Test 2 Flashcards
What is the practice, teaching of, and research in comprehensive preventive and therapeutic oral health care of children from birth through adolescence; with particular focus on providing oral health care to clients with special needs?
Pediatric Dentistry
How has the focus of pediatric dentistry changed over the years?
Focus has changed from restoration to prevention
When is the most desirable time to begin preventative dental care?
First year of life
What time period focused on extractions only?
1900’s
What time period finally had an organized group to promote dentistry for children?
1920’s
What time period focused on restorative?
1940’s
What time period focused on preventive?
1950’s
When did Crest become the first ADA approved fluoridated toothpaste?
1964
When was the effectiveness and usefulness of sealants endorsed?
1983
How are pediatric offices different?
Treatment areas are open bay concept
Dental personnel in bright coordinating colours
Display cheerfulness, pleasant evnironment with a nonthreatening decor
What are the different types of ages?
Chronological
Emotional
Mental
What is concrete thinking?
Seeing things in a very literal way
What is abstract thinking?
Involves insight, sudden perception and problem solving
What are Paiget’s Stages of Child Development?
- Sensorimotor (0-2)
- Preoperational (2-7)
- Concrete Operations (7-11)
- Formal Operations (11-15)
What are the characteristics of the sensorimotor stage?
0-2 years old
Dominated by sucking and grasping
Learn primarily through touch, sight, sound, and manipulation
Intelligence does not involve reflective thought
Looks towards sounds
Smiles in response to voices
Mimics people
Does not understand object permanence
What are the dental relevancies of the sensorimotor stage?
Too young to respond rationally to dental needs
Very curious
Parents should be modeling ideal practices for child
What are the preoperational stage characterisitics?
2-7 years old
Starts to use symbols and language
Focuses on obvious characterisitics of an object
Cannot think in reverse
What are the dental relevancies of the preoperational stage?
Child remains fairly concrete in their thinking
Need regular dental visits
May need restorative work
May have bad oral habits (thumb sucking)
May be difficult to manage
Use simple language involving the five senses
What are the characteristics of the concrete operations stage?
7-11 years old
More evaluative in their thought process
Non so egocentric
Reversibilty in problem solving is present
Fixed on the concrete still
What are the dental relevancies of the concrete operations stage?
More capable of coping in anxious situations
Value of OH can be discussed
What are the characteristics of the formal operations stage?
11-15 years old
Develop ability to think abstractly
What is defined as techniques used to modify a response from a client relative to the success of the dental procedure?
Behaviour management
What scale was developed to measure paediatric patient’s behaviour?
Frankl Scale
What it the Frankl Scale for?
To alert the next clinican as to the behavoiur of the patient
What does a 1 mean on the Frankl scale?
Definitely negative, refusal of treatment
What does a 2 mean on the Frankl scale?
Negative, reluctance to accept treatment
What does a 3 on the Frankl scale mean?
Positive, acceptance of treatment
What does a 4 on the Frankl scale mean?
Definitely positive, good rapport with dental team
What are the goals of behaviour management?
Avoid or minimize pain
Reduce or mange a child’s anxiety
Protect child and operator
Teach child difference between painful and nonpainful stimuli
Enhance child’s self esteem
Install a positive attitude to OH
Permit efficient and effective treatment
What is defined as a repeated response or reaction to stimulus?
Behaviour Patterns
True or False: once the child is successful in having his or her own way, they will repeat the behaviour
True
What are the principles of the guidance co-operational model?
- Tell the child ground rules before and during treatment
- Praise co-operative behaviour
- Keep your cool
- Use voice control
- Allow the child to play a role
- Avoid attempting to talk a child into co-operation
When should parents be present in the operatory?
With children under 4
Initial appointment for young children
During OH/tx plan intstruction
Emergency care
Foreign language speaking clients
Selected special needs
How to work with a parent in the operatory?
Inform parent of office guidelines
Children do best when parent is out of child’s vision
Parent is relaxed
Parent leaves if child is not cooperating
What type of child is non-communicative reacting by becoming passive or quiet, may cry, have nightmares, or wet the bed?
