Spring - Pedo Final

Question 1

What percent of children in the US have special health care needs? And out of them, how many have trouble in life?

Answer 1

15% and then 60%

Question 2

What is the definition of SHCN, special health care needs?

Answer 2

Those with “any physical, developmental, mental, sensory, behavioral, cogni5ve, or emo5onal impairment or limi5ng condi5on that requires medical management, health care interven5on, and/or use of specialized services or programs.”

Question 3

What percentage of GP’s and pedo dentists respectively each treat children with SHCN?

Answer 3

GP’s 10% and Pedo’s 95%

Question 4

What are the purposes of the new patient exam with SHCN kids?

Answer 4

Goal is to establish the “Dental Home”
Iden5fy child as a pa5ent with SHCN prior to first visit
Schedule extra 5me
Obtain and record list of medical providers, consult when necessary
Never treat a stranger, especially in the case of pa5ents with SHCN
LISTEN, establish a rela5onship, reduce anxie5es, develop trust

Question 5

What is protective stabilization?

Answer 5

Defined as “any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely.”

Question 6

What is active immobolization vs passive immobilization?

Answer 6

Ac#ve immobiliza5on involves restraint by another person, such as the parent, den5st, or dental auxiliary.

Passive immobiliza5on u5lizes a restraining device.

Question 7

What are the three indications for protective stabilization?

Answer 7

1. A pa5ent requires immediate diagnosis and/or limited treatment and cannot cooperate because of lack of maturity or mental or physical disability.
2. A pa5ent requires diagnosis or treatment and does not cooperate ader other behavior management techniques have failed.
3. The safety of the pa5ent, staff, parent, or prac55oner would be at risk without the use of protec5ve stabiliza5on.

Question 8

What are the four contraindications for protective stabilization?

Answer 8

1. A coopera5ve nonsedated pa5ent.
2. Pa5ents who cannot be safely stabilized due to medical or physical condi5ons.
3. Pa5ents who have experienced previous physical or psychological trauma from protec5ve stabiliza5on (unless no other alterna5ves are available).
4. Nonsedated pa5ents with non-emergent treatment requiring lengthy appointments.

Question 9

What are the Do’s and Dont’s of protective stabilization?

Answer 9

Protec5ve stabiliza5on must NOT be used as punishment Protec5ve stabiliza5on must NOT be used solely for convenience
Pa5ent record MUST display informed consent, indica5ons for use, type of stabiliza5on used, and dura5on of applica5on
Tightness and dura5on of stabiliza5on MUST be monitored and reassessed at regular intervals Stabiliza5on around the extremi5es or chest must NOT ac5vely restrict circula5on or respira5on
Stabiliza5on MUST be terminated as soon as possible in a pa5ent who is experiencing severe stress or hysterics to prevent possible physical or psychological trauma

Question 10

What are the common disabilities or disorders you see with kids?

Answer 10

Intellectual Disabili5es 
Learning Disabili5es 
Down Syndrome (Trisomy 21) 
Au5sm Spectrum Disorder 
Cerebral Palsy 
Asthma

Question 11

What defines mild intellectual disability?

Answer 11

A child with mild intellectual disability is one who, because of low intelligence, requires
special supports in the school environment.

Question 12

What percent of mild intellectual disability patients will function acceptably as adults?

Answer 12

80%

Question 13

What defines moderate intellectual disability?

Answer 13

A child with moderate intellectual disability can be expected to master many voca5onal, leisure, and self-help skills within a suppor5ve environment with trained personnel who help them with problems with which they may not be able to cope on their own.

Question 14

What defines severe intellectual disability?

Answer 14

A child with severe or profound intellectual disability may present a significant challenge and may be grouped in special educa5on programs or group homes.

Question 15

Children with intellectual disability usually never have a higher incidence of poor oral hygiene, gingivi5s, malocclusion, and untreated caries. True or False?

Answer 15

False, they usually do.

As the severity of intellectual disability increases, typical oral signs of clenching, bruxing, drooling, pica, trauma, missing teeth, and self-injurious behaviors increase.

Providing dental treatment for a person with intellectual disability requires adjus5ng to social, intellectual, and emo5onal delays.

Question 16

What are some tips to treating kids with intellectual disability?

Answer 16

Give the family a brief tour of the office before ajemp5ng treatment.
Be repe55ve; speak slowly and in simple terms.
Make sure explana5ons are understood by asking the pa5ent if there are any ques5ons. Give only one instruc5on at a 5me.
Ac5vely listen to the pa5ent.
Invite the parent/guardian into the operatory for assistance and to aid in communica5on. Keep appointments short and simple.
Schedule the pa5ent’s visit appropriately.

Question 17

What is a learning disability in kids?

Answer 17

Defined as a neurological condi5on that interferes with the individual’s ability to store, process, or produce informa5on.

May affect a person’s ability to read, write, count, speak, or reason.
May affect memory, ajen5on, coordina5on, social skills, and emo5onal maturity.
Learning disabili5es may run in families, indica5ng a possible gene5c factor, and are some5mes confused with intellectual disabili5es, au5sm, deafness, and behavioral disorders.
They include condi5ons that have been referred to as perceptual handicaps, brain injury, minimal brain dysfunc5on, dyslexia, and developmental aphasia.

