Guidelines (created by another user)

Question 1

Fluoride Use contributes to?

Answer 1

Prevention, inhibition and reversal of caries

Question 2

What topics are included in anticipatory guidance/counseling?

Answer 2

diet, oral hygiene, nonnutritive habits, injury prevention, speech/language milestones, piercings, substance abuse

Question 3

Injury prevention topics for the infant to young child should focus on what topics?

Answer 3

car seat, electrical cord safety, play objects, pacifiers.

Question 4

Children with white spot lesions are considered what level of caries risk?

Answer 4

high

Question 5

Xylitol use and its effects?

Answer 5

decrease MS levels in plaque and saliva and reduce dental caries

Question 6

CRA is split into 3 categories which are?

Answer 6

biological, protective, and clinical findings

Question 7

CRA biological factors for 0-5 yo indicating HIGH risk include?

Answer 7

primary caregiver has active caries, low SES, >3 sugary snacks or beverages, put to bed with bottle containing sugar

Question 8

CRA biological factors for 0-5 yo indicating MOD risk include?

Answer 8

child with SN, recent immigrant

Question 9

CRA clinical findings for 0-5yo indicating HIGH risk include?

Answer 9

dmfs>1, white spot or enamel defects present, elevated MS levels

Question 10

CRA clinical findings for 0-5yo indicating MOD risk include?

Answer 10

plaque on teeth

Question 11

CRA biological and clinical findings for >=6yo indicating HIGH risk include?

Answer 11

low SES
>3 snacks
>=1 interproximal lesion
low salivary flow
active WSL or enamel defect

Question 12

CRA biological and clinical findings for >=6yo indicating MOD risk include?

Answer 12

recent immigrant
SHCN
defective restoration
intraoral appliance

Question 13

Whats the difference in caries management protocol in >3yo for a high risk patient with an engaged parent and one without?

Answer 13

With an engaged parent, you can actively surveil incipient lesions, with a non-engaged parent you may want to restore incipient lesions.

Question 14

Periodontal dx in pregnant patients is linked to what findings?

Answer 14

preterm deliveries, low birth weight babies, preeclampsia

Question 15

primary goal of perinatal oral health care with regards to caries transmission?

Answer 15

lower cariogenic bacteria in mother to delay colonization of infant.

Question 16

For pregnant women frequently vomiting, what remedy may help against erosion?

Answer 16

rinsing with a cup of water containing a teaspoon of baking soda and waiting an hour before brushing

Question 17

In pregnant patients, what can help reduce plaque levels?

Answer 17

Fl toothpaste and rinsing with a sodium fluoride rinse or chlorhexidene rinse

Question 18

Safest time to perform dental treatment on a pregnant pt?

Answer 18

second trimester

Question 19

How many times should a pregnant pt chew xylitol gum ?

Answer 19

2-3 times a day to help reduce MS levels and colonization

Question 20

what are some behaviors that parents can avoid which will help prevent early colonization of MS in infants?

Answer 20

avoid saliva sharing behaviors such as sharing utensils, cleaning a pacifier or toy, sharing cups

Question 21

is human breast milk associated with increased risk of caries?

Answer 21

No, but frequent night time bottle feeding is.

Question 22

What is associated with increased risk of caries in infants?

Answer 22

breastfeeding>7 times a day after 12 months, nighttime bottle feeding with juice, repeated use of no spill cup, and frequent snacking

Question 23

When should third molars be removed?

Answer 23

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.

Question 24

What is positive youth development?

Answer 24

aspect of adolescent oral health care in which you build a strong interpersonal relationship with the patient addressing psychological and social needs.

Question 25

what is perimyolysis?

Answer 25

enamel erosion seen in bulimics

Question 26

nutrients of particular importance during pregnancy are?

Answer 26

``` b6 b12 folate calcium zinc ```

Question 27

category A drugs in pregnancy?

Answer 27

studied in humans and safe to use

Question 28

category B drugs in pregnancy?

Answer 28

show no evidence of risk to humans(Pen, Amox, Lido, Tylenol)

Question 29

category C drugs in pregnancy?

Answer 29

use with caution, such as aspirin containing drugs and NSAIDs

Question 30

category D drugs in pregnancy?

Answer 30

do not use, such as tetracycline

Question 31

pregnant women who smoke increase risks of?

Answer 31

ectopic pregnancy, spontaneous abortion, preterm delivery, low birth weight infants, intellectual disability, clefts, SIDS

Question 32

infants exposed to secondhand smoke have higher rates of?

Answer 32

lower respiratory illness, middle ear infections, asthma, and caries

Question 33

What is the consensus on using bleaching products in pregnant females?

Answer 33

Avoid using them in females who have existing amalgam restorations as hydrogen peroxide can release inoraganic mercury into the bloodstream

Question 34

what oral changes may occur secondary to pregnancy?

Answer 34

xerostomia, shift in microbial flora(to more anaerobic) causing periodontitis.

Question 35

consensus on antacids used during pregnancy?

Answer 35

they have high sugar content and increase risk of caries

Question 36

what drugs are not recommended during pregnancy?

Answer 36

aspirin containing products, nsaids(if necessary, avoid during 1st and 3rd trimester), erythromycin, tetracycline

Question 37

aapd defines special health care needs as?

Answer 37

any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment that impose limitations in self-maintenance. Can be congenital, acquired, or developmental.

Question 38

which shcn patients are most susceptible to effects of oral diseases?

Answer 38

pts with compromised immunity(leukemia, HIV), cardiac conditions associated with endocarditis

Question 39

SCHN also include patients with disorders or conditions which manifest only in oro-facial complex, such as?

Answer 39

AI, DI, cleft lip/palate, oral cancer

Question 40

What is the most common site of inflicted oral injuries?

Answer 40

lips, then oral mucosa, teeth, gingiva, and tongue

Question 41

Unintentional or accidental injuries must be distinguished from abuse by?

Answer 41

judging whether the history, including timing and mechanism of injury is consistent with the characteristics of the injury

Question 42

what finding in prepubertal children is pathognomonic of sexual abuse?

Answer 42

oral and perioral gonorrhea in prepubertal children

Question 43

why is HPV resulting in oral or perioral warts not necessarily sexual abuse?

Answer 43

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

Question 44

ecchymoses, lacerations, or abrasions found in what pattern may indicate bite mark abuse?

Answer 44

ellipitcal or ovoid

Question 45

Bite marks have a central area of ecchymoses caused two ways, which are?

Answer 45

positive pressure through biting or negative pressure through suctioning.

Question 46

dog bite vs human bite?

Answer 46

dog bite tears flesh, human bite compresses flesh causing abrasions, lacerations, contusions

Question 47

an intercanine distance measuring more than ? is suspicious of an adult bite

Answer 47

3.0 cm

Question 48

what technique is employed to swab for DNA in potential abuse situations?

Answer 48

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.

Question 49

define dental neglect

Answer 49

willful failure of parent to seek and follow through with treatment

Question 50

Fluoride mechanisms of action?

Answer 50

inhibit demineralization, promote remineralization, inhibit dental caries my affecting metabolic activity

Question 51

fluoride toothpaste recommendations for less than 3 and greater than 3 yo?

Answer 51

rice size for less than 3, pea size for greater than 3

Question 52

when are fluoride supplements considered?

Answer 52

in high risk children drinking fluoride deficient water(

Question 53

what is xylitol?

Answer 53

5 carbon, naturally occurring sugar, found in trees, fruits, vegetables, and is intermediate product of glucose metabolic pathway.

Question 54

Xylitol amount needed and its effects?

Answer 54

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)

Question 55

xylitol side effects?

Answer 55

gas and diarrhea. Can be reduced if xylitol introduced slowly

Question 56

which pain intensity scales are used in pediatric dentistry?

Answer 56

FACES pain scale for ages 4-12, wong baker for children over 3.

Question 57

communication in behavior management of a child is affected through what 4 characteristics?

Answer 57

dialogue, tone of voice, facial expression and body language.

Question 58

the four essential ingredients of communication in behavior management are?

Answer 58

the sender the message, including facial expression and body language the context the receiver

Question 59

what characteristics influence a childs reaction to the dental setting?

Answer 59

``` age/cognitive level temperament/personality anxiety and fear reaction to strangers previous dental experience maternal dental anxiety ```

Question 60

what are the goals of behavior guidance?

Answer 60

``` establish communication alleviate fear and anxiety deliver quality dental care build a trusting relationship promote positive dental attitude ```

Question 61

Basic behavior guidance techniques include these communicative techniques

Answer 61

``` TSD voice control nonverbal communication positive reinforcement distraction ```

Question 62

stabilization devices must be used with caution in patients with what medical history?

Answer 62

patients with respiratory compromise(asthma) | patients who will receive medications(local anesthetics, sedatives) that can depress respiration

Question 63

what are contraindications to protective stabilization?

Answer 63

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

Question 64

When is sedation indicated?

Answer 64

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.

Question 65

What to address in terms of infant feeding? What do you place in bottles?

Answer 65

formulas, breastmilk, or water in infant bottles.

Question 66

Is milk considered cariogenic?

Answer 66

No, but it is a vehicle for cariogenic substances(chocolate powder)

Question 67

Is breastmilk alone cariogenic?

Answer 67

No, but prolonged nighttime feeding is associated with increased risk for caries.

Question 68

WSL in children younger than three classifies them as what?

Answer 68

SECC

Question 69

What are indications for fluoride OTC rinses?

Answer 69

orthodontic appliances, radiation therapy, prosthetic appliances, high sucrose diet, high CRA

Question 70

what type of filtration systems typically reduce fluoride levels?

Answer 70

reverse osmosis and distillation

Question 71

Prevalence of fluorosis increasing or decreasing?

Answer 71

increasing, # of new cases is on the rise due to higher levels of ambient fluoride.

Question 72

Fluoride toxicity treatment >8mg/kg and

Answer 72

8mg/kg, induce vomiting, give milk, go to ER

Question 73

frequency of bw radiographs for low caries risk patient?

Answer 73

12 to 24 month interval in primary dentition | 18 to 36 month interval in permanent dentition

Question 74

CBCT benefit?

Answer 74

360 degree scan, can be used to scan specific locations, useful for evaluating bone

Question 75

major biological risks associated with xrays?

Answer 75

carcinogenesis, fetal effects, mutations

Question 76

for soft tissue trauma, what radiologic adjustment is made?

Answer 76

use 1/4 normal exposure time

Question 77

plaque induced gingivitis may be associated with steroid hormones during which situations?

Answer 77

puberty pregnancy oral contraceptives menstruation

Question 78

these drugs cause gingival enlargement

Answer 78

phenytoin(dilantin) - antiepileptic cyclosporin(immunosuppressant) calcium channel blockers(nifedipine, almodipine, diltiazem)

Question 79

key characteristics of drug induced gingival enlargement?

Answer 79

usually painless growth at interdental and marginal gingiva regresses after cessation of drug RELATED to plaque control does not occur in edentulous areas

Question 80

key characteristics of a gingival abscess? Treatment of gingival abscess?

Answer 80

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

Question 81

characteristics of vitamin C associated gingivitis?

Answer 81

edematous, spongy gingiva spontaneous bleeding impaired wound healing

Question 82

NUG/NUP characteristics and predisposing factors?

Answer 82

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

Question 83

LAP characteristics in primary dentition?

Answer 83

attachment and bone loss in primary dentition, usually affects primary molars, children are otherwise healthy, inflammation not a prominent feature

Question 84

LAP characteristics in permanent dentition? Vs GAP characertistics

Answer 84

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

Question 85

Hypophosphatasia features?

Answer 85

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

Question 86

hypophosphatasia diagnosis?

Answer 86

low alkaline phosphatase, phosphoethanolamine in urine

Question 87

Leukocyte adhesion defect features?

Answer 87

generalized periodontitis in primary and young permanent dentition frequent respiratory, skin, ear bacterial infections

Question 88

Leukocyte adhesion defect treatment?

Answer 88

antibiotic therapy, OH, poss extraction of affected teeth

Question 89

Papillon Lefevre syndrome features?

Answer 89

palmar and plantar hyperkeratosis | premature loss of primary and permanent teeth

Question 90

Chediak Higashi Syndrome features?

Answer 90

oculocutaneous albinism, photophobia, nystagmus, neuropathy, severe gingivitis and periodontitis

Question 91

Neutropenia features?

Answer 91

``` several forms severe gingivitis with ulceration premature loss of primary teeth severe periodontal disease in permanent dentition other soft tissue infections common ```

Question 92

Langerhans cell histiocytosis features?

Answer 92

bone lesions may produce "floating teeth"

Question 93

acute leukemia gingival features?

Answer 93

gingival enlargement due to leukemic infiltrates, usually in AML

Question 94

Epinephrine and norepinephrine are contraindicated in what patients?

Answer 94

patients with hyperthyroidism patients on TCA(due to dysrhythmias) when halogenated gases are used for GA(myocardium sensitized to epi)

Question 95

You may want to get a consult to use an LA with epi in these patients?

Answer 95

``` cardiovascular disease thyroid disease diabetes sulfite sensitivity those on MOA, TCA, or phenothiazines ```

Question 96

allergy to one amide does not rule out use of another amide but allergy to one ester

Answer 96

rules out use of another ester

Question 97

Why should local anesthetics without vasoconstrictors be used with caution?

Answer 97

due to rapid systemic absorption which can result in overdose

Question 98

which local anesthetic can induce methemoglobinemia symptoms, which are?

Answer 98

prilocaine + benzocaine blue cyanosis of lips, mucous membranes, and nails. Respiratory and circulatory distress

Question 99

prilocaine contraindicated in what patients?

Answer 99

methemoglobinemia sickle cell anemia anemia patients receiving acetaminophen or phenacetin

Question 100

LA overdose objective symptoms of the CNS include?

Answer 100

Excitation followed by depression muscle twitching, tremors, talkativeness, slowed speech, shivering, followed by seizure activity. Unconsciousness and respiratory depression may occur

Question 101

LA overdose objective symptoms of the CVS include?

Answer 101

HR and BP increase followed by vasodilatation and BP decrease. Bradycardia and cardiac arrest may occur.

Question 102

LA dose should be adjusted upward/downward when used with opioids?

Answer 102

downward as opioids like demerol also cause CNS depression and lower seizure threshold

Question 103

what are contraindications to using nitrous oxide?

Answer 103

some COPD emotional disturbances or drug related dependencies first trimester of pregnancy treatment with bleomycin sulfate cobalamin deficiency methyltetrahyrdofolate reductase deficiency

Question 104

Most common adverse effects of nitrous oxide?

Answer 104

nausea, vomiting, diffusion hypoxia

Question 105

Formocresol method of action in pulpotomys is?

Answer 105

tissue fixation

Question 106

CaOH and MTA method of action in pulpotomys is?

Answer 106

mineralization

Question 107

What is the concept of rescue in terms of sedation?

Answer 107

to be able to rescue a patient from a deeper unintended level of sedation

Question 108

minimal sedation definition?

Answer 108

drug induced state in which patients respond normally to verbal commands

Question 109

moderate sedation definition?

Answer 109

drug induced depression of consciousness in which patients respond purposefully to verbal commands either alone or with light tactile stimulation(tap on shoulder)

Question 110

deep sedation definition?

Answer 110

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

Question 111

the physical exam before sedating a child includes?

Answer 111

airway evaluation looking for tonsillar hypertrophy abnormal anatomy like mandibular hypoplasia

Question 112

effect of herbal medicines on sedation medications?

Answer 112

many herbal medications inhibit p450, prolonging sedative agents.

Question 113

general rule of thumb to evaluate sedation recovery in a patient?

Answer 113

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.

Question 114

The vast majority of sedation complications can be managed with simple maneuvers, like?

Answer 114

``` supplemental oxygen opening the airway suctioning bag mask valve ventilation OCCASIONALLY endotracheal intubation Laryngeal mask airway(for airway obstruction) ```

Question 115

a minimum fasting period of 2 hours is required for these items before sedation?

Answer 115

clear liquids, including water, juices without pulp, carbonated beverages, black coffee and clear tea

Question 116

a minimum fasting period of 4 hours is required for these items before sedation?

Answer 116

breast milk

Question 117

a minimum fasting period of 6 hours is required for these items before sedation?

Answer 117

infant formula cows milk light meal consisting of toast and clear liquids.

Question 118

asa class 3?

Answer 118

pt with severe systemic disease(actively wheezing)

Question 119

asa class 2?

Answer 119

pt with mild systemic disease(controlled reactive airway disease)

Question 120

Recommended Discharge criteria after sedation?

Answer 120

easily arousable and protective reflexes intact patient can talk patient can sit unaided presedation level of responsiveness is achieved

Question 121

What are some of the risks associated with sedation of pediatric patients?

Answer 121

``` hypoventilation apnea airway obstruction laryngospasm cardiopulmonary impairment ```

Question 122

Is spontaneous ventilation and cardiovascular function usually maintained in moderate sedation?

Answer 122

yes

Question 123

Is the ability to maintain ventilatory function present in deep sedation?

Answer 123

Yes, but it may be impaired

Question 124

Is cardiovascular function usually maintained in deep sedation?

Answer 124

yes

Question 125

is ability to maintain ventilatory function impaired in GA? Is ability to maintain cardiovascular function impaired in GA?

Answer 125

yes | CVS may be impaired

Question 126

what are the goals of sedation?

Answer 126

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

Question 127

What type of sedative drug is recommended for painful procedures?

Answer 127

analgesic medications such as opioids

Question 128

what type of sedative drug is recommended for non painful procedures?

Answer 128

sedative/hypnotics

Question 129

what patients are candidates for mild, moderate or deep sedation?

Answer 129

asa 1 or 2 pts

Question 130

what do you do if emergency sedation is required in a patient who just drank liquid or ate food?

Answer 130

weigh the risk of sedation and the possibility of aspiration against the benefits of performing the procedure promptly

Question 131

which drugs, if combined with midazolam, can prolong sedation?

Answer 131

erythromycin, cimetidine, or any others that inhibit cytochrome p450

Question 132

what medications can produce drug drug interactions with common sedation drugs used in pediatric dentistry?

Answer 132

HIV meds, anticonvulsants, psychotropic medications. Get a consult, always.

Question 133

what should be a part of the health evaluation before a sedation?

Answer 133

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

Question 134

what vital signs should be evaluated before and after sedation?

Answer 134

HR BP RR Temperature

Question 135

what is the SOAPME acronym meaning in terms of being prepared for a sedation emergency?

Answer 135

``` 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) ```

Question 136

what type of monitoring is required for minimal sedation?

Answer 136

just observation and intermittent assessment of their sedation

Question 137

what type of monitoring is required for moderate sedation?

Answer 137

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

Question 138

What monitoring is required during moderate sedation?

Answer 138

continuous monitoring of oxygen saturation and heart rate, and intermittent recording of RR and BP at 5 mins

Question 139

what personnel is required for deep sedation?

Answer 139

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

Question 140

what equipment is required for deep sedation?

Answer 140

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

Question 141

why is capnography useful in monitoring sedations?

Answer 141

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

Question 142

how many personnel are required for office based deep sedation/GA?

Answer 142

3, anesthesiologist, dentist, office staff

Question 143

Factors for high caries risk include?

Answer 143

``` 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 ```

Question 144

is it always recommended to place SSC over teeth treated with pulp therapy?

Answer 144

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

Question 145

what is the total etch technique?

Answer 145

3 steps. An etchant to remove smear layer, primer to penetrate the dentin, then a bonding agent.

Question 146

what is the self etch technique?

Answer 146

2 step technique. The primer and bonding agent are combined, saving a step after etching

Question 147

when is the most significant window of potential exposure to BPA?

Answer 147

right after placing resin based composites or sealants

Question 148

how can you reduce BPA exposure ?

Answer 148

remove the residual monomer layer after placement by rubbing with pumiced cotton roll and thoroughly rinsing with an air water syringe

Question 149

What are properties of GI that make them favorable to use in children?

Answer 149

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

Question 150

When do you use ITR?

Answer 150

``` very young patients uncooperative patients patients with special health care needs anyone for whom traditional cavity preparation needs to be postponed caries control ```

Question 151

ITR and ATR are most successful when applied to what teeth?

Answer 151

single or small 2 surface restorations

Question 152

GI are recommended for use as?

Answer 152

``` cements bases and liners cl 1,2,3 and 4 restorations in primary teeth cl 3 and 5 restorations in perm teeth caries control ```

Question 153

purpose of resin infiltration?

Answer 153

halt progression of small proximal carious lesions by surrounding them with unfilled resin

Question 154

what is the technique of resin infiltration?

Answer 154

treat with hydrochloric acid dry the surface infiltrate over 2 applications the unfilled resin polymerize the resin with light

Question 155

when are resin based composites contraindicated?

Answer 155

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

Question 156

when are labial resins or porcelain veneers indicated?

Answer 156

restoration of mostly permanent anterior teeth with fractures, developmental defects, intrinsic discoloration, and/or other esthetic conditions

Question 157

why are removable prosthetic appliances used?

Answer 157

maintain space obturate congenital or acquired defects esthetics/occlusal function facilitate infant speech development or feeding

Question 158

when should you take a radiograph of a primary tooth pulpectomy?

Answer 158

right after completion to assess fill and prognosis

Question 159

indications of a protective liner in a vital primary tooth?

Answer 159

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

Question 160

Indications of a direct pulp cap in primary teeth?

Answer 160

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

Question 161

what are the indications for a direct pulp cap in young permanent teeth?

Answer 161

young permanent tooth with normal pulp that has a small carious or mechanical exposure. Place MTA or CaOH over exposure site.

Question 162

How do you perform apexification?

Answer 162

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

Question 163

Non nutritive sucking habits can lead to what changes?

Answer 163

excess OJ, decreased overbite, open bite, narrowed maxillary arch, posterior crossbite

Question 164

what are factors that can lead to bruxism?

Answer 164

emotional stress, parasomnias, TBI, neurologic disabilities, malocclusion, muscle recruitment

Question 165

what is the management for bruxism?

Answer 165

patient/parent education, occlusal splints, psychological techniques, and medications

Question 166

what is tongue thrusting and what can it lead to?

Answer 166

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

Question 167

what are some dental treatment modalities for self injurious or self mutilating behaviors?

Answer 167

lip bumpers, occlusal bite appliances, protective padding, and extractions, odontoplasty

Question 168

Mouth breathers can contribute to what malocclusion?

Answer 168

increased facial height, anterior open bite, increased oj, narrow palate.

Question 169

OSAS may be associated to what malocclusion?

Answer 169

narrow maxilla, crossbite, low tongue positon, vertical growth, open bite.

Question 170

excluding third molars, what is the most common missing permanent tooth?

Answer 170

mandibular second premolar followed by maxillary lateral incisor

Question 171

a congenitally missing tooth can be suspected in what patients?

Answer 171

patients with asymmetric eruption sequence or ankylosis of primary mandibular second molars

Question 172

Are supernumerary primary teeth followed by supernumerary permanent teeth?

Answer 172

in 1/3 of the cases

Question 173

Mesiodens are usually found in what position?

Answer 173

palatal/lingual

Question 174

what is the best way to locate a supernumerary tooth?

Answer 174

parallax or slob rule

Question 175

recommended treatment for supernumerary primary tooth?

Answer 175

Not done, usually erupts into occlusion and exfoliates normally. Surgical extraction can harm developing permanent incisors

Question 176

recommended extraction time for permanent supernumerary(mesiodens)

Answer 176

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

Question 177

When can you suspect EE of permanent incisors?

Answer 177

after trauma to primary incisors pulplly treated primary incisors with asymmetric eruption mesiodens

Question 178

how can distal tipping of permanent molars be accomplished

Answer 178

brass wires(.02 size, pt seen every few days for wire tightening), separators, elastics, fixed appliance with open coil spring, halterman appliance

Question 179

when is extraction of the primary maxillary canine indicated?

