Pediatrics2 Flashcards
The most common congenitally missing primary tooth is the: • primary mandibular canine • primary maxillary lateral incisor • primary maxillary canine • primary mandibular first molar
primary maxillary lateral incisor (This is rare)
The most common congenitally missing permanent teeth, with the exception of the maxillary and mandibular third molars, are ?
- the mandibular second premolars (3.4%), followed by
- the maxillary lateral incisors (2.2%), and
- the maxillary second premolars
most diagnostic of an ankylosed primary molar?
Cessation of eruption (tooth is out of occlusion)
A 15-month-old child would normally have all of the following teeth erupted EXCEPT one. Which one is the EXCEPTION? • primary lateral incisors and canines • primary canines and first molars • primary canines and second molars • primary central and lateral incisors • primary first and second molars
primary canines and second molars
All of the following are true when comparing the normal child periodontium to the normal adult periodontium EXCEPT one. Which one is the EXCEPTION?
• there is greater blood and lymph supply
• the alveolar crest is flatter
• the cementum is thicker and more dense than that of the adult
• gingival pocket depths are larger
• attached gingiva is not as wide
the cementum is thicker and more dense than that of the adult (the cementum is thinner and less dense than that of the adult) Cementum tends to increase with age.
The permanent mandibular second premolar typically erupts when a child is about: • 5-6 years old • 8-9 years old • 11-12 years old • 13-14 years old
11-12 years old
As a general guideline, a permanent tooth should erupt when approximately ? of its root is completed
three-fourths
Apex is fully developed ? after eruption.
2 to 3 years
Calcification of the primary teeth begins in the ? trimester of pregnancy.
second
The sum of the mesiodistal widths of the primary molars in any one quadrant is:
• 5-10 mm greater than the permanent teeth that succeed them - premolars
• 2-5 mm less than the permanent teeth that succeed them - premolars
• 2-5 mm greater than the permanent teeth that succeed them - premolars
• 5-10 mm less than the permanent teeth that succeed them - premolars
2-5 mm greater than the permanent teeth that succeed them - premolars
the primate spaces?
distal to lower C and mesial to upper C
The most frequently taken radiographic views in pediatric dentistry are:
•molar bitewing radiographs
•mandibular molar periapical radiographs
•mandibular anterior periapical radiographs
•maxillary molar periapical radiographs
molar bitewing radiographs
At age ? a child should have their first panoramic x-ray to get all vital information on developing teeth, roots, and any possible malocclusion
6
The drawback of a panorex is that ?
there is a loss of image detail (it is hard to diagnose early carious lesions)
Which of the following is the most common primary tooth to be retained? • maxillary second molars • maxillary first molars • mandibular second molars • mandibular first molars
mandibular first molars
If a permanent tooth bud is accidentally extracted while removing a primary molar, the best treatment is ?
to immediately orient the tooth bud, replant the bud using digital pressure, and suture.
The best way to extract a primary molar that has the permanent tooth bud close to its roots?
section the tooth and remove the parts individually
At the age of 6 years, a child's head is what percentage of its adult size? • 30% • 50% • 80% • 90%
90% - this is typical of all neural tissues in the body
At birth, (the width/height and depth) ? of the face has reached the greatest percentage of its adult size
width
At birth, ? is very near the size it will eventually attain in adulthood (as compared to the cranial base, mandible, mid-face, etc.). The brain and the cranial base are fully developed by age ? years
- the cranial vault
* 6
From age 6-12 years, the body’s lymph tissue is ?% of its normal adult mass
200%
Dentists are ? to report suspected child abuse or neglect. Proof of abuse or neglect is not necessary
mandated by law
Neglect means:
willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection
The first deciduous (primary) tooth to erupt is the: • mandibular central incisor • mandibular first molar • maxillary central incisor • maxillary first molar
mandibular central incisor
The first permanent tooth to erupt is ?
the mandibular first molar, followed shortly thereafter by the maxillary first molar.
The first permanent tooth to begin calcifying is ?
the mandibular first molar (at birth).
The first succedaneous tooth to erupt is ?
the mandibular central incisor.
Ordinarily, a 6-year-old child would have what teeth clinically visible in the mouth?
