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Flashcards in Pediatric Dentistry Deck (132):
1

max. conc. of nitrous should not exceed

flow rate is

50%

6 L/min

2

earliest symptom of conscious sedation is

light headedness

3

drug used for pediatric sedation by acting on CNS to induce sleep is

CHLORAL HYDRATE
-kids enter period of excitement and irritability before becoming sedated

4

short acting barbiturates include

secobarbital (seconal)
pentobarbital (nembutal)

sedatives by oral admin. but aren't as good, non-analgesic, can cause hyper-excitability

5

standard prophylaxis for kids is

amox
50 mg/kg 1 hr before

6

pulpectomy (RCT) is indicated when

-periapical pathology
-canals filled with ZOE paste (min. tissue rxn)

7

pulpotomy

preserves radicular VITAL pulp when the entire coronal pulp is amputated; allows resorption and exfoliation of the primary tooth, but preserves its role as a natural space maintainer
-coronal pulp shows evidence of inflammation and degen. change

8

2 pulpotomy techniques

1. Calcium hydroxide - tx PERMANENT teeth when there is a pathologic change in pulp at carious exposure site; indicated for peranent teeth with immature root development and healthy pulp tissue in canals

2. Formocresol - tx PRIMARY teeth with carious exposure, success depends on VITAL root tip. Formecrosl causes surface fixation of pulp tissue and odontoblast degeneration.

9

indications and contraindications for Formecresol pulpotomy

indications - tooth sensitive to sweets, pulp exp during caries excavation, xray shows deep caries to pulp

contra - internal resorption on xray, tooth painful with swelling

10

direct pulp capping is used on

PERMANENT teeth (not primary cause of CaOH's alkaline pH), tooth is ASYMPTOMATIC, there's a small exposure

with mild irritation, resolves itself
with severe irritation, internal resorption can occur

11

contraindications of a direct pulp cap on primary teeth

spontaneous pain
large exposure
excessive bleeding
xray evidence of internal resorption

12

indirect pulp capping goals

preserve pulp vitality, prevent exposure, save tooth structure, arrest caries, promote reparative dentin formation

indications - permanent teeth with rampant caries, large caries close to pulp

contraindications - don't use when spontaneous pain, furcation involvement, pulpal involvement, don't do in KIDS

13

adolescents with rampant caries may need caries control before final restoration to arrest lesions. this involves __

removing gross caries, placing CaOH and an interim restoration like IRM (reinforced ZOE)

14

ER tx of fractures of permanent teeth with immature apices

Class I - smooth edges, restore
Class II - CaOH to exposed dentin and restore
Class III - CaOH, place temp, if exposure is big then perform CaOH pulpotomy -> pulpectomy eventually
Class IV - CaOH pulpotomy -> pulpectomy eventually

15

in a kid with a fully formed apex, if there is a pinpoint exposure and it has been a while (day) since it happened, what is tx?

what if it happened right away?

1 day - conventional RCT

imm - direct pulp cap with CaOH

16

MOST COMMON craniofacial malformations (50% of all defects)

cleft palate and cleft lip

17

Cleft lip

during 5th-6th week of embryonic life, from failure of maxillary and frontonasal processes to merge
-more common in males
-more common on left side

Class I - unilateral notch of vermillion NOT into lip
Class II - unilateral notch of vermillion extending into lip but not nasal floor
Class III - unilateral notch of vermillion but into lip and floor of nose
Class IV - bilateral clefting

-occurs during 4-6 wks of pregnancy

18

Cleft palate

opening in roof of mouth where 2 sides of palate did not unite, occurs in 6th-8th week of embryonic life
-fissure in midline
-isolated clefts more common in females
-impaired speech and swallowing

Class I - only soft palate
Class II - both palates but not alveolar process
Class III - both palates and alveolar process on one side of premaxilla
Class IV - soft palate and continues thru alveolus on both sides of premaxilla

