Pedo (doc micks) Flashcards by yan mae de

When does crowns of primary teeth begins to calcify?

3.5-6mos. utero
4-6mos. utero
14-24 wks utero
2nd trimester

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‼️📌Remember

Enamel of primary central incisor is completed at what age?

1 1/2 - 2 1/2 months of age

15month old child except Canine & 2nd molar

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6 y/o molar

1st molar

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12 y/o molar

2nd molar

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Crown permanent incisor

Apical & Lingual

Inclination : Labial Inclination

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What do you where in primary tooth

Overretained deciduous tooth

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📌📌‼️‼️

It takes___ years for most crowns to complete its formatiom , except for 1st molar____ & cuspid ____

4-5 yrs
3yrs
6yrs

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‼️📌Crowns of permanent central incisors are completely calcified at what age?

4-5 yrs

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From start of calcification to root completion it would take ____ yrs
except canines ___ yrs

10 yrs

13yrs

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Permanent teeth erupt when approximately ____ of its root is completed

2/3

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Apex fully developed _____ years after eruption

2-3yrs

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Max.

61245378

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Mand.

61234578

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present at time of birth
mandibular incisor region
hypocalcified

Nata teeth

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present within the first 30 days after birth

hypocalcified

Neonatal Teeth

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Tetracycline staining can affect a child’s teeth until what age?

<8 y/o

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5 y/o taking tetracycline side effects can be:

Canine
PM
2nd molars

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Tx of Natal teeth

Extraction to prevent aspiration

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Natal teeth of mobile

Extraction to prevent aspiration to the Righ lung

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Natal teeth not mobile

No tx

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‼️📌📌📌Nolla’s Stage of Tooth Development‼️‼️

Stage 0- Absence of crypt
Stage 1- Presence of crypt
Stage 2- Initial calcification
Stage 3- 1/3 of crown completed
Stage 4 - 2/3 of crown completed
Stage 5- crown almost completed
Stage 6- crown completed, root formation begins
Stage 7- 1/3 of root completed
Stage 8- 2/3 of root completed
Stage 9 - root almost completed ; open apex
Stage 10- root completed ; closed apex

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Characteristics of Primary Mand. 1st molar (D)

Doesn't resemble any other teeth
Pot belly appearcance
No central fossa
BIG MB cervical ridge
rounded & short distal surface
Flat & long mesial surface

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early extractiom of primary

Delayed eruption
drifting
Malocclusion

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REMEMBER‼️📌📌

only ant. teeth that have a greater width than height

Primary Maxillary Central Incisors

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All anterior teeth

4 lobes

All PM

4 lobes | expcept mand. 2nd PM - 5 lobes

First molars

5 lobes | Max. 1st molar - 4 lobes & 5 lobes

2nd molars

4 lobes

Most common lesion primary molar | Permanent

Bifurcation lesion Reason: Because many accessory canal pulpal floor Apical lesion (Periapical)

separation anxiety | mother is cenrer of his world

2 yrs old

big talker Brief attention span exhibit tantrums

4 yrs old

loves to learn new thing likes to dramatize things "susceptible to praises"

8 yrs old

increase interest in appearance | peer group oriented

12 yrs old

📌‼️‼️BE | What id the general characteristics 12 y/o

Reject Parental Authority

‼️📌📌First dental visit

As soon as first tooth eruptd or within 6mos. of first tooth eruption no later than first bday

First tooth beush

First tooth erupts

when 2 teeth touchong

First flossing

‼️📌📌BE | Infant oral care cleaning the gauze bedtime

0-6mos.

minimal apprehension

Cooperative

deficient in comprehension & or communication skills

Lacking cooperative ability

Special needs

Autism Cerebral Palsy ADHD Down syndrome

inclined plane / tongue blade

Ant. Cross bite

capable of behavimg but disruptive in dental setting 3-5 y/o 6-8 y/o

Potentially cooperative

temper tantrums | 3-6 y/o

Uncontrolled

overprotective parents | I donl't want to attitude

Defiant

shielding or hesitating behavior | 3-5 y/o preschool

Timid

white knuckler | 7 y/o

Tense cooperative

absence of tears

Whinning

spoiled brat

Incorrigible

least ideal

Fearful

‼️📌BE | What should the dentisf do when communicating mute child?

