PEDO pt 2 Flashcards
1
Q
a basic rule in space management in the developing dentition is that eruption of anterior teeth should be reasonably symmetrical. why?
A
asymmetry in exfoliation may lead to significant midline deviations
2
Q
in the primary dentitions, what appliances are indicated for space maintenance for first primary molars? second primary molars? incisors?
A
- first primary molars: band and loop space maintainer for unilateral and bilateral loss
- second primary molars: distal shoe or acrylic partial
- incisors: consider esthetics and speech; use fixed or removable appliance
3
Q
in the mixed dentition, what appliances are indicated for space maintenance for primary mandibular canines? first primary molars? second primary molars?
A
- primary mandibular canines: lower lingual holding arch
- first primary molars: band and loop space maintainer unilateral, or palatal holding arch bilateral
- second primary molars: palatal holding arch for unilateral and bilateral loss
4
Q
T or F:
loss of a primary incisor in the primary dentition usually causes loss of overall arch circumference
A
- false
- generally does not cause loss of overall arch circumference
- might result in localized space loss, especially if there was no interdental primary spacing before the loss
5
Q
replacement of lost primary incisors is considered more for ___ than for space maintenance
A
esthetics and possibly development of speech
6
Q
describe removable partial dentures for loss of primary teeth
A
- posterior adams clasps, C clasps, or ball clasps are placed for retention
- patient is usually at least 3 years old, and it is determined after consultation with parents that there is a reasonable expectation that the pt will tolerate wearing the appliance
7
Q
describe fixed partial dentures for loss of primary teeth
A
- orthodontic bands on second primary molars
- 0.036-0.040 inch stainless steel wire
- replacement teeth are fixed to the wire
- appliance is intended mostly for patients younger than 3 years old or if questionable compliance in wearing a removable appliance
8
Q
lateral ectopic eruption of permanent incisors is characterized by early exfoliation of ___
A
- a primary lateral incisor
- often results in a midline deviation
- treatment of choice is extraction of remaining lateral so as to minimize a midline deviation
9
Q
localized space loss can occur very quickly after loss of a permanent tooth. what is the treatment for space maintenance?
A
- an appliance should be constructed and inserted as soon as possible after tooth loss
- a removable appliance with fingers springs, or fixed orthodontics
10
Q
unilateral primary canine loss usually causes what?
A
- lingual collapse of permanent incisors
- loss of arch length
- increased overbite - after lingual collapse, the mandibular incisors erupt further, increasing overbite
- increased overjet secondary to lingual collapse of mandibular incisors
- midline deviation to the side of canine loss
11
Q
bilateral primary canine loss usually causes what?
A
- lingual collapse of permanent incisors
- loss of arch length
- increased overbite - after lingual collapse, the mandibular incisors erupt further, increasing overbite
- increased overjet secondary to lingual collapse of mandibular incisors
12
Q
what appliance should be used for bilateral canine loss in the mixed dentition?
A
lower lingual holding arch
13
Q
what are the treatment options for unilateral canine loss in the mixed dentition?
A
- extract contralateral primary canine and place lower lingual holding arch
- lower lingual holding arch with a spur if a midline deviation has not occurred (prevents distal drift)
14
Q
what are the treatment options for unilateral and bilateral primary first molar loss in the primary dentition? what appliance should you avoid?
A
- band and loop space maintainer for unilateral and bilateral
- do not use lower lingual holding arch until permanent incisors are erupted (incisors typically erupt lingually and can get trapped by the appliance)
15
Q
what are the treatment options for unilateral and bilateral primary first molar loss in the mixed dentition?
A
- unilateral: band and loop
- bilateral: lower lingual holding arch or palatal holding arch, or nance appliance
16
Q
what size stainless steel wire is used to fabricate a distal shoe space maintainer?
A
0.040 inch
17
Q
acrylic partial dentures might be indicated for patients what what medical conditions (these conditions contraindicate a distal shoe space maintainer)?
A
- blood dyscrasia
- congenital heart defect
- immunosuppression
- diabetes
18
Q
most “kiddie” partial dentures are fabricated such that the acrylic is positioned mesial to the soft tissue contour of what tooth?
A
first permanent molar (this allows for the unimpeded eruption of the first permanent molar)
19
Q
unilateral loss of a second primary molar in the mixed dentition usually requires what appliance?
