Pedo Midterm Flashcards
According to Dr Berry, what are 5 advantages of a rubber dam?
- Improved management
- Improved workingconditions
- Aseptic field forpulp treatment
- Protect patient
- Increased efficiency
According to the textbook, what are five advantages of rubber dams?
- Saves time
- Aids management
- Controls saliva
- Provides protection
- Helps dentist educate parents
When is a slit dam indicated?
Primary dentition quadrant restoration and no pulp therapy indicated
If only one tooth requires work, is a slit dam indicated?
No. Just isolate that one tooth.
What should be done to the preselected tooth clamp?
Ligate with 18” piece of floss
8A and W8A are clamps indicated for what deciduous teeth?
Primary molars and smaller permanent first molars
Which clamp is indicated for partially erupted teeth and why?
W8A or 8A, jaws of clamp or oriented cervically
The 14A clamp is indicated for what teeth and their condition?
Permanent first or second molars not fully erupted
What is one disadvantage and one advantage of the slit dam technique?
Less isolation but easier to place
Is the clamp and dam placed as one unit in the slit dam technique?
Clamp first then dam and frame placed as one unit.
How is the dam prepared for the slit dam technique?
hole punched for most posterior tooth and most anterior tooth, then connect the 2 holes by cutting a slit
What tooth morphology helps hold the rubber dam in place?
cervical undercut on mesial of primary canine
What is done with the edges of the rubber dam to improve isolation?
Invert the edges
How is the wing clamp used differently than a non- winged clamp?
winged clamp placed on most posterior hole in the dam, clamp, dam & frame placed as a unit
What does the book say is indicated for Class I lesions?
Conservative caries excavation and restoration using combo of bonding restorative and sealant materials
Why is the proximal portion of a primary tooth Class II prep carried further buccally and lingually?
Broad flat contacts of primary molars
What is the most common mistake in the preparation of primary teeth?
over-extension
What is the treatment of choice in primary teeth when excessive tooth structure must be removed?
Stainless steel crown
What are 4 desirable characteristics of primary tooth preparations?
- Conservative
- Extended sufficiently to remove all carious tooth structure
- Adequate retention for resto material
- Uniform depth pulpal floor and slightly rounded
What is the benefit of composite resin &/or glass ionomer restorative material?
Thermal insulation to the pulp
What do proximal lesions in a preschool child indicate?
Excessive caries activity
What is one way to treat very small incipient lesions in conjunction with improved oral hygiene?
Topical fluoride therapy
For amalgam, what is indicated even if the occlusal surface is not cavitated?
Minimal occlusal dovetail for retention
For esthetic restorative materials (composite resin or glass ionomer) what is indicated if the occlusal surface is not cavitated?
Only do the proximal prep, then you can seal the occlusal (with or without enamelplasty)
What is the big deal with the anatomy of the Mandibular first primary molar and how it affects a cavity preparation?
It has an oblique ridge that should not be crossed making the Class I prep more mesially placed
What is a consideration when prepping a Primary mandibular second molar on a 7 year old?
Make sure you are prepping the primary tooth and not a permanent mandibular molar (#19 or #30)
What is indicated if the marginal ridge has been broken through by caries, is a Class II or a Stainless Steel Crown indicated?
Stainless steel crown
What is the ideal width of the isthmus or the Class II preparation?
1/3 intercuspal width?
How should the floor of the proximal box be designed in a pedo Class II preparation?
Slightly rounded buccal-lingually
What determines the bucco-lingual extent of the proximal box in Class II prep?
Amount of tooth in contact with adjacent tooth and the extent of carious lesion
What should be done with axio-pulpal line angle where the occlusal floor and proximal box meet?
Beveled
Which pulp horn is most easily hit in an occlusal preparation of a molar?
Mesial
What must be used to avoid overhangs in Class II?
Matrix is adapted to contours of the tooth and a wedge is utilized
What matrix band is popular in pedo as it is soft and easily adaptable to tooth contours and requires no extraoral apparatus (like a toffelmire)?
Condit’s T-band
What must be done once restoration is completed, dam apparatus removed, and occlusion is adjusted?
Warn patient and accompanying adult to avoid lip, cheek, and tongue injury due to chewing while anesthetized
What are 7 common errors in cavity preps?
- Fail to extend occlusal outline into susceptible pits and fissures
- Fail to follow outline of cusps
- Isthmus cut too wide
- Flair of proximal walls too great
- Angle formed by axial, B, L walls too great
- Gingival contact not broken
- Axial wall not conforming to the proximal contour of the tooth and the mesial-distal width of the gingival floor is too great
What is indicated when mandibular primary incisors have extensive caries?
Extraction
What is another way to treat interproximal caries (class III) on mandibular primary incisors?
Interproximal disked (???) and topical fluoride
What is frequent site of caries attack in patients at high risk for caries?
Distal surface of primary canine
What is the shape of a class III prep?
Triangular
Which way should the dovetail go in a Class III prep and why?
Gingival. Because primary incisal edge is thinner and would be more prone to fracture
What is indicated if the interproximal extension of a Class III gets extensive and undermines the incisal edge?
Convert to Class IV or do an anterior crown
What can be used as a matrix for Class III?
T bands or mylar matrix
What is indicated if the Class V caries extend into the proximal contacts in molars?
Stainless Steel Crowns
What is the name of Dr. Berry’s niece?
Rebekkah
What is the name of Dr. Berry’s dog?
Bentley McLovin
Which has better success rate, stainless steel crowns or direct restorations?
Stainless Steel Crown
What are 6 indications for Stainless Steel Crowns?
- Large lesions on primary teeth
- Rampant Caries
- Following pulp therapy (pulpectomy/pulpotomy)
- Teeth w/ developmental defects
- Fractured teeth
- Temporary restoration of young permanent teeth
On which tooth and why do large multi-surface lesions have a high direct restoration failure rate?
Primary Mandibular first molars. Funny shape does not retain restoration well
What are 7 indications for Stainless Steel Crown on posterior teeth?
- Primary or young permanent teeth w/ extensive caries
- Hypoplastic primary or permanent teeth not able to restore with a bonded restoration
- Hereditary anomalies (Dentinogenesis imperfect)
- Pulpotomy or pulpectomy restoration
- Fractured tooth
- Primary tooth to be an abutment for an appliance
- Habit breaking or ortho appliance attachment
What must you ask when considering restoring a primary tooth with a Stainless Steel Crown?
What is the length of time the child will keep tooth?
What restoration would be indicated for a General Anesthesia or Oral sedation with respect to a behavior problem child?
