Paeds (COH, Ortho & Endo)

Question 1

What are 3 ways in which the increased width of permanent INCISORS are accommodated for?

Answer 1

1. Primate Spacing (in deciduous dentition) 2. Proclination (permanent incisors erupt palatal/lingually) 3. Growth of maxilla/mandible

Question 2

Outline the steps in Cveks’s Partial Pulpotomy…

(Include review times)

Answer 2

• LA/Rubber Dam
• Access cavity
• Remove 2mm (1-3mm) infected pulp tissue
• Control haemorrhage with saline cotton pleget
• Cover pulp with non-setting CaOH
• Seal with SETTING CaOH & GIC
• Restore with composite
• Review: 6-8 weeks and then 1 year after

Question 3

Give an example of 1. Positive 2. Negative Reinforcement, used to reduce child anxieties

Answer 3

1. POSITIVE = Stickers, Certificates or Positive encouragement
2. NEGATIVE = Remove stimulus (e.g. if we don’t behave teddy/mummy will have to leave”)

Question 4

What is meant by “Primate Spacing” in Deciduous dentition?

Answer 4

Space between: B+C (before C) in upper arch C+D (after C in lower arch Which then allows for more space upon eruption of permanent teeth

Question 5

What are 3 requirements to do Pulpectomy on decidious teeth?

Answer 5

1. “Irreversible Pulpitis” diagnosed - Clinical signs (including profuse bleeding after initial Pulpotomy stages)
2. NON-Vital radicular pulp (+/- infection) - If infection on opening, temporise and do in 2 stages
3. Good Px cooperation

Question 6

According to 1989 Children’s Act, which adults have parental responsibility? (5)

Answer 6

• Birth mothers
• Birth fathers married to (or were married to) birth mother at time of childs birth
• UNmarried birth fathers of children born after 01/12/2003 if name on birth certificate
• Legal (Special) guardians - Court order
• Local authorities - Child in care

N.B. Foster Carers do NOT have PR

Question 7

How might the following patients require additional imput during GA:

1. Diabetic?
2. Bleeding disorders?
3. Sickle-Cell disease?

Answer 7

1. Insulin sliding scale & Glucose monitoring
2. Factor replacement
3. Pre-op hydration

Question 8

In surface remodelling, does the anterior maxilla undergo APPOSITION or RESORPTION?

Explain this in reference to overall maxilla growth direction/translation…

Answer 8

RESORPTION

This goes AGAINST, the overall translation of the Maxilla in the downwards and forwards direction

This translation is achieved mainly through growth at (Cranomaxillary) Suture

Question 9

What are 7 indications FOR Pulp Therapy (saving a carious tooth)?

Answer 9

• MH Contra-indications to XLA (E.g. bleeding disorder)
• Co-operative Px
• Motivated Px
• Regular attender
• Previous Tx (LA experience)
• Long time before tooth exfoliation
• Strategic (e.g. maintain E’s)

Question 10

What is the difference between PULPOTOMY and PULPECTOMY?

(Define both)

Answer 10

PULPOTOMY = Removal of Coronal Pulp

PULPECTOMY = Removal of Coronal AND Radicular Pulp

Pulpe_c_tomy = _C_omplete

Question 11

What are the IDEAL properties of a conscious sedation agent? (7 - Think process of administering, action and recovery)

Answer 11

• Comfortable and non-threatening method of administration
• Rapid onset
• Predictive sedative and anxiolytic action
• Controllable duration of action
• Analgesic (no LA/needles needed)
• No side effects
• Rapid and complete recovery

Question 12

What are 2 aims of conscious sedation for the DENTIST?

Answer 12

1. Safe completion of quality care (via minimising any disruptive behaviours of child)
2. Leave child fit for discharge at end of treatment

Question 13

What are some of the safety features on IHS machines?

Answer 13

• Scavenger systems - ball should stay in middle
• Nitrous Oxide “Shut off” - Minimum of 30% O₂ delivery at all times, automatic shut off of NO₂ if exceeds 70%
• Pin index patterns - Different for O₂ and NO₂ to ensure no confusion
• Pressure reducing valves - Reduce to 60psi
• Colour Coded
• Oxygen Flush button
• Bodok Seal - gas tight seal betweeen cylinder and tubing

Question 14

What are 2 contraindications to GA in children?

