Midterm Flashcards by Marjorie Wolfe

If the pH falls below __ a dysbiotic microbiome categorized by and increase in the acidic biofilm species

5
Normal mouth pH = 7
Demineralization starts at pH 5.5

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Presence of 1+ decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in child under age 6

Early childhood caries (ECC)

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Describe severe early childhood caries (S-ECC)

<3 yr : any sign of smooth surface caries
3-5 yr: 1+ cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth
decayed, missing or filled score of greater than or equal to:
4 (age 3), 5 (age 4), 6 (age 5)

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establish dental home within __ months of first tooth or __

6
12 months of age

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Primary
Secondary
Tertiary preventative measures for ECC

Primary: needs to begin before disease occurs, education, limited sugar intake, avoid nighttime bottles, avoid baby bottle/breastfeeding past 12 months, brushing x2 day, topical fluoride treatment, fluoridated water

Secondary: prevent progression of/remineralization of caries before cavitation stage, early detection, sealants, more frequent fluoride varnish

Tertiary: SDF, restoration

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Crown structure of a pediatric patient

Onion shaped
converging towards the occlusal

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In a pediatric tooth, Enamel rods in cervical area are directed to the

occlusal (change class II prep shape)

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Is enamel and dentin thinner or thicker in a pediatric tooth

Thinner (1-1.5 max width to ADJ)

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Contact on a pediatric tooth are

broad and flat

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Color of a pediatric tooth

Lighter (B2-A1)

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Root shape of a pediatric tooth

narrower and longer compared to their crown length (permanent teeth have shorter thicker roots)

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Resorption begins when __ of root is formed
Tooth is shed when __ of root is formed

1/3
1/2

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Furcations on primary teeth

Closer to the crown (more susceptible to damage)

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Pulp structure of pediatric teeth

larger chambers
pulp horns closer to outer surface
mesial pulp horn is higher

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__ teeth should be erupted before age 3

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Primary molars are replaced by

permanent premolars

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2nd primary molars resemble __ , maxillary 1st primary molars resemble __ , mandibular 1st molars resemble __

1st permanent molars
1st permanent premolars
none (milk man)

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Teeth present at birth

natal teeth

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Neonatal teeth

Teeth that erupt within 30 days of birth

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when the developing tooth moves inside the alveolar bone but cannot yet be seen clinically

Pre Emergent eruption
(begins once the root formation has started)

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Emergence: when a cusp or an incisal edge of a tooth first penetrates the gingiva. Occurs when __ is established.

75% of the final root length

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This must exist to move the tooth

eruption force

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When does eruption occur

Follows a circadian rhythm, occurs mainly during early hours of sleep or after meals

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Post emerging eruption

continuous movement until it reaches occlusion (faster during this stage)
Eruption does not stop once the tooth is in occlusion- continues to equal the rate of the vertical growth of the face
On average a molar erupts about 10 mm after occlusion

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Primary teeth eruption

Mandibular incisors maxillary incisors Maxillary lateral incisors mandibular lateral incisors Maxillary 1st molars mandibular 1st molars Maxillary canines Mandibular canines Mandibular 2nd molars maxillary 2nd molars

Comp exam care pathway

Interview Oral exam Detection Images Occlusion Susceptibility

What is used to asses pain

FLACC

Probing primary teeth should be done after __ as tolerated by the child

eruption of 1st permanent molars and incisors

What do the colors of plaque tablets mean

Pink = 24 hour plaque Purple = 48 hour plaque Blue = 1 week plaque (pH = 3)

Biofilm removal: teach the parent to __ when should cleaning first occur?

Lift the lip Clean baby gums using damp washcloth day after home 1 yr soft toothbrush and fluoride smear

Caries risk assessment tool (CAT-AAPD) should be performed as soon as

first primary tooth erupts

04HIP PEDBEH 03HIP 01HIP

general consent Pediatric behavior management auth for use imaging notice of privacy

D0150 D0120 D0140

Comprehensive exam recall exam emergency exam

Non-nutrutive sucking habit >3yr =

malocclusion (class II)

Sugar consumption is higher among children whose mothers were

younger had less schooling smoked

Babies breastfed in the 1st hour of life

consume less sugar during first 6 months

Acidic foods = Alkaline foods =

demineralize remineralize (cows milk contains calcium, phosphorus, casein to stabilize plaque pH)

Appearance of occlusal surfaces (pit and fissure) ICDAS 0 ICDAS 1 ICDAS 2 ICDAS 3 ICDAS 4 ICDAS 5 ICDAS 6

0 = sound 1 and 2 = initial 3 and 4 = moderate 5 and 6 = advanced

This should not be used to detect disease before clinical examination

radiographs

used for diagnosis of pulp status, decay depth, root development/resorption, furcation

used for diagnosis of proximal caries, measure bone loss, pulp status

BWX If there is an interproximal lesion on one side of the mouth it is usually mirrored on the other side of the mouth

used for diagnosis of crowding, extra or missing teeth, after dental trauma, any other pathology

Pano

No root formation of permanent tooth + extraction of primary tooth =

Permanent tooth will not erupt

½ to 2/3 root formation of permanent tooth + extraction of primary tooth =

Permanent tooth will erupt faster

Radiographs on a new pediatric patient

2-4 BWXs capture D of 2nd primary molar to D of canine (size 0-1 sensor) (Pano if mixed dentition)