A
bilateral holding arch
20
Q
what are the appropriate appliance choices for bilateral tooth loss?
A
- lingual holding arch
- palatal holding arch
- nance holding arch
- removable appliance
21
Q
what are the factors you should consider in planning for space maintenance in terms of the amount of resorption of primary roots?
A
- if more than 1/4 of the root remains owing to normal resorption, space maintenance is likely necessary
- if less than 1/4 of the root remains and if there is no bone left between the primary tooth and permanent tooth, space maintenance is likely unnecessary
22
Q
when planning for space maintenance, if there is no bone remaining between the primary molar and permanent premolar and if the cusp tip of the permanent tooth is radiographically at the level of the furcation, is space maintenance necessary?
A
no
23
Q
if bone is interposed between the primary molar and the permanent premolar, is space maintenance necessary?
A
yes, it is usually indicated
24
Q
if there is bone destruction in the region of the primary molar furcation, it is possible that the permanent tooth may erupt very early, with less than ___ root completion. however, it is also possible that bone will ___
A
- 3/4
- form again (covering the permanent tooth)
25
describe the implications of not using a space maintainer
- most space closure occurs within the first 6 months, and can even occur in days
- if the prediction of eruption of the permanent tooth is difficult, the dentist should use a space maintainer
26
in the molar area, closure occurs essentially by ___, not ___ movement of the tooth
- tipping
| - bodily
27
T or F:
| active eruption of a neighboring tooth tends to decrease the amount of space loss
false, it tends to increase the amount of space loss
28
are chronologic age and average eruption times important factors in planning space maintenance?
- no
| - it is more important to consider things like root development of erupting teeth
29
what is the "rule of 7" for primary molars?
- eruption is delayed if loss of the primary molar occurs before age 7
- eruption is accelerated if loss of the primary molar occurs after age 7
- this does not mean that space maintenance is not needed after age 7
30
first permanent molars may become impacted under the distal aspect of the second primary molar. which arch is this more common in?
maxillary
31
what is the treatment for an ectopic permanent molar that has become impacted under the distal aspect of the second primary molar?
- varies in severity; if mild, it might self correct
- treatment can include an orthodontic separator, titanium clip separator, brass ligature wire, humphrey appliance, or nance appliance and open coil spring
32
distal eruption of premolars is most common in which premolars?
mandibular second premolars
33
in cases where a permanent premolar erupts in a distal direction, it typically resorbs the distal root of the second primary molar but not the mesial root, requiring extraction of the primary molar. is space maintenance necessary?
yes, unless the cusp tip of the premolar is at the level of the floor of the pulp chamber of the primary molar and if, on extraction, the permanent tooth can be visualized
34
is buccal or lingual eruption of permanent premolars common?
yes
35
what is the treatment of choice for the buccal or lingual eruption of a permanent premolar?
- if the primary molar is not ready to exfoliate within a few weeks, extraction of the primary molar is the treatment of choice
- after extraction, the permanent premolar tends to move into the correct position as long as there is adequate space
36
what is the incidence of akylosed primary molars?
- occurs in 1% of african americans and 4% of whites
- has a familial pattern
- higher prevalence with congenitally absent premolars
37
ankylosis of primary molars usually begins after ___ begins
root resorption
38
how can an ankylosed primary molar be diagnosed?
- appearance (out of occlusion)
- no mobility, even with advanced resorption
- hollow sound when tapped
- perhaps seen on radiograph (break in periodontal membrane)
39
what is the treatment for an ankylosed tooth?
- possibly no treatment
- observe for space loss and tipping of adjacent teeth
- if ankylosed tooth is below the normal height of contour of the interproximal surface of the adjacent tooth, extract and consider space maintenance
- as a temporary treatment, a SSC or composite bonding has been used to extend the existence of the ankylosed tooth
40
what is the incidence of congenitally absent teeth (excluding 3rd molars)?
1.5-10%
41
if third molars are not included, the most common congenitally missing tooth is the ___, followed by the ___, followed by the ___
- mandibular second premolar
- lateral incisor
- maxillary second premolar
42
is gingivitis common in children?
yes, and is treated with improved oral hygiene
43
for children with gingivitis, parental participation in oral hygiene is necessary in children younger than ___ because of the child's lack of manual dexterity
- 8 years old
| - parental supervision is often necessary for older children
44
what is puberty gingivitis?
