Pedo- ABGD Flashcards
What is the eruption sequence for primary teeth?
ABDCE
Max: In months:
(6-10: 8-12: 11-18: 16-20: 20-30)
Mand:
(5-8: 7-10: 11-18: 16-20: 20-30)
What is the eruption sequence for MAX PERM teeth?
61245378
What is the eruption sequence for MAND PERM teeth?
61234578
Spacing- name of classification and types
Baume Type 1: 2/3 of primary dentition, generalized
Type 2: 1/3 non-spaced
Ideal overjet, Overbite and overlap in primary dentition
OJ: 0-3mm
OB: 2mm
OL: 30-50%
Describe the mesial step and what it will likely lead to?
mandibular is forward (most like class 1, MB in mand B groove)- 14% of patients
most likely to class 1
possible class III
Describe the distal step and what it will likely lead to?
Md is back. always lead to class II
10% of patients
Describe the flush and what it will likely lead to?
End to end- 76% of patients
56% have a late mesial shift to class I
46% stay end to end or shift to class II
What is the best predictor of sagittal relationships?
primary canines
What is incisor liability
size different between primary and perm incisors. larger perm
gained from spacing in primary dentition, labial eruption of perm incisors, and intercainine width increase
What is the incisor liability for max arch
7.1mm (ortho says 7mm)
What is the incisor liability for mand arch
5.1mm (ortho says 6mm)
What is the intercanine width increase? MAX and MAND
MAX: 3mm
MAND: 2.4mm
What is leeway space?
Size difference in perm pm and primary molars. primary molars are larger. M-D AKA
What is the anticipated space gained in MAX and MAND leeway space?
MAX: 0.9-1.2mm/side
MAND: 1.7-2.4mm/side
What is the late mesial shift?
loss of leeway. M tipping of PERM 1st molars after primary 2M exfoliate. Helps to make class I
What is the Early mesial shift
closure of space. Perm molars guide on the primary 2M roots and closes the space ~4yo.
neonatal is
during the 1st month after of birth
natal is
@birth
What are 3 pediatric oral anomalies - neonatal or natal?
Bohn Nodules
Dental Lamina Cyst
Epstein Pearls
Staining
Mucous gland tissue on the MAX RIDGE is called
Bohn nodules
Remnants of the dental lamina on the CREST of the alveolar ridge
Dental Lamina Cysts
trapped epithelial remnants on the mid palatal raphe
Epstein pearls
What causes color changes in developing teeth?
Tetracycline at 3-5 months-7years
CF, Trauma
What 4 teeth are most likely likely to be congenitally missing?
3rdM > Mand 2PM > Max Lat > Max 2PM
What is it called when there is one root but two crowns
Gemination
What is it called when there are two teeth together- typically with 2 pulps.
Fusion- no additional teeth. sometimes looks like a missing tooth.
What are the benefits of Fluoride
inhibit demineralization, remineralization, antibacterial (disrupts enzyme systems) decrease in solubility of the tooth
What is the % and ppm of the F ion in toothpaste
0.1%, 1000ppm
What is the % and ppm of the F ion in rx toothpaste (prevident)
1.1%, 5000ppm
What is the % and ppm of the F ion in mouth rinses like ACT?
.05% NaF, 227ppm
0.2 NaF = 900ppm
What is the % and ppm of the F ion in varnish
5% NaF, 22,700ppm
1.23% APF = 12,300 can etch porcelain
Optimal level of F in water?
0.7ppm
If the patient is > than 6 mo old, how much to supplement fluoride?
H2O has <0.3
6mo-3y = 0.25
3y-6y = 0.5mg
6-16y = 1g
H2O has 0.3-0.6
3-6yo =0.25
6-16 = 0.5 mg
How much more F release do we see from SDF?
2-3x more
Whats the caries reduction % when using SDF?
80%
How much SDF and what ppm?
35% SDF = 44,800 ppm F
Contraindications for SDF?
desquamative gingiva, allergy to silver, esthetic conerns
Dont give the SSKI (potassium iodide-delays staining) to someone who is pregnant
How many teeth does one drop of SDF treat?
5-8
How to apply SDF?
Dry tooth, apply, wait 30-60 seconds, dry.
What is the makeup of SDF
24.4-28.8% silver, 5-5.9% F at a pH of 10
How does SDF provide benefits?
F: squamous layer plugs for dentin tubules. fluorapatite.
Silver is antimicrobial and breaks down membranes, inhibits DNA replication, fights MMP and collagenases to resist enzymatic destruction.
What is the pH of SdF
10
Early childhood caries- how to define?
any caries in a kid younger than 6yo
Severe ECC- how to define?
caries in anyone under 3
DMF >/= 4@3yo
5@4yo
6@5yo
DMF- decayed missing filled
How to pulpotomy- on primary teeth
remove infected tissue. using fomocresol(1min), ferric sulfate (10-15 sec), 5% NaOCl (30 secs) elecrosurg or lazer, stop bleeding and disinfect.
Place MTA or Biodentine on top.
What are the 3 zones of fixation when using fomocresol?