19

Acute Necrotizing Ulcerative Gingivitis (ANUG, Vincent's Angina, Trench Mouth)

clinical manifestations

tx

painful hyperemic gingiva, punched out papilla, covered by GRAY pseudomembrane with foul odor
-fusopirochetal infxn caused by FUSIFORM/FUSIBACTERIUM, SPIROCHETES, P. INTERMEDIA
-assoc. with poor OH, common in conditions with crowding and malnutrition, stress and smoking risk factors too
-YOUNG ADULTS 15-35 yrs.

clinical manifestations - inflamed, painful, bleeding gingiva, poor appetite, fever, malaise, odor

tx - debridement, H2O2, abx therapy

20

Primary (Acute) Herpetic Gingivostomatitis

viral infection
-characterized by: inflamed gingiva, sore throat, fever, malaise, lymphadenopathy, small fluid filled vesicles on mucosa of the lips/tongue/gingiva
-round ulcers with RED AREOLAE on CHEEKS
-self limiting, lasts 7-10 days
-tx: oral fluids
-common in PRESCHOOL kids

21

Atrophic Gingivitis

gingival recession without bone loss

22

Acute Lymphocytic/Lymphoblastic Leukemia (ALL)

most common pediatric cancer, form of acute leukemia most responsive to therapy

signs - fatigue, pallor, weight loss, easy bruising -> fever, hemorrhages, weak, bone/joint pain, repeated infxns

oral features - gingival oozing, petechiae, hematoma, ecchymosis, oral ulceration, pharyngitis, gingival infxn unresponse to therapy, submandibular lymphadenopathy

-susceptible to candida infxns (Nystatin)

23

most common type of leukemia in kids is

lymphoblastic leukemia

24

Apert Syndrome

cranial-limb anomaly
-malformations of skull, midface, hands, feet (NOT blindness)
-assoc. with supernumerary teeth, crowding, Class III

major features - prematurely fused cranial sutures, retruded midface, fused fingers and toes

25

Autism

appears in first 3 yrs, 4x more common in boys
-difficult to tx autistic pt cause of impaired communication
-can use sedatives and reduce loud sonds

26

Attention Deficit Disorder (ADD)

what tx?

short attention span, hyperactivity, impulsive behavior
-cause unknown
-10x more common in males

Methylphenidate (ritalin) - mild CNS stimulant
Amphetamines (dextroamphetamine)

27

Achondroplasia

short-limb dwarfism
-most kids die before 1

clinical features - disproportionate short stature, prominent forehead, depressed bridge of nose, small maxilla causing overcrowding of teeth, Class III malocclusion

28

Gigantism oral features

-enlarged tongue
-teeth tipped buccal or lingual
-mand prognathism
-long roots

29

Pituitary dwarfism oral features

-delayed eruption and exfoliation
-short clinical crowns, smaller roots
-smaller dental arch -> malocclusion
-mandible underdeveloped

30

Cellulitis

acute spreading infxn of dermis and subcutaneous tissues, causing pain, erythema, edema, warmth

caused by - Group A streptococci & Staph Aureus

-harder to tx in kid cause dehydration

31

Ludwig's Angina

cellulitis that affects submandibular, sublingual, submental spaces
-causes elevation of tongue and mouth -> obstruction of airway
-hospital immediately

32

Cretinism (child hypothyroidism) is a

deficiency caused by congenital absence of THYROXINE
-severe HYPOthyroidism in a kid characterized by defective mental and physical development
-dwarfed body with curved spine and pendulous abdomen
-distorted limbs
-severe mental retardation

dental findings - underdeveloped mandible, overdeveloped maxilla, enlarged tongue causing malocclusion, delayed tooth eruption, longer retention of deciduous teeth

33

Cystic Fibrosis

INHERITED disease of exocrine glands
-sticky mucus from faulty transport of Na+ and Cl in cells lining organs
-glands most affected are in pancreas, respiratory system, sweat glands
-inherit defective copy of CF gene
-dx tool is sweat test (elevated Na and Cl)
-dark teeth

combo of steatorrhea, chronic resp. infxn, functional disturbances in secretory mechanisms of various glands