• all (20) primary teeth and 4 permanent first molars
• 18 primary teeth and 2 permanent mandibular central incisors
• 18 primary teeth, 2 permanent mandibular central incisors, and 4 permanent first molars
all (20) primary teeth and 4 permanent first molars
• The permanent mandibular centrals erupt between the ages of 6-7 years
• The permanent maxillary centrals erupt between the ages of 7-8 years
A 7-year-old child would have the following teeth present clinically?
18 primary and 6 permanent teeth
When attempting a MO Class II amalgam preparation and filling on a primary tooth, you encounter a very large mesial marginal ridge that resembles a cusp. You also notice a transverse ridge from mesiolingual to mesiobuccal cusp that is rather large. This tooth proves difficult to restore, which tooth is it? • mandibular first molar • maxillary first molar • mandibular second molar • maxillary second molar
mandibular first molar (This transverse ridge separates the mesial portion from the remainder of the occlusal surface)
which cusp of lower D is the largest and longest cusp?
mesiobuccal cusp
how many central fossa is in lower D?
It has no central fossa
A neophyte dental student, only about 2 weeks into the program, gets scared when her 10-year-old cousin gets hit in the face and loses a tooth. She calls you and says that her cousin lost his permanent mandibular first molar. Once she tells you more about the root morphology of the tooth, you realize it is a primary tooth and the child simply lost his: • primary mandibular canine • primary mandibular first molar • primary mandibular second molar • primary maxillary first molar
primary mandibular second molar
The primary teeth that present the most noticeable morphologic deviations from the permanent teeth are ?
the first molars
? has the greatest faciolingual diameter of all primary teeth.
The primary second molar
Which tooth is the only anterior tooth in either dentition to have a shorter incisocervical height than the mesiodistal width? • the primary mandibular central incisor • the primary mandibular lateral incisor • the primary maxillary lateral incisor • the primary maxillary central incisor
the primary maxillary central incisor
The primary mandibular central incisor more closely resembles the permanent ?
mandibular lateral incisor
Morphologically, the primary maxillary second molar strikingly resembles the: • permanent maxillary third molar • permanent maxillary second molar • permanent maxillary first molar • permanent mandibular second molar
permanent maxillary first molar - but they are smaller
The largest and longest pulp horn in upper E is ?
the MB
A 10-1 /2-year-old patient comes into your office. You are not sure whether his maxillary canines are permanent or primary. Which of the following statements will help you determine whether they are permanent or primary canines?
• the cusp of the primary maxillary canine is much shorter than the cusp of the permanent maxillary canine
• the mesial cusp ridge on the primary maxillary canine is shorter than the distal cusp ridge; this is opposite of all other canines
• the cusp on the primary maxillary canine is much longer and sharper than the cusp on the permanent maxillary canine
• the primary maxillary canine is much narrower and longer than the permanent maxillary canine
the cusp on the primary maxillary canine is much longer and sharper than the cusp on the permanent maxillary canine (The mesial cusp ridge is longer than the distal cusp ridge (this is opposite of all other canines))
The occlusal form of the ? varies from that of any tooth in the permanent dentition. • the primary mandibular first molar • the primary maxillary first molar • the primary mandibular second molar • the primary maxillary second molar
the primary maxillary first molar
the smallest molar labiolingually?
upper D
- the longest cusp of upper D?
* the second longest, but sharpest of upper D?
- the MB cusp
* he ML cusp
An 11-year-old child traumatized a permanent maxillary central incisor some time ago. The tooth has never been restored. It is now painful and there is evidence of swelling. A periapical x-ray discloses a pathosis associated with the apex. The suggested treatment is: • pulpotomy • extraction • pulpectomy • observation
pulpectomy - root canal therapy
contraindication to a pulpotomy?
tooth is painful and there is swelling (you need healthy pulp tissue in the root for success of a pulpotomy)
Treatment of Vital immature Teeth?
Apexogenesis- (can be regarded as a very deep pulpotomy) MTA is frequently used for this procedure
Treatment of Nonvital Mature Teeth?
Root Canal Therapy
Treatment of Vital Mature Teeth?
1- Indirect pulp capping
2- Direct pulp capping
3- Partial or Cervical Pulpotomy
Treatment of Nonvital immature Teeth?
Apexification
Pulp therapy is generally contraindicated in children who have ?
serious illnesses (i.e., leukemia, cancer patients, etc.)