The Quiet Child
How to address the quiet child?
Keep talking and reassuring, eventually the child will respond if handled correctly
What type of child may fall asleep as a reaction to anxiety, fatiuge, hunger or professional’s personality or voice?
The Sleeper
How to manage the sleeper?
Not a problem except may need mouth prop and requires caution not to startle the child when awakening.
What type of child asks dozens of questions?
The Curious Child
How to manage the curious child?
Inform child that there will be no surprises and you will explain everything. If the child gets carried away, repeat instructions in a firm voice.
What type of child may be boisterous, spoiled, manipulative, defiant and may exhibit coughing, gagging, desire to vomit, urinate or defecate? They may cry and scream hysterically, ask for parents or give you various commands.
The Uncooperative Child
How to manage the uncooperative child?
If gentleness and logic fail, reiterate that you sympathize with them.
Let them know that behaviour is unacceptable.
Use voice warnings.
Set rules of behaviour.
Use another approach
Complete one procedure
Ask parents to speak to child
Premdicate or gas
What type of child has possible negative past experiences and may cry?
The Apprehensive Child
How to manage the apprehensive child?
Encourage child to talk about fears
Do not say don’t worry or don’t cry
Who does early childhood caries affect?
Children under 6
True or False: Acute hepetic gingivostomatitis primary herpetic infections go unnoticed in some preschoolers.
True
How does actue herpetic gingivostomatitis manifest?
Intraorally as inflamed gingiva with yellow or white fluid-filled vesicles. These vesicles are usually found on the mucous membranes and will rupture forming painful ulcers. Child is unable to tolerate any acidic food or beverages and is often tired or irritable
True to False: children accumulate plaque quickly but do not get the inflammation that an adult experiences.
True
What used to be acceptable within sports on account of the game but new legislation for prevention has changed tis outlook within the community?
The “hockey” smile
An athlete is __x more likely to sustain damage to the teeth when not wearing a mouthguard.
60x
When must signs of ADD be present to get a diagnosis?
Before the age of 7 and persisted for at least 6 months
Signs and symptoms of ADD
Easily frustrated
Trouble paying attention
Daydreaming
Moody behaviour
Fidgeting
Inconsistency
Impulsivity
Disorganization
Over/under reactive
Difficulty with fine motor skills
Easily confused
Disruptive/aggressive
Scocially immature
Shy/withdrawn
What are the interventions for ADD?
Child management training
Medication
Educational interventions
Social skills training
Psychologial therapy
Family counseling
What are the common side affects of ADD medications?
Dry mouth
Orthostatic hypotension
Nervousness
Drowsiness
Tics
Dizziness
What is defined as the period of growth and development that occurs in an individual as they move from childhood to adulthood?
Adolescence
What are the physical changes in adolescents?
Increase in muscle mass
Redistribution of body fat
Increase in rate of skeletal growth
Development of genital tissues and secondary sexual characteristics
Intellectutal changes during adolescence is called
The Formal Operational Stage
Why can young adolescents present a challenge for communication?
Because they are often intrepreted as being moody and sensitive
How to ensure successful dialogue with teens?
Determining what motivates existing habits
What are some motivational factors for communication?
Appearance
Fashion
Music
Sports
Celebrities
Will some teens want treatment without a parent present?
Yes
What are some environmental challenges for teens?
Smoking
Drugs
STIs
Peer pressure
Acne
More competitive education
Career decisions
Alcohol
Family pressure
Increased accidental trauma
What dental changes to adolescents experience?
All permanent teeth have erupted
Root formation is complete by 16 (except the 8s)
Ortho may be needed
Increase in gingivitis
Increase in caries
What is a gingival inflammation exaggerated by the hormonal fluctuations of puberty?
Puberty Associated Gingivitis
When does puberty associated gingivitis usually diminish?
By age 18
What are other factors that aggavate the gingivitis in this age group?
Ortho
Caries
What is the role of the dental hygienist for adolescents?
Educate parents and child of this hormonal condition and the extreme importance of proper oral hygiene.