Stainless steel crown (to avoid restoring again)
What percentage of 2 surface amalgams needing replacement before age of 8?
70-71.4%
What percentage of Stainless Steel Crowns that require further treatment?
11-12.8%
From longest to shortest, put the relative restoration materials in order.
SSC (70%/5yrs) > Amalgam (60%/5 yrs) > Composite (40%/32 mos) > GI (4%/4 yrs)
What plier is used in the middle portion of the crown, usually on the buccal and lingual surfaces to contour the crown to the shape of the tooth?
Contour plier
What plier is used in the very bottom portion around the entire circumference of the crown to ensure better cervical adaptation?
Crimping pliers
What should be done first, the stainless steel crown prep or the caries excavation?
Crown prep first, then if any carious dentin remains it is excavated
What size crown should be selected to cover the prep?
The smallest crown that covers the prep
When prepping for a stainless steel crown, how far should you reduce the occlusal?
1.0-1.5 mm clearance from opposing while maintaining occlusal contours
When prepping for a stainless steel crown, what should be done before performing the proximal slices?
Pulpotomy (if indicated)
When prepping for a stainless steel crown, what are the dimensions of the proximal slices?
Near vertical carried gingivally breaking contact so an explorer can be passed freely b/w adjacent teeth making a feathered edge with no lip
What is the most important part of the preparation for a stainless steel crown?
Proximal reduction
What may prevent seating of the crown?
ledging
When prepping for a stainless steel crown, far must extend proximal slices and why?
Extend them below the gingival in order to avoid ledging.
Is there a buccal-lingual reduction on a stainless steel crown prep?
No, want to keep that anatomy to aide crown fit
What are the advantages of the 3M Ion Crown or ESPE Prefabricated SSC?
Trimmed and crimped to save time and accurately duplicate anatomy for better fit and function
When is a Unitek SSC indicated?
Significant space loss secondary to decay or the caries extend further gingivally than Ion crown covers
What are the characteristics of the Unitek stainless steel crown?
Flat axial surfaces requiring contouring Crown must be shortened and marginally adapted
What are the steps to fitting the stainless steel crown?
- Pick size
- Adjust crown length
- Adjust crown margin
- Contour
- Crimp
What is the procedure for seating the stainless steel crown?
Lingual to buccal due to primary tooth buccal bulge
What is an indicator that the crown may be to big or the margin is not accurately crimped?
Blanching of the tissue
When adjusting the crown length, how far should the crown to sit subgingivally?
1 mm below gingival crest
What does crown contouring do?
Reduces the circumference of the crown
What is the purpose of crimping?
Crimping ensures good cervical margin adaptation
How is crimping achieved?
Cervical 1-2 mm crown turned under to provide “snap” on seating
What are 2 common cements used in cementing crowns?
- Polycarboxylate
2. Glass ionomer
What can be used to aide seating crown?
Child biting on a stick
After seating the crown, what should be checked?
- Contact
- Occlusion
- Subgingival and interproximal excess cement
Does stainless steel occlusion have to be perfect?
No, primary molars adjust themselves quickly
What would be a common problem for crown not seating proximally?
Proximal ledging
What can be done with crown positioning if there is space loss?
Rotate crown slightly or use flate beaked pliers to flatten contact point to reduce M-D width
Do stainless steel crowns interfere with primary tooth exfoliation?
No, primary crown will come out with SSC
What is the years until tooth lost when a crown or alloy restoration not significantly different?
3 years
For what age and below are crowns significantly better?
5 years old
What are indications for Strip Crowns?
- Extensive or multisurfaced caries
- Congenitally malformed teeth
- Discolored teeth
- Fractured teeth
- Sufficient crown material remains after caries removal to retain resin
Do Strip crowns require a Buccal and Lingual reduction and why?
Yes, to allow room for composite
When a strip crown form is trimmed, where does the cervical margin extend?
Slightly below gingival crest
What are big risks for the strip crowns?
Staining and breaking
What is ART?
Atraumatic Restorative Treatment. To prevent pain and preserve teeth in individual w/o access to regular or conventional oral health care
What is the term for amputation of the coronal portion of the pulp?
Pulpotomy
What is the status of the pulp tissue that is left in the roots after the pulpotomy?
Vital
What is the thought behind leaving vital pulp tissue in the roots?
It allows roots to resorb as normal and exfoliate
During a pulpotomy, after unroofing and removing the coronal pulp from the tooth, what is done next?
Control bleeding
What are 3 pulpal medicaments that can be used after bleeding is controlled and before tooth is restored?
Formocresol, Ferric Sulfate, MTA
How long should it take to control bleeding for a pulpotomy to be successful?
3-5 minutes
How should everything appear for a pulpotomy to be indicated?
Blood is red and normal and canal tissue appears normal
How is formocresol used?
Placed on pulp stumps for 5 min then covered with zinc oxide eugenol paste (IRM) and restored with a stainless steel crown
What are 5 effects of formocresol?
- Bactericidal effect
- Devitalizing effect
- Converts bacteria and pulp to inert compounds
- Inactivates oxidative enzymes in pulp
- Makes pulp inert and resistant to enzymated breakdown
What is Ferric Sulfate used for?
Control bleeding (15 sec) then cover pulp w/ zinc oxide eugenol and restore
What are 4 requirements of a successful pulpotomy?
- Eliminate infection in tooth
- Tooth preserved in healthy, non-pathogenic condition
- Arch space maintained
- Normal resorption of primary tooth and eruption of permanent successor
What is the term for removal of the tissue from the coronal pulp chamber and the root canals?
Pulpectomy
When does calcification of primary teeth begin?
~3.5-4 months in utero
What is the general eruption of the primary teeth?
Primary teeth erupt in typical sequence starting ~6-7mos(mand central) and ending at 26 months (max 2nd molar)
Which dentition shows more variability, primary or permanent?
Permanent
What are 2 things primary occlusion adapts to?
- Skeletal growth
2. Occlusal wear
Which teeth have more proprioception, primary or permanent?
Permanent
Of the 3 planes of growth of the mouth, which is the first to stop: A-P, Vertical, Transverse?
Transverse (~12 y.o)
Of the 3 planes of growth in the mouth, which is the 2nd plane of growth to stop growing: A-P, Vertical, Transverse?
Vertical
Which plane of life continues throughout life?
Anterior-Posterior
Who are more advanced at all stages of dental calcification and development, girls or boys?
Girls
Teeth do no begin to move occlusally until when?
Crown form is completed
Are caries genetic?
No
What largely determines tooth size?
Genetics
Which are rarer: supernumerary teeth or congenitally missing teeth?