Answer 179

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

Question 180

how do you treat ectopically erupting incisors?

Answer 180

extract the necrotic or over-retained pulpally treated primary incisor in the early mixed dentition and align orthodontically when they erupt

Question 181

ankylosis in the permanent dentition occurs most frequently following what type of trauma?

Answer 181

luxation injuries

Question 182

when is extraction of an ankylosed primary tooth recommended?

Answer 182

exfoliation usually occurs normally but if tooth is over-retained, then extract

Question 183

when is the best time to de-rotate teeth, specifically mandibular incisors?

Answer 183

just after emergence in the mouth. Transseptal fibers establish after CEJ passes alveolar crest

Question 184

when is space maintainence considered for a primary maxillary incisor?

Answer 184

when the child has an active digit habit

Question 185

What are undesirable effects of space maintainers?

Answer 185

``` interference with permanent eruption caries plaque accumulation inhibition of alveolar growth pain ```

Question 186

what are some space regaining appliances?

Answer 186

fixed or removable appliances including hawley retainer lip bumper headgear

Question 187

what is a functional shift?

Answer 187

when the midlines undergo a compensatory shift when the teeth occlude in crossbite

Question 188

how can you correct a simple anterior xbite?

Answer 188

acrylic incline plane acrylic retainer with finger springs fixed appliance with finger spring if space is needed, then expansion appliance also used

Question 189

facial bones like the maxilla and body of mandible grow by what type of bone formation?

Answer 189

intramembranous

Question 190

the cranial base and condyle of the mandible grow by what formation?

Answer 190

endochondral

Question 191

which type of bone formation is more modifiable with dentofacial orthopedics

Answer 191

intramembranous

Question 192

how does the cranial vault form?

Answer 192

intramembranous

Question 193

where does appositional growth predominate in the mandible?

Answer 193

posterior border of the ramus with remodeling resorption along anterior border

Question 194

when do females usually have their growth spurt?

Answer 194

11 - 14 years

Question 195

when do males usually have their growth spurt?

Answer 195

13.5 - 18 years

Question 196

features of hypodivergent/brachyfacial face type?

Answer 196

posterior face greater than anterior face height counter clockwise condylar rotation expressed as flat mandibular plane deep bite

Question 197

features of hyperdivergent/dolicofacial face type?

Answer 197

anterior vertical facial growth greater than posterior face height clockwise condylar rotation expressed as steep mandibular plane open bite tendency gummy smile lip cimpetence

Question 198

what is the longest growing facial dimension?

Answer 198

depth(antero-posterior)

Question 199

3 to 6mm of primary spacing results in what spacing/crowding in the mixed dentition?

Answer 199

no transitional crowding

Question 200

spacing less than 3mm in primary dentition results in what spacing/crowding in the mixed dentition?

Answer 200

20% incisor crowding

Question 201

no spacing in primary dentition results in what spacing/crowding in the mixed dentition?

Answer 201

50% incisor crowding

Question 202

mesial step(15%) molar plane usually results in what class in permanent dentition?

Answer 202

cl 1

Question 203

ftp molar plane(75%) usually results in what class in permanent dentition?

Answer 203

most shift to cl 1, some stay end on or shift to full cl 2

Question 204

how do you replace prematurely lost primary incisors?

Answer 204

hollywood brige, space loss unlikely if primary canines erupted into occlusion

Question 205

second primary molar loss results in greater dimensional arch length loss in max or mand?

Answer 205

in max

Question 206

what appliances can you use in primary dentition to correct functional posterior crossbites?

Answer 206

RPE of haas, hyrax w arch quad helix removable schwartz plate

Question 207

what appliances can be used to treat a true class 3 anterior crossbite in the primary dentition?

Answer 207

reverse pull headgear/facemask chin cup MAY also require maxillary expansion

Question 208

what age should you consider intervention with a NNS habit and appliance?

Answer 208

before eruption of permanent anterior teeth around 5-6 years of age

Question 209

what appliances can be used for NNS habits?

Answer 209

cribs rakes bluegrass appliance

Question 210

what molar classification is the most common in mixed dentition?

Answer 210

end on class 2 with majority shifting to class 1 with late mesial shift

Question 211

what is upper leeway space on avg? lower leeway space?

Answer 211

0.9mm per quad on upper, 1.7mm per quad on lower

Question 212

what appliances can you use to regain space in the maxillary arch?

Answer 212

headgear fixed molar "distalizing" appliances - pendulum or distal jet removable appliance

Question 213

what appliances can you use to regain space in the mandibular arch?

Answer 213

lip bumper "active" lingual arch removable split-saddle

Question 214

vast majority of children present with what amount of incisor crowding at 8 to 9 yo?

Answer 214

0 to 4mm

Question 215

if patient has greater than 4mm of incisor crowding and has a hyperdivergent facial profile, what is the likely therapy?

Answer 215

extraction therapy because it deepens the bite

Question 216

if patient has greater than 4mm of incisor crowding and has a hypodivergent facial profile, what is the likely therapy?

Answer 216

directed toward non-extraction therapy and arch expansion to open the bite

Question 217

how much space can you gain by disking the ML corner of primary canines?

Answer 217

1 to 2mm per side, indicated when less than 3 to 4mm incisor crowding and when laterals actively erupting

Question 218

what other treatment can you perform when incisor crowding is greater than 4mm?

Answer 218

can ext primary canines to coincident midlines and place LLHA

Question 219

how many ectopically erupting permanent molars self correct?

Answer 219

2/3rds

Question 220

irreversible ectopic molars are diagnosed with lack of self correction by what features?

Answer 220

dental age 7, supraerupting lower first molar above occlusal plane

Question 221

what appliances can you use to correct ectopically erupting maxillary molar?

Answer 221

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)

Question 222

what features are usually present in a dental/functional anterior crossbite?

Answer 222

proclined lowers, retroclined uppers

Question 223

what features are usually present in a skeletal anterior crossbite?

Answer 223

retroclined lowers, proclined uppers

Question 224

what are features of a functional posterior crossbite in the mixed dentition?

Answer 224

midline shift to crossbite side cl 2 molars on crossbite side facial asymmetry - mandible shorter on crossbite side

Question 225

what appliance/biomechanics can you use to correct isolated/single posterior crossbites in mixed dentition?

Answer 225

cross arch elastics

Question 226

what appliance can you use to correct posterior crossbites in the mixed dentition?

Answer 226

``` cross arch elastics for single/isolated posterior xbite. w arch quad helix rpe of haas/hyrax removable schwartz plate ```

Question 227

what is the treatment/intervention for excessive mesial orientation of the permanent maxillary canine?

Answer 227

removal of primary canine around the time permanent canine has 2/3 root development

Question 228

when do you remove supernumerary teeth?

Answer 228

when no harm will come to developing permanent teeth, when 1/2 to 2/3 root development of adjacent permanent teeth

Question 229

To modify growth(fix xbites, cl 2/3 malocclusions), one must treat during active growth periods, such as when?

Answer 229

in conjunction with pubertal growth spurt or earlier

Question 230

Cl 2 Div 1 malocclusion features?

Answer 230

normal maxilla retrognathic mandible vertical growth tendency ANB>6

Question 231

Cl 2 Div 2 malocclusion features?

Answer 231

normal maxilla mild mandibular retrognathia deepbite growth tendency ANB

Question 232

what functional appliances are used in a Cl 2 malocclusion with a retrusive mandible? When should you not use a functional appliance?

Answer 232

``` bionator/orthopedic corrector activator frankel herbst(displaces mandible forward, restrains maxilla) mara ``` They increase lower face height, dont use in dolichofacial growers!

Question 233

what functional appliances are used in a cl 2 malocclusion with a protrusive maxilla?

Answer 233

cervical pull headgear(opens bite) | high pull headgear(deepens bite)

Question 234

what functional appliances are used in anteroposterior cl 3 malocclusions?

Answer 234

restrain mandibular growth by: chin cup therapy protract maxilla by using: extraoral reverse pull headgear(facemask) dont use in dolichofacial growing patterns

Question 235

indications of general anesthesia?

Answer 235

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

Question 236

contraindications to GA?

Answer 236

respiratory infection active systemic disease with temperature NPO violation healthy, cooperative patient with minimal dental needs

Question 237

how do NPO guidelines relate/differ for 3yo?

Answer 237

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

Question 238

what are ways to manage a childs psyche before general anesthesia?

Answer 238

operating room tour allowing child to bring favorite toy allowing parent/guardian to join patient as early as possible in recovery room

Question 239

asa class 4?

Answer 239

severe life threatening systemic disease or disorder

Question 240

when is a physical examination required before GA?

Answer 240

within 30 days of procedure

Question 241

Universal protocol for GA cases include what three topics?

Answer 241

SIGN IN TIME OUT SIGN OUT

Question 242

what is part of the universal protocol of sign out?

Answer 242

hemostasis achieved mouth thoroughly inspected, foreign bodies removed throat pack removed

Question 243

what monitoring equipment is recommended for GA?

Answer 243

``` precordial stethoscope bp cuff ecg temperature probe pulse ox capnograph monitors ```

Question 244

whats the dental preop protocol for patient protection?

Answer 244

tape eyes shoulder roll and head rest stabilized endotracheal tube drape appropriately

Question 245

function of throat pack?

Answer 245

prevent anesthesia gas backflow and debris backflow thoroughly irrigate and suction oro/nasopharynx before insertion use a moist, sterile guaze

Question 246

what are possible intra-operative complications during GA?

Answer 246

dislodged endo/nasotracheal tube disconnected or infiltrated IV nasal bleeding lips and tongue edema

Question 247

For post surgical orders, you want to maintain IV until patient is stable. What is calculated IV rate for a 35kg patient?

Answer 247

4-2-1 method. 40+20+15=75ml/hr

Question 248

when do you discontinue IV fluids after a GA case?

Answer 248

when pt is fully awake, alert, and has taken PO fluids

Question 249

What are discharge criteria for a patient following moderate/deep sedation and GA?

Answer 249

``` 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 ```

Question 250

what does the aldrete post anesthesia recovery scale look at to discharge pts?

Answer 250

``` Scale where you need >9 to discharge activity - voluntarily or on command respiration ciculation oxygenation consciousness ```

Question 251

what post op instructions do you give to patients after sedation/GA?

Answer 251

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)

Question 252

what pain management is recommended post op?

Answer 252

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

Question 253

how do you manage nausea/vomiting post op?

Answer 253

phenergan .25-.5mg/kg PR | zofran IV

Question 254

what are common post surgical complications immediately post anesthetic and post discharge?

Answer 254

``` nausea vomiting croup hypoxia bleeding - post discharge: low grade fever(common) sore throat ```

Question 255

how can you manage a sore throat post op?

Answer 255

use ice chips or popsicles initially

Question 256

define dental home

Answer 256

the ongoing relationship between dentist and patient/parent, inclusive of all aspects of oral health

Question 257

disruptions during the initiation stage of tooth development lead to?

Answer 257

hypodontia or supernumerary teeth

Question 258

disruptions during the morphodifferentiation stage of tooth development lead to?

Answer 258

``` anomalies of size and shape, e.g macrodontia microdontia taurodontism dens invaginatus ```

Question 259

disruptions during the histodifferentiation, apposition, and mineralization stage of tooth development lead to?

Answer 259

enamel hypoplasia AI DI DD

Question 260

AI characteristics?

Answer 260

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

Question 261

what are pathologies associated with AI?

Answer 261

enlarged follicles impacted permanent teeth ectopic eruption agenesis of second molars

Question 262

hypocalcified AI characteristics?

Answer 262

normal thickness smooth surface less hardness

Question 263

hypoplastic pitted AI characteristics?

Answer 263

normal thickness pitted surface normal hardness

Question 264

hypoplastic generalized AI characteristics?

Answer 264

reduced thickness smooth surface normal hardness

Question 265

hypomaturation AI characteristics?

Answer 265

normal thickness chipped surface less hardness opaque white coloration

Question 266

which collagen type is most associated with DI disorders?

Answer 266

type 1 collagen

Question 267

what are clinical manifestations of DI?

Answer 267

in all 3 types: blue-gray to yellow-brown discoloration that appears opalesecent enamel frequently fractures off due to weak dentin support

Question 268

Shields type 1 DI characteristics?

Answer 268

``` 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 ```

Question 269

Shields type 2 DI characteristics?

Answer 269

Primary and permanent dentition equally affected. Most severe. Bell-shaped crowns. Opalescent hue. "Shell teeth" (esp. primary teeth) w/ short roots + enlarged pulp chambers -- LESS common feature. Only mantle dentin formed. Rapid wear of primary + permanent crowns. Permanent tooth pulps small or completely obliterated. Multiple pulp exposures (esp. primary dentition). Regular tubules Enamel pitting.

Question 270

Shields Type III DI characteristics?

Answer 270

bell shaped crowns teeth with shell like appearance and multiple pulp exposures normal thickness enamel with extremely thin dentin

Question 271

Dentin Dysplasia type 1 characteristics?

Answer 271

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

Question 272

Dentin Dysplasia type II characteristics?

Answer 272

``` 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 ```

Question 273

what disorder has pulpal findings similar to DD Type II?

Answer 273

pulpal dysplasia | thistle tube shaped pulp chambers and multiple pulp stones

Question 274

what restorative care is considered for AI?

Answer 274

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

Question 275

what restorative care is considered for DI?

Answer 275

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

Question 276

what malocclusion is often present in DI Type 1?

Answer 276

Cl 3 malocclusion posterior crossbite open bite

Question 277

what is the goal of treatment in dentin dysplasia?

Answer 277

to retain teeth as long as possible

Question 278

what restorative care is considered for dentin dysplasia?

Answer 278

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.

Question 279

when does the tmj begin developing?

Answer 279

8 weeks after conception

Question 280

from adolesence to adulthood, what happens to the condyle?

Answer 280

becomes greater in width than length

Question 281

what are the medical conditions that can mimic TMD?

Answer 281

``` 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 ```

Question 282

alterations in any one or a combination of these can lead to TMD?

Answer 282

``` teeth PDL TMJ muscles of mastication hard to predict which patients will eventually develop TMD ```

Question 283

etiologic factors contributing to TMD are?

Answer 283

``` trauma occlusal factors parafunctional habits posture changes in freeway dimension of the rest position orthodontic treatment ```

Question 284

what are the most common mandibular fractures in children?

Answer 284

unilateral and bilateral intracapsular or subcondylar fractures

Question 285

what occlusal factors are most associated with TMD?

Answer 285

``` 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 ```

Question 286

what parafunctional habits in particular can lead to TMJ?

Answer 286

bruxism clenching hyperextension

Question 287

TMDs can generally be classified into what three categories?

Answer 287

disorders of the muscles of mastication disorders of the TMJ disorders in other related areas that may mimic TMD

Question 288

most effective form of treatment of TMD involved active or passive treatment?

Answer 288

both active(involving patient effort) and passive(stabilization splint)

Question 289

reversible therapies of TMD include?

Answer 289

patient education(relaxation training, behavior coping strategies) physical therapy(jaw exercises, TENS, massages) behavioral therapy prescription medications splints

Question 290

irreversible therapies of TMD include?

Answer 290

``` occlusal adjustment mandibular repositioning(headgear, functional appliances) orthodontics ```

Question 291

Untreated odontogenic infections can lead to ?

Answer 291

pain, abscess, and cellulitis

Question 292

what complaints do patients with infections of the upper face have? What do you need to rule out?

Answer 292

facial pain fever inability to eat or drink rule out sinusitis

Question 293

infections of the lower face usually involve what complaints?

Answer 293

pain, swelling, and trismus

Question 294

infections of the lower face usually involve what anatomy?

Answer 294

teeth skin local lymph nodes salivary glands

Question 295

most odontogenic infections are managed how?

Answer 295

pulp therapy extraction I and D

Question 296

to avoid inadvertent trauma or extraction of a permanent successor during primary tooth extraction, what needs to be evaluated?

Answer 296

primary molars with roots encircling the successors crown may need to be sectioned to protect the permanent tooths location

Question 297

when does canine palatal impaction usually occur?

Answer 297

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

Question 298

when is extraction of the primary canines the treatment of choice?

Answer 298

when malformation or ankylosis is present when the risk of resorption of the adjacent tooth is evident when trying to correct palatally impacted canines

Question 299

If no improvement in canine position occurs in how long is surgical and ortho treatment recommended?

Answer 299

1 year

Question 300

what are some post operative complications from removal of third molars?

Answer 300

``` alveolar osteitis parathesia infection trismus hemorrhage ```

Question 301

how often is a supernumerary in the primary dentition followed by one in the permanent dentition?

Answer 301

33 percent

Question 302

what is a paramolar?

Answer 302

a supernumerary tooth in the maxillary molar area

Question 303

when is a mesiodens suspected?

Answer 303

asymmetric eruption pattern of maxillary incisors delayed eruption of max incisors ectopic eruption of a maxillary incisor

Question 304

complications of supernumerary teeth include

Answer 304

delayed/lack of eruption crowding resorption of adjacent teeth dentigerous cyst formation

Question 305

how does treatment of a primary supernumerary mesiodens different from a permanent mesiodens?

Answer 305

removal of primary mesiodens is not usually recommended

Question 306

when is extraction of unerupted primary and permanent mesiodens recommended?

Answer 306

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

Question 307

when is surgical exposure necessary after extraction of a primary or permanent mesiodens?

Answer 307

if adjacent teeth do not erupt within 6 to 12 months after removal of the mesiodens

Question 308

characteristics of epsteins pearls?

Answer 308

occur 75-80% of all newborns in median palatal raphe

Question 309

dental lamina cysts characteristics?

Answer 309

crests of the dental ridges, most commonly seen bilaterally in the region of the first primary molars

Question 310

bohns nodule characteristics?

Answer 310

remnants of salivary gland epithelium | buccal and lingual aspects of the ridge

Question 311

epsteins pearls, bohns nodules, and dental lamina cysts typically present as what?

Answer 311

asymptomatic 1 to 3mm nodules or papules. smooth, whitish, filled with keratin no treatment necessary, usually disappear in first 3 months of life

Question 312

congenital epulis of the newborn characteristics?

Answer 312

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

Question 313

eruption cyst(hematoma) characteristics?

Answer 313

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

Question 314

mucocele characteristics?

Answer 314

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)

Question 315

when is treatment suggested for maxillary frenum?

Answer 315

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.

Question 316

when should the frenectomy be performed if ortho treatment is indicated?

Answer 316

when the diastema is allowed to close as much as possible and after ortho closure.

Question 317

when should a mandibular labial frenum be treated?

Answer 317

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

Question 318

ankyloglossia characteristics?

Answer 318

short, thick lingual frenum | problems with breastfeeding, tongue mobility, speech, malocclusion, and gingival recession

Question 319

frenuloplasty vs frenectomy?

Answer 319

frenuloplasty - various methods to release the tongue tie and correct the anatomic situation frenectomy - cutting the frenum

Question 320

There is little consensus on treatment for ankyglossia, however most professionals agree on?

Answer 320

if a short lingual frenum inhibits tongue movement and creates deglutition problems, frenectomy may be indicated

Question 321

frenectomy techniques?

Answer 321

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

Question 322

natal teeth?

Answer 322

present at birth

Question 323

neonatal teeth?

Answer 323

present within first 30 days of being born

Question 324

natal or neonatal molars identified in the posterior region may be associated with systemic conditions or syndromes?

Answer 324

pfieffer syndrome | histiocytosis x

Question 325

when should natal and neonatal teeth be maintained?

Answer 325

when not causing feeding problems or excessively mobile

Question 326

what can failure to diagnose riga fede disease lead to?

Answer 326

dehydration and inadequate nutrient intake for the infant

Question 327

treatment for riga fede disease?

Answer 327

smooth incisal edges. If ineffective, then extract

Question 328

when is extraction of a natal or neonatal tooth contraindicated?

Answer 328

in newborns due to risk of hemorrhage. Unless child is 10 days old, consult pediatrician

Question 329

which oral wounds have an increased risk of infection and should be covered with antibiotics?

Answer 329

intraoral lacerations that appear to have been contaminated by extrinsic bacteria open fractures joint injuries

Question 330

what needs to be taken into consideration when prescribing an antibiotic?

Answer 330

``` when to give it(usually right away) IV vs intramuscular vs oral administration how long(5 to 7 days minimum course) ```

Question 331

if a child presents with pulpitis, apical periodontitis, draining sinus tract, or a localized intraoral swelling, are antibiotics indicated?

Answer 331

if no systemic signs of infection(no fever or facial swelling), then No.

Question 332

if a child presents with an acute facial swelling of dental origin, are antibiotics indicated?

Answer 332

yes, along with treating or extracting the tooth/teeth

Question 333

which antibiotic is recommended for avulsed permanent incisors(open or closed)

Answer 333

Tetracycline is drug of choice, but can cause discoloration. Can also give Pen V

Question 334

is antibiotic therapy indicated in pediatric periodontal diseases?

Answer 334

in some cases, yes. Neutropenias, papillon-lefevre syndrome, leukocyte adhesion deficiency), the immune system is unable to control the growth of periodontal pathogens

Question 335

what is the interaction between antibiotics and oral contraceptive use?

Answer 335

rifampicin, tetracycline, and penicillin antibiotics reduce oral contraceptive effectiveness during therapy and for up to one week after therapy

Question 336

what are post procedural symptoms of acute infection?

Answer 336

fever, malaise, weakness, lethargy

Question 337

When is antibiotic prophylaxis recommended?

Answer 337

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

Question 338

what other medical conditions may predispose to IE and may require antibiotic prophylaxis?

Answer 338

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

Question 339

what is the dosage for antibiotic prophylaxis?

Answer 339

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

Question 340

Is antibiotic prophylaxis recommended for patients with shunts, indwelling vascular catheters(central lines) or medical devices?

Answer 340

No.

Question 341

Is antibiotic prophylaxis recommended for VA, VC, or VV shunts?

Answer 341

Yes. Ventriculoatrial, ventriculocardiac, or ventriculovenus shunts for hydrocephalus are at risk due to their vascular access. VP shunts do not require prophylaxis.

Question 342

what patients with prosthetic joints should be considered for antibiotic prophylaxis?

Answer 342

patients with a prosthetic joint replacement previous prosthetic joint infection inflammatory arthropathies(rheumatoid arthritis, lupus) emophilia malnourishment

Question 343

what is the most frequently documented source of sepsis in the immunosuppressed cancer patient?

Answer 343

oral cavity

Question 344

what are some acute oral sequelae as a result of cancer therapies and HCT regimens?

Answer 344

``` 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 ```

Question 345

what are the objectives of a dental exam before cancer therapy?

Answer 345

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

Question 346

What is part of the initial evaluation before initiating cancer therapy?

Answer 346

``` medications including bisphosphonates hematological status(CBC) coagulation status immunosuppression status presence of an indwelling venous access line ```

Question 347

what is part of the initial evaluation for HCT patients?

Answer 347

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

Question 348

what are preventive strategies for cancer patients?

Answer 348

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

Question 349

what are diet recommendations for cancer patients?

Answer 349

recommend a non cariogenic diet and advise patients of high carigenicity of dietary supplements and oral pediatric medicines rich in sucrose

Question 350

how can one prevent trismus for patients receiving radiation therapy?

Answer 350

oral stretching exercises/physical therapy before radiation begins

Question 351

what is therapy for trismus ?

Answer 351

prosthetic aids to reduce severity of fibrosis trigger point injections analgesics muscle relaxants

Question 352

how can one reduce radiation to healthy oral tissues?

Answer 352

use of lead lined stents prostheses shields salivary gland sparing techniques

Question 353

what are important hematological considerations ANC for dental care?

Answer 353

ANC>2000, no need for antibiotic prophylaxis ANC 1000-2000, use clinical judgment ANC

Question 354

what are important hematological considerations(platelet count) for dental care?

Answer 354

Platelet>75000: no additional support needed Platelet 40000-75000: platelet transfusions may be considered pre and 24 hours post operatively Platelet

Question 355

what are localized and generalized procedures to manage prolonged bleeding?

Answer 355

``` sutures hemostatic agents pressure packs gelatin faoms microfibrillar collagen topical thrombin aminocaproic acid tranexamic acid ```

Question 356

When all dental needs cannot be treated before cancer therapy is initiated, what procedures are prioritized?