Indirect pulp treatment is a procedure performed in a tooth with:
• a necrotic pulp
• a deep carious lesion adjacent to the pulp
• a periapical radiolucency
• pulp tissue that is irreversibly infected due to caries or trauma
a deep carious lesion adjacent to the pulp (The caries that is estimated to be approximating a potential pulp exposure is left in the tooth if it is still sufficiently healthy (i.e.,affected - not infected dentin)
A 4-year-old child presents with acute pain associated with a primary mandibular second molar that has a large carious lesion with pulpal involvement. Radiographically, there is periapical pathology on the distal root. The child is very cooperative and is able to tolerate long appointments. What is the preferred choice of therapy for the primary mandibular second molar? • incision and drainage • pulpotomy • primary tooth endodontics (pulpectomy) • extraction
primary tooth endodontics (pulpectomy) The canals and chamber are then filled with ZOE then a stainless steel crown.
if there wasn’t any periapical pathology, a formocresol pulpotomy would be indicated. If the child were older and there was a periapical radiolucency but successful pulpectomy could not be accomplished, the treatment of choice would be extraction with placement of a space maintainer.
Which treatment is the proper one for a Class II fracture of a permanent tooth with an immature apex?
• pulpectomy
• apply calcium hydroxide to exposed dentin and restore tooth with a permanent restoration
• pulpotomy
• observe
apply calcium hydroxide to exposed dentin and restore tooth with a permanent restoration
The first indication for a pulpotomy is carious invasion deep enough to cause mechanical exposure of the pulp or inflammation of the coronal pulp.
Inflammation or infection of pulp tissue beyond the coronal pulp contraindicates a pulpotomy.
• 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
Direct pulp caps (DPC) involve direct placement of the capping material on the pulp. ? is the agent that is most frequently used. • cavity varnish • glass ionomer • ZOE • calcium hydroxide
calcium hydroxide (Primary teeth do not respond to direct pulp capping procedures, move directly to the pulpotomy procedure)
One alternative to the traditional full-strength formocresol pulpotomy is the formocresol pulpotomy using a diluted solution of formocresol. A ? dilution has been recommended and has been shown to produce good long-term therapeutic results.
one-fifth - 20%
All of the following statements are true EXCEPT one. Which one is the EXCEPTION?
• the occlusal anatomy of primary teeth is not as defined as that of permanent teeth; therefore, amalgam preps can be more conservative
• enamel and dentin are thicker in primary teeth; therefore, amalgam preps are deeper
• the pulpal horns of primary teeth are longer and pointed; therefore, amalgam preps must be conservative to avoid a pulpal exposure
• primary molars have an exaggerated cervical bulge that makes matrix adaptation much more difficult
• the occlusal table is narrower on primary molars
enamel and dentin are thicker in primary teeth; therefore, amalgam preps are deeper
Primary molars have an exaggerated cervical constriction that requires special care in the formation of ? preps
the gingival floor in Class II
Enamel rods in the gingival third of primary teeth extend occlusally from the DEJ, eliminating the need in Class II preps for ?
the gingival bevel that is always required when preparing Class II preps on permanent teeth
When preparing a Class II amalgam prep on a primary tooth, the proximal box should be ? at the cervical than at the occlusal aspect
broader
The success rates for mandibular nerve blocks are lower in children than in adults because the mandibular anatomy is less developed in children.
The anterioposterior position of the mandibular foramen is about the same or slightly more mesial in children than in adults.
• 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 false (foramen is about the same or slightly more distal)
The bulbous, conically shaped primary teeth also affect the amount of extension of the occlusal outline of the preparation. The general rule is that the occlusal outline is about ? of the intercuspal distance, between the buccal and lingual cusps, on the occlusal surface of primary molars. • one-half • one-third • two-thirds • three-quarters
one-third
Depth cuts can be used as a gauge to help establish the depth of the occlusal reduction when preparing a primary tooth for a stainless steel crown.
Approximately ? of the occlusal surface should be removed.
• 1 to 1.5 mm
• 3 to 3.5 mm
• 4 to 4.5 mm
• 5 to 5.5 mm
1 to 1.5 mm
The most common error in preparing teeth for stainless steel crowns (SSCs) is ?
to leave an interproximal ledge
Which of the following statements are true. Select all that apply.
