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Flashcards in Pedo Quiz 1 Deck (258):

What are the main failures after vital pulp therapy?

  • Failures After Vital Pulp Therapy
  • age, surgical trauma, sealing pressure, bad material choice, subsequent infection, clean surgical techniques
  • Internal Resorption
    • can happen after pulpotomy, not much to do about it
  • Alveolar Abscess
    • months after pulp therapy, usually just extract it, but can try deeper pulpal therapy
  • Early Exfoliation or Overretention of Primary Teeth with Pulp Treatments
    • early exfoliation may be caused by low grade chronic infection, space maintenance is important
    • overretention can just be treated with extraction if it looks like it will be an issue


What is the MyPyramid food guide?

  • replaces food guide pyramid and adds activity on the left side
  • several versions­ kids, adults, pregnant, vegetarian


S. mutans levels are elevated during active orhtodontic treatment, but not during the retention phase of treatment.  True or False?



The length of the corwn from the cerivcal to the incisal edge of a primary maxillary lateral incisor is greater than the mesiodistal width.  True or False?

True, which is opposite of the maxillary central incisor.


A tooth that is definitely ankylosed will not undergo root resorption in the future and will not be normally exofoliated.  True or False?

False, it still can happen if you're lucky, and probably only if there is a permament successor below.


What are the two main factors in deciding where to perform pulp therapy on the tooth of a pediatric patient?

  • First, the dentist must decide that the tooth has a good chance of responding favorably to the pulp therapy procedure indicated.
  • Second, the advisability of performing the pulp therapy and restoring the tooth must be weighed against extraction and space management. For example, nothing is gained by successful pulp therapy if the crown of the involved tooth is nonrestorable or the periodontal structures are irreversibly diseased. By the same rationale, a dentist is likely to invest more time and effort to save a pulpally involved second primary molar in a 4-year-old child with unerupted first permanent molars than to save a pulpally involved first primary molar in an 8-year-old child.


At what age should you start to worry if lingually positioned permament mandibular incisors to primary incisors haven't self-corrected themselves yet?

At around 8 to 8.5 years, and removal of the primary teeth should be considered, but only if the root had failed to resorb.  Otherwise leave them alone.


When should topical fluoride be applied for the general anesthesia patient?

After the restorative work has been completed for that quadrant, but before the removal of the rubber dam.


What are the different ways in which fluoride fights decay?

  • The ingestion of fluoride results in its incorporation into the dentin and enamel of unerupted teeth; this makes the teeth more resistant to acid attack after eruption into the oral cavity. In addition, ingested fluoride is secreted into saliva. Although it is present in low concentrations, the fluoride is accumulated in plaque, where it decreases microbial acid production and enhances the remineralization of the underlying enamel. Fluoride from saliva is also incorporated into the enamel of newly erupted teeth, thereby enhancing enamel calcification (frequently called enamel maturation ), which decreases caries susceptibility. As a topically applied therapeutic agent, fluoride is effective in preventing future lesion development, in arresting or at least slowing the progression of active cavitated lesions, and in remineralizing active incipient lesions. Topical fluoride also has some antimicrobial properties.
  • Although it is difficult to separate the benefits of the different mechanisms of action of fluoride, research has suggested that the predominant mechanism is the impact of fluoride on the remineralization of demineralized enamel.


What are the characteristics of dietary zinc?

  • Zinc is crucial to proper growth and development, sexual maturation, immune function, and wound healing. Zinc plays a role in taste and smell acuity as well as in facilitating the activity of vitamin A.
  • Deficiency will cause impaired, wound healing, alterations of oral epithelium ,xerostomia, poor taste/smell, reduced apetite, higher risk of candida and perio infections​


What are the characteristics of Ferric Sulfate?

  • agglutinogen for use after pulpotomy, much faster to use than formacreosol.  Astringedent.


How many Americans suffer from eating disorders?

5 million


What are natal teeth?

The teeth present at birth


Where do accessory canals in the primary pulp chamber floor lead directly into?

The intra radicular furcation


In what circumstance would you have recall appointments every 3 months with a child?

If they have a systemic illness or are special needs patients


With which tooth is an eruption sequestrum most common?

With the eruption of the first permament molar


What does a lingual spacing arch help do?

It helps keep the permament molars all the way back and helps with arch space.  He does a lot of interceptive orthodontics, anticipating problems, getting teeth out that are causing problems, and making space for future growth and development.  It is a great service for your patients. He uses a lot of removable appliances.


Which radiographs should be taken for recall patients with no clinical caries and no high risk factors?

Posterior bite-wing examination at 12-14 month intervals if proximal surfaces of primary teeth cannot be visualized or probed.  And if they already have some permanent teeth, 12-24 month intervals.


What are the materials used for an indirect pulp cap?

  • Calcium Hydroxide - glass ionomer or reinforced ZOE should be placed over it to provide a seal against microleakage since calcium hydroxide has a high solubility, poor seal, and low compressive strength.
  • Zinc Oxide and Eugenol
  • Resin Modified Glass Ionomer
  • Glass Ionomer Cement (Vitrebond)


What are the differences in indirect pulp caps with immature permanent teeth vs primary teeth?

There are no differences


What are the materials used for a pulpectomy?

  • ZOE
  • Iodoform Paste - Bacteriocidal, resorbable
  • *Although the medicaments and materials may change, the access opening technique will remain the same.


What are the objectives of an indirect pulp cap?

  • The restorative material should seal completely the involved dentin from the oral environment. The tooth’s vitality should be preserved. No post- treatment signs or symptoms such as sensitivity, pain, or swelling should be evident. There should be no radiographic evidence of pathologic external or internal root resorption or other pathologic changes. There should be no harm to the succedaneous tooth.


Which two specialties are most likely to have a patient who commits suicide?

Pediatric dentists and orthodontists


Dental caries susceptibility is usually lower in down syndrome patients in comparison with everyone else.  True or False?



Children who consume excessive amounts of carbohydrates often have a sparse flow and very thin watery saliva. True or False?

False.  They have thick viscous saliva.  Reduction of sugar intake can help.


A toothache coincident with or immediately after a meal may not indicate extensive pulpal inflammation.  True or False?

True.  The pain may be caused by an accumulation of food within a carious lesion, by pressure, or by a chemical irritation to vital pulp protected by only a thin layer of intact dentin.


Roots are shorter and wider in comparison to crown size with primary teeth.  True or False?

False.  The roots are longer and more slender in comparison to crown size. And primary tooth canals are tortuous and ribbon-like.


What are the indications for an indirect pulp cap?

In a tooth with NO pulpitis, or with reversible pulpitis when the deepest carious dentin is not removed to avoid a pulp exposure.  The pulp is judged by clinical and radiographic criteria to be vital and able to heal from the carious insult.


What are the characteristics of tobacco, alcohol, and illicit drug use in youth?

  • Smoking is correlated with nutritional deficiency due to lower intake, faster metabolism of vitamin C, postpones feelings of hunger but leads central adiposity despite less overall weight
  • Tobacco may be a gateway drug to other worse drugs
  • Alcohol has lots of empty calories (7kcal/g vs 4 for carbs) which diplaces nutritional foods
  • Use of other drugs (heroin, meth, cocaine, etc) leads to psychological effects which in turn influence nutrition and drive/ability to eat properly


When will pulp therapy failure be evident?

