Pedo Quiz 2 Flashcards
What is the history of sealants?
1955 - Buonocore described the technique of acid-etching as a simple method of increasing the adhesion of self-curing methyl methacrylate resin materials to dental enamel. He used 85% phosphoric acid to etch enamel for 30 seconds.
1965 - Bowen develops the bis-GMA resin, which is the chemical reaction product of bisphenol A and glycidyl methacrylate. This is the base resin used in most of the current commercial sealants.
Based on current research, the ADA agrees that BPA in dental sealants and composites poses a small known health threat. True or False?
False. Based on current research, the American Dental Association agrees with the authoritative government agencies that the low-level of BPA exposure that may result from dental sealants and composites poses no known health threat.
The cariostatic properties of sealants are attributed to the physical obstruction of pits and grooves. True or False?
True
Bonded resin sealants are underused in preventing pit-and-fissure caries on at-risk surfaces. True or False?
True.
Bonded resin sealants, placed by appropriately trained dental personnel, are safe, effective, and underused in preventing pit-and-fissure caries on at-risk surfaces. Effectiveness is increased with good technique and appropriate follow-up and resealing as necessary.
Sealant benefit is increased by placement on surfaces judged to be at high risk for, or surfaces that already exhibit, incipient caries lesions. As with all dental treatment, appropriate follow-up care is recommended.
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. True or False?
True
Placing sealant over minimal-enamel caries has been shown to be ineffective at inhibiting lesion progression. True or False?
False, has been shown to be effective
Placement of a low-viscosity, hydrophilic material-bonding layer as part of or under the actual sealant has been shown to enhance its long-term retention and effectiveness. True or False?
True
Glass-ionomer materials have been shown to be effective as pit-and-fissure sealants but can be used as transitional sealants. True or False?
False, they have shown to be ineffective as pit-and-fissure sealants, but they can be used as transitional sealants effectively.
What are the steps to the sealant technique?
Identify susceptible tooth Clean tooth with rotary brush Etch the tooth Clean and dry Apply bonding agent Apply sealant Polymerize and check for voids Adjust occlusion
What are the steps to the preventive resin technique?
Identify occlusal caries Remove only caries Etch the tooth Clean and dry Apply bonding agent Apply composite resin and sealant Polymerize and check for voids Adjust occlusion
What are the steps to a class I cavity preparation for amalgam?
Remove caries Remove overhanging tooth structure Pulpal floor into dentin Extend for prevention Clean and dry Fill with amalgam Contour Adjust occlusion
What are the steps to a class I cavity preparation for composite?
Remove only caries Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin and sealant Polymerize and check for voids Adjust occlusion
What are the steps to a class II cavity preparation for amalgam?
Remove caries Remove overhanging tooth structure Pulpal and axial floors into dentin Extend for prevention Clean and dry Place matrix and wedge Fill with amalgam Contour Adjust occlusion
What are the steps to a class II cavity preparation for composite?
Remove only caries – box prep possible Place matrix and wedge Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin and sealant Polymerize and check for voids Adjust occlusion
What are the steps to a class III cavity preparation for composite?
Remove only caries – dovetail and bevels prn Place matrix and wedge Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin(s) Polymerize and check for voids Adjust occlusion
What are the steps to a class IV cavity preparation for composite?
Remove only caries – dovetail and bevels prn Place matrix and wedge Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin(s) Polymerize and check for voids Adjust occlusion
What are the steps to a class V cavity preparation for composite?
Identify caries Access and remove only caries - #330, #4 Consider bevel and additional retention Isolate carefully near the gingival margin Etch the tooth Clean and dry Apply bonding agent Apply composite resin Polymerize and check for voids Contour and polish for esthetics
What are the six full coverage indications for primary teeth?
- Restorations for teeth with extensive and/or multiple caries lesions
- Restorations for hypoplastic teeth that cannot be adequately restored with bonded restorations
- Restorations for teeth with hereditary anomalies, such as dentinogenesis imperfecta or amelogenesis imperfecta
- Restorations for pulpotomized or pulpectomized teeth with increased danger of fracture of the remaining coronal tooth structure
- Restorations for fractured teeth
- Restorations for primary teeth to be used as abutments for appliances or attachments for habit breaking and orthodontic appliances
What are the steps for a posterior stainless steel crown preparation?