Answer 356

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

Question 357

Is it better to do pulp therapy in primary teeth or extraction before a patient initiates cancer therapy?

Answer 357

May be better to do extraction to provide more definitive therapy, periodically monitor existing pulp and crowns for signs of resorption or furcal radiolucency.

Question 358

what is the consensus for endodontics in permanent teeth before a patient begins cancer therapy?

Answer 358

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

Question 359

what is the consensus on orthodontic appliances before, and cancer therapy?

Answer 359

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.

Question 360

what is the consensus on periodontal therapy before and during cancer therapy?

Answer 360

reduce potential sources of infection such as pericoronitis by cutting the flap if hematological status permits, and extract those teeth with poor prognosis

Question 361

Consensus on extractions before cancer therapy begins?

Answer 361

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

Question 362

what are the dental and oral objectives DURING immunosuppression periods?

Answer 362

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

Question 363

what is recommended if fluoridated toothpaste is burning a patients mucosa during cancer therapy?

Answer 363

switch to a mild flavored non fluoridated toothpaste

Question 364

what is recommended if a patient cant tolerate a toothbrush during severe mucositis?

Answer 364

use a foam brush or super soft brush soaked in chlorhexidene

Question 365

how is lip care managed during cancer therpay?

Answer 365

use lanolin based creams and ointments, better than petrolatum based products

Question 366

how does one approach dental care during cancer therapy?

Answer 366

defer elective dental care and consider emergency treatment after physician consult

Question 367

How do you manage mucositis during cancer therapy?

Answer 367

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)

Question 368

how do you manage xerostomia during cancer therapy?

Answer 368

``` 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 ```

Question 369

when can you resume orthodontic care after cancer therapy is completed?

Answer 369

after at least a 2 year disease free period | when patient is no longer using immunosuppressive drugs

Question 370

what orthodontic strategies should be used when providing care for patients with dental sequale after cancer therapy is completed?

Answer 370

use appliances that minimize risk of root resorption use lighter forces terminate treatment earlier than normal don't treat the lower jaw

Question 371

whats important to consider in any cancer patient who received bisphosphonates or radioation therapy to the jaws?

Answer 371

always receive a consult with oral surgeon/periodontist

Question 372

what oral complications are correlated with phases of HCT?

Answer 372

``` oral infections gingival leukemic infiltrates bleeding ulceration TMD ```

Question 373

How long is elective dental care usually postponed following HCT?

Answer 373

usually 100 days until immunological recovery has occurred

Question 374

General rule for dental treatment for HCT patients?

Answer 374

complete it before patient becomes immunocompromised

Question 375

craniofacial, skeletal and dental developmental issues are some issues seen by cancer survivors, and are more common in what age?

Answer 375

among children who were less than six years of age at the time of their cancer therapy

Question 376

What are some long term effects of cancer therapy?

Answer 376

tooth agenesis microdontia crown disturbance(size, shape, enamel hypoplasia, pulp chamber anomalies) root disturbances(blunting, early apical closure) reduced mandibular length, reduced alveolar process height permanent salivary gland hypofunction/dysfunction

Question 377

What radiographs are taken for fractures and luxations in permanent teeth?

Answer 377

PA occlusal view PA with lateral angulations

Question 378

what is an infraction injury?

Answer 378

an incomplete fracture(crack) of the enamel without loss of tooth structure

Question 379

what radigraphic findings are seen in an infraction injury?

Answer 379

no radiographic abnormalities

Question 380

what is the treatment of an infraction dental injury?

Answer 380

to prevent discoloration of the infraction lines, can etch and seal with resin, otherwise no treatment necessary

Question 381

what is the follow up procedure for an infraction injury?

Answer 381

no follow up necessary unless it is associated with a luxation injury

Question 382

in general what presentation provides a favorable outcome for infraction, enamel fractures, enamel dentin fractures, and enamel dentin pulp fractures?

Answer 382

asymptomatic teeth positive response to pulp testing continuing root development in immature teeth

Question 383

in general what presentation provides for an unfavorable outcome for infraction, enamel fractures, enamel dentin fractures, and enamel dentin pulp fractures?

Answer 383

symptomatic teeth negative response to pulp testing signs of apical periodontitis no continuining root development

Question 384

what radiographs are recommended for an enamel fracture, enamel-dentin fracture, and enamel-dentin-pulp fracture, and why?

Answer 384

periapical, occlusal and eccentric exposures to rule out the possible presence of a root fracture or a luxation injury, and of lip or cheek to search for fragments or foreign materials

Question 385

what is the typical follow up for an enamel fracture, enamel dentin fracture, and enamel dentin pulp fracture?

Answer 385

6-8 weeks and 1 year

Question 386

what is the typical treatment for an enamel-dentin fracture?

Answer 386

bond available tooth fragment. Otherwise provisional treatment, covering exposed dentin with GI or a more permanent restoration using a bonding agent and composite resin. If exposed dentin within 0.5mm of pulp, place CaOH and cover with GI

Question 387

what is the recommended treatment for an enamel-dentin-pulp fracture in young permanent teeth with immature apices and those that just recently matured?

Answer 387

in young patients with immature permanent teeth and in young patients with completely formed teeth, preserve pulp vitality by pulp capping or partial pulpotomy.

Question 388

what material is placed on the pulp in an enamel dentin pulp fracture?

Answer 388

CaOH

Question 389

what is recommended treatment for an enamel dentin pulp fracture in patients with mature apical development?

Answer 389

RCT usually the treatment of choice, although pulp capping or partial pulpotomy may be selected. If tooth fragment is available, it can be bonded to the tooth.

Question 390

What clinical findings are seen in a crown-root fracture without pulp exposure?

Answer 390

a fracture involving enamel, dentin and cementum without exposing pulp tender to percussion crown fracture extending below gingival margin mobile coronal fragment

Question 391

what radiographic findings are usually seen in a crown root fracture without pulp exposure?

Answer 391

apical extension of fracture usually not visible, take PA, occlusal, and eccentric exposures.

Question 392

what is emergency treatment for a crown-root fracture without pulp exposure?

Answer 392

temporary stabilize loose segment to adjacent teeth until definitive treatment plan is made

Question 393

what are non emergency treatment alternatives for a crown root fracture without pulp exposure?

Answer 393

remove the fragment and restore the tooth remove the fragment, perform endo treatment with a post retained crown. Preceded by gingivectomy, sometimes ostectomy remove the fragment, perform endo treatment and orthodontic extrusion, then post retained crown remove the fragment, surgically extrude tooth, splint, perform endo Decoronate and submerge root for an implant later Extract tooth with immediate or delayed implant retained crown or a bridge.

Question 394

what is the follow up protocol for crown-root fracture without pulp exposure?

Answer 394

6-8 weeks and 1 year

Question 395

what clinical findings are seen in a crown root fracture with pulp exposure?

Answer 395

fracture involving enamel, dentin, cementum, and exposing the pulp tender to percussion mobile coronal fragment

Question 396

what is emergency treatment in a crown root fracture with pulp exposure?

Answer 396

temporary stabilize loose segment to adjacent teeth and in patients with open apices or young patients with completely formed teeth, preserve pulp vitality by partial pulpotomy, using CaOH. RCT recommended in patients with mature apical development

Question 397

what is the non emergency treatment of a crown root fracture with pulp exposure?

Answer 397

Fragment removal and gingivectomy - Endo, post retained crown Orthodontic extrusion - endo, post retained crown Surgical extrusion - splint, perform endo 4 weeks later Root submergence-decoronation, for implant placement later extraction with immediate or delayed implant retained crown restoration or bridge

Question 398

what clinical findings are seen in a root fracture?

Answer 398

``` mobile and displaced coronal segment tender to percussion bleeding from gingival sulcus negative pulp test transient crown discoloration(red or gray) may occur ```

Question 399

what radiographic findings are seen in a root fracture?

Answer 399

recommend a PA 90 degree angle film and occlusal view | fracture of the root in a horizontal or oblique plane

Question 400

what is the treatment for a root fracture?

Answer 400

reposition, if displaced asap, check position radiographically stabilize the tooth with a flexible splint for 4 weeks(if fracture at cervical area, longer split recommended up to 4 months) monitor pulp healing for at least 1 year to determine pulpal status. if pulp necrosis develops, RCT of the coronal tooth segment

Question 401

what is a root fracture?

Answer 401

a fracture confined to the root involving the cementum, dentin and pulp

Question 402

what is follow up for a root fracture?

Answer 402

4 weeks for clinical and radiographic and splint removal 6-8 weeks for clinical and radiographic 4 months for clinical and radiographic and splint removal for root fractures in cervical thirds 6 months for C and R 1 year for C and R 5 years for C and R

Question 403

what is a favorable outcome of root fractures?

Answer 403

positive response to pulp testing | signs of repair between fractured segments

Question 404

what is an unfavorable outcome of root fractures?

Answer 404

symptomatic negative pulp response extrusion of coronal segment radiolucency at fracture line

Question 405

what are common radiographic findings in an alveolar fracture?

Answer 405

fracture lines may be located at any level, from marginal bone to the root apex, take pa with several angulations, occlusal film, and panoramic

Question 406

what is the treatment for an alveolar fracture?

Answer 406

reposition and splint, suture gingival lacerations, stabilize splint for 4 weeks

Question 407

what is the follow up for an alveolar fracture?

Answer 407

Clinical and radiographic follow up at 4 weeks, 6-8 weeks, 4 months, 6 months, 1 year, 5 years

Question 408

what are favorable outcomes of an alveolar fracture?

Answer 408

positive pulp testing | no signs of apical periodontitis

Question 409

what are unfavorable outcomes of an alveolar fracture?

Answer 409

symptomatic negative pulp testing signs of apical periodontitis or external inflammatory root resorption

Question 410

what are clinical findings seen in a concussion?

Answer 410

tender to touch or percussion, not displaced or mobile

Question 411

what is treatment and follow up for a concussion?

Answer 411

nothing, monitor pulpal status for 1 year and follow up after 4 weeks, 6-8 weeks and after 1 year.

Question 412

what are clinical findings seen in a subluxation?

Answer 412

tender to percussion mobility no displacement bleeding from gingival crevice may be noted

Question 413

what is treatment for a subluxation?

Answer 413

normally no treatment necessary but can place a flexible splint to stabilize the tooth for patient comfort for 2 weeks

Question 414

what is follow up for a subluxation?

Answer 414

2 weeks, 4 weeks, 6-8 weeks, 6 months and 1 year

Question 415

what radiographic findings do you see in extrusive luxation?

Answer 415

increased periodontal ligament space apically

Question 416

what is the treatment for extrusive luxation?

Answer 416

reposition tooth into socket, stabilize using flexible splint for 2 weeks, RCT is indicated in mature or immature young permanent teeth where pulp necrosis is expected

Question 417

what is the follow up procedures for extrusive luxation, lateral luxation and intrusive luxation?

Answer 417

2 weeks, 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years

Question 418

what are some unfavorable outcomes associated with extrusive luxation, lateral luxation and intrusive luxation?

Answer 418

apical periodontitis negative pulp response breakdown of marginal bone(in which case splint for extra 3-4 weeks) external inflammatory resorption or replacement resorption

Question 419

what are clinical findings associated with a lateral luxation?

Answer 419

immobile percussion gives a metallic(ankylosed) sound fracture of the alveolar process present

Question 420

what are radiographic findings associated with lateral luxation?

Answer 420

widened periodontal ligament space best seen on eccentric or occlusal exposures

Question 421

what is treatment for lateral luxation?

Answer 421

reposition and stabilize for 4 weeks with flexible splint, begin RCT if pulp becomes necrotic

Question 422

what are clinical findings associated with intrusive luxation?

Answer 422

immobile | percussion may give metallic(ankylosed) sound

Question 423

what are radiographic findings seen in intrusive luxation?

Answer 423

PDL space may be absent from all or part of the root | CEJ located more apically in intruded tooth

Question 424

what is the treatment for intrusive luxation for teeth with incomplete root formation?

Answer 424

allow eruption without intervention if no movement within a few weeks, initiate orthodontic repositioning if tooth is intruded more than 7mm, reposition surgically or orthodontically

Question 425

what is the treatment for intrusive luxation for teeth with complete root formation?

Answer 425

allow spontaneous eruption if tooth intruded less than 3mm. If no movement after 2-4 weeks, reposition surgically or orthodontically before ankylosis can develop 3-7mm, reposition surgically orthodontically if >7mm, reposition surgically pulp will likely become necrotic, RCT using temp filling with calcium hydroxide and should begin 2-3weeks after repositioning once repositionined surgically or orthodontically, splint for 4-8 weeks

Question 426

what patient instructions are usually given following TDI?

Answer 426

avoid contact sports soft diet for up to 2 weeks brush teeth with a soft toothbrush after each meal use chlorhexidine or non alcohol mouth rinse twice a day for 1 week

Question 427

when is replantation of an avulsed tooth not indicated?

Answer 427

severe caries or perio disease non cooperating patient severe medical conditions(immunosuppression and severe cardiac conditions)

Question 428

what would you tell a teacher regarding first aid for an avulsed tooth at the place of accident for one of her students?

Answer 428

pick tooth up by the crown if tooth is dirty, run under cold water for 10 seconds and reposition it, bite on a paper towel to hold in place if reposition not possible, place in HBS medium, cold milk or in the cheek and bring to emergency clinic

Question 429

from a clinical point of view, the condition of the PDL cells of an avulsed tooth should be classified into what three groups?

Answer 429

PDL cells are most likely viable -- replanted immediately or after a very short time PDL cells may be viable but compromised -- kept in storage medium(HBSS, saline, milk or saliva) and EO dry time 60min or kept in non physiologic storage medium

Question 430

what is the treatment for an avulsed permanent tooth with a closed apex that has been replanted?

Answer 430

clean area suture gingival lacerations verify positioning clinically and radiographically splint for 2 weeks administer systemic antibiotics check tetanus protection RCT 7-10 days after replantation but before splint removal

Question 431

what is the treatment for an avulsed permanent tooth with a closed apex in a physiologic medium with EO dry time less than 60 minutes?

Answer 431

clean root and apex with saline stream and soak tooth in saline irrigate socket with saline replant tooth slowly suture gingival lacerations verify position clinically and radiographically splint for 2 weeks administer systemic antibiotics check tetanus protection initiate RCT 7-10 days after replantation and before splint removal

Question 432

what is the treatment for an avulsed permanent tooth with a closed apex that has a dry time longer than 60 min or other reasons suggesting non viable cells?

Answer 432

remove attached non viable soft tissue carefully with gauze RCT can be carried our prior to replantantion or 7-10 days after replantation treat root surface with 2% sodium fluoride solution for 20 minutes(to slow ankylosis) -- not an absolute recommendation irrigate socket with saline replant tooth suture gingival laceration verify position clinically and radiographically splint tooth for 4 weeks using flexible splint administer systemic antibiotics check tetanus protection

Question 433

what is the goal in delayed replantation(EO>60 mins)?

Answer 433

esthetic, functional and psychological reasons to maintain alveolar bone contour knowing the tooth will likely be lost due to ankylosis and resorption of the root.

Question 434

when may decoronation be necessary in an avulsed tooth?

Answer 434

when infraposition >1mm is seen

Question 435

what is the treatment for an avulsed perm tooth with an open apex that has been replanted before the patients arrival at the clinic?

Answer 435

``` leave tooth in place clean area with saline or chlorhexidine suture gingival lacerations verify positioning clinically and radiographically splint for 2 weeks administer systemic antibiotics check tetanus protection goal for replanting immature teeth is potential revascularization(if does not occur, then initiate RCT) ```

Question 436

what is the treatment for an avulsed perm tooth with an open apex where the tooth has been kept in a physiologic storage medium and EO dry time is less than 60 minutes?

Answer 436

if contaminated, clean root surface and apex with saline. can consider topical application of antibiotics(to enhance chance of revascularization) remove coagulum in the socket and replant tooth slowly suture gingival laceration verify positioning clinically and radiographically splint 2 weeks administer systemic antibiotics check tetanus protection goal for replanting immature teeth is possible revascularization(if does not occur, RCT recommended)

Question 437

what is the treatment for an avulsed perm tooth with an open apex where the dry time is longer than 60 minutes or other reasons suggesting non viable cells?

Answer 437

remove attached non viable soft tissue with gauze treat root surface with 2% sodium fluoride soak for 20 minutes(not absolute recommendation but can slow down ankylosis) RCT tooth prior to replantation or 7-10 days later remove coagulum from the socket with stream of saline replant tooth suture gingival laceration verify positioning clinically and radiographically stabilize for 4 weeks administer systemic antibiotics check tetanus protection eventual outcome will be ankylosis and resorption of the root

Question 438

what is the first choice for systemic antibiotics after replanting an avulsed tooth?

Answer 438

tetracycline is first choice. If discoloration risk/issue, can give Pen V or amoxicillin as an alternative in the first week after replantation.

Question 439

what topical antibiotics are suggested for use in replanting an avulsed tooth with an open apex with EO dry time

Answer 439

mino or doxycycline 1mg per 20ml of saline for 5 min soak, aid in pulp revascularization and periodontal healing

Question 440

when do you refer a patient out for tetanus booster after an avulsion?

Answer 440

if tooth has contacted soil or tetanus coverage is uncertain

Question 441

what is the follow up protocol for replanted avulsed permanent teeth?

Answer 441

clinical and radiographic follow up 4 weeks, 3 months, 6 months, 1 year and yearly thereafter.

Question 442

what are favorable outcomes for a replanted tooth with a closed apex?

Answer 442

``` asymptomatic normal mobility normal percussion sound no radiographic evidence of resorption or periradicular osteitis lamina dura appears normal ```

Question 443

what are favorable outcomes for a replanted tooth with a open apex?

Answer 443

``` asymptomatic normal mobility normal percussion sound radiographic evidence of arrested or continued root formation and eruption pulp canal obliteration is expected ```

Question 444

what are unfavorable outcomes for a replanted tooth with a closed apex?

Answer 444

``` symptomatic excessive mobility or no mobility metallic percussion sound radiographic evidence of inflammatory, infection related or ankylosis related resorption infraposition of tooth ```

Question 445

what are unfavorable outcomes for a replanted tooth with a open apex?

Answer 445

``` symptomatic excessive mobility or no mobility metallic percussion sound radiographic evidence of inflammatory, infection related or ankylotic related resorption) or absence of continued root formation infraposition of tooth ```

Question 446

what are treatment options for when a replanted tooth is expected to be lost?

Answer 446

``` decoronation autotransplantation resin retained bridge denture orthodontic referral ```

Question 447

what are some of the consequences that can occur following severe injuries to primary teeth and or alveolar bone?

Answer 447

tooth malformation impacted teeth eruption disturbances white or yellow-brown discoloration of crown and hypoplasia of permanents

Question 448

what is the most common sequelae following intrusion and avulsion of primary teeth in children?

Answer 448

white or yellow brown discoloration of crown and hypoplasia of permanent incisors

Question 449

what factors during primary tooth trauma influence treatment selection?

Answer 449

childs maturity and ability to cope with the situation time for shedding of the injured tooth the occlusion

Question 450

what is recommended treatment for a primary tooth enamel fracture?

Answer 450

smooth sharp edges

Question 451

what is the treatment and follow up for an enamel-dentin fracture in a primary tooth?

Answer 451

place GI over exposed dentin or build up with composite, follow up in 3-4 weeks just clinically

Question 452

what is the treatment and follow up for an enamel-dentin-pulp fx, crown root fx, in a primary tooth?

Answer 452

preserve pulp vitality if possible with partial pulpotompy and CaOH over pulp, GI over this and then composite or EXT. F/U 1 week clinically, 6-8 weeks clinical and radiographic, 1 year clinical and radiographic follow up

Question 453

what are unfavorable outcomes of an enamel dentin pulp, crown root fx in a primary tooth?

Answer 453

apical periodontitis | no continued root formation

Question 454

what is the treatment for a crown root fracture in a primary tooth?

Answer 454

fragment removal and coronal restoration if fracture involves small part of the root. Extraction in all other situations

Question 455

what is the treatment for a root fracture in a primary tooth?

Answer 455

if coronal fragment not displaced, no treatment if coronal fragment displaced, can reposition and splint, otherwise only extract coronal fragment and leave apical fragment

Question 456

what is the treatment of an alveolar fracture in the primary dentition?

Answer 456

reposition any displaced segment and then splint for 4 weeks. GA often indicated to accomplish this

Question 457

what is the follow up for an alveolar fracture in primary teeth?

Answer 457

1 week clinically, 3-4 weeks for splint removal and clinical and radiographic eval, 6-8 weeks C and R, 1 year C and R, and every year after until exfoliation

Question 458

what is an unfavorable outcome in primary teeth suffering an alveolar fracture?

Answer 458

apical periodontitis or external inflammatory root resorption, signs of disturbances in permanent successors

Question 459

what is recommended treatment for subluxation in primary teeth?

Answer 459

no treatment, keep clean with soft toothbrush, swab affected area with chlorhexidine 2x/day for 1 week

Question 460

what are unfavorable outcomes in concussion and subluxation and extrusive luxation in primary teeth?

Answer 460

dark discoloration of crown. No tx necessary unless apical periodontitis develops or a fistula.

Question 461

what is the recommended treatment for extrusive luxation in primary teeth?

Answer 461

in immature developing primary teeth

Question 462

what does a yellow discoloration of the crown indicate in primary TDI?

Answer 462

pulp obliteration and has a good prognosis

Question 463

what is the recommended treatment for lateral luxation in primary teeth?

Answer 463

if no occlusal interference, allow tooth to reposition spontaneously in case of slight occlusal interference, slight grinding indicated with more severe occlusal interference, tooth can be gently repositioned in severe displacement with crown dislocated in labial direction, extraction is treatment of choice

Question 464

what radiographic findings are seen in intrusion in primary teeth with the apex displaced toward or through the labial bone plate?

Answer 464

apical tip can be visualized and tooth appears shorter than its contralateral

Question 465

what radiographic findings are seen in intrusion in primary teeth with the apex displaced toward the permanent tooth germ?

Answer 465

apical tip cannot be visualized and the tooth appears elongated

Question 466

what is the treatment for intrusion in primary teeth?

Answer 466

if displaced towards the labial bone plate, allow spontaneous repositioning if displaced towards permanent tooth germ, Extract

Question 467

when is splinting suggested in primary tooth TDIs?

Answer 467

for alveolar bone fractures and possibly for intra-alveolar root fractures

Question 468

what are instructions given to parents following primary tooth TDIs?

Answer 468

brushing with a soft brush and use of alcohol free chlorhexidine topically on area 2x/day for 1 week soft diet for 10 days restrict use of pacifier

Question 469

what are the general principles for the management of medical emergencies?

Answer 469

1. stop treatment and assess situation 2. position patient. If unconscious, supine with legs elevated to increase cerebral blood flow or on L side to prevent aspiraton. If status epilectus(protect patient) 3. Activate EMS 4. ABCs of life support/AED. Airway(head tilt, chin lift), breathing(check respirations), circulation(check pulse quality) 5. Supplemental oxygen(nasal hood--> passive oxygen delivery, nonrebreather mask--> can breathe but need more oxygen, bag valve mask-->unconscious 6. Calm and comfort patient 7. Vital signs 8. Drugs

Question 470

what is the management for syncope?

Answer 470

1. Recline, feet up 2. Loosen clothing that may be binding 3. Ammonia inhales 4. Administer oxygen 5. Cold towel on back of neck 6. Monitor recovery

Question 471

what is the management for airway obstruction?

Answer 471

stop tx BLS, head tilt, chin lift, abdominal thrusts for foreign body, supplemental o2 for soft tissue obstruction EMS transport

Question 472

what is the management for hyperventilaton syndrome?

Answer 472

``` stop treatment BLS calm, comfort patient vital signs have patient hold breath for 10 second intervals consider o2 mask (instead of paper bag) EMS if no resolution ```

Question 473

what is the management for acute asthma?

