1
Q
What is the primary objective of pulp therapy in primary dentition? There are 8 ways that it does this, what are they?
A
- Prevent or eradicate infection and to maintain the integrity and health of the teeth and their supporting tissues.
- Prevent space loss and malocclusion, Aid in mastication, Preserve primary teeth in case of hypodontia, Prevent possible speech problems, Maintain esthetics, Prevent tongue habits, Prevent psychosocial effects, Maintain normal eruption patterns and timing.
2
Q
Anatomical differences of pulps between primary and secondary teeth? *(pulp size, mesial pulp horns, pulp horns, mand. vs max., accessory canals, roots, canals, anterior teeth, cervical region of molars)
A
- In relation to crown, pulps of primary are larger.
- Mesial pulp horns are closer to the outer surface.
- Pulp horns are longer.
- The mandibular molar chambers are larger than the maxillary molar chambers.
- Accessory canals allow for pulp chamber infections to lead into the intra-radicular furcation.
- Roots are longer and more slender.
- Canals are more tortuous/ribbon like.
- Anteriors are narrower mesiodistally.
- Cervical region roots of molars diverge greatly.
3
Q
To identify/diagnose a tooth you need the Diagnostic Criteria. What is involved in obtaining the Diagnostic Criteria? Before preceding what most be obtained and then documented in the chart?
A
- History, Symptoms, Radiographs and Clinical Evaluation.
- Informed Consent
4
Q
When should you use a Protective Liner? How is it done? What 5 materials are used?
A
- Tooth with normal pulp, all caries removed.
- Liner placed in deep areas of a preparation to minimize injury, promote tissue healing, promote tertiary dentin formation, minimize micro-leakage and minimize sensitivity.
- GLUMA, Calcium Hydroxide, Bonding Agents, Glass Ionomers and RMGI
5
Q
When should you use an Indirect Pulp Cap? How is it done? What 5 materials are used?
A
- Tooth with no pulpitis OR that has reversible pulpitis. Deepest carious dentin is not removed to avoid pulp exposure. Pulp is still vital and able to heal from insult.
- Radiopaque base placed over existing caries (leave some caries) and may be covered by a stainless steel crown.
- Calcium Hydroxide, Zinc Oxide/Eugenol, Resin Glass Ionomer, Mineral Trioxide Aggregate and Glass Ionomer Cement.
6
Q
When should you use an Direct Pulp Cap? How is it done? What 5 materials are used?
A
- Tooth with normal pulp following a small mechanical/traumatic exposure (pulp exposure), when conditions are optimal - if carious this is not recommended in primary teeth.
- Radiopaque base placed over pulp.
- Calcium Hyroxide, Mineral Trioxide Aggregate, Glass Ionomer, RMGI and reinforced ZOE.
7
Q
When should you use a Pulpotomy? How is it done? What materials?
A
- When caries removal results in pulp exposure in a primary tooth with a normal/reversible pulpitis/traumatic pulp exposure.
- Prepare tooth for full coverage, do not perforate pulpal floor, just remove CORONAL pulp (4,6, spoon), apply medicaments.
- Doesn’t matter what material you use as long as your procedures are good. *(ZOE-IRM is the gold standard)
8
Q
When should you use a Pulpectomy? How is it done? What 4 materials?
A
- Primary tooth with irreversible pulpitis/necrosis or when a pulpotomy fails.
- Prepare for full coverage crown, do not perforate pulpal floor, remove pulp (4,6, spoon, broach) and file until point of resistance/just short of radiographic apex (<35), obturate (ZOE/Iodoform).
- ZOE, Calcium Hydroxide, MTA, Iodoform Paste.
9
Q
What are the 4 keys to success in these pulp therapies?
A
- Diagnosis, Isolation, Technique and Seal
10
Q
What are contraindications for pulp therapies in primary teeth (5)?
A
- Close to exfoliation
- Periapical abscess formation with swelling and drainage.
- Cellulits
- Unrestorable Tooth
- Medically Complex (Transplants, cancer, immunosuppression)
11
Q
What are the crown options for primary teeth (3)?
A
- Stainless Steel Crown
- Veneered Stainless Steel Crown
- Zirconium Crown
12
Q
With pulpal therapies, what are differences in the procedures between primary and permanent teeth?
A
- Protective Liner, Indirect Pulp Cap and Direct Pulp Cap are the same.
- Pulpotomy: In maturing permanent teeth it is more conservative with pulpal access, want to promote tooth maturation and apexogenisis.
- Pulpectomy: In maturing permanent teeth it is more conservative with pulpal access, want to promote tooth maturation and apexogenisis. May want to endodontically refer.
13
Q
Dental caries are ___ more times common than asthma and ___ more common than hay fever. ____ million school hours per year are lost. Caries prevalence of children under 4 in us ___-___%
A
- 5, 7
- 51 million
- 38-49%
14
Q
What is the most common chronic childhood disease, most common reason for a child to miss school and is largely untreated in children under age 3?