34

Cleidocranial Dysplasia (dDysostosis)

INHERITED disorder of bony development
-absent or incompletely formed clavicles
-characteristic facial appearance, dental abnormalities
-supernumerary teeth, delayed eruption, peg-shaped teeth, missing teeth

35

Ectodermal Dysplasia

HEREDITARY condition caused by abnormal development of skin, hair, nails, teeth, sweat glands
-different types but X-linked anhidrotic is most common
-anodontia or oligodontia, conical shaped anteriors
-atrophic skin, defective hair, hypoplastic sweat glands

36

Anhidrotic ectodermal dysplasia

most common, only affects males, characterized by lack of perspiration

37

retained primary teeth are an oral manifestation of what 2 conditions

Ectodermal and
Cleidocranial Dysplasia

38

Diabetes

what is the triad?

oral complications?

body can't properly use and store glucose

triad - polydipsia (thirst), polyphagia (hunger), polyuria (freq. urination)

Type I Diabetes (insulin dependent, juvenile-onset) - body stops making insulin, prone to ketoacidosis, blindness may develop

oral complications - xerostomia, infection, poor healing, perio disease, burning mouth syndrome

39

Diphtheria

acute, contagious disease caused by bacterium CORYNEBACTERIUM DIPHTHERIA
-production of a systemic toxin damaging to heart and CNS

40

Down Syndrome (Trisomy 21)

CONGENITAL, chromosomal abnormality

low caries rate
high prevalence perio disease
delayed eruption
malocclusion
enamel dysplasia
delayed mental and physical development
short, stocky build, broad, flat face, slanty eyes
prominent, thick tongue
**heart defects common, SBE prophylaxis is required for dental tx**
reduced resistance to infxn

41

Gingivostomatitis

sores on mouth and gingiva caused by HERPES (HSV-1), characterized by inflammation of gingiva and mucosa, common esp. in kids

42

Acute (Primary) Herpetic Gingivostomatitis

kids <3 (1-5 yrs) with prodromal symptoms (fever, malaise, irritability, headache, dysphagia, vomiting, lymphadenopathy)

-tx by mild topical (ex. Dyclone) for pain

-virus that causes this is closely related to herpes that causes chickenpox (varicella zoster)

43

common sequelae of Acute Herpetic Gingivostomatitis

-recurrent herpes labialis (cold sores)
-spherical vesicles
-kid will have circulating anti-herpes antibodies (HSV-1 antibodies)

44

Herpangina

viral infection (strain of coxsackie A)
-young kid
-oral ulcers (white to whitish gray base and red border on roof of mouth and throat)
-fever, sore throat, headache
-goes away in a week, tx is palliative

45

Hemangioma

most COMMON BENIGN TUMOR of INFANTS
-vascular birthmarks, biologically active
-5x more common in girls
-common on lips, tongue, buccal mucosa, flat or raised, deep red or blushish
-removed surgically

ex. asymptomatic blue lesion on tongue, minimal increase in size 5 yrs

46

Lymphangioma

well circumscribed nodule or mass of lymphatic vessels, often in neck and axilla
-compressible and spongy red to blue translucent lesions

tx by excisional biopsy

47

Neurofibroma

firm, encapsulated tumor by proliferation of SCHWANN CELLS
-on tongue, buccal mucosa, vestibule, palate
-can become malignant (5-15%)

MULT. LESIONS are assoc. with NEUROFIBROMATOSIS (Von Recklinghausen's Disease)

48

Nursing Bottle Caries (Baby Bottle Tooth Decay/Bottle Mouth Syndrome)

widespread caries, most commonly affecting MAXILLARY INCISORS
-in combo with Strep mutans

max incisors > max and mand 1st molars > mand. canines

49

Pierre Robin Syndrome

HEREDITARY disorder
-presents micrognathia, glossoptois (down displacement/retraction of tongue), high arch or cleft palate

50

Porphyria

3 major findings?

dx?