Answer 473

1. Sit patient upright or in a comfortable position 2. Administer oxygen 3. Administer bronchodilator 4. If bronchodilator is ineffective, administer epinephrine 5. Call for emergency medical services with transportation for advanced care if indicated

Question 474

what is the management of AMS/CVA/TIA

Answer 474

``` recognize, and stop treatment BLS with supplemental o2 rapid glucose test-treat hypoglycemia ems vital signs ```

Question 475

what is the management of chest pain/angina pectoris?

Answer 475

recognize, stop treatment BLS with supplemental o2 calm patient vital signs nitro 0.4mg SL tab or spray(can repeat q5mins to max of 3x) only if systolic BP>100 consider N20 if no relief after 3 doses of nitro, assume MI

Question 476

what is the management of MI?

Answer 476

``` recognize, stop treatment BLS with supplemental o2 call EMS vital signs 2 baby aspirin(160mg) chewable nitro 0.4mg SL tab or spray if systolic BP>100 nitrous oxide 50% until EMS arrival ```

Question 477

what is the management of cardiac arrest?

Answer 477

recognize, call for EMS BLS with supplemental o2 AED, defibrillate if indicated

Question 478

what is the management of an allergic reaction?

Answer 478

``` recognize and stop treatment BLS with supplemental o2 vital signs benadryl 25-50mg PO or deep IM(1mg/kg) epi 1:1000 IM if anaphylactic, use EpiPen for 5 years and older, EpiPen Jr for younger repeat EPI every 5-10min as needed activate EMS ```

Question 479

what is the management of seizures?

Answer 479

1. Recline and position to prevent injury 2. Ensure open airway and adequate ventilation 3. Monitor vital signs 4. If status is epilepticus, give diazepam and call for emergency medical services with transportation for advanced care if indicated

Question 480

what is the management of hypoglycemia?

Answer 480

``` prevent it by giving light food before an appt stop treatment, position patient BLS with supplemental oxygen rapid glucose test if conscious - Sugar PO if unconscious - glucagon 1mg IM monitor vital signs activate EMS ```

Question 481

what is the management of local anesthetic or other drug overdose?

Answer 481

1. Assess and support airway, breathing, and circulation (CPR if warranted) 2. Administer oxygen 3. Monitor vital signs 4. If severe respiratory depression due to benzodiazpine OD, establish IV and give flumazenil. If severe respiratory depression due to narcotic OD, administer naloxone. 4. Call for emergency medical services with transportation for advanced care if indicated

Question 482

what is the management of fluoride toxicity or other poison ingestion?

Answer 482

``` recognize, stop tx and position patient call poison control BLS with supplemental oxygen EMS do not give ipecac monitor vital signs ```

Question 483

Review the BLS healthcare flow chart

Answer 483

No seriously, review it.

Question 484

what is asthma?

Answer 484

chronic inflammatory disorder of the airways

Question 485

what are triggers for asthma attacks?

Answer 485

``` viral infections allergens exercise cold air GERD stress ```

Question 486

what are examples of controllers(given daily to control chronic asthma and relievers?)

Answer 486

Controllers are: inhaled corticosteroids, leukotriene antagonists Relievers are: beta agonists like Albuterol

Question 487

what are some oral findings seen with asthmatics?

Answer 487

poss increased caries and tooth wear oral candidiasis following steroid use. Rinse with water following steroid dose to reduce candidiasis. decreased salivary flow following beta agonist use gingivitis from mouth breathing

Question 488

what is suggestive of poor asthma control and necessitates referral to childs physician?

Answer 488

use of albuterol > 2x/week nightime awakening with symptoms >2x/week concurrent upper respiratory illness causing asthma symptoms

Question 489

when should you consult with a childs physician regarding their asthma?

Answer 489

systemic gluocorticoids were used in the past month | if patient had >4 oral steroid uses in the past year

Question 490

what drugs are recommended for sedating an asthmatic and which are to be avoided?

Answer 490

recommended are benzodiazapines and hydroxyzine. | Avoid barbituates and narcotics(meperidine and morphine, can cause bronchospasm)

Question 491

in which asthmatics is nitrous oxide effective and safe?

Answer 491

in mild to moderate asthmatics

Question 492

is it safe to use local anesthetics in asthmatics?

Answer 492

LA with vasoconstrictors are safe to use unless a known allergy to betasulfite

Question 493

what is the usual medical treatment for arthiritis?

Answer 493

NSAIDS and selective cox2 inhibitors are first line therapy | second line therapy are immunosuppressives including methotrexate, corticosteroids, hydroxychloroquine, gold

Question 494

what are the dental considerations for patients with arthritis?

Answer 494

patients in chronic pain limited movement so positioning is important short appointments preferred possible TMJ involvement with limited opening, decreased mandibular growth, open bite and ankylosis with destruction of condyles children may refer to TMJ pain as earaches children with JRA may have difficulty brushing teeth if hands or arms involved

Question 495

what are the surgical considerations for patients with arthritis?

Answer 495

for children on aspirin, hold 10 days and preferably determine PT and PTT patients on oral steroids may require steroid supplementation to prevent adrenal suppression if patient taking gold or pencillamine, perform a CBC

Question 496

what is wegener granulomatosis?

Answer 496

a systemic vasculitis affecting small and medium arteries, venules, and arterioles,

Question 497

what clinical findings are seen in wegener granulomatosis?

Answer 497

nasal or oral inflammation with ulceration | subglottic stenosis

Question 498

what is behcet disease?

Answer 498

vasculitides in children

Question 499

what are clinical findings of behcet disease?

Answer 499

oral apthous ulcers genital ulceration ocular disease

Question 500

what is treatment of the vasculitidies?

Answer 500

using nsaids, corticosteroids, and cytotoxic agents

Question 501

what is systemic lupus erythematosus?

Answer 501

chronic inflammatory disorder of unknown cause multi organ system involvement can see oral ulcers, arthritis, seizures, hematologic disorders and much more

Question 502

what medications are usually used to treat SLE?

Answer 502

``` corticosteroids NSAIDs hydroxychlorquine methothrexate cytotoxic agents ```

Question 503

what are dental considerations for patients with SLE?

Answer 503

increased susceptibility to infection assess need for sbe prophylaxis secondary to heart damage supplemental steroids to prevent adrenal suppression assess kidney function as renal complications are common sjogren syndrome is a complication that has xerostomia

Question 504

what oral manifestations are seen with t cell defects and neutrophil deficiencies?

Answer 504

``` oral candidiasis severe gingivitis gingivostomatitis recurrent apthous ulceration recurrent herpes simplex infection premature exfoliation of primary teeth ```

Question 505

what clinical manifestations are seen with b cell deficiencies?

Answer 505

few oral complications | recurrent bacterial infections, esp pneumonia and skin infections.

Question 506

what is the dental management for patients with t cell, b cell, and neutrophil defects or deficiencies?

Answer 506

aggressive prevention may need CBC, WBC and platelet count before invasive procedure extraction of pulpally involved teeth to prevent septicemia acyclovir for recurrent herpes simplex antifungal - nystatin, amphotericin B chlorhexidine mouthwash

Question 507

what is digeorge syndrome cause and effects?

Answer 507

spontaneous 3rd and 4th pharyngeal pouch development defect resulting in T cell defects and other effects. Often has VCF-Syndrome ``` Catch 22 C-Cardiac anomalies A- abnormal facies T- thymic hypoplasia C- Cleft palate H - hypocalcemia ```

Question 508

what are some of the most common cancers in childhood aged 0-19 years?

Answer 508

Luekemias - ALL and AML CNS Malignancies - Second most common Lymphomas - third most common, including hodgkins disease and non hodgkins lymphoma sympathetic nervous system tumors such as neuroblastomas

Question 509

what is the most frequently documented source of sepsis in the cancer patient?

Answer 509

the mouth

Question 510

what are some oral complications of chemotherapy and radiotherapy?

Answer 510

``` mucositis TMD xerostomia dentinal sensitivity secondary infections bleeding craniofacial and dental development abnormalities ```

Question 511

what are some craniofacial and dental developmental abnormalities seen in patients receiving chemotherapy and radiotherapy?

Answer 511

``` tooth agensis microdontia crown disturbance(size, shape, enamel hypoplasia) root disturbances reduced mandibular length reduced alveolar process height ```

Question 512

what ANC and platelet hematological parameters should be followed?

Answer 512

>1000/mm3, no antibiotics necessary | 75000, OK but be prepared to handle bleeding

Question 513

what basic prioritization of procedures takes place in hematological patients?

Answer 513

infections, extractions, scaling, and sources of tissue irritation, followed by carious teeth, root canal therapy, and replacement of faulty restorations.

Question 514

cardiac defects are associated with which common congenital disorders?

Answer 514

``` down syndrome turner syndrome marfan syndrome ehler danlos syndrome osteogenesis imperfecta ```

Question 515

what are some symptoms seen in congenital heart disease patients?

Answer 515

dyspnea cyanosis(late in L to R shunting, early in R to L shunting) polycythemia(increase in hemoglobin concentration) clubbing of toes and fingers syncope weakness murmur

Question 516

what are some common congenital heart diseases?

Answer 516

``` ASD VSD patent ductus arteriosus transposition of great vessels persistent truncus arteriosus(blood from both ventricles moves together through a single valve) Tetralogy of Fallot ```

Question 517

what is rheumatic fever?

Answer 517

acute inflammatory condition that develops in some individuals following group a strep infection(strep throat). Thought to arise as an autoimmune reaction

Question 518

what is rheumatic heart disease?

Answer 518

cardiac damage that can result from rheumatic fever mostly to mitral or aortic valve

Question 519

how are heart murmurs caused?

Answer 519

through turbulence of blood flow through the valves and chambers of the heart

Question 520

what are cardiac arrhythmias?

Answer 520

variation in the normal rhythm of the heart beat, due to disturbance in rate, rhythm, or conduction

Question 521

what is the dental management and considerations for a patient with cardiac arrhythmias?

Answer 521

medical consultation to establish risk classification(low,mod,high) minimize stressful situations reduce anxiety with pre-med, nitrous oxide or sedation short morning appointments minimize use of epi avoid GA avoid electrical equipment that may interefere with a pacemaker

Question 522

what common medications are used to control cardiac arrhytmias and what are their oral side effects?

Answer 522

verapamil, digoxin, propranolol, quinidine, procainamide, lidocaine and their oral effects are: ulceration lupus like syndrome xerostomia petechiae

Question 523

what is the dental management for a patient with congestive heart disease?

Answer 523

avoid procedures that may cause a gag reflex minimize epi use prevent orthostatic hypotension investigate potential bleeding problems from use of anticoagulants

Question 524

what are oral complications seen in congestive heart failure patients?

Answer 524

``` infection bleeding petechiae ecchymoses drug related effects: xerostomia, lichenoid mucosal reactions ```

Question 525

what dental procedures is antibiotic prophylaxis recommended for IE?

Answer 525

all dental procedures that involve manipulation of gingival tissues, the periapical region of teeth, or performation of the oral mucosa

Question 526

what are dental/oral findings seen in type 1, 2, 3 and 4 diabetes?

Answer 526

``` xerostomia increased caries risk oral candidiasis burning mouth or tongue taste alteration inc. periodontal risk poor wound healing acetone breath ```

Question 527

What are dental considerations when encountering a child with diabetes?

Answer 527

Get recent blood glucose levels, frequency of hypoglycemic episodes, medications avoid hypoglycemic episodes by scheduling morning appt, short appointments, eat a light meal and take medications, minimize stress aggressive periodontal care

Question 528

what symptoms are seen during a hypoglycemic episode?

Answer 528

weakness, nervous, pale skin, confused, palpitations, increased sweating, hunger, tremors

Question 529

what is the treatment for a hypoglycemic episode?

Answer 529

stop treatment | administer orange juice or soda or IM glucagon

Question 530

congenital hypothyroidism aka?

Answer 530

cretinism

Question 531

acquired primary hypothyroidism aka?

Answer 531

hashimotos disease(autoimmune disease)

Question 532

what are oral findings associated with hypothyroidism?

Answer 532

``` enlarged tongue delayed dental development and eruption malocclusion gingival edema delayed skeletal development protruding tongue and thick lips ```

Question 533

what are dental considerations/management for patients with hypothyroidism?

Answer 533

good medical history sensitivity to stress, infection, surgery sensitive to drugs such as sedatives and opioid analgesics

Question 534

what is graves disease?

Answer 534

generalized overactivity of the thyroid gland | autoimmune dx

Question 535

what are oral findings seen in hyperthyroid patients?

Answer 535

osteoporosis of the alveolar bone dental caries and periodontal disease more likely teeth and jaws develop more rapidly premature loss of primary teeth with early eruption of permanent teeth damaged salivary gland

Question 536

primary adrenal insufficiency aka?

Answer 536

addisons diease

Question 537

what are oral findings/complications associated with adrenal insufficiency?

Answer 537

hyperpigmentation of the skin and mucous membranes delayed healing infection

Question 538

what are dental considerations to take into account for patients with adrenal insufficiency?

Answer 538

dental infection can cause adrenal crisis in patients with adrenal insufficiency children with adrenal insufficiency are high risk patients, obtain medical consult to avoid adrenal crisis, ask patient to take glucocorticoid as physician prescribes schedule morning appointment only For dental extractions or surgery, likely have to inc steroid dose

Question 539

what syndrome is characterized by hyperadrenalism?

Answer 539

Cushings syndrome

Question 540

what are some dental findings associated with hyperadrenalism?

Answer 540

osteoporosis | delayed wound healing

Question 541

what dental management considerations are taken into account for patients with hyperadrenalism?

Answer 541

susceptibility to fracture | implants contraindicated

Question 542

what oral pathology is seen in hyperparathyroidism patients?

Answer 542

hyperparathyroidism=hypercementosis loss of lamina dura decreased density of bony trabeculae, ground glass appearance loss of cortication of the inferior border of the mandible and the mandibular canal lyric bone cysts in the jaw vague jaw pain and sensitivty to percussion soft tissue calcification of the salivary glands pulp stones

Question 543

what oral pathology is seen in hypoparathyroidism patients?

Answer 543

``` circumoral paresthesia enamel hypoplasia delayed eruption enamel attrition short, blunted roots dentin dysplasia malformed or impacted teeth partial anodontia predisposition to oral candidiasis ```

Question 544

what dental findings are seen in hypopituitarism?

Answer 544

``` decreased linear facial measurements delayed tooth eruption smaller mandible small crowns in the gingivo-occlusal dimension reduced root length crowding and malocclusion due to small dental arch hypofunction of salivary glands and decreased salivary flow at risk for caries and periodontal disease delayed development hypodontia ```

Question 545

what are some dental considerations to keep in mind when treating a patient diagnosed with hypopituitarism ?

Answer 545

good medical history, growth and development assessment as part of early orthodontic evaluation, dental caries prevention and treatment, periodontal disease prevention and management

Question 546

what dental/oral findings are seen in a patient diagnosed with hyperpituitarism?

Answer 546

``` frontal bossing enlargement of nose and lips – prognathism – malocclusion – increased spacing between the teeth (intradental separation) – macroglossia – temporomandibular arthritis – macrodontia – hypercementosis – radiodense cortical plate ```

Question 547

what dental considerations should be taken into account when treating a patient with hyperpituitarism?

Answer 547

* Consult with physician as appropriate * IE (SBE) consideration * Management of craniofacial abnormalities * Sedation considerations: sleep apnea (50% of patients), snoring due to increased soft tissue mass in the airways

Question 548

what are anemias?

Answer 548

a reduction in the red blood cell volume or hemoglobin concentration below the range or values that occur in healthy people(12-18g/100ml)

Question 549

what are dental considerations for a low risk anemia patient?

Answer 549

if the cause is known, is being treated, or patient has normal hematocrit, treat as a normal dental patient

Question 550

what are the dental considerations for a high risk anemia patient?

Answer 550

patient receiving frequent therapy, patient with bleeding problems get hematology consult defer elective treatment until stable treatment goals are aimed at minimizing stress deep sedation, general anesthesia, and invasive surgical procedures may require hospitalization

Question 551

what clotting factor is deficient in hemophilia A? B?

Answer 551

8, 9

Question 552

what drugs can cause platelet dysfunction?

Answer 552

aspirin ibuprofen naprosyn

Question 553

what important topics must be discussed in the oral history for patients suffering from anemias and other bleeding disorders?

Answer 553

Hematology consult History: frequent nose bleeds; heavy menstrual flow; easy bruisability, family history of bleeding disorders Physical findings: petechiae and ecchymosis; generalized spontaneous gingival hemorrhage Lab screening, PT, PTT and platelet count

Question 554

what management considerations are done for moderate and high risk anemics and other patients with bleeding disorders?

Answer 554

medical consult, may be necessary to treat in hospital hemophilias treated with factor replacement Bring to 40-50% normal level for restorative and 80-100% for extractions Vasopressin acetate(DDAVP) for mild to moderate factor 8 deficiecny Amicar or cyclokapron as antifibrinolytic supplement post treatment nasotracheal intubation may be contraindicated

Question 555

what is usually seen in impetigo contagiosa

Answer 555

self limiting | tiny pustules that rupture without pain, see perioral skin involvement, intraoral lesions are not seen

Question 556

what are some findings seen in bacterial pharyngitis?

Answer 556

Diffuse erythema and inflammation of the tonsils and their pillars, petechaie of the soft palate, and pharynx with anterior cervical lymphadenopathy

Question 557

what oral findings are seen in syphilis?

Answer 557

primary chancre (oral mucosa, gingiva, or lips) mucous patches oral gummas congenital dental anomalies(hutchinsons incisors, mulberry molars)

Question 558

Tuberculosis is associated with what oral findings?

Answer 558

Associated with chronic oral ulcers, granulomas, jaw osteomyelitis, cervical lymphadenitis, and salivary gland involvement

Question 559

what is seen in hand foot and mouth disease?

Answer 559

Oral vesicles with rapid ulceration, 5-10 in number; occasional regional lymphadenopathy

Question 560

what is the differential diagnosis for hand foot and mouth disease?

Answer 560

``` aphthous stomatitis chickenpox erythema multiforme herpes simplex virus herpangina ```

Question 561

what oral findings are seen in herpangina?

Answer 561

``` coxsackie a virus Oropharyngeal vesicles and ulcerations involving soft palate, uvula, tonsils, anterior pillars, posterior pharynx ```

Question 562

what is the differential diagnosis for herpangina?

Answer 562

``` herpes simplex virus, bacterial pharyngitis, infectious mononucleosis, hand-foot-mouth disease ```

Question 563

what oral findings are seen in acute herpetic gingivostomatis?

Answer 563

small punctuate vesicles that rupture to form shallow ulcers with smooth margins surrounded by a red halo; lesions occur in all areas of the mouth with gingiva and lips most common; gingiva shows acute inflammation

Question 564

what oral findings are seen in chickenpox and what are the differential diagnosis?

Answer 564

``` oral vesicles and ulceration DD: contact dermatitis, herpes simplex virus, impetigo, urticaria ```

Question 565

condyloma acuminatum papules usually occur where?

Answer 565

on nonkeratinized mucosa i.e. lips, floor of the mouth, lateral and ventral surfaces of the tongue, buccal mucosa, soft palate; rarely on gingiva

Question 566

the major target cell for infection in HIV is?

Answer 566

CD4 cells

Question 567

what oral manifestations are seen in HIV patients?

Answer 567

fungal infections with candidiasis most common, viral infections (HSV infection), bacterial infections including necrotizing ulcerative gingivitis and/or periodontitis, hairy leukoplakia (rarely in children), non-Hodgkin’s lymphoma, salivary gland enlargement with parotitis most common, oral bleeding due to thrombocytopenia, recurrent aphthous stomatitis, linear gingiva erythema

Question 568

how do you treat oral candidiasis?

Answer 568

5 to 7 day course, topical nystatin, clotrimazole troches, systemic flucozonale

Question 569

how do you treat angular chelitis?

Answer 569

topical imidizole cream

Question 570

how do you treat herpes simplex virus seen in HIV or other immunocompromised patients?

Answer 570

systemic acyclovir

Question 571

how do you treat linear gingival erythema?

Answer 571

optimal plaque control, chlorhexidine rinses

Question 572

what oral forms of candidiasis are seen?

Answer 572

pseudomembranous (thrush) or atrophic (erythematous); thrush can involve the lips, tongue, gingiva, buccal mucosa, and palate; atrophic candidiasis: scraping of lesions reveals erythema and bleeding at base; glossitis also seen

Question 573

what is dialysis?

Answer 573

artificial means of removing nitrogenous and other toxic products of metabolism from the blood and to maintain fluid and electrolyte balance

Question 574

when should dental care be scheduled for dialysis patients?

Answer 574

soon after dialysis and avoided before receiving dialysis

Question 575

what is the definition of autism?

Answer 575

a disorder of neural development characterized by impaired social interaction and communication, and by restrictive behavior

Question 576

What are characteristics of asperger syndrome?

Answer 576

relatively strong verbal skills trouble with social situations and sharing enjoyment obsessive interests

Question 577

what are characteristics of autistic children?

Answer 577

``` – severe language problems – lack of interest in others – repetitive behaviors – resistance to change – irrational routines ```

Question 578

what are dental considerations for autistic patients?

Answer 578

``` desensitization(may take several visits) positive reinforcement keep sentences short and simple music can be an aid use parents help when demonstrating toothbrushing, use patients limbs instead of demonstrating yourself use the same people as previous appointment use the same treatment room ```

Question 579

what oral findings are seen in down syndrome patients?

Answer 579

– higher incidence of periodontal disease – altered eruption and malocclusion(cl 3) – anomalies in tooth morphology – drooling – macroglossia – clenching and bruxism – high vaulted palate

Question 580

what medical history should be asked to parents of children with seizures?

Answer 580

* Type * date of last seizure, how many * how well controlled, date of last hospitalization for seizure * History of injuries from previous seizures * Duration * Triggers * Medications and compliance * Diet

Question 581

what is the oral evaluation and management considerations for patients with seizures?

Answer 581

• Make sure patient has taken medications and has eaten • Schedule when patient has not recently been ill and when seizures are less likely to occur in the day • Schedule when well rested • Xylocaine decreases seizure threshold • Dental light may trigger a seizure so consider dark glasses • Avoid sudden unexpected movement • Aggressive oral hygiene program

Question 582

what is MELAS?