Supernumerary teeth
Supernumerary teeth are more common in males or females?
Males
Dental arch width changes are timed more to dental development or skeletal growth?
Dental development
When does dental arch circumference decrease?
During late transitional and early permanent dentition
Why does dental arch circumference diminish as we get our permanent teeth?
Because the leeway space between C,D,E is taken up as 3,4,5, which are wider than their predecessors erupt into that space
What is the most important baby tooth and why?
Primary 2nd molars (AJ & KT, or the E’s in the Palmar notation). Distal Surface of primary 2nd molars determine initial permanent molar (3,14,19,30) occlusion
What can happen if the E’s (Primary Second Molars) are lost early?
Permanent 1st molars will tip mesially and block out permanent 2nd bicuspids
What is the tooth that shows the greatest variability in development?
3rd molars
What is the sequence for Primary teeth calcification and times?
A Dorky Boy Can Eat (Palmer notation) A (14 wks) [centrals] D (15 wks) [1st molar] B (16 wks) [laterals] C (17 wks) [cuspids] E (19 wks) [2nd molar]
When do A,D,B initiate calcification?
6 wks
When do C,E initiate calcification?
7 & 8 wks respectively
In what order do the cusps of the posterior teeth calcify?
MB, ML, DB, DL
My Big Mother Likes Dry Biscuits During Lunch
How many calcification centers does an anterior tooth have?
One
When does the first permanent molar begin calcification?
At birth
What is Piscitelli’s Rule of 3’s?
Ffind out when calcification ends, add 3 years for eruption, then 3 years for root closure in permanent
When do primary teeth roots complete?
18 mos post eruption
When do permanent teeth roots complete?
3 years post eruption
By 12 months, an average child has how many teeth?
6-8
Which is more important: the timing of the eruption or the sequence of eruption?
Sequence because it helps determine tooth position in the arch
Why does Early Childhood Caries characteristically affect A, B, D, but skip the C’s (Palmer notation)?
A,B,D erupt before C so they are exposed longer to insults
What is the common appearance for an erupting tooth (especially centrals and max 2nd molar) but requires no intervention?
Eruption hematoma
Premature teeth erupt prior to what age?
3 months
What is the term for teeth present at birth?
Natal Teeth
What is the term for teeth present within first 30 days of life?
Neonatal teeth
hich are more common, Natal or neonatal?
Natal 3:1 more common
What is a consideration for Natal and neonatal teeth?
90% are true primary teeth so try to preserve them if possible
Are natal/neonatal teeth well formed and what is an associated finding?
Not well formed, can be mobile due to poor root formation. Riga-fede disease (ventral tongue trauma from suckling)
What are 2 syndromes that can have natal/neonatal teeth?
- Chondroectodermal dysplasia (Ellis-van Creveld)
2. Cleft Lip and Palate
What are 3 structures in the newborn that can be confused for natal/neonatal teeth?
- Dental Lamina cysts
- Bohn’s nodules
- Epstein’s pearls
What are cysts found on the crest of baby’s alveolar ridge that can be confused for natal/neonatal teeth?
Dental Lamina Cysts
What is the term for cysts found on the buccal and lingual aspects of ridge and palate (away from midline raphe) that can be confused for natal/neonatal teeth?
Bohn’s Nodules (Bohn’s Buccal)
What is the term for cysts found on the midline palatal raphe that can be confused for natal/neonatal teeth?
Epstein’s Pearls (Pearls Palate)
What is the Baume classification based on?
Space between anteriors
What does Baume Type I entail?
Spaced anteriors
What does Baume Type II entail?
No space between anteriors
What are the wide spaces mesial to the maxillary canines and distal to the mandibular canines?
Primate space
What is the primate space important for?
Bicuspid eruption
What goes into the primate space of the opposing arch in primary occlusion?
Primary cuspid tips go into the primate space of the opposing arch
The total interdental spacing between primary teeth ________ (decreases/increases) continually with age?
Decreases due to loss of Leeway space
Primary dentition Angle Classes of occlusion can be measured how?
Primary molar terminal plane
Flush Terminal plane indicates what?
The distal surface of the maxillary and mandibular 2nd molars are in line (most likely becomes Angle Class I)
Mesial Terminal Plane or Mesial Step means what?
Distal of Max Molar is distal to the distal of the mand molar (if draw staircase down from distal of Max molar to the distal of the Mand Molar, the step would point mesial)(Most likely becomes Angle Class I)
Distal Terminal Plane or Distal Step means what?
Distal of Max Molar is mesial to distal of Mand Molar (if drew staircase down from distal of Max molar to distal of Mand molar the step would go distal)(Most likely becomes Angle Class II)
Piscitelli says what Terminal Plane is most common (60%)?
Mesial Step
Most common tooth to get Turner’s tooth and why?
2nd premolar because E was sick
How do 1st perm molars erupt?
MandIbular erupt mesial and rotate distal into occlusion guided by distal of mandibular E, maxillary erupt distal and swing mesial into occlusion stopped by distal Max E
If the E (Palmer notation) is missing what 2 things will happen to the erupting permanent 1st molar?
Will Tip mesial . anytime there is tipping there is extrusion
What is the angle of primary incisors and their overbite/overjet?
Upright with little overbite or overjet
Permanent incisors angled how?
Labial angulation w/ overbite and overjet
What is the Leeway space of Nance?
Combined M-D width of deciduous canines and molars (C,D,E) differ from those of permanent canines and molars
How much Leeway space per each side maxillary arch and total Leeway Space of Nance for Maxilla?
- 9mm/half arch
1. 8 mm total Leeway Maxillary Arch
How much Leeway space per each side mandibular arch and total Leeway Space of Nance for Mandible?
- 7 mm/ half arch
3. 4 mm total Leeway Mandibular Arch
What are 2 things that close primate space?
Eruption permanent incisors
Eruption permanent molars
Why does the intercanine width change with the eruption of the mandibular incisors?
Mand canines move distal into their primate space increasing slightly their intercanine width
If incisors erupt lingual to their deciduous predecessors, should anything be done, and what natural force will help push them into occlusion?
Don’t do anything. Tongue will push permanents labially
What is a way to determine if a canine will be impacted?
If cuspid overlaps lateral on the radiograph, 80% chance cuspid will be impacted (b/c it is supposed to guide into place along distal root surface of lateral)
If a patient has primate space and a flush terminal plane, what angle class will the permanent molar erupt into and how?
The eruptive force of permanent mandibular molar forces mandibular space closes allowing for Class I = Early Mesial Shift
How does a permanent molar get into Class I occlusion if there is no primate space and the primary occlusion was Flush Terminal Plane?