What is 1 extra (only applies to adults)?

Answer 14

• MH comorbidities (e.g. cardiac problems)
• Allergies to drugs used in GA

Adult only: No suitable escort available

Question 15

What are the 3 aims of PULPOTOMY?

(Think process)

Answer 15

1. Remove inflammed coronal pulp
2. Preserve /fix remaining radicular pulp
3. Maintain tooth viability

Question 16

What are 3 main safety considerations during conscious sedation, which should be monitored?

Answer 16

1. Px is conscious (duh)
2. Px retains protective reflexes
3. Px can understand and respond to verbal stimulus throughout

Question 17

What are the advantages (1) and disadvantages (3) of endodontic treatment on an IMMATURE tooth?

Answer 17

ADVANTAGES: Good prognosis as better blood supply

DISADVANTAGES:

• Shorter root (less favourable crown to root ratio)
• Difficult to obturate (open apex!)
• Weak root (increased risk of fracture

Question 18

What are 3 aims of conscious sedation for the CHILD?

Answer 18

1. Prevent/reduce anxiety-related dental fear and pain
2. Improve cooperation
3. Promote positive attitude & response to treatment

Question 19

What are 7 signs of OVER Sedation with IHS?

Answer 19

• Nausea/Vomiting
• Headaches
• Px complains of feeling “unpleasant”
• Laughing or giddiness
• Decreased cooperation (e.g. persistant mouth closing)
• Irregular respiratory rate
• Loss of consciousness

Question 20

What are the advantages of Nitrous Oxide use in Inhalation Sedation? (10)

Answer 20

• Colourless, slightly sweet gas at RT
• Anxiolysis (via GABA)
• Mild analgesia - Opioid (N.B. Only mild, LA needed & Benzodiazepines are NOT analgesic)
• Low blood gas solubility → Rapid induction & recovery
• Haemodynamic stability
• Minimal metabolism (less than 0.01%)
• Weak anaesthetic (MAC 105%) → Difficult to make Px unconscious
• Non irritant to mucosa
• Hypnosis & Euphoria
• Flexible depth and duration of anaesthesia

Question 21

Outline the pre-operative checks for IHS…

Answer 21

• Px MH (especially no airway blockages, if temporary e.g. hayfever → Delay Tx)
• Eaten
• Escort present (responsible parent/guardian with no other children present)
• Consent
• Chaperone (trained dental nurse) present through entire procedure
• Pre-procedural machine checks

Question 22

What are 5 indications of Inhalation Sedation use in child?

Answer 22

1. Dental Anxiety
2. Long procedures
3. Traumatic procedure (e.g. XLA)
4. Gag reflex
5. Medically compromised patient (e.g. cardiac problems where GA CI)

Question 23

In absence of an adult with PR, who can consent for a child’s life-saving treatment? (2)

Answer 23

• School teachers in loco parentis
• 2 Consultants

Question 24

What are 3 anatomical differences between Immature and Mature Permanent teeth?

Answer 24

1. Shorter roots
2. Open root apex
3. Thinner dentine

Question 25

How should suspected child abuse be reported in the dental practice?

Answer 25

* Take detailed history & examination, talk to parent/carer and child about injury causes * Consult with colleagues * Explain concerns to parent/carer (unless suspect risk to child) * Report to social services or safeguarding team within hospital trust

Question 26

What is the difference between APEXOGENESIS and APEXIFICATION? *N.B. Both done on IMMATURE PERMANENT teeth (not deciduous)* | (Define both)

Answer 26

APEXOGENESIS = Pulp therapy on VITAL tooth, performed to encourage physiological development of root APEXIFICATION = Pulp therapy on NON-VITAL tooth, performed to induce a calcified barrier at open apex of incomplete root formation, through use of CaOH (natural barrier) or MTA (artificial barrier)

Question 27

Outline the clinical procedure when administering IHS for Px

Answer 27

* Pre-op checks * Machine turned on and set to: **100% O₂** at **6L/min** for **1 min** * Incremental increases in NO₂: 1. 10% increase per min till 20% NO₂ 2. 5% increase per minute after * Gradually increase NO₂ concentration till adequate sedation is achieved * Pharmacological assistance given to Px: *Calm voice, Story-telling & Reassurance*

Question 28

What are the 5 options for Pulp Therapy in decidious teeth? Which has the lowest success rate?

