Diagnosis, Radiography and Treatment Planning for the Pediatric Patient

Question 1

Oral examination:

Answer 1

Answer
questions in axiUm chart
(i.e. gingival health,
presence of ulcers etc.)
Remember to look at the
gingival tissues as well as
the teeth

Question 2

Role of Dental Prophylaxis
(4)

Answer 2

Remove
Demonstrate
Facilitate
Introduce

Question 3

Remove

Answer 3

Remove plaque/calculus – You may need a
scaler if there is calculus

Question 4

Demonstrate

Answer 4

Demonstrate proper hygiene methods to
parent/caregiver

Question 5

Facilitate

Answer 5

Facilitate a thorough clinical examination

Question 6

Introduce

Answer 6

Introduce the patient to dental procedures

Question 7

SEQUENCE OF EVENTS
Remember that the dentist is
the one who prescribes
—
— is used to
determine how the patient
may respond to radiographs
COMPLETE THE ORAL EXAM
AND PROPHYLAXIS BEFORE
DECIDING WHAT
— TO TAKE

Answer 7

radiographs
Prophylaxis
RADIOGRAPHS

Question 8

Charting

Answer 8

Primary teeth (A-T)
Permanent teeth (un-
erupted, missing)

Question 9

Charting
Chart —
after your clinical exam
Use this information to
determine which
— you want to
take.
Then re-chart adding
areas of — that can be
seen radiographically

Answer 9

caries and teeth
radiographs
decay

Question 10

Occlusal Examination
Evaluate presence/absence of
— – developmental
— present or absent
Note — status ie. Mesial step, Distal step or Flush terminal plane
Note — relationship ie. Class I, II or III
Note crowding

Answer 10

spacing
Primate Spaces
occlusal
Canine

Question 11

Primate spaces are present in two locations:
(2)

Answer 11

Maxillary Primate Space - between the primary maxillary
canine and primary maxillary lateral incisor.
Mandibular Primate Space – between the primary
mandibular canine and primary mandibular first molar.

Question 12

Developmental Spaces

Answer 12

Developmental spaces are the spaces between the primary
anterior teeth maxillary and mandibular.
These spaces along with the primate spaces help to alleviate
crowding during the transition from the primary dentition to
the mixed dentition and permanent dentition.

Question 13

Molar Relation
If the permanent first molars are unerrupted use the molar
relation terminology of

Answer 13

mesial step, flush terminal plane, or
distal step.
If the patient has permanent molars, use Angle’s Classification
of Class I, II, and III.

Question 14

PRIMARY DENTITION
When looking at the primary dentition to determine
the molar relationship you want to focus on the
relation of the

Answer 14

distal surfaces of the maxillary and
mandibular primary second molars.

Question 15

Flush Terminal Plane –

Answer 15

the distal surface of the
maxillary and mandibular second primary molars
are in the same plane.

Question 16

Mesial Step –

Answer 16

the distal surface of the mandibular
second primary molar is mesial to the distal
surface of the maxillary second primary molar.

Question 17

Distal Step –

Answer 17

the distal surface of the mandibular
second primary molar is distal to the distal
surface of the maxillary second molar.

Question 18

FIRST PERMANENT MOLARS
When looking at the molar relation and the patient has

Answer 18

firstpermanent molars focus on the MB cusp of the maxillary firstmolar in relation to the buccal groove of the mandibular firstmolar.

Question 19

Class I -

Answer 19

the MB cusp of the maxillary first permanent molaris located in the buccal groove of the mandibular firstpermanent molar.

Question 20

Class II –

Answer 20

the MB cusp of the maxillary first permanent
molar is located mesial to the buccal groove of themandibular first permanent molar.

Question 21

Class III –

Answer 21

the MB cusp of the maxillary first permanent
molar is located distal to the buccal groove of the mandibularfirst permanent molar.

Question 22

Canine Relation
Class I -

Answer 22

the distal incline of the mandibular canine
occludes with the mesial incline of the maxillary canine.

Question 23

Canine Relation
Class II -

Answer 23

the distal incline of the mandibular canine occludes distal to the
mesial incline of the maxillary canine.