Question 18

What percent of kids have a learning disability, and more in boys or girls?

Answer 18

(3-15% and 4x more prevalent in boys)

Question 19

Most children with learning disabilities accept dental care and cause no unusual management problems for the dentist. True or False?

Answer 19

True

Question 20

What are the odds of getting Trisomy 21?

Answer 20

1 in 691

Question 21

What are the characteristics of Trisomy 21?

Answer 21

Trisomy 21 (1:691)
Learning disabilities
Cardiac anomalies, leukemia, respiratory infec5ons Underdeveloped midface, prognathic occlusal rela5onship Mouth breathing
Open bite, crowding
Appearance of macroglossia
Fissured lips and tongue
Angular cheili5s
Delayed erup5on 5mes
Missing and malformed teeth
Low level of caries
High incidence of rapid, destruc5ve periodontal disease

Question 22

What percent of down syndrome kids have cardiac anomalies?

Answer 22

40%

Question 23

What are the odds of being autistic?

Answer 23

1 in 68. Also more in boys, 10 fold increase in last 10 years.

Question 24

What does the dental caries risk attribute to for autistic kids?

Answer 24

Dental caries risk due to behavioral and sensory issues affec5ng oral hygiene measures and dietary challenges.

Question 25

What are some tips to treating autistic kids in your office?

Answer 25

Consider a “get to know you” visit
Have office forms filled out prior to appointment Schedule plenty of 5me
Ask Mom and Dad for help
Break down appointments into small tasks
Use familiar products
Avoid surprises
Consistent rela5onships
Recognize limita5ons
Periodic seda5on can be indicated

Question 26

What causes cerebral palsy? And what are the characteristics of it?

Answer 26

Caused by insult, permanent damage to brain in the prenatal and perinatal periods

One of the primary handicapping condi5ons of childhood
1.5-3:1000
Muscle weakness
s5ffness, or paralysis
Poor balance or irregular gait, and uncoordinated or involuntary movements Intellectual disability
Seizure disorders
Sensory deficits or dysfunc5ons
Speech disorders 
Joint contractures 
Periodontal disease 
Dental caries 
Malocclusions Bruxism
Trauma

Question 27

What are some tips to treating cerebral palsy kids?

Answer 27

Consider trea5ng a pa5ent who uses a wheelchair in the wheelchair
If pa5ent requires transfer to a dental chair, ask about preference for mode of transfer Stabilize the pa5ent’s head throughout all phases of dental treatment
Place, maintain pa5ent in midline of dental chair, with arms and legs close
Keep the pa5ent’s back slightly elevated to minimize difficul5es in swallowing
Determine pa5ent’s degree of comfort and assess the posi5on of the extremi5es
Use stabiliza5on judiciously to control flailing movements of the extremi5es
Consider mouth props, but consider gag and swallowing reflexes, and 5me
Minimize startle reflex reac5ons
Introduce intraoral s5muli slowly to avoid elici5ng a gag reflex or to make it less severe
Consider the use of the rubber dam
Work efficiently and quickly and minimize pa5ent 5me in the chair
Seda5on or general anesthesia may be an op5on for more complex pa5ents

Question 28

What are the odds of having Asthma as a kid?

Answer 28

1 in 10

Question 29

Asthma is the second leading cause of pediatric hospitalization and school absenteeism. True or False?

Answer 29

False, it is numero uno

Question 30

What are the main asthma triggers?

Answer 30

Triggers: anxiety, exercise, respiratory infec5ons, allergens, cold air, smoke, pollu5on

Question 31

What are the symptoms and characteristics of asthma patients?

Answer 31

Presenta5on:
wheezing
labored or rapid breathing chest 5ghtness
coughing
gasping, inability to talk
Intermijent or Persistent
Mild, moderate or severe

Decreased saliva5on with prolonged use of B2 agonist inhaler
Increased risk of candidiasis with prolonged use of cor5costeroid inhaler
Increased caries risk
Increased gingivi5s
Airway related orofacial changes - high palatal vault, overjet, increased facial height

Question 32

How do you treat asthma kids?

Answer 32

Consult with physician as necessary
Pa5ent should have an inhaler, but always stock in emergency kit Pre-dosing in moderate to severe cases prn
Avoid prolonged supine position, treat in more upright position
Postpone treatment in presence of respiratory infec5on
Minimize aerosolized dental materials such as acrylic
Minimize stress
Nitrous oxide acceptable
Always prepare for uncontrolled asthma5c episode requiring interven5on

Question 33

From the Utah survey, what percentage of special needs kids have all of their needed preventive dental care?

Answer 33

10.9

Question 34

From the Utah survey, what percentage of special needs kids did not have all of their needed preventive dental care?

Answer 34

77.4

Question 35

From the Utah survey, what percentage of special needs kids did not need other dental care?

Answer 35

70.2

Question 36

From the Utah survey, what percentage of special needs kids got all needed other dental care taken care of?

Answer 36

25.8

Question 37

From the Utah survey, what percentage of special needs kids had other unmet dental care needs?

Answer 37

4.1

Question 38

Children with Down syndrome may show delays of up to 2 years. True or False?

