Guidelines Flashcards
Fluoride Use contributes to?
Prevention, inhibition and reversal of caries
What topics are included in anticipatory guidance/counseling?
diet, oral hygiene, nonnutritive habits, injury prevention, speech/language milestones, piercings, substance abuse
Injury prevention topics for the infant to young child should focus on what topics?
car seat, electrical cord safety, play objects, pacifiers.
Children with white spot lesions are considered what level of caries risk?
high
Xylitol use and its effects?
decrease MS levels in plaque and saliva and reduce dental caries
CRA is split into 3 categories which are?
biological, protective, and clinical findings
CRA biological factors for 0-5 yo indicating HIGH risk include?
primary caregiver has active caries, low SES, >3 sugary snacks or beverages, put to bed with bottle containing sugar
CRA biological factors for 0-5 yo indicating MOD risk include?
child with SN, recent immigrant
CRA clinical findings for 0-5yo indicating HIGH risk include?
dmfs>1, white spot or enamel defects present, elevated MS levels
CRA clinical findings for 0-5yo indicating MOD risk include?
plaque on teeth
CRA biological and clinical findings for >=6yo indicating HIGH risk include?
low SES >3 snacks >=1 interproximal lesion low salivary flow active WSL or enamel defect
CRA biological and clinical findings for >=6yo indicating MOD risk include?
recent immigrant
SHCN
defective restoration
intraoral appliance
Whats the difference in caries management protocol in >3yo for a high risk patient with an engaged parent and one without?
With an engaged parent, you can actively surveil incipient lesions, with a non-engaged parent you may want to restore incipient lesions.
Periodontal dx in pregnant patients is linked to what findings?
preterm deliveries, low birth weight babies, preeclampsia
primary goal of perinatal oral health care with regards to caries transmission?
lower cariogenic bacteria in mother to delay colonization of infant.
For pregnant women frequently vomiting, what remedy may help against erosion?
rinsing with a cup of water containing a teaspoon of baking soda and waiting an hour before brushing
In pregnant patients, what can help reduce plaque levels?
Fl toothpaste and rinsing with a sodium fluoride rinse or chlorhexidene rinse
Safest time to perform dental treatment on a pregnant pt?
second trimester
How many times should a pregnant pt chew xylitol gum ?
2-3 times a day to help reduce MS levels and colonization
what are some behaviors that parents can avoid which will help prevent early colonization of MS in infants?
avoid saliva sharing behaviors such as sharing utensils, cleaning a pacifier or toy, sharing cups
is human breast milk associated with increased risk of caries?
No, but frequent night time bottle feeding is.
What is associated with increased risk of caries in infants?
breastfeeding>7 times a day after 12 months, nighttime bottle feeding with juice, repeated use of no spill cup, and frequent snacking
When should third molars be removed?
when impaction or malposition can lead to caries, cysts, pericoronitis, periodontal problems, pain and generally when risks of early removal are less than risks of late removal.
What is positive youth development?
aspect of adolescent oral health care in which you build a strong interpersonal relationship with the patient addressing psychological and social needs.
what is perimyolysis?
enamel erosion seen in bulimics
nutrients of particular importance during pregnancy are?
b6 b12 folate calcium zinc
category A drugs in pregnancy?
studied in humans and safe to use
category B drugs in pregnancy?
show no evidence of risk to humans(Pen, Amox, Lido, Tylenol)
category C drugs in pregnancy?
use with caution, such as aspirin containing drugs and NSAIDs
category D drugs in pregnancy?
do not use, such as tetracycline
pregnant women who smoke increase risks of?
ectopic pregnancy, spontaneous abortion, preterm delivery, low birth weight infants, intellectual disability, clefts, SIDS
infants exposed to secondhand smoke have higher rates of?
lower respiratory illness, middle ear infections, asthma, and caries
What is the consensus on using bleaching products in pregnant females?
Avoid using them in females who have existing amalgam restorations as hydrogen peroxide can release inoraganic mercury into the bloodstream
what oral changes may occur secondary to pregnancy?
xerostomia, shift in microbial flora(to more anaerobic) causing periodontitis.
consensus on antacids used during pregnancy?
they have high sugar content and increase risk of caries
what drugs are not recommended during pregnancy?
aspirin containing products, nsaids(if necessary, avoid during 1st and 3rd trimester), erythromycin, tetracycline
aapd defines special health care needs as?
any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment that impose limitations in self-maintenance. Can be congenital, acquired, or developmental.
which shcn patients are most susceptible to effects of oral diseases?
pts with compromised immunity(leukemia, HIV), cardiac conditions associated with endocarditis
SCHN also include patients with disorders or conditions which manifest only in oro-facial complex, such as?
AI, DI, cleft lip/palate, oral cancer
What is the most common site of inflicted oral injuries?
lips, then oral mucosa, teeth, gingiva, and tongue
Unintentional or accidental injuries must be distinguished from abuse by?
judging whether the history, including timing and mechanism of injury is consistent with the characteristics of the injury
what finding in prepubertal children is pathognomonic of sexual abuse?
oral and perioral gonorrhea in prepubertal children
why is HPV resulting in oral or perioral warts not necessarily sexual abuse?
can be transmitted by oral-genital contact, vertically from mother to infant during birth, horizontally transmitted through nonsexual contact from a child or caregivers hand to mouth
ecchymoses, lacerations, or abrasions found in what pattern may indicate bite mark abuse?
ellipitcal or ovoid
Bite marks have a central area of ecchymoses caused two ways, which are?
positive pressure through biting or negative pressure through suctioning.
dog bite vs human bite?
dog bite tears flesh, human bite compresses flesh causing abrasions, lacerations, contusions
an intercanine distance measuring more than ? is suspicious of an adult bite
3.0 cm
what technique is employed to swab for DNA in potential abuse situations?
double swab technique. First use a sterile swab moistened with distilled water, then use a second dry swab on the same area. A third control swab is taken from an uninvolved area.
define dental neglect
willful failure of parent to seek and follow through with treatment
Fluoride mechanisms of action?
inhibit demineralization, promote remineralization, inhibit dental caries my affecting metabolic activity
fluoride toothpaste recommendations for less than 3 and greater than 3 yo?
rice size for less than 3, pea size for greater than 3
when are fluoride supplements considered?
in high risk children drinking fluoride deficient water(
what is xylitol?
5 carbon, naturally occurring sugar, found in trees, fruits, vegetables, and is intermediate product of glucose metabolic pathway.
Xylitol amount needed and its effects?
3-8g/day, reduces levels of MS in the plaque and saliva, works most effectively on erupting teeth, gum not recommended in less than 4yo(use syrup)
xylitol side effects?
gas and diarrhea. Can be reduced if xylitol introduced slowly
which pain intensity scales are used in pediatric dentistry?
