Pedo Final Flashcards
What are the strengths and advantages to the main resin restoration materials?
Glass ionomers may be considered pharmacologically therapeutic because they release fluoride over time; they also have minimal shrinkage during setting. Composite resins possess durability and superior esthetic qualities. When managed properly, both materials are capable of providing superior marginal sealing at the tooth– restorative material interface.
Verbal communication with younger children is best initiated with complimentary comments, followed by questions that elicit an answer other than “yes” or “no.” True or False?
True
Behavioral goals for most children include:
A. Leaning back in the chair
B. Legs out straight
C. Hands on their tummy
D. Counting teeth
E. All of the above
E
What are the instructions for sedation procedures regarding changes in health?
- It is important to notify the office of the developement of a cold, cough, fever, or any illness within 14 days before the sedation appointment. For your child’s safety, the sedation may need to be rescheduled.
What is mild mental retardation?
Also called educable. It is the largest group of retardation and comprises 85% of people with mental retardation. They develop social and communciation skills in the preschool years and can grow to live succesfully in the community as adults.
What is a “get to know me” form?
A form to fill out for a special needs patient (not for everyone). It is a guide to each child with autism.
What are the main activity instructions before a sedation procedure?
- Plan the child’s sleep and awakening times to encourage the usual amount of sleep the day before the sedation appointment
- Please arrive on time for your scheduled appointment.
- The legal guardian must accompany the child to the sedation appointment
- A second responsible adult must join you and your child at the time of discharge. This enables one adult to drive the car while the other focuses on the child.
- Make sure your child uses the restroom before the sedation.
How does tell-show-do differ from behavior shaping?
- As well as demanding the reinforcement of cooperative behavior, behavior shaping also includes the need to retrace steps if misbehavior occurs. For example, if a child is shown an instrument and looks away, the dentist must revert to the explanatory portion of the procedure. Behavior shaping requires that the “desired behavior” be observed along the way.
What should you expect from children with autism or special needs as they grow up?
That they’ll progress behaviorally and do better in your office
What are the main activity instructions after the sedation procedure?
- Your child may take a long nap. He/she may sleep from 3 to 8 hours and may be drowsy and irritable for up to 24 hours after the sedation. When asleep, you should be able to awaken him/her easily.
- Your child may be unsteady when walking or crawling and will need support to protect him/her from injury. An adult must be with the child at all times until the child has returned to his/her usualy state of alertness.
- Closely supervise any activity for the remainder of the day.
What is the Frankl behavioral rating scale?
- Definitely negative
- Negative
- Positive
- Definitively positive
Can be used shorthand, with –, -, +, ++
When are glass ionomer selants most often indicated?
- Glass ionomer may be useful as a sealant material in deeply fissured primary molars that are difficult to isolate due to the child’s precooperative behavior and in partially erupted permanent molars that the clinician believes are at risk for developing decay. In such cases, glass ionomer materials must be considered a provisional sealant to be reevaluated and probably replaced with resinbased sealants when better isolation is possible. Because questions exist regarding the strength and retention of glass ionomer, further long term research is necessary before it is recommended as a routine pit and fissure sealant material.
What two behaviors together usually predict success for simple operative treatment?
A. Sitting in mom’s lap for the exam
B. Performing a normal exam in the dental chair
C. Taking bite wing x-rays
D. B and C only
E. None of the above
D
What are some key points from the “care of your child after sedation” form?
- “today your child had dental treatment under conscious sedation”
- Children respond to sedation in their own way
- They won’t be able to walk, so carry or wheelchair
- Child should not ride bikes, play outside, handle sharp objects, work with tools, climb stairs, until they are back to normal for at least 1 hour
- Keep child home from school or daycare after treatment and possibly the next day if still drowsy or can’t walk, should be back to normal within 24 hours
- Begin giving clear liquids like juices, water, popsicles or broth. If child does not vomit after 30 minutes, you may continue with solid foods
- Reasons to call the doctor include: you can’t arouse your child, child is unable to eat or drink, child has pain or vomiting, child develops a rash.