- prepubertal and pubertal period
| - characterized by enlarged, bulbous interproximal gingival tissue on the labial aspects of the anterior teeth
45
what is the treatment for puberty gingivitis?
improvement in oral hygiene, removal of local irritants, and nutritional counseling
46
what are some common conditions in children that can aggravate gingivitis?
mouth breathing, crowded teeth, erupting teeth, and braces
47
what are the three types of herpes simplex infections that occur in children?
- primary herpetic gingivostomatitis
- acute herpetic gingivostomatitis
- recurrent herpes simplex (cold sore or fever blister)
48
what is the etiology of primary herpetic gingivostomatitis?
herpes simplex virus type 1
49
describe primary herpetic gingivostomatitis
- usually affects children younger than 6
- no previous exposure
- most primary infections are subclinical
50
what are the symptoms of acute herpetic gingivostomatitis?
- liquid-filled yellow or white vesicles intraorally and periorally that rupture
- ruptured vesicles are 1-3mm in diameter with a pseudomembrane and have erythematous borders
- fever, malaise, lymphadenopathy
- duration is 10-14 days
51
where are acute herpetic gingivostomatitis lesions located?
mucous membrane, including tonsils, hard and soft palates, buccal mucosa, tongue, palate, and gingiva
52
what is the treatment for acute herpetic gingivostomatitis?
- topical anesthetics such as 0.55 dyclonine hydrochloride and viscous lidocaine
- coating solutions such as diphenhydramine elixir and kaolin-pectin compound
- topical acyclovir or penicyclovir
- analgesics such as acetaminophen and ibuprofen
53
where does recurrent herpes simplex usually occur?
outside of the lips
54
how are recurrent herpes simplex lesions treated? what is recurrence usually associated with?
- systemic or topical antiviral medications
| - recurrence frequently associated with emotional stress or local physical trauma
55
the etiology of recurrent aphthous ulcer is ___
unknown
56
describe recurrent aphthous ulcers
- painful oval ulceration on unattached mucous membrane
| - minor aphthae heal in 7-10 days
57
what is the treatment for recurrent aphthous ulcers?
topical antiinflammatory and analgesic agents
58
what is the most common cause of inadequate attached gingiva?
- labial eruption path
- other causes may be a high frenum attachment, high vestibule, self inflicted injury, trauma, and use of smokeless tobacco
59
what is the treatment for inadequate attached gingiva?
- sometimes orthodontic treatment can cause some increase of attached gingiva
- free gingival graft is the common treatment
60
in the absence of recession, treatment of a heavy maxillary frenum with diastema is delayed until which teeth have erupted?
- permanent cuspids
- if the midline diastema has not closed, orthodontic closure is accomplished first, and a frenectomy is performed afterward
61
a patient is considered to have restricted tongue movement if the tongue cannot touch the ___
maxillary alveolar process
62
what can lingual frenums cause?
- children may be unable to develop proper speech sounds and surgery may be indicated in conjunction with speech therapy
- lingual frenum may also cause recession
63
a high mandibular anterior frenum may be associated with ___
gingival recession
64
what is the treatment for a mandibular anterior frenum?
frenectomy and gingival graft
65
what types of periodontal disease can occur in children?
aggressive periodontitis (localized aggressive periodontitis in the permanent dentition, localized aggressive periodontitis in the primary dentition, and generalized aggressive periodontitis)
66
what is characteristic of localized aggressive periodontitis in the permanent dentition?
- previously known as localized juvenile periodontitis
- loss of attachment and bone on first permanent molars and permanent incisors
- rapid loss of attachment
67
in localized aggressive periodontitis in the permanent dentition, there is an increased bacterial count of ___
aggregatibacter (actinobacillus) actinomycetemcomitans
68
localized aggressive periodontitis in the permanent and primary dentition is most common in what population?
african americans
69
how is localized aggressive periodontitis in the permanent dentition treated?
surgical intervention and antibiotics (metronidazole with or without amoxicillin, tetracycline)
70
describe the characteristics and treatment of generalized aggressive periodontitis in children
- involvement of the entire dentition
- significantly increased amount of plaque and calculus
- treatment includes surgical intervention and antibiotics
71
describe the characteristics of localized aggressive periodontitis in the primary dentition
- previously known as localized prepubertal periodontitis
| - most common in the primary molar area
72
what is the treatment of localized aggressive periodontitis in the primary dentition?
debridement and antibiotics
73
what are the characteristics of acute necrotizing ulcerative gingivitis?
