Peds/Ortho Flashcards
A fearful patient is slowly introduced to dental tools by talking about them, then by looking at them, then by touching them. After these procedures, the patient no longer fears the instruments. This process is BEST described as:
A. classical conditioning. B. extinction. C. imprinting. D. modeling.
B. Extinction:
refers to the elimination of a response when the stimulus no longer has a significant effect on the individual. An example could be that you hear a strange noise when you visit a new house, and the noise arouses your attention. After the noise continues for a while and has no effects (e.g., the house does not explode, nobody bursts into your room, and the ceiling does not fall down), you may begin to ignore the stimulus. In the dental example, when talking, looking, and touching the instruments has no bad effect, the fear of the instruments may be markedly reduced. The fear response is thus extinguished (extinction). Classical conditioning (choice A) links an existing involuntary behavior with a new stimulus. Modeling (choice D) involves imitating behavior. Imprinting (choice C) is a primitive learning type found in ducks and geese.
Defects in the forebrain usually result in:
A. involuntary control of muscle tone. B. malformation of facial structures. C. inability to interpret auditory information. D. inability to maintain balance and equilibrium.
B. malformation of facial structures:
The development of the face begins around the end of the fourth week under the inductive influence of the ventral portion of the forebrain signaling the development of the nasal placodes.
Controlling of muscle tone, interpretation of auditory information, processing of incoming sensations, and outgoing motor commands is controlled by the midbrain.
The hindbrain is responsible for maintaining balance/equilibrium.
Open bites in children may be caused by all of the following, EXCEPT:
A. a pacifier. B. thumb/digit sucking. C. a skeletal component. D. early loss of deciduous teeth.
D. Early loss of deciduous teeth:
is not associated with the development of open bite. Prolonged use of a pacifier may create an open bite. Continual sucking of a digit or thumb can also create open bites in children.
Children with excessive face height, such as a skeletal open bite or long face syndrome, have a normal upper face and normal maxilla but a short mandibular ramus, which accounts for the steep mandibular plane. This kind of growth pattern occurs when vertical growth in the molar region is greater than growth at the condyle, resulting in anterior open bite. Similarly, forces that impede the eruption in the incisal region also result in anterior open bite. Orthodontic treatment via headgear is indicated.
Which of the following is used as a last resort for treating a thumb-sucking habit?
A. Bluegrass appliance B. Spinning bead retainer C. Both Bluegrass and spinning bead retainer D. Hay rake
D. hay rake:
discourages thumb sucking by making it as uncomfortable as possible. This is considered an appliance of last resort. The rake is often modified into a crib form (the tips of the appliance are rounded). This is more tolerable for the patients.
The Bluegrass appliance treats thumb sucking through counterconditioning. Patients use their tongue to spin the Teflon roller, which is especially useful in mixed dentition. The spinning bead retainer is a myofunctional appliance. It is used to retrain the tongue into a proper position, and it also is used to deter thumb sucking. Patient cooperation is not required because the appliance evokes a spontaneous reaction to play with the spinner and correctly positions the dorsum of the tongue against the soft palate.
One determines the severity of a skeletal problem or discrepancy between the upper and lower jaw by:
A. Wits measurement. B. SNA. C. SNB. D. the difference between SNA and SNB. E. all of the above.
E. All these measurements aid in determining the severity of a skeletal problem and/or discrepancy between the upper and lower jaw.
Wits measurement is a determinant of skeletal classification. This is a linear measurement.
SNA determines the maxilla position. It is an angle drawn from sella to nasion to point A. The normal measurement is 82 degrees.
SNB indicates the position of the mandible relative to the maxilla. It is an angle from sella to nasion to point B. The norm for SNB angle is 80 degrees.
The difference between SNA and SNB should be approximately 2 degrees. If the number is more or less, it is indicative of a skeletal discrepancy.
The lower first molar is mesially positioned relative to the upper first molar. This represents which Angle’s classification?
A. Angle's Class I B. Angle's Class II C. Angle's Class III D. None of the above
C. Angle’s Class III:
Classification of the molars using Angle’s methods is the foundation for orthodontic evaluation. Class I malocclusion (choice A) is a normal class I molar relationship, with the mandibular molar one half tooth mesial to the maxillary molar. The mesiobuccal cusp of the maxillary first permanent molar occludes with the mesiobuccal groove of the mandibular first permanent molar. Class I has a normal molar relationship, but the line of occlusion is incorrect due to malposed teeth, rotations, etc. Class II and Class III have no specified line of occlusion, only distally placed lower first molars in Class II (choice B) and mesially placed lower molars in Class III (relative to that described for Class I). Because choice C is correct, choice D is incorrect.