INHERITED disorders, abnormalities in production of heme pigments, myoglobin, ctyochromas
-can cause discoloration of teeth

3 major findings
1. Photodermatitis (light sensitivity causing rash)
2. Neuropsychiatric complaints
3. Visceral complains (ab pain, cramping)

Dx - red urine, purple brown teeth, sensitive to sunlight, gets blisters and swelling on face/hands in sunlight

51

Causes of tooth discolration (4 conditions)

1. Porphyria
2. Cystic Fibrosis - dark
3. Erythroblastosis Fetalis - destruction of erythrocytes, blue-green
4. Tetracycline therapy - yellow to brown, gray to black

52

Rieger's Syndrome

delayed sexual development, hypothyroidism, dental features like hypodontia, underdeveloped premaxilla, cleft palate, protruding lower lip

53

Recurrent Aphthous Ulcers (Canker sores)

unknown cause, triggered by stress, dietary deficiencies (iron, folic acid, vit B12), periods, hormonal changes, etc.

-painful white or yellow ulcers with red halo on NON-KERATINIZED oral mucosa

-RAS and intra-oral herps are distinguished on location

-more in women

54

RAS occur on __ whereas intra-oral herpes occur on __

RAS - mobile mucosa

intra-oral herps - tissue bound to periosteum

55

3 classes of Recurrent Aphthous Ulcers

1. Recurrent minor < 1 cm
2. Recurrent major > 1 cm, lasts > 2 wks, scars
3. Recurrent herpetiform - clusters and ulcers

56

pts with __ ulcers should be screened for diabetes mellitus or Behcet's syndrome

Recurrent herpetiform

57

Grand Mal Epilepsy (Tonic Clonic)

most common seizure disorder (90% of epileptics)
-tonic-clonic, 2-5 min.
-tx: pt in supine position, prevent injury, basic life support (head tilt), oxygen if cyanosis

58

Petit Mal Epilepsy (Absence)

-in childhood under 16 yrs., 5-10 sec.
-mgmgt is protective, little or no danger

59

Measles (Rubeola)

from PARAMYXOVIRUS
-fever, cough, rash
-KOPLIK'S SPOTS 1-2 mm yellow white oral lesions, looks like necrotic ulcers with bright red margin

60

German Measles (Rubella)

benign viral disease
-red, bumpy rash, swollen lymph nodes, mild fever
-PETECHIAE spots on soft palate
-hypoplastic primary incisors from maternal rubella

61

Mumps

uni or bilateral swelling of salivary glands, usually PAROTID (parotitis)
-papilla on opening of parotid duct on buccal mucosa is puffy and red

62

Smallpox (Variola)

viral disease, high fever, nausea, vomiting, chills, headache

oral manifestations - ulceration of mucosa and pharynx, sometimes swollen tongue

63

Scarlet Fever

exotoxin mediated, from group A beta hemolytic strep infxn

symptoms - strep throat, fever, sore throat, headache, STRAWBERRY TONGUE

-enlargement of FUNGIFORM PAPILLAE above level of white desquamating filiform papilla -> looks like strawberry

tx by penicillin

64

Amelogenesis Imperfecta

INHERITED, dominant trait
-thin, soft enamel

65

Dentinogenesis Imperfecta

INHERITED, dominant
-undermineralized dentin
-bulbous crowns with short roots, opalescent dentin obliterates pulp cavity
-teeth wear rapidly

Type I: assoc. with OSTEOGENESIS IMPERFECTA, kids have blue schlera, fragile bones, hearing loss
Type II: most common
Type III: Brandywine, multiple pulpal exposures

66

Dens-in-Dente (Dens Invaginatus)

tooth within tooth from invagination of all enamel organ layers into DENTAL PAPILLA

-most involves MAX LATERAL incisor
-pulp usually exposed, so should be RCT

67

Enamel hypocalcification

HEREDITARY
-enamel is soft and undercalcified, but normal in quantity
-defective maturation of ameloblasts