FACES pain scale for ages 4-12, wong baker for children over 3.
communication in behavior management of a child is affected through what 4 characteristics?
dialogue, tone of voice, facial expression and body language.
the four essential ingredients of communication in behavior management are?
the sender
the message, including facial expression and body language
the context
the receiver
what characteristics influence a childs reaction to the dental setting?
age/cognitive level temperament/personality anxiety and fear reaction to strangers previous dental experience maternal dental anxiety
what are the goals of behavior guidance?
establish communication alleviate fear and anxiety deliver quality dental care build a trusting relationship promote positive dental attitude
Basic behavior guidance techniques include these communicative techniques
TSD voice control nonverbal communication positive reinforcement distraction
stabilization devices must be used with caution in patients with what medical history?
patients with respiratory compromise(asthma)
patients who will receive medications(local anesthetics, sedatives) that can depress respiration
what are contraindications to protective stabilization?
cooperative, non sedated patients
previous physical or psychological trauma from protective stabilization
patients who cannot be stabilized safely due to medical(asthma) or physical conditions(OI)
patients requiring non emergent treatment
When is sedation indicated?
fearful, anxious patient whom basic behavior guidance have not been successful
patients unable to cooperate due to psychological or emotional maturity
when sedation may protect developing psyche and reduce medical risk.
What to address in terms of infant feeding? What do you place in bottles?
formulas, breastmilk, or water in infant bottles.
Is milk considered cariogenic?
No, but it is a vehicle for cariogenic substances(chocolate powder)
Is breastmilk alone cariogenic?
No, but prolonged nighttime feeding is associated with increased risk for caries.
WSL in children younger than three classifies them as what?
SECC
What are indications for fluoride OTC rinses?
orthodontic appliances, radiation therapy, prosthetic appliances, high sucrose diet, high CRA
what type of filtration systems typically reduce fluoride levels?
reverse osmosis and distillation
Prevalence of fluorosis increasing or decreasing?
increasing, # of new cases is on the rise due to higher levels of ambient fluoride.
Fluoride toxicity treatment >8mg/kg and
8mg/kg, induce vomiting, give milk, go to ER
frequency of bw radiographs for low caries risk patient?
12 to 24 month interval in primary dentition
18 to 36 month interval in permanent dentition
CBCT benefit?
360 degree scan, can be used to scan specific locations, useful for evaluating bone
major biological risks associated with xrays?
carcinogenesis, fetal effects, mutations
for soft tissue trauma, what radiologic adjustment is made?
use 1/4 normal exposure time
plaque induced gingivitis may be associated with steroid hormones during which situations?
puberty
pregnancy
oral contraceptives
menstruation
these drugs cause gingival enlargement
phenytoin(dilantin) - antiepileptic
cyclosporin(immunosuppressant)
calcium channel blockers(nifedipine, almodipine, diltiazem)
key characteristics of drug induced gingival enlargement?
usually painless growth at interdental and marginal gingiva
regresses after cessation of drug
RELATED to plaque control
does not occur in edentulous areas
key characteristics of a gingival abscess? Treatment of gingival abscess?
painful, localized lesion of marginal or interdental gingiva of sudden onset
caused by embedded object(popcorn hull, fingernail
Treat by establishing drainage and chlorhexidene irrigation
characteristics of vitamin C associated gingivitis?
edematous, spongy gingiva
spontaneous bleeding
impaired wound healing
NUG/NUP characteristics and predisposing factors?
rapid, painful gingivitis with interdental and marginal necrosis and ulceration
peak incidence in late teens and early 20s in developed countries, seen in younger kids in less develop countries
can be febrile
predisposing factors are malnutrition, stress, lack of sleep
Tx is aggressive debridement, OHI, follow up care, NSAIDS for pain and metronidazole and amoxicillin
LAP characteristics in primary dentition?
attachment and bone loss in primary dentition, usually affects primary molars, children are otherwise healthy, inflammation not a prominent feature
LAP characteristics in permanent dentition? Vs GAP characertistics
bone loss
may have minimal plaque and calculus compared to normal child
usually affects perm incisors and molars and no more than 2 other teeth
Tx is metro in combination with amoxicillin and aggressive debridement.
GAP - exhibit marked perio inflammation and high levels of plaque and calculus
Hypophosphatasia features?
Genetic disorder
4 forms:perinatal, infantile, childhood, adult. The earlier the onset, the more lethal the disease
can see premature loss of primary teeth(incisors)
abnormal cementum
large pulp chambers
permanent teeth often not affected
hypophosphatasia diagnosis?
low alkaline phosphatase, phosphoethanolamine in urine
Leukocyte adhesion defect features?
generalized periodontitis in primary and young permanent dentition
frequent respiratory, skin, ear bacterial infections
Leukocyte adhesion defect treatment?
antibiotic therapy, OH, poss extraction of affected teeth
Papillon Lefevre syndrome features?
palmar and plantar hyperkeratosis
premature loss of primary and permanent teeth
Chediak Higashi Syndrome features?
oculocutaneous albinism, photophobia, nystagmus, neuropathy, severe gingivitis and periodontitis
Neutropenia features?
several forms severe gingivitis with ulceration premature loss of primary teeth severe periodontal disease in permanent dentition other soft tissue infections common
Langerhans cell histiocytosis features?
bone lesions may produce “floating teeth”
acute leukemia gingival features?
gingival enlargement due to leukemic infiltrates, usually in AML
Epinephrine and norepinephrine are contraindicated in what patients?
patients with hyperthyroidism
patients on TCA(due to dysrhythmias)
when halogenated gases are used for GA(myocardium sensitized to epi)
You may want to get a consult to use an LA with epi in these patients?
cardiovascular disease thyroid disease diabetes sulfite sensitivity those on MOA, TCA, or phenothiazines
allergy to one amide does not rule out use of another amide but allergy to one ester
rules out use of another ester
Why should local anesthetics without vasoconstrictors be used with caution?
due to rapid systemic absorption which can result in overdose
which local anesthetic can induce methemoglobinemia symptoms, which are?
prilocaine
blue cyanosis of lips, mucous membranes, and nails. Respiratory and circulatory distress
prilocaine contraindicated in what patients?
methemoglobinemia
sickle cell anemia
anemia
patients receiving acetaminophen or phenacetin
LA overdose objective symptoms of the CNS include?
Excitation followed by depression
muscle twitching, tremors, talkativeness, slowed speech, shivering, followed by seizure activity. Unconsciousness and respiratory depression may occur
LA overdose objective symptoms of the CVS include?