Answer 28

1. Indirect Pulp Capping (CaOH) 2. Direct Pulp Capping - *NOT RECOMMENDED, LOWEST SUCCESS RATE* 3. Cvek's Partial Pulpotomy (1-3mm coronal pulp) 4. Conventional Pulpotomy 5. Pulpectomy

Question 29

Where are growth rotations most common? In terms of Facial height, Overbite and Space closure...What are the outcomes of: 1. Forward rotation? 2. Backward rotation?

Answer 29

Mandible (but can also occur in maxilla) **FORWARD** * DECREASED facial height (short face) * INCREASED overbite * Space closure = DIFFICULT **BACKWARD** * INCREASED facial height * DECREASED overbite OR an openbite * Space closure = Easier

Question 30

When is "Two Stage Pulpotomy" / "Desensitisation" done? (2) What are the stages?

Answer 30

If uncooperative Px or inadequate analgesia 1. Remove as much coronal pulp as possible 2. Place Ledermix/ Odontopaste on pulp and cover with Temp filling (IRM/GIC) 3. Px returns 7-10 days later 4. Remove filling and assess *(Continue with Pulpotomy OR Pulpectomy)* Ledermix → Tooth devitalisation

Question 32

What is meant by "Flush Terminal Plane" in Deciduous dentition? When and how is this later lost?

Answer 32

Straight line of occlusion between E's on upper and lower jaw, leading to Class II occlusion Lost through "Leeway Space" as combined messy-distal width of C,D and E is LARGER than that of 3,4 and5 (By 1mm/quadrant on upper and 2mm/quadrant on lower jaw) Erupting teeth guided into Class I (perfect) occlusion upon loss of E's

Question 33

Outline the POST-operative procedure & checks after IHS (3)

Answer 33

* Give Px oxygen flush: 100% O₂ for 2-3 mins to prevent diffusion hypoxia * Slowly sit Px up, give POIG (verbal & written) and discharge with responsible parent/guardian * Fill in Tx record form and rate sedation level with "Ramsey Scale"

Question 34

What are the eruption dates for Permanent dentition? In general, do upper or lower teeth erupt first?

Answer 34

In general, lower teeth will erupt first. (General: 6-8 = Incisors and 6s 10-12 = Rest) 6 YEARS: U+L6, L1 7 YEARS: U1, L2 8 YEARS: U2 11 YEARS: L3, U+L4 12 YEARS: U3, U+L5, U+L7 (All +/- 18 months) 17-21 YEARS = U+L8

Question 35

What are the 4 types of abuse a child may encounter?

Answer 35

1. Emotional 2. Physical 3. Sexual 4. Neglect

Question 36

What is the best type of consent for IHS?

Answer 36

2 Stage Consent 1st at Tx appt (given written leaflet to take home and mask to practice with)

Question 37

What are 3 medical conditions with signs that may be confused with abuse?

Answer 37

* Impetigo - *Similar to cigarette burns* * Birthmarks - *Bruising* * Facial infcetion *- Trauma* ## Footnote *N.B. Also consider CLUMSY children!*

Question 38

What are 4 SIGNS adequate sedation has been achieved with IHS?

Answer 38

* Normal, smooth respiration (12-20 breaths/min) * Decreased muscle tone → Relaxed arms and legs * Peripheral vasodilation (slight flushing of extremeties and face) * Slight increase in BP & HR (SNS activity)

Question 39

When is Ledermix or Odontopaste used in endo? What do they do?

Answer 39

Steroid/Antibiotic Paste used in "2 step technique"/ "Desensitisation" in cases of uncooperative Px or inadequate analgesia. Placed after coronal pulp removal and Ledermix causes Tooth devitalisation Temporary restoration placed on top, Px returns 7-10 days later (remove and continue with treatment)

Question 40

Outline the initial stages of Pulpotomy in a deciduous tooth. How do you dictate whether to continue pulpotomy or change treatment?