• dental decay in primary teeth is an infectious process that can be very painful and can spread and affect the development of the adult teeth
• dental decay in primary teeth most often means there will be dental decay in the adult teeth
• primary teeth are slightly more opaque on x-ray film than permanent teeth because of a lower inorganic content
• dental decay in primary teeth tends to progress more rapidly from initial surface demineralization to involvement of the dentin
• the enamel layer of primary teeth is thinner in all dimensions as compared to permanent teeth
• dental decay is more prominent in primary teeth than in permanent teeth
- dental decay in primary teeth is an infectious process that can be very painful and can spread and affect the development of the adult teeth
- dental decay in primary teeth most often means there will be dental decay in the adult teeth
- dental decay in primary teeth tends to progress more rapidly from initial surface demineralization to involvement of the dentin
- the enamel layer of primary teeth is thinner in all dimensions as compared to permanent teeth
There must be ?% loss in mineralization before caries is radiographically evident with standard D and E-speed intraoral films
30-60
The minimum number of lobes from which any tooth may develop is: • two • three • four • five
four
Listed below are the usual events in the histogenesis of a tooth. Place them in their correct sequence ® from what happens first to what happens last.
• deposition of the first layer of dentin
• differentiation of odontoblasts
• deposition of the first layer of enamel
• elongation of the inner enamel epithelial cells of the enamel organ
- elongation of the inner enamel epithelial cells of the enamel organ —this influences mesenchymal cells on the periphery of the dental papilla to differentiate into odontoblasts (#2 below)
- differentiation of odontoblasts
- deposition of the first layer of dentin
- deposition of the first layer of enamel
Korff fibers is a name given to the rope like grouping of fibers in ? that seem to have something to do with ?
- the periphery of the pulp
* the formation of the dentin matrix
A young girl presents to the dentist with yellow, thin, chalky enamel, but sound dentin. The diagnosis is amelogenesis imperfecta. In amelogenesis imperfecta, there is an error in what stage in the life cycle of a tooth? • initiation • bud stage • cap stage • bell stage • apposition • calcification • eruption • attrition
bell stage
Dens in dente, gemination, fusion, and tubercle formation occur during ? phase.
cap stage
Enamel dysplasia, enamal hypoplasia, concrescence, and the formation of enamel pearls occur during ? stage
apposition
Which structure functions to shape the root (or roots) and induce dentin formation in the root area so that it is continuous with the coronal dentin? • dental papilla • dental lamina • dental sac • hertwig sheath
hertwig sheath
Tooth development is initiated by ? influence on ?
- the mesenchyme’s inductive
* the overlying ectoderm.
A 3-year-old patient reports to your office with an intrusion injury on teeth #E and #F. You inform the child’s parents about the current standard of care regarding intruded teeth. Which of the following statements best describes the current understanding regarding intruded primary teeth?
• the intruded teeth should be extracted
• the intruded teeth should be left to reerupt
• the therapeutic approach to intrusion injuries in primary teeth is controversial. Some authors in the field advocate extraction and some advocate leaving the tooth to reerupt.
• the intruded teeth should be gently moved into position with gauze and stabilized by splinting
the therapeutic approach to intrusion injuries in primary teeth is controversial. Some authors in the field advocate extraction and some advocate leaving the tooth to reerupt. (For National Board purposes, the correct treatment is to administer no treatment and let the tooth reerupt.)
with an intrusion injury on a primary incisor:
• Reeruption usually occurs in ?
• If the intruded incisor is contacting the permanent tooth bud, the primary tooth should ?
• Primary endodontics (pulpectomy) or extraction would only be necessary if the tooth became ?
• During the ? months after the injury, you may observe that there is pulpal necrosis,
- 2 - 4 months
- be extracted
- necrotic later
- first 6
Repositioning displaced primary teeth that are mobile is not recommended. Extraction is recommended due to ?
the potential of aspiration in young children
- Concussion
- Subluxation
- Lateral Luxation
- Intrusion
- Extrusion
- Avulsion
- The tooth is not mobile and not displaced.
- The tooth is loosened but not displaced.
- The tooth is displaced in a labial, lingual, or lateral direction.
- The tooth is driven into its socket.
- Central dislocation of the tooth from its socket.
- Tooth is completely displaced from the alveolus.