What is a noncontagious infection that is common in young adults also known as Vincent’s Infection or Trench Mouth?
Necrotizing Gingivitis
When does necrotizing gingivitis usually occur?
When the individual’s resistance is low during periods of stress or illness.
What are the signs and symptoms of necrotizing gingivitis?
Blunted or cratered papillae
Bleeding
Greyish pseudomembrane covering the gingival margin
Oral pain
Fetid mouth ordor from bacterial accumulation
Poor appetite
Fever
Malaise
Treatment options for necrotizing gingivitis
Cleansing with hydrogen peroxide
Debridement with topical anaesthetics
Rinses with chlorhexidine
OHI
A loss of periodontal attachment and supporting bone in one or more locations occurs in ___% of teenagers.
5-46%
What is an aggressive form of periodontal disease that causes a rapid loss of the alveolar bone and peiodontal ligament supporting the permanent teeth?
Incisor/molar pattern periodontitis
Why is there an increase in dental caries during adolescence?
Poor OH
Poor nutrition
Anorexia
Bulimia
What is defined as a mental illness that results in phsyiological, biologic, physical, mental, emotional and deterioration of the person?
Eating Disorders
What are the top three eating disorders?
Anorexia Nervosa
Bulimia Nervosa
Binge Eating
When does anorexia most often first display signs?
Age 12-18
What are the oral manifestations of bulimia?
Perimolysis - erosion
Caries
Sore throat
Buring tongue
Angular cheilosis
Vitamin deficiences can cause dry mouth, glossitis, and bleeding gingiva
Palatal trauma
Enlarged parotid gland
Xerostomia
True or False: obesity is becoming an epidemic
True
Oral manifestations of obesity
Reduced saliva flow
Increase saliva flow
Gingival bleeding
Higher prevalence of perio
What is the second leading cause of death among adolescents?
Suicide
What common oral findings may be present with drug and alcohol abuse?
Periodontal disease
Bruxism
Oral cancer
Why is alcohol #1 on the abuse list?
- Readily available in most homes
- Inexpensive
- Easy to obtain from peers
More than ___ million adolescents have smoked cigarettes.
8.5 million
What refers to any tobacco that is placed in the mouth or nose without being ignited?
Smokeless tobacco
Smokeless tobacco users are __x as likely to develop an oral-pharyngeal carcinoma than non users.
4x
The risk of cancers of the gingiva and buccal mucosa increases ___x for smokeless tobacco users.
50x
What are the two types of cancers associated with smokeless tobacco?
Verrucous
Squamous cell carcinoma
What are the most common dental fears?
Injection or pain
Loss of control
Claustrophobic
Financial
Embarassment of dental condition
Dental office sounds
What are the physiological changes seen with dental fear?
Increased heart rate
Sweating
Decreased peripheral blood flow
Altered respiration
Altered gastric acitvity
Altered pain perception
The objectives of coping mechanisms are
To modify how threatening the client perceives the dental appointment and how the client feels they are going to manage an anxiety producing sitation
What behavioural management techniques are available for fearful clients
Distraction
Densensitization
FLooding
Behavioural modeling
What is the desensitization technique?
the client is instructed to imagine the appointment in small steps from beginning to end and substitute fear for a relaxation technique
What is the flooding technique?
Client imagines most fearful situation they can think of and are trained to relax while imagining them.
What are two new ideas for managing the fearful client?
Weighted blanket
Vitual reality
What are the guidelines for providing care for the fearful client?
- Avoid inflicting pain if possible
- Accidental pain should be identified and cause should be stopped
- Warnings of pain should be given
- Use gentle terminology
- Be truthful
- Go slowly
- Give praise
- Keep a quiet environment
What are a type of mental illnesses characterized by severe worry and nervousness that inferes with a person’s life?
Anxiety disorders
How many Canadians are affected by anxiety disorders?
4.5 - 15.3%
What are the medication choices for anxiety disorders?
SSRI’s
Tricyclic Antidepressants
Benzodiazepines
Monoamine Oxidase Inhibitors