Answer 40

1. Give LA 2. Apply Rubber dam 3. Access cavity and caries removal 4. Remove pulp chamber roof → Canal visualisation 5. Irrigate 6. Remove coronal pulp with EXCAVATOR 7. Control haemorrhage with saline-soaked Cotton Plegit (apply with pressure for 4 mins) HAEMOSTASIS ⇒ Pulpotomy NO HAEMOSTASIS ⇒ Pulpectomy or XLA

Question 41

What are 4 features of the nasal mask used for IHS?

Answer 41

* One way breathing valve * Active scavenger system * Inner & Outer lining * Hose connectors

Question 42

What is meant by the "Ugly Duckling Phase"? How does it often present?

Answer 42

During Mixed Dentition: Impact of unerupted canine crown on roots of neighbouring 2 --\> Splaying of incisors (Often resolved upon eruption of the canine!) May present as midline diastema

Question 43

What is the difference between Cranial Base and Cranial Vault? (Hint: Start by describing them and give examples)

Answer 43

**CRANIAL VAULT** * Flat bones of skull *(e.g. frontal, parietal, occipital and squamous part of temporal)* * Separated by sutures (or "fontanelles" at birth) * Growth: INTRAMEMBRANOUS **CRANIAL BASE** * Inner bones of skull *(e.g. ethmoid, sphenoid, basioccipital and petrous part of temporal)* * Growth: Endochondral & "Spheno-occipital Synchondrosis")

Question 44

[Think Endo] What are 5 anatomical differences between decidious and permanent teeth? (Hint: Where does bone loss occur? How large is the pulp? Where are accessory canals?)

Answer 44

DECIDUOUS: * Larger pulp chamber with more pronounced pulp horns * Thinner enamel * More divergent roots and longer in comparison to crown * Accessory canals present at root bifurcation *(→ difficult radiograph detection of pulp necrosis)* * Bone loss occurs at root furcation (vs. root apex of permanent molars)

Question 45

What type of CaOH (setting/non setting) is used in: 1. Indirect Pulp Capping? 2. Direct Pulp Capping? 3. Cvek's (Partial Pulpotomy)? 4. Conventional Pulpotomy? 5. Pulpectomy? (as an alternative for GP) 6. Apexogenesis? (Immature permanent tooth) 7. Apexification? (Immature permanent tooth) What are 2 other uses?

Answer 45

1. Setting 2. Setting 3. BOTH (Non-setting first →then Setting CaOH and GIC → Then Composite restoration) 4. None (15.5% Ferric Sulphate) 5. Non-setting 6. TRICK Q (Apexogenesis = Pulp therapy on a immature permanent tooth and can include all of 1-4) 7. Non-setting * Sealer * Intra-Canal Medicament - Non-setting

Question 46

What are the 2 main aims of Pulp Therapy (in deciduous teeth)?

Answer 46

1. Maintain vitality of tooth and supporting structures 2. Maintain the dental arch ## Footnote *ESPECIALLY imporant in retaining E's. Loss of E's → Mesial drifting of erupting 6's (leading to space loss and possible impaction or lingual eruption of 5's)*

Question 47

What 3 cells are involved in Ossification? (& their function)

Answer 47

1. OSTEOBLASTS = New bone formation 2. OSTEOCLASTS - Bone resorption 3. OSTEOCYTES = Mature permanent bone cell

Question 48

What type of growth occurs at the Cranial Base?

Answer 48

1. Endochondrial Ossification - *Develops from "Primary Cartilagenous Chondrocranium"* 2. Spheno-Occipital Synchondrosis - *Growth between 2 bones → main impact on anterio-posterior relationship of maxilla to the mandible* 3. Surface Remodelling

Question 49

What does the Cephalocaudal Gradient of Growth tell us?

Answer 49

After 3rd month of foetal life, proportion of total body size contributed by the head/face steadily declines 50% (2 month foetus) 30% (Birth) 6% (25 years)

Question 50

What is meant by the Parent-Child-Operator triangle? Who is at the apex? Who has control?

Answer 50

3 way interaction between parent, dentist & child - with CHILD at the APEX of the triangle. - Parent provides physical support and verbal consent - Give child some control (e.g. "put you hand up if you want to stop" "shall we do filling on left or right first?") - Avoid 3 way conversation during procedures: 1 person (dentist) talking

Question 51

What is the PRE and POST operative advice for children undergoing GA?

