipulation necessary to accomplish the surgery
• all of the above
all of the above
The most common premedication prior to general anesthesia is ?
Versed
Premedication with a barbiturate (IV) may cause ?
paradoxical excitement in a young child
After extracting a tooth on a child patient, the biggest postoperative concern is ?
the prevention of lip biting
All of the following instances may make the use of a rubber dam impractical EXCEPT one. Which one is the EXCEPTION?
• the presence of fixed orthodontic appliances
• a patient with congested nasal passages or other nasal obstruction
• a very nervous or anxious patient
• a recently erupted tooth that will not retain a clamp
a very nervous or anxious patient
Minimum oxygen concentration in nitrous oxide is ?
30%.
nitrous oxide in excess of ? % are usually contraindicated in dental office sedation.
50%
Minimum alveolar concentration (which is the concentration required to produce immobility in 50% of patients) of nitrous oxide is ?
105%
The total flow rate of nitrous oxide is ? for most children
4 to 6 L/min
The maintenance dose of nitrous oxide during the dental appointment is usually around ?
30-35%
On termination of nitrous oxide administration, inhalation of 100% oxygen for ? (minutes ?)is recommended
not less than 3-5 minutes
The phenomenon of "strawberry tongue" is associated with: • herpangina • scarlet fever • diphtheria • mumps
scarlet fever (an exotoxin-mediated disease arising from group A beta-hemolytic streptococcal infection)
the drug of choice for scarlet fever ?
Penicillin
Early diagnosis and treatment for scarlet fever are important to prevent complications, which include ?
local abscess formation, rheumatic fever, arthritis, and glomerulonephritis
which lesions are generally ulcers usually on the roof of the mouth and in the throat? The ulcers may be very painful. Generally, there are only a few lesions. The disease usually runs its course in less than a week
Herpangina
what is the enlargement of interdental areas, and spontaneous or easily stimulated bleeding? Treatment includes professional cleaning and improved oral hygiene
Puberty gingivitis
All of the following statements concerning acute necrotizing ulcerative gingivitis (ANUG) are true EXCEPT one. Which one is the EXCEPTION?
• it is also called Vincent infection, Vincent angina, or “trench mouth”
• it is a gingival disease characterized by painful hyperemic gingiva, punched-out erosions of the interproximal papilla, covered by a gray pseudomembrane with an accompanying fetid odor
• risks include poor oral hygiene, poor nutrition, smoking, and emotional stress
• it usually affects children
• fusiforms and spirochetes, as well as Prevotella intermedia, have been implicated in the etiology of acute necrotizing ulcerative gingivitis (ANUG)
• it usually affects children (ANUG occurs in young to middle-aged)
Four Classes of Cleft Palate: • Class I • Class II • Class III • Class IV
- involves only the soft palate.
- involves soft and hard palates but not the alveolar process.
- same as Class II but with alveolar process involvement on one side of the premaxilla.
- involves the soft palate and continues through the alveolus on both sides of the premaxilla.
Four Classes of Cleft Lip: • Class I • Class II • Class III • Class IV
- a unilateral notching of the vermillion not extending into the lip.
- same as Class I but the cleft extends into the lip but not to the floor of the nose.
- same as Class II but extending into the floor of the nose.
- any bilateral clefting of the lip whether incomplete notching or complete clefting.
- Females more often affected
* Males more often affected
- Cleft Palate
* Cleft Lip
Ectodermal dysplasia is characterized by: Select all that apply. • sparse hair • lack of sweat glands • oversized crowns • elongated roots • normal mental status • an enlarged mandible • absence of teeth
• sparse hair • lack of sweat glands • normal mental status • absence of teeth (conical shape of the anterior teeth)
difference between primary herpetic gingivostomatitis and aphthous stomatitis?
- aphthous stomatitis: occur only on mobile mucosa and there is a history of recurrence and no fever
- gingivostomatitis: occur on both mobile and attached mucosa and there is no history of previous episodes. With fever
difference between primary herpetic gingivostomatitis and ANUG?
ANUG, the interdental papillae are necrotic while in primary herpes, the interdental papillae are intact
Cellulitis in a child is easier to treat than in adults.