68

Enamel hypoplasia

DEVELOPMENTAL
-enamel is hard, but thin and deficient cause of defective enamel matrix formation with deficiency in cementing substance
-common sequelae in kid with hx of generalized growth failure in first 6 mo. of life
-manifestation of HYPOPARATHYROIDISM (prevent with Vit D)

69

Concrescence

Gemination

Fusion

C - joined by cementum, after roots complete

G - single tooth germ splits to form 2 separate crowns

F - 2 tooth buds joined and appear as a large crown

Fusion or gemination occurs during INITIATION and PROLIFERATION stages

70

Anodontia
1. Complete True
2. Partial

1. Complete true - usually assoc. with hereditary ectodermal dysplasia

2. Partial - common and affects max 3rds, max laterals, mand 2nd PMs`

71

Conditions that cause DELAYED EXFOLIATION and DELAYED ERUPTION

Systemic
-Cleidocranial dysostosis, Down's, Ectodermal dysplasia, Gardner's, Osteogenesis imperfecta, Rickets, Severe congenital heart disease, MR

Localized - abscess, ankylosis

Hypothyroidism, Hypopituitarism, Hypoparathyroidism

72

Child vs. Adult Periodontium

-Child periodontium has greater blood and lymph supply
-alveolar crest is flatter and bone is thinner
-gingival pockets are larger, attached gingiva is narrower
-tissues are redder
-lack of stippling
-round and rolled gingival margins
-cementum is thinner
-PDL fibers run parallel to tooth

73

primary teeth begin to form at __ weeks in utero and calcify at __ months in utero

6 wks

4 months

74

Stages in tooth development (life cycle)

1. Initiation (Bud) - formation of dental lamina [fusion, gemination]

2. Proliferation (Cap) - enamel organ formed [fusion, gemination]

3. Differentiation (Bell, Histodifferentiation) - final shaping of tooth, cells become tissue forming cells in enamel organ [dentinogenesis and amelogenesis imperfecta]

4. Apposition - deposit dental tissues, most cells of pulp are fibroplasts

5. Calcification (Mineralization) - primary teeth calcify in 2nd trimester of pregnancy (14 wks/4 mo. in utero)
-at birth, 20 deciduous and 4 1st molars calcified
-in a 2 yr. old 40 teeth have calcified
-cariostatic effect of fluoride
-tetracycline stain incorporated
-roots done by 3-4 yrs.

6. Eruption - through gingiva
7. Attrition - loss of tooth structure

75

enamel is derived from what germ layer

ECTODERM - determine crown root and shape

All other tooth structures come from mesenchyme (MESODERM)

76

Stages of Tooth Histogenesis (5)

1. Elongation of inner enamel epithelial cells of enamel organ
2. Differentiation of odontoblasts
3. Deposit of 1st layer of DENTIN
4. Deposit of 1st layer of ENAMEL
5. Deposit of root dentin and CEMENTUM

77

Korff's fibers

rope-like fibers in pulp periphery, help form dentin matrix

78

Hertwig's Epithelial Root Sheath (HERS)

from joining of inner and outer enamel epithelium of enamel organ
-uniform growth causes single rooted tooth, medial outgrowths cause multi-rooted teeth

79

when a tooth erupts, how much of the root has formed?

in primary teeth, root is formed in __ months

in permanent, it takes __ yrs

2/3

18 months

3 yrs

80

Lobes

primary centers of ossification, separated by developmental grooves

min # of lobes from which a tooth develops is 4

anteriors = 4 (3 labial, 1 lingual)
premolars = 4 (3 buccal, 1 lingual) cept md 2nd (3 buccal, 2 lingual)
1st molars = 5
2nd molars = 4
3rd molars = 4

81

Primary Tooth Eruption
Rule of Four

7 mo. - 4 teeth erupted - 4 mand centrals
11 mo. - 8 teeth erupted - 4 max laterals
15 mo. - 12 teeth erupted - 4 1st molars
19 mo. - 16 teeth erupted - 4 canines
23 mo. - 20 teeth erupted - 4 second molars