  • Rarely does a failure in pulp therapy or an endodontic procedure on a primary tooth cause the child to experience acute symptoms. Failures are usually evidenced by pathologic root resorption or rarefied areas in the bone and are discovered during regular recall appointments.


Whatis the objective of a direct pulp cap?

  • The tooth’s vitality should be maintained. No post-treatment signs or symptoms such as sensitivity, pain, or swelling should be evident. Pulp healing and reparative dentin formation should result. There should be no radiographic signs of pathologic external or progressive internal root resorption or furcation/apical radiolucency. There should be no harm to the succedaneous tooth.


How does the primary maxillary canine differ from the primary mandibular canine?

The primary mandibular canine crown is slightly shorter, and the root is around 2 mm shorter, and it is not as large labiolingually.


What are the characteristics of a nonvital pulp therapy?

  • Complete Pulpectomy
  • try to save the second molar due to space maintenance.
  • similar to normal endo therapy, but tricky because kid teeth are wierd


What is a mesiodens?

A mesiodens is a supernumerary tooth in the maxillary anterior incisor region. If the supernumerary tooth were found in the posterior region it would be termed a distomolar or distodens (4th molar). If the tooth happens to be found lingually or buccally, the term paramolar is used (see Figure 2). Developmental alterations can occur affecting the number of teeth, the size of teeth, the shape of teeth, and the structure of teeth.

-These need to be extracted – but you can’t go in and extract them without looking at other teeth around them – if adjacent teeth are not completely formed then you can cause a defect (wait until clinical crown is formed on adjacent teeth) – window (not to early or too late)


Where is bottle caries most likely to occur?

On the maxillary anterior linguals, not on the mandibulars because the tongue projects.


What is the #1 chronic disease and #1 reason for missed school hours in kids?

Dental Caries


Where do epstein pearls usually form?

Along the midpalatine raphe, they are remnants of epithelial tissue trapped along the raphe as the fetus grew.


DIAGNOdent is capable of detecting noncavitated lesions confined to the outer half of enamel.  True or False?

False, it is not.


What is the correct way to sit with an infant during an oral exam?

Have the kid sit in between your legs, looking away from you, at their parent.


What are the characteristics of gluteraldehyde?

bacteriocidal, fixes tissue instantly, small molecule for better penetration.  probably not worth using though


Where do dental lamina cysts usually form?

Are found on the crest of the maxillary and mandibular dental ridges, and originate from remnants of the dental lamina.


What does a sixteen-film survey consist of?

  • The 12-film survey
  • Four permanent molar radiographs


What are the strengths of Diagnodent, DIFOTI (Transillumination), and QLF?

  • Diagnodent is best for hidden deep occlusal caries,
  • DIFOTI may someday replace bitewings, 
  • QLF may be best for incipient lesions.


What does a four-film series consist of?

  • A Maxillary and mandibular anterior occlusal
  • Two posterior bite-wings.


What does fluoride do and how much do kids need?

It replaces the hydroxyl groups to form fluoroapatite instead of hydroxyapatite which ends up being less soluble and more resistant to demineralization.  We put fluoride in the water so permanent teeth can develop and be stronger.  It doesn’t do a lot for the teeth in the mouth already, and that is not what this is for.  Salt Lake and Weber is fluoridated, but most of the other parts of the state are not fluoridated so we can give them prescriptions.  

  • 1mg of fluoride a day for kids who are 6 and above, until about age 13
  • 0.5mg a day for kids 3-6, this is prescription fluoride.
  • 1ppm is what is recommended in the water.  
  • Studies show that fluoride still has the effect despite the milk wait you are supposed to do.


What was Diagnodent developed for?

The detection and quantification of dental caries of occlusal and smooth surfaces.  Increased fluorescence reflects carious tooth substance.


Where are eruption cysts most frequently seen?

In the primary second molar or the first permanent molar regions.  


The bisecting angle technique is more accurate than the paralleling technique.  True or False?

False, the paralleling technique is more accurate and should be used more often.


Eruption hematomas (cysts) are usually bilateral.  True or False?



Children and adolescents living in povery suffer 4 times as much tooth decay as their affluent counterparts.  True or False?

False, it is 2 times as much.


How long should the dental office fluoride treatment be?

  • A 4 minute treatment is recommended.  It is known that most of the fluoride uptake in the enamel occurs during the first minute after application. However, measurable benefits do continue to accrue for approximately 4 minutes if the topical preparation remains in contact with the teeth. We continue to recommend the 4-minute application whenever possible. If gel or foam is applied with a tray technique, use of an ample amount will force the substance into the proximal areas. The trays should be about one third to one half full for gel and full (level with the edge) for foam


What are the characteristics of dietary iron?

  • As a component of blood hemoglobin and muscle myoglobin, iron fulfills its primary role in the body, which is to provide cells with a constant supply of oxygen.
  • deficiency has declined; higher in overwieght
  • linked to poor cognition and behavior in school
  • prolonged bottle feeding is positively correlated with defeciency
  • oral signs­: glossitis, angular cheilitis, tongue atropy (bald), mucosal pallor


In what countries is substance abuse most common for teenagers?

US and UK


What percentage of high school seniors has reported non medical use of prescription drugs?



Pulp testing does not provide reliable evidence of the degree of inflammation of the pulp.  True or False?

True.  The reliability of the pulp test for the young child can also be questioned sometimes because of the child's apprehension associated with the test itself.

Electric pulp test is not so good, can use transmitted light technique


Of adolescents who have never smoked, what percentage are considered susceptible to start smoking?



Why do some permanent teeth grow on the buccal and lingual sides?

The jaw is too small to accomodate them, and permament teeth are one size, they don' grow once they erupt.


What is the eruption sequence for primary teeth?

  1. Mandibular central incisor = 8 months
  2. Maxillary central incisor = 10 months
  3. Maxillary lateral incisor = 11 months
  4. Mandibular lateral incisor = 13 months
  5. Maxillary and mandibular first molar = 16 months
  6. Maxillary canine = 19 months
  7. Mandibular canine = 20 months
  8. Mandibular second molar = 27 months
  9. Maxillary second molar = 29 months


What causes peg teeth, microdontia, macrodontia?

  • The morphologic pattern of the tooth becomes established when the inner enamel epithelium is arranged so that the boundary between it and the odontoblasts outlines the future dentinoenamel junction. Disturbances and aberrations in morphodifferentiation lead to abnormal forms and sizes of teeth. Resulting conditions include peg teeth, other types of microdontia, and macrodontia.


What are the characteristics of achondroplastic dwarfism and its dental relevancy?

Lack of calcification in the cartilage of the long bones, large head, trunk is normal, hands are pump, fontanelles are open at birth, upper face underdeveloped.  Also associated with chronic gingivitis due small maxilla and crowding and open bite. Development of the dentition is slightly delayed.


What are two effective ways of diagnosing an ankylosed tooth?