Answer 51

PRE * Fasting (1-4-6 rule, light meal no less than 8 hours before) * Parent escort (unaccompanied with no other children) * Consent POST * 4hr in hospital - Eat, drink & pass urine * Necessary Transport * 1-2 day recovery

Question 52

Why do we use CaOH in pulp therapy? What is a disadvantage to its use? What is a better alternative? Why dont we use this?

Answer 52

* High pH (12.5 - 12.8) → BACTERIOSTATIC * Initiates formation of Cementum-like hard tissue barrier * Cheap and easy to use Disadvantages = LT use → Dentine wall weakening and increased risk of root fracture Alternative = MTA (Expensive & can undergo discolouration)

Question 53

Which areas of the maxilla undergo Appositon and Resporption in Surface Remodelling?

Answer 53

**APPOSITION** * ANS * Hard palate * Tuberosity * Sutures (Posterior & Superior) **RESORPTION** * Anterior Maxilla *- goes against translation* * Floor of nose * Anterior alveolar process * Antrum walls

Question 54

Why are decidious teeth not obturated with Gutta Percha? What 3 materials can be used instead?

Answer 54

Gutta Percha doesnt resorb (need material which resorbs with decidious teeth upon exfoliation) ALTERNATIVE = RESORBABLE PASTE * Non-setting CaOH * CaOH & Iodoform Paste (e.g. _VitapexTM_ or EndoflasTM) * Slow-Setting Pure ZOE

Question 55

What type of growth occurs at the Mandible?

Answer 55

1. Intramembranous Ossification (mainly) 2. Endochondral Ossification (at CONDYLES) → Elongation of Mandible downwards and forwards 3. Surface Remodelling

Question 56

What is meant by "Neglect"? What are 6 signs of Neglect?

Answer 56

Neglect = Persistant failure to meet a child's basic physical and/or psychological needs 1. Lack of nutrition → Stunted growth 2. Inappropriate clothing 3. Lack of hygiene 4. Frequent injuries (unsafe environment) 5. Developmental delays 6. Withdrawn or attention-seeking behaviour

Question 57

What are the 2 aims of PULPECTOMY?

Answer 57

1. Remove irreversibly inflammed coronal and radicular pulp 2. Obturate canals with material that resorbs at same rate as deciduous tooth and will be rapidly eliminated if accidentally extruded through apex

Question 58

What is the definition of: 1. Class I Molar Relationship? 2. Class I Incisal Relationship?

Answer 58

1. Mesio-Buccal cusp of upper 6 occluded with mid-buccal groove of lower 6 2. Lower incisal edge occlude with the cingulum plateau of upper incisors

Question 59

According to Childrens Act 1989, who is classified as a child? (3)

Answer 59

* Anyone who hasnt reached their 18th birthday * OR up to 19th birthday if disabled * Unborn children

Question 60

What are the 4 main types of pharmacological agents used for Conscious Sedation? Which is first time for children below 12 years?

Answer 60

1. Inhalation Sedation (Nitrous Oxide & Oxygen) = FIRST LINE!!! 2. Oral Sedation (Benzodiazepines, e.g. Midazolam) 3. Transmucosal Sedation (as above) 4. Intravenous Sedation (as above)

Question 61

What are oro-facial signs of Physical abuse? (3)

Answer 61

* Bruising * Tooth trauma * Abrasions/Lacerations *N.B. Abused (mainly Neglected) children are moe likely to have carious teeth*

Question 62

What are the disadvantages of Nitrous Oxide in Inhalation Sedation? (6)

Answer 62

* ST Side Effects → Nausea, Headache or Loss of consciousness (rare) * LT Exposure Side Effects → B12 def. Anaemia, Bone marrow suppression, Liver disease or Increased miscarriage/Reduced fertility risk * Environmental damage * Expensive * Bulky equiptment * Route of administration close to oprating side → Reduced access to oral cavity for Tx

Question 63

What are 9 non-pharmalogical techniques to treat an anxious child?