A
- Dental Caries
15
Q
What is caused by gastric acid and acid regurgitations usually due to acid reflux, anorexia or bulimia?
A
- Intrinsic Erosion
16
Q
What is caused by dietary acids (sugar, sugar drinks) and contribute to an acidic state of the mouth? At what pH level does tooth enamel begin to demineralize?
A
- Extrinsic Erosion
- Below 5.5 (soda averages at 2.5)
17
Q
What causes tooth discoloration, transparency of the edges of the tooth, tooth sensitivity and chips/falling out of restorations?
A
- Enamel Erosion
18
Q
What is loss of root structure due to living body cells attacking part of the tooth, and can be caused by trauma, tooth eruption, chronic inflammation, but MOST commonly Orthodontics? When it is caused specifically by tooth eruption, what is it called?
A
- External Root Resorption
- Ectopic Root Resorption
19
Q
What is a condition where the dentin and pulpal walls begin to resorb centrally within the root canal and can be caused by trauma, or a reaction of materials/methods used in pulpotomies?
A
- Internal Root Resorption
20
Q
What makes trauma different between primary and permanent teeth? What is Concussion, Intrusion, Extrusion, Subluxation, Lateral Luxation, and Avulsion?
A
- Primary: Teeth tend to move within softer bone and have less fractures.
- Permanent: Teeth tend to fracture and not move within denser bone.
- Concussion: Trauma that causes sensitivity but no damage.
- Intrusion: Tooth up into bone.
- Extrusion: Tooth away from bone.
- Subluxation: Increased mobility but no damage.
- Lateral Luxation: Sideways
- Avulsion: Tooth falls out of socket due to trauma.
21
Q
What is a chemical, bacterial, and mechanical irritation, but is usually due to bacterial invasion from death of pulp tissue? What does this look and feel like?
A
- Acute Alveolar Abscess
- Tenderness of the tooth. Patient has throbbing severe pain with swelling of the overlying soft tissue. When swelling become extensive, it result into cellulits and the patients facial appearance changes.
22
Q
What is a diffuse infection of the soft tissues, occurs more frequently in younger children, caused by primary or permanent pulpal necrosis, is characterized by considerable swelling of face or neck due to collateral edema and a spreading fascial infection acutely ill, patient may have high fever with malaise and lethargy, is very painful and have a hard time sleeping and eating?
A
- Cellulitis
23
Q
What is due to long standing, low grade infection of the periradicular bone, a chronic alveolar abscess develops?
A
- Chronic Alveolar Abscess
24
Q
What is caused by bacteria in plaque building up, gums become inflamed and bleed during tooth bushing, the teeth are still firmly planted in their sockets and no irreversible bone or other tissue damage has occurred?
A
- Gingivitis
25
What is a chronic inflammatory disease that destroys bone and gingival tissues that support the teeth and it is the major cause of adult tooth loss? ___% of Americans are affected by this.
- Periodontal Disease
| - 75%
26
What are Firm, non-tender, fixed to the surface, rough or cauliflower surface, pale, usually well-circumscribed, asymptomatic, slowly growing? What are examples of this?
- Benign Epithelial Tumors
| - Papilloma, Verruca vulgaris, Fibroma, irritation fibroma, epulis fissuratum.
27
What two malignant lesions make up more than 50% of all childhood cancers? What are examples of each?
- Leukemia (blood cancer) and Brain cancers (Most common solid type tumors).
- Leukemia: Acute Lymphoblastic Leukemia (ALL) - 1/3 of childhood cancers
- Brain Tumors: Gliomas and Medulloblastomas
28
What are composed of mature Enamel, dentin, and pulp tissue but are a developmental anomaly, they are the most common odontogenic tumor, and can interfere with eruption of Perm teeth? There are two forms of this, what are they and what makes them different? Treatment?
- Odontoma
- Compound and Complex:
- Compound Odontoma: Tooth
look-like structures “denticles”, occurs most often in the anterior region of the maxillae (unerupted canine).
- Complex Odontoma: No resemblance to a normal tooth. It tends to occur in the posterior region of the mandible.
- Local Excision
29
What is the attempted division of a single tooth germ, that appears as a bifid crown on a single root, Crown is usually wider than normal, a Shallow groove extending from incisal edge gingivally and is More frequent in primary teeth?
- Gemination
30
What 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, and may result in the absence of the permanent tooth when primary tooth is effected?
- Fusion
31
What is the fusion of teeth involving only cementum?
- Concrescence
32
What is a developmental anomaly of a lingual
invagination of enamel, Can occur in primary and permanent teeth, Common presentation is pulp necrosis and dental abscess, Teeth are usually normal shape, and treatment is cover with sealant or restoration?