HR and BP increase followed by vasodilatation and BP decrease. Bradycardia and cardiac arrest may occur.
LA dose should be adjusted upward/downward when used with opioids?
downward as opioids like demerol also cause CNS depression and lower seizure threshold
what are contraindications to using nitrous oxide?
some COPD
emotional disturbances or drug related dependencies
first trimester of pregnancy
treatment with bleomycin sulfate
cobalamin deficiency
methyltetrahyrdofolate reductase deficiency
Most common adverse effects of nitrous oxide?
nausea, vomiting, diffusion hypoxia
Formocresol method of action in pulpotomys is?
tissue fixation
CaOH and MTA method of action in pulpotomys is?
mineralization
What is the concept of rescue in terms of sedation?
to be able to rescue a patient from a deeper unintended level of sedation
minimal sedation definition?
drug induced state in which patients respond normally to verbal commands
moderate sedation definition?
drug induced depression of consciousness in which patients respond purposefully to verbal commands either alone or with light tactile stimulation(tap on shoulder)
deep sedation definition?
drug induced depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated verbal or painful stimlation. May lose protective airway reflexes
the physical exam before sedating a child includes?
airway evaluation looking for
tonsillar hypertrophy
abnormal anatomy like mandibular hypoplasia
effect of herbal medicines on sedation medications?
many herbal medications inhibit p450, prolonging sedative agents.
general rule of thumb to evaluate sedation recovery in a patient?
if a patient is able to stay awake for 20 minutes in a quiet environment, and discharge when they are acting the same way as when they arrived.
The vast majority of sedation complications can be managed with simple maneuvers, like?
supplemental oxygen opening the airway suctioning bag mask valve ventilation OCCASIONALLY endotracheal intubation Laryngeal mask airway(for airway obstruction)
a minimum fasting period of 2 hours is required for these items before sedation?
clear liquids, including water, juices without pulp, carbonated beverages, black coffee and clear tea
a minimum fasting period of 4 hours is required for these items before sedation?
breast milk
a minimum fasting period of 6 hours is required for these items before sedation?
infant formula
cows milk
light meal consisting of toast and clear liquids.
asa class 3?
pt with severe systemic disease(actively wheezing)
asa class 2?
pt with mild systemic disease(controlled reactive airway disease)
Recommended Discharge criteria after sedation?
easily arousable and protective reflexes intact
patient can talk
patient can sit unaided
presedation level of responsiveness is achieved
What are some of the risks associated with sedation of pediatric patients?
hypoventilation apnea airway obstruction laryngospasm cardiopulmonary impairment
Is spontaneous ventilation and cardiovascular function usually maintained in moderate sedation?
yes
Is the ability to maintain ventilatory function present in deep sedation?
Yes, but it may be impaired
Is cardiovascular function usually maintained in deep sedation?
yes
is ability to maintain ventilatory function impaired in GA? Is ability to maintain cardiovascular function impaired in GA?
yes
CVS may be impaired
what are the goals of sedation?
guard patient safety and welfare
minimize discomfort and pain
minimize psychological trauma
control anxiety
control behavior and/or movement to allow safe completion of a procedure
return patient to a state of safe discharge
What type of sedative drug is recommended for painful procedures?
analgesic medications such as opioids
what type of sedative drug is recommended for non painful procedures?
sedative/hypnotics
what patients are candidates for mild, moderate or deep sedation?
asa 1 or 2 pts
what do you do if emergency sedation is required in a patient who just drank liquid or ate food?
weigh the risk of sedation and the possibility of aspiration against the benefits of performing the procedure promptly
which drugs, if combined with midazolam, can prolong sedation?
erythromycin, cimetidine, or any others that inhibit cytochrome p450
what medications can produce drug drug interactions with common sedation drugs used in pediatric dentistry?
HIV meds, anticonvulsants, psychotropic medications. Get a consult, always.
what should be a part of the health evaluation before a sedation?
age, weight, health history including system overview, meds, allergies, any think that may increase potential for airway obstruction(history of snoring/sleep apnea), previous sedations/GAs
what vital signs should be evaluated before and after sedation?
HR
BP
RR
Temperature
what is the SOAPME acronym meaning in terms of being prepared for a sedation emergency?
S = size appropriate suction equipment O = adequate Oxygen supply A = size appropriate airway equipment(endotracheal tubes, bag valve mask) P = Pharmacy(appropriate drugs) M = Monitors(pulse ox, BP cuffs, ECG) E = special Equipment or drugs for particular case(defibrillator)
what type of monitoring is required for minimal sedation?
just observation and intermittent assessment of their sedation
what type of monitoring is required for moderate sedation?
The practitioner - who must be able to perform bag valve mask ventilation(at the minimum) to be able to oxygenate a child who develops airway obstruction or apnea. Have knowledge of PALS
Support personnel to monitor physiologic parameters, have knowledge of BLS
What monitoring is required during moderate sedation?
continuous monitoring of oxygen saturation and heart rate, and intermittent recording of RR and BP at 5 mins
what personnel is required for deep sedation?
1 person to solely monitor patient vital signs, airway patency, adequacy of ventilation and to administer drugs.
1 person trained in PALS
1 support personnel
what equipment is required for deep sedation?
need a pulse ox, heart rate monitor, bp monitor, precordial stethoscope, record RR and an ECG monitor and a defibrillator. Must establish IV line placed for deep sedation
why is capnography useful in monitoring sedations?
helps diagnose the simple presence or absence of respirations, airway obstruction or respiratory depression, particularly in patients sedated in less accessible locations. Measures expired CO2
how many personnel are required for office based deep sedation/GA?
3, anesthesiologist, dentist, office staff
Factors for high caries risk include?
DMFS greater than childs age numerous white spot lesions high levels of MS Low SES high caries rate in siblings/parents diet high in sugar frequent snacking
is it always recommended to place SSC over teeth treated with pulp therapy?
No. Can place amalgam or resin restoration in a tooth with a conservative pulpal access, sound lateral walls and less than 2 years to exfoliation
what is the total etch technique?
3 steps. An etchant to remove smear layer, primer to penetrate the dentin, then a bonding agent.
what is the self etch technique?