Tapping on it and an adjacent tooth with a blunt instrument.  Will sound more solid.  And radiographs.


Which teeth are usually unaffected in severe ECC?

Mandibular incisors (tongue helps)


What is the dietary fluoride supplementation schedule for kids from 6 years up to ast least 16 years old?

1 mg of less than 0.3 ppm fluoride and 0.50 mg of 0.3 to 0.6 ppm fluoride


What are things associated with lower rates of drug use?

Positive ethos, overall levels of strong school relationships and engagement


The cusp of carabelli is seen on the primary maxillary 1st molar.  True or False?

False.  It is seen on the permanent maxillary first molar but on the primary maxillary second molar! And it is found on the lingual side.


What are some characteristics that a patient with a high risk for caries might demonstrate?

  • 1. High level of caries experience
  • 2. History of recurrent caries
  • 3. Existing restoration of poor quality
  • 4. Poor oral hygiene
  • 5. Inadequate fluoride exposure
  • 6. Prolonged nursing (bottle or breast)
  • 7. Diet with high sucrose frequency
  • 8. Poor family dental health
  • 9. Developmental enamel defects
  • 10. Developmental disability
  • 11. Xerostomia
  • 12. Genetic abnormality of teeth
  • 13. Many multisurface restorations
  • 14. Chemo/radiation therapy


What is the summary of pulp capping materials?

1. For indirect pulp therapy, there has been significantly more use of glass ionomer and less zinc oxide–eugenol or calcium hydroxide liners; and most do not reenter a tooth following indirect pulp therapy.

2. Formocresol is still the preferred pulpotomy medicament but ferric sulfate use has increased. Zinc oxide–eugenol remains the base of choice after a pulpotomy.

3. Slightly less pulpectomy therapy was advocated for abscessed teeth. When done, more were advocating iodoform and calcium hydroxide combined paste fillers. Few advocate a two- appointment pulpectomy procedure.

4. Disagreements continue and the AAPD pulp therapy guidelines and pulpal research were not always applied.

5. Diplomates tended to practice pulpal therapy similar to the way program directors teach.


How do infants acquire S. Mutans?

From their mothers usually.  And reducing the number of bacteria in mother delays the colonization in the mouths of children.


How much toothpaste should be used on pediatric patients when brushing their teeth?

Just a pea-sized amount


What types of habits should be discussed at the first exam with a pediatric patient?

Thumb sucking, pacifiers, grinding, clenching, brushing, fingernail biting.  Thumb sucking can cause narrow and arched palates if thumb is there.  If it persists after the primary teeth have erupted, it can cause an anterior open bite.  If they stop sucking their thumb it will correct some but if they have developed a crossbite it can’t fix it all  And to help with grinding, you snap oversized crowns on the posterior molars so they can't grind anymore.  Night guards don’t work (constantly changing and low compliance) – put SSC on over the top of the posterior primry molars – when kids try to grind they bite the metal together and can’t grind – different proprioception, some kids end up griding through the SSC – just replace the crown (use a glass ionomer cement to bond the tooth)


What are the six contraindications to pulp therapy in primary teeth?

  1. Pathologic internal or external root resorption
  2. Close to exfoliation
  3. Periapical abscess formation with swelling and drainage unless the tooth deemed important
  4. Cellulitis
  5. Unrestorable tooth
  6. Medically complex pediatric patients: transplants, cancer, immunosuppression


How do you remove biofilm in dental unit water lines?



Where does normal resorption first take place on primary molars?

On the innersurface or the lingual surface of the roots.


What are the oral implications of Bulimia Nervosa?

  • Because of the exposure of the tooth surfaces to the highly acidic regurgitated gastric contents, enamel erosion is common among bulimia nervosa patients. The degree of enamel damage can be extensive. Although unanimity of opinion does not exist, the suggestion has been made that toothbrushing after vomiting actually promotes enamel loss and that, instead, patients should be instructed to rinse with an alkaline solution such as sodium bicarbonate dissolved in water. Other suggestions include use of liquid sugar-free antacids, water, or milk. Fluoride treatment should be considered because of its potential for remineralizing previously demineralized areas of the dentition. Daily rinses with 0.5% sodium fluoride and administration of a 1.1% neutral fluoride gel in custom trays can be recommended.


Anorexia Nervosa is more common in young women than Bulimia.  True or False?

False.  Bulimia is.


What is the diagnostic criteria of Bulimia Nervosa?

  • Consumption of an unusually large amount of food in a discrete time period (within 2 hours)
  • • A perceived lack of control over eating during an episode
  • • Compensatory behavior to rid the body of excess calories and prevent weight gain
  • • The occurrence of binge eating and compensatory behaviors at least twice a week for 3 months
  • • A persistent concern with body shape and size


What are the three primary biologic effects of low-level radation that concern us?

  1. Carcinogenesis
  2. Teratogenesis (malformations)
  3. Mutagenesis


Which type of fluoride is most widely accepted for the topical fluoride/varnish systems?

Sodium fluoride


What are the characteristics of formalin (formacresol)?

Preparations containing formalin (formacreosol)

not well established, germicidal and fixitive

doesn’t stimulate healing, just fixes the tissue


Why is it desirable for the mandibular canine to erupt before the first and second premolars in the mandible?

Aids in maintaining adequate arch length and in preventing lingual tipping of the incisors, and lingual tipping can cause an increased overbite.  For this reason use of a passive lingual arch appliance is often indicated when the primary canines have been lost prematurely or when the sequence of eruption is undesirable.


What does a dental hemogram suggest?

  • A history of spontaneous pain and clinical evidence of profuse pulpal hemorrhage tend to correlate well with significant inflammation of pulpal tissue.


What are the materials used for a protective liner procedure? What is GLUMA's composition?

  • GLUMA - 5% glutaraldehyde and 35% HEMA (hydroxyethyl methacrylate in water).  Useful as a desensitizer, cavity disinfectant, a rewetting agent and an adhesion promoter.
  • Calcium Hydroxide
  • Bonding Agents
  • Glass Ionomers


What two main sialagogues are used for xerostomia?

pilocarpine and cevimeline


A dentist should never have a need to take periapicals, isolated occlusals, or bite-wing films in infants.  True or False?

False.  Trauma, toothache, caries, are all reasons to.  Carious lesions appear smaller on radiographs than they actually are.


What is the dietary fluoride supplementation schedule for kids from birth to 6 months old?

0, no need for it.


What are the two main important considerations when deciding whether to perform a radiographic examination for children?

  1. The stage of dentition
  2. The risk of dental caries


Which seven organs should be shielded when possible for dental x-rays?

  1. Skin
  2. Bone marrow
  3. Gonads
  4. Eyes
  5. Thyroid
  6. Breasts
  7. Salivary glands


What is the process of a partial pulpectomy?

  • vital pulp, but signs of hyperemia without necrosis or PA pathology
  • removal of coronal pulp as in pulpotomy and removal of pulp with barbed broach and Hedstrom, careful to avoid the apex irrigate with 3% bleach, dry canals until bleeding stops apply thin zinc oxide paste to canals with paper points. roll thick mix into a point and place in  canal as with GP. Restore with full coverage crown. May want to use KRI paste or Vitapex instead of ZOE


For dental charting in pediatric patients, how do you number the teeth?  What are the most posterior teeth in each quadrant called?