Answer 38

True

Question 39

Children can often get herpetic gingivostomatitis or herpes labialis before 6 months of age. True or False?

Answer 39

False

Question 40

Herpetic Gingivostomatitis only takes place in children. Usually under the age of 12. True or False?

Answer 40

False, can occur in adolescents and young adults.

Question 41

What are the main medications associated with gingival overgrowth?

Answer 41

1. Calcium channel blockers
2. Phenytoin sodium
3. Cyclosporine

Question 42

What three special needs diagnoses are frequently seen in Utah?

Answer 42

1. Trisomy 21, Down Syndrome
2. Cleft Lip and Palate
3. Craniofacial Syndromes

Question 43

What is the average age for a baby with Down Syndrome to get their first tooth?

Answer 43

12-14 months, maybe 24 months

Question 44

What is the average age for a baby with Down Syndrome to get all baby teeth by?

Answer 44

4-5 yrs, whereas normal is 2-3 years. Permanent incisors and 6 year molars may not erupt until 8-9 yrs of age.

Question 45

What are the four main things to consider prior to dental procedures for sedating special needs kids?

Answer 45

1. Behavior/ communication
2. Airway obstruction
3. GER
4. Atlantoaxial instability

Question 46

What is the most common craniofacial anomaly?

Answer 46

Most common is cleft lip and/or palate

Question 47

How many newborns are affected each year with cleft lip and/or palate?

Answer 47

1 in 750. Approximately one-half of these infants have associated malformations, either minor or major, occurring in conjunction with the cleft

Question 48

What is the Utah average for cleft lip/palate newborns?

Answer 48

1 in 450. No change in rate during 13 years of surveillance.

Question 49

When did the whole idea behind TEAMS attacking cleft palates first appear in literature?

Answer 49

1998

Question 50

According to the 1998 TEAM standard, which professionals make up the team?

Answer 50

Oral surgeon, Orthodontist, Speech pathologist

Question 51

According to the 1998 TEAM standard, what four tools were used to treat patients?

Answer 51

1. CT and MRI
2. Cephalometric radiographs
3. Dental study models
4. PICU

Question 52

What four things are vital to reduction of mortality from craniofacial operations?

Answer 52

1. Establishment of a dedicated surgical team
2. Frequent performance of operative procedures
3. Adequate support facilities
4. Longitudinal follow-up

Question 53

What does the A, B, C, D, E, and F stand for in the Initial Clinical Assessments?

Answer 53

A - airway
B - breathing
C - circulation
E - exposure
F - feeding

Question 54

What two syndromes are involved in complex craniofacial clefting?

Answer 54

1. OAVS

2. Goldenhar’s Syndrome

Question 55

Referral for team evaluation and management of special needs children is only appropriate within the first few years of life. True or False?

Answer 55

False. The optimal time for the first evaluation is within the first few weeks of life and, whenever possible, within the first few days. However, referral for team evaluation and management is appropriate for patients at any age.

Question 56

Care should be coordinated by the team but should be provided at the local level whenever possible; however, complex diagnostic and surgical procedures should be restricted to major centers with the appropriate facilities and experienced care providers. True or False?

Answer 56

True

Question 57

What is esophageal atresia?

Answer 57

You don’t have an intact communiciation in your esophagus (child can’t feed, life threatening)

Question 58

Why is spina bifida associated with latex sensitivity?

Answer 58

These patients because of frequent contact with medical professionals are at risk with latex sensitivity (spina bifida and latex sensitivity go hand in hand)

Question 59

If you have a patient with a non-lethal condition, you are federally and professionally obligated to give that person a full life. True or False?

Answer 59

True. If a person has a lethal condition, this is a different story.

Question 60

What orofacial characteristics are often associated special needs kids?

Answer 60

— Maxillary (upper jaw) hypoplasia
— Decreased anterior and posterior face height
— Anterior open bite
— Hypodontia
— Oligodontia
— Maxillary and mandibular planes rotate forward

Question 61

What are the two main characteristics of down syndrome involving the teeth?

Answer 61

Oligodontia and Macrodontia

Question 62

What are the three levels to dental care?

Answer 62

1. Primary (GP)
2. Secondary (Specialist)
3. Tertiary (subspecialist, in a facility with a tertiary care setting such as OR, anesthesiology)

Question 63

What are two popular combinations with down syndrome patients?

Answer 63

Clefts and Ectodermal dysplasia

Question 64

What three things does ectodermal dysplasia affect?

Answer 64

1. Hair (pilosebaceous complexes, anhydrosis)
2. Teeth (hypodontia) (conical, reduced VD)
3. Nails (sebacious complexes)

Question 65

With what type of patients is bruxism common?

Answer 65

Neuro patients. Treatment is generally extraction.

Question 66

Why would we test for alkaline phosphatase levels in pedo special needs patients?

Answer 66

Because of hypohphosphatasia, and early severe perio disease. Odontophosphotasia is an increase in a particular type of phosphate. Only involves the roots of teeth.

Question 67

What does CPAP stand for and what does it do with special needs patients?

Answer 67

CPAP – continuous pressure alternating pressure -> provides positive pressure to open up the airway

• Good option unless the midface is so far back that the mask won’t fit
• If you put pressure on a growing bone then it goes back

Question 68

What is the characteristic look of Gastroesophageal Reflux (GER)?