Late Mesial Shift = done when the E exfoliates from the mandible before the maxilla allowing that permanent first to move mesial to Class I
What are the width changes that occur between 6-13 years as the child goes from primary to mixed dentition to early permanent dentition?
- Intercanine width increases
2. Interarch width decreases
If there is a problem in the initiation of a tooth, what will be the clinical manifestation?
Problems in tooth number (Hyper/hypodontia)
If there is a problem in the proliferation of a tooth, what can be the clinical manifestation?
Problems in tooth number, size, proportion (Gemination/twinning)
Morphodifferentiation problems give what clinical manifestations?
Size and Shape problems
Histodifferentiation problems give what clinical manifestations?
Problems of enamel (Amelogenesis imperfect) and dentin (dentinogenesis imperfect)
Mineralization and Maturation problems occur when during development and manifest how?
Post eruptive, some A.I., fluorosis, localized hypomineralization, interglobular dentin
If you are missing the primary tooth, will you have the permanent tooth?
No
List in order starting with most common, the teeth often found missing.
3rd Molars > Mand 2nd PM > Max Laterals > Max 2nd PM
What is the most commonly missing tooth in the permanent dentition?
Maxillary laterals
What are the most frequent microdonts?
Peg laterals > 2nd PM > 3rd molars
Hyperdontia, Hypodontia, Anodontia are problems associated with what histopathology : Initiation, Proliferation, Morphodifferentiation, Apposition?
Initiation and Proliferation
Microdontia, macrodontia, conjoined teeth are problems associated with what histopathology : Initiation, Proliferation, Morphodifferentiation, Apposition?
Proliferation and Morphodifferentitation
Enamel hypoplasia, dentinal dysplasia, hypercementosis, enamel pearls are problems associated with what histopathology : Initiation, Proliferation, Morphodifferentiation, Apposition?
Apposition
Dens in dente/Dens invaginitis, Dens evaginitis/Talon cusp, Taurodontism, Dilaceration are problems associated with what histopathology : Initiation, Proliferation, Morphodifferentiation, Apposition?
Morphodifferentiation
What type of developmental defect has a single pulp, split crown, will result in the mouth having a greater than usual number of clinical crowns and is more common in primary teeth?
Gemination
What is a single bud with supernumerary image and 2 separate crowns?
Twinning
What type of developmental defect has 2 separate pulp chambers, but clinically have correct # clinical crowns and is more common in primary teeth?
Fusion
What is the term for fusion that occurs after root formation is completed?
Concrescence
What is a congential anomaly that frequently has delayed toot eruption?
Trisomy 21 (Down Syndrome)
What are oral characteristics of Trisomy 21?
Smaller max and mand causing protruding tongue, dental crowding, higher rate gingivitis, lower caries rate
What is a congenital syndrome with mandibular prognathism caused by increased mandibular length and short cranial bases, delayed development of dentition (sometimes primary dentition at age 15), presence of supernumerary teeth. And they can touch their shoulders in front of them?
Cleidocranial dysplasia
Deficient thyroid gland function will cause early or delayed tooth eruption?
Delayed (hypothyroid = Cretinism)
Deficient pituitary gland function will cause early or delayed tooth eruption?
Delayed (hypopituitary = low growth hormone)
Would a pituitary dwarf or an achondroplastic dwarf have a crowded arch?
Achondroplastic dwarf
What should you do if you see a dental anomaly in one area of the dentition?
Look for it elsewhere
What is an abortive attempt by a single tooth bud to divide. One bud, one tooth, one root canal?
Gemination
What is a union of normally discrete teeth. Two teeth, Dentin Union, separate root canals
Fusion
What is the term for fusion of two teeth along the root surface. Two teeth, Cementum union, separate root canals?
Concresence
Gemination occurs during what stage of tooth growth cycle and which set of teeth is it more common in?
- Proliferation
2. Primary dentition
What will be the crown morphology of a tooth that fused late in tooth development?
One tooth almost 2x normal size or tooth withbifid crown
What is the term for Complete cleavage of a tooth bud resulting in the formation of a supernumerary tooth?
Twinning
What is the term for elongation of the pulp at the expense of the root. Body of the tooth is enlarged while the roots are reduced in size. Increase pulp exposure risk for cavity prep?
Taurodontism
Dens in Dente/Dens Invaginatus/Tooth within a tooth is verified how?
Radiograph
Dens in dente most common in what tooth?
Permanent maxillary lateral incisor
What is a clinical indicator of Dens in dente?
Deep lingual pits on maxillary permanent lateral incisor
What is the treatment for Dens in dente?
Seal or restore the invagination
What non-genetic things can cause anomalies of structure and texture of tooth?
insults during tooth formation
Autosomal dominant incomplete penetrance trait more common in permanent dentition with a higher frequency in Asians, deaf and blind, but missing third molars is not considered this (instead considered variant of normal)?
Hypodontia
What is seen more in primary dentition: hypodontia/hyperdontia or germination/fusion?
germination/fusion
What is the frequency of missing teeth (other than 3rd molars)?
Mand 2nd PM 33%
Max Lat Inc 27%
Max 2nd PM 15%
Mand Lat Inc 12%
What is an autosomal recessive syndrome with polydactyl, short stature and cardiac anomalies, that has missing teeth (Hypodontia)?
Chondroectodermal dysplasia (Ellis-vanCreveld syndrome)
What is an autosomal dominant syndrome with missing maxillary incisors (hypdontia) and degeneration of the anterior chamber of the eye?
Rieger Syndrome
What is a syndrome that can be X-linked or autosomal recessive presenting with nose anomalies (either long or broad nasal tip and long nasal philtrum), cleft lip and palate, digital anomalies, and missing teeth (Hypodontia)?
Oro-facial digital syndrome
In Ectodermal dysplasia, what are the 4 most commonly affected tissues?
Hair (Tricodysplasia)
Teeth (Hypodontia)
Nails (Onchodysplasia)
Sweat glands(dyshydrosis)
To reach a diagnosis of ectodermal dysplasia, one of what three conditions must be met?
2 or more ectodermal tissues involved (hair, teeth, nails, skin/sweat glands)
Genetic diagnosis
1st degree affected relative
What are some common oral findings with ectodermal dysplasia?
Multiple missing or all teeth missing Conical, peg shaped teeth, esp Canine/incisor Lack of alveolar process development
What is an oral treatment for hypodontia and/or altered teeth of ectodermal dysplasia?
Denture for the child
What are the most common permanent teeth in ectodermal dysplasia?
