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PEDO pt 2 Flashcards

1
Q

a basic rule in space management in the developing dentition is that eruption of anterior teeth should be reasonably symmetrical. why?

A

asymmetry in exfoliation may lead to significant midline deviations

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2
Q

in the primary dentitions, what appliances are indicated for space maintenance for first primary molars? second primary molars? incisors?

A
  • first primary molars: band and loop space maintainer for unilateral and bilateral loss
  • second primary molars: distal shoe or acrylic partial
  • incisors: consider esthetics and speech; use fixed or removable appliance
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3
Q

in the mixed dentition, what appliances are indicated for space maintenance for primary mandibular canines? first primary molars? second primary molars?

A
  • primary mandibular canines: lower lingual holding arch
  • first primary molars: band and loop space maintainer unilateral, or palatal holding arch bilateral
  • second primary molars: palatal holding arch for unilateral and bilateral loss
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4
Q

T or F:

loss of a primary incisor in the primary dentition usually causes loss of overall arch circumference

A
  • false
  • generally does not cause loss of overall arch circumference
  • might result in localized space loss, especially if there was no interdental primary spacing before the loss
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5
Q

replacement of lost primary incisors is considered more for ___ than for space maintenance

A

esthetics and possibly development of speech

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6
Q

describe removable partial dentures for loss of primary teeth

A
  • posterior adams clasps, C clasps, or ball clasps are placed for retention
  • patient is usually at least 3 years old, and it is determined after consultation with parents that there is a reasonable expectation that the pt will tolerate wearing the appliance
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7
Q

describe fixed partial dentures for loss of primary teeth

A
  • orthodontic bands on second primary molars
  • 0.036-0.040 inch stainless steel wire
  • replacement teeth are fixed to the wire
  • appliance is intended mostly for patients younger than 3 years old or if questionable compliance in wearing a removable appliance
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8
Q

lateral ectopic eruption of permanent incisors is characterized by early exfoliation of ___

A
  • a primary lateral incisor
  • often results in a midline deviation
  • treatment of choice is extraction of remaining lateral so as to minimize a midline deviation
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9
Q

localized space loss can occur very quickly after loss of a permanent tooth. what is the treatment for space maintenance?

A
  • an appliance should be constructed and inserted as soon as possible after tooth loss
  • a removable appliance with fingers springs, or fixed orthodontics
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10
Q

unilateral primary canine loss usually causes what?

A
  • lingual collapse of permanent incisors
  • loss of arch length
  • increased overbite - after lingual collapse, the mandibular incisors erupt further, increasing overbite
  • increased overjet secondary to lingual collapse of mandibular incisors
  • midline deviation to the side of canine loss
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11
Q

bilateral primary canine loss usually causes what?

A
  • lingual collapse of permanent incisors
  • loss of arch length
  • increased overbite - after lingual collapse, the mandibular incisors erupt further, increasing overbite
  • increased overjet secondary to lingual collapse of mandibular incisors
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12
Q

what appliance should be used for bilateral canine loss in the mixed dentition?

A

lower lingual holding arch

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13
Q

what are the treatment options for unilateral canine loss in the mixed dentition?

A
  • extract contralateral primary canine and place lower lingual holding arch
  • lower lingual holding arch with a spur if a midline deviation has not occurred (prevents distal drift)
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14
Q

what are the treatment options for unilateral and bilateral primary first molar loss in the primary dentition? what appliance should you avoid?

A
  • band and loop space maintainer for unilateral and bilateral
  • do not use lower lingual holding arch until permanent incisors are erupted (incisors typically erupt lingually and can get trapped by the appliance)
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15
Q

what are the treatment options for unilateral and bilateral primary first molar loss in the mixed dentition?

A
  • unilateral: band and loop

- bilateral: lower lingual holding arch or palatal holding arch, or nance appliance

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16
Q

what size stainless steel wire is used to fabricate a distal shoe space maintainer?