Where does this most commonly occur?
- Dens Invaginatus
- Maxillary permanent
lateral incisor
33
What 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?
- Cherubism (Familial Fibrous Dysplasia)
34
Amelogenesis or enamel formation occurs in three stages, what are they?
• 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
35
Enamel Hypoplasia is usually due to deficiencies in what? What is this more common in?
- Vitamin A, C, and D, Calcium, and Phosphorus.
| - Individuals with Bilateral and Unilateral Cleft Lip and Palate.
36
What is interference with dental development at birth, or while the enamel is forming, may result in a qualitative effect on the mineralization of 1 to 4 of the permanent first molars?
- Molar-Incisor Hypomineralization (MIH)
37
Hypoplasia caused by Fluoride Dental Fluorosis occurs during a critical time of _____ to __-__ years. What also occurs during this time period?
- Birth to 4-5 years
38
What is an anomaly that is characterized by a tendency for the body of the tooth to enlarge at the expense of the roots. The pulp chamber is elongated and extends deeply into the region of the roots, and the clinical significance of the condition becomes apparent only if vital pulp therapy or root canal therapy is necessary?
- Taurodontism
39
What is a developmental disturbance of the dentin originating during the histodifferentiation stage of tooth development, the teeth have a variable blue-gray to yellow-brown discoloration due to defective, abnormally colored dentin shining through the translucent enamel, and is an autosomal dominant trait? There are three types of this, what makes them different?
- Dentinogenesis Imperfecta
- Type I: Dentin defect along with Osteogenesis Imperfecta, Fragile bones, Blue sclera, pre-senile deafness, macrocephaly,
triangular (acorn) skull, Postnatal growth deficiency, and Roots are thin and tapered-pulp canal ribbon like.
- Type II: One of most common inherited defects in men, and Treatment is complicated by the lack of proper root structure.
- Type III: Brandywine Type inheritance, Opalescent color of the teeth, Bell shaped appearance of teeth, Shell tooth appearance on x-ray.
40
What is a rare disturbance of dentin formation that has two types: Type 1: Root canal and pulp chambers are absent, and Type 2: Primary dentition
appears opalescent with obliterated pulp chambers and Permanent dentition has normal color with thistle tube pulp configuration with pulp stones?
- Dentin Dysplasia
41
There are the 4 types of Amelogenesis Imperfecta what makes them different? (Hypocalcified, Hypoplastic, Hypomaturation)
- Hypocalcified: Most common, individuals usually have an open bite with soft enamel that has normal thickness.
- Hypoplastic: Hard thin enamel, small teeth, may be linked to Down Syndrome, Treacher Collins, Cerebral Palsy or Sturge Weber Syndrome.
- Hypomaturation: Normal enamel thickness but with low radio-density and is soft, fractures/flaking, brown color, 'snow capped', and hard to tell between enamel and dentin in radiograph.
- Combination of the three
42
What is complete failure of teeth to develop is very rare and may be part of Ectodermal Dysplasia? What is the agenesis (lack of growth of some (fewer than 6) teeth and not including 3rd molars? What is a condition when more than 6 permanent teeth are missing? What is involves 85% of unerupted/impacted canines and the remainder erupt bucally?
- Anodontia
- Hypodontia (usually maxillary lateral incisors & mandibular second premolars)
- Oligodontia (associated with Ectodermal Dysplasia and Down Syndrome)
- Hypodontia & Palatally Displaced Canines
43
What includes several primary/permanent teeth failing to develop, all teeth may be missing, conical and peg shaped teeth especially canines and incisors, lack of development of the alveolar process, abnormalities of Hair (most common - Tricodysplasia), nails,skin, and sweat glands. Skeletal structures are normal. Generally normal mental capacity and normal life span? What teeth are most commonly missing and what teeth are most commonly present?
- Ectodermal Dysplasia
- Missing: Mand. Incisors/Premolars and Max. Premolars.
- Present: Max. Cent. Incisors, Max. Canines, and Max./Mand. First Molars.
44
What can cause intrinsic discoloration/pigmentation of teeth? (Biliruben, antibodies, disorder and its drug therapy)
- Hyperbilirubinemia (excess levels of bilirubin)
- Biliary Atresia: Rare liver disease causing buildup of bilirubin.
- Erythroblastosis Fetalis: Transplacental passage of maternal antibodies against red blood cell antigens of the infant.
- Cystic Fibrosis: Life-shortening disorder characterized primarily by poor digestion and obstruction and infection of the airways.
- Tetracycline Therapy: Occurs when drug is administered during the time that teeth are calcifying, turn yellow/brown/grey.
45
What four things can cause Macroglossia?
- Hypothyroidism
- Down Syndrome
- Allergic Reaction
- Trauma
46
What is 'tongue-tied' that is caused due to a short lingual frenum and causes speech difficulties?