Discolored primary teeth that are symptom-free and show no radiographic changes are best treated by:
• no treatment
• extirpation of the pulp tissue followed by the placement of ZOE paste in the root canal space
• extraction
• pulpotomy
no treatment (They should be examined periodically by taking a radiograph)
An 8-year-old patient presents to your office with a small pulp exposure on the permanent maxillary left central incisor, resulting from a fracture of the tooth. The injury is about 1-hour old. Your clinical and radiographic examinations show there are no other injuries. What is the indicated course of therapy at the time of the emergency?
• place a direct pulp cap and proceed with a glass ionomer Band-Aid restoration
• begin partial pulpotomy therapy immediately
• begin endodontic therapy immediately
• schedule the patient for endodontic therapy as soon as possible, once the initial anxiety from the traumatic episode has abated
place a direct pulp cap and proceed with a glass ionomer Band-Aid restoration (partial pulpotomy therapy is indicated in cases where the exposure is of longer duration (e.g., longer than 2 hours))
- Permanent teeth with large, open apices, which have been fractured with resulting large pulp exposures, and where the fracture injury is of recent duration, are treated by ?
- the apices are already closed?
- coronal calcium hydroxide pulpotomies
* conventional endodontic therapy is appropriate
Avulsed primary teeth are ?. The prognosis for replanted primary teeth is poor and, worse, ankylosis also can result.
not replanted
Recently traumatized teeth may give ? responses to pulp vitality tests. This impaired nerve conduction may be temporary or permanent, only time will tell
false-negative
A 9-year-old patient has fractured the root of the permanent maxillary right lateral incisor. There is no other identifiable injury. The fracture occurred around the middle of the root. What is the indicated course of therapy at this time?
• begin endodontic therapy immediately
• extract the tooth and the root remnant if possible
• do nothing if the tooth seems fairly stable
• splint the tooth to the adjacent two or three teeth
splint the tooth to the adjacent two or three teeth
(1. Fractures in the middle third of the root have the poorest prognosis,
2. the standard monitoring period for fixed splinting for root fractures is 3 months.
3. 75% of permanent teeth with root fractures maintain their vitality)
For an avulsed permanent tooth, ? has been advocated as the best system to use. To allow for flexibility, a light orthodontic wire can be used. It should be left in place for ? maximum to prevent akylosis
- the composite resin retained arch wire splint
* 1-2 weeks
Splinting for root fracture in the primary dentition?
is not recommended
What is the most reliable method to determine the pulp vitality in the case of a recently traumatized primary tooth? • radiograph • electric pulp test • thorough intraoral exam • there is no reliable method
there is no reliable method
In young children with avulsed and replanted permanent teeth that have open apices, the blood supply is usually regained within ? after replantation but nerve supply lags behind
the first 20 days
The chief cause of failure of replantation of permanent
teeth is ?
external root resorption
The patient is a 5-year-old child with acute pain associated with tooth #K. If tooth #K was extracted, what type of space maintainer would be needed?
• band and loop space maintainer
• distal shoe space maintainer (fixed)
• distal shoe space maintainer (removable)
• crown and loop space maintainer
distal shoe space maintainer (fixed)
The most frequently found ectopic teeth (eruption of a tooth in an abnormal position) are ?
the maxillary first permanent molars and canines
What cement is the best choice for cementing a lower fixed bilateral holding arch in place? • zinc phosphate cement • zinc oxide eugenol cement • IRM • glass ionomer cement
glass ionomer cement
A mother of a 6-year-old female reports that her daughter has complained of a severe spontaneous pain on the upper right side of her mouth. Your examination indicates a large lesion on the distal aspect of the primary maxillary right first molar which extends to the pulp. All other maxillary teeth are present and are noncarious. You decide that extraction of the tooth is warranted. What type of space maintainer will you advise for the patient?
• maxillary right removable unilateral appliance
• maxillary removable bilateral appliance
• maxillary right band and loop appliance
• distal shoe space maintainer
maxillary right band and loop appliance
? of permanent central incisors often causes early exfoliation of primary lateral incisors . This often results in a midline deviation
The lateral ectopic eruption
Amount of resorption of primary roots for space maintenance fabrication?
if more than one-fourth of the root remains, space maintenance is likely necessary; if less than one-fourth of the root remains and if no bone is left between the primary tooth and permanent tooth, space maintenance is likely unnecessary
Most space loss occurs within ? months after a primary tooth extraction
the first 6