2 step technique. The primer and bonding agent are combined, saving a step after etching
when is the most significant window of potential exposure to BPA?
right after placing resin based composites or sealants
how can you reduce BPA exposure ?
remove the residual monomer layer after placement by rubbing with pumiced cotton roll and thoroughly rinsing with an air water syringe
What are properties of GI that make them favorable to use in children?
chemical bonding to enamel and dentin
thermal expansion similar to that of tooth structure
biocompatiable
uptake and release of fluoride
decreased moisture sensitivity compared to resins
When do you use ITR?
very young patients uncooperative patients patients with special health care needs anyone for whom traditional cavity preparation needs to be postponed caries control
ITR and ATR are most successful when applied to what teeth?
single or small 2 surface restorations
GI are recommended for use as?
cements bases and liners cl 1,2,3 and 4 restorations in primary teeth cl 3 and 5 restorations in perm teeth caries control
purpose of resin infiltration?
halt progression of small proximal carious lesions by surrounding them with unfilled resin
what is the technique of resin infiltration?
treat with hydrochloric acid
dry the surface
infiltrate over 2 applications the unfilled resin
polymerize the resin with light
when are resin based composites contraindicated?
cant achieve isolation
patients needing large multi surface restorations in posterior primary dentition
in cl 2 restorations that extend beyond the proximal line angle
in high risk patients who have multiple caries and/or tooth demineralization and poor compliance
when are labial resins or porcelain veneers indicated?
restoration of mostly permanent anterior teeth with fractures, developmental defects, intrinsic discoloration, and/or other esthetic conditions
why are removable prosthetic appliances used?
maintain space
obturate congenital or acquired defects
esthetics/occlusal function
facilitate infant speech development or feeding
when should you take a radiograph of a primary tooth pulpectomy?
right after completion to assess fill and prognosis
indications of a protective liner in a vital primary tooth?
place in a vital primary tooth when all caries has been removed to minimize injury to pulp, promote pulp tissue healing and tertiary dentin formation
Indications of a direct pulp cap in primary teeth?
only done in primary teeth with a normal pulp following a small mechanical or traumatic exposure, NOT IN TEETH WITH A CARIOUS EXPOSURE. Place MTA or CaOH
what are the indications for a direct pulp cap in young permanent teeth?
young permanent tooth with normal pulp that has a small carious or mechanical exposure. Place MTA or CaOH over exposure site.
How do you perform apexification?
in non vital young permanent teeth.
Remove coronal and radicular tissue just short of apex
irrigate with hypochlorite or chlorhexidene
place CaOH for 2-4 weeks
Root end closure done with MTA, or with absorbable collagen wound dressing to allow MTA to be packed in, then obturate with gutta percha
Non nutritive sucking habits can lead to what changes?
excess OJ, decreased overbite, open bite, narrowed maxillary arch, posterior crossbite
what are factors that can lead to bruxism?
emotional stress, parasomnias, TBI, neurologic disabilities, malocclusion, muscle recruitment
what is the management for bruxism?
patient/parent education, occlusal splints, psychological techniques, and medications
what is tongue thrusting and what can it lead to?
abnormal tongue position(forward of the normal resting positon) and deviation from the normal swallowing pattern, associated with open bite, abnormal speech, protruding maxillary incisors
what are some dental treatment modalities for self injurious or self mutilating behaviors?
lip bumpers, occlusal bite appliances, protective padding, and extractions, odontoplasty
Mouth breathers can contribute to what malocclusion?
increased facial height, anterior open bite, increased oj, narrow palate.
OSAS may be associated to what malocclusion?
narrow maxilla, crossbite, low tongue positon, vertical growth, open bite.
excluding third molars, what is the most common missing permanent tooth?
mandibular second premolar followed by maxillary lateral incisor
a congenitally missing tooth can be suspected in what patients?
patients with asymmetric eruption sequence or ankylosis of primary mandibular second molars
Are supernumerary primary teeth followed by supernumerary permanent teeth?
in 1/3 of the cases
Mesiodens are usually found in what position?
palatal/lingual
what is the best way to locate a supernumerary tooth?
parallax or slob rule
recommended treatment for supernumerary primary tooth?
Not done, usually erupts into occlusion and exfoliates normally. Surgical extraction can harm developing permanent incisors
recommended extraction time for permanent supernumerary(mesiodens)
early mixed dentition to allow perm incisors to erupt spontaneously - about 1/2 to 2/3 root development of adjacent permanent teeth.
Later removal reduces chances of spontaneous eruption. If no eruption in 6 months, use ortho extrusion
When can you suspect EE of permanent incisors?
after trauma to primary incisors
pulplly treated primary incisors
with asymmetric eruption
mesiodens
how can distal tipping of permanent molars be accomplished
brass wires(.02 size, pt seen every few days for wire tightening), separators, elastics, fixed appliance with open coil spring, halterman appliance
when is extraction of the primary maxillary canine indicated?
when canine bulge cannot be palpated in the alveolar process and there is radiographic overlapping of the canine with the formed root of the lateral during the mixed dentition
how do you treat ectopically erupting incisors?
extract the necrotic or over-retained pulpally treated primary incisor in the early mixed dentition and align orthodontically when they erupt
ankylosis in the permanent dentition occurs most frequently following what type of trauma?
luxation injuries
when is extraction of an ankylosed primary tooth recommended?
exfoliation usually occurs normally but if tooth is over-retained, then extract
when is the best time to de-rotate teeth, specifically mandibular incisors?
just after emergence in the mouth. Transseptal fibers establish after CEJ passes alveolar crest
when is space maintainence considered for a primary maxillary incisor?
when the child has an active digit habit
What are undesirable effects of space maintainers?
interference with permanent eruption caries plaque accumulation inhibition of alveolar growth pain
what are some space regaining appliances?
fixed or removable appliances including
hawley retainer
lip bumper
headgear
what is a functional shift?
when the midlines undergo a compensatory shift when the teeth occlude in crossbite
how can you correct a simple anterior xbite?
acrylic incline plane
acrylic retainer with finger springs
fixed appliance with finger spring
if space is needed, then expansion appliance also used
facial bones like the maxilla and body of mandible grow by what type of bone formation?
intramembranous
the cranial base and condyle of the mandible grow by what formation?
endochondral
which type of bone formation is more modifiable with dentofacial orthopedics
intramembranous
how does the cranial vault form?
intramembranous
where does appositional growth predominate in the mandible?
posterior border of the ramus with remodeling resorption along anterior border
when do females usually have their growth spurt?
11 - 14 years
when do males usually have their growth spurt?
13.5 - 18 years
features of hypodivergent/brachyfacial face type?
posterior face greater than anterior face height
counter clockwise condylar rotation expressed as flat mandibular plane
deep bite
features of hyperdivergent/dolicofacial face type?
anterior vertical facial growth greater than posterior face height
clockwise condylar rotation expressed as steep mandibular plane
open bite tendency
gummy smile
lip cimpetence
what is the longest growing facial dimension?
depth(antero-posterior)
3 to 6mm of primary spacing results in what spacing/crowding in the mixed dentition?
no transitional crowding
spacing less than 3mm in primary dentition results in what spacing/crowding in the mixed dentition?