Right A to J Left

T to K


What is an eruption sequestrum?

It is a white spicule of hard tissue overlying the central fossa of a mandibular first pemanent molar, which is just beginning to erupt through the mucosa.  Can take this out with a curette if it is causing a problem (left over material from when the tooth is forming).


What are the most common supernumerary teeth?

Mesiodens.  They need to be extracted.  You have to look at the teeth around them and see where the clinical crowns are, if they are not completely formed, and you extract, you can cause a defect, so you wait until the clinical crown is formed on the adjacent tooth before you extract the supernumerary tooth.


What are the "other causes" of delayed eruption of the teeth?

  • Fibromatosis gingivae, albright hereditary osteodystrophy, chondroectodermal dysplasia, de lange syndrome, and a bunch of other crap.
  • Of additional interest is the effect of bisphosphonate therapy on children with osteogenesis imperfecta. Bisphosphonates inhibit the ability of osteoclasts to resorb bone. Indeed, one study demonstrated that children with osteogenesis imperfecta that were treated with bisphosphonates had an associated mean delay of 1.67 years in tooth eruption.


What are the four implications of Anorexia Nervosa and dental care?

  1. Decrease in amount and production of saliva
  2. Increased consumption of carbonated and sports drinks
  3. Increased self-induced vomiting
  4. Increased caries rate


Which teeth are the most common missing teeth?

The third molars first, and then maxillary lateral incisors, and then mandbular 2nd premolars.


Childhood overweight is a risk a factor for disordered eating.  True or False?



What are the five positive historical findings that represent clinical situations for which radiographs may be indicated?

  1. Previous periodontal or endo therapy
  2. History of pain or trauma
  3. Familial history of dental anomalies
  4. Postoperative evaluation of healing
  5. Presence of implants


Why don't you see a lot of infections and hypomineralization involving baby teeth?

Because they are formed at birth


When performing an intraoral exam, what should be looked at first?

  • There is a temptation to look first for obvious carious lesions. Certainly controlling carious lesions is important, but the dentist should first evaluate the condition of the oral soft tissues and the status of the developing occlusion. If the soft tissues and the occlusion are not observed early in the examination, the dentist may become so engrossed in charting carious lesions and in planning for their restoration that other important anomalies in the mouth are overlooked. Any unusual breath odors and abnormal quantity or consistency of saliva should also be noted.


The CEJ of primary teeth can present with cementum over enamel, cementum and enamel edge to edge, or a gap in between.  True or False?



What were the percentages reported in 2001 for substance abuse trends for 8th graders, 10th graders, and 12th graders?

8th graders, down 32%

10th graders, down 25%

12th graders, down 13%


What is the greatest dimnsion of the crown of the primary maxillary first molar?

The mesiodistal concact areas.


What are the steps to a pulpectomy?

  1. Prepare tooth for full coverage
  2. Excavate caries
  3. Unroof pulp chamber with large access
  4. Do not perforate pulpal floor
  5. Remove coronal pulp (#4, #6, spoon)
  6. Extirpate radicular pulp with broaches
  7. File short of radiographic apex (<35) Instrument only to point of resistance Dry canals with paper points
  8. Obturate with ZOE or iodoform paste
  9. Seal chamber
  10. Place crown


The eruption of permament mandibular incisors lingually to their primary counterparts has a poor prognosis but is very uncommon.  True or False?

False.  It is common in patients with an arch length inadequacy and in those who are just fine.  


When is the average timeline for start and finished eruption of primary teeth in kids with Down Syndrome?

  • The first primary teeth may not appear until 2 years of age, and the dentition may not be complete until 5 years of age. The eruption often follows an abnormal sequence, and some of the primary teeth may be retained until 15 years of age.


What are the characteristics of hypopituitarism and its dental relevancy?

Results from early hypofunction of the pituitary gland and can result in pituitary dwarfism.  Delayed eruption of the dentition is common.  Extraction of the primary teeth is not indicated even though permanent teeth are present, because they usually don't erupt.


What is the only cause for anterior primary teeth to become ankylosed?



What are the characteristics of dietary vitamin D?

  • Adequate stores of vitamin D are crucial for proper skeletal and dental development. Vitamin D increases calcium absorption from the gastrointestinal tract; when vitamin D concentrations are inadequate, calcium absorption decreases. Vitamin D acts in concert with parathyroid hormone to maintain tight control of blood calcium levels. A slight decrease in blood calcium concentration stimulates secretion of parathyroid hormone, which mobilizes calcium and phosphorus from the skeleton to reestablish calcium homeostasis in the blood. Vitamin D may play a role in immune function; in addition, lack of the vitamin may contribute to a number of diseases including hypertension, multiple sclerosis, and cancer.
  • The major source of vitamin D is exposure to sunlight. Ultraviolet rays from the sun trigger vitamin D synthesis from its precursor, 7-dehydrocholesterol, in the skin.


What type of saliva has been proven to induce caries?

Thick, ropy saliva and thin, watery saliva


Where do Bohn nodules usually form?

Along the buccal and lingual aspects of the dental ridges and on the palate away from the raphe. These are remnants of mucous gland tissue.


Sugar-free gum can eventually have the effects of sugared gum if you chew long enough.  True or False?

  • True
  • It breaks down into the same things as gum and can be cariogenic.
  • Synthetic sugars are broken down over time (change gum frequently)


What does an eight-film survey consist of?

  • Maxillary and mandibular anterior occlusal (or periapical)
  • Right and Left maxillary posterior occlusal (or periapical)
  • Right and Left primary mandibular molar periapicals
  • Two posterior bite-wings


Quantitative light fluorescence enhances the early detection of dental caries and is uniquely useful in monitoring the progressoin or regression of lesions.  True or False?

True.  But this cannot detect interproximal lesions.


The ankylosed primary molars must always be surgically removed in order to make room for the permanent teeth.  True or False?

False.  They are surgically removed frequently but don't always have to be and can shed on their own.


When should the first exam be with a child?

At eruption of first tooth or no later than 12 months, repeat every 6 months, because regularity helps children relax.


What are the materials for a direct pulp cap?

  • Calcium Hydroxide
  • Mineral Trioxide Aggregate (MTA)
  • Glass ionomer or reinforced ZOE should be placed in addition to provide a seal against microleakage since these materials have a high solubility, poor seal, and low compressive strength.


How long does Dr. Bekker brush kids teeth until?

Until 8 or 9 years old because they are not good at it.


What are the characteristics (from the book) of a pulpotomy for permanent and primary teeth?

  • removal of coronal portion of the pulp
  • excessive bleeding or inability to achieve anesthesia indicate severely inflamed pulp and worse prognosis
  • excavate coronal pulp with spoon excavator, ensure a clean cut. Rinse chamber with water and hold in a cotton pellet until clots form.
  • CaOH or MTA for permanent teeth, especially with immature roots. Cap amputated pulp with CaOH, cover with hard setting cement. Poor prognosis in hyperemic pulps. Good for coronal fracture causing pulp exposure. Often need a full coverage restoration.
  • Same dx criteria for primary teeth. Procedure is same as for permanent teeth, except formocreosol is used. Formocreosol is applied to cotton pellet which is held on pulp stumps for 5 mins and then dried with more pellets. Stumps are capped with ZOE paste and tooth is restored with SSC. Some debate about the time and concentration of formocreosol.