A 9-year-old girl presents to the office for the first time. She has an anterior cross bite involving tooth 8. Which of the following is indicated?
A. Open the bite B. Use a spring palatal to the tooth in cross bite via a removable appliance C. An expansion screw placed palatal to the tooth in cross bite via a removable appliance D. Bluegrass appliance
D. Bluegrass appliance:
treats thumb sucking through counterconditioning. Patients use their tongue to spin the Teflon roller, which is especially useful in mixed dentition. Before any cross bite can be corrected, the tooth to be corrected must not be in occlusion.
The tooth must be allowed to move unhindered to its correct position. Either a spring or an expansion screw placed palatal to the tooth in cross bite, via an appliance, will correct the problem. Cross bites can be corrected quickly, usually within 1 to 2 months.
A child accidentally drinks 50 cc of topical fluoride gel. Which of the following procedures is LEAST likely to help prevent poisoning?
A. Ingestion of milk B. Ingestion of calcium-containing antacid C. Ingestion of concentrated sodium carbonate D. Gastric lavage E. Ingestion of syrup of ipecac
C. Ingestion of concentrated sodium carbonate:
Topical fluoride is dangerous if swallowed in large quantities. Fluoride can be made into the insoluble and non-toxic calcium fluoride form by precipitating it with calcium from milk or calcium antacid tablets. Sodium carbonate or sodium bicarbonate will not have any positive effect. Gastric lavage is “stomach pumping” and empties the stomach contents. This will remove most fluoride if begun early enough. Syrup of ipecac is an emetic (vomit-inducer), and will empty stomach contents as well.
The fears of a young child, as expressed in his/her first dental visit are:
A. subjective and independent of the home environment. B. subjective and partially dependent on the home environment. C. objective and independent of the home environment. D. objective and partially dependent on the home environment. E. equally objective and subjective.
B. subjective and partially dependent on the home environment:
Objective fears (choices C and D) are fears based on an individual’s own experience, while subjective fears (choices A and B) are based on external information. However, it should be noted that a child who has never been to the dentist cannot have objective fears, because objective fears are based on personal experience. The subjective fears that the patient may have usually have come from the parents or other family members such as older siblings.
Which of the following measurements is used for determining growth direction?
A. Wits analysis B. SN-GoGn angle C. Y-axis to SN D. Both SN-GoGn angle and y-axis to SN
D. Both SN-GoGn angle and y-axis to SN:
Note that clockwise growers are patients whose treatment should be referred to orthodontists due to the degree of difficulty in achieving a good result.
Wits analysis determines skeletal classification.
SN-GoGn angle is the angular measurement that is a determinant of growth direction. The norm is 32 degrees.
- A large angle indicates clockwise growth.
- A small angle indicates counterclockwise growth.
Y-axis to SN measurement is also a determinant of growth direction. This angle is between nasion to sella to gnathion. The norm is +66 degrees plus or minus 2 degrees.
- A high angle indicates a clockwise grower.
- A low angle indicates a counterclockwise grower.
Extraction of a permanent canine should NOT be considered if the canine:
A. is erupting labially due to insufficient space for eruption. B. is undergoing external/internal resorption. C. is ankylosed and cannot be transplanted. D. has a severely dilacerated root and/or impaction is severe.
A. is erupting labially due to insufficient space for eruption:
Extraction of a canine erupting labially due to insufficient space for eruption is contraindicated because it can compromise orthodontic treatment results and functional occlusion. The canine has a long, strong root and all efforts should be made to save it. Space may be made for it through extraction of another tooth, followed by orthodontic movement or another method. Choices B, C, and D are cases in which canine extraction is indicated and are therefore incorrect.
A child presents with a primarymolar that is decayed. Clinically, it has a large carious lesion, and the entire coronal aspect of the tooth is discolored. There is history of trauma. An abscess is also noted. Radiographs reveal that the decay is very close to the pulp chamber. The child complains of pain, especially at night. Which of the following is the MOST appropriate treatment?