Recall pediatric patient and radiographs

BWXs every 6, 12, 24 months depending on CRA

Transitional dentition (6-7 years) radiographs

bitewings, panoramic Panoramic - growth and development problems Panoramic every 5 years

Adolescent radiographs

every 5 years panoramic, bitewings (2-4 depending on caries risk)

When to take a PA on a child

Pulp status Decay depth Root development / resorption Furcation

distal of max and mand 2nd primary molars are in same vertical plane

flush terminal plane (develops into Class 1)

distal of mand 2nd primary molar is more distal than max 2nd primary molar

distal step (develops into Class 2)

distal of mand 2nd primary molar is more mesial than max 2nd primary molar

mesial step (develops into Class 3)

Mixed dentition: __ used to classify occlusion when 1st molars are missing

canines

Primate spaces:

large spaces found mesial to maxillary primary canines and distal to mandibular canines (helps molars erupt into class I occlusion) (no space = crowding)

Caries risk assessment High risk: Moderate risk: Low risk:

disease indicators present or risk factors outweigh protective factors no disease indicators, risk and protective factors balanced no disease indicators, very few risk factors

Disease indicator (High caries risk) (7)

White spots decalcification enamel defects obvious decay Restoration present Plaque obvious gums bleed easily Inadequate saliva flow

Mother active dental decay Bottle other than water, milk or formula Continued bottle use Child sleeps with bottle Frequent >3x/day snacks Saliva reducing factors (meds, cancer treatment, genetics) Incr risk of infection and decay Developmental problems Caregiver low health literacy Drug use Orthodontic appliance Deep pit and fissures

intra and extra oral Risk factors (moderate risk if equal to protective factors, high risk if outweighs)

pH indicating paper place __ blue/green = __, yellow = __

lingual of mandibular molars basic acidic

Saliva check: Bite wax for 3-5 minutes spit saliva into cup Stimulated flow rate: measured in mL (should be above __)

1mL/min

divided into different age groups (0-3, 3-5) risk divided by feeding patterns

CAMBRA

What caries risk assessment do we find in axium

AAPD-CRA

Chlorhexidine is effective against __ but __ is resistant

S. mutans Lactobacilli (opposite charges attract)

Explain 1X1X1

Chlorhexidine can lowe bacterial challenge by using daily one week each month

Understand the relevance of systemic fluorides on tooth formation

Ameloblasts secrete enamel matrix proteins (amelogenin) mineralized in 2nd stage to form enamel External factors (fluoride) can stop development/mineralization of enamel (ameloblast stop secreting) = Enamel Defects

ability to influence processes by facilitating calcium and phosphate precipitation

FLuoride

= drinking water = mouthwash = pediatric toothpaste used to be = toothpaste

0.1 – 1 ppm 50-250ppm 500-600ppm 1000-1450ppm

When the pH in the mouth falls below 5.5 the teeth demineralize

-Ca and PO4 minerals are removed from the tooth --> saliva is hyper mineralized -formation of white spot lesions -When the pH is reestablished at 7.0 the Ca and PO4 minerals are incorporated from the saliva back into the tooth structure -Fluoride helps Ca and PO4 be incorporated faster and more efficiently -forms calcium fluorate (CaF) : accumulates in smooth enamel and dental plaque

Pediatric Fluorides Brush x2 day with >__ Smear (__) for kids under 3yr that cant spit, pea sized (__) for kids over 3yr that can spit

1,000ppmF 0.1mg F 0.25mg F

Varnishes __ (5% NaF) Can be used to reduce tooth sensitivity

22,600 ppm

Turns tooth black, arrests lesion without having to numb or drill tooth

Silver Diamine Fluoride (SDF)

%NaF / 2.2 = %F %F x 10,000 = ppm

Ex: 5% NaF / 2.2 = 2.26%F x 10,000 = 22,600 ppm

caries reduction after 5 yr (reduced 70% compared to chlorhexidine or fluoride varnish)

Xylitol

Pericoronitis:

inflammation of gums around wisdom teeth, happens when don’t brush properly

38% (44,800ppm), changes microbiome (kills some bacteria, allows other bacteria to grow) Arrests carious lesions Stains tooth black (put Vaseline on gums to prevent from staining) High caries risk pt Used for very young pt who otherwise would have to be under anesthesia to do restoration

SDF

remove carious tissue using hand instruments only, restore with material that sticks to tooth (glass ionomer)

atraumatic restorative treatment (ART) (Should not be used when: abscess, fistula, pulp exposed, chronic inflammation of pulp, inaccessible to hand instrument)

restore, arrest or prevent progression of caries when traditional cavity prep is not feasible

interim therapeutic restorations (ITR)

use separators to create space in between teeth, remove separators after 15mins, choose prefabricated crown of appropriate height, fill with GI, cement onto tooth, clean excess -decay is sealed under preformed metal crown (PMC) without LA, tooth preparation or caries removal

Hall technique

Lesion in a permanent vs primary tooth

Lesion in permanent tooth: cavitation follows single canal (enamel rods/dentinal tubules) into dentin towards the pulp Lesion in primary tooth: lesion is bigger, spreads faster and over larger area (Gets to pulp faster)

5 dentin types

Destroyed Infected (bacteria, soft) Affected (demineralized) Sclerotic Normal

__ single most important factor in protecting pulp against injury

Remaining dental thickness

Midterm Flashcards

(80 cards)