What are other factors to consider when evaluating the idea of performing pulp therapy on a pediatric patient?

1. The level of patient and parent cooperation and motivation in receiving the treatment

2. The level of patient and parent desire and motivation in maintaining oral health and hygiene

3. The caries activity of the patient and the overall prognosis of oral rehabilitation

4. The stage of dental development of the patient

5. The degree of difficulty anticipated in adequately performing the pulp therapy (instrumentation) in the particular case

6. Space management issues resulting from previous extractions, preexisting malocclusion, ankylosis, congenitally missing teeth, and space loss caused by the extensive carious destruction of teeth and subsequent drifting

7. Excessive extrusion of the pulpally involved tooth resulting from the absence of opposing teeth


What are the objectives of a pulpotomy?

  • The radicular pulp should remain asymptomatic without adverse clinical signs or symptoms such as sensitivity, pain, or swelling. There should be no postoperative radiographic evidence of pathologic external root resorption. Internal root resorption may be self-limiting and stable. The clinician should monitor the internal resorption, removing the affected tooth if perforation causes loss of supportive bone and/or clinical signs of infection and inflammation. There should be no harm to the succedaneous tooth.


What is the most common sequence of eruption of permanent teeth in the mandible?

  1. First molar
  2. Central incisor
  3. Lateral incisor
  4. Canine
  5. First premolar
  6. Second premolar
  7. Second molar


What are the three ways in which kids should be getting fluoride?

Water, toothpaste, varnish


What does CAT stand for?

Caries risk Assessment Tool


When does hard tissue formation begin for maxillary and mandibular primary teeth?

  1. Maxillary and mandibular central incisors = 14 weeks in utero
  2. Maxillary and mandibular first molars = 15.5 weeks in utero
  3. Maxillary and mandibular lateral incisors = 16 weeks in utero
  4. Maxillary and mandibular canines = 17 weeks in utero
  5. Mandibular second molars = 18 weeks in utero
  6. Maxillary second molars = 19 weeks in utero


What are the differences in direct pulp caps with immature permament teeth vs primary teeth?

There are no differences


What are some positive clinical signs/symptoms for which radiographs may be indicated?

  • 1. Clinical evidence of periodontal disease
  • 2. Large or deep restorations
  • 3. Deep carious lesions
  • 4. Malposed or clinically impacted teeth
  • 5. Swelling
  • 6. Evidence of facial trauma
  • 7. Mobility of teeth
  • 8. Fistula or sinus tract infection
  • 9. Clinically suspected sinus pathology
  • 10. Growth abnormalities
  • 11. Oral involvement in known or suspected systemic disease
  • 12. Positive neurologic findings in the head and neck
  • 13. Evidence of foreign objects
  • 14. Pain and/or dysfunction of the temporomandibular joint 15. Facial asymmetry
  • 16. Abutment teeth for fixed or removable partial prosthesis
  • 17. Unexplained bleeding
  • 18. Unexplained sensitivity of teeth
  • 19. Unusual eruption, spacing, or migration of teeth
  • 20. Unusual tooth morphology, calcification, or color
  • 21. Missing teeth with unknown reason


What is the main drug whose use is increasing the most in high school?



When taking radiographs on pediatric patients, how many and in what order?

This is a test question.  You should tak two bitewing and two occlusals.  You should start with the occlusals first because they are easier and then take the bitewings.  And phosphor plates are probably a little easier.


How many appointments does a typicaly pulpectomy take in primary teeth?

Currently, pulpectomies in primary teeth are commonly completed in a single appointment. If the tooth has painful necrosis with purulence in the canals, however, completing the pulpectomy procedure over two or three visits should improve the likelihood of success.


What is the standard material for pulp capping normal vital pulp tissue?

Calcium hydroxide


Which teeth are the teeth most often observed to be ankylosed?

The mandibular primary molars


What are the three microorganisms of greatest concern to causing problems when involved in dental water lines and such?

Pseudomonas, Legionella, and Mycobacterium


What are the differences between pulpotomies with immature permanent teeth vs primary teeth?

Immature permanent teeth = More conservative pulap access.  Use reparative and regenerative materials such as Calcium Hydroxide, MTA, to promote tooth maturation and apexogenesis. Temporary Crown?


A gingival abscess or a draining fistula associated with a tooth with a deep carious lesion is an obvious clinical sign of an reversibly diseased pulp.  True or False?

False, should be irreversibly diseased pulp.  


When is a partial pulpectomy performed?

  • A partial pulpectomy may be performed on primary teeth when coronal pulp tissue and the tissue entering the pulp canals are vital but show clinical evidence of hyperemia. The tooth may or may not have a history of painful pulpitis, but the contents of the root canals should not show evidence of necrosis (suppuration). In addition, there should be no radiographic evidence of a thickened periodontal ligament or of radicular disease. If any of these conditions is present, a complete pulpectomy (described later) or an extraction should be performed.


When is initiation of periodontal screening recommended in chidlren?

Following eruption of the permament incisors and the first molars.


What is the root cause of supernumerary teeth?

It is the result of a continued budding of the enamel organ, as well as the degree of differentiation of the cells and if they detach from the enamel organ.


What is the general rule regarding the eruption sequence?

-As a general rule, mandibular counterparts come in 6 months before maxillary, same with them coming out. And If you get teeth in early, you lose them early, and same if you get them late


What are the nutritional considerations for kids 6 to 12 years old?

  • slower growth, less caloric requirment but similar nutritional requirements requires more careful
  • food choices
  • eat breakfast and veggies


What type of film is place in the patient's mouth for the occlusal techniques?

No. 2 periapical film


What do we do with affected dentin when performing an indirect pulp cap?

Leave it there, don't do anything.  


How is salivary flow determined?

  • Unstimulated Salivary Flow (USF) rate.  
  • The USF rate is measured after a period of 1 hour without eating, drinking,chewing gum, or brushing the teeth. Sitting in the “coachman” position, on the edge of the dental chair, the patient passively drools into a funnel inserted into a graduated cylinder for 5 minutes.
  • The volume of saliva collected in the cylinder after 5 minutes is divided by 5 to determine the USF. A USF rate of less than 0.1 mL per minute is diagnostic of salivary gland hypofunction. If the USF rate is less than 0.1 mL per minute, the next step is to measure the stimulated salivary flow (SSF). The patient should chew unflavored paraffin for 45 chews or 1 minute and expectorate into a funnel inserted into a graduated cylinder. The SSF rate should be 1 to 2 mL per minute; less than 0.5 mL per minute is scored as an abnormal rate.


Why are teeth especially susceptible to caries during the first two years post-eruption?

  • Because enamel calcification is incomplete at the time of eruption of the teeth and an additional period of about two years is required for the calcification process to be completed by exposure to saliva,


At what age are the roots completed for each primary tooth?