20% incisor crowding
no spacing in primary dentition results in what spacing/crowding in the mixed dentition?
50% incisor crowding
mesial step(15%) molar plane usually results in what class in permanent dentition?
cl 1
ftp molar plane(75%) usually results in what class in permanent dentition?
most shift to cl 1, some stay end on or shift to full cl 2
how do you replace prematurely lost primary incisors?
hollywood brige, space loss unlikely if primary canines erupted into occlusion
second primary molar loss results in greater dimensional arch length loss in max or mand?
in max
what appliances can you use in primary dentition to correct functional posterior crossbites?
RPE of haas, hyrax
w arch
quad helix
removable schwartz plate
what appliances can be used to treat a true class 3 anterior crossbite in the primary dentition?
reverse pull headgear/facemask
chin cup
MAY also require maxillary expansion
what age should you consider intervention with a NNS habit and appliance?
before eruption of permanent anterior teeth around 5-6 years of age
what appliances can be used for NNS habits?
cribs
rakes
bluegrass appliance
what molar classification is the most common in mixed dentition?
end on class 2 with majority shifting to class 1 with late mesial shift
what is upper leeway space on avg? lower leeway space?
0.9mm per quad on upper, 1.7mm per quad on lower
what appliances can you use to regain space in the maxillary arch?
headgear
fixed molar “distalizing” appliances - pendulum or distal jet
removable appliance
what appliances can you use to regain space in the mandibular arch?
lip bumper
“active” lingual arch
removable split-saddle
vast majority of children present with what amount of incisor crowding at 8 to 9 yo?
0 to 4mm
if patient has greater than 4mm of incisor crowding and has a hyperdivergent facial profile, what is the likely therapy?
extraction therapy because it deepens the bite
if patient has greater than 4mm of incisor crowding and has a hypodivergent facial profile, what is the likely therapy?
directed toward non-extraction therapy and arch expansion to open the bite
how much space can you gain by disking the ML corner of primary canines?
1 to 2mm per side, indicated when less than 3 to 4mm incisor crowding and when laterals actively erupting
what other treatment can you perform when incisor crowding is greater than 4mm?
can ext primary canines to coincident midlines and place LLHA
how many ectopically erupting permanent molars self correct?
2/3rds
irreversible ectopic molars are diagnosed with lack of self correction by what features?
dental age 7, supraerupting lower first molar above occlusal plane
what appliances can you use to correct ectopically erupting maxillary molar?
brass ligature wire
elastic separators
disking of primary second molar distal end
fixed palatal arch wire from E’s with distalization spring to first molar(Humphrey appliance)
fixed palatal arch wire from E’s with distalization elastics to bonded button on first molar(Haltermann appliance)
what features are usually present in a dental/functional anterior crossbite?
proclined lowers, retroclined uppers
what features are usually present in a skeletal anterior crossbite?
retroclined lowers, proclined uppers
what are features of a functional posterior crossbite in the mixed dentition?
midline shift to crossbite side
cl 2 molars on crossbite side
facial asymmetry - mandible shorter on crossbite side
what appliance/biomechanics can you use to correct isolated/single posterior crossbites in mixed dentition?
cross arch elastics
what appliance can you use to correct posterior crossbites in the mixed dentition?
cross arch elastics for single/isolated posterior xbite. w arch quad helix rpe of haas/hyrax removable schwartz plate
what is the treatment/intervention for excessive mesial orientation of the permanent maxillary canine?
removal of primary canine around the time permanent canine has 2/3 root development
when do you remove supernumerary teeth?
when no harm will come to developing permanent teeth, when 1/2 to 2/3 root development of adjacent permanent teeth
To modify growth(fix xbites, cl 2/3 malocclusions), one must treat during active growth periods, such as when?
in conjunction with pubertal growth spurt or earlier
Cl 2 Div 1 malocclusion features?
normal maxilla
retrognathic mandible
vertical growth tendency
ANB>6
Cl 2 Div 2 malocclusion features?
normal maxilla
mild mandibular retrognathia
deepbite growth tendency
ANB
what functional appliances are used in a Cl 2 malocclusion with a retrusive mandible? When should you not use a functional appliance?
bionator/orthopedic corrector activator frankel herbst(displaces mandible forward, restrains maxilla) mara
They increase lower face height, dont use in dolichofacial growers!
what functional appliances are used in a cl 2 malocclusion with a protrusive maxilla?
cervical pull headgear(opens bite)
high pull headgear(deepens bite)
what functional appliances are used in anteroposterior cl 3 malocclusions?
restrain mandibular growth by:
chin cup therapy
protract maxilla by using:
extraoral reverse pull headgear(facemask)
dont use in dolichofacial growing patterns
indications of general anesthesia?
patients for whom LA is ineffective
extremely uncooperative, anxious, fearful, physically resistant patient
patients with extensive orofacial/dental trauma
patients for whom GA would protect developing psyche
contraindications to GA?
respiratory infection
active systemic disease with temperature
NPO violation
healthy, cooperative patient with minimal dental needs
how do NPO guidelines relate/differ for 3yo?
Both are 2 hours for clear liquids and less than 3 is 6 hours for solids/milks and >3yo is 8 hours for solids/milk
what are ways to manage a childs psyche before general anesthesia?
operating room tour
allowing child to bring favorite toy
allowing parent/guardian to join patient as early as possible in recovery room
asa class 4?
severe life threatening systemic disease or disorder
when is a physical examination required before GA?
within 30 days of procedure
Universal protocol for GA cases include what three topics?
SIGN IN
TIME OUT
SIGN OUT
what is part of the universal protocol of sign out?
hemostasis achieved
mouth thoroughly inspected, foreign bodies removed
throat pack removed
what monitoring equipment is recommended for GA?
precordial stethoscope bp cuff ecg temperature probe pulse ox capnograph monitors
whats the dental preop protocol for patient protection?
tape eyes
shoulder roll and head rest
stabilized endotracheal tube
drape appropriately
function of throat pack?
prevent anesthesia gas backflow and debris backflow
thoroughly irrigate and suction oro/nasopharynx before insertion
use a moist, sterile guaze
what are possible intra-operative complications during GA?
dislodged endo/nasotracheal tube
disconnected or infiltrated IV
nasal bleeding
lips and tongue edema
For post surgical orders, you want to maintain IV until patient is stable. What is calculated IV rate for a 35kg patient?
4-2-1 method. 40+20+15=75ml/hr
when do you discontinue IV fluids after a GA case?
when pt is fully awake, alert, and has taken PO fluids
What are discharge criteria for a patient following moderate/deep sedation and GA?