A

0.040 inch

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17
Q

acrylic partial dentures might be indicated for patients what what medical conditions (these conditions contraindicate a distal shoe space maintainer)?

A
  • blood dyscrasia
  • congenital heart defect
  • immunosuppression
  • diabetes
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18
Q

most “kiddie” partial dentures are fabricated such that the acrylic is positioned mesial to the soft tissue contour of what tooth?

A

first permanent molar (this allows for the unimpeded eruption of the first permanent molar)

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19
Q

unilateral loss of a second primary molar in the mixed dentition usually requires what appliance?

A

bilateral holding arch

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20
Q

what are the appropriate appliance choices for bilateral tooth loss?

A
  • lingual holding arch
  • palatal holding arch
  • nance holding arch
  • removable appliance
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21
Q

what are the factors you should consider in planning for space maintenance in terms of the amount of resorption of primary roots?

A
  • if more than 1/4 of the root remains owing to normal resorption, space maintenance is likely necessary
  • if less than 1/4 of the root remains and if there is no bone left between the primary tooth and permanent tooth, space maintenance is likely unnecessary
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22
Q

when planning for space maintenance, if there is no bone remaining between the primary molar and permanent premolar and if the cusp tip of the permanent tooth is radiographically at the level of the furcation, is space maintenance necessary?

A

no

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23
Q

if bone is interposed between the primary molar and the permanent premolar, is space maintenance necessary?

A

yes, it is usually indicated

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24
Q

if there is bone destruction in the region of the primary molar furcation, it is possible that the permanent tooth may erupt very early, with less than ___ root completion. however, it is also possible that bone will ___

A
  • 3/4

- form again (covering the permanent tooth)

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25
Q

describe the implications of not using a space maintainer

A
  • most space closure occurs within the first 6 months, and can even occur in days
  • if the prediction of eruption of the permanent tooth is difficult, the dentist should use a space maintainer
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26
Q

in the molar area, closure occurs essentially by ___, not ___ movement of the tooth

A
  • tipping

- bodily

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27
Q

T or F:

active eruption of a neighboring tooth tends to decrease the amount of space loss

A

false, it tends to increase the amount of space loss

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28
Q

are chronologic age and average eruption times important factors in planning space maintenance?

A
  • no

- it is more important to consider things like root development of erupting teeth

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29
Q

what is the “rule of 7” for primary molars?

A
  • eruption is delayed if loss of the primary molar occurs before age 7
  • eruption is accelerated if loss of the primary molar occurs after age 7
  • this does not mean that space maintenance is not needed after age 7
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30
Q

first permanent molars may become impacted under the distal aspect of the second primary molar. which arch is this more common in?

A

maxillary

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31
Q

what is the treatment for an ectopic permanent molar that has become impacted under the distal aspect of the second primary molar?

A
  • varies in severity; if mild, it might self correct
  • treatment can include an orthodontic separator, titanium clip separator, brass ligature wire, humphrey appliance, or nance appliance and open coil spring
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32
Q

distal eruption of premolars is most common in which premolars?

A

mandibular second premolars

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33
Q

in cases where a permanent premolar erupts in a distal direction, it typically resorbs the distal root of the second primary molar but not the mesial root, requiring extraction of the primary molar. is space maintenance necessary?

A

yes, unless the cusp tip of the premolar is at the level of the floor of the pulp chamber of the primary molar and if, on extraction, the permanent tooth can be visualized

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34
Q

is buccal or lingual eruption of permanent premolars common?

A

yes

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35
Q

what is the treatment of choice for the buccal or lingual eruption of a permanent premolar?

A
  • if the primary molar is not ready to exfoliate within a few weeks, extraction of the primary molar is the treatment of choice
  • after extraction, the permanent premolar tends to move into the correct position as long as there is adequate space
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36
Q

what is the incidence of akylosed primary molars?