A. Pulpotomy B. Extraction C. A sedative filling D. Stainless steel crown
B. Extraction:
Once an abscess is present on a primary tooth, there is no treatment choice. The only treatment is an extraction. Primary teeth that have abscesses, unlike permanent teeth, do not respond well to a pulpotomy (choice A). Attempting to place a sedative filling (choice C) does not treat the problem. Stainless steel crowns (choice D) are often used to restore primary molars; however, that cannot be utilized here because of the pathology. The abscess and pain will remain or progress.
The following signs and symptoms associated with congenital hypothyroidism include all of the following EXCEPT:
A. short stature B. exophthalmos. C. disproportionately enlarged head D. developmental delay/intellectual disability
B. Exophthalmos:
The following signs and symptoms associated with congenital hypothyroidism include a stocky stature (choice A), a disproportionately enlarged head (choice C), poor mental and physical development (choice D), edematous protruding tongue, and delayed eruption of teeth. Exophthalmos (choice B) refers to bulging eyes, a symptom of hyperthyroidism.
One determines the direction of growth, clockwise or counterclockwise, by all of the following, EXCEPT:
A. use of SN-GoGn. B. mandibular plane angle. C. y-axis. D. L1-NB angle.
D. L1-NB angle:
SN-GoGn assesses the growth direction of the mandible. Mandibular plane angle is used to give the direction of growth as related to the cranium. The y-axis, or growth axis, is an estimate of potential growth direction. These are all used for skeletal analysis and growth direction.
The L1-NB angle is used for dental analysis.
- If this angle is less than 25 degrees, the patient is either Class II Division 2 or Class III.
- If the angle is greater than 25 degrees, the patient could be Class II Division 1.
A 14-year-old boy presents for a new patient examination. Clinical examination reveals no caries. Radiographs reveal a lower premolar with an elongated, rectangular pulp chamber indicative of taurodontism. Although this may be an isolated finding, what syndrome could this be related to?
A. Down syndrome B. Treacher Collins syndrome C. Gardner's syndrome D. Cleidocranial dysplasia
A. Down syndrome:
In taurodontism, the distance from the CEJ to the furcation is increased, giving the radiographic appearance of very short roots with a relatively large crown. This condition can be found in some cases of Down’s syndrome.
Treacher Collins syndrome: associated with a hypoplastic mandible/complex, ear abnormalities, and downslanting palpebral fissures.
Gardner’s syndrome: radiographically reveals impacted and supernumerary teeth, as well as multiple, well-defined radiopacities, which are osteomas.
Cleidocranial dysplasia: radiographically reveals hyperdontia. They are mainly found in the premolar and molar regions.
What is the MOST optimal treatment time to use cervical headgear based on skeletal maturation indicators (SMI)?
A. SMI 1 B. SMI 5 C. SMI 8 D. SMI 10
B. SMI 5:
SMI 4 to 7 has a peak velocity period of growth. This is marked by pubertal growth. There is ossification of the adductor sesamoid and epiphyseal capping on hand-wrist radiographs.
SMI 1 involves epiphyseal widening and represents a period of growth and the next best desirable time for treatment after SMI 7 to 11. SMI 8 involves epiphyseal/diaphyseal fusion and represents a period of decelerating growth.
Fears demonstrated by a child after direct stimulation of sensory nerves in the mouth are:
A. subjective fears. B. objective fears. C. neither subjective nor objective fears. D. exaggerated fears.
B. Objective fears:
are based on real experience of an individual person. You may have an objective fear of swimming pools if you fell in and almost drowned in one several years ago. Subjective fears (choice A) are due to some influence other than direct personal experience. You may have been told that swimming pools are dangerous, or may know of a case where someone was hurt in one. Your parents might have warned you of the danger of swimming pools when you were a child. In the dental office, a patient can have objective fears based on a negative experience that he or she actually experienced. If a child had direct stimulation of sensory nerves in the mouth (most likely pain), this experience can lead to objective fear. A story from the parent about how a dentist once took his or her teeth out with a big pair of pliers and no anesthesia, also can scare the child. This fear would be subjective, which makes choice C incorrect. Exaggerated fear (choice D) is more a description about the patient’ s reaction rather than the actual type or source of fear.
Serial extraction consists of all of the following, EXCEPT:
A. extraction of primary lateral incisors as the permanent central incisors erupt. B. extraction of the primary canines as the permanent laterals erupt. C. extraction of the primary first molars 6 to 12 months before their normal exfoliation. D. extraction of the permanent maxillary first premolars before the eruption of the permanent maxillary canines. E. extraction of the primary maxillary first molars before the permanent maxillary second premolars erupt.