The most common causative organisms of cellulitis are group A streptococci and Staphylococcus aureus.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is fake, the second is true
the first statement is false, the second is true (Cellulitis in a child is harder to treat because dehydration occurs more frequently, rapidly, and severely in children than in adults.)
If cellulitis involves the submandibular, sublingual, and submental space it is called ?
Ludwig angin
3 clinical stages of odontogenic infection?
- Periapical osteitis: occurs when the infection is localized within the alveolar bone.
- Cellulitis: develops as the infection spreads from the bone to the adjacent soft tissue
- Suppuration
Historically, the incidence of dental decay in individuals with Down syndrome has been reported to be ?. The rate of periodontal disease in these persons has been reported to be?
• extremely high, extremely low
• relatively the same as the general population, extremely high
• extremely low, relatively the same as the general population
• extremely low, extremely high
extremely low, extremely high (Down = trisomy 21)
The most common form of diabetes in children is: • type I • type II • type III • type IV
type I (insulin-dependent diabetes mellitus)
The hemangioma is usually treated by conservative surgical excision.
Capillary hemangioma is the most common type.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true
hemangioma is common on ?
lips, tongue, and buccal mucosa
The most common site for neuroblastomais is ?
the abdomen (near the adrenal gland)
The most common site for lymphangioma is ?
neck and axilla
a neurofibroma is a moderately firm, encapsulated tumor resulting from the proliferation of ?. They occur on the ?
- Schwann cells
* tongue, buccal mucosa, vestibule, and palate.
An outstanding oral manifestation of achondroplasia is: • rampant caries • periodontal disease • overcrowding of teeth • supernumerary teeth
overcrowding of teeth (A Class III malocclusion is very common, maxilla may be small)
achondroplasia = short-limb dwarfism
oral manifestations of gigantism?
enlarged tongue
oral manifestations of pituitary dwarf?
- the shedding of the teeth are delayed
* mandible is underdeveloped
Which of the following are oral manifestations of Apert syndrome? Select all that apply. • class II malocclusion • severely delayed eruption • trapezoidal-shaped mouth • severe crowding of the teeth • ectopic eruption • shovel-shaped incisors • byzantine-arch shaped palate
• severely delayed eruption • trapezoidal-shaped mouth • severe crowding of the teeth • ectopic eruption • shovel-shaped incisors • byzantine-arch shaped palate Class III malocclusion is most common
Which of the following are true concerning a young epileptic who has a grand mal seizure in the dental office? Select all that apply.
• it is generally fatal
• it is best treated by injecting insulin
• they generally recover if restrained from self-injury and oxygen is maintained
• it can be prevented with antibiotics
they generally recover if restrained from self-injury and oxygen is maintained
The most common of the craniofacial malformations is: • bifid tongue • macroglossia • cleft palate and cleft lip • anodontia
cleft palate and cleft lip
The lip and primary palate begin to develop at ?
4 to 5 weeks gestational age
Clefts of the lip are more frequent in which gender? and which side?
males, the left side
Which type of leukemia is referred to as the "leukemia of childhood"? • acute myeloid leukemia • chronic myelocytic leukemia • acute lymphocytic leukemia • chronic lymphocytic leukemia
acute lymphocytic leukemia - the cells that normally develop into lymphocytes (lymphoblasts) become cancerous and rapidly replace normal cells in the bone marrow (a life-threatening disease, peak age is around 4 years old, overall cure rate is 80%)
An important diagnostic finding in congenital porphyria is the presence of red-brown teeth in both the deciduous and permanent dentition.
The oral mucosa is rarely affected in porphyrias.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true (a rare metabolic error resulting in failure of the conversion of porphyrins)
If a 5-year-old child receives tetracycline therapy, the teeth affected will be ?
the canines, premolars, and second molars
In baby bottle decay, the teeth typically are decayed in a specific order. Place the teeth in the correct order. • maxillary posterior teeth • mandibular posterior teeth • maxillary anterior teeth • mandibular anterior teeth
maxillary anterior teeth, maxillary posterior teeth, mandibular posterior teeth, mandibular anterior teeth
time for the first dental visit?