Answer 582

``` classic mitochondrial disorder Mitochondrial Myopathy Encephalopathy Lactic Acidosis Stroke Like Episodes ```

Question 583

what are common oral findings seen in mitochondrial disorders?

Answer 583

acid erosion due to increased vomiting

Question 584

when do neural tube defects usually occur?

Answer 584

3-4 weeks in utero, before mom even knows she is pregnant

Question 585

what are dental considerations for patients with neural tube defects such as spina bifida, arnold chiari malformation?

Answer 585

• Latex allergy precautions • Consultation with patient’s physician regarding nature of defect and past medical history • Some patients with neural tube defects have mental disabilities • In adolescence, some spina bifida patients develop depression • Access for wheelchair • Antibiotic prophylaxis for patients with VA or VV shunt for hydrocephalus • Consider treatment in wheelchair inclined slightly or in dental chair at more upright position– supine position may be difficult for patient • For patients with Arnold-Chiari malformation, consider treatment with patient in a more upright position

Question 586

define cerebral palsy and what are some characteristics?

Answer 586

* Nonprogressive disorder resulting from malfunction of the motor centers and pathways of the brain * Characterized by paralysis, weakness, incoordination or other aberrations of motor function

Question 587

what are characteristics of the spastic type of cerebral palsy?

Answer 587

tightness, stiff or rigid muscles, contractures and lack of control (most common form with 70-80% of all cases)

Question 588

what are characteristics of the dyskinetic(athethoid) type of cerebral palsy?

Answer 588

slow, writhing, involuntary movements, hypotonia (10-15% | of cases)

Question 589

what are characteristics of the ataxic type of cerebral palsy?

Answer 589

tremors or uncoordinated voluntary movements (5% of cases)

Question 590

what clinical manifestations are seen in cerebral palsy?

Answer 590

* Intellectual disablity 60% * Seizure disorders 30-50% * Sensory deficits 35% * Speech disorders * Joint contractures, hip dislocation, spinal disorders * Microcephaly frequently present * GI problems- GERD * Spasticity

Question 591

what oral/dental findings are seen in cerebral palsy patients?

Answer 591

* Periodontal disease * Dental caries-poor oral hygiene * Malocclusions-anterior open bite, Angle Cl II * Bruxism * Increased erosion * Trauma and injury * Hyperactive bite reflex * Increased gag reflex * Dysphagia * Increased drooling * Mouth breathing

Question 592

what dental considerations are taken into account when treating cerebral palsy patients?

Answer 592

• Assistive stabilization and postural maintenance – Place and maintain your patient in the center of the dental chair – Do not force limbs into unnatural positions – Consider treating in wheel chair – Stabilize patient’s head during treatment – Consider supports for limbs • Use mouth props or finger splints • Keep patient’s back slightly elevated to minimize swallowing difficulties • Forewarn patients of stimuli to minimize startle reactions

Question 593

what are muscular dystrophys and what is the most common one of childhood?

Answer 593

A group of familial disorders in which degeneration of muscle fibers occurs Duchenne

Question 594

what are common dental/oral findings seen in muscular dystrophy patients?

Answer 594

* Plaque/gingivitis * Higher caries rates * TMD problems * Poor oral control * Trauma and injury

Question 595

what are dental considerations for patients with msucular dystrophys?

Answer 595

* Supports (e.g., mouth props) help with muscle weakness during treatment * May need transfer to dental chair and postural support * Sedation and/or general anesthesia * deficits in protective airway reflexes * Should not place patient in a supine position * short appointments

Question 596

what are common infant soft tissue lesions?

Answer 596

Neonatal cysts such as epstein pearls, bohns nodules, dental lamina cysts

Question 597

where do you find epstein pearls?

Answer 597

occurs on the palatal midline

Question 598

where do you find dental lamina cysts?

Answer 598

aka gingival cyst of the newborn, occurs on alveolar mucosa

Question 599

where do you find bohns nodules?

Answer 599

occurs on junction of hard and soft palate

Question 600

what do the three neonatal cysts have in common?

Answer 600

white papules that slough off

Question 601

what are characteristics of riga fede disease?

Answer 601

– chronic trauma from primary incisors | – ulcerated lesion or mass on anterior ventral tongue

Question 602

what is treatment for riga fede disease?

Answer 602

identify the cause; modify feeding position and bottle used; smooth incisal edges; apply chlorhexidine rinse to ulcer for secondary infection; topical steroids may be indicated

Question 603

you can see tongue trauma in certain patients? What conditions may have neuropathologic ulcers?

Answer 603

``` Š familial dysautonomia Š Lesch-Nyhan syndrome Š Gaucher disease Š cerebral palsy Š Tourette ```

Question 604

what are characteristics of a vascular malformation: an uncommon infant soft tissue lesion?

Answer 604

– present at birth and is persistent – tends to grow with child – occurs in the head and neck region, including facial skin – may be associated with skeletal changes and be intrabony – red, purple, blue macule, nodule of diffuse swelling

Question 605

what are characteristics of hemangioma: an uncommon infant soft tissue lesion?

Answer 605

– may involve major salivary glands, usually parotid – diffuse enlargement of gland – normal or reddish-blue skin coloration – regresses with age

Question 606

what are characteristics of lymphangioma - cystic hygroma: an uncommon infant soft tissue lesion?

Answer 606

– diffuse swelling of cervical region of neck, parotid gland – compromised airway – does not regress – tx: may include surgery

Question 607

what are characteristics of neonatal alveolar lymphangioma: an uncommon infant soft tissue lesion?

Answer 607

– present at birth – usually occurs in African American males – Alveolar ridge; mandible more common than maxilla – Translucent pink to blue, fluctuant swelling – tx: none; resolves spontaneously

Question 608

what are characteristics of congenital epulis; a rare infant soft tissue lesion?

Answer 608

– firm pink to red mass arising from alveolar mucosa at birth – maxillary lateral and canine region most common site – females > males – maxilla > mandible – tx: excision

Question 609

what are characteristics of melanotic neuroectodermal tumor of infancy: a rare infant soft tissue lesion?

Answer 609

– smooth surfaced expansile lesion of alveolus – anterior maxilla most common site – may be pigmented – usually occurs in infants under 6 months – maxilla > mandible – displacement of teeth – X-ray: poorly circumscribed radiolucency with floating teeth – tx: excision

Question 610

what are characteristics and treatment of hemifacial hypertrophy: an rare infant lesion?

Answer 610

– unilateral oral and facial enlargement, usually evident at birth – involves soft tissues, bone, tongue, palate, teeth – teeth may exfoliate and erupt prematurely – intellectual disability in 25% – increased incidence of embryonal tumors (Wilm tumor, hepatoblastoma) – tx: cosmetic surgery; orthodontics

Question 611

what are characteristicis of hemifacial microsomia(Goldenhar syndrome): a rare infant lesion?

Answer 611

– unilateral microtia, macrostomia(wide mouth) and failure of formation of mandibular ramus and condyle – unknown etiology – frequent eye and skeletal involvement – 50% have cardiac pathology—VSD, PDA – tx: orthognathic surgery, distraction osteogenesis

Question 612

what are the types of white oral pathology lesions?

Answer 612

ones that wipe off - nonadherent | ones that don't wipe off - adherent

Question 613

what are characteristics of candidiasis and treatment?

Answer 613

– increased susceptibility with long-term antibiotics, corticosteroids, drugs that cause xerostomia, debilitating disease, oral appliances – oral lesions: multifocal white or red patches that may burn – pseudomembranous form is white and wipes off – chronic hyperplastic form is rare; may be associated with endocrine disease; and is red, white and adherent – tx: nystatin, clotrimazole, ketoconazole, fluconazole, itraconazole

Question 614

what are characteristics and treatment of the white lesion of leukoedema?

Answer 614

– most prominent in African Americans – bilateral, filmy white, adherent, wrinkled patches – stretching of mucosa causes lesion to disappear – increase thickness of mucosa, intracellular edema of – tx: none

Question 615

what are characteristics and treatment of the white lesion of frictional keratosis/cheek and tongue biting lesions?

Answer 615

– white, smooth to shaggy, adherent patches; nontender – may observe a prominent linea alba on buccal mucosa – usually on gingiva, buccal mucosa, lateral tongue – tx: none; reversible lesion

Question 616

what are characteristics and treatment of the white lesion of mucosal burn(chemical, thermal)?

Answer 616

– thermal burn is common and is due to pizza, soup, etc – usually occurs on palate and tongue – chemical burn is caused by a number of agents, including aspirin, formocresol, ferric sulfate, phosphoric acid, phenol – usually occurs on gingiva, buccal, labial mucosa, perioral skin – irregular red erosion or white necrotic patch that wipes off; tender

Question 617

what are characteristics of the white lesion of fordyce granules?

Answer 617

– Ectopic sebaceous glands in oral mucosa – Becomes more prominent during puberty – Flat to slightly elevated, submucosal yellow-white papules or plaques – Common sites are buccal mucosa and lips – tx: none

Question 618

what are characteristics and treatment of the white lesion of cinnamon contact stomatitis?

Answer 618

– cause: flavoring agent in oral hygiene products, candy, gum – occurs on buccal mucosa and lateral tongue – white, shaggy, adherent patches with erythema; tender – tx: identify cause and discontinue offending agent

Question 619

what are characteristics and treatment of the white lesion of smokeless tobacco keratosis?

Answer 619

– chewing tobacco, snuff, snus – occurs in the vestibular mucosa – white, wrinkled, adherent plague; gingival recession, stained, sensitive teeth, root caries, halitosis – precancerous lesion – tx: reversible if discontinue the habit; persistent lesions require a biopsy

Question 620

what are characteristics and treatment of the rare white lesion of white sponge nevus?

Answer 620

– autosomal dominant – diffuse, white, thickened, adherent and wrinkled oral mucosa; becomes more prominent in adolescence – present at birth, may involve other mucosal sites – tx: none; persistent condition

Question 621

what are characteristics and treatment of the localized gingival lesion of parulis?

Answer 621

– odontogenic or gingival infection; entrapped foreign body – red or pinkish white nodule with purulence; fluctuates in size – soft and tender to palpation – tx: treat source of infection; curette lesion; antibiotics may be indicated

Question 622

what are characteristics and treatment of the localized gingival lesion of pygoenic granuloma?

Answer 622

– reactive lesion due to irritation – occurs anywhere in mouth but gingiva is common site – sessile, red nodule that bleeds freely – surface ulceration is common – soft, friable and nontender to palpation – tx: surgical excision, removal of irritant

Question 623

what are characteristics and treatment of the localized gingival lesion of irritation fibroma?

Answer 623

– reactive hyperplasia due to chronic trauma – occurs on buccal mucosa, tongue, gingiva, tongue – pink, smooth nodule; nontender – tx: surgical excision – variant: frenal tag

Question 624

what are characteristics and treatment of the localized gingival lesion of peripheral ossifying fibroma?

Answer 624

– reactive lesion – only occurs on the gingiva – firm, pink or red nodule that begins in the interdental papilla; usually ulcerated – may displace or loosen teeth – X-ray may show calcification – tx: surgical excision down to periosteum – recurrence rate – up to 16%

Question 625

what are characteristics and treatment of the localized gingival lesion of eruption hematoma?

Answer 625

– soft tissue dentigerous cyst – associated with eruption of primary and permanent teeth – red, purple swelling of alveolar mucosa – X-ray may show an enlarged follicular space – tx: none, unless delayed eruption

Question 626

what are characteristics and treatment of the localized gingival lesion of squamous papilloma?

Answer 626

– caused by human papillomavirus – occurs on soft palate, tongue and labial mucosa; uncommon on the gingiva – pink or white papillary, pedunculated nodule – tx: excisional biopsy – tx: important to rule out condyloma acuminatum

Question 627

what are characteristics and treatment of the localized gingival lesion of peripheral giant cell fibroma?

Answer 627

– reactive lesion caused by local irritation – occurs on gingival or alveolar mucosa only – red or purple nodule that may bleed – may cause superficial bone resorption – tx: surgical excision and remove local irritation – there is a 10% recurrence rate – may represent central bony lesion with soft tissue extension

Question 628

what are characteristics and treatment of the localized gingival lesion of giant cell fibroma?

Answer 628

– fibrous hyperplasia of unknown cause – occurs on gingiva, tongue, hard palate – pink, smooth to stippled nodule; nontender – tx: surgical excision – developmental variant: retrocuspid papilla

Question 629

what are characteristics and treatment of the generalized gingival lesion of linear gingival erythema?

Answer 629

– HIV-related gingivitis – distinct linear band of fiery red and edematous attached gingival that may extend beyond the mucogingival junction – does not respond to normal plaque control – tx: chlorhexidine rinse; antifungal agents

Question 630

what are characteristics and treatment of the generalized gingival lesion of plasma cell gingivitis?

Answer 630

– allergic reaction to multiple allergen including toothpaste, candy, chewing gum, mouthwash – diffuse enlargement of the attached gingival of sudden onset – bright red and swollen tissues that burn – tx: identify and eliminate the allergen; topical steroids

Question 631

what are characteristics and treatment of the rare generalized gingival lesion of gingival fibromatosis?

Answer 631

– may be familial or idiopathic – diffuse, multinodular overgrowth of fibrous tissue of gingiva – autosomal dominant, if familial – may be associated with several syndromes; may be associated with hypertrichosis – clinically identical to phenytoin-induced gingival overgrowth – may delay eruption of teeth and malocclusion – tx: surgical excision; recurrence is common

Question 632

what are characteristics and treatment of the rare generalized gingival lesion of leukemia?

Answer 632

– gingivitis secondary to neutropenia – gingival enlargement due to leukemic infiltrates, especially in myelomonocytic types – other signs include spontaneous gingival bleeding, mucosal petechiae and ecchymosis, ulcerations, tumor-like growths, mobility of teeth

Question 633

what are some systemic factors associated with gingivitis?

Answer 633

``` – hormonal changes, pregnancy – diabetes mellitus – systemic lupus erythematosus – scurvy (vitamin C deficiency) – Down syndrome and other syndromes – immune dysfunction – heavy metal poisoning ```

Question 634

what are the two types of pigmented lesions?

Answer 634

* Pigmented lesions that are localized or solitary | * Pigmented lesions that are generalized or multiple

Question 635

what are common localized pigmented lesions?

Answer 635

* Amalgam/graphite tattoo: grey macule on the gingival and palate * Melanocytic nevus: common on skin but rare in mouth; usually on the palate * Melanotic macule: usually brown macule on the lower lip

Question 636

what are rare localized pigmented lesions?

Answer 636

Melanoma Melanotic Neurotectodermal tumor of infancy Oral Melanoacanthoma

Question 637

what is a common generalized pigmentation?

Answer 637

brown hairy tongue: exogenous staining of elongated filiform papillae

Question 638

what is an uncommon generalized pigmentation?

Answer 638

Smokers Melanosis: brown patch on anterior gingiva and labial mucosa; usually in females; may be localized

Question 639

what are characteristics of the rare generalized pigmentation of endocrine disease?

Answer 639

– Addison disease – adrenal insufficiency – weakness, nausea, vomiting, low BP, pigmentation – oral: diffuse grey patches

Question 640

what are characteristics of the rare generalized pigmentation of peutz-jeghers syndrome?

Answer 640

– autosomal dominant – melanin hyperpigmentation of lips – benign polyposis of small intestine; up to 9% become malignant – buccal lesions less likely to fade than lip lesions

Question 641

what medications can cause generalized pigmentation of the oral cavity, usually the hard palate and gingiva?

Answer 641

antimalarial drugs (chloroquine), antibiotics (minocycline), hormones (estrogen), tranquilizer (chlorpromazine) produce grey coloration of mucosa

Question 642

what generalized pigmentation does ingestion of bismuth produce?

Answer 642

Š gingivostomatitis similar to NUG | Š blue-black pigmentation of interdental papillae

Question 643

what generalized pigmentation and characteristics does ingestion of lead produce?

Answer 643

Š salivary gland swelling and dysphagia | Š grey pigmentation of marginal gingiva

Question 644

what generalized pigmentation and characteristics are seen in mercury ingestion?

Answer 644

Š ropy, viscous saliva Š faint grey alveolar gingival pigmentation Š periodontal disease similar to NUG

Question 645

what generalzied pigmentation are seen in silver ingestion?

Answer 645

Š skin slate grey | Š diffuse pigmentation

Question 646

what generalized pigmentation are seen in copper ingestion?

Answer 646

Š blue-green gingiva and teeth

Question 647

what generalized pigmentation are seen in zinc ingestion?

Answer 647

Š blue-grey line on gingiva | Š periodontal involvement

Question 648

what generalized pigmentation are seen in hemochromatosis?

Answer 648

• Hemochromatosis—iron storage disease | – bronzing of skin and grey pigmentation of palate

Question 649

what are characteristics of neurofibromatosis?

Answer 649

generalized pigmentation and café au lait macules and pigmented neurofibromas

Question 650

what are characteristics of mccune albright syndrome?

Answer 650

café au lait macules, endocrine disease, polyostotic fibrous dysplasia

Question 651

what are characteristics of the hemorrhagic lesion of heriditary hemorrhagic telangiectasia(aka Osler-weber renu syndrome)?

Answer 651

– autosomal dominant – multiple dilated capillaries (telangiectasia) of skin and mucous membranes – lesions blanch with pressure – arteriovenous fistulas of lung, liver, brain – increased risk for abscesses – bleeding from mouth secondary only to epistaxis – all dental manipulation must be atraumatic as possible – prophylactic antibiotics may be indicated with AV fistulas

Question 652

what other hemorrhagic lesions are seen and should be included in a differential diagnosis?

Answer 652

``` acquired coagulation disorders thrombocytopenia Factor 8 deficiency Factor 9 deficiency Von willebrand disease Vitamin K deficiency Liver disease Sturge Weber ```

Question 653

what are characteristics of of the hemorrhagic disorder of liver disease?

Answer 653

– diminished absorption of fat soluble Vitamins A, D, E, K (Vitamin K needed for production of prothrombin, Factors VII, IX, X) – liver produces all coagulation factors except VIII and possibly XIII

Question 654

what are characteristics of the hemorrhagic disorder of sturge weber angiomatosis?

Answer 654

– congenital port wine stains of face that follows the trigeminal nerve – leptomeningeal angiomas – ipsilateral facial angiomatosis usually – ipsilateral gyriform calcifications of cerebral cortex – intellectual disability – seizures – hemiplegia(paralysis of one side of the body) – ocular defects – bleeding, pyogenic granulomas, gingival hyperplasia and alveolar bone loss with gingival involvement

Question 655

what are some differential diagnosis for lip and buccal mucosa swellings?

Answer 655

``` mucocele trauma-hematoma irritation fibroma verruca vulgaris lipoma multifocal epithelial hyperplasia(heck disease) angioedema traumatic neuroma benign mesenchymal neoplasm benign and malignant salivary gland tumors MEN 2B nasolabial cyst ```

Question 656

what are characteristics of verruca vulgaris?

Answer 656

– common on skin but uncommon in mouth – caused by HPV 2, 4,6,40 – occurs on skin, especially hands, face – oral sites include lip vermilion, labial mucosa anterior tongue – pink or white stippled to papillary nodules; usually multiple – tx: excisional biopsy in mouth

Question 657

what are characteristics of the lip and buccal mucosa swelling of lipoma?

Answer 657

``` – well circumscribed submucosal mass – soft, freely movable – yellow color – common on buccal mucosa, tongue, floor of mouth – tx: surgical excision ```

Question 658

what are characteristics of mulifocal epithelia hyperplasia(Hecks disease)?

Answer 658

– caused by HPV 13, 31 – risk factors include genetics, ethnicity, poverty, malnutrition, poor hygiene, HIV infection – numerous pink nodular lesions with a stippled, flat-topped to papillary surface – labial and buccal mucosa, tongue are common sites – may be mistaken for condylomas – tx: excise large lesions; may spontaneously resolve

Question 659

what are characteristics of multiple endocrine neoplasia 2b besides seeing lip and buccal mucosa swellings?

Answer 659

– autosomal dominant – Marfanoid body, narrow facies, full lips – mucosal neuromas of lips, tongue, buccal mucosa and gingiva – medullary carcinoma of the thyroid – pheochromocytoma(tumor of adrenal medulla releasing epi and norepi leading to raised bp, palpitations, headaches)

Question 660

what are characteristics of the nasolabial cyst?

Answer 660

– results from entrapment of epithelium along junction of maxillary, lateral nasal, and globular process – females > males – tx: surgical excision

Question 661

what are characteristics of vascular malformations besides macroglossia?

Answer 661

– present at birth – become clinically evident in late infancy or childhood – may increase in size following trauma, infection, or endocrine changes – red, purple, blue macule of nodule – 35% associated with skeletal changes – may involve the jaws – important signs: thrill, bruit, warmth, pain, bleeding, ulceration, tooth mobility

Question 662

what are characteristics of lymphangioma besides macroglossia?

Answer 662

``` – diffuse vs. cystic – tongue most common site – usually pink in color – surface often papillary and vesicular – usually occur early in life – tx: surgical excision; commonly recurs ```

Question 663

what are characteristics of hemangioma besides macroglossia?

Answer 663

``` – vascular tumor of infancy – flat or raised blue-red lesion – usually develop first year of life – blanches on pressure – usually involutes by adolescence ```

Question 664

what are characteristics of granular cell tumor besides macroglossia?

Answer 664

– dorsal tongue most common site – pale, smooth or slightly stippled nodule – probably derived from nerve tissue – tx: surgical excision

Question 665

what are characteristics of hamartoma and choristoma besides macroglossia?

Answer 665

– tongue is most common site – may be associated with syndromes such as oral-facial-digital syndrome – tx: surgical excision

Question 666

what are characteristics of down syndrome besides macroglossia?

Answer 666

``` – microdontia, oligodontia(congential absence of 6 or more teeth excluding third molars) – Class III malocclusion – open-mouth posture – fissured tongue – decreased caries (historical) – increased periodontal disease – delayed eruption and over-retained teeth – tooth morphological abnormality – abnormal palate shape (70%) – enamel hypoplasia ```

Question 667

what are characteristics of cretinism besides macroglossia?

Answer 667

– congenital hypothyroidism (myxedema in adults) – intellectual disability, retarded somatic growth – shortening of cranial base—retraction of nose with flaring – mandible underdeveloped, maxilla overdeveloped – tongue enlargement secondary to edema, delayed tooth eruption, exfoliation – progressive infiltration of skin and mucous membranes by glycoaminoglycans – tx: thyroid replacement therapy

Question 668

what are characteristics of the various storage diseases the mucopolysaccharides such as hurlers and hunters syndrome besides macroglossia?

Answer 668

``` – short stature – coarse facies, large head – decreased IQ – nasal bridge depressed – enlarged lips – open-mouth and protruding tongue after 5 years – widely spaced teeth – localized areas of bone destruction – enlarged dental follicles; delayed tooth eruption ```

Question 669

what are characteristics of beckwith wiedeman syndrome besides macroglossia?

Answer 669

``` – omphalocele or umbilical hernia – cytomegaly of adrenal cortex – renal medullary dysplasia – hyperplastic visceromegaly – postnatal somatic gigantism – mild microcephaly – severe hypoglycemia – neoplasms (nephroblastoma most common) ```

Question 670

what are characteristics of lingual thyroid besides macroglossia?

Answer 670

``` – developmental lesion – ectopic thyroid tissue in tongue – located midline base of tongue – hypothyroidism (33%%) – tx: thyroid replacement therapy; +/- surgery ```

Question 671

what are characteristics of raunula besides sublingual swellings?

Answer 671

– mucous retention in oral floor – dome shaped, painless, soft swelling of normal or blue color – unilateral; fluctuates in size – involves submaxillary or sublingual gland – tx: excision or marsupialization

Question 672

what are characteristics of sialolithiasis besides a sublingual swelling?

Answer 672

– calcium salts around focal debris in duct – usually involves Wharton’s duct – episodic pain and swelling when eating – yellow-white mass may be seen close to ductal orifice – X-ray: may aid in detection – tx: gentle message, salivary stimulation, surgery

Question 673

what are characteristics of the oral lymphoepithelial cyst besides sublingual swellings?

Answer 673

– entrapped epithelium within lymphoid tissue – undergoes cystic degeneration – occurs in oral floor, soft palate, tonsillar region and lateral tongue – persistent yellow-white nodule – tx: observe or excisional biopsy

Question 674

what are common causes of soft tissue neck swellings?

Answer 674

reactive lymphadenopathy - secondary to odontogenic infections or viral infections.