A. Maintain a natural communication

‼️📌 Frankl Behavioral Rating Scale Fearful shows extreme negativism Definitely negative

Frankl I

negative | shows negative attitude but NOT PRONOUNCED

Frankl II

Positive | Likes & accepts thr tx but CAUTIOUS

Frankl III

Definitely positive | Laughing & enjoying the situation

Frankl IV

uses voice to control child , FIRM | establish authority

Voice Control

verbal praises & toys

Positve Reinforcement

diverts px education short attention span

Distraction

posture body language patting the shoulder

Non- verbal communication

gradual exposure to new stimuli or experience

Desensitization

learning by observation

Modeling

Aversive Technique or

HOM

Used for px who can understand but is DEFIANT | Not for handicapped & very young children

Aversive Technique / HOM

uses physical restraining equipments | should not be presented as punishments

Protective Stabilization

Parent Assistant head lock

Passive restraint

Papoose | Pedi wrap

Determines a child behavior

1. Age 2. Mothers' Anxiety 3. Past medical history

‼️📌📌‼️ | Drugs don't use for premedicating 8 y/o severe apprehension

Naloxone (narcan)

Most common drug oral sedation

Chloral Hydrate

Advantages of Sedation of Chloral hydrate

Ease of Administration

Disadvantages of Chloral Hydrate

Slow onset of action Child may spit Nausea & vomiting Respiratory depression- excessive dose

most common inhalation

Nitrous Oxide Oxygen Inhalation

mild odourless & reversible inhalation drug | Produces ONLY ANALGESIA & minimal conscious sedation

Nitrous Oxide Oxygen

Most common adverse effect of Nitrous Oxide

Nausea

Adminstering concentration of N2O

70% N202 | 30% O2

Maintaining concentration

30% N202 | 70% O2

Properties of NO

Anxiolytic Analgesic Amnesic

oversedste ma reverse ant effect

Flumazenil (IM)

Proper response to N2O2?

Feeling of floating & giddiness tingling of digits

Combined volume of gases delivered?

3-5 L (min dental decks | 4-6 L

What to do during termination of N2O2?

100% 02 inhaled not <3-5mins prevent Diffusion Hypoxia

no peer involvement

Solitary

observing others play

On looking

play activity along side

Parallel play

with interaction

Associative play

highest form of play

Cooperative

📌‼️‼️‼️REMEMBER | 1st bacteria to colonize the mouth after birth?

Strep. Salivarius

Bacteria associated with PLAQUE?

Strep. Sanguis

pH of Saliva

6.2- 7.6

Critical enamel ph

5.5-5.7

Initial sign of dental caries

White spots & Incipient caries / white spot lesions

tooth mineral is affected firtmwhen there is sctivd csries?

CRbonate

Incipient proximal decalcification | Proximal lesin primary molar

Below the contact / Gingival to the contact area Radiograph : Children: Bitewing Proximal Caries

used for prevention & control of caries | Most effective way is systemic

Fluoride Therapy

systemic

Fluoridation

topical, cavity varnish , toothpaste

Fluoridization

📌‼️‼️‼️REMEMBEr | Fluoride can inhibit what enzymes

Phosphatase | Enulase

Where is the site of excretion of fluoride

Kidney

Optimal Fluoride Concentration for public water

0.7-1.2 ppm

What determines the fluiride content in a community water

Climate/ Temp.

Rule of 6

- No supplemental systemic fluoride fluoride level > 0.6 ppm f px is < 6mos. px older 16 y/o

Demineralization

Carbonate Calcium Phosphate

RemineralizRion

Fluoride Calcium Phosphate

Indication of N2Op

Minimal to moderate anxiety

Contrainidications N2O

Nasal obstruction Uncooperative Active pulmonary Infection

Topical fluoride will NOT CAUSE FLUOROSIS only

Systemic will

Advantage

Proximal & smooth surfaces benefits the most

Fluoride converts HYDROXYAPATITE crystals into

FLUOROAPATITE

Toothpaste contains

1,100 ppm of Fluoride

‼️📌📌BE Types of Fluoride

1. NaF 2. APF 3. SNF

concentration of NaF

2-5%

APF concentration

1.23%

SnF concentration

Tooth discoloration

SnF - Brown NaF-none APF- noe

pH of NaF

pH- 9.2

APF | ph

pH -+3-3.5

SnF | ph

ph - 2.1-2.3

child know how to spit

APF

Adult lethal dose

4-5g

Child Lethal Dose

15mg/kg

Fluoride Varnish

5% >22,600 ppm > 22.6 mg f/ml

Supplemental fluoride factors to consider

Age | Fluoride content commonly water

‼️📌📌REMEMBER | Silver Diamine Fluoride

Black Staining

contains how much ppm F?