Within 6 months of eruption of the first tooth (no later than the first birthday)
- natal teeth ?
* neonatal teeth ?
- already present at the time of birth
* grow in during the first 30 days after birth
All of the following statements concerning recurrent aphthous ulcers (canker sores) are true EXCEPT one. Which one is the EXCEPTION?
• they occur in women more than men
• they may occur at any age, but usually first appear between the ages of 10 and 40 years
• the cause is a Coxsackie virus
• they appear to be associated with stress
•they usually appear on nonkeratinized oral mucosa, including the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gingiva
the cause is a Coxsackie virus (the cause is unknown) they usually begin with a tingling or burning sensation
- recurrent aphthous ulcers occur primarily on ?
* lesions of intraoral herpes occur on ?
- mobile (unattached) mucosa
* attached mucosa
aphthous classifications:
- Recurrent aphthous minor
- Recurrent aphthous major
- Recurrent herpetiform (multiple, small, diffuse, painful, superficial ulcers)
Recurrent aphthous major diameter?
> 1 cm (heal with scarring)
Patients with frequent aphthous recurrences should be screened for ?
diabetes mellitus or Behcet syndrome
Topical steroids for aphthous ?
Kenalog in Orabase (5 g tube, Dry lesion. Coat lesion with a thin film after each meal and at bedtime)
Cretinism is a deficiency disease caused by the congenital absence of: • insulin • thyroxine • calcitonin • epinephrine
thyroxine (Thyroxine is a hormone secreted by the thyroid gland). other name is hypothyroidism
Dental findings of cretinism ?
underdeveloped mandible with an overdeveloped maxilla, enlarged tongue, thickened lips due to glycosaminoglycan deposits, unerupted yet fully developed permanent dentition
Severe hypothyroidism in adults is called ?
myxedema
In children with cystic fibrosis, halitosis is common.
In children with cystic fibrosis, both dental development and eruption are delayed.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true
The most reliable diagnostic tool in cystic fibrosis is ?
the sweat test, which shows elevations of both sodium and chloride
"Koplik spots" are associated with: • smallpox (variola) • german measles (rubella) • mumps • measles (rubeola)
measles (rubeola)
The principal characteristics of attention-deficit/hyperactivity (ADHD) disorder are all of the following EXCEPT one. Which one is the EXCEPTION? • inattention • mental retardation • hyperactivity • impulsivity
mental retardation
Common Medications used to treat ADHD?
stimulants such as:
• Ritalin (methylphenidate)
• Concerta (methylphenidate extended release)
Which of the following is the most common cause of endocarditis following a dental procedure? • escherichia coil • viridans streptococci • staphylococci • bacteroides
viridans streptococci — alpha-hemolytic streptococci
Oral prophylaxis for endocarditis ?
- Amoxicillin 50 mg/kg (max 2 g)
* Clindamycin 20 mg/kg (max 600 mg)
Which of the following is the most frequently utilized route of administration for sedation in pediatric patients? • oral • inhalation • IV • IM
inhalation — the agent used most frequently is nitrous oxide
Nitrous oxide function?
an altered state of awareness with impaired motor function
The combined volume of gases being delivered (oxygen and nitrous) should be at least ? liters/minute.
3 to 5
Calculate the number of milligrams per cartridge of anesthetic:
multiplying the percent of local anesthetic times 10, then multiply this by the size of the cartridge, typically 1.8 ml.
- for example, 2% x 10 x 1.8 mL = 36 mg/cartridge
The maximum recommended dose of local anesthetic with/without vasoconstrictors, whether it be lidocaine or mepivacaine, is ?
4.4 mg/kg and the absolute maximum dosage is 300 mg
the proper response to nitrous oxide?
The feeling of floating or giddiness with tingling of the digits
solubility of nitrous oxide in blood than alveolar air?
less
? alone or in combination with other drugs, is the most common sedative agent used in pediatric dentistry. • pentobarbital • secobarbital • paraldehyde • chloral hydrate
chloral hydrate (acts on the CNS to induce sleep) Chloral hydrate and the barbiturates are classified as sedative-hypnotics
A 15-year-old female has lived in a nonfluoridated area all of her life. Which of the following is most likely to occur in this young lady when she moves to a community where the drinking water naturally contains 6 ppm of fluoride?