Question 675

what are uncommon causes of soft tissue neck swellings?

Answer 675

Lipoma Epidermoid Cyst Infections Mononucleosis - caused by EBV(see fever, palatal petechia, pharyngitis) HIV associated salivary gland disease

Question 676

what are characteristics of cat scratch fever besides soft tissue neck swellings?

Answer 676

– caused by Bartonella henselae – usually due to scratch or bite from cats – scratches on face result in submandibular lymphadenopathy or enlarged parotid lymph nodes – tx: usually resolves within 4 months; antibiotics may be necessary

Question 677

what are characteristics of hodgkins lymphoma besides soft tissue neck swellings?

Answer 677

– malignant lymphoproliferative disease – usually unilateral, painless enlarging mass – unilateral presentation – most common nodes are cervical and supraclavicular nodes – may be associated with fever, weight loss, night sweats, pruritus – tx: radiation and chemotherapy

Question 678

can you see a soft tissue neck swelling due to leukemia?

Answer 678

yes, enlarged lymph nodes due to infection and leukemic infiltrates

Question 679

what are characteristics of thyroglossal duct cyst besides soft tissue neck swellings?

Answer 679

– remnant of thyroglossal duct – occurs midline anywhere along path of thyroglossal duct – usually below hyoid – may move up and down with tongue movement

Question 680

what are characteristics of mumps besides soft tissue neck swellings?

Answer 680

– usually involves parotid – paramyxovirus (cytomegalic virus or staph in immunocompromised patient) – incubation 2–3 weeks – pain, fever, malaise, headache, vomiting may precede swelling – xerostomia – tx: symptomatic

Question 681

what are characteristics of kawasaki disease besides soft tissue neck swellings?

Answer 681

``` – Mucocutaneous lymph node syndrome – bilateral conjunctivitis – fissured lips – infected pharynx – strawberry tongue – erythema of palms and soles – rash – cervical adenopathy ```

Question 682

what are characteristics of tuberculosis besides soft tissue neck swellings?

Answer 682

– infectious disease that affects the lungs – caused by Mycobacterium tuberculosis – clinical findings: weight loss, fever, night sweats, productive cough – most common extrapulmonary sites in the head and neck region are the cervical lymph nodes – tx: multiagent antibiotic therapy

Question 683

what are characteristics of salivary gland tumor besides soft tissue neck swellings?

Answer 683

– pleomorphic adenoma most common benign lesion – parotid most common site – mucoepidermoid carcinoma most common malignant lesion

Question 684

what are characteristics of branchial cleft cyst?

Answer 684

– area of anterior border of sternocleidomastoid muscle | – soft, movable, poorly delineated mass

Question 685

what are characteristics of squamous papilloma besides palatal swellings?

Answer 685

– caused by HPV 6, 11 – occurs on the tongue, labial mucosa and soft palate – it is the most common mass of the soft palate – solitary, pink or white nodule with multiple fingerlike projections – tx: none required

Question 686

what are characteristics of nasopalatine duct cyst besides palatal swellings?

Answer 686

– arises from remnants of nasopalatine duct – located in midline between roots of maxillary incisors – may cause root divergence – may cause fluctuant swelling – X-ray: oval to heart-shaped radiolucency – tx: surgical excision/curettage – rare soft tissue counterpart is the cyst of the incisive papilla

Question 687

what are characteristics of inflammatory papillary hyperplasia besides palatal swellings?

Answer 687

– reactive hyperplasia of the hard palatal mucosa – associated with dentures, palatal coverage appliances, high palatal vault, mouthbreathing – red or pink sheets of papules; nontender – may be associated with candidal infection, along with trauma from appliance – tx: antifungal agent, disinfect appliance, may need to decrease the wearing of the appliance; surgical excision

Question 688

what are characteristics of condyloma acuminatum besides palatal swellings?

Answer 688

– caused by HPV 6,11,16,18 – sexually transmitted disease – may be infected at birth – oral sites: palate, tongue, oral floor, labial mucosa – multiple coalescing, pink nodules; cauliflower surface – tx: excisional biopsy

Question 689

what are characteristics of necrotizing sialometaplasia besides palatal swellings?

Answer 689

– reactive lesion of minor salivary glands due to ischemia and infarction – may start as a swelling that progresses to cratered, irregular ulcer – usually unilateral but may be bilateral – ranges from nontender to painful – tx: incisional biopsy to confirm diagnosis; resolves in about 6 weeks

Question 690

what are the differential diagnosis for maxillary and or mandibular enlargements?

Answer 690

``` Sickle cell anemia Albright syndrome Fibrous Dysplasia-monostotic form Cherubism Neoplasm Gigantism Hemihypertrophy Thalassemia ```

Question 691

What are characteristics of sickle cell anemia besides mandibular or maxillary enlargements?

Answer 691

– autosomal recessive – defective hemoglobin S (substitution valine for glutamic acid on beta chain) – sickling occurs under low O2 – X-ray: stepladder trabeculation, hair on end – painful crises; may have had splenectomy; may need antibiotics for dental treatment

Question 692

what are characteristics of albright syndrome besides mandibular and or maxillary enlargements?

Answer 692

– polyostotic fibrous dysplasia – abnormal skin pigmentation “coast of Maine” – endocrine dysfunction—precocious deformity – X-ray—“ground glass” appearance of lesions

Question 693

what are characteristics of fibrous dysplasia(monostotic form) besides mandibular and or maxillary enlargements?

Answer 693

– benign fibro-osseous lesion of jaw – begins early in life with gradual painless enlargement, then stabilizes in adulthood – may obliterate mucobuccal fold – X-ray: ground glass appearance

Question 694

what are characteristics of cherubism besides mandibular and or maxillary enlargements?

Answer 694

``` – autosomal dominant – bilateral fullness of cheeks – hypertelorism – irregularly spaced dentition – lesions similar to central giant cell tumor – multilocular radiolucencies ```

Question 695

What are characteristics of gingantism besides mandibular and or maxillary enlargement?

Answer 695

– excess growth hormone – underlying lesion usually adenoma of the anterior lobe of pituitary – may be seen radiographically

Question 696

what are characteristics of hemihypertrophy besides maxillary and or mandibular enlargements?

Answer 696

– nonspecific, may occur in a variety of disorders – may involve single digit, limb, face, or half of body – usually evident at birth – right > left – males > females – embryonic tumors may be associated with this disorder

Question 697

what are characteristics of thalassemia besides maxillary and or mandibular enlargements?

Answer 697

``` – defect in rate of hemoglobin synthesis – persistent fetal hemoglobin – most commonly involves beta chain – severe hypochromic, microcytic anemia – homozygous: major – heterozygous: minor – hair on end radiographic appearance – tx: transfusions ```

Question 698

what are causes of oral ulcers and stomatitis?

Answer 698

``` Herpes gingivostomatitis Recurrent herpes simplex virus Angular Chelitis Herpangina Apthous Ulcers Trauma Impetigo Hand, Foot and Mouth Disease Erythema Multiforme Varicella(Chickenpox) Chemotherapy NUG Behcet Syndrome Epidermyolysis Bullosa SLE Lesch-Nyhan syndrome ```

Question 699

what are characteristics of herpes gingivostomatitis?

Answer 699

– Herpes Simplex Type I – fever, lymphadenopathy, headache, malaise, intense gingival erythema, and oral vesicles throughout mouth – vesicles rupture leaving painful ulcers – widespread ulcers occur on any oral mucosal site and lip vermillion – cytology: multinucleated giant epithelial cells, – tx: systemic acyclovir may be warranted; palliative and supportive care

Question 700

what are characteristics of recurrent herpes simplex infection?

Answer 700

– cause: reactivation of the HSV-1 – prevalence: 20-35% – types: herpes labialis, facialis, intraoral HSV – risk factors: UV light, trauma, fever, dental treatment – site: perioral skin, vermillion, gingiva, hard palate – duration: 7-14 days – recurrent, tender lesions, sudden onset, prodrome, clustered vesicles that ulcerate – complications: scars, erythema multiforme, Bell palsy; blindness – tx: topical anesthetics, topical and systemic antiviral agents

Question 701

what are characteristics of herpangina?

Answer 701

– usually coxsackievirus – multiple small vesicular lesions involving tonsillar pillars, uvula and soft palate – vesicles rupture leaving ulcers with erythematous borders – malaise, fever – most common in young children during summer months – tx: supportive and palliative care

Question 702

what is treatment for apthous ulcer?

Answer 702

tx: coating agents, topical anesthetics, steroids

Question 703

what are characteristics of impetigo?

Answer 703

– most commonly caused by Staphylococcus aureus or in combination with Group A ß-hemolytic streptococcus – scaly and thick amber crusts that are pruritic localized – localized disease treated with topical antibiotics – widespread disease treated with systemic antibiotics

Question 704

what are characteristics of hand, foot and mouth disease?

Answer 704

– usually coxsackie virus – common age is infants to age 4 – fever, malaise, lymphadenopathy – vesicles and ulcers on buccal, labial mucosa, tongue; skin lesions on hands, arms, feet, and legs – tx: palliative and supportive resolves in 7–10 days

Question 705

what are characteristics of erythema multiforme?

Answer 705

– immunologically mediated disease – triggers: drugs, HSV, Mycoplasma pneumonia, other infections, tattooing, 50% unknown – site: extremities, palmar and plantar surfaces, neck, face, eyes, lips oral mucosa – acute onset, fever, sore throat; blood crusted lips, irregular ulcers, erythema – target lesions on skin – may have ocular and genital involvement (Stevens-Johnson syndrome) – tx: identify cause; palliative care

Question 706

what are characteristics of chemotherapy?

Answer 706

– drug-induced mucositis – widespread involvement – pain, bleeding, sloughing, erythema, irregular ulcerations – tx: supportive and palliative care

Question 707

what are characteristics of behcet syndrome?

Answer 707

``` – cause is unknown – rare in children – oral aphthae – genital ulcerations – ocular lesions – tx: steroids ```

Question 708

what are characteristics of NUG and treatment of NUG?

Answer 708

– fusiform bacteria, spirochetes, HHVs – painful lesions, necrosis, ulceration, punched out papillae; halitosis – predisposing factors: vitamin deficiencies, compromised immune function, stress, poor oral hygiene, cigarette smoking, viral infections (HIV, EBV, measles) – rare in young children – tx: debridement, oral hygiene, antimicrobial oral rinse, +/- systemic antibiotics

Question 709

what are characteristics and treatment of epidermolysis bullosa?

Answer 709

– hereditary vesiculobullous disease of skin and mucous membranes – multiple types – EB simplex – most common; autosomal dominant – junctional EB – severe form; autosomal recessive – blistering of hands, feet, mouth, in particular – scarring is common – oral problems: enamel hypoplasia, microstomia, ankyloglossia, caries, gingivitis – tx: no satisfactory treatment; caries prevention, minimize trauma – severe forms are life-threatening

Question 710

what are characteristics of SLE and treatment of SLE?

Answer 710

– chronic multisystem progressive disorder – autoimmune disease – oral ulcerations, erosions and white striations; mimics lichen planus, secondary candidiasis – skin lesions, arthralgia, hematologic disorders are common – butterfly rash on face – tx: steroids, other immunosuppressive agents, antifungal agents

Question 711

what are characteristics of lesch-nyhan syndrome?

Answer 711

– X-linked – MR – spastic CP – choreoathetosis(involuntary bodily movements) – bizarre, self-mutilating behavior – including lip destruction with teeth – absence of hypoxanthine - guanine – phosphoribosyltransferase (enzyme involved in purine metabolism)

Question 712

what is the differential diagnosis for multilocular radiolucencies?

Answer 712

``` Odontogenic Keratocyst Nevoid basal cell carcinoma syndrome Ameloblastoma Ameloblastic Fibroma Central giant cell granuloma Odontogenic myxoma Aneurysmal bone cyst Central Hemangioma/Vascular malformation Cherubism ```

Question 713

what are characteristics of odontogenic keratocyst and treatment?

Answer 713

– aggressive odontogenic cyst – X-ray: expansile unilocular or multilocular with thin sclerotic border – pericoronal, periapical, central location – most common in posterior mandible—ascending ramus area – may be locally aggressive with expansion of bone and root resorption; often painful; drainage – 25-40% associated with unerupted tooth – tx: surgical excision +/- ostectomy – high recurrence rate of 30% – associated with nevoid basal cell carcinoma syndrome

Question 714

what are characteristics of nevoid basal cell carcinoma syndrome?

Answer 714

``` – enlarged occipitofrontal circumference – mild ocular hypertelorism – multiple basal cell carcinomas – multiple odontogenic keratocysts of the jaws – epidermoid cysts of the skin – palmar and plantar pits – calcified falx cerebri – rib anomalies – spina bifida occulta – hyperpneumatizaton of paranasal sinuses ```

Question 715

what are characteristics of ameloblastoma and treatment?

Answer 715

– may occur at any age, although most common between 20–40 years; rare to uncommon under the age of 19 – commonly involves posterior mandible – arises from remnants of odontogenic epithelium – clinical findings: usually painless expansion – X-ray: multilocular radiolucency, may cause root resorption; often associated with unerupted third molar – tx: surgical excision with marginal block resection; recurrence rate of 15% with this treatment

Question 716

what are characteristics and treatment of ameloblastic fibroma?

Answer 716

– mixed odontogenic tumor – commonly found in posterior mandible (70%), often associated with unerupted tooth (75%) – generally seen in patients under 20 years – painless expansion – X-ray: multilocular radiolucency; unilocular when small – tx: surgical excision but may recur – ameloblastic fibrosarcoma may arise from the lesion

Question 717

what are characteristics of central giant cell granuloma?

Answer 717

– non-neoplastic lesion – aggressive and nonaggressive variants – commonly involves mandible (70%), may cross midline – locally invasive – X-ray: multilocular with smooth or ragged border; unilocular when small – frequently causes tooth displacement – tx: surgical excision; recurrence rate – 15-20%

Question 718

what are some jaw lesions in children with giant cell histology?

Answer 718

Š hyperparathyroidism Š cherubism Š giant cell tumor Š aneurismal bone cyst

Question 719

what are characteristics of odontogenic myxoma and treatment?

Answer 719

– uncommon, arises from mesenchyme of tooth germ – more commonly involves posterior portion of jaws – slow progressive swellings; may cause facial deformity – X-ray: unilocular or multilocular radiolucency with faint radiopaque striations (stepladder appearance); margins usually well-defined – may displace unerupted teeth, most commonly associated with missing or unerupted tooth; may resorb teeth – tx: surgical excision; recurrence rate of 25%

Question 720

what are characteristics of aneurysmal bone cyst?

Answer 720

– under 20 years peak incidence – tender, painful in 50% – eccentric ballooning of involved area – X-ray: expansible, cystic, honeycombed, or soap bubble radiolucency; unilocular when small – tx: curettage; moderate recurrence rate

Question 721

what are characteristics of central hemangioma/vascular malformation?

Answer 721

– may have soft tissue hemagiomas – listen for bruit, palpate for thrill – gingival bleeding, tooth mobility; bony expansion – X-ray: radiolucency with vague margins; may have a honeycomb appearance; unilocular when small – potentially life threatening

Question 722

what are characteristics of cherubism?

Answer 722

– autosomal dominant disorder – bilateral fullness of cheeks and angles of the mandible – hypertelorism and upslanting eyes – malocclusion with displaced teeth – X-ray: expansile multilocular radiolucencies in all 4 quadrants; displaced toothbuds – tx: tends to burn out over time; cosmetic recontouring

Question 723

what is the differential diagnosis for solitary or multiple radiolucencies with indistinct or ragged borders?

Answer 723

``` Periapical granuloma Langerhans cell histiocytosis Melanotic neuroectodermal tumor of infancy Acute suppurative osteomytelitis Osteosarcoma Ewing sarcoma Central sarcomas of bone Burkitt lymphoma Leukemia(AML) Metastatic lesions ```

Question 724

what are characteristics of leukemia(AML)?

Answer 724

– widespread involvement – gingival enlargement due to leukemia infiltrates – loss of lamina dura – X-ray: diffuse, poorly defined radiolucency – tooth mobility – occasionally periosteal bone formation – tx: chemotherapy

Question 725

what are characteristics of albright syndrome(polyostotic fibrous dysplasia)?

Answer 725

– abnormal skin pigmentation – large café au lait macules – endocrine dysfunction – multiple bones are affects – precocious puberty in females – X-ray: poorly defined margins, ground-glass appearance

Question 726

what are characteristics of dentigerous cyst?

Answer 726

– forms around crown of impacted tooth – may be expansile, painless, tooth eruption failure – common sites: mandibular molar, maxillary canine – X-ray: pericoronal, unilocular radiolucency – tx: enucleation of cyst +/- tooth extraction; recurrence is rare

Question 727

what are characteristics of adenomatoid odontogenic tumor?

Answer 727

– anterior region; maxilla > mandible – painless expansion; usually associated with crown of unerupted tooth, especially canine – may exhibit flecks of opacities – tx: enucleation; recurrence is rare

Question 728

what is the differential diagnosis of pericoronal radiolucencies containing radiopacities?

Answer 728

``` Eruption sequestrum Odontoma Calcifying odontogenic cyst(Gorlin cyst) Adenomatoid Odontogenic tumor Ameloblastic fibro-odontoma Calcifying epithelial odontogenic tumor(Pindborg tumor) ```

Question 729

what are characteristics of eruption sequestrum?

Answer 729

– dysplastic cementum in dental follicle – occurs in the molar region – X-ray: small opacity in soft tissue overlying an erupting molar – most spontaneously exfoliate

Question 730

what are characteristics of odontoma?

Answer 730

– common odontogenic lesion – delayed tooth eruption is a common sign – occurs in maxilla more than mandible – often pericoronal but may be periapical or intraradicular – X-ray: compound – resembles tooth-like structures; complex – amorphous mass; both have a radiolucent border – tx: excisional biopsy – tx: may be associated with calcifying odontogenic cyst, ameloblastic fibroodontoma

Question 731

what are characteristics of calcifying odontogenic cyst(gorlin cyst)?

Answer 731

– affects both maxilla and mandible; 65% in the anterior region – 33% associated with unerupted tooth; most are located centrally in bone – 25% associated with odontomas, especially in children – may appear peripherally as gingival lesion – X-ray: well-circumscribed radiolucency with radiopaque flecks or tooth-like structures – tx: surgical excision – there are aggressive and nonaggressive variants

Question 732

what are characteristics of ameloblastic fibro-odontoma?

Answer 732

– mixed odontogenic tumor – site: posterior mandible is the most common – usually asymptomatic; involved with an unerupted tooth – X-ray: usually unilocular radiolucency with variable amounts of calcifications that resemble odontomas – tx: curettage; does not recur

Question 733

what are characteristics of calcifying epithelial odontogenic tumor(pindborg tumor)

Answer 733

– mandible, premolar-molar region most commonly involved – painless swelling of jaw – often associated with an unerupted tooth – may have a central location – well circumscribed radiolucency containing varying sized radiopacities; some are totally radiolucent – tx: local resection; 15% recurrence rate

Question 734

what is the differential diagnosis for periapical or central radiolucencies with distinct borders?

Answer 734

``` Developing tooth bud Periapical(radicular) cyst Nasopalatine duct cyst Simple bone cyst(traumatic bone cyst) Stafne bone defect Median paltal cyst ```

Question 735

what are characteristics of periapical(radicular) cyst?

Answer 735

– inflammatory cyst due to nonvital tooth – uncommon in the primary dentition – usually asymptomatic but may be tender and cause swelling – root resorption is common; may displace teeth – X-ray: unilocular radiolucency with well defined to indistinct borders – tx: extract primary tooth, enucleate cyst; endodontics for permanent tooth – multiple periapical granulomas and cysts are associated with dentin dysplasia type 1

Question 736

what are characteristics of simple bone cyst(traumatic bone cyst)?

Answer 736

``` – usually in mandible – usually asymptomatic without expansion – teeth vital – may cross midline – X-ray: usually unilocular with scalloping between roots of vital teeth – tx: surgical exploration ```

Question 737

what are characteristics of stafne bone cyst?

Answer 737

– usually seen in adolescent males when it occurs in children – localized below the mandibular canal – represents the submandibular fossa – X-ray: cyst-like radiolucency of posterior mandible

Question 738

what are characteristics of median palatal cyst?

Answer 738

– arises from epithelium entrapped along fusion line of two palatal processes – ovoid or circular radiolucency that is not associated with the incisive canal – may cause fluctuant swelling of palate that is posterior to the palatine papilla – teeth are vital

Question 739

what is the differential diagnosis with cleft lip and palate?

Answer 739

``` Cleft Lip/Palate - Isolated Pierre Robin sequence Mandibular dysostosis(Treacher Collins syndrome) Cleidocranial Dysplasia Oral-facial digital syndrome Apert syndrome ```

Question 740

what are characteristics of cleft lip and palate?

Answer 740

– Defective fusion of bones and soft tissues – CL + CP occurs 45%; CP only occurs 30%; CL only occurs 25% – 400 syndromes associated with CL +/- CP – genetic and environmental causes for nonsyndromic clefts – environmental causes: maternal alcohol use, maternal cigarette use, folic acid deficiency, corticosteroid use, anticonvulsants drugs

Question 741

what are characteristics of pierre robin sequence?

Answer 741

``` – glossoptosis(retraction of tongue) – micrognathia – cleft palate – 15–25% have heart disease – mandibular growth usually progresses normally ```

Question 742

what are characteristics of mandibulofacial dysostosis(treacher collins syndrome)?

Answer 742

– 1st branchial arch, pouch, groove – downsloping palpebral fissures, depressed cheekbones, deformed pinnae, receding chin, large fish-like mouth – hypoplastic mandible – 30% cleft palate

Question 743

what are characteristics of cleidocranial dysplasia?

Answer 743

– brachycephalic – frontal & parietal bossing – depressed nasal bridge – delayed closure of sutures and fontanelles (wormian bones) – supernumerary teeth – clavicular defect – delayed or failure of exfoliation of 1° teeth – delayed eruption of 2° teeth – palate highly arched often with submucous cleft or complete cleft – roots lack layer of cellular cementum

Question 744

what are characteristics of oral facial digital syndrome?

Answer 744

– hypoplastic alar cartilages – hypotrichosis – brachycephaly – intellectual disability – syndactyly(webbed), clinodactyly(curved fingers/toes) – median pseudo-cleft upper lip – cleft tongue, cleft palate – multiple hyperplastic frenae with clefts – hypodontia: mandibular lateral incisors – hyperdontia: maxillary canines – hamartomas/choristomas on tongue

Question 745

what is the differential diagnosis for craniosynostosis?

Answer 745

Apert Syndrome Crouzon Syndromr Pfeiffer Syndrome Carpenter Syndrome

Question 746

what are characteristics of Apert Syndrome?

Answer 746

``` – premature closure of cranial sutures – syndactyly – turribrachycephaly(high prominent forehead) – high steep flat frontal bones – shallow orbits, ocular hypertelorism – parrot nose – 30% cleft palate – intellectual disability – crowded dentition – V-shaped maxilla – Class III with anterior openbite – delayed tooth eruption ```

Question 747

what are characteristics of crouzon syndrome?

Answer 747

``` – premature closure of cranial sutures – brachycephalic – maxillary hypoplasia – ocular hypertelorism – parrot nose – crowded dentition – V-shaped arch – Exophthalmia – no hand anomalies ```

Question 748

what are characteristics of pfeiffer syndrome?

Answer 748

– usually normal intelligence – broad thumbs and great toes -- neonatal and natal primary molars

Question 749

what are characteristics of carpenter syndrome?