CV function stable airway uncompromised patient easily aroused with protective reflexes intact pain and bleeding controlled patient adequately hydrated no nausea/vomiting pt can sit unaided and ambulate with minimal assistance presedation level of responsiveness
what does the aldrete post anesthesia recovery scale look at to discharge pts?
Scale where you need >9 to discharge activity - voluntarily or on command respiration ciculation oxygenation consciousness
what post op instructions do you give to patients after sedation/GA?
encourage adequate hydration with clear liquids
soft diet day of surgery
diet as tolerated after 24 hours
limit activity day of surgery
OHI(use moistened gauze or toothettes 1-2 days post op, regular brushing and flossing 1-4 days post op)
what pain management is recommended post op?
OTC childrens tylenol or motrin q4-6 hours prn pain.
Tylenol 10mg/kg q4-6h, max 65mg/kg
Motrin(ibuprofen) 10mg/kg q 4-6h, max 40mg/kg
how do you manage nausea/vomiting post op?
phenergan .25-.5mg/kg PR
zofran IV
what are common post surgical complications immediately post anesthetic and post discharge?
nausea vomiting croup hypoxia bleeding - post discharge: low grade fever(common) sore throat
how can you manage a sore throat post op?
use ice chips or popsicles initially
define dental home
the ongoing relationship between dentist and patient/parent, inclusive of all aspects of oral health
disruptions during the initiation stage of tooth development lead to?
hypodontia or supernumerary teeth
disruptions during the morphodifferentiation stage of tooth development lead to?
anomalies of size and shape, e.g macrodontia microdontia taurodontism dens invaginatus
disruptions during the histodifferentiation, apposition, and mineralization stage of tooth development lead to?
enamel hypoplasia
AI
DI
DD
AI characteristics?
4 types: hypocalcified, hypoplastic pitted, hypoplastic generalized, hypomaturation
accelerated tooth eruption or late eruption
anterior open bite
affects all or nearly all of teeth in both primary and permanent dentition
what are pathologies associated with AI?
enlarged follicles
impacted permanent teeth
ectopic eruption
agenesis of second molars
hypocalcified AI characteristics?
normal thickness
smooth surface
less hardness
hypoplastic pitted AI characteristics?
normal thickness
pitted surface
normal hardness
hypoplastic generalized AI characteristics?
reduced thickness
smooth surface
normal hardness
hypomaturation AI characteristics?
normal thickness
chipped surface
less hardness
opaque white coloration
which collagen type is most associated with DI disorders?
type 1 collagen
what are clinical manifestations of DI?
in all 3 types:
blue-gray to yellow-brown discoloration that appears opalesecent
enamel frequently fractures off due to weak dentin support
Shields type 1 DI characteristics?
All teeth in both dentition affected, primary most severely, then perm molars and incisors bulbous crowns cervical constriction thin roots early obliteration of pulp chambers PARL and root fractures
Shields type 2 DI characteristics?
Primary and permanent dentition equally affected bulbous crowns cervical constriction thin roots early obliteration of pulp chambers
Shields Type III DI characteristics?
bell shaped crowns
teeth with shell like appearance and multiple pulp exposures
normal thickness enamel with extremely thin dentin
Dentin Dysplasia type 1 characteristics?
aka Radicular Dentin Dysplasia, Rootless teeth
crowns are mostly normal in color and shape
roots are short and constricted
crescent or chevron shaped pulp chambers
PCO
periapical radiolucencies, representing abscesses, granulomas, or cysts
Dentin Dysplasia type II characteristics?
aka Coronal Dentin Dysplasia normal root lengths bulbous crowns cervical constrictions thin roots amber tooth discoloration PCO thistle tube shaped pulp chambers NO PARL present
what disorder has pulpal findings similar to DD Type II?
pulpal dysplasia
thistle tube shaped pulp chambers and multiple pulp stones
what restorative care is considered for AI?
discolored enamel can be bleached or microabraded
composite resins or porcelain veneers if enamel can be bonded
if enamel cannot be bonded, full coverage restorations
what restorative care is considered for DI?
routine restorative care to treat mild to moderate DI, full coverage restorations most successful in teeth exhibiting crowns and roots as close to normal teeth
With loss of VDO, overdenture therapy can be used
bleaching
veneers
Endodontic consult if PARL present
what malocclusion is often present in DI Type 1?
Cl 3 malocclusion
posterior crossbite
open bite
what is the goal of treatment in dentin dysplasia?
to retain teeth as long as possible
what restorative care is considered for dentin dysplasia?
poor crown to root ratios indicate prosthetic replacement including dentures, overdentures, partial dentures, and dental implants.
DD type 2 with normal crown to root ratio can be restored with full coverage restorations, veneers or normal restorative care.
when does the tmj begin developing?
8 weeks after conception
from adolesence to adulthood, what happens to the condyle?
becomes greater in width than length
what are the medical conditions that can mimic TMD?
trigeminal neuralgia cns lesions odontogenic pain sinus pain otological pain neoplasias parotid diseases vascular diseases myofascial pain cervical muscle dysfunction Eagle's syndrome otitis media allergies airway congestion rheumatoid arthritis
alterations in any one or a combination of these can lead to TMD?
teeth PDL TMJ muscles of mastication hard to predict which patients will eventually develop TMD
etiologic factors contributing to TMD are?
trauma occlusal factors parafunctional habits posture changes in freeway dimension of the rest position orthodontic treatment
what are the most common mandibular fractures in children?
unilateral and bilateral intracapsular or subcondylar fractures
what occlusal factors are most associated with TMD?
skeletal anterior open bite overjet greater than 6 to 7mm CR to CO slide greater than 4mm cl 3 malocclusion 5 or more missing posterior teeth
what parafunctional habits in particular can lead to TMJ?
bruxism
clenching
hyperextension
TMDs can generally be classified into what three categories?
disorders of the muscles of mastication
disorders of the TMJ
disorders in other related areas that may mimic TMD
most effective form of treatment of TMD involved active or passive treatment?
both active(involving patient effort) and passive(stabilization splint)
reversible therapies of TMD include?
patient education(relaxation training, behavior coping strategies)
physical therapy(jaw exercises, TENS, massages)
behavioral therapy
prescription medications
splints
irreversible therapies of TMD include?
occlusal adjustment mandibular repositioning(headgear, functional appliances) orthodontics
Untreated odontogenic infections can lead to ?
pain, abscess, and cellulitis
what complaints do patients with infections of the upper face have? What do you need to rule out?
facial pain
fever
inability to eat or drink
rule out sinusitis
infections of the lower face usually involve what complaints?
pain, swelling, and trismus
infections of the lower face usually involve what anatomy?
teeth
skin
local lymph nodes
salivary glands
most odontogenic infections are managed how?
pulp therapy
extraction
I and D
to avoid inadvertent trauma or extraction of a permanent successor during primary tooth extraction, what needs to be evaluated?
primary molars with roots encircling the successors crown may need to be sectioned to protect the permanent tooths location
when does canine palatal impaction usually occur?
when the cusp tip of the permanent canine is overlaying the distal half of the long axis of the root of the permanent lateral incisor
when is extraction of the primary canines the treatment of choice?
when malformation or ankylosis is present
when the risk of resorption of the adjacent tooth is evident
when trying to correct palatally impacted canines
If no improvement in canine position occurs in how long is surgical and ortho treatment recommended?