Question 24

Canine Relation
Class III -

Answer 24

the distal incline of the mandibular canine occludes mesial to
the mesial incline of the maxillary. canine

Question 25

End to End -

Answer 25

when the patient is in centric occlusion and the incisal edges of the upper and lower incisors are contacting.

Question 26

Open Bite -

Answer 26

when the patient is in centric occlusion and the posterior teeth are in contact but the upper and lower incisors are not overlapping.

Question 27

OVERBITE

Answer 27

The amount of vertical overlap that is present between the incisal edge of the maxillary central incisors and mandibular central incisors.

Question 28

Malocclusion Class I -

Answer 28

Normal relationship of molars, but the line of occlusion incorrect because of malposed teeth, rotations, or other causes.

Question 29

Malocclusion Class II -

Answer 29

Upper molar mesially positioned relative tolower molar.

Question 30

Malocclusion Class III -.

Answer 30

Upper molar distally positioned relative tolower molar

Question 31

CROWDING

Answer 31

Inadequate arch length to accommodate the mesial- distal width of all the teeth in the arch.

Question 32

SPACING

Answer 32

Excess arch perimeter compared to the total mesial-distal width of all the teeth in the arch in the permanent or mixed dentition, not including space from lost primary teeth or developmental spaces in the primary dentition.

Question 33

Crossbite Anterior –

Answer 33

maxillary incisors occlude lingual to the mandibular incisors.

Question 34

Crossbite Anterior oUnilateral -

Answer 34

occurs on one side of the arch or only on one tooth.

Question 35

Crossbite Anterior oBilateral -

Answer 35

occurs on both sides of the arch.

Question 36

Crossbite Anterior oFunctional -

Answer 36

caused by an occlusal interference that requires the mandible to shift anteriorly in order to achieve maximum occlusion.

Question 37

Crossbite Posterior -

Answer 37

buccal cusps of the maxillary posterior teeth occlude lingual to the buccal cusps of the mandibular posterior teeth.

Question 38

Crossbite Posterior oUnilateral -

Answer 38

occurs on one side of the arch or only on one tooth.

Question 39

Crossbite Posterior oFunctional shift –

Answer 39

caused by an occlusal interference that requires the mandible to shift laterally in order to achieve maximum occlusion. Most posterior crossbites in pediatric patients are functional in nature

Question 40

Crossbite Posterior oBilateral -

Answer 40

occurs on both sides of the arch.

Question 41

Identify any oral habits that the patient exhibits. This may include but is not limited to: (4)

Answer 41

Mouth breathing Tongue thrusting Thumb/Digit sucking Lip biting

Question 42

Oral Habits (4)

Answer 42

Pacifier versus thumb Frequency, duration, intensity Alters oral structures Can be reversed

Question 43

Low Risk =

Answer 43

Optimal fluoride exposure Consumption of cariogenic foods at mealtime High caregiver socioeconomic status Regular use of dental care

Question 44

Moderate Risk =

Answer 44

Suboptimal fluoride exposure Occasional between-meal snacks with cariogenic snacks Midlevel caregiver socioeconomic status Irregular use of dental services

Question 45

High Risk =

Answer 45

Suboptimal fluoride exposure Frequent cariogenic snacks Low-level caregiver socioeconomic status No usual source of dental care

Question 46

Prescribing Radiographs: New Patient Primary Teeth/No visible caries/No closed contacts =

Answer 46

= NO BITEWINGS

Question 47

Prescribing Radiographs: New Patient Primary Teeth/No visible caries or pathology/Closed contacts=

Answer 47

BITEWINGS

Question 48

Prescribing Radiographs: New Patient Mixed Dentitions/No visible caries/Closed Contacts =

Answer 48

BITEWINGS AND PANORAMIC FILM OR SELECTED PERIAPICAL FILMS

Question 49

Panoramic Films Mixed dentition –

Answer 49

preferably after first permanent molars and permanent incisors have all erupted Delaying until those teeth have erupted will give you a better idea of permanent canine positioning Take another panoramic film after the 2nd permanent molars have erupted to evaluate the presence of 3rd molars