Total 4-14 teeth, more in the maxilla. Maxillary Central, maxillary canines, Max and mand 1st molars commonly present
What syndromes are associated with Hypodontia?
Can Robert Order Hummus? Chondroectodermal dysplasia/Ellis van Creveld Rieger syndrome
Orofacial digital syndrome
Hypohidrotic Ectodermal Dysplasia
What is the genetics for Hypohidrotic Ectodermal Dsyplasia?
X-linked recessive
Is hyperdontia more common in males or females?
Males
What is the most common supernumerary tooth?
Maxillary anterior mesiodens
What is the most common way to get Hyperdontia?
Autosomal dominant with lack of penetrance
What is an autosomal dominant syndrome with multiple odontomas (Hyperdontia), malignant intestinal polyps?
Gardner’s syndrome
What is an autosomal dominant syndrome of variable expression presenting with Hyperdontia, hypoplastic clavicles, and acorn shaped skull?
Cleidocranial dysplasia
Is cleft lip and palate due to straight genetics?
No. Multifactorial inheritance: genetics and environment
Where are extra teeth most common in Cleft Lip and Palate and why?
In area of bony sutures due to splintering of developing tooth bud
What are 3 syndromes associated with Hyperdontia?
Girls Can Clean Gardner’s Syndrome
Cleidocranial Dysplasia Cleft Lip and palate
What are 3 broad categories of Amelogenesis Imperfecta?
Hypoplastic
Hypocalcified
Hypomature
The defective tooth structure in Amelogenesis Imperfecta is limited to what?
enamel
What is the enamel type and tooth appearance of Hypoplastic Amelogenesis Imperfecta?
- Hard thin enamel
2. Small teeth, occasionally tapered (think diastemas)
What is the problem with the enamel in Hypoplastic Amelogenesis Imperfecta?
Enamel matrix imperfectly formed, but is calcified
What is the enamel type and tooth appearance of Hypocalcified Amelogenesis Imperfecta?
Normal thickness enamel but soft & abrades easily Pitted surface
Moth eaten radiograph
What is the problem with the enamel in Hypocalcified Amelogenesis Imperfecta?
Matrix normal thickness but calcification deficient making enamel soft
What is the enamel type and tooth appearance of Hypomature Amelogenesis Imperfecta?
Soft enamel of normal thickness
Fractures and flakes easily
Can’t tell enamel from dentin on radiographs
What is the only distinguishing difference between Hypocalcified and Hypomature Amelogenesis Imperfecta?
Radiograph
Hypocalcified = moth eaten
Hypomature = no diff b/w dentin and enamel
What is the A.I. type that is X-linked dominant?
Hypoplastic A.I.
What is the A.I. type that is X-linked recessive?
Hypomature A.I.
What are 3 types of Dentinogenesis Imperfecta?
Type I
TypeII
Type III
This Dentinogenesis Imperfecta type always occurs with Osteogenesis Imperfecta?
Type I
If pt has osteogenesis imperfect does that mean they will have D.I.?
No
Which dentition is more severly affected in Type I D.I.?
Primary
This D.I. type never occurs with O.I. and is also called Hereditary Opalescent Dentin?
Type II
This D.I. type is found in racial isolates in Maryland.
Type III or Brandywine type
Type III D.I. has what radiographic appearance?
Shell teeth
Normal dentin formation is confined to a thin layer next to enamel and cementum, followed by a layer of disorderly dentin containing few tubules. The roots are short and the primary teeth may exfoliate
Shell teeth
What is major difference in pt’s clinical appearance between Type I and type II D.I.?
Type I has characteristics of O.I. (Blue sclera, presenile deafness, acorn skull, growth deficiency)
What is the tooth difference in Type I and type II D.I.?
Type II affects both primary and permanent dentition equally while type I affects primary dentition more severly
What is the basic dentinogenesis Imperfecta clinical appearance in primary dentition?
Primary or permanent teeth reddish brown to gray opalescent. Primary enamel breaks off and dentin abrades easily giving a polished dentin surface
What is the basic Dentinogenesis Imperfecta radiographic appearance?
Slender roots
Bulbous crowns
Pulp chamber small or entirely absent Multiple root fractures, especially in older pts
Does Hereditary Opalescent Dentin (type II D.I.) show high penetrance in a family?
Yes
What is a viable treatment option in Type II D.I.?
Implants b/c bone is good (no osteogenesis imperfect as in type I)
What are 2 types of Dentin dysplasia?
Radicular/Type I Coronal/ Type II
What dentition is affected in Radicular Dentin dysplasia (Type I)?
Primary and permanent
Where is the usual appearance of radicular Dentin Dysplasia (type I)
Short pointed roots
Absent pulp or chevron shaped pulp in crown
Clinical crown appearance in Radicular Dentin Dysplasia (type I)
Normal size and shape
What dentition is affected in Coronal dentin dysplasia (type II)?
Primary. Permanent appears normal
What other genetic disorder does Coronal dentin dysplasia (type II) resemble?
- Dentinogenesis Imperfecta
- Opalescent primary dentition and obliterated
pulp chambers
What is the characteristic shape of a pulp chamber of Coronal Dentin dysplasia (Type II)?
Thistle tube
What is the most common inherited abnormality of renal tubular transport?
Hypophosphatemia/ Vit D resistant rickettsia
What and when is the clinical appearance of hypophosphatemia/ Vit D resistant rickettsia?
2nd year life, short stature and bowing of legs in boys (X linked dominant)
What gender is hypophosphatemia more common in?
Girls twice a likely as boys
What tooth problem associated with hypophosphatemia/ Vit D resistant rickettsia?
Large pulp chambers and pulpal extensions to the enamel in primary and permanent teeth
What would be clinical clue for hypophosphatemia/ Vit D resistant rickettsia?
Spontaneous tooth abscess
What is a localized arrest of tooth development with unknown cause giving rise to only outline of crown being evident and called Ghost Teeth?
Regional odontodysplasia
Does Regional Odontodysplasia cross the midline?
No, usually limits to a quadrant
If a tooth looks submerged below occlusal plane, suspect that it is?
Ankylosed
What is the most common tooth ankylosed?
Mand primary molars or traumatized permanent incisors
What is a spicule of bone overlying erupting permanent molar that requires no treatment?
Eruption sequestration
What is usually found on the maxillary molar furcation and requires no treatment, but can contribute to periodontitis?
Enamel pearl
What conditions are associated with apposition problem?
Dentinal dysplasia (Type I and II) Regional Odontodysplasia Enamel pearl Compound Odontoma Complex odontoma Hypercementosis
What conditions are associated with histodifferentiation problems?