82

Periods of dentition

1. Primary 6 mo. - 6 yr.
2. Mixed 6-12 yr.
3. Permanent 12+

83

Primary vs. Permanent Teeth

-primary are lighter in color
-primary pulps are bigger
-primary crowns are bulbous, constricted
-primary crowns smoother
-primary anteriors roots taper more
-enamel ends abruptly at cervical line instead of getting thinner

84

Primary vs. Permanent Molars

-crowns shorter with pronounced B & L cervical ridges, constricted cervical area
-occlusal table is narrow F-L
-anatom is shallower
-prominent mesial cervical ridge
-longer roots, more slender, divergent, less curved

sum of M-D widths of primary molars in a quadrant is 2-5 mm > permanent teeth that follow them (premolars)

-enamel on occlusal is 1 mm thick (perm = 2.5 mm)

85

permanent tooth most likely malposed in cases of mand arch space discrepancy

permanent mand 2nd premolar

86

primary tooth most likely to be crowded out of the arch

primary maxillary canine

87

primary tooth that does not look like any other primary or permanent tooth

primary mandibular 1st molar
-oval occlusal surface, wider M-D > B-L
-occlusal table rhomboid shape
-transverse ridge btw MB and ML
-MB cusp largest and longest

88

primary mandibular 2nd molar looks like

permanent mandibular 1st molar
-this primary tooth has the greatest F-L diameter of all primary teeth

89

most atypical tooth of all the molars (primary and perm)

primary maxillary 1st molar
-smallest molar in all dimensions except labiolingual
-bicuspid
-H shaped occlusal pit-groove pattern
-has THREE ROOTS

90

primary tooth that looks like permanent max 1st molar

primary max 2nd molar
-can have 5th cusp of carabelli
-prominent MB cervical and oblique ridge

91

when do permanent 1st molars calcify

at birth

92

at 6, a child's head is __ % of adult size

90%
-brain and cranial base are fully developed

93

human development facts at birth

-jaw large enough to accomodate all primary teeth
-width of face reached its adult size
-palate is flat

94

from ages __ to __ body's lymph tissue is 200% of normal adult

6-12

95

fissure sealants succeed by

altering host susceptibility

96

caries activity is directly proportional to

consistency, frequency, oral retention of fermentable carbs

97

to prevent caries, CDC recommends __ ppm of fluoride in drinking water, and the max is __

0.7 ppm

max = 1.2

98

optimal conc. of fluoride for water depends on

air temp

99

fluorides often added to water are (3)

sodium fluoride
sodium silicofluoride
hydrofluosilic acid

deposits of fluoride happens on SMOOTH SURFACES

100

professional applied topical fluorides (3)

1. Sodium Fluoride (NaF) - basic, good taste, no effect on materials

2. Stannous Fluoride (SnF2) - does not etch porcelain, tastes bad, ACIDIC, STAINS demin enamel and porcelain, not used in US, advantage is single tx can be given

3. Acidulated Phosphate Fluoride - tastes better, but can damage prcelain, ACIDIC, contraindicated on porcelain and composite, can corrode surface of titanium implants

101

most stable reaction product of a topical app of F- is

fluoroapatite

102

beneficial effects of fluoride

1. interferes with plaque (plaque sticks to teeth cause DEXTRANS are insoluble and sticky)
2. antibacterial
3. enhances enamel remin
4. decreases enamel solubility
5. inhibits glycolysis

103

mechanisms of fluoride to inhibit caries

1. topical effect - enamel remin
2. F- converts hydroxyapatite by substituting OH for F- (F- is smaller and has greater affinity for HA)
3. F- inhibits glycolysis (inhibits production of glucosyltransferase)

104

F- mouth rinses have greatest effect on

newly erupted teeth

105

greatest conc. of F- exist on

outermost layer of enamel (so be careful in prophy)