Question 50

Prescribing Radiographs : Return Patients (Recall Patients) – Based upon Caries risk and clinical findings Recall patients with clinical caries or ↑ caries risk=

Answer 50

Bitewings every 6-12 months if contacts closed

Question 51

Recall patients with primary dentition and no clinical caries and ↓ caries risk=

Answer 51

Bitewings every 12 - 24 months if contacts closed

Question 52

Recall patients with mixed dentition and no clinical caries and ↓ caries risk =

Answer 52

Bitewings every 18- 36 months if contacts closed

Question 53

radiographsAdditional Films

Answer 53

“Sandwich bite” films sometimes prescribed to evaluate anterior teeth (maxillary and/or mandibular) These are prescribed as periapical films Particularly if there is a history of missing teeth in the family Can be used to introduce the child to radiographs

Question 54

Bitewing Radiographs Should capture

Answer 54

distal of cuspids and extend posteriorly

Question 55

Position tube head perpendicular to

Answer 55

embrasures to open contacts

Question 56

Vertical angulation of +--- degrees Sometimes use vertical bitewings to help patient tolerate ---

Answer 56

10 films

Question 57

BitewingsRemember that children have “---” mandibles and maxillae You need to position the cone accordingly

Answer 57

shorter

Question 58

Periapical RadiographsIndicated for suspected or identified Evaluate (4)

Answer 58

pathology Evaluate dental development Evaluate trauma Evaluated deep caries Evaluate oral aspects of suspected systemic disease

Question 59

Periapical films Bisecting angle technique:

Answer 59

central ray directed perpendicular to the plane that bisects the angle created by the long axis of the tooth and film

Question 60

What size film? In most cases size -- film is used for bitewings and periapical films in young children Progress to size -- films as soon as the patient can tolerate the size

Answer 60

0 2

Question 61

Other Risk Factors – Health Conditions (3)

Answer 61

Active Caries Present in Mother Children with special health care needs Conditions that impair salivary flow/composition

Question 62

Infant/Toddler Examination Should be recommended to occur at

Answer 62

12 months of age or within 6 months of the eruption of the first tooth Knee-to- Knee position facilitates exam

Question 63

How to prepare:

Answer 63

1. Check out BOE (for mirror) 2. Wear full PPE (do not need glasses or bib for patient) 3. Doctor’s chair facing chair with no wheels for parent & patient outside the cubicle 4. Place overhead light over chairs within reach

Question 64

When your patient arrives: Get Let Complete

Answer 64

child’s height and weight if child is cooperative (if they are very young and/or unable to stand, ask parent if they know recent approximate height and weight) child sit comfortably with parent while obtaining medical history and medications appropriate forms for child’s age and fill out all questions you can without having to look in the child’s mouth

Question 65

GRAB A MEMBER OF THE PEDO FACULTY --- YOU DO YOUR EXAM!

Answer 65

BEFORE

Question 66

Anticipatory Guidance for Caregivers

Answer 66

Anticipatory guidance is the process of providing practical, developmentally- appropriate information about children’s health to prepare parents for the significant physical, emotional, and psychological milestones. Individualized discussion and counseling should be an integral part of each visit. Topics to be included are oral hygiene and dietary habits, injury prevention, nonnutritive habits, substance abuse, intraoral/perioral piercing, and speech/language development.

Question 67

Treatment Sequence Avoid --- procedures on first appointment if at all possible

Answer 67

traumatic – We don’t extract teeth first if we don’t have to do so

Question 68

Mandibular versus maxillary arch injections –

Answer 68

Variable among faculty and practitioners

Question 69

Quadrant dentistry is ideal but may not be practical with dental students who are learning Nitrous oxide/oxygen analgesia recommendations –

Answer 69

using nitrous must be “justified” in the notes. Why are we using it???

Question 70

Appointment Based UMKC Sequence

Answer 70

1st Appointment Exam and prophy/radiographs and treatment plan Remember we do not “screen” patients. They are your patients to begin providing care to immediately. Re-appoint for restorative care if needed. If no care needed place the patient on a 6 month recall Ask faculty for help and don’t be afraid to ask questions Peers may not have the correct information Inactivations/transfers must be done with Pedo faculty only

Question 71

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