A
  • occurs in 1% of african americans and 4% of whites
  • has a familial pattern
  • higher prevalence with congenitally absent premolars
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37
Q

ankylosis of primary molars usually begins after ___ begins

A

root resorption

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38
Q

how can an ankylosed primary molar be diagnosed?

A
  • appearance (out of occlusion)
  • no mobility, even with advanced resorption
  • hollow sound when tapped
  • perhaps seen on radiograph (break in periodontal membrane)
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39
Q

what is the treatment for an ankylosed tooth?

A
  • possibly no treatment
  • observe for space loss and tipping of adjacent teeth
  • if ankylosed tooth is below the normal height of contour of the interproximal surface of the adjacent tooth, extract and consider space maintenance
  • as a temporary treatment, a SSC or composite bonding has been used to extend the existence of the ankylosed tooth
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40
Q

what is the incidence of congenitally absent teeth (excluding 3rd molars)?

A

1.5-10%

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41
Q

if third molars are not included, the most common congenitally missing tooth is the ___, followed by the ___, followed by the ___

A
  • mandibular second premolar
  • lateral incisor
  • maxillary second premolar
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42
Q

is gingivitis common in children?

A

yes, and is treated with improved oral hygiene

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43
Q

for children with gingivitis, parental participation in oral hygiene is necessary in children younger than ___ because of the child’s lack of manual dexterity

A
  • 8 years old

- parental supervision is often necessary for older children

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44
Q

what is puberty gingivitis?

A
  • prepubertal and pubertal period

- characterized by enlarged, bulbous interproximal gingival tissue on the labial aspects of the anterior teeth

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45
Q

what is the treatment for puberty gingivitis?

A

improvement in oral hygiene, removal of local irritants, and nutritional counseling

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46
Q

what are some common conditions in children that can aggravate gingivitis?

A

mouth breathing, crowded teeth, erupting teeth, and braces

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47
Q

what are the three types of herpes simplex infections that occur in children?

A
  • primary herpetic gingivostomatitis
  • acute herpetic gingivostomatitis
  • recurrent herpes simplex (cold sore or fever blister)
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48
Q

what is the etiology of primary herpetic gingivostomatitis?

A

herpes simplex virus type 1

49
Q

describe primary herpetic gingivostomatitis

A
  • usually affects children younger than 6
  • no previous exposure
  • most primary infections are subclinical
50
Q

what are the symptoms of acute herpetic gingivostomatitis?

A
  • liquid-filled yellow or white vesicles intraorally and periorally that rupture
  • ruptured vesicles are 1-3mm in diameter with a pseudomembrane and have erythematous borders
  • fever, malaise, lymphadenopathy
  • duration is 10-14 days
51
Q

where are acute herpetic gingivostomatitis lesions located?

A

mucous membrane, including tonsils, hard and soft palates, buccal mucosa, tongue, palate, and gingiva

52
Q

what is the treatment for acute herpetic gingivostomatitis?

A
  • topical anesthetics such as 0.55 dyclonine hydrochloride and viscous lidocaine
  • coating solutions such as diphenhydramine elixir and kaolin-pectin compound
  • topical acyclovir or penicyclovir
  • analgesics such as acetaminophen and ibuprofen
53
Q

where does recurrent herpes simplex usually occur?

A

outside of the lips

54
Q

how are recurrent herpes simplex lesions treated? what is recurrence usually associated with?

A
  • systemic or topical antiviral medications

- recurrence frequently associated with emotional stress or local physical trauma

55
Q

the etiology of recurrent aphthous ulcer is ___

A

unknown

56
Q

describe recurrent aphthous ulcers

A
  • painful oval ulceration on unattached mucous membrane

- minor aphthae heal in 7-10 days

57
Q

what is the treatment for recurrent aphthous ulcers?

A

topical antiinflammatory and analgesic agents

58
Q

what is the most common cause of inadequate attached gingiva?

A
  • labial eruption path
  • other causes may be a high frenum attachment, high vestibule, self inflicted injury, trauma, and use of smokeless tobacco
59
Q

what is the treatment for inadequate attached gingiva?