38% silver ammonia fluoride

Side effect

Black staining but can stop arrest the active caries 44,800 ppm F

Tx of Fluoride Toxicity

Syrup of Ipecac | Milk of Magnesia- induce vomiting

anomaloes n #

Initiation | Proliferation

anomLy in enamel structure or dentin

Histodiff. Amelogenesis Dentinogenesis

anomaly size or shape

Morphodifferentiation

Tissue formation | Hypoplasia Enamel

Apposition

excessive ingestion of fluoride

Calcification | fluorosis/ mottled enamel

emerge eruption

uses weight in lbs / 150 adult dose

Clark's Rule

uses age

Young's rule

infants | infant dose- age in mos

Fried's rule

susceptible to decay Histodifferentiation Yellow teeth Hypersensitivity

Amelogenesis Imperfecta

Types of AmelogenisismImperfecta

Enamel Hypoplasia Enamel hypocalcification Enamel hypomaturation

Allergic to Penicillin

Erythromycin

Term for permanent teeth having hypoplastic defect crown resulting a local infection / trauma

Turners Tooth

‼️📌📌What vitamin & mineral deficiency NOT in enamel hypoplasia

Vit. B

Enamel Hypoplasia deficiency

A, D, C calcium phosphorus

sign . gray brown teeth, opalescdnt hue, weak enamel

BE. Radiographic of DI

Obliterated Pulp chamber | Extensive deposits of 2ndary Dentin

Type of Dentinogenesis Imoerfecta | associated w/ OI

Type I

Blue sclera Brittle /Fragile Bone Hearing Loss

Osteogenesis Imperfecta

most common type of OI, not associated w/ OI/ Hereditary Opalescent Dentin

Type II Dentinogenesis Imperfecta

multiple pulpal exposure & PA lesions | Brandywine Type DI/ Teeth w/ shell like appearance

Type III Dentinogenesis Imperfecta

Type I of Dentin Dysplasia

- Rootless teeth / radicular type - short pointed root &pulp - absent pulp chamber & pulp canal - multiple PA lesion

coronal | thistle tube shaped pulp chamber

Type II Dentin Dysplasia

Rampant caries due to Sleeping with Feeding Bottle | aka. baby bottle tooth decay

Early Childhood caries/ Nursing Bottle caries | Severe Early Childhood Caries

pattern of Early Childhood Caries

Cervical Max. Incisors ➡️ Max. Posterior➡️ Mand. posterior➡️ Mand. Incisor

Most common early childhood caries

Max.Incisors

Least early childhood caries

Mand. Incisors - tongue & saliva

Only involves Gingiva Rare: Preschool occurs in 15-30 y/o only GINGIVA signs & symptoms: Painful hyperemic gingival Punched out erosions covered by GRAY PSEUDOMEMBRANE, FETID ODOR Microorganisms: FuPS

Necrotizing Ulcerative Gingivitis/ Vincent's Infection, / Vincent Angina/ Trench Mouth Fusobacterium, Prevotella Intermedia , Spirochetes