- Acidophillic
2 Broad pale staining - Zone of inflammation
Pulpectomy- how to? on primary teeth
clean and shape. Obturated with CaOH, zinc Oxide/Eugenol, or Iodoform/CaHydroxide.
What are the conversion ratio for the types of Fluoride?
NaF = 2.2, SnF2 = 4.1 APF = 1
What ppm is 2% F?
2% F x 10= 20 mg/g
20mg/g / 2.2(conversion ratio) = 9.009 mg/g F ion x 1000 = 9090 ppm
What is the toxicity of F per kg?
5mg F / Kg
LETHAL 15mg F/kg
Death in 4 hrs.
Signs of F toxicity?
GI, CNS; Death in 4 hrs
Is it toxic:
A 30 lb(13.62 kg) 3yr old ingests 3oz of Aim toothpaste where there is 170g in 6oz
YES its toxic..
0.24% NaF x 10= 2.4/2.2= =1.090 mg/g F ion= 1090 ppm=1mg/mL
3oz=85mL or 85mg F
13.62 x 5mg/kg(toxic)=68.1mg
Space Maintenance: PRIMARY DENTITION: what to do if 2M are missing?
distal shoe
Space Maintenance: PRIMARY DENTITION: what to do if 1M are missing?
Band & Loop/ Crown and loop
Space Maintenance: PRIMARY DENTITION: what to do if multiple molars are missing?
Removable acrylic saddle
Space Maintenance: Early Mixed DENTITION: what to do if 2M are missing?
MAX: Nance, Transpalatal Arch, B&L(r)
MAND: B&L (r)
Space Maintenance: early mixed DENTITION: what to do if multiple molars are missing?
Mx: Nance, Transpalatal Arch
Md: Removable acrylic saddle
Space Maintenance: Early Mixed DENTITION: what to do if 1M are missing?
B&L or NON
Space Maintenance: LATE Mixed DENTITION: what to do if 2M are missing?
Mx: Nance, Transpalatal Arch
Md: LLHA
Space Maintenance: LATE Mixed DENTITION: what to do if 1M are missing?
None
Space Maintenance: LATE Mixed DENTITION: what to do if 1M are missing?
Mx Nance
Md: LLHA
How to define Early Mixed dentition
First permanent molars erupted
Some or none of the permanent incisors erupted
Lower lingual holding arch could impede eruption
How to define Late mixed dentition
Permanent first molars erupted
All permanent incisors erupted
Frankel scale: most compliant to least
4, 3, 2, 1
What doe N2O effect?
CNS for anxiolysis, slight analgesia
What % of N2o is ideal
30-40%, no more than 50%
Contraindications to N2O
COPD, drug dependencies, 1st trimester of Pregnancy, Nasal obstruction, large meal within 2 hrs, tx with bleomycin sulfate, methylenetetrahydrofolate reductase deficiency, B12 deficiency
What is the max Lido dose for pedo
4.4mg/kg
What is the max mepivicaine dose for pedo?
4.4mg/kg
What is the max septodose for pedo?
7mg/kg
What is the dosage for APAP for kids <12?
10-15mg/kg/dose
Q4-6H
MAX: 90mg/kg/day
What is the dosage for IBU for kids <12
4-10mg/kg/dose
Q6-8h
max: 40mg/kg/day
ITR vs ART?
IRT: GI cements, provisional WITH F/U
ART: no f/u planned
What drugs might be used for sedation other than N2O?
Midazolam (Versed), Triazolam, Diazepam, - benzos
Meperidine/Hydroxyzine
What is the classification system and scale for tonsils?
Brodsky:
1: <25%
2: 2-50%
3: 50-75%
4: >75%
Mallampati classification
1-4.
What is different about the enamel and dentin of primary teeth vs perm
primary teeth have thinner enamel and dentin, with enamel rods directing occlusal
broader, flatter contact. brighter and lighter in color
Primate spaces- where?
Mand- Distal to the canine
Maxillary -Mesial to the canine
Average (early) age of eruption of primary central incisors?
MAND: 5 mp
Max: 6 mo
Average age of eruption of primary laterals
MAND: 7
Max: 8 mo
Average age of eruption of primary canines
16-20 months
Average age of eruption of primary 1M?
11-18 months
Average age of eruption of primary 2M?
20-30 months
When do primary teeth start calcification?
4 months in utero
What is the order of eruption for adults
Mand CI then Max CI
MAN LI, then MaxLI
Mad Can
Mx then Mand- 1PM
Mx then mand 2PM
MAX canine
2M
3M
At what age does the 1st perm molars calcify
birth
At what age does the lateral incisors erupt?
Mx 8-9,
Md: 7-8
At what age does the central incisors erupt?
Mx: 7-8y
Md: 6-7 y
At what age does the canines erupt?
Mx: 11-12
Md: 9-11
At what age does the 1PM erupt?
10-12 y
At what age does the 2PM erupt?
Mx: 10-12, Md: 11-13
At what age does the 1M erupt?
5.5-7
At what age does the 2M erupt?
12-14
At what age does the 3M erupt?
17-30
Ages Crowns are complete?