• 50% reduction in dental caries
• moderate dental fluorosis
• an increase in the amount of fluoride stored in her bones
• gastrointestinal problems
an increase in the amount of fluoride stored in her bones (50% reduction in dental caries and Moderate fluorosis will not occur since age 15)
Up to a level of ? ppm fluoride, there is an inverse relation between dental decay and fluoride concentration. As fluoride concentration increases beyond 1 ppm, there is an increased prevalence of fluorosis and no increase in the reduction of dental decay.
1
Fluoridation has several mechanisms for caries inhibition.
Included are enhancement of remineralization of enamel, inhibition of glycolysis, and the incorporation of fluoride into the enamel hydroxyapatite crystal.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true
Fluoride mouth rinses have been shown to have the greatest effect on ?
newly erupted teeth (the second and third permanent molars if continued into the teen years)
Which of the following fluoride therapies should be recommended to a 13-year-old child who is prone to decay and lives in a community where the water is fluoridated at an appropriate level? Select all that apply.
• professionally applied fluoride every 6 months
• fluoride toothpaste
• dietary fluoride supplements
• a low concentration fluoride mouth rinse
• a high concentration fluoride mouth rinse
- professionally applied fluoride every 6 months
- fluoride toothpaste
- a low concentration fluoride mouth rinse
“Rules of 6s” ?
if fluoride level is greater than 0.6 ppm, if patient is less than 6 months old, and if patient is older than 16, no supplemental systemic fluoride is indicated.
All of the acidulated phosphate fluoride products should be applied for ? in order to achieve the best results. • 1 minute • 2 minutes • 3 minutes • 4 minutes
4 minutes
Currently there are four types of topical fluoride agents that are used on the teeth by health care providers?
- Acidulated phosphate fluoride (APF) - in gel, foam, or solution form (most popular)
- 2% neutral sodium fluoride - in gel, foam, or solution form
- 8% stannous fluoride - in powder form supplied in bulk containers or powder preweighted capsule form; mixed with water immediately before use
- Fluoride-containing varnishes
Acidulated phosphate fluoride and stannous fluoride should not be used on patients with ?
porcelain, glass ionomer, and composite restorations (They have remove the glaze from the surface of these restorations). Neutral sodium fluoride is used in these cases
Before fluoride applications:
• vaseline is applied to protect any teeth with sealants
• the teeth should be dry to prevent dilution of the fluoride concentration
• all bacterial plaque must be removed to prevent interference with fluoride uptake by the enamel surface
• patients should be placed in a semi-supine position
the teeth should be dry to prevent dilution of the fluoride concentration
You examine a 10-year-old boy in your practice and determine that he has multiple carious lesions. The family resides in a rural area and drinks well water. What is your advice regarding fluoride supplementation?
• prescribe fluoride tablets for the patient immediately
• arrange for a sample of the patient’s well water to be sent to a laboratory to assess the amount of naturally occurring fluoride in the water. Then prescribe the appropriate dose of fluoride supplementation in lieu of the fluoride that is occurring in the water, if any.
• the child is too old for fluoride supplementation to be of benefit, so you do not recommend it
• none of the above
arrange for a sample of the patient’s well water to be sent to a laboratory to assess the amount of naturally occurring fluoride in the water. Then prescribe the appropriate dose of fluoride supplementation in lieu of the fluoride that is occurring in the water, if any.
Clinical studies demonstrate that acidulated phosphate fluoride is most effective at what pH? • 1.0 • 2.5 • 3.2 • 5.5
3.2 (acidic)
The pH of NaF is approximately 9.2 (basic)
The lethal dose of fluoride for a typical 3-year-old child is approximately: • 100 mg • 200 mg • 350 mg • 500 mg
500 mg
What is the most effective method of reducing the dental caries problem in the general population?
• school water fluoridation
• fluoridation of the communal water supply
• fluoride rinses at home
• frequent dental visits
fluoridation of the communal water supply
fluoride is excreted by ?
the kidney
The U.S. Public Health Department sets the optimal fluoride level at ? for public water
0.7 to 1.2 ppm