  1. Maxillary central incisor and mandibular central and lateral incisors = 1.5 years
  2. Maxillary lateral incisor = 2 years
  3. Maxillary and mandibular first molar = 2.5 years
  4. Maxillary and mandibular second molar = 3 years
  5. Maxillary and mandibular canine = 3.5 years


What percentage of males and females have anorexia nervosa, bulimia nervosa, or binge eating disorders?

1% of males and 5% of females


What are the characteristics of dietary vitamin B?

  • Vitamin B 12 is one of the B-complex vitamins, and contains cobalt in the molecule; thus it is the only vitamin that contains a mineral. Vitamin B 12 is essential for the synthesis of red blood cells and for myelin synthesis in the nervous system.


What are the differences in pulpectomies with immature permanent teeth vs primary teeth?

Immature permanent teeth = More conservative pulpal access. Use reparative and regenerative materials such as Calcium Hydroxide, MTA to promote tooth maturation and apexification. Endodontic referral. Temporary crown?


What is the dietary fluoride supplementation schedule for kids from 3 years to 6 years old?

0.50 mg of less than 0.3 ppm fluoride, and 0.25 mg of 0.3 to 0.6 ppm fluoride.  


What is the most common anomaly seen in eruption?

The lingual eruption of mandibular permanent incisors


How can you treat ankylosed permament teeth?

  • The removal of soft tissue and bone covering the occlusal aspect of the crown should be attempted first, and the area should be packed with surgical cement to provide a pathway for the developing permanent tooth.
  • Can also try luxation every 6 months or so to break the ankylosed area
  • Delayed treatment may result in total ankylosis


Zinc oxide-Eugenol is a very popular direct pulp-capping material.  True or False?



What are the objectives of a pulpectomy?

  • Following treatment, the radiographic infectious process should resolve in six months, as evidenced by bone deposition in the pretreatment radiolucent areas, and pre-treatment clinical signs and symptoms should resolve within a few weeks. There should be radiographic evidence of successful filling without gross overextension or under-filling. The treatment should permit resorption of the primary tooth root and filling material to permit normal erup(on of the succedaneous tooth. There should be no pathologic root resorption or furcation/apical radiolucency.


What is the most prevalent unmet health need among American children?

Dental care


Developmental lines are very prominent in the crown of a primary maxillary central incisor.  True or False?

False.  They are not usually evident, thus the labial surface is smooth.


What are the nutritional considerations for a kid 3 to 6 years old?

  • don’t feed them adult portions, don’t make mealtime a battle zone (easier said than done)
  • kids lose “baby fat” not from calorie restriction, but from phsycial activity
  • need for wholesome, low sugar snacks


How does a tooth fight back against irritation and infection?

  • If the irritation to the pulp is relatively mild and chronic, the pulp will respond with inflammation and will attempt to eliminate the irritation by blocking with irregular dentin the tubules through which the irritating factors are transmitted. If the irritation is intense and acute and if the carious lesion is developing rapidly, the defense mechanism may not have a chance to lay down the reparative dentin barrier, and the disease process may reach the pulp. In this instance the pulp may attempt to form a barrier at some distance from the exposure site. These calcified masses are sometimes evident in the pulp horn or even in the region of the pulp canal entrance.


What is the dietary fluoride supplementation schedule for kids from 6 months to 3 years old?

0.25 mg of Less than 0.3 ppm Fluoride


If a lesion on a tooth has been cavitated, it must be restored.  True or False?

  • False. Even after cavitation occurs, if the pulp is not yet involved and if the cavitated area is open enough to be self-cleansing (plaque-free), the caries process can halt and become an “arrested lesion.” Arrested lesions typically exhibit much coronal destruction, but the remaining exposed dentin is hard and usually very dark, there is no evidence of pulpal damage, and the patient has no pain. We also must emphasize that treating a carious tooth by providing a restoration does not cure the disease.


Where in the mouth do kids have difficulties in brushing teeth?

Along the gum lines, especially maxillary buccal and mandibular lingual


Up until at least what age should you see a pediatric patient?

Up to at least 16 years


Most authors agree that genetic influences on dental caries are relatively minor in comparison with the overall effect of environmental factors.  True or False?



What is the typical bite-wing film size used for smaller patients?

No. 0


What are the nutritional considerations for a kid 12 to 18 years old?

  • girls need to meet similar nutritional targets, but eat less calories, so need to plan more carefully
  • female athlete triad­: disordered eating, amennorhea, osteoporosis
  • boys are at risk of developing snacking patterns that will make them fat later


Primary anterior teeth are narrower mesiodistally.  True or False?

False, they are wider.


What percentage of adolescent girls and boys binge eat or purge at least once a week?

10% of adolescent girls and 3% of adolescent boys


The history of either presence or absence of pain is just as reliable in the differential diagnosis of the condition of the exposed primary pulp as it is in permanent teeth.  True or False?



What is Binge Eating Disorder?

it is defined by the consumption of excessive amounts of food along with the sensation of loss of control

The diagnostic criteria are:

• Recurrent episodes of binge eating are characterized by eating in a discrete period of time more food than most people would eat in similar circumstances and having a sense of lack of control over eating during the episode.

• Binge eating episodes are associated with three or more of the following: • Eating much more rapidly than normal

• Eating until feeling uncomfortably full

• Eating large amounts of food when not feeling hungry

• Eating alone from embarrassment of the amount consumed

• Feeling disgusted, depressed, or guilty after overeating

• Feeling marked distress regarding binge eating

• Binge eating at least 2 days per week for 6 months, on average

• Binge eating is not associated with regular use of inappropriate compensatory behavior.


Are maxillary or mandibular molar chambers larger?

Mandibular molar chambers are bigger than maxillary ones.


What are the three anatomical areas in our teeth more vulnerable to dental decay?

  • In addition to occlusal surfaces, lingual pits on the maxillary permanent molars, buccal pits on the mandibular permanent molars, and lingual pits on the maxillary permanent lateral incisors are vulnerable areas in which the process of dental caries can proceed rapidly.


What are the main signs of teething and difficult eruptions?

Fever?? Drooling, chewing on fingers.  Diarrhea?  Book doesn't agree on all of this.  Treat the symptoms, lots of liquids for dehydration, push food and liquid since they usually don’t want to eat (alter acetaminophen and motrin) – accentuates the effects of the drug.


What is a good lead-in question to finding out the child's social and psychological development without offending anyone?

How is he or she doing in school?


Is fast film or slow film better for better images and shorter exposure?

Fast film.  Higher KVP, less time.


What percentage of 8th graders and 12th graders use Oxycontin for non medical purposes?

8th grade - 1.8%

12th grade - 5.2%


What do you look at during the actual exam for a kid's first dental appointment?

  1. General growth and health
  2. Chief complaint
  3. Extra oral soft tissue and TMJ evaluation
  4. Intraoral soft tissue
  5. Oral hygiene and periodontal health
  6. Intra oral hard tissue
  7. Caries risk
  8. Behavior


What could it mean regarding teeth if a kid has a fever, pain, and swelling?