E. extraction of the primary maxillary first molars before the permanent maxillary second premolars erupt:
In the early mixed dentition stage, a patient with severe crowding can choose to undergo selective extraction of primary and sometimes permanent teeth to make room for others. This was used to treat severe crowding without or with minimal use of appliances but is now viewed as an adjunct to later comprehensive treatment.
Serial extraction treatment begins in the early mixed dentition with:
- extraction of primary incisors
- followed by extraction of the primary canines to allow eruption and alignment of the permanent incisors. After extraction of the primary canines, crowding problems are usually under control for 1 to 2 years, but foresight is necessary.
The goal is to influence the permanent first premolars to erupt ahead of the canines so that they can be extracted, and the canines can move distally into this space. The maxillary premolars usually erupt before the canines, so the eruption sequence is rarely a problem in the upper arch. In the lower arch, however, the canines often erupt before the first premolars, which causes the canines to be displaced facially. To avoid this result, the primary first mandibular molar should be extracted when there is one half to two thirds root formation of the first premolar. This usually will speed up the premolar eruption and cause it to enter the arch before the canine. The result is easy access for extraction of the first premolar before the canine erupts.
The local community’s drinking water has a fluoride ion level of 0.4 ppm (parts per million). The fluoride supplementation of a 2-year-old is:
A. none. B. 0.25 mg/day. C. 0.5 mg/day. D. 1 mg/day.
A. none:
No fluoride supplementation is due for a child 6 months to 3 years of age who lives in a community with drinking water that is fluoridated at 0.3 to 0.6 ppm.
Supplementing a child at this age, in time, leads to over-fluoridation and dental sequelae. If a child has excessive exposure to fluoride, it may lead to dental fluorosis. In this situation, the enamel becomes permanently discolored with brown or chalky-white spots. In severe cases, teeth may be weak and more prone to breaking.
A dental examination of a 4-year-old patient reveals two small cavities on the primary maxillary laterals. The cavities appear to be confined to enamel. Which of the following is NOT appropriate treatment?
A. Take radiographs. B. Restore the teeth. C. Allow the teeth to exfoliate without restorations. D. All of the above are appropriate,
C. Allow the teeth to exfoliate without restorations:
Carious teeth (primary or permanent) that remain in the mouth untreated will eventually become symptomatic. Radiographs (choice A) are necessary to confirm that the patient does indeed have only two cavities and no associated pathology. It will also allow you to determine the extent of the carious lesions. Restoring the teeth (choice B) at this time is a simple procedure. If you do not treat and allow them to exfoliate, the child may return at a later date with a larger cavity. This cavity may now cause pain or create an abscess. Also, the patient is only 4 years old. The permanent teeth will not erupt until 8 to 9 years of age. Assuming the child will retain these teeth for several more years emphasizes the importance of restoring the teeth early.
Examination and radiographs of a 9-year-old patient reveal no premolars to replace the lower primary second molars. The child has no carious lesions, and all the permanent molars have been sealed. The parents are informed and wonder how the lack of premolars will affect their child in the future. Which of the following would NOT be expected?
A. Resorption of a primary molar at any time B. Prosthetic replacement in the future C. The primary tooth remaining well into adulthood D. No exfoliation of the primary molar since its successor is missing
D. No exfoliation of the primary molar since its successor is missing:
A primary molar is not meant to last a lifetime. The tooth will resorb and exfoliate regardless of the presence or lack of a successor. Resorption of the molar may be delayed, but loss is certain. With no successor, a primary tooth can resorb at any time (choice A), and patients must be notified. After primary tooth loss, the edentulous area can be replaced via a fixed or removable prosthesis (choice B). An implant is a wonderful option if economically feasible. Primary teeth with no successors often last until adulthood (choice C), but tooth lifespan is unknown and limited.
A pediatrician refers a 1-year-old patient for an evaluation. The child is completely edentulous, and both the parent and the child’s pediatrician are concerned. The medical history is NOT significant. Which of the following should be the next step to take?
A. Contact the pediatrician to conduct a full blood/laboratory workup. B. Reassure the parent that this is normal and reevaluate the patient in 6 months. C. Fabricate pedi-partials to ensure that the child eats properly. D. Place gingival incisions on ridges to accelerate the eruption of the primary teeth.