A. Mesial reduction B. Distal reduction C. Occlusal reduction D. Rounding of the line angles E. Occasional reduction of buccal bulge F. Remove remaining caries G. Pulp therapy if necessary H. Snap fit is the goal
What are the keys to selecting a posterior stainless steel crown size?
A. Smallest crown that fits appropriately
B. Correct occlusogingival crown length which includes no interference with occlusion and 0.5 – 1 mm subgingival
C. Trim and contour for adaptation to tooth and follow natural contours of marginal gingival tissue
D. It is possible to shape and contour the stainless steel crown to the remaining tooth structure
How does preparing a primary tooth for a posterior zirconia crown differ from a SSC?
A. Increased mesial reduction vs. SSC B. Increased distal reduction vs. SSC C. Increased occlusal reduction vs. SSC D. Rounding of the line angles E. Reduction of buccal bulge more likely F. Remove remaining caries G. Pulp therapy if necessary H. Passive fit is the goal
What are the keys to selecting a posterior zirconia crown size?
A. Smallest crown that fits appropriately
B. Correct occlusogingival crown length which includes no interference with occlusion and 0.5 – 1 mm subgingival
C. Must prepare the tooth to fit the crown
D. It is NOT possible to shape and contour the zirconia to the remaining tooth structure
It is NOT possible to shape and contour the SSC to the remaining tooth structure. True or False?
False. You can with SSC but not with Zirconia
What are the steps to preparing an anterior primary tooth for a crown?
Mesial reduction Distal reduction Incisal reduction Rounding of the line angles Reduction of cingulum Remove remaining caries Pulp therapy if necessary
What are the three main anterior crown options for primary teeth?
- Composite strip crown
- Veneered stainless steel crown
- Zirconia crown
Dental caries is 5 times more common than asthma and 7 times more common than hay fever. True or False?
True
51 million school hours per year are lost in U.S. due to dental-related illness. # 2 chronic childhood disease behind Asthma. True or False?
False, caries is the #1 chronic childhood disease. • Dental problems (toothache) most common reason a child misses school
• Several studies show caries prevalence of children under 4, in U.S. ranging from 38-49%.
• Increasing in poor and near poor U.S. preschool children
• This disease is largely untreated in children under age 3
What are the two main types of anesthetic at the school for kids?
2% Lidocaine with 1:100,000 epi.
4% Articaine with 1:100,000epi.
Each carp 1.7 ml
What are the calculations for Lidocaine, the max dosage that can be used?
Lidocaine 2% (34mg/1.7ml cartridge)
4.4mg/kg x _____kg =___mg (not to exceed300mg total dose) A 46 lb. 20 kg child can receive 2.4 carp.
So if a 46 lb kid (20 kg) walked in, you would multiply
20 kg X 4.4mg/kg = 88mg. And because there are 34 mg in one carpule, you could give them 2.4 carp max
What are the calculations for Articaine, the max dosage that can be used?
Articaine 4% (68mg/1.7ml cartridge)
7mg/kg x _____kg=mg ____mg(not to exceed 500mg total dose) A 46lb 20kg child can receive 2.1 carp.
So if a 46 lb kid (20 kg) walked in, you would multiply
20 kg X 7mg/kg = 140mg. And because there are 68mg in one carpule, you could give them 2.1 carpules
How many milligrams of Lidocaine 2% are in 1 carpule?
34 mg per 1.7 ml cartridge
How many milligrams of Articaine 4% are in 1 carpule?
68 mg per 1.7 ml cartridge
What is the maximum dosage (mg/kg) for Lidocaine 2%?
4.4mg/kg
What is the maximum dosage (mg/kg) for Articaine 4%?
7mg/kg
What are the maximum total dosages of mg for both Lidocaine 2% and Articaine 4%?
300 mg for Lidocaine and 500 mg for Articaine
What size of needle does he recommend for each shot, maxillary and mandibular?
