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Pedo Final Flashcards

1
Q

Minimal sedation

A

Respond normally
Some cognitive function and coordination may be impaired
Respiratory and cardiovascular function unaffected

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2
Q

Moderate Sedation

A

More effort required to get a response
Crying can be expected in young patients
Airway is intact
Ventilation and cardiovascular function intact

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3
Q

Deep sedation

A

Loss of protective reflexes
Loss of ability to maintain airway
Cardiovascular function may be impaired

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4
Q

5 Goals of Sedation

A
  1. Guard the patients’ safety and welfare
  2. Minimize discomfort and pain
  3. Control anxiety, minimize psychological trauma, maximize amnesia
  4. Control behavior and movement to allow safe completion of procedure
  5. Return patient to state of safe discharge
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5
Q

Office must have adequate what to provide sedation

A

Equipment to manage emergencies
Trained in monitoring
ACLS or PALS trained

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6
Q

1-3 yrs
Heart Rate
Blood Pressure
Respiratory Rate

A

70-110
90-105/55-70
20-30

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7
Q

3-6 yrs
Heart Rate
Blood Pressure
Respiratory Rate

A

65-110
95-110/60-75
20-25

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8
Q

6-12
Heart Rate
Blood Pressure
Respiratory Rate

A

60-95
100-120/60-75
14-22

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9
Q

12 yrs
Heart Rate
Blood Pressure
Respiratory Rate

A

55-85
110-135/65-85
12-18

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10
Q

When airway is too obscured

A

+3 or +4

Anything more than 50% blocked

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11
Q

ASA Class I

A

A normal healthy patient

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12
Q

ASA Class II

A

A patient with mild systemic disease (controlled reactive airway disease)

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13
Q

ASA class III

A

A patient with severe systemic disease (a child who is actively wheezing)

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14
Q

ASA class IV

A

A patient with severe systemic disease (a child with status asthmaticus)

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15
Q

ASA class V

A

A moribund patient who is not expected to survive without operation (a patient with severe cardiomyopathy requiring heart transplantation)

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16
Q

Medical History Evaluation

A

Allergies & previous reactions
Current medications. Dosage, time, route
Diseases or abnormalities, pregnancy in adolescent
Previous hospitalizations
History of previous sedation or anesthesia
Review of body systems
Family history of disease or sedation reactions
Age and weight

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17
Q

Physical Evaluation

A

Vital signs
Airway patency and tonsilar size
ASA classification
Name, address & telephone (# of child’s medical home)

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18
Q

Look up eating instructions concerning sedation procedure

A

in the book

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19
Q

Eating and drinking instructions before sedation

A

No milk or solid foods 6 hours before appointment
Clear liquids are allowed 3 hours before
Everyone in household must know this

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20
Q

Clear liquids

A 
Water
Fruit juice without pulp
Carbonated beverages
Clear tea or black coffee
up to 2 hours before - AAPD
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21
Q

AAPD dietary insturctions

A

clear liquids up to 2 hours before
Breast mild up to 4 hours before
Infant formula up to 6 hours before
Non-human milk up to 6 hours before
A light meal - up to 6 hours before
-avoid fatty foods/meats that take a long time to digest
Medications can be taken with sip of water on day of procedure