Dentinogenesis Imperfecta Type I and II
An anyklosed tooth would be associated with what problem type?
Eruption
Premature teeth would be associated with what problem type?
Proliferation
When would extraction versus disking of premature tooth be indicated?
Extract if loose and worried about aspiration
Disk if sound and want to treat or avoid Riga-Fede
Hypoplastic A.I. is associated with what problem type?
Histodifferentiation
Hypomature A.I is associated with what problem type?
Apposition
Hypocalcified A.I is associated with what problem type?
Calcification
What is apposition?
Result of layer like deposition of nonvital extracellular secretion in the form of a tissue matrix by odontoblasts/ameloblasts
Histodifferentiation and Morphodifferentiation occur at what stage of tooth development?
Bell Stage: differentiation dental papilla cells to odontoblasts and IEE cells to ameloblasts
A deficiency in initiation (Bud Stage) or Proliferation (Cap Stage) will result in what number of teeth?
Hypodontia
What are 4 things a dental team must assess?
- Developmental level
- Dental attitudes
- Temperament
- Predict child’s reaction to treatment
What term implies a sequential unfolding that may involve changes in size, shape, function, structure or skill?
Development
What is the term for a child’s total physical growth and efficiency from the moment of conception until adulthood?
Physical development
What is the most frequent pediatric behavior seen, treated with straightforward tell-show-do (TSD)
Cooperation
What is the label given to a child that does not have the ability to cooperate or communicate either due to age, or a specific mental, physical, or emotional problem
Lacking cooperative ability
What is the label given to a child that has the ability to communicate and cooperate and whose uncooperative behavior can be modified?
Potentially cooperative ability
What is another term for a child lacking cooperative ability when indicating that the child’s young age precludes them from cooperation?
Pre-cooperative
What is a nonspecific feeling of apprehension, worry, uneasiness or dread whose source may be unknown?
Anxiety
What is a feeling of fright or dread related to an identifiable source?
Fear
What is any persistent and irrational fear of something specific, such as and object or situation?
Phobia
When did a majority of reported dental anxiety (50.9%) occur?
Childhood onset related to direct experience
What are 4 causes of dental fear and dental behavior management problems?
- General emotional status
- Parental dental fears
- Previous dental treatment
- Experiences of Pain
What are 4 cultural variables affecting child’s behavior?
- Society standards
- Community standards
- Family standards
- Parenting styles
Do all fearful children also present as a behavior management problem?
No, only minority of BMP children are fearful
What is the key to decision of parent being in the operatory?
It is controversial, but either way make policy clear to parent before treatment
If parent is to be in the operatory, they should be told they are expected to act as what?
Silent observers
All decisions regarding behavior must be based on what?
Risk vs benefit
Who shares in the decision making process regarding treatment?
Parents must be informed and get consent
What is the difference between consent and assent?
Consent implies understanding and voluntary accordance while assent is to give in or acquiesce
What is the best way to attain informed consent and truly make the parent feel informed : forms and videos or oral presentation of the information?
Oral presentation
What are 2 types of defensive mechanisms?
- Active (childlike)
2. Passive (adultlike)
What is the concept of acceptable behavior?
I have no idea. I think this was a typo.
What behavior control increases the possibility of a particular behavior occurring?
Positive reinforcement
Should reinforcement be immediate or delayed?
Immediate
What is meant by avoiding a power struggle and what should be the nature of the choices given?
Give choices so child feels in control, but only choices they are not allowed to say no to. E.g ask if they want to brush their teeth or have you brush their teeth. Either way, a toothbrush is going in their mouth.
Do not give a child a choice if….?
You can’t live with the answer
What are 3 types of basic behavior techniques?
- Tell Show Do (TSD)
- Nitrous Oxide sedation
- Voice control
What are 5 types of advanced behavior techniques?
- Passive restraint
- Hand over mouth
- Oral premdication
- Active restraint
- General anesthesia
Does voice control have to be yelling?
No it could be a whisper but the goal is to get attention and establish authority
When would voice control be contraindicated?
When child can’t understand or cooperate
Why do Tell Show Do?
Teach patient and shape response through desensitization
What is an example of Nonverbal communication with Behavior management?
Walk in happy
Motivational interviewing has what type of listening?
Active or reflective listening
What is most acceptable behavior management accepted by parents?
Tell-show-do
What is the most acceptable way to evaluate and record a child’s behavior?
Frankl Behavioral Rating Scale
What is a shortcoming of the Frankl scale?
Does not communicate sufficient clinical info on uncooperation E.g, “-“ is not as good as “-, tears”
Frankl rating 4 (++)
Definitely positive
Frankl rating 3 (+)
Positive. Cautious but compliant.
Frankl rating 2 (-)
Negative. Reluctant, uncooperative, some negative attitude
Frankl rating 1 ( - - )
Definitely Negative. Refusal, crying, fearful
What is the purpose of the written and oral functional inquiry?
Learn about patient and parent concerns and gather info to estimate cooperation of child
What are some examples of Tell Show Do and innocuous language?
Rubber Dam Clamp = tooth ring Rubber dam = raincoat Nitrous = happy gas or flavored air Local anesthesia = Mr. Bubbles Sealant = Paint Etch = Blue Shampoo
What are 6 fundamentals of behavior guidance?
- Positive approach
- Team attitude
- Organization
- Truthfulness
- Tolerance
- Flexibility
What is the term for caries activity in any primary tooth in a child younger than 6 yrs old having a distinctive pattern, with many teeth affected and the caries developing rapidly?
Early Childhood Caries
What is the typical pattern for ECC?
Maxillary anterior teeth, Max and mand first primary molars, sometimes mandibular canines
What is the definition of ECC from the book?
The presence of one or more decayed (non-cavitated or cavitated), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months or younger or children younger than 3 yrs any sign of smooth surface caries indicates Severe-ECC
What primary teeth are usually not affected by ECC?
Mandibular incisors
Dental Caries is what type of disease and what does it require?
Infectious disease
Susceptible host/tooth
Cariogenic Microflora
Carbohydrate source Exposure time
What cycle does the dynamic disease process of dental caries follow?
Demineralization in low pH and remineralization in high pH
Which has better evidence for oral health promotion: health education, Motivational interviewing, MI paste vaccinations?
Motivational interviewing
What are methods to increase the Oral Health Literacy of identified at risk families for Early Childhood Caries?
Communicate w/o using dental jargon
No more than 3 new concepts/visit
Use demonstration aides
Have pt repeat back instructions in own words
What are risk factors for Early childhood Caries?