- painful, bleeding gingival tissues
- blunting of interproximal papillae
- pseudomembrane on the marginal gingiva
- fetid breath
- high fever
74
acute necrotizing ulcerative gingivitis is caused by what bacteria? what population is it most common?
- caused by fusiform bacilli (spirochetes) and other anaerobes
- most common in teenagers and young adults
75
what is the treatment for acute necrotizing ulcerative gingivitis?
responds well to debridement, oxidizing mouth rinses, and antibiotics
76
trauma to the primary dentition occurs in ___% of children. trauma to the permanent dentition occurs in ___% of children by age 14
- 30%
| - 22%
77
what are the possible reactions of a tooth to trauma?
- pulpal hyperemia
- internal hemorrhage
- calcific metamorphosis (pulp canal obliteration)
- peripheral root resorption
- pulpal necrosis
- ankylosis
78
what can pulpal hyperemia lead to?
may lead to infarction and necrosis as a result of increased intrapulpal pressure
79
describe internal hemorrhage
- capillary rupture secondary to increased pressure
- occurs within 2-3 weeks after trauma
- may cause discoloration
80
describe calcific metamorphosis (pulp canal obliteration)
- partial obliteration of the pulp chamber and canal
- these teeth normally remain vital
- yellow, opaque appearance
81
describe internal resorption
- caused by osteoclastic action
| - "pink spot" perforation may occur
82
-describe peripheral root resorption
- caused by damage of periodontal structures
- usually occurs in severe injuries with displacement of the tooth
- types: surface (normal PDL, small areas), replacement (ankylosis), and inflammatory (granulation tissue, radiolucency)
83
describe pulpal necrosis
- caused by severing of apical vessels or prolonged hyperemia and strangulation
- may not occur for several months
84
describe ankylosis
- can occur with PDL injury, which leads to inflammation and osteoclastic activity (may cause fusion between and root surface)
- clinically, occlusal or incisal surface of ankylosed tooth is gingival to adjacent teeth
- during growth, eruption of normal teeth continues, but because ankylosed teeth are osseointegrated, these teeth appear to be sinking into the gingival tissue
85
what are the consequences to permanent teeth with injury to the primary predecessor?
- hypocalcification and hypoplasia
- reparative dentin
- dilaceration
86
when evaluating a trauma case, what should you do for a child who has not had tetanus coverage?
antitoxin (tetanus immune human globlulin)
87
when evaluating a trauma case, what should you do for children with previous tetanus coverage that is dated?
toxoid booster
88
when evaluating a trauma case, what is the protocol for active tetanus immunization?
- 3 injections of diphtheria, pertussis, and tetanus (DPT) vaccine during first year
- booster at 1.5 and 3 years
- booster at 6 years and then every 4-5 years
89
typically, radiographs are indicated at what intervals after traumatic injury?
1, 2, and 6 months intervals (general follow up assessments are accomplished at these visits as well)
90
what is the treatment for concussion and subluxation of primary and permanent teeth?
- usually no treatment is immediately necessary
- recommend soft diet
- reinforce need for good oral hygiene
- 0.12% chlorhexidine gluconate oral rinse or 3% hydrogen peroxide to aid healing
- teeth with open apices are more likely to remain vital
91
what is the treatment for intruded primary teeth?
- the root of the primary tooth is likely positioned closely to the labial of the permanent incisor
- the intruded tooth is usually left alone unless it can be determined that it is impinging on the permanent successor
- teeth should be reviewed and radiographs should be obtained
92
what is the treatment for extruded primary teeth?
- if a primary incisor is extruded greater than 3mm, the tooth should be extracted
- if the pt is seen before formation of a periapical blood clot, the tooth may be repositioned carefully and splinted for 7-14 days, and endo treatment should be initiated
93
what is the treatment for an avulsed primary tooth?
- replantation can be considered if within 30 minutes of avulsion, but prognosis is poor
- splint if necessary
- soft diet
- antibiotics
- follow with primary endo and space maintainer
94
what is the treatment for an avulsed permanent tooth?
- replantation
- antibiotics: not susceptible to tetracycline staining (doxycycline 4.4 mg/kg/day q12h on day 1, 2.2-4.4 mg/kg/day for 7 days), susceptible to tetracycline staining (penicillin V 25-50 mg/kg/day in three to four divided doses for 7-10 days)
- endodontic treatment
95
how are root fractures of primary teeth treated?