Answer 63

1. Gradual Exposure 2. Acclimatisation 3. Tell-Show-Do 4. Behavioural Shaping 5. Modelling 6. Positive Reinforcement 7. Negative Reinforcement 8. Distraction 9. Desensitisation

Question 64

Why can't we do RCT on non-vital immature tooth? (2)

Answer 64

* Open apex = No seal for obturation * Wide funnel shaped canals = difficulty obturation *(often higher MAF needed)*

Question 65

How does Pulpectomy in deciduous tooth differ to RCT in permanent tooth? (4)

Answer 65

* Irrigation in deciduous = 0.1% Sodium Hypochlorite, 0.9% Saline or 0.4% Chlorhexidine * WL = _2mm_ (vs. 1mm) from root apex * Maximum file size = 30 (vs. 80) * Obturation with: CaOH, Iodoform paste (e.g. VitapexTM) or slow-set ZOE (vs. GP)

Question 66

What is the main material used to achieve haemostsasis in Pulpotomy? How is this achieved? What are 6 alternative materials?

Answer 66

**15.5% Ferric Sulphate** Forms "Ferric Ion Complex" when in contact with blood via protein binding → _Mechanical_ vessel seal → Haemostasis Does NOT induce healing or reparative dentine!! Alternatives: * MTA *(best but expensive)* * CaOH * Electro-surgery * Laser * Gluteraldehyde * Bone morphogenic/osteogenic protein

Question 67

What are the 2 aims of pulp therapy on IMMATURE PERMANENT teeth if pulp is: 1. Vital? 2. Non-Vital?

Answer 67

VITAL: 1. Preserve pulp vitality 2. Allow continued root development (including apex formation) NON-VITAL 1. Create natural apical barrier (CaOH) 2. Create artificial apical barrier (MTA)

Question 68

What is the purpose of a "Scavenger System" in IHS?

Answer 68

Removes excess gas allowing for good Px ventilation Prevents exhailed NO₂ release to operator

Question 69

What is the difference between Graded Experience and Acclimatisation (non-pharmacological techniques to treat an anxious patient)?

Answer 69

Graded Experience = Gradual introduction to the dental environment (e.g. non-invasive procedures first) Acclimatisation = Repeating of simple interventions to build familiarity (adding new procedures one at a time)

Question 70

Once Haemostasis achieved (healthy clotted radicular pulp stumps seen) how is Pulpotomy continued?

Answer 70

1. 15.5% Ferric Sulphate applied with microbrush and left for 15 seconds 2. Rinse and Dry 3. Restore with IRM(ZOE) or GIC 4. Coronal seal restoration (ideally SSC/PMC)

Question 71

What is the MAXIMUM exposure limit to Nitrous Oxide in IHS?

Answer 71

100ppm over 8 hours

Question 72

What are 4 possible reasons for IHS failure? How can these be rectified?

Answer 72

1. Px not breathing adequately through nose *⇒ Encourage nose breathing and ensure no blockages* 2. Ineffective seal on mask *⇒ Ensure tight seal* 3. Px too anxious, cannot cooperate *⇒ Stop Tx and reconsider options (e.g. GA)* 4. Faulty IHS machine *⇒ Stop Tx and have checked by trained engineer*

Question 73

What are 6 indications for GA in children?

Answer 73

* Failed sedation attempts - severe dental anxiety * Pre-cooperative child * UNcooperative child (e.g. Special Care) * Multiple extractions in more than 1 quadrant * Complex Tx * LA allergies (rare)

Question 74

Outline process of APEXIFICATION on non-vital immature permanent tooth... How often should this be repeated? What are the outcomes if: 1. An apical barrier forms? 2. No apical barrier forms?

Answer 74

# * LA/Rubber Dam * Access cavity * Irrigate with Chlorhexidine or Sodium Hypochlorite (0.5%) * Clear canal * Fill with Non-setting CaOH then compres apically with wet cotton pellet * Temp restoration Repeat every 3 months for 18 months - 2 years 1. Apical barrier forms → Obturate (GP) 2. No Apical barrier forms after above time → Artificial barrier formed using MTA

Question 75

What are the 4 main types of pulp treatment on VITAL IMMATURE teeth ("Apexogenesis")? Why do we not do Pulpectomy?