Answer 68

Cobble stoning. Bright red and pebbly appearance in the posterior pharyngeal wall) in the throat and erosion

• Score the tonsils
• Score the throat

Question 69

What are the two components of Asthma?

Answer 69

1. Inflammation

2. Allergic reaction

Question 70

In the study, what percentage of kids aged from 6 to 11 exhibited oral habits such as nail and object biting, sucking, tongue thrusting, or lip and cheek biting?

Answer 70

33-37%

Question 71

What were the five conclusions from the Sucking habits in Saudi children study?

Answer 71

1. Sucking habits were found in nearly half of 3- to 5-year-old Saudi children with dummy sucking as the dominant type.
2. We found no significant effect of gender difference, child birth rank, or family income on the prevalence of sucking habits.
3. Parents’ educational level is positively related to dummy-sucking habit with no appreciable effect on digit-sucking.
4. Prevalence of digit and dummy-sucking was the lowest among children who have good opportunity for breastfeeding.
5. A significant relationship was found between persistent sucking habits and malocclusion in the form of distal molar and class II canine relationship, increased overjet, and anterior open bite. Posterior crossbite is no more common in sucking habits than in children without these habits.

Question 72

What is the effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits?

Answer 72

The presence of crossbite was high in children with severe airway obstruction, particularly in those with hypertrophied adenoids and tonsils. On the contrary, most of the children with a posterior crossbite did not have a history of pacifier or finger sucking.

Question 73

What did the study on dental arch diameters and relationships to oral habits conclude?

Answer 73

In most cases, dummy use and mouth breathing were associated with a reduction in the intercanine distance in the maxillary arch. A dummy habit leads to a reduction in maxillary arch width, and mouth breathing causes a reduction in the size of both arches.

Question 74

What is the etiology of bruxism?

Answer 74

The etiology of bruxism includes habit, emotional stress (response to anxiety, tension, anger, or pain), parasomnias, neurologic abnormalities, tooth malocclusion, and, rarely, a medication side-effect.

Question 75

The etiology of bruxism is usually identified fairly quickly. True or False?

Answer 75

False, it is often unknown

Question 76

For children younger than 8 years, treatment is usually not required for bruxism. True or False?

Answer 76

True

Question 77

There is an improvement of bruxism after tonsil and adenoid surgery. True or False?

Answer 77

True

Question 78

What are the four main causes of bruxism?

Answer 78

1. High anxiety level
2. Malocclusion
3. TMD
4. Oral habits

Question 79

What are the main four therapeutic approaches for bruxism?

Answer 79

1. Oclusal adjustment of dentition
2. Interocclusal appliances
3. Behavior modification
4. Pharmaceuticals

Question 80

The relationship between oral habits and unfavorable dental and facial development is cause and effect rather than associational. True or False?

Answer 80

False, that is backwards

Question 81

Habits of sufficient frequency, duration, and intensity may be associated with dentoalveolar or skeletal deformations such as increased overjet, reduced overbite, posterior crossbite, or long facial height. True or False?

Answer 81

True

Question 82

With sucking habits, the magnitude of force is more important than duration. True or False?

Answer 82

False, duration is more important, with resting pressure form lips, cheeks, and tongue having the greatest impact on tooth position.

Question 83

What five things has prolonged nonnutritive sucking habits been associated with?

Answer 83

1. Decreased maxillary arch width
2. Increased overjet
3. Decreased overbite
4. Anterior open bite
5. Posterior crossbite

Question 84

It is recommended to provide parents with guidance to help their children to stop sucking habits by what age or younger?

Answer 84

36 months

Question 85

Evidence indicates that juvenile bruxism has far-reaching effects into adulthood. True or False?

Answer 85

False, it is self-limiting and does not persist in adults

Question 86

What are some treatment modalities for kids with physchiatric disorders, traumatic brain injuries, etc, to avoid mouth and tooth damage?

Answer 86

Lip bumpers, occlusal bite appliances, protective padding, and extractions.

Question 87

Research says that mouth breathing may contribute to the development of increased facial height, anterior open bite, increased overjet, and narrow palate, but it is not the sole or even the major cause of these conditions. True or False?

Answer 87

True

Question 88

What five things can obstructive sleep apnea syndrome be associated with?

Answer 88

1. narrow maxilla
2. crossbite
3. low tongue position
4. vertical growth
5. open bite

Question 89

What are the four main specialists that oral habit problems are referred to?

Answer 89

1. Orthodontists
2. Psychologists
3. Myofunctional therapists
4. Otolaryngologists

Question 90

The use of an appliance to manage oral habits is indicated only when the child wants to stop the habit and would benefit from a reminder. True or False?

Answer 90

True

Question 91

What part of the skull dictates how the face grows for the most part?

Answer 91

Calvarium

Question 92

What type of disease are children with clefts more susceptible to?

Answer 92

Meniere’s disease

Question 93

What is the common vaccine worried about with tooth injuries?

Answer 93

Tetanus

Question 94

A force strong enough to fracture, intrude, or avulse a tooth is also strong enough to result in cervical spine or intracranial injury. True or False?