- Ankyloglossia
47
Fissured tongue is usually seen in whom? What includes smooth areas devoid of filiform papillae and changes every few days?
- Down Syndrome and Hypothyroidism
| - Geographic Tongue
48
What is a white coating that CAN be scraped off? What is this condition called when observed in cases of Scarlet Fever and Kawasaki Disease?
- Candida Yeast Infection
| - White Strawberry Tongue
49
What can cause a maxillary Diastema that is frequently seen in pre-school children and should be carefully analyzed after the anterior teeth (including canines) have erupted? What can cause tooth chipping, dental abrasion, gingival recession, a swollen/infected tongue and is opposed by the ADA and AAPD due to pathological and sequelae associated with these?
- Abnormal Labial Frenum
| - Tongue Piercing
50
What is the goal of non-pharmacologic management of children's behaviors?
- Promote positive dental attitudes and improve the dental health of society.
51
What is the key to successful outcomes with children?
- Appropriate assessment of the child AND family to prepare them to participate actively in a positive manner in the child's oral care.
52
What assessment tool has the two primary goals of learning about the patients and parental concerns and to gather information to enable a reliable estimate of the cooperative ability of the child? This inquiry is coupled with what to better help the dentist apply the appropriate behavior guidance strategies?
- Functional Inquiry
| - Clinical Experience
53
High anxiety on the part of the parents will have a negative effect on the child's behavior, what is this called? If stress continues over a prolonged period of time and has lifelong effects, what is this called?
- Parental Anxiety
| - Toxic Stress
54
When should dental visits begin?
- Age 1 (aids with preventable disease and coping mechanism for future visits)
55
What is when patients are shown positive photographs/images of dentistry in the waiting area before the dental appointment and providing parents and children with the context to be able to ask relevant questions? What is when patients are show a video or directly observe a young cooperative patient undergoing dental treatment?
- Postive Pre-Visit Imagery
| - Direct Observation
56
What technique involves verbal explanation, a demonstration for the patient (visual, auditory, olfactory and tactile), and then an exact demonstration of the procedure?
- Tell-Show-Do
57
What is a deliberate alteration of voice volume, tone or pace to influence a behavior? This may have an aversive effect with some parents (explain before treatment if used) Is the distraction technique successful? What about parental presence?
- Voice Control
- Yes (TV, assistant, earphones)
- Has pros and cons
58
What is a Social Reinforcer? A Non-Social Reinforce?
- 'Thank you' and 'Good Job'
| - Tokens and Toys
59
What time of the day is best for appointments with children?
- Morning appointments (more alert and team is more fresh)
| * (Also age grouping is successful-Young children morning, teenagers in afternoon)
60
What does PITA stand for? *(be careful what you record in a patients chart)
- Pain In The A%$
61
Behavioral guidance for each patient should be customized primarily by what two things?
- Needs of the child and Desires of the parent
62
There are two types of Protective Stabilization, what are they?
- Active Immobilization: Restraint by a person such as the dentist or parent.
- Inactive Immobilization: Pedi-Wrap or Papoose Board
63
According to the Texas Administrative Code, what must be completed in order to use Protective Stabilization? What must be obtained before Protective Stabilization can be used? When is stabilization indicated? *(92% of parents wanted to be in the room and 90% felt that restraint was helpful)
- An accredited Post-Doctoral Program
- Continuing Education course no less than 8 hours with both didactic and clinical education
- Written and signed consent that is separate from the consent forms for other procedures.
- Immediate/Urgent treatment when they cannot cooperate.
64
If parents are denied access into a procedure what must you do as the dentist?
- Provide a reason with documentation of the explanation in the patient's chart. *(Parent has the right to terminate restraint/procedures at any time)
65
What is the most frequently used pediatric sedation technique used today? What drug is used to abolish the effects of nitrous (opioid antagonist)? ___% of nitrous oxides with a full mask is equivalent to ___ -____ mg of morphine? With Subcutaneous (under the skin injection) morphine, what amount should not be exceeded per dose? What about IV morphine? What percent of nitrous should not be exceeded? Can dental personnel near high ambient air levels of NO2 be affected? How much oxygen minimal is used in the 'Fail-Safe'? What is the most efficient type of scavenger?
- Nitrous Oxide (85% of pediatric dentists) - It does have abuse potential.
- Naloxone *(Also used for overdose)
- 30% NO2, 10-15 mg Morphine
- Subcutaneous: Not to exceed 15 mg/dose (usually 0.1-0.2/kg is needed)
- Not to exceed 10 mg/dose (usually 0.05-0.1 mg/kg needed)
- 50% NO2
- Yes, chronic exposure can cause neurotoxicity, reproductive problems and liver problems. (5-20 deaths)
- 30% O2
- Double-Mask Type
Pediatrics and Orthodontics
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