Molars may be coming in


The primary mandibular central incisor is larger in all dimensions than the primary mandibular lateral incisor except labiolingually.  True or False?

False, it is the exact opposite.


For each primary tooth, how much enamel is formed at birth?

Maxillary central incisor = 5/6ths

Maxillary lateral incisor = 2/3rds

Maxillary canine = 1/3rd

Maxillary first molar = cusps united, occlusal completely calcified, plus half to three fourths crown height

Maxillary second molar = cusp united, occlusal incompletely calcified, calcified tissue covers one fifth to one fourth crown height

Mandibular central incisor = 3/5ths

Mandibular lateral incisor = 3/5ths

Mandibular canine = 1/3rd

Mandibular first molar = cusps united, occlusal completely calcified

Mandibular second molar = cusps united, occlusal incompletely calcified



The prevalence and severity of periodontal disease in children with down syndrome is lower than the norm.  True or False?

False, the opposite is true. As well as chronic conjuctiitis, respiratory tract infections, macroglossia, NUG.


Which tooth does the primary mandibular second molar resemble?

The permanent mandibular first molar.


What are the differences in protective liner application with immature permanent teeth vs primary teeth?

No differences


What is the buccal object rule?

  • It helps localize embedded or unerupted teeth to find out if they are behind or in front of the other ones.  It states that the image of any buccally oriented object appears to move in the opposite direction from a moving x-ray source. On the other hand, the image of any lingually oriented object appears to move in the same direction as a moving x-ray source.


What is the amount of time usually taken for a permanent tooth to have a complete crown and the beginning of eruption until the tooth is in full occlusion?

5 years for permanent teeth


During what week is the earliest observance of the development of the human tooth?

6th week


What are neonatal teeth?

Teeth that erupt in the first 30 days following birth.  Less than 10% of neonatal teeth are supernumerary.


Which radiographs should be taken for recall patients with clinical caries or high-risk factors?

Posterior bite-wing examination 6-month intervals or until no carious lesions are evident


What are some possible reasons for a reduction in salivary flow?

  • Acquired dysfunction from psycological or emotional disturbance
  • Mumps
  • Sjogren syndrome
  • Hypohidrotic ectodermal dysplasia
  • Head and neck irradiation
  • Nervey pathway issue
  • Vitamin B complex deficiency
  • Myasthenia Gravis
  • Antihistamines


 What are the main five morphologic differences between primary and permanent teeth?

  1. Primary teeth are wider mesiodistally (The crowns of the primary teeth are wider mesiodistally in comparison with crown length than are those of the permanent teeth)
  2. Anterior prmiary roots are long and narrow compared with the crowns
  3. Primary teeth roots are "flared" mesiodistally (This affects extractions, and use the apical 3rd rule.  If you break root tips off in an extraction you want to get them out if it is apical 1/3 or below you can leave it and it will resorb or erupt – need to watch it (get radiographs) (The roots of the primary molars are relatively longer and more slender than the roots of the permanent teeth. There is also a greater extension of the primary roots mesiodistally. This “flaring” allows more room between the roots for the development of the premolar tooth crowns.)
  4. Prominent cervical ridges (This is important as you try and fit stainless steel crowns)
  5. Primary teeth are lighter than permanent teeth


What is the most important thing regarding the intrepretation of radiographs?

The dentist must develop a systematic approach so that no areas of the radiographs are missed.


What are the two types of Anorexia Nervosa?

  • Anorexia may be of the restrictive type, in which food intake is severely limited or the binge eating/purging type, in which individuals engage in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
  • • Refusal to maintain a body weight equal to or greater than 85% of that expected for the patient's age and height.
  • • An intense fear of gaining weight or becoming fat, even though the individual is underweight.
  • • A distorted view of one's body weight, size, or shape; the emaciated anorexic individual actually feels fat.
  • • In postmenarchal women and girls, the absence of at least three consecutive menstrual cycles.


What does fluoride do to teeth?

  • The presence of fluoride has a profound effect on the remineralization process; not only does fluoride greatly enhance the rate of remineralization of enamel by saliva but it also results in the formation of a fluorohydroxyapatite during the process, which increases the resistance of the remineralized enamel to future attack by acids. Fluoride also has antimicrobial effects.


How do you go about treating teeth and pulp on kids who are medically compromised?

  • consider premedication with abx for seriously ill children
  • be extremely careful about performing pulpectomies on children with serious illnesses  (endocarditis, nephritis, leukemia, solid tumors, neutropenia, any kind of WBC suppression)


Which teeth are usually the first permanent teeth to erupt?

The mandibular first permanent molars.  They are quickly followed by the mandibular central incisors.  But other studies have proven the opposite.


When is enamel completed for each primary tooth?

  1. Maxillary central incisor = 1.5 months
  2. Mandibular central incisor and maxillary lateral incisor = 2.5 months
  3. Mandibular lateral incisor = 3 months
  4. Mandibular first molar = 5.5 months
  5. Maxillary first molar = 6 months
  6. Maxillary and Mandibular canine = 9 months
  7. Mandibular second molar = 10 months
  8. Maxillary second molar = 11 months


What are the characteristics of dietary calcium?

  • Calcium is essential for proper nerve and muscle activity, blood clotting, transport of ions across cell membranes and mineralization of the skeleton and dentition.
  • The concept that dental alveolar bone height loss is associated with osteoporosis is supported by research; therefore strategies for reducing osteoporosis risk also may help retard alveolar bone loss.


If you have one or two ankylosed teeth, you are more likely to have other teeth become ankylosed.  True or False?



If the child's behavior is such that obtaining films of adequate diagnostic quality is doubtful, then radiographs should be deferred until behavior improves.  True or False?



When is a pulpectomy indicated?

  • A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (eg, excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (eg, suppuration, purulence). The roots should exhibit minimal or no resorption.


Caries is more associated with carbohydrates consumed during mealtimes rather than in betwen meals.  True or False?

False, its the snackers that are the worst.


What are the steps to a pulpotomy?

  1. Prepare tooth for full coverage
  2. Excavate caries
  3. Unroof pulp chamber with large access
  4. Do not perforate pulpal floor
  5. Remove coronal pulp (#4, #6, spoon)
  6. Obtain hemostasis with pressure
  7. Apply medicaments
  8. Dry chamber with cotton pellets
  9. Seal chamber
  10. Place crown


Studies have shown that there is justification for recommending the higher fluoride level (seven times the optimum for community water) for school water fluoridation programs.  True or False?

False, not worth it the research says. Doesn't help that much more.


In primary first molars, where is the mesial pulp horn?

Right under the surface.  Primary teeth pulp chambers are larger in relation to the tooth.


What are the nutritional considerations for a pregnant adolescent?

  • higher burden of nutrional at a time when nutrition is harder anyways
  • risk of preterm delivery, anemia, post partum weight gain, low birth wieght
  • need special attention to adequate nutrition and appropriate gestational wieght gain


Which primary tooth has no resemblance to any of the permanent teeth?

The mandibular first molar


When looking in the mouth of a pediatric patient, what are some things you look for?