Tx. NUG

Debridement Antibiotic Hydrogen Rinses

``` will develop Class III Max. Deficiency, small maxilla, class 3 malocclusion , delayed eruption &:exfoliation of teeth underdeveloped mandible short limbs dwarfism ```

Achondroplasia

enlarged tongue & longer root ; Skeletal Class III

Gigantism

Skeletal Class III after epiphyseal plates closed

Acromegaly

affect children ⬇️ 3 y/o very contagious | Fever, painful reddish ulcerations in gingiva & mouth

Primary Herpetic Gingivostomatitis

What is the causative agent of Primary Herpetic Gingivostomatitis

HSV-1

what do you call the secondary infection?

Recurrent Herpes Labialis / Cold sores / Fever Blister

painful white / yellow ulcers with bright red that causes apthous ulcers

Coxsackie virus

Herpangina, Hand-foot- mouth d.

Coxsackie A

Mouth blisters

Herpangina

<1cm & last for 2 weeks

Minor Apthous Ulcers

>1cm & last for more than 2 weeks w/ scarring

Major Apthous Ulcers

Clusters of Ulcers

Recurrent Herpetiform

📌‼️‼️Frequenr recurrences of ulcers should be screened for

DM & Behcet's Syndrome

Diabetes Mellitus trias

Polydipsia Polyphagia Polyuria

uveitis - inflammation of uvea | vasculitis- inflammation of BV

Behcet's Syndrome

occurs during 6th-8th week in utero

Cleft Palate

occurs during 5th- 6th week in utero

Cleft lip

Syndromes associated in cleft lip & palate

Stickler Syndrome Van Der Wonde / Lip Pits - obturator Di George syndrome

📌‼️‼️‼️ 2 Medial Nasal Process failed to fuse to form imtermaxillary segment

Median Cleft Lip

Correctin of Cleft on Soft palate

Staphylorrhapy

Hard Palate

Uranorrhapy

‼️📌📌📌 | Most common malocclusion cleft lip & palate px

Class 3 Maxillary Retrusion

📌‼️‼️BE | Pattern of Caries Development Primary 2nd molar

Occlusal Mesial Distal

DDx, of ANUG

Interdental papilla | Necrotic

DDx.Primary Herpetic Gingivostomatits

Interdental papilla intact

‼️📌BE | Most common cause Generalized Acute Gingival Inflammation in preschool/children

Acute Herpetic Gingivostomatitis

Cleft lip Class I Class II

Microform / Incomplete cleft lip

Uranoschisis

cleft on hard palate

staphyloschisis

soft palate

RULE of 10

10 wks 10 lbs 10 gm/ dl hemoglobin

delayed up to 9-18 months after birth

Cleft Palate repair | Palatoplasty

micronagthia, airway obstruction posterior displacement tongue ;glossoptosis Bird face Cleft palate

Pierre Robin Syndrome

Absent Nasal Bone; associated with Supernumerary Needs affection & love Less common to dental caries & more prone to PD- weak immune system Delayed eruption Heart Defects are common (Tetratology of Fallot) PROV

Trisomy 21( Down's Syndrome)

``` Fish face down slanting eyes eyelids coloboma underdeveloped cheek bone micrognathis malformed ears ```

Treacher Colling Syndrome / Mandibulofacial Dysostosis

📌‼️‼️Most common type gingivitis seen in children

Eruption Gingivitis

Physical & mental retardation Associated with Congenital Hypothyroidism Delayed Eruption

Cretinism (hypothyroidism in Children)

Delayed ERUPTION

Hypothyroidism | Hypopituitarism

Absence of Clavicle Clinical sign few teeth Radiographic sign: numerous supernumerary teeth

Cleidocranial Dysplasia/ Cleidocranial Dysostosis / Marie- Sainton Syndrome

‼️📌📌📌Best interest of dentist & unerupted teeth

Cleidocranial Dysplasia / Cleidocranial Dysostosis/ Marie - Sainton Syndrome

delayed ERUPTION

Gingival Fibromatosis

bluish purple, elevated area of tissue, appears before eruption of a tooth

Eruption Cyst

whitish gingival cyst of Newborns, buccal, lingual surface of alveolus

Bohn's Nodules

Most common hemophilia in Children Cause : fx 8 deficiency more common males

Hemophilia A

abnormal Ectoderm affects skin, hair, sweat glands & tooth enamel Alveolar bone development is Lacking -due to absence of permanent tooth

l Ectodermal Dysplasia

Median Palatine Raphe

Epstein Pearl

Crest of alveolar mucosa

Dental Lamina Cyst

Hemp. C

Rosenthal Syndrome XI

Contraindicated Hemophilic px

``` Aspirin Anticoagulant Warfarin Coumadin Heparin ```

absence of all teeth

Anodontia

6 or more missing

Oligodontia

less than 6

Hypodontia

Vital tooth with provoked pain/ reversible pulpitis 1.8mm of dentin thickness between pulp & carious lesion root resorbed Not greater than or equal 2/3 (deciduous)

Pulpotomy

Procedure of Pulpotomy