Answer 75

1. Indirect Pulp Capping 2. Direct Pulp Capping 3. Cvek's Partial Pulpotomy 4. Conventional Pulpotomy Pulpectomy only done in NON-VITAL teeth

Question 76

What type of growth occurs at the Maxilla (Naso-Cranial Complex) ?

Answer 76

1. Intramembranous Ossification 2. Growth at sutures * Craniomaxillary suture → Downward & Forward * Sagittal (Median Palatal) → Increased maxilla width 3. Surface Remodelling

Question 77

What is the SDCEP definition of Conscious Sedation?

Answer 77

"A technique in which use of a drug(s) produces a state of CNS depression, enabling treatment to be carried out, but during which : - verbal contact with the patient is maintained - drugs carry a wide enough margin of safety to render loss of consciousness unlikely

Question 78

What can be used to assess dental anxiety in patients: 1. Under 8 years? 2. Above 8 years?

Answer 78

1. Facial imaging scale (1-5) 2. Modified Child Dental Anxiety Scale

Question 79

What communication techniques can be used to reduce child anxieties? 1. VERBAL (3) 2. NON VERBAL (3)

Answer 79

1. VERBAL - Speed -Tone - Words ("Childrenese" and empathy) 2. NON-VERBAL - Pictures - Media (distraction) - Body language

Question 80

What is the difference between "Cvek's Pulpotomy" and "Conventional Pulpotomy"?

Answer 80

**Cvek's Pulpotomy:** * _Partial_ pulpotomy - Removal of 1-3mm inflammed pulpal tissue to reach underlying healthy tissue (MI) * Better prognosis in Immature permanent teeth with OPEN apex (vs CLOSED) **Conventional Pulpotomy:** * ALL Coronal pulp removed

Question 81

Is there more post-natal growth facially or cranially? How do the 2 differ?

Answer 81

FACIALLY At birth, face/jaws are UNDERDEVELOPED and take up 1/8th skull --\> Increasing in volume to 1/2 skull in adulthood Volume of while body taken up by Cranial/Facial volume reduces from 50% (2 month foetus) to 6% (adult) - Still grows

Question 83

What type of growth occurs in the Cranial Vault?

Answer 83

1. Intramembranous Ossification 2. Growth at sutures 3. Surface remodelling (OUTWARDS growth as apposition on exterior bone and sutures, with resorption on inner surface)

Question 84

Name the following features on the IHS equiptment:

Answer 84

(a) NO₂ flowmeter (b) O₂ flowmeter (c) Gas mixture control (d) Gas flow rate control (e) Oxygen flush button (f) Air entrapment valve (g) Gas outlet

Question 85

What is the difference between a SIGN and SYMPTOM? (Define both)

Answer 85

**SIGN =** _Objective_ evidence of disease, discovered by a _clinician_ upon examination **SYMPTOM =** _Subjective_ evidence of disease, experienced and reported by the _patient_

Question 86

In IHS, what Colour cylinder, Pressure & Phase (Gas/Liquid/Solid) is present for: 1. NITROUS OXIDE? 2. OXYGEN?

Answer 86

NITROUS OXIDE * Blue cylinder * 800psi * Gas/Liquid Phase (heavier than air) OXYGEN * White cylinder * 2000psi * Gas Phase only

Question 87

What are the 3 growth outcomes of Maxilla growth?

Answer 87

1. Forwards 2. Downwards 3. Widening of palatal vault

Question 88

What is meant by "Leeway Space"?

Answer 88

The difference in combined mesio-distal width of C, D and E vs. 3, 4 and 5 (where C, D and E are WIDER!!) By 1mm per quadrant - Upper jaw (2mm) By 2mm per quadrant - Lower Jaw (4mm) Results in loss of E's "Flush Terminal Plane" and teeth are now guided into Class I relationship

Question 89

When is deciduous dentition established? (years)

Answer 89

2.5 years (+/-6 months)

Question 90

When analysing occlusion, what are "Andrew's 6 Keys of Occlusion"?

Answer 90

1. Molar relationship 2. Mesio-distal crown angulation 3. Labio-lingual crown inclination 4. Tooth rotations 5. Tight contacts +/- Spacing 6. "Curve of Spee" (occlusal plane curvature on the mandible, beginning at premolars and ending at terminal molar)

Question 91

What is the difference between Growth and Development? (Define each)

Answer 91

GROWTH = Anatomical phenomenon involved with increase in size (hypertrophy) or number (hyperplasia) DEVELOPMENT = Physiological phenomenon involved with increase in complexity

Question 92

What are 5 SYMPTOMS of adequate sedation with IHS?