Answer 94

True

Question 95

What is a class I crown fracture?

Answer 95

Simple involving little or no dentin

Question 96

What is a class II crown fracture?

Answer 96

Involving considerable dentin but no pulp

Question 97

What is a class III crown fracture?

Answer 97

Extensive fracture of crown with exposure of dental pulp

Question 98

What is a class IV crown fracture?

Answer 98

Loss of entire crown

Question 99

According to Ellis and Davey’s classification for tooth fractures, what is Class I through Class IX?

Answer 99

I = enamel only
II = dentin but no pulp
III = dentin and pulp
IV = tooth becomes non-vital
V = avulsion
VI = fracture of root without loss of crown
VII = displacement of tooth with neither crown or root fracture
VIII = displacement and crown fractureWha
IX = traumatic injuries of primary teeth

Question 100

What is the treatment order (#1-9) for a broken tooth?

Answer 100

1. Soft tissue
2. Pulp therapy
3. Repositioning
4. Stabilization
5. Restoration
6. Extraction
7. Medication (Tylenol at night, Ibu during day)
8. Referral
9. Record treatment and rationale

Question 101

You should always restore a crown fracture on the first visit in order to prevent future complications. True or False?

Answer 101

False, tooth might be traumatized. A temporary cover of dentin can be accomplished easily without to much additional trauma to tooth, this is often the treatment of choice. Often the temporary resin can be left on, when final restoration is finished.

Question 102

What is pulpal hyperemia?

Answer 102

A trauma of even a so-called minor nature is immediately followed by pulpal hyperemia. Difficult to determine the initial pulpal response and in predicting the long-range reaction of the pulp, congestion of blood in the pulp chamber can often be seen in exam, color often appears reddish

Question 103

What is internal hemorrhage

Answer 103

Hyperemia and increased pressure may cause the rupture of capillaries and the escape of red blood cells, with subsequent breakdown and pigment formation. The extravasated blood may be reabsorbed before gaining access to the dentinal tubules, in which case little if any color change will be noticeable and what does appear will be temporary.

More severe case, there is pigment formation in dentinal tubules. The change in color is evident within 2 to 3 weeks after the injury, and although the reaction is reversible to a degree, the crown of the injured tooth retains some of the discoloration for an indefinite period.

Pulp may remain vital, if color change remains dark-grey likelihood of vitality is low.

Question 104

Discoloration that becomes evident for the first time months or years after an accident, however, is evidence of a necrotic pulp. True or False?

Answer 104

True

Question 105

According to the study, what percent of dark grey teeth that had been pulpectomized ended up being necrotic?

Answer 105

98%

Question 106

What is calcific metamorphosis of the dental pulp?

Answer 106

A frequently observed reaction to trauma is the partial or complete obliteration of the pulp chamber and canal.

The crowns of teeth that have undergone this reaction may have a yellowish, opaque color. Primary teeth demonstrating calcific metamorphosis will usually undergo normal root resorption

Permanent teeth will often be retained indefinitely. However, a permanent tooth showing signs of calcific changes as a result of trauma should be regarded as a potential focus of infection.

Question 107

What is internal resorption?

Answer 107

• Destructive process thought to be caused by odontoclastic action
• May be observed radiographically in the pulp chamber or canal within a few
  weeks or months following injury
• Destructive action may progress slowly or rapidly
• If caught soon enough, it may be able to be stopped with endodontic procedures
• Is associated with a pink spot

Question 108

What is external root resorption?

Answer 108

• Trauma with damage to the periodontal structures may cause external root resorption.
• The reaction starts from outside, the pulp may not become involved
• Resorption usually continues unabated until root structure is gone
• Usually seen in severe trauma which there has been some degree of displacement of tooth

Question 109

What are the characteristics of pulpal necrosis?

Answer 109

• Little relationship exists between the type of injury to the tooth and the reaction of the pulp tissue and surrounding tissues
• A severe blow causing displacement may sever the apical vessels.
• A less severe blow that doesn’t cause displacement can also cause damage to apical vessels which may eventually cause pulpal necrosis
• A tooth injury that causes coronal fracture as opposed to displacement has a better pulpal prognosis.
• Injured teeth with pulpal necrosis often are asymptomatic and radiograph initially
normal
• Some teeth do not recover and external and internal resorption may occur and therefore need to be WATCHED!!!

In a less severe type of injury, the hyperemia and slowing of blood flow through the pulpal tissue may cause eventual necrosis of the pulp. In some cases the necrosis may not occur until several months after the injury.

Question 110

How is a necrotic pulp treated on a primary tooth?

Answer 110

• A necrotic pulp in an anterior primary tooth may be successfully treated if no extensive root resorption or bone loss has occurred.
• Trauma to the periapical tissues during canal instrumentation must be carefully avoided. After the canal has been properly prepared via a facial access in this example, it is filled with slow-setting zinc oxide–eugenol. The canal walls are first lined with a thin mix of the canal-filling material. A thicker mix should then be placed in the pulp chamber. Over this is placed a pledget of cotton, and the material is forced into the canal with a small amalgam plugger.

Question 111

What are the characteristics of Ankylosis?