- I would suggest using either short or xshort for maxillary injection, using local infiltration directly above tooth being treated.
- Use 27 gauge long for mandibular injection using inferior alveolar and long buccal injection
- Use Xshort or short for palatal and Xshort for PDL
What causes enamel/intrinsic erosion?
Caused by gastric acid and acid regurgitations due to medical or psychological issues (e.g.Acid reflux, anorexia, bulimia, etc.)
What is Bulimia?
Eating food then regurgitating it up, allows stomach acids to dissolve teeth, lingual surfaces are eroded
What causes extrinsic erosion?
Occurs when dietary acids (e.g. sugar, diet sodas, fruit drinks, carbonated drinks, energy drinks, etc.)
contribute to the mouth’s being in a very acidic state.
At what pH level does tooth enamel begin to demineralize?
Tooth enamel begins to demineralize at pH levels below 5.5. Soda has a average pH of 2.5.
What is the pH of Coca-Cola and how many tsp of sugar does it have per 12 oz?
pH 2.53, 9.3 tsp sugar/12 oz. And there are usually 5.69 grams in 1 tsp, so Coke has more than 50 grams of sugar
What are the signs of enamel erosion once the enamel wears down?
• Teeth may become further worn down
• Teeth become discolored because the enamel has worn away and the dentin is exposed
• The edges of the front teeth may look transparent
• Tooth sensitivity can occur when the enamel is worn away both on the lip and tongue surfaces of the
teeth. The dentin is softer than enamel, and it is more sensitive to touch, air, biting forces and acid exposure
What is external root resorption?
External resorption is the breakdown or destruction and subsequent loss of the root structure of a tooth. This is caused by living body cells attacking part of the tooth.
Root resorption of secondary teeth can occur as a result of pressure on the root surface. This can be from trauma, ectopic teeth erupting in the path of the root, chronic inflammation. Most common cause is Orthodontics!
What is ectopic root resorption?
Whenever the crown of one tooth, comes close or in contact with the root of another tooth, resorption can take place
What is internal root resorption?
Internal resorption is an unusual condition were the dentin and pulpal walls begin to resorb centrally within the root canal. The cause can sometimes be attributed to trauma to the tooth, but other times there is no
known etiology.
Internal resorption often happens with reaction of materials and methods used in
pulpotomies in primary teeth. True or False?
True
Why do primary teeth tend to move within the bone as opposed to fracturing when trauma occurs?
Because the bone structure surrounding primary teeth isn’t as thick and dense as around permanent teeth. With permanent teeth, it is just the opposite.
What is an acute alveolar abscess?
• It is a chemical bacterial and mechanical irritation but usually due to bacteria invasion from death of pulp tissue.
• Tenderness of the tooth. Patient has throbbing severe pain with swelling of the overlying soft tissue. When swelling become extensive, it result into cellulite and the
patients facial appearance changes.
What is cellulitis?
• Cellulitis is a diffuse infection of the soft tissues
• Occurs more frequently in younger children
• Caused by primary or permanent pulpal necrosis
• Characterized by considerable swelling of face or neck due to collateral edema and a
spreading fascial infection
• Appear acutely ill, may have high fever with malaise and lethargy
• Very painful, have a hard time sleeping and eating
Cellulitis occurs more often in adults. True or False?
False, in younger children
What is a chronic alveolar abscess?
Due to long standing, low grade infection of the periradicular bone, chronic alveolar abscess develops. Generally no clinical signs and symptoms occur in case of chronic alveolar abscess. Discharge may be there from sinus opening in case of chronic abscess.
What is gingivitis?
In the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
What is periodontal disease?
Periodontal disease is a chronic inflammatory disease that destroys bone and gingival tissues that support the teeth. Periodontal disease affects nearly 75% of Americans and is the major cause of adult tooth loss.
What are the characteristics of soft tissue injuries?
• Mouth injuries are common, especially in children, and may involve the teeth, jaw, lips, tongue, inner cheeks, gums, roof of the mouth (hard or soft palates),
neck, or tonsils.