A
  • sometimes orthodontic treatment can cause some increase of attached gingiva
  • free gingival graft is the common treatment
60
Q

in the absence of recession, treatment of a heavy maxillary frenum with diastema is delayed until which teeth have erupted?

A
  • permanent cuspids
  • if the midline diastema has not closed, orthodontic closure is accomplished first, and a frenectomy is performed afterward
61
Q

a patient is considered to have restricted tongue movement if the tongue cannot touch the ___

A

maxillary alveolar process

62
Q

what can lingual frenums cause?

A
  • children may be unable to develop proper speech sounds and surgery may be indicated in conjunction with speech therapy
  • lingual frenum may also cause recession
63
Q

a high mandibular anterior frenum may be associated with ___

A

gingival recession

64
Q

what is the treatment for a mandibular anterior frenum?

A

frenectomy and gingival graft

65
Q

what types of periodontal disease can occur in children?

A

aggressive periodontitis (localized aggressive periodontitis in the permanent dentition, localized aggressive periodontitis in the primary dentition, and generalized aggressive periodontitis)

66
Q

what is characteristic of localized aggressive periodontitis in the permanent dentition?

A
  • previously known as localized juvenile periodontitis
  • loss of attachment and bone on first permanent molars and permanent incisors
  • rapid loss of attachment
67
Q

in localized aggressive periodontitis in the permanent dentition, there is an increased bacterial count of ___

A

aggregatibacter (actinobacillus) actinomycetemcomitans

68
Q

localized aggressive periodontitis in the permanent and primary dentition is most common in what population?

A

african americans

69
Q

how is localized aggressive periodontitis in the permanent dentition treated?

A

surgical intervention and antibiotics (metronidazole with or without amoxicillin, tetracycline)

70
Q

describe the characteristics and treatment of generalized aggressive periodontitis in children

A
  • involvement of the entire dentition
  • significantly increased amount of plaque and calculus
  • treatment includes surgical intervention and antibiotics
71
Q

describe the characteristics of localized aggressive periodontitis in the primary dentition

A
  • previously known as localized prepubertal periodontitis

- most common in the primary molar area

72
Q

what is the treatment of localized aggressive periodontitis in the primary dentition?

A

debridement and antibiotics

73
Q

what are the characteristics of acute necrotizing ulcerative gingivitis?

A
  • painful, bleeding gingival tissues
  • blunting of interproximal papillae
  • pseudomembrane on the marginal gingiva
  • fetid breath
  • high fever
74
Q

acute necrotizing ulcerative gingivitis is caused by what bacteria? what population is it most common?

A
  • caused by fusiform bacilli (spirochetes) and other anaerobes
  • most common in teenagers and young adults
75
Q

what is the treatment for acute necrotizing ulcerative gingivitis?

A

responds well to debridement, oxidizing mouth rinses, and antibiotics

76
Q

trauma to the primary dentition occurs in ___% of children. trauma to the permanent dentition occurs in ___% of children by age 14

A
  • 30%

- 22%

77
Q

what are the possible reactions of a tooth to trauma?

A
  • pulpal hyperemia
  • internal hemorrhage
  • calcific metamorphosis (pulp canal obliteration)
  • peripheral root resorption
  • pulpal necrosis
  • ankylosis
78
Q

what can pulpal hyperemia lead to?

A

may lead to infarction and necrosis as a result of increased intrapulpal pressure

79
Q

describe internal hemorrhage

A
  • capillary rupture secondary to increased pressure
  • occurs within 2-3 weeks after trauma
  • may cause discoloration
80
Q

describe calcific metamorphosis (pulp canal obliteration)