B. Reassure the parent that this is normal and reevaluate the patient in 6 months:
It is not uncommon to see a 12-month-old child who is edentulous. Infants up to 18 months of age have been documented as edentulous and still normal in the eruption pattern. However, if the condition persists beyond 18 months, the clinician must pursue the issue. Lab tests (choice A), including genetic/blood tests, may rule out any illnesses or syndrome. The tests are not indicated at this age when no familial history of syndromes is reported. Pedi-partials (choice C) at this age are also not indicated. Incisions of the ridges to accelerate eruption (choice D) are difficult and harmful, with no benefit to the patient.
Which of the following is NOT a midsagittal landmark?
A. Sella B. Nasion C. Pogonion D. Porion
D. Porion (po):
is a bilateral landmark. The anatomical porion point is located in the superior and posterior portions of the external auditory meatus, but it is difficult to visualize. Hence, the use of metallic porion point was conventionally adopted in order to replace the anatomic porion point. The metallic porion point is located at 4.5 mm from the centre of the cefalostat’ s metallic olive. Sella (s) (choice A) is the center of the hypophyseal fossa (sella turcica). Nasion (na) (choice B) is the junction of the nasal and frontal bones at the most posterior point of curvature of the bridge of the nose. Pogonion (pog) (choice C) is the most anterior point on the contour of the chin. Therefore, s, na, and pog are midsagittal.
The pulp chamber of a primary molar exhibits which of the following?
A. Short, wide pulpal horns B. Majority of the pulp chamber located in the root trunk C. Long, narrow pulpal horns D. Pulp chamber in the crown is small compared with the roots E. Rounded, bubble-like chamber
C. Long, narrow pulpal horns:
Primary molars have long pulp chambers with narrow pulpal horns. Because of their close proximity to the tooth surface, a clinician can easily expose the pulp when preparing a Class II lesion. Primary molars do not have short, wide pulpal horns (choice A). For primary teeth, the majority of the pulp chamber is found in the crown portion of the molar. In the permanent molars, the majority of the pulp chamber is in the root trunks (choice B). The pulp chamber tends to mimic or follow the tooth border shape, rather than be smaller than the roots (choice D). The pulp would never be a uniform, rounded shape (choice E).
Which statement is FALSE following successful completion of orthodontic treatment in the long term?
A. Relapse occurs in most cases. B. Retention appliances maintain the correct position of the teeth and allow for future dentoalveolar and skeletal growth. C. The facial skeleton and soft tissues of males continue to grow past age 18. D. All of the above.
B. Retention appliances maintain the correct position of the teeth and allow for future dentoalveolar and skeletal growth:
Appliances focus on maintaining the correct position of the teeth. No compensations are made for future dentoalveolar and skeletal growth of the jaws in either the horizontal or vertical direction. In the long term, orthodontic treatment with or without extractions has the same degree of relapse (choice A). Boys do generally mature later than girls (choice C). Even a change of 1 to 2 mm during the postpubertal years may have a profound effect on the long-term stability of an orthodontic treatment result. Therefore, a person’s growth pattern must be closely monitored, and the retention device must be selected according to their growth pattern. Because choices A and C are incorrect, choice D is also incorrect.
A chronic pulpal infection in a primary molar is first noted radiographically as:
A. periapical bony changes. B. internal root resorption. C. changes in the bony furcation. D. external root resorption.
C. changes in the bony furcation:
Chronic pulpal infection usually reflects in the furcal area because there is communication between the pulp chamber and the bony furcation. Periapical bony changes are usually seen from acute pulpal infections. Internal root resorption is usually a result of trauma and progresses rapidly. The several different disturbances cause external root resorption; it can be either orthodontically provoked or acquired by trauma, virus, or congenital diseases.
The simplest orthodontic movement, which involves only a single force in one direction, is which of the following?
A. Intrusion B. Tipping C. Molar uprighting D. Bodily movement
B. Tipping:
is easily accomplished by exerting a single force on the crown of a tooth in either the buccal or lingual direction. When this is carried out, the tooth will rotate around its center of resistance, which is located halfway down the root of the tooth. The greatest pressure will be felt at the apex of the tooth and the crest of the alveolar bone. Intrusion (choice A) is the process of moving a maxillary tooth up (or down for a mandibular tooth) toward the apex. This is very difficult due to the slow bone resorption at the apex and the difficulty of anchorage in exerting an intrusive force. Molar uprighting (choice C) is similar to the tipping process but is complicated by the involvement of multiple roots. Bodily movement (choice D) involves two forces, one at the crown of the tooth and one at the root of the tooth. The involvement of these two forces is necessary to accomplish movement of the entire tooth.