According to the literature, what percent of pediatric patients reported dental fear/anxiety?
9%. Girls more so than boys. And dental fear was closely associated with temperamental traits such as shyness, inhibition, and negative emotionality, and behavioral problems were associated with activity and impulsivity.
Treating adults involves a one-to-one relationship and treating a child involves a one-to-two relationship. True or False?
True
Which phosphoric acid concentrations are recommended for sealants? And for how long?
- 30% to 50%. 20 seconds.
- Enamel rich with fluorhydroxyapatite may be resistant to etching and may need to be exposed for longer periods. Primary teeth may also sometimes be resistant to etching and may require a longer etching time.
- Dentin bonding agents can be helpful when isolation is not feasible or on buccal surfaces of molars which have lower retention rates.
What are the eight recommendations of the AAPD regarding the support for sealant use?
- Bonded resin sealants, placed by appropriately trained dental personnel, are safe, effective, and underused in preventing pit and fissure caries on atrisk surfaces. Effectiveness is increased with good technique and appropriate followup and resealing as necessary.
- Sealant benefit is increased by placement on surfaces judged to be at high risk or surfaces that already exhibit incipient carious lesions. Placing sealant over minimalenamel caries has been shown to be effective at inhibiting lesion progression. As with all dental treatment, appropriate followup care is recommended.
- The best evaluation of risk is made by an experienced clinician using indicators of tooth morphology, clinical diagnostics, past caries history, past fluoride history, and present oral hygiene.
- Caries risk, and therefore potential sealant benefit, may exist in any tooth with a pit or fissure, at any age, including primary teeth of children and permanent teeth of children and adults.
- Sealant placement methods should include careful cleaning of the pits and fissures without removal of any appreciable enamel. Some circumstances may indicate use of a minimal enameloplasty technique.
- Placement of a low-viscosity, hydrophilic material bonding layer as part of or under the actual sealant has been shown to enhance the long-term retention and effectiveness.
- Glass ionomer materials have been shown to be ineffective as pit and fissure sealants but can be used as transitional sealants.
- The profession must be alert to new preventive methods effective against pit and fissure caries. These may include changes in dental materials or technology.
What color are sealants?
- Sealant materials may be transparent or opaque. Opaque materials are available in tooth color or white. Transparent sealants are clear, pink, or amber. The clear and toothcolored sealants are esthetic but are difficult to detect at recall examinations. Recent advances in sealant technology include lightactivated coloring agents that allow for color change during and/or after polymerization. These compositional changes do not affect the sealant, but only offer some arguable benefit in the recognition of sealed surfaces.
What is severe mental retardation?
About 3 to 4 % are in this. As adults, they can perform simple talks in a specific setting.
Chemicallly cured sealants exhibit a smaller chance of incorporating air bubbles than do light-cured sealants. True or False?
False, mixing is required which can screw it up.
What are some steps of the D-termined program by Tesini?
A. Do treatment no matter what the cost
B. Divide the skill
C. Drill the skill
D. Drill and fill at the first appointment
E. B & C only
E
What things should you keep the same at each appointment?
A. Same assistant
B. Same doctor
C. Same routine
D. Change things up, kids do well with change
E. A, B, & C only
E
What are the six requisites of sedation?
- Through knowledge of agent used
- Carefully planned & documented rational for use of drug
- Evaluate patient for contraindications
- Informed consent
- Office must be adequate: equipment to manage emergencies, trained in monitoring, ACLS or PALS trained
- Mobil emergency medical services available
A child’s coordination cannot be judged by physical size. True or False?
True
Sealants may be able to help arrest incipient caries, but sealants should not be placed over deeper caries. True or False?
True
What is an ASA class III child?
- A patient with severe systemic disease (a child who is actively wheezing)
Children under age 3 generally:
A. Can sit in the dental chair alone
B. Can take bite wing x rays
C. Are easily treated in the dental office
D. Want to sit in mom’s lap
E. None of the above
D
What are 3 keys to success when working with children?