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22
Q

Dietary restrictions to avoid

A

Emesis

throwing up

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23
Q

Look up - child care after sedation

informed consent

A

forms

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24
Q

Eruption times table

A

table

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25
White spicule of hard tissue overlying the central fossa of a mandibular first permanent molar
Sequestrum | No treatment, unless symptoms
26
Natal teeth | Neonatal teeth
natal - teeth present at birth Neonatal - teeth that erupt in first 30 days following birth less than 10% of neonatal teeth are supernumerary
27
Behaviors at 2 years
``` Gross motor skill like run and jump see and touch Attached to parents No sharing some interest in self help ```
28
Behaviors at 4 years
Impose powers Small social groups, reaches out Independent self help skill Thank you and please
29
Behaviors at 5 years
``` Consolidation period More deliberate Pride in possession Start giving up comfort objects Play nice with other kids ```
30
IQ
Mental age | Avoid making assumptions based on size or other development
31
Degrees of Mental Retardation
Mild - Educable Moderate - Trainable Severe Profound
32
Mild mental retardation
Educable 85% of all with retardation need a little extra help but end up doing just fine
33
Moderate mental retardation
Trainable | with support and training they can still function
34
Severe mental retardation
simple tasks | need lots of support and generally line in a group home type setting
35
Profound mental retardation
Identifiable neurologic disorder
36
Parental Anxiety
anxious parents = anxious kids
37
Cooperation classifications
Cooperative Lacking in cooperative ability Potentially cooperative
38
Frankl Behavioral Rating Scale | Rating 1
Definitely negative | Refusal of treatment, forceful crying, fearfulness, or any other overt evidence of extreme negativism
39
Frankl Behavioral Rating Scale | Rating 2
Negative Reluctance to accept treatment, uncooperativeness, some evidence of negative attitude but not pronounced (sullen, withdrawn)
40
Frankl Behavioral Rating Scale | Rating 3
Positive Acceptance of treatment cautious behavior at times willingness to comply with the dentist, at times with reservation
41
Frankl Behavioral Rating Scale | Rating 4
Definitely positive Good rapport with the dentist interest in the dental procedures Laughter and enjoyment
42
Fundamentals of behavior guidance
``` Positive Approach Team attitude Organization Truthfulness Tolerance Flexibility ```
43
Positive Approach
Children respond to what is expect by the dentist to some extent Use positive statements
44
Team Attitude
Warmth and interest, pleasant smiles, note any hobbies or accomplishment
45
Organization
Establish who will bring the patient back, etc. | Delays and indecisiveness make kids nervous
46
Truthfulness
Everything is completely black or white to kids | tell the truth and establish trust
47
Tolerance
figure out when you are the most tolerant and try to schedule your patients accordingly
48
Flexibility
be ready to switch it up at any time as needed
49
More important than the comprehension of actual words
the tone and volume of communication
50
Behavior shaping model
state the goal or task Explain the necessity Divide it up Explain at an appropriate level of understanding Successive approximations. Tell, show, do. keep the kid as informed as possible about what's going on Reinforce appropriate behavior - be specific and praise skills Disregard minor inappropriate behavior since paying attention to it may be reinforcing
51
Retraining
need to determine what caused the bad association in the child's mind and then create a good one instead
52
Aversive conditioning
Hand over mouth - screaming and kicking are linked to restraint such as this last resort old practice
53
Practical considerations for behavioral management
Scheduling - don't keep kids waiting, mornings usually better Length of appointment may become an issue Having parents wait in waiting room may be better Treasure box, don't bribe, never promise beforehand
54
Which molar pulp chambers are bigger in primary teeth - Max or Mand
Mandibular molar chambers are bigger
55
Indications for protective liner
Normal pulp Placed in deep areas of a prep to minimize injury to pulp Promotes pulp tissue healing and decreases sensitivity Tertiary Dentin formation
56
Protective liner materials
GLUMA - glutaraldehyde and HEMA, desensitizer, disinfectant Calcium Hydroxide Bonding Agents Glass Ionomers
57
Indirect Pulp Cap Indications
No pulpitis deepest carious dentin is not removed Pulp deemed 'healable' from procedure
58
Indirect Pulp Cap Materials
Calcium Hydroxide - topped with glass ionomer or ZOE to provide seal against microleakage ZOE Resin Modified Glass Ionomer Glass Ionomer Cement
59
Direct Pulp Cap Indications
Normal pulp small mechanical or traumatic exposure Not recommended in primary teeth
60
Direct Pulp Cap Materials
Calcium Hydroxide MTA Glass ionomer or ZOE should seal these materials
61
Pulpotomy Indications
When caries removal results in pulp exposure in a primary tooth can be healthy or pulpitis pulp
62
Pulpotomy Materials
Devitalization/Fixation - Formocresol Preservation - Ferric sulfate (may mask pulpal signs) and chlorhexidine Regeneration - MTA Sealing and filling coronal pulp chamber - ZOE
63
Pulpectomy Indications
Primary tooth with irreversible pulpitis or necrosis Radicular pulp exhibits problems Hemorrhaging not controlled Minimal or no root resorption
64
Pulpectomy Materials
ZOE | Iodoform paste - bacteriocidal, resorbable
65
Contraindications to pulp therapy in primary teeth
Pathologic internal or external root resorption Close to exfoliation Periapical abscess formation with swelling and drainage - unless tooth is deemed important Cellulitis Unrestorable tooth Medically complex pts
66
Differences for immature permanent teeth - pulpotomy
More conservative pulpal access Reparative/regenerative materials - Calcium hydroxide and MTA Promotes maturation and apexogenesis
67
Differences for immature permanent teeth - Pulpectomy
More conservative access Calcium hydroxide and MTA Apexification Endodontic referral
68
Acid etching for bonding first done when
1955
69
Sealants use which materials
Bis-GMA resin | Urethane Dimethacrylates
70
Activation of sealants
Used to be by UV | Now by visible light at 470nm
71
Sealants may be filled with what materials
SiO2 or quartz
72
Colors of selants
clear, white, pink, amber | light activated color
73
Sealant effect on caries
Cariostatic by mechanically obstructing pits and grooves and preventing bacterial penetration Can halt incipient caries, but should not be placed over deeper caries
74
Effectiveness of sealants mainly linked to
length of retention
75
Pros and cons to glass ionomer sealants
fluoride release, less need for stringent isolation longevity is a concern, more follow-up Ineffective as long term sealants for pit and fissures
76
Topical fluoride application and sealant bond
topical fluoride does not affect bonding of sealants
77
Sealants may be contraindicated when
Rampant caries Well coalesced pits and fissures When patient cannot cooperate
78
How long to etch for
20 mins - may be longer for for high fluoride or primary teeth lasers not as good as acid
79
Direct resin crowns -
use celluloid crown form to build up composite resin
80
Hypoplastic 1st molars that need immediate restoration
should be treated with bonded composite or GI build up to save tooth structure Not a SSC due to aggressive preparation
81
Alternative restoration treatment
Scoop out caries | fill with GI

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