C: 4-5
LI: 4-5
Can 6-7
1PM: 5-6
2PM: 6-7
1M: 30-36 months
2M: 7-8
At what age do roots finish forming?
C: 4-5
LI: 4-5
Can 6-7
1PM: 5-6
2PM: 6-7
1M: 30-36 months
2M: 7-8
When do D E F G exfoliate?
6-8yrs
When do N O P Q exfoliate?
6-8yrs
When do C H M R exfoliate?
10-11
When do B I L S exfoliate?
10-11
When do A J K T exfoliate?
12-13
What are some behavior
management options for a
crying child in your dental chair?
Positive pre-visit imagery
Direct observation
Tell-show-tell
Ask-tell-ask
Voice Control
Non-verbal communication
Positive reinforcement and descriptive praise
Distraction
Memory restructuring
Parental presence or absence
Communication techniques w/ parents
Nitrous oxide and oxygen inhalation
What is the ideal amount of nitrous oxide to administer?
What is the maximum limit?
ideal: 30-40%,
Max 50%
O2 always 50%>
What are some contraindications to Nitrous
Oxide usage?
COPD
Severe emotional disturbances
Drug related dependencies
1st trimester of pregnancy
Nasal obstruction
Inability to accept nasal hood
Large meal within 2 hours of tx
Treatment with bleomycin sulfate (ABX used in
chemotherapy)
Methylenetetrahydrofolate reductase deficiency
(enzyme responsible for processing amino acids)
Vitamin B12 deficiency
What makes a primary tooth a poor candidate for
pulpotomy?
If there is a history of:
Severe toothache
Persistent toothache
Abnormal mobility
Percussion pain
When would you consider a CVEK pulpotomy? Describe the technique
Vital Tooth pulp exposure, asymptomatic Partial pulpotomy, preserves pulp vitality, allows apexogenesis
Technique:
RDI, Sterile bur, remove 2-3mm of pulp, hemostasis (CHX or NaOCl), MTA, CaOH, restore with sealing restoration, radiographs at 6, 12 months
What is CAMBRA?
Caries Management By Risk Assessment
-current decay levels (# of decayed
teeth)
-current bacterial challenge
-decay history (DMF index)
-dietary habits
-current meds
-saliva status (amt, buffering)
-medical conditions
-oral appliances present
-oral hygiene habits
What should be done in the
case of fluoride toxicity?
- <8mg/kg: milk, observe
- > 8mg/kg or unknown: induce vomiting, milk, ER,
they will lavage with 1-5% calcium chloride soon (Fl binds in stomach)
Milk can help reduce absorption
Ex. 1 6oz tube of toothpaste is about 180mg Fl for a 30lb (15kg) child, half the tube (3oz) would be toxic
Symptoms of toxicity: Gastric and Headaches
What is the treatment of a
trauma case?
Check head and C-spine
Check soft tissue
Treat Teeth
Best Transport media for
avulsed teeth
- Tooth socket
- Cell preserving fluid (hank’s balanced salt solution)
- Milk
- Sterile saline
- Saran Wrap
- Saliva
NOT WATER and try NOT dry
What is SDF? How does it work?
-38% silver diamine Fl
-44,800ppm Fl
-approved for sensitivity; off label use for caries reduction
-80% caries reduction (twice that of Fl alone)
-2-3x Fl retained than other types
-silver is anti-microbial: breaks cell membranes, inhibits DNA replication
-“zombie effect”: bacteria consume SDF impregnated bacteria
-Fl prevents demineralization and promotes
remineralization
-squamous layer plus dentin tubules, decreases sensitivity
-counteracts MMPs and cysteine catchepsins
(collagenases) to resist enzymatic digestion
SDF Advantages and
Disadvantages
Advantages:
-inexpensive
-quick
-no anesthetic
Disadvantages:
-unesthetic
-doesn’t restore form/function
Describe the SMART Technique
Place opaque GI over SDF
treated lesion
Different types of fluoride
levels (PPM)
Varnish:
SDF:
ACT:
OTC Toothpaste:
ClinPro/Prevident:
Varnish: 22,700
SDF: 44,800
ACT: 227
OTC Toothpaste: 1,000
ClinPro/Prevident: 5,000
Physical differences between
primary and permanent teeth
Primary:
-thinner enamel
-broader contacts
-more bulbous crowns
-wider M-D
-shorter O-C
How much Fl is in water?
0.7-1.2 PPM
What is a serial extraction and
its sequence?
-Phase 1 Orthodontics when there is severe crowding (>10mm/arch) but no skeletal problem
-Not a sub for comprehensive care, potentially makes phase 2 easier
-NOT ROUTINE
Goal: Prevent Incisor Crowding
No Set EXT sequence:
-prim incisors (if necessary)
- prim canines (8-9) to allow room for incisors
-lower primary first molar (encourages early eruption of PM when root is 2/3rd formed
-*lower canine usually erupts prior to lower premolars
-first premolars for canine space
Exfoliation Sequence for
Primary Teeth:
Max:ABDEC
(7-8: 8-9: 9-11: 9-12: 11-12)
Mand: ABCDE
(6-7: 7-8: 9-11: 10-12: 11-13)