Answer 749

``` – acrocephaly – soft tissue syndactyly – congenital heart disease – intellectual disability – hypogenitalism – mild obesity ```

Question 750

What are characteristics of achondroplasia?

Answer 750

``` – 80% sporadic, mutations, AD – 1/20,000 live births – short limbed dwarfism – enlarged head – depressed nasal bridge – short, stubby hands – lordotic(curved) lumbar spine – prominent buttocks – protuberant abdomen ```

Question 751

what are characteristics of hypopituitarism?

Answer 751

– well proportioned body, fine silky hair, wrinkled atrophic skin – hypogonadism – eruption and exfoliation delayed – malocclusion common due to small dental arch

Question 752

what are characteristics of chondroectrodermal dysplasia(Ellis van Creveld syndrome)?

Answer 752

– bilateral manual postaxial polydactyly – 40-50% have cardiac defects – hidrotic ectodermal dysplasia(pt can sweat) – fusion of middle of upper lip to maxillary gingival margin; multiple frenae – 25% natal teeth

Question 753

what are characteristics of hallerman-streiff syndrome?

Answer 753

– dyscephaly(malformed crnium and face) – thin beaked nose – mandibular hypoplasia – hypotrichosis(abnormal or lack of hair) – small palpebral fissures(space between upper and lower eyelid) – bilateral congenital cataracts, microphthalmia – diminished body growth – oral findings: high palatal vault, hypodontia, natal teeth, over-retained primary teeth, supernumerary teeth

Question 754

what are characteristics of turner syndrome?

Answer 754

``` – 45 X karyotype – females only – near normal IQ – sterile – coarctation of aorta most common cardiac defect – webbed neck – enamel hypoplasia ```

Question 755

what are characteristics of osteogenesis imperfecta?

Answer 755

``` – 4 types – type 1 is most common and mildest form – autosomal dominant – multiple bone fractures – hearing loss – hypermobility of joints – capillary fragility – blue sclera – usually dentinogenesis imperfecta – tx: bisphosphonate therapy may helpful to prevent bone fractures ```

Question 756

what are characteristics of hypothyroidism?

Answer 756

– endocrine disease due to dysfunctional thyroid gland or pituitary gland tumor – dry skin, swollen face and extremities, husky voice – bradycardia, hypothermia – swollen lips and tongue – failure of teeth to erupt – tx: thyroid replacement therapy or treat the primary cause

Question 757

which formulas have more fluoride contact? Ready to use infant fomulas or non milk based formula?

Answer 757

Non milk based formula because calcium fluoride is added. Even more when reconstituted with fluoridated water.

Question 758

how much xylitol is to be consumed to continuously produce positive results?

Answer 758

4-10 grams per day divided into 3 to 7 consumption periods

Question 759

what are xylitols effects?

Answer 759

reduced plaque formation and bacterial adherence(antimicrobial), inhibits enamel demineralization(reduces acid production), direct inhibitory effect on MS

Question 760

When is ITR most successful?

Answer 760

when applied to single surface or small 2 surface restorations

Question 761

Define ECC?

Answer 761

presence of 1 or more decayed, missing or filled tooth surfaces in any primary tooth in a child less than 6

Question 762

Define SECC?

Answer 762

any sign of smooth surface caries in a child younger than 3. From 3-5, 1 or more cavitated, missing, or filled surfaces in primary maxillary anterior teeth or a dmf score of age+1

Question 763

what is the consenus on frequent night time bottle feeding with milk and ad libitum breast feeding with ECC?

Answer 763

they are associated with ECC but consistently implicated in ECC. While ECC may not arise fro breast milk alone, breast feeding in combination with other carbohydrates has been found to be highly cariogenic

Question 764

Regarding the policy on ECC, what preventive strategies are recommended?

Answer 764

Reduce parents/siblings MS levels Minimize saliva sharing activites Implement oral hygiene measures Avoid sugar containing beverages Infants are not put to sleep wiht a bottle filled with milk or liquids containing sugars Ad libitum breast feeding should be avoided after eruption of first tooth and when other carbs are introduce

Question 765

Infants and children exposed to smoke are at risk for?

Answer 765

``` SIDS acute respiratory infections middle ear infections bronchitis pneumonia asthma allergies Caries in the primary dentition Enamel hypoplasia in primary and perm dentition ```

Question 766

intraoral jewelry or oral piercings have been associated with

Answer 766

``` gingival inflammation recession caries metal allergy pain infection scar formation tooth fractures speech impediment nerve damage ```

Question 767

type 1 mouthguard?

Answer 767

custom mouthguard, mostly of maxillary arch. Recommend mandibular mouthguard for class 3

Question 768

type 2 mouthguard?

Answer 768

mouth formed, or boil and bite, most commonly used

Question 769

type 3 mouth guard?

Answer 769

stock mouthguards, held in place by clenching

Question 770

what are the common side effects associated with teeth bleaching vital teeth?

Answer 770

tooth sensitivty and tissue irritation, increased marginal leakage of existing restoration

Question 771

what are common side effects from internal bleaching of nonvital teeth?

Answer 771

external root resorption and ankylosis

Question 772

what is the most common side effect of external bleaching of nonvital teeth?

Answer 772

increased marginal leakage of existing restoration

Question 773

what is the concern with too much dental bleaching?

Answer 773

degradation product is hydroxyl free radical which can cause periodontal damage

Question 774

current literature supports use of what for bleaching nonvital teeth?

Answer 774

using sodium perborate mixed with water for bleaching nonvital teeth, get less root resorption and side effects.

Question 775

characteristics of acetaminophen?

Answer 775

non opoid, and is not an NSAID. Does not have any inflammatory properties.

Question 776

what are characteristicis of diazepam(Valium) including its onset, reversal, contraindications, halflife?

Answer 776

CNS Depression-minimal CV or respiratory effect amnesia, ataxia(acts in corex, limbic system) onset 45min, half life 20 hours 0.25mg/kg Flumazenil reversal dose .01mg/kg Contraindicated in narrow angle glaucoma

Question 777

what are characteristics of midazolam(versed) including its onset, reversal, contraindications, halflife? What patients is versed recommended?

Answer 777

``` CNS depression-minimal CV or respiratory effect amnesia onset 15 min, 30-40 min working time 05-0.75mg/kg to 15 mg total Flumazenil reversal dose .01mg/kg ``` * 3-4 x more potent than Valium * Good for autistic and ADHD * Better for defiant children * Anterograde amnesia * Paradoxical effect/excitation

Question 778

what are characteristics of hydroxyzine(vistaril) including its onset, halflife?

Answer 778

``` Antiemetic, antihistamine CNS depression: anxiolytic, bronchodilator analgesic causes dry mouth onset in 15-30 min, duration 2-4 hours 1.0mg/kg ```

Question 779

what are characteristics of meperidine(demerol) incl onset, reversal, and side effects?

Answer 779

Causes CNS, CV, and respiratory depression naloxone reversal .1mg/kg(occurs after 1-2min) causes sedation, analgesia, lowers seizure threshold Caution in patients with pulmonary complications, head trauma, seizures, hepatic/renal disease, airway obstruction, comcomitant local anesthesia dose important onset is 30 mins, duration is 2-4 hours 2.0mg/kg max for 50 mg max metabolized by liver, excreted by kidney side effects include dizziness, xerostomia, sweating, nausea/vomiting, seizures, respiratory depression

Question 780

what are common lab values for a PT bleeding screen?

Answer 780

PT(measures extrinsic) - 1-18 sec Prolonged in liver disease and in Vit K deficiency

Question 781

what are common lab values for a PTT bleeding screen?

Answer 781

PTT values are by lab control(measures intrinsic), prolonged in hemophilia A, B and C and VWF disease

Question 782

what are normal lab values for platelets?

Answer 782

140k-340k, measures clotting potential, increased in polycythemia, leukemia, severe hemorrhage, decreased in thrombocytopenia purpura

Question 783

what are lab values for bleeding time?

Answer 783

normal is 1-6 min, measures quality of platelets, prolonged in thrombocytopenia

Question 784

what is the normal value for INR?

Answer 784

without anticoagulant therapy it is 1, with anticoagulant therapy target is 2-3, measures extrinsic clotting function and is increased with anticoagulant therapy

Question 785

what is the normal value for hemoglobin and what is its significance?

Answer 785

Hemoglobin measures the oxygen carrying capacity of blood. | 12-18g/100ml, low in hemorrhage, anemia, high in polycythemia

Question 786

what is the normal value for hematocrit?

Answer 786

35-50%, low in hemorrhage and anemia, high in polycythemia and dehydration

Question 787

what is the normal value for red blood cell count?

Answer 787

4-6 million/mm3, low in hemorrhage, anemia, high in polycythemia, heart disease, pulmonary disease

Question 788

what is the normal white blood cell count?

Answer 788

Infant is 8000-15000mm3, 4-7yo is 6000-15000mm3, 8-18 yo is 4500-13500mm3, Low in aplastic anemia, drug toxicity, specific infections, High in inflammation, trauma, toxicity, leukemia

Question 789

for traumatic dental injuries, what is included in the history of the injury?

Answer 789

``` Non-dental injuries LOC? Altered orientation/mental status Hemorrhage from nose/ears HA/nausea/vomiting Neck pain Spontaneous dental pain Pain on mastication Reaction to thermal changes Previous dental trauma Habits? ```

Question 790

for traumatic dental injuries, what is included in the extraoral exam?

Answer 790

``` CN deficit Facial fractures Lacerations Contusions Swelling Abrasions Hemorrhage/drainage Foreign bodies TMJ deviation/asymmetry ```

Question 791

for traumatic dental injuries, what is included in the intraoral exam?

Answer 791

``` Molar classification Canine classification OB OJ Xbite Midline Deviation Interferences ```

Question 792

what should be examined on radiographs after acute dental trauma?

Answer 792

``` Caries/previous restorations Pulp size Root development Root fracture Periodontal ligament space periapical pathology alveolar fracture foreign body developmental anomaly ```

Question 793

what is the consensus on presurgical orthopedics for cleft lip and palate patients?

Answer 793

some believe the nasoalveolar molding technique can provide for improved nasal cartilage and increased length of the columella while others believe that infant orthopedics makes no difference

Question 794

what is the current treatment protocols for phase 1 orthodontic management of cleft lip and palate patients?

Answer 794

Phase 1 includes monitoring the eruption status of teeth, space management, and prevention of ectopic eruption of permanent teeth by removal of primary retained teeth and impacted permanent teeth and then Maxillary expansion at around 7 years

Question 795

When is maxillary expansion performed in CLP patients in preparation for alveolar bone grafting?

Answer 795

After eruption of 6 year molars and at the time of eruption of maxillary incisors at around 7 years old.

Question 796

When is bone grafting usually performed in CLP patients?

Answer 796

Around 7 to 10 years before eruption of the permanent canine or when canine has 1/2 to 3/4 of its final root length.

Question 797

What decision must be made in CLP patients after bone grafting?

Answer 797

Keep the space open for an implant or prepare for cuspid substitution.

Question 798

what implant properties in order of significance can affect success of an endosseous implant in a grafted cleft site?

Answer 798

Length-13mm or more are more successful Diameter Surface Characteristics

Question 799

what is the current treatment protocol "gold standard" for bone grafting in CLP patients?

Answer 799

filling the alveolar cleft with autogenous marrow | bone harvested from the iliac crest under general anesthesia.

Question 800

When is an implant typically placed in CLP patients?

Answer 800

Approximately 4-6 months after regraft placement(15-17 years)

Question 801

Why isn't an implant placed after the first graft at 8 to 11 years?

Answer 801

Implant may act as an ankylosed tooth and become submerged during rapid growth of adolescence.

Question 802

When is placement of an endosseous implant into a grafted site in a CLP patient a reliable and predictable treatment option?

Answer 802

when orthodontic treatment and cuspid substitution cannot compensate for the missing lateral incisor

Question 803

What other ways can you approach treating a patient with CLP and missing incisor?

Answer 803

Fixed Bridges and prosthetic appliances such as dentures

Question 804

What is the general timing of surgical correction of CLP?

Answer 804

Rule of tens. | 10 weeks in age, 10 kg in weight, and a hemoglobin of 10.

Question 805

What is usually the first and second procedure in CLP surgical repair?

Answer 805

The first procedure is usually to repair the lip and nasal deformity(2 to 5 months). Thereafter, before speech is developed, the palate is repaired and ear tubes placed(10 months). Children with velopharyngeal insufficiency may require further surgery to prevent nasal escape causing hypernasal speech(this occurs at 4-5 years along with a revision of the lip and nose)

Question 806

CL repair occurs at 10 weeks, cleft palate repair occurs when?

Answer 806

Approximately 6-18 months, generally around 10 months, may improve speech but can cause midface retrusion

Question 807

When is an obturator formed for CLP patients?

Answer 807

Between 0-3 months to facilitate feeding, a new obturator is made after lip repair at 3 months to last until palate repair at 10 months

Question 808

what areas should be covered in anticipitaory guidance related to oral hygiene?

Answer 808

frequency and duration, a technique demonstration with the child, review of devices, dentifrice use, location at home, positioning ideas, and problem solving such as how to fit oral hygiene into the family pattern

Question 809

what is the dietary pattern that is considered normal for a child from 6 months ot 12 months?

Answer 809

A child may be breast or bottle fed into six months of age. In the next six months, breastfeeding may be stopped or continued, depending on the needs and wishes of the mother and child. Some solid food is introduced in this period as well and bottle feeding ends with a transition to a cup at meal times. At 12 months, the child should be feeding himself and drinking from a cup on a trial basis since the process is initially messy

Question 810

what characteristics of fluoride varnish make it the preferred method to deliver fluoride over foams and trays?

Answer 810

Fluoride varnish is ideal for the preschool child because it can be put on easily and requires minimal compliance. Today’s formulations taste good, can be placed on semi-wet teeth, and are tooth colored. The effectiveness of fluoride varnish is well established, while the use of foams or gels in brush-on regimens enjoys little scientific support

Question 811

what are important health history questions to ask when deciding to sedate a child?

Answer 811

Any hx of snoring, OSA, mouth breathing?

Question 812

what is observed during an airway assessment of a child when deciding to sedate?

Answer 812

``` Obesity Limited Neck Mobility Micrognathia/Retrognathia Macroglossia Tonsillar Obstruction % Limited Oral Opening ```

Question 813

What post-op topics are reviewed with parents after a sedation?

Answer 813

``` Transportation Airway protection/Observation Activity Diet Nausea/Vomiting Fever Rx Anesthetized Tissues Dental Treatment Rendered Pain Bleeding ```

Question 814

what is the compression to ventilation ratio in performing BLS for infants and children with a single rescuer and two rescuers?

Answer 814

Single Rescuer 30:2 | Two Rescuers 15:2

Question 815

when is systemically administered fluoride considered for children at high caries risk?

Answer 815

If they are drinking fluoride deficient water(

Question 816

if a patient walks in with tetralogy of Fallot, what follow up questions are you going to ask?

Answer 816

``` history of cardiac surgery, respiratory difficulty, medications, symptoms experienced by the patient, limitations or restrictions on any activities ```

Question 817

explain what the tanaka johnson analysis is and how to calculate it?

Answer 817

It's a mixed dentition space analysis used to estimate how much leeway space you will have. Add up the M-D width of the lower permanent incisors and divide by 2. Add 10.5 for the lower buccal segment and 11mm for upper buccal segment. Then subtract the number above from the M-D width of the primary molars and primary canine. Gives you estimated leeway space.

Question 818

mild lower anterior crowding of 1-4mm in the mixed dentition can be managed how?

Answer 818

1. Use an LLHA to hold the leeway space until 12 year molar fully erupts(LLHA prevents mesial shift of 2nd molar, allowing mild anterior crowding to re-align into the leeway space 2. Disking of select primary teeth(canines)

Question 819

moderate lower anterior crowding of 5 to 9mm in the mixed dentition can be managed how?

Answer 819

Flaring of anterior teeth, distalization of permanent first molars, or arch expansion with appliances such as a lip bumper or limited orthodontics with bands on the molars, brackets on the incisors (“2 × 4”) and open coil springs

Question 820

severe lower anterior crowding of >10mm in the mixed dentition can be managed how?

Answer 820

Serial extraction, or wait until the permanent dentition and consider extraction, followed by full orthodontics Consider in cl 1 malocclusion, normal OB, and only in the absence of skeletal discrepancies

Question 821

can a LLHA be used to solve lower anterior crowding of greater than 5mm?

Answer 821

Typically no, it will help alleviate some crowding but it mostly holds only 3 to 5mm of space.

Question 822

what are the three modalities used to stop NNS habits?

Answer 822

Behavior modification(uses positive reinforcement, rewards calender), Extra oral(ace bandage around the elbow at night to keep child from bending her arm to place finger in mouth, placing bitter tasting liquids on the digit), Intra oral appliances(cribs, rakes, bluegrass, spurs)

Question 823

Deleterious effects on the teeth and supporting structures are minimized if children will stop their digit sucking habits by approximately what age?

Answer 823

before age 6, before eruption of permanent dentition

Question 824

what kind of appliance do you use to correct a true unilateral posterior crossbite?

Answer 824

Unilateral post xbite has no shift of midlines on closure whereas bilateral posterior xbite HAS a shift of midlines on closure. You want to use an appliance that only places forces on the maxillary arch side causing the crossbite, not a quad helix, w arch, rpe of haas or hyrax which typically corrects bilateral xbites

Question 825

patients with what medical history cannot tolerate intra tissue metal extensions space maintainers such as distal shoes?

Answer 825

Those with congenital heart disease, a bleeding disorder, history of heart surgery, or any other immunocompromised situation.

Question 826

an anterior crossbite with upright incisors is typically of dental/functional or skeletal origin?

Answer 826

upright origin is typically of dental/functional origin. Dental/functional anterior xbite has retroclined uppers and proclined lowers. Skeletal anterior xbite has retroclined lowers and proclined uppers.

Question 827

what are signs of enamel erosion and how can you treat cases of established erosion of enamel?

Answer 827

Thermal sensitivity and margins of restorations appearing higher than the tooth surface are related to erosion of enamel Fluoride may be used to minimize hard tissue loss and control sensitivity. A daily neutral sodium fluoride mouth rinse or gel to combat enamel softening by acids and control pulpal sensitivity may be prescribed.

Question 828

Which ASA patients are routinely accepted for in office moderate sedation?

Answer 828

ASA 1. | ASA 2 patients require a medical consult and are not routinely accepted.

Question 829

what is the brodksy scale? What is the meaning of a patient who is brodsky +3?

Answer 829

part of the airway assessment that indicates how much space the tonsillar tissue occupies in the pharyngeal area brodsky+3 means the tonsillar tissue takes up >50% of the space and should thus be considered for GA as airway obstruction complications increase significantly with sedation

Question 830

what are the fundamental guidelines for monitoring a patient during moderate(conscious)sedation?

Answer 830

- Continuous monitoring of oxygen saturation and heart rate, and intermittent recording of respiratory rate and blood pressure that should be recorded on a time based record - Frequent checking of restraint devices to prevent airway obstruction or chest restriction - Frequent checking of the patient’s head position to ensure airway patency - Presence of a functioning suction apparatus

Question 831

If a parent of a 3 yo child with SECC does not want to pursue GA, what option can you give them?

Answer 831

attempts could be made to place interim restorations while trying to reduce the patient’s anxiety with short, easy visits

Question 832

what does the mallampati score evaluate?

Answer 832

assesses the degree to which the practitioner can visualize the uvula during voluntary tongue protrusion. Difficult to obtain in a uncoop child ``` I = full visibility of tonsils, uvula, and soft palate II = visibility of hard and soft palate, upper portion of tonsils and uvula III = Soft and hard palate and Base of Uvula IV = Only hard palate ```

Question 833

what is included as part of the airway assessment for GA and/or bag valve mask ventilation?

Answer 833

``` brodsky/mallampati micrognathia large tongue short neck limited cervical spine or TMJ mobility children with high BMI or obesity also includes looking for any loose or already chipped/damaged teeth, crowns, bridges, or dentures ```

Question 834

what is the fundamental point in providing oxygen therapy to a child suffering respiratory insufficiency?

Answer 834

Many ways to deliver oxygen, but pick the least invasive yet maximally effective route to minimize increasing the child’s anxiety, which will only serve to increase oxygen demand.

Question 835

In an unconscious pediatric patient with no spontaneous respirations, what is the best airway adjunct choice for initial airway management to provide ventilation and oxygenation?

Answer 835

bag valve mask connected to oxygen.

Question 836

In a conscious pediatric patient exhibiting signs of respiratory distress, what is the first airway adjunct that should be attempted?

Answer 836

try a nasal cannula, call 911 and continually monitor respiratory status.

Question 837

How is a child with a partial airway obstruction | managed?

Answer 837

use a non rebreather face mask. Use bag valve mask for unconscious patient.

Question 838

these food allergies can alert a practitioner to a latex allergy?

Answer 838

bananas, mangos, avocado, kiwi, and passion fruit

Question 839

what are signs of an asthma attack?

Answer 839

``` audible expiratory wheezing hacking, non productive cough dyspnea cyanosis around lips and nailbeds nasal flaring and intercostal retraction tachycardia ```

Question 840

craniofacial characteristics of down syndrome include?

Answer 840

Hypoplastic midface and maxilla Mild microcephaly Upslanting palpebral fissures Short neck

Question 841

a medical history for a down syndrome patient should include these questions about congenital heart disease as 50% of patients have heart complications

Answer 841

```  History of cardiac problems  Symptoms of cardiac problems  Any surgeries for cardiac problems  Medications for cardiac problems  Restrictions on activities ```

Question 842

down syndrome patients present with these oral facial and dental anomalies?

Answer 842

``` Class III malocclusion Macroglossia Delayed dental eruption Hypodontia Microdontia Ectopic eruption and impaction of teeth Periodontal disease ```

Question 843

down syndrome patients are at an increased risk for complications associated with sedation and general anesthesia because

Answer 843

``` Congenital heart defects Small naso-pharyngeal complex Increased incidence of airway anomalies Cervical Spine instability Obesity Obstructive sleep apnea ```

Question 844

what are possible intra oral and extra oral concerns in CP patients?

Answer 844

- Hypotonia of the tongue and perioral musculature can result in anterior open bites and constricted palates. - Immature swallow pattern, with characteristic tongue thrust, can also contribute to anterior open bite. - A poor swallow reflex, seen in some patients with CP, can result in persistent drooling

Question 845

how are seizures classified?

Answer 845

 Generalized (involve both cerebral hemispheres) and involves loss of consciousness  Partial (limited to a discrete segment of the cerebral cortex) with no loss of consciousness; may have altered consciousness  Status epilepticus: Prolonged, non-self-limiting seizure activity; can be life threatening  Generalized and partial seizures are subclassified depending on clinical manifestations

Question 846

what specific questions do you ask if a patient has a seizure disorder?