106

the toothpaste/dentrifice component most likely to inactive F- is

dicalcium phosphate

107

ER tx for kid who ate a lot of F- is

acute F- toxicity symptoms may appear within __ min and persist up to __ hrs

induce vomiting, have them drink a lot of milk or something with calcium to decrease acidity and form complexes with fluoride

DON'T have them drink sodium bicarb or do ammonia under nose

Acute F- toxicity appears in 30 min, lasts up to 24 hrs

108

F- is mainly eliminated from body via

most F- absorption happens where?

kidneys
(but fluoride in body mostly in skeletal tissue)

absorption in stomach

109

acute fluoride poisoning

-causes of death are cardiac failure and respiratory paralysis

15 mg/kg for kid can be lethal
4-5 g for adult is lethal

range of lethal dose is 20- 50 mg/kg

110

dental fluorosis

irreversible diffuse symmetric hypomineralization disorder of ameloblasts
-only when exposure when enamel is developing
-from chronic (low dose long term) intake, NOT topical

111

pit and fissure sealants are best retained on what teeth?

which teeth benefit the most?

retained on max and mand. premolars

max and mand 1st molars benefit the most

112

principal feature of a sealant req for success is

adequate retention

caries protection is 100% in pits and fissures that remain sealed

113

components of pit and fissure sealants

1. bis-GMA - monomer
2. initiator - benzoyl peroxide
3. accelerator - amine is self cured
4. opaque filler - titanium oxide added to make it look diff than occlual enamel

114

H&N cancer pts can benefit by using what 2 kinds of fluoride at home?

NaF
Stannous F-

115

daily use of F- gels at home is indicated in

-rampant enamel or root caries
-xerostomia
-H&N radiation therapy
-use on abutment teeth under overdenture
-hypersensitive roots

116

components of NaF paste used to treat root sensitivity

sodium fluoride
kaolin
glycerin

117

__ ppm is optimum F- conc. in drinking water

1.0 ppm

US public health sets optimum at 0.7-1.2

118

How much F- is in a 8.2 oz tube of toothpaste? mg? ppm?

232 mg
1100 ppm

NaF or sodium monofluorophosphate contain 1.0 mg/g toothpaste

119

F- conc. increases or decreases in external layer of enamel through life

increases

120

Ellis Crown Fracture Classification

Class I - simple, involves little or no dentin -> enameloplasty

Class II - involves considerable dentin, no pulp -> CaOH or GI

Class III - with pulpal exposure -> pulp therapy and restore, then RCT with ZOE

Class IV - entire crown lost -> pulpectomy and SSC

121

Root fractures in primary teeth

uncommon cause pliable bone lets the teeth fall out
-in apical third usually heals itself
-use heavy wires to stabilize (splinting NOT recommended in kids teeth)

122

most reliable vitality test

thermal esp. in incisors (if it doesnt respond -> necrosis)

EPT not reliable

shine light to see pulpal hyperemia

123

why don't you need gingival bevel in Class II for primary teeth

enamel rods in gingival third extend occlusally from DEJ

124

indications for SSCs

extensive caries, hypocalcified teeth, teeth with dentinogenesis or amelogenesis imperfecta, after pulpal tx, abutment for a space maintainer, or fractured tooth

125

SSC Tooth Prep

cusps reduced 1.0 - 1.5 mm

break contact

126

where is mandibular foramen in relation to occlusal plane compared to adults

it's LOWER

127

girls reach puberty __ yrs earlier than boys

2 yrs

128

contraindications to rubber dam

if they have fixed ortho, congested nose, recently erupted tooth that won't hold clamp

129

most common premed prior to general anesthesia for kids is

VERSED

premed with barbiturate can cause paradoxical excitement

130

how to manage angry child

separate parent, with permission use HOME technique, display authority

131

how to manage fearful child

parent stand behind chair, allow child to express fear, change focus, use sedaiton

132

how to manage mentally retarded child

short appts, morning, give tour, only 1 instruction at a time, reward