• Lips often cushion the teeth during a fall, bearing the brunt of the injury and resulting in bruises and lacerations. Viral & bacterial infections, cancers, fungal
infections
- A lot of the times they are self-inflicted, like post local anesthesia trauma from biting on tongue, aspirin burn, electrical burn
What are some benign lesions of the mouth?
Benign Epithelial Tumors
- Firm; non-tender; fixed to the surface; rough or cauliflower surface; pale.
Papilloma,Verruca vulgaris
- Overlying mucosa is normal unless traumatized; usually well-circumscribed, asymptomatic, slowly growing. Fibroma, irritation fibroma, epulis fissuratum (by lip of denture)Many other types
What two cancers cause greater than 50% of all childhood cancers?
Leukemia’s (blood cancers) and brain cancers
What is the most common type of Leukemia in children?
ALL - Acute Lymphoblastic Leukemia, approximately 1/3
What are the two most common malignant solid type tumors in kids?
Brain tumors
- Gliomas
- Medulloblastomas
What are examples of other malignant solid tumors that are less common in kids?
- Neoroblastomas
- Wilms tumor
- Sarcomas
- Rhabdomyosarcoma
- Osteosarcoma
What are odontomas?
Odontomas are composed of all mature Components of dental hard and soft tissue: Enamel, dentin, and pulp tissue. Because of their slow growth and well differentiation, they are generally considered to represent harmartomas rather than true neoplasms
What are the clinical features of odontomas?
- They are the most common odontogenic tumor
- They often interfere with eruption of Perm teeth
- They begin to develop as normal dentition starts to develop and cease when the teeth stop development
- There is no sex predilection
- They occur in young age group, with the average age being second decade of life
What are the differences between compound odontomas and complex odontomas?
Compound
• It is a collection of small radiopaque masses, some or all may be tooth look-like structures “denticles”
• Occurs most frequently (62%) in the anterior region of the maxillae and usually associated with the crown of an unerupted canine
• Usually asymptomatic and discovered during routine radiograph exam when there is a delayed eruption of permanent tooth
Complex
• Is composed of haphazardly arranged dental hard and soft tissue.
• It has no resemblance to a normal tooth. It tends to occur in the posterior region
of the mandible (70%).
• There might be a missing tooth if it arises from a normal tooth follicle.
How are odontoma’s treated?
- Odontoma’s are treated by simple local excision
- Excellent Prognosis
- They don’t recur and are not invasive
What is gemination?
One Bud, One tooth, One root canal.
Gemination- attempted division of a single tooth germ, appears as a bifid crown on a single root. Crown is usually wider than normal. Shallow groove extending from incisal edge gingivally. More frequent in primary teeth
What is fusion?
Two teeth, dentin union
Fusion- represents the union of two independently developing primary or permanent teeth. Usually limited to front teeth. Fused teeth will have separate pulp chambers and separate pulp canals. Sometimes absence of permanent tooth when primary teeth fuse.
What is concrescence?
Fusion of teeth involving only cementum
What is dens invaginatus (dens in dente)?
- Developmental anomaly is a lingual invagination of enamel
- Probable communication between the cavity of the invagination and pulp chamber
- Can occur in primary and permanent teeth, most common is maxillary permanent lateral incisor
- Common presentation is pulp necrosis and dental abscess
- Teeth are usually normal shape
- Cover with sealant or restoration
What is cherubism, and the other name for it?
(Familial Fibrous Dysplasia)
• Cherubism is a rare childhood disease affecting jaw development. The Children have “chubby faces”
• Usually inherited as an autosomal-dominant feature, reduced penetrance in females.
• Radiographically, multilocular areas of bone destruction (“soap-bubble lesions”)
• Primary teeth may exfoliate early due to loss of alveolar bone support or resorption
• Permanent teeth are usually ectopic being displaced by growing lesion
• Stabilizes or even regress after puberty
What are the three stages of amelogenesis?
- First stage- enamel matrix is secreted by ameloblasts
- Second stage- tooth undergoes calcification
- Third stage- enamel maturation, with crystal growth and removal of water and protein, continues until eruption