Answer 92

* Lightheadedness/Dizziness * Peripheral tingling * Wave of warmth * Analgesia (mild) - Oral tissues, hands etc * Euphoria

Question 93

What is the definition of General Anaesthesia?

Answer 93

A drug induced state of _reversible_, _controlled_ UNconsciousness; during which the patieny is not rousable.

Question 94

What are 5 signs of Sexual abuse?

Answer 94

* Direct allegation * STI * Pregnancy * Trauma * Emotional (e.g. inappropriate sexual behaviours)

Question 95

What are the 3 main planes of sedation with Nitrous Oxide? Which is ideal? (include NO₂ concentrations)

Answer 95

PLANE I (10-25% NO₂) PLANE II (20-55% NO₂) - IDEAL PLANE III (50-70% NO₂)

Question 96

What are 7 CONTRA-INDICATIONS for Pulp Therapy (to extract a carious deciduous tooth)?

Answer 96

* MH contra-indications to Pulp therapy (e.g. debilitating illness or cardiac lesion) * Poor co-operation * Not motivated (child or parent) * Several teeth involved * Tooth close to exfoliation * Unrestorable tooth (insufficient tooth tissue) * Acute abscess with cellulitis

Question 97

What are the 4 main sites of Cranio-facial growth? What type of Ossification occurs at each?

Answer 97

1. **Cranial Vault** - Intramembrane 2. **Cranial Base** - Endochondral 3. **Maxilla (Naso-cranial complex)** - Intramembrane 4. **Mandible** - Intramembrane (main) BUT Endrochondral at condyles

Question 98

What are 10 Contra-Indications for Inhalation Sedation use in child?

Answer 98

1. Px refusal (inc. consent issues, e.g. language barrier) 2. Nasal obstruction 3. Respiratory infection 4. COPD 5. Pre-cooperative child 6. Immunocompromised 7. Increased intra-cranial pressure 8. Ear/Eye pressure 9. Multiple Sclerosis 10. Bleomycin chemotherapy

Question 99

When does tooth calcification begin? When (& what tooth) is usually first deciduous tooth to erupt?

Answer 99

4-6 months in utero 6-9 months: Lower incisors

Question 100

What are some risk factors for abused children? (5)

Answer 100

* Parent/carer drug or alcohol abuse * Parent/carer mental health issues * Family violence * Previous child or animal abuse * Disabled children

Question 101

What are 3 things the dentist should be monitoring during IHS?

Answer 101

1. Breathing rate and depth 2. Skin colour *- Flushing normal but too much may be evidence of hypoxia 2^º to respiratory depression and reddness localised to areas hand/rubber dam touched may be allergies* 3. Level of relaxation (Cooperation and Communication)

Question 102

What is "Ossification"? What are the 2 main forms? (Explain difference/mechanism)

Answer 102

Ossification = Formation of new bone 1. INTRAMEMBRANOUS *(New cells formed at periosteum/outer bone, secete ECM and mineralise to form bone in layers)* 2. ENDOCHONDRAL *(Begins & spreads from "Primary Ossification Centre" - Cartilage formed and then replaced by bone)*

Question 103

What are the 2 main pulp treatments for a NON-VITAL IMMATURE tooth?

Answer 103

1. APEXIFICATION (Either natural barrier with CaOH or artificial barrier with MTA) 2. Pulp revasculisation *(replacement of damaged pulp with viable pulp tissue - still under study)*

Question 104

How does most growth of the mandible (forwards and downwards translation) occur?

Answer 104

Via Surface Remodelling **APPOSITION** * Posterior ramus * Outer body of mandible * Chin * Condylar cartilage **RESORPTION** * Anterior ramus * Inner body of mandible * Incisor roots (labial) * Anterior/Inferior Condyle aspect

Question 105

What is the difference between SIGNS and SYMPTOMS of IHS?

Answer 105

SIGNS = What the sedationist observes SYMPTOMS = What the patient feels