A
  • partial obliteration of the pulp chamber and canal
  • these teeth normally remain vital
  • yellow, opaque appearance
81
Q

describe internal resorption

A
  • caused by osteoclastic action

- “pink spot” perforation may occur

82
Q

-describe peripheral root resorption

A
  • caused by damage of periodontal structures
  • usually occurs in severe injuries with displacement of the tooth
  • types: surface (normal PDL, small areas), replacement (ankylosis), and inflammatory (granulation tissue, radiolucency)
83
Q

describe pulpal necrosis

A
  • caused by severing of apical vessels or prolonged hyperemia and strangulation
  • may not occur for several months
84
Q

describe ankylosis

A
  • can occur with PDL injury, which leads to inflammation and osteoclastic activity (may cause fusion between and root surface)
  • clinically, occlusal or incisal surface of ankylosed tooth is gingival to adjacent teeth
  • during growth, eruption of normal teeth continues, but because ankylosed teeth are osseointegrated, these teeth appear to be sinking into the gingival tissue
85
Q

what are the consequences to permanent teeth with injury to the primary predecessor?

A
  • hypocalcification and hypoplasia
  • reparative dentin
  • dilaceration
86
Q

when evaluating a trauma case, what should you do for a child who has not had tetanus coverage?

A

antitoxin (tetanus immune human globlulin)

87
Q

when evaluating a trauma case, what should you do for children with previous tetanus coverage that is dated?

A

toxoid booster

88
Q

when evaluating a trauma case, what is the protocol for active tetanus immunization?

A
  • 3 injections of diphtheria, pertussis, and tetanus (DPT) vaccine during first year
  • booster at 1.5 and 3 years
  • booster at 6 years and then every 4-5 years
89
Q

typically, radiographs are indicated at what intervals after traumatic injury?

A

1, 2, and 6 months intervals (general follow up assessments are accomplished at these visits as well)

90
Q

what is the treatment for concussion and subluxation of primary and permanent teeth?

A
  • usually no treatment is immediately necessary
  • recommend soft diet
  • reinforce need for good oral hygiene
  • 0.12% chlorhexidine gluconate oral rinse or 3% hydrogen peroxide to aid healing
  • teeth with open apices are more likely to remain vital
91
Q

what is the treatment for intruded primary teeth?

A
  • the root of the primary tooth is likely positioned closely to the labial of the permanent incisor
  • the intruded tooth is usually left alone unless it can be determined that it is impinging on the permanent successor
  • teeth should be reviewed and radiographs should be obtained
92
Q

what is the treatment for extruded primary teeth?

A
  • if a primary incisor is extruded greater than 3mm, the tooth should be extracted
  • if the pt is seen before formation of a periapical blood clot, the tooth may be repositioned carefully and splinted for 7-14 days, and endo treatment should be initiated
93
Q

what is the treatment for an avulsed primary tooth?

A
  • replantation can be considered if within 30 minutes of avulsion, but prognosis is poor
  • splint if necessary
  • soft diet
  • antibiotics
  • follow with primary endo and space maintainer
94
Q

what is the treatment for an avulsed permanent tooth?

A
  • replantation
  • antibiotics: not susceptible to tetracycline staining (doxycycline 4.4 mg/kg/day q12h on day 1, 2.2-4.4 mg/kg/day for 7 days), susceptible to tetracycline staining (penicillin V 25-50 mg/kg/day in three to four divided doses for 7-10 days)
  • endodontic treatment
95
Q

how are root fractures of primary teeth treated?

A
  • if the root fracture is in the apical half, splinting may be unnecessary, especially if there is minimal mobility
  • if the root fracture is in the coronal half with increased mobility, either a rigid splint or extraction is the treatment of choice
96
Q

are root fractures in primary teeth common?

A

no, they are rare owing to the bone surrounding the teeth at that age being more malleable

97
Q

describe splinting for reimplantation and displacement trauma

A
  • nonrigid splint
  • bond 0.016inch x 0.022inch SS ortho wire or 0.018 inch round SS wire or monofilament nylon (20-30lb test)
  • 0.028inch round SS if 3-4 teeth are mobile
  • titanium trauma splint
  • wire must be passive
  • use composite or flowable
  • splint should remain for 7-14 days
98
Q

what does long term rigid splinting of replanted teeth increase the risk of?