Answer 111

• Another reaction observed after trauma to anterior primary and permanent teeth is Ankylosis
• A condition caused by injury to the PDL and subsequent inflammation which is associated with invasion of osteoclastic cells.
• This results in irregularly resorbed areas on the PDL surface
• This causes a mechanical lock or fusion between alveolar bone and the root surface
• Adjacent teeth continue to erupt, whereas the ankylosed tooth remains fixed in relation to surrounding structures.

Question 112

How do you treat primary and permanent ankylosed teeth respectively?

Answer 112

• The ankylosed anterior primary tooth should be removed if there is evidence of its causing delayed or ectopic eruption of the permanent successor. If ankylosis of a permanent tooth occurs during active eruption, eventually a discrepancy between the position of this tooth and its adjacent ones will be obvious. The uninjured teeth will continue to erupt and may drift mesially, with a loss of arch length. Therefore either surgical repositioning or the removal of a permanent tooth that becomes ankylosed is often necessary, especially if the ankylosis occurs during the preteen or early teen years.

Question 113

When bonding a composite resin restoration to a fracture, slight beveling of the fractured enamel margins is usually recommended with the feathered-edge technique to remove loose enamel rods and ensure a fresh surface for etching. True or False?

Answer 113

True

Question 114

Calcium hydroxide is often put on exposed dentin of fractured teeth. True or False?

Answer 114

True.
The exposed dentin may be protected with a layer of hard-setting calcium hydroxide, and etching should extend 2 or 3 mm beyond the fracture to allow an adequate surface for feather-edging of the resin restorative materials.

Question 115

According to the study, what percent of the patients had changes to permanent teeth caused by previous injuries to primary dentition?

Answer 115

40%

Question 116

Generally the developing permanent tooth buds develop buccally to the root of the primary tooth. True or False?

Answer 116

False, lingually. With an intrusion, the intruded primary tooth generally remains labial to Permanent tooth bud.

Question 117

If primary tooth intrudes on lingual area and displaces permanent tooth bud it should be removed. True or False?

Answer 117

True. Intruded primary teeth should be observed; no attempt should be made to reposition them after the accident. Most injuries of this type occur at an age when it would be difficult to construct a splint or a retaining appliance to stabilize the repositioned teeth.

Question 118

What are the possible outcomes for an intruded primary tooth?

Answer 118

Primary anterior teeth intruded as a result of a blow may often re-erupt within 3 to 4 weeks after the injury.

During the first 6 months after the injury, however, the dentist often observes one or more of the reactions of the pulp and supporting tissues that have been mentioned previously in this chapter, the most common of which is pulpal necrosis. Even after re-eruption, a necrotic pulp can be treated if the tooth is sound in the alveolus and no pathologic root resorption is evident.

Question 119

How do you treat primary teeth that have been displaced but not intruded?

Answer 119

Primary teeth that are displaced but not intruded should be repositioned by the dentist or parent as soon as possible after the accident, to prevent interference with occlusion. The prognosis for severely loosened primary teeth is poor. Frequently the teeth remain mobile and undergo rapid root resorption.

Question 120

What did the study conclude regarding the prognosis of loosened teeth with teeth with root formation and completed and teeth with uncompleted root formation?

Answer 120

He concluded that the immediate and future prognosis for the pulp was more favorable if root formation was still incomplete at the time of the accident. Root resorption, which was observed in all three groups of loosened teeth, was most common in impaction cases. Teeth with complete root formation seemed to undergo resorption more frequently than those with incomplete root formation. However, when resorption did occur, it was more extensive and progressed more rapidly in teeth with incomplete root development.

Question 121

Intruded permanent teeth have a poorer prognosis than primary teeth. The tendency for the injury to be followed by rapid root resorption, pulpal necrosis, ankylosis. True or False?

Answer 121

True

Question 122

What is the treatment for a permanent tooth with closed apex and only intruded 3mm or less?

Answer 122

Treatment for permanent tooth with closed apex and only intruded 3mm or less is to let tooth erupt without intervention. WATCH, may need to pull down with orthodontics.

Question 123

What is the treatment for a permanent tooth with closed apex and only intruded or extruded 7mm?

Answer 123

Reposition tooth surgically and stabilize for 4-8 weeks with a flexible splint.
Pulp will become necrotic, root canal treatment started 2-3 wk after stabilization, fill with Ca(OH) initially to stop external resorption.

Question 124

How do you treat a permanent tooth that has intruded less than 7 mm with an open apex?

Answer 124

Allow it to erupt spontaneously If doesn’t erupt within 2-4 weeks orthodontically reposition.

Question 125

How do you treat a permanent tooth that has intruded more than 7 mm with an open apex?

Answer 125

If Permanent tooth is intruded more than 7mm, surgically reposition tooth and stabilize with flexible wire for 4-8 weeks.
Endodontic therapy should be initiated with Ca(OH) monitor closely before initiating endodontic treatment

Question 126

In immature permanent teeth that underwent spontaneous eruption after intrusion had the highest failure rate. True or False?

Answer 126

False, had the lowest.

Question 127

Extrusive luxation of a permanent tooth usually results in pulpal necrosis. True or False? And how do you treat it?

Answer 127

True. Treatment is repositioning of tooth, splinting with a flexible splint, and initiation of Ca(OH) endodontic treatment.