1 year
what are some post operative complications from removal of third molars?
alveolar osteitis parathesia infection trismus hemorrhage
how often is a supernumerary in the primary dentition followed by one in the permanent dentition?
33 percent
what is a paramolar?
a supernumerary tooth in the maxillary molar area
when is a mesiodens suspected?
asymmetric eruption pattern of maxillary incisors
delayed eruption of max incisors
ectopic eruption of a maxillary incisor
complications of supernumerary teeth include
delayed/lack of eruption
crowding
resorption of adjacent teeth
dentigerous cyst formation
how does treatment of a primary supernumerary mesiodens different from a permanent mesiodens?
removal of primary mesiodens is not usually recommended
when is extraction of unerupted primary and permanent mesiodens recommended?
mixed dentition to allow normal eruptive force of permanent incisor to bring itself into the oral cavity
when adjacent incisors have at least 1/2 to 2/3 root development
when is surgical exposure necessary after extraction of a primary or permanent mesiodens?
if adjacent teeth do not erupt within 6 to 12 months after removal of the mesiodens
characteristics of epsteins pearls?
occur 75-80% of all newborns in median palatal raphe
dental lamina cysts characteristics?
crests of the dental ridges, most commonly seen bilaterally in the region of the first primary molars
bohns nodule characteristics?
remnants of salivary gland epithelium
buccal and lingual aspects of the ridge
epsteins pearls, bohns nodules, and dental lamina cysts typically present as what?
asymptomatic 1 to 3mm nodules or papules.
smooth, whitish, filled with keratin
no treatment necessary, usually disappear in first 3 months of life
congenital epulis of the newborn characteristics?
aka granular cell tumor
seen only in newborns
protuberant mass arising from gingival mucosa
most often found in anterior maxillary ridge
feeding and respiratory problems common
females 8:1 predilection
surgical excision is treatment
eruption cyst(hematoma) characteristics?
most commonly found in mandibular molar region
if the cyst does not rupture spontaneously or lesion becomes infected, roof of the cyst may be opened surgically
mucocele characteristics?
arise from rupture of a minor salivary gland excretory duct
well circumscribed bluish translucent fluctuant swellings
lower lip lateral to midline, buccal mucosa, ventral tongue, retromolar region, floor of mouth(ranula)
when is treatment suggested for maxillary frenum?
when attachment exerts a traumatic force on the gingiva causing papilla to blanch
or if it causes a diastema to remain after eruption of permanent canines. Do frenectomy after ortho closure.
when should the frenectomy be performed if ortho treatment is indicated?
when the diastema is allowed to close as much as possible and after ortho closure.
when should a mandibular labial frenum be treated?
when factors causing gingival/periodontal inflammation cannot be controlled. Early treatment can prevent subsequent inflammation, recession, pocket formation, but if food and plaque is removed and inflammation is controlled, need for treatment decreases
ankyloglossia characteristics?
short, thick lingual frenum
problems with breastfeeding, tongue mobility, speech, malocclusion, and gingival recession
frenuloplasty vs frenectomy?
frenuloplasty - various methods to release the tongue tie and correct the anatomic situation
frenectomy - cutting the frenum
There is little consensus on treatment for ankyglossia, however most professionals agree on?
if a short lingual frenum inhibits tongue movement and creates deglutition problems, frenectomy may be indicated
frenectomy techniques?
involves surgical incision, establishing hemostasis, and suturing of the wound. Dressing placement or the use of antibiotics is not necessary
Recommended to maintain soft diet, OH, and analgesics as needed
natal teeth?
present at birth
neonatal teeth?
present within first 30 days of being born
natal or neonatal molars identified in the posterior region may be associated with systemic conditions or syndromes?
pfieffer syndrome
histiocytosis x
when should natal and neonatal teeth be maintained?
when not causing feeding problems or excessively mobile
what can failure to diagnose riga fede disease lead to?
dehydration and inadequate nutrient intake for the infant
treatment for riga fede disease?
smooth incisal edges. If ineffective, then extract
when is extraction of a natal or neonatal tooth contraindicated?
in newborns due to risk of hemorrhage. Unless child is 10 days old, consult pediatrician
which oral wounds have an increased risk of infection and should be covered with antibiotics?
intraoral lacerations that appear to have been contaminated by extrinsic bacteria
open fractures
joint injuries
what needs to be taken into consideration when prescribing an antibiotic?
when to give it(usually right away) IV vs intramuscular vs oral administration how long(5 to 7 days minimum course)
if a child presents with pulpitis, apical periodontitis, draining sinus tract, or a localized intraoral swelling, are antibiotics indicated?
if no systemic signs of infection(no fever or facial swelling), then No.
if a child presents with an acute facial swelling of dental origin, are antibiotics indicated?
yes, along with treating or extracting the tooth/teeth
which antibiotic is recommended for avulsed permanent incisors(open or closed)
Tetracycline is drug of choice, but can cause discoloration. Can also give Pen V
is antibiotic therapy indicated in pediatric periodontal diseases?
in some cases, yes. Neutropenias, papillon-lefevre syndrome, leukocyte adhesion deficiency), the immune system is unable to control the growth of periodontal pathogens
what is the interaction between antibiotics and oral contraceptive use?
rifampicin, tetracycline, and penicillin antibiotics reduce oral contraceptive effectiveness during therapy and for up to one week after therapy
what are post procedural symptoms of acute infection?
fever, malaise, weakness, lethargy
When is antibiotic prophylaxis recommended?
prosthetic heart valves
previous history of IE
unrepaired or incompletely repaired cyanotic congenital heard disease
completely repaired congenital heart defect with prosthetic material or device during the first 6 months after the procedure
repaired CHD with residual defects at the site
cardiac transplantation recipients with cardiac valvulopathy
what other medical conditions may predispose to IE and may require antibiotic prophylaxis?
patients with compromised immune systems:
HIV
SCIDS
neutropenia
cancer chemotherapy
hematopoietic stem cell or solid organ transplantation
head and neck radiotherapy
autoimmune disease(juvenile arthritis, lupus)
chronic steroid use
diabetes
bisphosphenate therapy
what is the dosage for antibiotic prophylaxis?
oral amoxcillin 50mg/kg
IV ampicillin if unable to take oral meds at 50mg/kg
allergic to penicillins, then take clindamycin at 20mg/kg oral and IV
Is antibiotic prophylaxis recommended for patients with shunts, indwelling vascular catheters(central lines) or medical devices?