A

replacement root resorption (ankylosis)

99
Q

what is the systemic fluoride “rule of 6”?

A
  • if fluoride level is greater than 0.6ppm, no supplemental systemic fluoride is indicated
  • if the pt is less than 6 months old, no supplemental systemic fluoride is indicated
  • if the pt is more than 16 years old, no supplemental systemic fluoride is indicated
100
Q

traditionally, intervention for digit-sucking habits is indicated at age ___ if the child has not stopped the habit

A

5 or 6 years old

101
Q

what are the 3 appliance types used for digit-sucking intervention?

A
  • removable maxillary retainer with rounded SS wire loops placed in the anterior palate region
  • fixed reminder appliance in which a SS crib is placed in the anterior palate region
  • “bluegrass” appliance, which is a fixed appliance that features a six sided plastic roller in the anterior palate region
102
Q

what are symptoms associated with teething?

A

increased temperature, drooling, diarrhea, dehydration, and loss of appetite

103
Q

what are some ways teething symptoms can be reduced?

A
  • chilled teething rings

- topical anesthetic and nonaspirin analgesics

104
Q

___ teeth are teeth that are present at birth. ___ teeth are teeth that erupt in the first 30 days.

A
  • natal

- neonatal

105
Q

most natal and neonatal teeth are what kinds of teeth?

A

90% are primary teeth, 10% are supernumerary teeth, and most are mandibular incisors (85%)

106
Q

what is the treatment for natal or neonatal teeth that are supernumerary teeth?

A

extraction

107
Q

what is the treatment for natal or neonatal teeth that are primary?

A
  • extraction if they are extremely mobile and there is danger of aspiration
  • if the tooth is causing ulceration on the ventral side of the tongue (riga-fede disease), the tooth may be smoothed or extracted
  • if the tooth is causing nursing difficulties, a breast pulp or smoothing or extraction may be recommended
108
Q

according to the american academy of pediatric dentistry, ___ is defined as the presence of more than one decayed (noncavitated or cavitated), missing (owing to decay), or filled tooth surface in any primary tooth in a child younger than 6 years old

A

early childhood caries

109
Q

how is severe early childhood caries diagnosed at different ages?

A
  • any sign of smooth surface decay in a child younger than 3
  • one or more cavitated, missing (owing to caries), or filled smooth surface in primary maxillary anterior teeth in ages 3-5
  • DMFS score greater than 4 for age 3
  • DMFS score greater than 5 for age 4
  • DMFS score greater than 6 for age 5
110
Q

what is a DMFS score?

A

decayed, missing (owing to caries), and filled score

111
Q

what is moyer’s mixed dentition analysis?

A
  • use the combined mesiodistal widths of the mandibular permanent incisors to predict the combined mesiodistal widths of the patient’s buccal segment (cuspid-first bicupsid-second bicuspid)
  • widths of mandibular incisors are used to predict maxillary buccal segment
  • page 532 in mosby’s for examples
112
Q

T or F:

dentists are mandated by law to report suspected child abuse or neglect, whether or not there is proof

A

true

113
Q

___% of physical abuse is in the craniofacial region, and ___% os in the oral region

A
  • 50%

- 25%

114
Q

if a sealant is placed on undetected incipient caries, does it result in progression of the lesion?

A

not if the sealant remains intact

115
Q

what are the contraindications for sealants?

A
  • rampant caries
  • interproximal caries
  • well-coalesced grooves
  • inability to maintain a dry field
116
Q

do resin-based sealants or glass-ionomer-based sealants have better retention?

A

resin-based

117
Q

for sealants, what is the tag formation in the enamel?

A

about 40um

118
Q

how do fluoride-containing sealants compare to conventional sealants in terms of retention?

A

they are similar

119
Q

fluoride-containing sealants show a ___% reduction of secondary caries

A

60%

m 2 (35 decks)

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