Frequent fermentable carb consumption Poor oral hygiene Lack of fluoride Low socio-economic status & cultural factors Enamel defects Chronic medical condition
Why is fluoride important for caries prevention?
inhibits bacterial metabolism
Inhibits demineralization
Enhances remineralization
What is a low birth weight baby and what does it do for ECC risk?
Less than 1500g, 3.3 lbs. Hypoplastic enamel ismore susceptible to caries
What are some ECC risks for special needs children?
May require frequent feeding
May have aversion to oral care
Delayed motor skills
Meds
What are things to look for in ECC risk assessment?
Visible plaque Early tooth eruption (0-6 mos) Visible decay/ white spot lesions/ enamel hypoplasia I nappropriate feeding habits Increased sugar intake Lack of fluoride Xerostomia (e.g. Asthma meds) Caregiver or sibling with decay
Knee to knee exam indicated for children up to what age?
0-3 years
What is a brief counseling approach that focuses on the skills needed to motivate others?
Motivational interviewing
Provides a framework for prevention that goes beyond caries to address all aspects of children’s oral health according to developmental milestones?
Anticipatory guidance
What should be told to parents about why baby teeth matter?
function, esthetics, maintain space for permanent teeth, no missed school due to tooth pain, positive self image
Is there any evidence that teething is associated with fever and/or diarrhea?
No
If patient presents with anterior open bite from non-nutritive sucking, when is intervention indicated?
When permanent central incisors erupt
Anterior open bite can self-correct before what age?
4 years old
When does non-nutritive sucking start?
29th week of gestation
What age is the highest risk for dental trauma?
2-5 years old
What is brushing guidance for a child under 2 years old?
Clean teeth with cloth or soft toothbrush 1x day, no toothpaste
What is brushing guidance for a 2-5 year old?
Brush with pea size fluoride toothpaste, caregiver performs
What is brushing guidance for a child over the age of 6?
Brush with fluoridated toothpaste 2xday, caregiver performs or supervises
When should flossing start?
When teeth begin to touch
What are the requirements for an acceptable child dentifrices?
Contain fluoride
Low abrasion
ADA acceptance seal
How long should patients brush?
1 minute
What are the toothbrush specifications for a child?
- Soft bristles
- Small head
- Thicker handle
Where does demineralization normally occur and why?
along gingival margin b/c that’s where plaque accumulates
How is fluoride antibacterial?
Concentrates in plaque and disrupts enzyme systems
How does fluoride help systemically?
Improves enamel crystallintiy, reduces acid solubility
What does fluoride do in the Demin/Remin cycle?
Inhibits demineralization, promotes remineralization
What is the Ideal amount of fluoride in water?
1 mg/L
What are 4 sources of fluoride?
- Water
- Diet
- Casual ingestion of dentifrices
- Prescribed supplements
If a child 6m<3 yrs gets less than 0.3ppm Fluoride, what should their supplement be?
0.25
Is a prophy required before placing a fluoride varnish?
No
If rubber cup prophylaxis completed what must follow?
Fluoride application
What is the benefit of topical fluoride varnish?
Eliminates risk of toxicity that exists w/ traditional fluoride treatments. Can be put on infants and young children
What are instructions following fluoride varnish application?
Soft, non-abrasive diet for rest of day, don’t brush teeth until tomorrow, alright to drink water right away
When is the prenatal period and how long does it last?
Conception to birth, 40 weeks
What is the time span of infancy?
1st 2 years of life
A birth is considered premature when it occurs before which week of pregnancy?
36 weeks
How long does “childhood” last for girls? Boys?
Girls: 2 to 10
Boys: 2 to 12
How long does adolescence last for girls? Boys?
Females: 10-18 yrs Males: 12-20 yrs
What is the term for a proportionate change in size or number?
Growth
What is the term for Increasing complexity and development (behavioral and physical)?
Development
What is the term for Changes in height, weight, sensory capacity and motor development?
Physical development (e.g. crawling to walking)
What is the term for a wide range of mental abilities-learning, language, memory, reasoning and thinking?
Intellectual development
What is another term for our feelings: how we deal with situations and the way we get along with other people?
Personality and Social Development
What is the term for split growth where body parts grow at own rate and reach maturity independently but in coordinated fashion?
Asynchronous growth
What growth pattern do we have?
Cephalocaudal growth- head growth first, then growth moves down body
What are some factors affecting growth?
Genetics (biggest factor) Sex Race Maternal size Socioeconomic status Nutrition Endocrine
What is the name of the curve that shows not all tissues grow at the same rate and its shape?
Scammon curve, S-shaped
What are 2 periods of rapid growth in humans?
infancy, early childhood, adolescent spurt (i realize there are three things listed here. oh well)
Neural tissue completes at what early age?
6-7 yrs
Which tissue decreases with age?
Lymphoid
Multiple births result in what for successive children?
Smaller infant weight and increased premature delivery
What is a pronounced deceleration of the growth of bones and soft tissues of the body that results from deficiency of this hormone and from what structure is it released?
Growth hormone from pituitary gland
Can the growth deficiencies associated with limited growth hormone from pituitary problems be corrected?
Yes with hormone replacement therapy
What will insufficient levels of thyroid hormone result in?
Mental deficiency and dwarfism
What is a measure by which individual accumulates organized knowledge and the use of that knowledge to solve problems and modify behavior?
Cognition
What is true of cognitive development?
All children move through in same order, no stages are skipped, rate at which move through stages varies
Does age alone indicate development level?
No
Birth to 3 month child would show what communication?
Recognize voice, vary cry to indicate needs
A 4-6 month old child would show what type of communication?
Move eyes toward sound, babbles p,b,m
7 month – 1yr child communication
Peekaboo, 1-2 words by 1st birthday
1-2 yr old child communication
Follow simple commands, put 2 words together
2-3 yr old child communication
Follow 2 requests, use f,g,t,d,n sounds
What age is a child that answers simple questions and can use sentences with 4 or more words?
3-4 year old
What is the age of a child that pays attention to a short story and answers simple questions, communicates easily with other children and adults?
4-5 year old child
What are the Myers Brigg testing categories for 2/3 of children temperament?
Easy child
Difficult child
Slow to warm up child
Do all kids fit into the Myers Brigg temperament patterns?
No, 1/3 do not
What is different in fear of a 4-6 year old versus a 10-12 yrs?
4-6 year old fears an ugly person while a 10-12 year old child fears bodily harm
What are 2 ways to prevent or treat fears?
- systemic desensitization (gradually expose to fearful object)
- Modeling (observe fearlessness in others)
What is the cause of Trisomy 21 (Down Syndrome)?