``` Removal caries Access prep Removal of Coronal pulp Medicament placement ZOE Crown (SSC) ```

hypohidrosis (lack of perspiration) hypodontia (missing teeth) hypotrichosis (fine sparse hair)

Anhidrotic Ectodermal Dysplasia

infected pulp with spontaneous pain/ nocturnal pain non- vital pulp with periradicular lesion root resorbed NOT greater than or equal to 2/3 (deciduous)

Pulpectomy - Internal resorption/ Pink tooth of Mummery

📌Contraindication Pulpectomy

Large bifurcatipn lesion bone loss mobile non-restorable tooth

📌‼️‼️Buckley's solution 1. Formaldehyde 2. Cresol 3. Glycerin 4. Water

19% 35% 15% 31%

physiologic development of Apex Seen in young permanent teeth pulpotomy or direct pulp cappimg Success & complete apical closure : tootg asymptomatic

Apexogenesis

CaOH➡️ GI➡️ final restoration- small carious / mechanical exposure MTA

Direct pulp capping

GI- final restoration - carious lesion result to pulp exposure

Indirect pulp capping infected dentin- remove Affected dentin- stay Indirect Pulp Capping

MTA- GI- Final restoratiom= CaOH

Partial Pulpotomy / Cvek Pulpotomy

Non- vital young permanent teeth with open apex

Apexification / Root End Closure

Procedure apexification

Canal filled with CaOH or MTA | After apical closure, proceed to RCT

Featheredge finish line

Anterior Strip off Crowns

incisal Ant. SOC

1-1.5mm

Labial & Proximal Ant. Strip off Crowns

1mm

Lingual Reductiof of Ant. Strip off crowns

0.5mm lingual

try in crown

Passive fit SOC

cervical 3rd -facial surfsce

Undercut

lingual surfsce: vents / holes

for excess material

remove excess & cure

GI & Composite

1mm subgingival Featheredge finish line 1.5mm overall reduction size GI cement snap fit

SSC

Direction SSC

Lingual Buccal Cement: Type I - GIC Common errors- Ledges Interproximal *Surface least amount reduction: Lingual

Primary teeth Vital Spontaneous pain Provoked pain

Pulpectomy | Pulpotomy

Loosening of teeth Slight- Moderate

Observe only Passive repositioning Active repositioning then stabilize

Displaced Intrusion, Lateral Luxation - Passive repositioning - Active repositioning then Stabilize

displace outside of its socket

Active repositioning then stabilize | Extrusion

Extrusion Primary Permanent

Primary- Reposition, no tx Severe - extract Permanent- Reposition & stabilization

completely out of the socket Do not reimplant- Primary - Reimplant &:stabilize for 2 wks

Avulsion

Take radiograph to verify Milk Saliva Last option- Water

Chief cause failure of Avulsed tooth

External resorption

Vital spontaneous pain

RCT- irreversible pulpitis

Avulsed tooth w/ incomplete root formation when RCT

only if the tooth exhibit pulpal necrosis | after reimplantation

tender to touch no mobility no displacement Tx. Observe (permanent & primary)

Concussion

mobility no displacement tender to touch TxOnserve Flexible splint 2 wks monitor pulpal condition

Subluxation

no mobility displaced labially / palatally Primart Interference Severely displaced

Lateral subluxation Selective grinding Extract

Avulsion

``` Hank's Solution Milk Saliva Reimplant Stabilize for 2 wks ```

``` Ellis Classification of tooth trauma EDENTRDLD I II III IV V VI VII VIII IX ```

``` Enamel Dentin Exposed pulp Non- vital / without loss of crown Teeth loss- trauma Root fracture Displacement Loss of Crown Deciduous Teeth ```

📌‼️‼️REMEMBER Primary ant.teeth Is not common more common

Fracture | Displacement

Permanent ant. teeth More common Not common

Fracture | Displacement

Most common ankylosed tooth

Mand.1st Molar

2 Terms Ankylosis

1. Submerged tooth | 2. Replacement resorption

Root fracture least favorable prognosis | Good prognosis

Cervical 3rd | Apical 3rd

Diagnose Ankylose Radiograph

Cessation of eruption

Replace the tooth bud

Sectioning