Question 128

The need for endodontic intervention is usually always warranted in cases of significant extrusion (more than 2 mm) of mature teeth. True or False?

Answer 128

True

Question 129

Replantation of permanent teeth continues to be practiced and recommended, however, slow or rapid root resorption often occurs with even the most precise and careful technique. True or False?

Answer 129

True

Question 130

What are the advantages to replantation?

Answer 130

1. Sometimes prolonged retention is achieved, especially when replanted rapidly
2. The replanted tooth serves as a space maintainer and often guides adjacent teeth into their proper position in the arch.
3. The replantation procedure also has psychological value.

Question 131

Replantation should be viewed as a temporary treatment. True or False?

Answer 131

True. Sometimes can last 5-10 years, sometimes only months. Most common age is 7-9 years. 3 times more frequent in boys.

Question 132

What is the most common age for an avulsion and are boys are girls more likely?

Answer 132

7-9 years, 3X more with boys

Question 133

What did the study say about replanted teeth within 30 minutes?

Answer 133

90% showed no evidence of resorption 2 or more years later

Question 134

What did the study say about replanted teeth more than 2 hours later?

Answer 134

95% had showed root resorption

Question 135

Do you get a better outcome with a open or closed apex for a replanted tooth?

Answer 135

Open apex. With closed, pulpotomies and Ca(OH) should be done within a few days.

Question 136

Primary teeth should be replanted when possible. True or False?

Answer 136

False, never.

Question 137

What should you tell parents when they call asking about what to do with their child’s avulsed tooth?

Answer 137

1. Make sure no other injuries, neurologic, or other higher priority injuries;
2. Primary teeth are not replanted.
3. Keep patient calm.
4. Find tooth, pick up by crown, avoid touching the tooth.
5. If tooth is dirty, wash it briefly (10seconds) under cold running water and reposition it. Try to encourage patient/parent to replant tooth. Bite on a handkerchief to hold tooth in position.
6. If repositioning is impossible, place tooth in suitable storage medium.
7. Seek emergency dental treatment immediately, unless patient needs other medical help

Question 138

In replanting teeth, the preservation of an intact and viable periodontal ligament is the most important factor in achieving healing without root resorption. True or False?

Answer 138

True

Question 139

When a patient arrives to your office with a displaced tooth, what are the steps you should take?

Answer 139

If an evaluation of the socket area shows no evidence of alveolar fracture or severe soft-tissue injury, the tooth is intact, and only a few minutes have elapsed since the injury, the dentist should replant the tooth immediately. Under the conditions just described, every effort should be directed toward preserving a viable periodontal ligament. Trope correctly asserts that treatment should be directed at avoiding or minimizing the resultant inflammation that occurs as a direct result of the two main consequences of tooth avulsion: attachment damage and pulpal infection. If the tooth was cleanly avulsed, it can probably be replanted without local anesthetic, and obtaining the initial radiograph can also be delayed until the tooth is replaced in the socket and held with finger pressure. The minutes saved may contribute to a more successful replantation. If a clot is present in the socket, it will be displaced as the tooth is repositioned; the socket walls should not be scraped with an instrument. If the tooth does not slip back into position with relative ease when finger pressure is used, local anesthesia and a radiographic evaluation are indicated. Local anesthetic should also be administered when fractured and displaced alveolar bone must be repositioned before the tooth is replanted. Soft-tissue suturing may be delayed until the tooth has been replaced in the socket; however, the suturing should be performed to control hemorrhage before the tooth is stabilized with a bonded splint.

Question 140

What are the good storage mediums for avulsed teeth?

Answer 140

1. Tooth must be kept moist, dehydration of tooth is damaging.
2. Hanks’ buffered saline- sometimes sold in stores.
3. Isotonic saline if available.
4. Pasteurized Cow’s milk is probably the most favorable medium that is easily available.
5. Tap water is not very good because is hypotonic and leads to cell lysis, but is better than dehydration.

Question 141

How long is a splint usually put on after replanting a tooth?

Answer 141

7-14 days. More severe subluxation, teeth that have been laterally displaced fracturing the alveolar process, splint 4-6 weeks.

Question 142

What are the eight criteria for an acceptable splint for a replanted tooth?

Answer 142

1. It should be easy to fabricate directly in the mouth without lengthy laboratory procedures.
2. It should be able to be placed passively without causing forces on the teeth.
3. It should not touch the gingival tissues, causing gingival irritation.
4. It should not interfere with normal occlusion.
5. It should be easily cleaned and allow for proper oral hygiene.
6. It should not traumatize the teeth or gingiva during application.
7. It should allow an approach for endodontic therapy. 8. It should be easily removed.

Question 143

When should endo/pulpectomy be done on a replanted tooth?

Answer 143

The pulp should be extirpated before the splint is removed, however, and preferably within 1 week after the injury. A sterile, dry cotton pellet or one dampened with CMCP and blotted on sterile gauze may be sealed in the pulp chamber after debridement and irrigation. The canal should be filled approximately 2 weeks after the injury. When the canal is filled, calcium hydroxide paste is the material of choice.