Answer 846

```  Type of seizures  Frequency of seizures  Date of last seizure  Anti-epileptic medications being taken  Precipitating factors (if known) ```

Question 847

How is aspergers different than autism and how is it the same?

Answer 847

Differ in that children with Asperger’s syndrome have good verbal and cognitive skills and is similar to autism in that they are still subject to many of the sensory issues common to other autistic spectrum disorders. Also, both aspergers and autism tend to like music or hand held video games as distractions.

Question 848

what occurs in a sickle cell crisis and what are the factors that precipitate a sickle cell crisis?

Answer 848

Affected red blood cells show increased adhesion to vascular endothelium. Intravascular aggregation of cells, inflammation of microvasculature, and vasoconstriction result in the clinical symptoms of sickle cell crisis. Can affect multiple systems in the body. Sequelae can include tissue anoxia, infarcts, necrosis, and pain. Precipitated by dehydration, hypoxia, infection, stress, and menstruation.

Question 849

What are oral considerations in patients with sickle cell anemia?

Answer 849

Enlarged maxilla Gingival enlargement Glossitis Pulpal necrosis in teeth without caries or history of trauma Facial or dental pain secondary to vaso-occlusive crisis Osteoporosis or Osteopenia Osteomyelitis

Question 850

What further questions are asked during the medical history for a patient with sickle cell anemia?

Answer 850

 Vaso-occlusive crises: frequency, duration, hospitalizations, date of last crisis  Damage to any organ systems?  History of transfusions and any related complications?  Current medication regimens  Current and past infections  Psychosocial issues

Question 851

What would you do if you had treatment planned a tooth I DO and J MO resin composites but were unable to isolate them effectively?

Answer 851

Either switch them to an amalgam restoration or place Resin modified GI restoration(fuji 2 LC) which is more forgiving in moist environments.

Question 852

when are class 2 composite restorations indicated?

Answer 852

Small pit and fissure caries Occlusal caries into dentin Cl 2 in primary teeth not extending beyond proximal line angle Cl 2 in perm teeth that extend 1/3 to 1/2 buccolingual width Cl 3,4,and 5 in prim and perm teeth and strip crowns in prim and perm teeth.

Question 853

when are class 2 composite restorations contraindicated?

Answer 853

Cant achieve isolation In teeth requiring large multiple surface restorations in the posterior primary dentition in high risk patients with multiple caries/tooth demineralization and who exhibit poor OH and whom maintenance is unlikely.

Question 854

what are indications for ITR?

Answer 854

 Uncooperative patients that will be managed non-pharmacologically  Patients with special needs  Interim restoration for caries control  Instances in which other restorative materials cannot be used

Question 855

what are questions to ask a hypoglycemic patient?

Answer 855

 When was the most recent hypoglycemic episode and has the patient experienced any complications from being hypoglycemic?  Has the patient been placed on a special or restricted diet?

Question 856

in a class 5 prep for a resin which margin is beveled and which is left as a butt margin?

Answer 856

Leave the enamel margin bevelled and the cementum margin butt.

Question 857

what are questions to ask a patient with a heart murmur?

Answer 857

 Documentation of heart murmur status  Follow-up evaluations of heart murmur  Any consults to a pediatric cardiologist  Any need for echocardiograms or chest films  Any symptoms experienced by the patient  Any medications that patient takes for this condition  Any need for antibiotic prophylaxis for subacute bacterial endocarditis  Any limitations or restrictions on any activities

Question 858

What important questions need to be asked when taking a medical history from a patient with congenital heart disease?

Answer 858

Nature of diagnosis (acyanotic or cyanotic), supportive medications, previous surgical corrections, future surgical corrections, current cardiac function, physical activity limitations, risk of IE

Question 859

Why are children with congenital heart disease more likely to develop dental caries in primary teeth?

Answer 859

Enamel is often hypoplastic and susceptible to early childhood caries; high-caloric diet; use of sucrose-rich medications; medications may induce xerostomia; parental indulgence with sweets, juices, sodas, etc.

Question 860

questions to ask a hemophilia patient?

Answer 860

```  Type and severity of hemophilia  Hemophilia team contact information  Compliance with medications  Frequency and management of bleeding episodes  Inhibitor status  History of blood borne diseases such as HIVinfection or hepatitis due to blood transfusions  Limitations or restrictions on activities ```

Question 861

What is the significance of inhibitors in | hemophilia?

Answer 861

Bleeding episodes continue despite appropriate factor replacement levels. Care for these patients may include use of a bypassing agent such as factor VIIa or activated prothrombin complex concentrate

Question 862

What local anesthesia techniques should be | done only after factor replacement?

Answer 862

Infiltrations into a highly vascularized area or into loose connective tissue, and posterior superior alveolar and inferior alveolar nerve blocks.

Question 863

what local hemostatic agents can be used in hemophiliacs and in other bleeding disorders?

Answer 863

pressure, absorbable gelatin product, cellulose materials, thrombin, microfibrillar collagen, fibrin glue, cyanoacrylate, acrylic stents, bone wax, electrocautery, resorbable sutures, periodontal dressings, and epinephrine

Question 864

What important questions need to be asked when taking a medical history from a patient with ALL?

Answer 864

Questions regarding the underlying disease, time of diagnosis, modalities of treatment the patient has received since the diagnosis, planned treatment, surgeries, complications, prognosis, current hematological status, allergies and medications

Question 865

what are dental considerations in a patient with liver disease?

Answer 865

give less anesthetic due to decreased metabolism bleeding problems greenish discolration of teeth due to unconjugated bile pigments being incorporated into teeth yellow skin Do not use NSAIDS because they increase chance of GI bleeding. Use acetaminophen in lower doses instead.

Question 866

what analgesics are used with caution in asthmatics?

Answer 866

aspirin and NSAIDs

Question 867

high ESR, CRP and platelet count are indicative of what?

Answer 867

an inflammatory process: eg crohns disease. Will see abdominal pain, diarrhea, poor appetite, weight loss, and anemia in crohns patients.

Question 868

what are oral manifestations seen in crohns disease? What is the key histological finding in crohns disease?

Answer 868

```  Lip and/or cheek swelling  Angular cheilitis  Mucogingivitis (inflammation of marginal and attached gingiva), most commonly in the anterior region multiple apthous ulcers ``` Key histological finding is non necrotizing granulomas.

Question 869

what questions do you ask a parent of a child with oral inflammation and fever such as herpetic gingivostomatitis infection?

Answer 869

 How long has it been since the child was initially unwell?  Are any other unwell children in the family or has the child come into contact with any other children, relatives, or caregivers who are also unwell or have similar lesions?  When was the last time the child had something to eat or drink?  When was the last time the child urinated?  Is the child able to sleep at night?  Does anything relieve the pain or discomfort?

Question 870

what questions are asked for an intra oral lesion such has peripheral giant cell granuloma?

Answer 870

How long has the swelling been present? When did you first notice it?  Has it changed in appearance (size, shape, color) recently?  Has there been any spontaneous bleeding from this swelling or only on brushing?  Is the lesion painful? Does it hurt spontaneously or only when stimulated?  Is there anything that makes it better or worse?

Question 871

what are characteristics of MTA? And how does it compare to CaOH?

Answer 871

MOA is mineralization pulp canal obliteration is common Compared with Ca(OH), MTA has demonstrated a greater ability to maintain the integrity of pulp tissue, producing a thicker dentinal bridge, less inflammation, less hyperemia, and less pulpal necrosis than Ca(OH)2

Question 872

what are contraindications to performing a pulpectomy?

Answer 872

in cases of infection involving the crypt of the succedaneous tooth, in teeth with non-restorable crowns, with perforation of the pulpal floor, with internal resorption perforating into the underlying bone, and with external resorption of more than one-third of the root

Question 873

What are the radiographic signs of root canal treatment failure in primary teeth, and how should they be handled?

Answer 873

Enlargement of a previously existing periapical or inter-radicular radiolucency and the development of a new lesion in a tooth without a pre-operative pathologic radiolucency are real failures and should eventually be extracted. However, in cases in which the pre-operative radiolucency remains unchanged, the patient should be recalled in another six months for re-evaluation

Question 874

According to Moskovitz, Sammara, and Holan (2005), which root-treated teeth are more prone to failure: the underfilled, flush, or overfilled?

Answer 874

overfilled resulted in more failures, although not stastically significant.

Question 875

What is more effective for disinfection of the root canal system in primary teeth: mechanical or chemical debridement?

Answer 875

because morphology is complicated in primary teeth and difficult to mechanically clean, chemical is more important.

Question 876

What are the indications for a partial pulpotomy | in a young permanent tooth?

Answer 876

1. A partial pulpotomy is indicated in a young | permanent tooth for a small (

Question 877

Why are young carious permanent molars good candidates for conservative treatments such as partial pulpotomy?

Answer 877

Young permanent teeth are good candidates for this conservative treatment because of their rich blood supply that enhances the healing ability

Question 878

What are the complications of a partial pulpotomy failure in an immature permanent molar?

Answer 878

Failure of a partial pulpotomy may result in pulp necrosis and/or a periapical abscess. Because the apex is not closed it is necessary to start an apexification procedure

Question 879

What are the possible treatment options for a pulpotomy on a young permanent molar using MTA?

Answer 879

(a) Coverage of the radicular pulp stump with MTA, followed by a temporary restoration with Coltosol and IRM; (b) placement of a wet cotton pellet over the MTA and on the second appointment verification of the setting of the MTA and placement of a permanent restoration; (c) placement of glass ionomer liner over the MTA and permanent restoration of the tooth

Question 880

in nonvital young permanent teeth, what are the reasons for preferring a single-visit root closure with MTA rather than apexificationwith Ca(OH)2?

Answer 880

3. (a) Ca(OH)2 apexification is more time consuming than creating an apical barrier with MTA; (b) Ca(OH)2 was shown to make these teeth more prone to fracture, whereas MTA strengthens the root; (c) it is assumed that MTA creates a better biologic seal; (d) root end closure with MTA is also more predictable

Question 881

what is the definition of acute apical periodontitis?

Answer 881

``` Acute periradicular (apical) periodontitis: Inflammation usually of the apical periodontium producing clinical symptoms including painful response to biting and percussion ```

Question 882

what is the definition of acute apical abscess?

Answer 882

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and eventually swelling of associated tissues

Question 883

what is the technique for performing revascularization?

Answer 883

1. Make a conservative access opening, followed by a length measurement (radiograph with an endodontic file or a Gutta Percha point). The file should be inserted 2 to 3 mm short of the apical foramen to prevent damage to vital apical tissues 2. Rinse with sodium hypochlorite and then chlorhexidine, inserting needle 2 to 3 mm short of apex. 3. Dry canal. 4. Introduce munce canal projector into orifice and build up space between projector and walls with flowable composite 5. Mix mino, cipro, metro with saline, and insert into orifice using sterile syringe 2 to 3mm short of apex 6. Clean access cavity, place cotton pellet, seal tooth temporarily for 4 weeks. 7. Ensure tooth is asymptomatic, no signs of pathology(sinus tract), place rubber damn, remove temp and cotton pellet, rinse 3mix out with sodium hypochlorite, dry with paper points, insert endo explorer or hand file past apex to induce bleeding, , stop bleeding 2 to 3 mm below level of CEJ, with a moist cotton pellet for 15 minutes, place MTA, followed by a wet cotton pellet and a temporary sealing material. 2 weeks later, remove the temp, place permanent restoration(composite in anterior region)

Question 884

What are instances in which immediate extraction of intruded primary incisors would be indicated?

Answer 884

If a radiograph, such as a lateral occlusal, indicates that the primary tooth is intimately associated with the permanent tooth bud, extraction may be indicated. Any potential aspiration risk to the child is also an indication for extraction. Extraction of the intruded incisor does not necessarily spare the successor from possible damage

Question 885

How long should one wait and watch intruded | primary incisors to re-erupt?

Answer 885

While reports note that the majority of intruded primary incisors will re-erupt within six months, re-eruption should be assessed monthly and teeth should demonstrate significant re-eruption (although not necessarily complete) by two months. If there is no evidence of re-eruption, then a careful clinical and radiographic examination must be completed to re-assess treatment options such as extraction

Question 886

If the intruded tooth is asymptomatic at one | week post injury, is the pulp healthy?

Answer 886

No. In the instance of any traumatic injuries, the pulp may provide false-positive responses clinically for up to three weeks post injury. Sequelae such as replacement resorption may not be apparent until six weeks post injury.

Question 887

If a root fracture was present in the apical one-third of the root, is it recommended to surgically extract the remaining root tip?

Answer 887

If the remaining root tip is intimately related to the permanent tooth bud, then any treatment must be approached with the understanding that there is potential for damaging the permanent tooth as well

Question 888

what are complications of dental trauma?

Answer 888

Tooth discoloration is a common post-traumatic complication  Dark gray discoloration of primary incisors soon after injury may fade and does NOT warrant immediate treatment  Discoloration noted soon after injury is not representative of definitive pulpal diagnosis (Holan 2004)  Tooth discoloration that first appears well after the trauma may be indicative of changes in pulp vitality and potential necrosis (Soxman et al. 1984)  All teeth involved in injury must be re-assessed for potential pulpal injury

Question 889

What are the situations in which extraction of | tooth and/or segments is warranted in root fractures of primary teeth?

Answer 889

As the fracture is placed more coronally, the prognosis worsens for the tooth. Furthermore, the aspiration risk must be assessed. Parents should be made aware of the possibility for the need to remove the coronal and/or entire segment at a later date if no treatment is immediately rendered

Question 890

Would management differ if discoloration had occurred 26 months after tooth injury?

Answer 890

transient discoloration immediately following injury is not uncommon. This discoloration is most often reddish or grayish. Discoloration that occurs well after the traumatic injury may be indicative of pulpal necrosis and result in inflammatory resorption despite the patient remaining asymptomatic

Question 891

When is splinting of primary teeth indicated?

Answer 891

Splinting primary teeth should be attempted only after careful risk:benefit analysis, including patient cooperation and behavior, ability for adequate isolation if a resin splint is used, and parental compliance and understanding of the need for follow-up care. While some studies have demonstrated success with splinting primary teeth, full medico-legal considerations need to be discussed with parents/caregivers

Question 892

what is the cvek pulpotomy technique?

Answer 892

Isolate tooth with rubber dam • Gently remove 1.5 to 2 mm of pulp tissue with sterile bur and copious irrigation with water (Figure 4.3.4) • Use wet cotton pellet to control hemorrhage. • Cover pulp with calcium hydroxide, followed by glass ionomer • Assure an excellent seal with composite resin provisional restoration (Figure 4.3.5). Final restoration may be completed at same appointment if it can be done atraumatically. However, final restoration should be deferred if tooth is mobile • Suture gingival lacerations (if indicated). Prescribe over-the-counter acetaminophen or ibuprofen for pain, as needed

Question 893

Can a tooth treated by a partial pulpotomy be | completely restored immediately?

Answer 893

It may be possible to complete the final restoration on a tooth treated with a partial pulpotomy; however, since luxation injuries frequently accompany such severe crown fractures, deferring the final restoration until the periodontal ligament (PDL) has healed is recommended

Question 894

what are flexible splint materials?

Answer 894

a fishing line(50lb test) or a light stainless steel crown orthodontic wire(0.16 to 0.18)

Question 895

What clinical and radiographic signs indicate | successful healing of root-fractured teeth?

Answer 895

Root-fractured teeth may heal with a hard tissue union, with interposition of connective tissues or with interposition of bone and connective tissues. Radiographic signs of success indicate presence of lamina dura and no signs of bone or root resorption

Question 896

ankylosis and replacement resorption often appears after how long after an injury?

Answer 896

2 to 3 months.

Question 897

What are the most common complications of an | intrusion injury?

Answer 897

Intrusions are serious injuries with a relatively poor prognosis because of the crushing of the PDL fibers, pulp tissue, and supporting bone. Ankylosis with resulting replacement root resorption is common, as is pulp necrosis and inflammatory root resorption

Question 898

How does the management of an intruded immature (open apex) permanent tooth differ from that of a mature tooth?

Answer 898

Recent evidence indicates that immature teeth may reposition themselves spontaneously so they can be monitored for several weeks. If no movement occurs, repositioning with orthodontic forces should be initiated. Some clinicians recommend mildly luxating the tooth prior to applying the orthodontic force

Question 899

In children in the early stages of the mixed dentition, it is sometimes hard to know if an incisor was intruded or if it had just not erupted completely. What clinical tests improve the diagnosis of an intrusion injury?

Answer 899

Intruded teeth are displaced forcefully into the alveolar bone and will be completely immobile. A percussion test will yield a high-pitched hollow or metallic sound. The PDL space will not be visible on radiographic exam

Question 900

What clinical and radiographic signs indicate | successful treatment of intrusion injuries?

Answer 900

The tooth is in normal position and responds normally to mobility and percussion tests. Radiographically, no replacement or inflammatory root resorption is occurring and intact lamina dura is evidenced around the root

Question 901

when is decoronation of a reimplanted avulsed tooth recommended?

Answer 901

Decoronation of the tooth to preserve the alveolar bone is recommended if teeth become ankylosed and infrapositioned greater than 1 mm.

Question 902

What is done 7-10 days after reimplantation and splinting of an avulsed permanent tooth with closed apex?

Answer 902

place CaoH in canals for approximately 1-2 months and obturate with gutta percha once no signs of resorption present

Question 903

what type of sutures are usually used for soft tissue injuries and what can they cause?

Answer 903

Resorbable sutures, such as polygycolic gut or vicryl, are often used. Resorbable sutures may cause localized inflammatory reactions which can delay healing, and thus are not used or recommended on the skin

Question 904

how do you treat laryngospasms?

Answer 904

with succinylcholine, do not use in children suspected of having MH.

Question 905

what is included on the admit note before GA?

Answer 905

current medical status diagnosis proposed treatment

Question 906

what is part of the universal procedure of time out?

Answer 906

Patient ID(Two identifiers) Antibiotics if needed, are given X-rays displayed Throat pack placed and time noted

Question 907

what is microabrasion and what is the technique for it?

Answer 907

Microabrasion- removal of the surface opaque layer of enamel, leaving the normal “yellow” color of the perm crown Use RD to protect tissues. Hydrochloric acid/pumice slurry is applied to the affected area using rubber cup for 10 sec only (repeat a max of time 10 times)

Question 908

what are characteristics of oral electrical burns?

Answer 908

``` o Often painless due to burn o Eschar sloughs off 7-10 days o Bleeding from facial artery possible o Use fixed appliance to stop contracture of wounds o Wear appliance for 6-12 months ```

Question 909

characteristics of child vs adult airway?

Answer 909

• Children have lots of lymph node tissue (usually decreases after age 10) • Funnel shaped airway o Narrowest part of adult airway is at vocal cords o Narrowest part of child airway is at Cricoid (pre-pubertal) • Large tongue and epiglottis • Mandible is less developed • Higher respiratory rate and ventilation • Smaller tidal volume • Lower residual functional capacity, therefore easily de-saturate • Weak chest muscles cause them to breathe more from the diaphragm which further reduces airway capacity

Question 910

which sedative is contraindicated in a patient taking adderall?

Answer 910

the narcotic Demerol

Question 911

following trauma, when should you take new PAs as can you see radiographic evidence of a PA lesion or root resorption?

Answer 911

3-4 weeks for PA lesion | 6-8 weeks for root resorption

Question 912

Guidance of eruption? Different from serial extraction! Goal of guidance of eruption is to keep all your teeth and use space maintenance to save as much space as possible.

Answer 912

When crowding greater than 10mm in both arches in cl 1 malocclusion Ext primary cuspids, wan't premolar to erupt before before canine, may have to ext D when premolar root 1/2-2/3 formed.

Question 913

when is protective stabilization indicated?

Answer 913

1. patients require immediate diagnosis and/or limited treatment and cannot cooperate due to lack of maturity or mental or physical disability; 2. the safety of the patient, staff, dentist, or parent would be at risk without the use of protective stabilization; 3. sedated patients require limited stabilization to help reduce untoward movement.

Question 914

what is included in the preop workup and consultation before proceeding with GA/hospital dentistry?

Answer 914

Obtain a complete health history including medications and abnormal health history Consultation with PCP Identify the CC and obtain clinical and radiographic exam before, if possible. Discuss with guardian the rationale for GA, risks/benefits associated with GA, anticipated post op behavior and limitation of activities, cost, physical exam, lab tests, admissions process, NPO guidelines and informed CONSENT

Question 915

what is the operating room protocol on the day of surgery?

Answer 915

Pre-op Evaluation o Weight o Review history and physical o Vital signs o Airway assessment o NPO status Medical Record o Admit note: current medical status, diagnosis, proposed tx o H&P reviewed o Surgical consent o Pre-op orders o Lab tests, results, consults, guardianship “Time Out”- completed immediately prior to start of procedure o Patient identification (2 identifiers) o Procedure to be performed Obtain x-rays prior to scrub in Place throat pack Perform thorough debridement , prophy, and detailed oral exam LA may be used to minimize post-op pain and bleeding Provide tx with the greatest longevity and requires the least maintenance

Question 916

when does the primary dentition initiate calcification?

Answer 916

4-6 months in utero.

Question 917

what syndromes have SN teeth?

Answer 917

``` cleidocranial dysplasia sturge weber gardner crouzon apert oro facial digital syndrome 1 ```

Question 918

in what direction does enamel maturation occur?

Answer 918

in two stages, matrix segments are formed and then mature from incisal to cervical, so incisal enamel matures earliest.

Question 919

at how many months does permanent maxillary central and mandibular incisors(laterals and centrals) begin and end calcification?

Answer 919

3-months - 5yo.

Question 920

hypoplasia of permanent maxillary central and mandibular incisors in the middle third of the crown suggests an insult to mineralization at what time frame?

Answer 920

14-34 months.

Question 921

when does calcification begin and end ofr permanent first molars?

Answer 921

at birth, ends at 3 years.

Question 922

when does calcification begin and end for permanent second molars?

Answer 922

3years - 8 years.

Question 923

when does calcification begin and end for maxillary lateral incisors permanent

Answer 923

10 mo - 5 yrs

Question 924

when does calcification begin and end for permanent canines?

Answer 924

4 mo - 6 years

Question 925

when does calcification begin and end for permanent premolars?

Answer 925

18 mo - 6.5 years

Question 926

what intubation tube size cheat do you use to figure out which size to use?

Answer 926

(Age/4) + 4

Question 927

what is the accepted treatment of chronic perio and other periodontal diseases?

Answer 927

SRP Systemic Drug Administrations Local Drug Delivery(of tetracycline, chlorhexidine) Surgical Therapy -- to facilitate access to the roots so they can be scaled Resective therapy(gingivectomy, gingivoplasty) Regenerative Surgical Therapy -- in those with significant attachment loss.

Question 928

is there a relationship between a missing primary tooth and its permanent successor?

Answer 928

yes, significant correlation.

Question 929

appearance of erosion in acid consumption, bulimia, GERD?

Answer 929

With acid consumption you see a polished stone appearance on the lingual of maxillary incisors. With bulimia you see generalized erosion from premolar to premolar on the lingual surfaces. With GERD you may see a cupped out appearance on molars, especially primary molars along with lingual erosion.

Question 930

what recommendations are given to GERD patients?

Answer 930

wait 2 hours to lay down after eating, sleep with your head propped up, avoid over eating, and avoid eating too fast

Question 931

associated conditions with GERD are?

Answer 931

``` asthma adhd cerebral palsy failure to thrive premature birth ```

Question 932

at what stage of root formation do teeth typically erupt?

Answer 932

mandibular central incisors and 1st perm molars at 1/2 root length. mandibular canines and 2nd molars erupt soon after 3/4 root completion all other teeth erupt at 3/4 root development Ext any primary tooth once its perm successor has 3/4 root development. Overretained

Question 933

when do you use a transpalatal arch vs a nance?

Answer 933

transpalatal arch causes less tissue irritation and can/should be used when primary molars are missing on one side, not bilaterally. Use a nance when primary molars missing bilaterally

Question 934

is there an association between dental anomalies such as ectopic eruption of 1st perm molars and hypoplasia?

Answer 934

Yes. The diagnosis of one anomaly may indicate an increased risk of other anomalies. The following are associated per Bacetti ``` Palatally displaced max canines Enamel hypoplasia Ectopic eruption of max 1st molars microdont/peg max lateral infraocclusion of primary molars missing 2nd perm premolars ```

Question 935

how does premature timing loss of primary molar affect premolar eruption?

Answer 935

Before age 5, delayed premolar eruption, after 8, accelerated premolar eruption

Question 936

characteristics of cystic fibrosis patients?

Answer 936

typically low level of caries due to prophylactic antibiotics that most patients are taking. Also don't see erosion that often because CF patients typically have higher concentrations of salivary bicarbonate and phosphates.