- Speed
- Excellent distraction
- Excellent pain control
When you are not sure how to treat a child, what should you do?
A. Treat them like your own child
B. Maximize revenue for the office
C. Get the treatment done no matter what the cost
D. Do treatment you are not qualified to do
E. None of the above
A. Treat them like your own child
What are the developmental changes of a five year old?
- Undergoes a period of consolidation, deliberate
- Takes pride in possessions
- Relinquishes comfort objects such as a blanket or thumb
- Plays cooperatively with peers
What should the SCC prep on primary molars look like?
- A local anesthetic should be administered and a rubber dam placed as for other restorative procedures. The proximal surfaces are reduced using a No. 69L bur at high speed ( Fig. 1820 (f20) ). Care must be taken not to damage adjacent tooth surfaces during the proximal reductions. A wooden wedge may be placed tightly between the surface being reduced and the adjacent surface to provide a slight separation between the teeth for better access. Nearvertical reductions are made on the proximal surfaces and carried gingivally until the contact with the adjacent tooth is broken and an explorer can be passed freely between the prepared tooth and the adjacent tooth. The gingival margin of the preparation on the proximal surface should be a smooth feathered edge with no ledge or shoulder present. The cusps and the occlusal portion of the tooth may then be reduced with a No. 69L bur revolving at high speed. The general contour of the occlusal surface is followed, and approximately 1 mm of clearance with the opposing teeth is required.
- It is usually not necessary to reduce the buccal or lingual surfaces; in fact, it is desirable to have an undercut on these surfaces to aid in the retention of the contoured crown. In some cases, however, it may be necessary to reduce the distinct buccal bulge, particularly on the first primary molar.
Resin-modified glass ionomer restorations placed in box-only preparations were more likely to show adhesive failure than those placed in dovetail preparations. True or False?
True
How do you establish yourself as a strong communicator with the patients?
- Help parents step back & hear one voice, the Dr.’s
- Simple, clear message
- Voice control and tone (stern talk)
- Multisensory communication
- Problem ownership
- Active listening
- Appropriate responses
What are the developmental changes of a two year old?
- Geared to gross motor skills, running, jumping
- Likes to see and touch
- Very attached to parent
- Plays alone, rarely shares
- Has limited vocabulary
- Becoming interested in self-help skills
What is an ASA class II child?
- A patient with mild systemic disease (controlled reactive airway disease)
What are the best ways to clean pits and fissures prior to etching and sealant placement?
- Acid etching completely removes the enamel pellicle, and a dental prophylaxis (even with a dental explorer) does not increase the retention of sealants. From a practical standpoint, in cases of poor oral hygiene, fissure cleansing with a rotating dry bristle brush may be beneficial.
- Pope and colleagues found that the use of a quarter round bur produced the greatest penetration of the sealant into etched enamel in laboratory studies. The use of an aluminum oxide air abrasion system allows sealant penetration greater than that achievable by use of pumice or a dry bristle brush alone.
- Teeth prepared with the bur exhibited the least microleakage. The amount of microleakage in the conventional and air abrasion groups was about equal.
What are the main two reasons why we have so many dietary restrictions for sedation patients?
- First, emesis during or immediately after a sedative procedure is a potential complication that can result in aspiration of stomach contents leading to laryngospasm or severe airway obstruction. Aspiration may even present difficulties later in the form of aspiration pneumonia. At the very least, it creates an unfavorable disruption of the office routine.
- Second, because most sedative agents are administered by the oral route, drug uptake is maximized when the stomach is empty.
It is important that communication with young patients occur from multiple sources while in the dental chair. True or False?
False, just the dentist.
What are the main six office/dental team strategies to manage behavior of parents and kids?
- Pre appointment behavior guidance
- Positive approach
- Organization-flow in office
- Truthfulness-under promise/over deliver
- Tolerance
- Flexibility
What can you do to reduce anxiety at the patient’s first appointment?
A. Do treatment at the first appointment
B. Take a tour of the office on the website prior to the appointment
C. Do not use the D-termined program
D. A & C only
E. None of the above
B