Root canal treatment should be initiated 7 to 10 days after replantation. Early extirpation of the pulp may help to control the early onset of inflammatory root resorption. Filling the root canal with calcium hydroxide also controls and may even arrest external inflammatory root resorption. If the calcium hydroxide is placed in the canal too soon (before adequate healing of the periodontal ligament), however, it may stimulate replacement root resorption. Andreasen suggested that 2 weeks after replantation is the ideal time to fill the canal with calcium hydroxide. The use of calcium hydroxide as a root-canal–filling material was described previously in the discussion of apexification.

The calcium hydroxide material used to fill the root canal should be replaced every 3 to 6 months until a decision is made to fill the canal with gutta-percha. The optimum duration of the calcium hydroxide treatment is unknown, but generally calcium hydroxide should be kept in the canal for at least 6 months or until root end closure (apical plug) occurs beyond 1 year. In cases in which an adjacent tooth is still unerupted, calcium hydroxide treatment is recommended until eruption of the adjacent tooth. It is believed that eruption may stimulate or accelerate the resorptive process in a nearby replanted root.

Question 144

How do oral electrical burns occur?

Answer 144

1. Childplacesfemaleendofa“live” extension chord into mouth
2. Childsucksorchewsonexposed or poorly insulated electrical wires
3. Electrolyte-richsalivaprovidesa short circuit between the chord terminals and mouth
4. Resultedinanarcphenomenon
5. Involvesintenseheatthatcauses
   coagulation tissue necrosis

Question 145

How do you treat oral burns?

Answer 145

• Control of minor hemorrhage, possibility of spontaneous arterial hemorrhage can occur in first 3 wks
• Check immunization status
• Possibly give broad spectrum antibiotics
• Treatment of choice is prosthetic
appliance to prevent contracture of healing tissue and create normal- appearing commissure

Question 146

When is direct pulp capping a traumatized tooth the best option?

Answer 146

If the patient is seen within an hour or two after the injury, if the vital exposure is small, and if sufficient crown remains to retain a temporary restoration to support the capping material and prevent the ingress of oral fluids, the treatment of choice is direct pulp capping.

But iff the final restoration of the tooth will require the use of the pulp chamber or pulp canal for retention, a pulpotomy or a pulpectomy is the treatment of choice.

Question 147

How is direct pulp capping done on a fractured tooth?

Answer 147

•Thin layer of dentin-type material placed over exposed pulp
then sealed with a bonded restoration,
•Most important is to seal and protect pulp tissue from oral fluids

Calcium hydroxide and MTA are great

Question 148

When is a pulpotomy on a traumatized tooth indicated?

Answer 148

If the pulp exposure in a traumatized, immature permanent (open apex) tooth is large, if even a small pulp exposure exists and the patient did not seek treatment until several hours or days after the injury, or if there is insufficient crown remaining to hold a temporary restoration, the immediate treatment of choice is a shallow pulpotomy or a conventional pulpotomy.

A SHALLOW or partial pulpotomy is preferable if coronal pulp inflammation is not widespread and if a deeper access opening is not needed to help retain the coronal restoration. Pulpotomy is also indicated for immature permanent teeth if necrotic pulp tissue is evident at the exposure site with inflammation of the underlying coronal tissue, but a conventional or cervical pulpotomy would be required. Yet another indication is trauma to a more mature permanent (closed apex) tooth that has caused both a pulp exposure and a root fracture. In addition, a shallow pulpotomy may be the treatment of choice for a complicated fracture of a tooth with a closed apex when definitive treatment can be provided soon after the injury

Question 149

How is the pulpotomy performed for a fractured tooth?

Answer 149

• Exposure site should be conservatively enlarged,1-2 mm of coronal pulp tissue removed for shallow or all tissue in pulp chamber removed for conventional pulpotomy
• Clean with copious irrigation, control hemorrhage with wet cotton pellet
• Dressing of Calcium Hydroxide gently placed to fill chamber
• Fill last of chamber with hard setting material to seal
• Tooth, then can be restored with bonded material

Question 150

What is apexogenesis?

Answer 150

In instances of complicated fractures of young permanent teeth with incomplete root growth and a vital pulp, the pulpotomy technique is the procedure of choice. The successful pulpotomy allows the pulp in the root canal to maintain its vitality and also allows the apical portion to continue to develop (apexogenesis).

Question 151

What is apexification and what are the steps?

Answer 151

Instead of apical surgery, a less traumatic endodontic therapy called apexification has been found to be effective in the management of immature, necrotic permanent teeth. The apexification procedure should precede conventional root canal therapy in the management of teeth with irreversibly diseased pulps and open apices.

1. Under rubber dam access the tooth, with files clean out the canal, rinse with hydrogen peroxide and sodium hypochlorite, dry canal with paper points and cotton.
2. Either wait 4 days or this apt fill canal with thick paste of calcium hydroxide. Excess should not be pushed beyond apex. Seal canal opening with cotton pledget and ZOE
3. Let tooth sit for 6 months, determine if a “positive stop” has been created. If not retreat check in 2-3 months./ if yes fill with gutta-percha

Question 152

What are the percentages for special needs health care patients who have unmet needs with dental being the most common? And what percentage of americans exhibit 80% of caries?

Answer 152

24%, and 20%