3 #21 chromosomes
What are 2 common sicknesses in Down Syndrome patient?
Frequent conjunctivitis
Frequent upper respiratory infections (can have increased prevalence of periodontal disease )
What are 2 reasons not to extract a natal/neonatal tooth?
- Actually a primary tooth (85-90%)
2. If it is a supernumerary tooth, it can leave a sinus tract down to the developing tooth bud
What is the difference between natal and neonatal teeth?
Natal present at birth, while neonatal erupt withing 1st 30 days
What are 3 names for similar structures that are commonly mistaken for neonatal/natal teeth?
Bohn’s nodules, Dental Lamina cysts, Epstein pearls
What is the term for displacement or malposition of erupting tooth?
Ectopic eruption
What is the most common cause of ectopic eruption?
Crowding
What is the most common ectopically erupted tooth?
Maxillary 1st molar
In what demographic are ectopic eruption more prevalent?
Patient with cleft lip/palate
Do the majority of ectopic eruptions self correct, and what are the factors?
Yes, 60-70%, if pt <7yrs old dentally and if locked in only by the enamel or dentin of the adjacent tooth
What are 4 times when an ectopic molar would not self correct?
- Child > 7 yrs old
- Permanent molar locked in PULP of primary 2nd molar,
- Severe mesial angulation of permanent molar (>3mm)
- 2nd primary molar mobile
What is the treatment if the 1st permanent molar is partially erupted but locked in enamel or dentin of distal Primary 2nd molar (E)?
Disk distal of E (will lose some leeway space)
Ortho separator to unlock “6” (Palmer)
Halterman appliance
What is a Halterman appliance?
Band and distalizer on E, w/ button bonded on occlusal of “6” as mesial as possible
Ectopic eruption of Permanent Lateral incisor causing early exfoliation of primary canine can cause what?
Midline shift to affected side and no room for permanent canine to erupt into
What is the treatment for ectopic eruption of Permanent lateral incisor?
Extract contralateral primary canine to balance midline, put in lower lingual holding arch (LLHA) to stop lingual tilt incisors, ortho and possible serial extractions
If ectopic eruption of mandibular permanent centrals lingual to primaries, what is indicated?
Let primaries exfoliate, if not out by 8-8.5 yrs old, EXT the primary mandibular centrals
If ectopic eruption of Max permanent central incisors lingual to primaries, what is indicated?
Extract primary central incisors ASAP to prevent anterior crossbite.
How do permanent canines tend to erupt in relation to over-retained primary canines?
Erupt facially (high & outside primary canines)
How do premolars tend to erupt in relation to over-retained primary molars?
Inferiorly and facially to primary molars
Tooth eruption is keyed to what?
Root development
Permanent incisors erupt when how much of root is complete?
1⁄2 or more of root developed
Permanent canines and premolars erupt when how much of root is complete?
2/3 of root developed
Is the impetus of tooth eruption known?
No
What is the definition of over-retained primary tooth?
Permanent tooth on one side erupted and contralateral primary tooth not replaced w/in 6 months
What are 3 causes of delayed eruption of permanent teeth?
Trauma leading to primary tooth infection Pathology (mesiodens) Syndromes (Down, Cleidocrancial dysplasia)
Treatment for (over)retained primary tooth and when must go in and get it?
Extract retained. If permanent not erupted in 6-12 months, expose surgically and get it down with ortho
What is the term for fusion of tooth to bone that can happen at any time during tooth eruption caused by a localized obliteration of the PDL, can be fibrous or bony, and can be all along root or just a point?
Ankylosis
What does an ankylosed tooth look like clinically?
Looks submerged
Ankylosis of primary teeth usually a result of what?
Trauma, luxation or reimplantation of avulsed tooth
What is the most common primary tooth to ankylose?
Mandibular primary 1st molar
Will the ankylosed primary tooth exfoliate normally?
Yes
What is a consideration with an ankylosed primary mandibular molar?
Space loss if crown is below contact area of adjacent teeth
What are treatment options for primary ankylosed tooth?
Luxate to break the ankylosis
Bonded resin build ups
Extract and space maintenance
What is the most common impacted tooth after 3rd molars?
Maxillary canines
What is the criteria for high probability of maxillary canine impaction (80%)?
If permanent canine overlaps pulp of permanent lateral incisor on panoramic of mixed dentition
What is the treatment if see an overlapping canine over lateral on the pan?
Extract primary canines
What is the key to treatment/prevention of impacted maxillary canines?
Early diagnosis via Panoramic radiograph while repeating Dr Carter’s mantra “No Rads to the Gnads.”
What should you wait on before doing a Frenectomy?
Delay until permanent incisors and canines have erupted
When is a Frenectomy done in conjunction with ortho: before or after?
After ortho to see if still necessary once the ortho has closed the diastema
Abnormal maxillary frenum can cause what?
Diastema
What is the technical term for tongue tied?
Ankyloglossia
Indicaitons for Frenectomy to relieve Ankyloglossia?
Pull on lingual attached gingival (can lead to Perio)
Speech difficulties
Feeding difficulties
Pain
What is a general rule for early or late exfoliation of primary teeth and the eruption of their successors?
The earlier you take out the primary tooth, the later the permanent tooth will come in and vice versa
If lose primary molar 5 or younger (usually lose between 9-12 years) what will be the eruption of the corresponding premolar?
Delayed
What is the most important factor in digit/pacifier sucking habits and their affect on anterior open bite?
Duration
What are the 3 overal factors influencing the anterior openbite associated with pacifier/digit sucking habits?
- Duration
- Frequency
- Intensity
What all happens orally with a sucking habit?
- Anterior open bite
- Palate constricts causing posterior crossbite
- Severe overjet
What is the cutoff age for cessation of sucking habit and ability of body to self-correct orally, IF THE OPEN BITE IS NOT SKELETAL?
4 yrs old or younger
What is key to successful cessation of sucking habit?
Child must want to stop
Only use positive reinforcement
What are the purpose of habit appliances?
Only as reminders
What is treatment for sucking habit 0-4 yr old?
Parent pulls thumb/pacifier out after child asleep
What is treatment for sucking habit in 5-8 yr old?
Positive reinforcement/appliance therapy
What is treatment for sucking habit over 8 yr old?
Appliance therapy/ortho
What are 2 reminder appliances for habit cessation?
Bluegrass
Tongue Crib
What do Bluegrass and crib appliance do?
decrease satisfaction by keeping thumb/pacifier from getting all the way in mouth. Also keep tongue back to allow lips to push overjett lingually.