No.
Is antibiotic prophylaxis recommended for VA, VC, or VV shunts?
Yes. Ventriculoatrial, ventriculocardiac, or ventriculovenus shunts for hydrocephalus are at risk due to their vascular access.
VP shunts do not require prophylaxis.
what patients with prosthetic joints should be considered for antibiotic prophylaxis?
patients with a prosthetic joint replacement
previous prosthetic joint infection
inflammatory arthropathies(rheumatoid arthritis, lupus)
emophilia
malnourishment
what is the most frequently documented source of sepsis in the immunosuppressed cancer patient?
oral cavity
what are some acute oral sequelae as a result of cancer therapies and HCT regimens?
pain mucositis ulcerations bleeding taste dysfunction secondary infections(candidiasis, herpes simplex virus) caries xerostomia post radiation osteonecrosis trismus craniofacial and dental developmental anomalies oral graft vs host disease
what are the objectives of a dental exam before cancer therapy?
identify and stabilize or eliminate potential sources of infection
communicate with the oncology team regarding the patients oral health status
educate the patient and parents about the importance of optimal oral care
What is part of the initial evaluation before initiating cancer therapy?
medications including bisphosphonates hematological status(CBC) coagulation status immunosuppression status presence of an indwelling venous access line
what is part of the initial evaluation for HCT patients?
type of transplant
HCT source(bone marrow, peripheral stem cells)
matching status
donor
conditioning protocol
date of transplant
presence of GVHD or signs of transplant rejection
what are preventive strategies for cancer patients?
brushing teeth and tongue 2 to 3 times daily regardless of hematological status
patients with poor oral hygiene may use chlorhexidene rinses until mucositis develops. Recommend using a alcohol free chlorhexidene
frequent fluoride varnish application
what are diet recommendations for cancer patients?
recommend a non cariogenic diet and advise patients of high carigenicity of dietary supplements and oral pediatric medicines rich in sucrose
how can one prevent trismus for patients receiving radiation therapy?
oral stretching exercises/physical therapy before radiation begins
what is therapy for trismus ?
prosthetic aids to reduce severity of fibrosis
trigger point injections
analgesics
muscle relaxants
how can one reduce radiation to healthy oral tissues?
use of lead lined stents
prostheses
shields
salivary gland sparing techniques
what are important hematological considerations ANC for dental care?
ANC>2000, no need for antibiotic prophylaxis
ANC 1000-2000, use clinical judgment
ANC
what are important hematological considerations(platelet count) for dental care?
Platelet>75000: no additional support needed
Platelet 40000-75000: platelet transfusions may be considered pre and 24 hours post operatively
Platelet
what are localized and generalized procedures to manage prolonged bleeding?
sutures hemostatic agents pressure packs gelatin faoms microfibrillar collagen topical thrombin aminocaproic acid tranexamic acid
When all dental needs cannot be treated before cancer therapy is initiated, what procedures are prioritized?
infections
extractions
periodontal care
and sources of tissue irritation before treatment of carious teeth, root canal therapy for permanent teeth and replacement of faulty restorations
Is it better to do pulp therapy in primary teeth or extraction before a patient initiates cancer therapy?
May be better to do extraction to provide more definitive therapy, periodically monitor existing pulp and crowns for signs of resorption or furcal radiolucency.
what is the consensus for endodontics in permanent teeth before a patient begins cancer therapy?
symptomatic non vital teeth should receive root canal therapy 1 week before initiating therapy. If not possible, then extraction, followed by 1 week of antibiotic therapy
asymptomatic non vital teeth can receive rct when a patients hematological status stabilizes
what is the consensus on orthodontic appliances before, and cancer therapy?
if a patient has poor oral hygiene or if HCT conditioning carries a risk for the development of moderate mucositis, then they should be removed.
what is the consensus on periodontal therapy before and during cancer therapy?
reduce potential sources of infection such as pericoronitis by cutting the flap if hematological status permits, and extract those teeth with poor prognosis
Consensus on extractions before cancer therapy begins?
Extract teeth before initiating radiation therapy or bisphosphonates for cancer therapy ideally. Includes nonrestorable teeth, root tips, teeth with periodontal pockets >6mm, and consider EXT all third molars before HCT
what are the dental and oral objectives DURING immunosuppression periods?
maintain optimal oral health during cancer therapy
manage any oral side effects that may develop
reinforce patient and parents education regarding importance of optimal oral care
what is recommended if fluoridated toothpaste is burning a patients mucosa during cancer therapy?
switch to a mild flavored non fluoridated toothpaste
what is recommended if a patient cant tolerate a toothbrush during severe mucositis?
use a foam brush or super soft brush soaked in chlorhexidene
how is lip care managed during cancer therpay?
use lanolin based creams and ointments, better than petrolatum based products
how does one approach dental care during cancer therapy?
defer elective dental care and consider emergency treatment after physician consult
How do you manage mucositis during cancer therapy?
good oral hygiene
analgesics
non-medicated oral rinses(0.9 percent saline or sodium bicarbonate rinses 4-6x/day)
Mucosal coating agents like Amphojel
Palifermin(keratnocyte growth factor-1)
Philadelphia mouthwash or magic mouthwash(no signifcant evidence for these however)
how do you manage xerostomia during cancer therapy?
frequent sips of water sugar free chewing gum or candy special dentrifices for oral dryness saliva substitutes alcohol free oral rinses oral moisturizers fluoride rinses or gel recommend placing a humidifier by bedside
when can you resume orthodontic care after cancer therapy is completed?
after at least a 2 year disease free period
when patient is no longer using immunosuppressive drugs
what orthodontic strategies should be used when providing care for patients with dental sequale after cancer therapy is completed?
use appliances that minimize risk of root resorption
use lighter forces
terminate treatment earlier than normal
don’t treat the lower jaw
whats important to consider in any cancer patient who received bisphosphonates or radioation therapy to the jaws?
always receive a consult with oral surgeon/periodontist
what oral complications are correlated with phases of HCT?
oral infections gingival leukemic infiltrates bleeding ulceration TMD
How long is elective dental care usually postponed following HCT?
usually 100 days until immunological recovery has occurred
General rule for dental treatment for HCT patients?
complete it before patient becomes immunocompromised