- if the root fracture is in the apical half, splinting may be unnecessary, especially if there is minimal mobility
- if the root fracture is in the coronal half with increased mobility, either a rigid splint or extraction is the treatment of choice
96
are root fractures in primary teeth common?
no, they are rare owing to the bone surrounding the teeth at that age being more malleable
97
describe splinting for reimplantation and displacement trauma
- nonrigid splint
- bond 0.016inch x 0.022inch SS ortho wire or 0.018 inch round SS wire or monofilament nylon (20-30lb test)
- 0.028inch round SS if 3-4 teeth are mobile
- titanium trauma splint
- wire must be passive
- use composite or flowable
- splint should remain for 7-14 days
98
what does long term rigid splinting of replanted teeth increase the risk of?
replacement root resorption (ankylosis)
99
what is the systemic fluoride "rule of 6"?
- if fluoride level is greater than 0.6ppm, no supplemental systemic fluoride is indicated
- if the pt is less than 6 months old, no supplemental systemic fluoride is indicated
- if the pt is more than 16 years old, no supplemental systemic fluoride is indicated
100
traditionally, intervention for digit-sucking habits is indicated at age ___ if the child has not stopped the habit
5 or 6 years old
101
what are the 3 appliance types used for digit-sucking intervention?
- removable maxillary retainer with rounded SS wire loops placed in the anterior palate region
- fixed reminder appliance in which a SS crib is placed in the anterior palate region
- "bluegrass" appliance, which is a fixed appliance that features a six sided plastic roller in the anterior palate region
102
what are symptoms associated with teething?
increased temperature, drooling, diarrhea, dehydration, and loss of appetite
103
what are some ways teething symptoms can be reduced?
- chilled teething rings
| - topical anesthetic and nonaspirin analgesics
104
___ teeth are teeth that are present at birth. ___ teeth are teeth that erupt in the first 30 days.
- natal
| - neonatal
105
most natal and neonatal teeth are what kinds of teeth?
90% are primary teeth, 10% are supernumerary teeth, and most are mandibular incisors (85%)
106
what is the treatment for natal or neonatal teeth that are supernumerary teeth?
extraction
107
what is the treatment for natal or neonatal teeth that are primary?
- extraction if they are extremely mobile and there is danger of aspiration
- if the tooth is causing ulceration on the ventral side of the tongue (riga-fede disease), the tooth may be smoothed or extracted
- if the tooth is causing nursing difficulties, a breast pulp or smoothing or extraction may be recommended
108
according to the american academy of pediatric dentistry, ___ is defined as the presence of more than one decayed (noncavitated or cavitated), missing (owing to decay), or filled tooth surface in any primary tooth in a child younger than 6 years old
early childhood caries
109
how is severe early childhood caries diagnosed at different ages?
- any sign of smooth surface decay in a child younger than 3
- one or more cavitated, missing (owing to caries), or filled smooth surface in primary maxillary anterior teeth in ages 3-5
- DMFS score greater than 4 for age 3
- DMFS score greater than 5 for age 4
- DMFS score greater than 6 for age 5
110
what is a DMFS score?
decayed, missing (owing to caries), and filled score
111
what is moyer's mixed dentition analysis?
- use the combined mesiodistal widths of the mandibular permanent incisors to predict the combined mesiodistal widths of the patient's buccal segment (cuspid-first bicupsid-second bicuspid)
- widths of mandibular incisors are used to predict maxillary buccal segment
- page 532 in mosby's for examples
112
T or F:
| dentists are mandated by law to report suspected child abuse or neglect, whether or not there is proof
true
113
___% of physical abuse is in the craniofacial region, and ___% os in the oral region
- 50%
| - 25%
114
if a sealant is placed on undetected incipient caries, does it result in progression of the lesion?
not if the sealant remains intact
115
what are the contraindications for sealants?
- rampant caries
- interproximal caries
- well-coalesced grooves
- inability to maintain a dry field
116
do resin-based sealants or glass-ionomer-based sealants have better retention?
resin-based
117
for sealants, what is the tag formation in the enamel?
about 40um
118
how do fluoride-containing sealants compare to conventional sealants in terms of retention?
they are similar
119
fluoride-containing sealants show a ___% reduction of secondary caries
60%