  1. Unusual Odors
  2. Tonsils (If you are considering sedating a child you need to look at the tonsils – can cause occlusion of the airway
  3. Occlusion (Cross bites and open bites)
  4. Count the teeth (supernumerary or missing?)
  5. Caries (Caries on primary teeth can affect the permanent teeth development and spacing)


Which organism is more important in smooth-surface decay on teeth, and rampant caries?

S. Sobrinus


What are three common infections that you might see with a pediatric patient?

  1. Head Lice
  2. Ring Worm
  3. Impetigo


What is an ectopic eruption?

When the tooth erupts in an abnormal position


What is the point of interceptive orthodontics?

To try and minimize the amount of future orthodontics needed. A lot of orthodontics today is two phase – start at 7, get them off, and then get them back on at 12.  Every child is different, look at them individually.


What are the most common neonatal teeth?

85% of them are mandibular primary incisors


What is the caries prevalence percentage for children 6-12 years of age with at least one decayed or filled primary tooth?



The longer you breast feed your child, the more likely they are to get caries and develop bat dietary habits that put them at risk for caries at an early age.  True or False?



At what age do primary second molars exfoilate?



What is the largest and sharpest cusp of the maxillary first molar?

The mesiolingual cusp.


It is almost always necessary to extract the primary mandibular central incisors when the permanent ones come in on the lingual side.  True or False?

False, if there is enough room, the condition is usually self-correcting.


What happens to kids who lose primary molars at 4 or 5 years of age and before?

  • The eruption of the premolar teeth is delayed.  If extraction of the primary molars occurs after the age of 5 years, there is a decrease in the delay of premolar eruption. At 8, 9, and 10 years of age, premolar eruption resulting from premature loss of primary teeth is greatly accelerated. Hartsfield stated that premature loss of teeth associated with systemic disease usually results from some change in the immune system or connective tissue. The most common of these conditions appears to be hypophosphatasia and early-onset periodontitis.


Why is it important for the eruption of the first permament molar to take place before the second permament premolar?

  • Eruption of the second permanent molar first encourages mesial migration or tipping of the first permanent molar and encroachment on the space needed for the second premolar. The importance of maintaining the second primary molar until its replacement by the second premolar is discussed in Chapter 27 . In the maxillary arch the first premolar ideally should erupt before the second premolar, and they should be followed by the canine. The untimely loss of primary molars in the maxillary arch, which allows the first permanent molar to drift and tip mesially, results in the permanent canine's being blocked out of the arch, usually to the labial side.


What is the definition of Early Childhood Caries (ECC)?

The presence of one or more decayed (noncavitated or cavitated), missing (bc of caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.  Smooth surface caries in a kid younger than 3 indicates Severe ECC.


Caries is left over the pulp horn during an indirect pulp therapy procedure to avoid exposure of the pulp.  True or False?

True.  After 6-8 weeks, the tooth can be reentered and the carious material can be removed. It is most likely sclerotic dentin now. But calcium hydroxide is the material usually placed over the remaining caries.  Most dentists don't reenter after the initial caries excavation though.


What are the steps to an indirect pulp cap?

  1. Prepare tooth for restoration
  2. Establish caries free margins
  3. Excavate gross caries, infected dentin
  4. Stop short of pulpal exposure
  5. Affected dentin remains
  6. Radiopaque base placed over caries Restore with a material that seals Consider SSC
  7. May be 1 step or two step procedure


What does CaOH due to tissue?

  • causes superficial pulpal necrosis and stimulates calcific barrier within the month for up to 12 months. The gold standard.


What are the first steps taken when addressing rampant caries?

  • The first steps are to initiate treatment of all carious lesions to stop or at least slow the progression of the disease and to identify the most important causes of the existing condition.


What are the three main crown options for primary teeth?

  1. Stainless Steel Crown
  2. Veneered Stainless Steel crowns
  3. Zirconium crowns


What is the objective of the placement of a protective pulp liner?

  • The placement of a liner in a deep area of the preparation is utilized to preserve the tooth’s vitality, promote pulp tissue healing and tertiary dentin formation, and minimize bacterial microleakage. Adverse post-treatment clinical signs or symptoms such as sensitivity, pain, or swelling should not occur.


Digital Transillumination can be just as good as radiography for detection of caries on interproximal tooth surfaces, as well as the depth of the lesion.  True or False?

True, but not the depth part.


What are the percentages of fluoride concentration normally used for home fluoride mouth rinses?

0.2% sodium fluoride rinse once weekly or 0.05% sodium fluoride rinse once daily


What percentage of adolescents have smoked 1 or more cigarettes in the last month?  And what is the age range we are talking about?

12% aged 12-19


What does a twelve-film survey consist of?

  • Four primary molar-premolar periapicals
  • Four canine periapicals
  • Two incisor periapicals
  • Two posterior bite-wings


There is no developmental groove in between the mesiobuccal and distobuccal cusps of the primary mandibular 1st molar.  True or False?

True.  And the mesiobuccal is the larger one.


What is the range for the average cost per person to fluoridate water in the community?

Anywhere from $0.10 per person to $0.50 per person.  Communal water fluoridation remains by far the most cost-effective caries prevention measure available.


What erupts in girls first, the mandibular canine or the maxillary and mandibular first premolars?

The mandibular canine.  But it is reversed in boys.  


Children within which group are increasingly recognized as a high-risk group for the development of traits such as narcissism, poor impuse control, depression, boredon, anxiety, drug use?

Children of wealthy parents


Retardation in the growth of the maxilla, mandible and the midface are all present in down syndrome patients.  True or False?



What are the characteristics of hypothyroidism and dental relevancy?

Hypothyroidism can cause delayed eruption.  Congenital hypothyroidism is called Cretinism, and if undetected, can cause mental deficiency and dwarfism.  Large tongue can cause anterior open bite and flaring of anterior teeth, and all of the malocclusion can cause a chronic hyperplastic type of gingivitis.  Juvenile hypothyroidism is the acquired version.  The facial features aren't stunted with this one, but delayed eruption is common with this as well.


The cervical region of primary molars are more bulbous and flare outwards to a greater degree than permanent molars.  True or False?



If all surfaces of all primary teeth, including interproximals, can be examined clinically because of open contact, then radiographs are not indicated.  True or False?



Older tissues and organs are less sensitive to radiation.  True or False?



What are the characteristics of cleidocranial dysplasia?

Absent clavicles, fontanelles are large, open sutures, small sinuses, mandibular prognathism, short maxilla, complete primary dentitation development delayed at 15 years of age, supernumerary teeth.


When is a direct pulp cap procedure indicated?

This procedure is indicated in a tooth with a normal pulp following a small mechanical or traumatic exposure when conditions for a favorable response are optimal.  Direct pulp capping of a carious pulp exposure in a primary tooth is not recommended.


What is the caries prevalence for pre-school aged children?

Anywhere from 20-50%


Are distal or mesial pulp horns closer to the outer surface of primary teeth?

Mesial pulp horns are, and they are readily expoesd to caries or trauma


When is a pulpotomy indicated?

When caries removal results in pulp exposure in a primary tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure.


What are the three treatment considerations for pedicatric patients with anorexia nervosa?

  1. Tooth brushing after vomiting can promote enamel loss
  2. Rinse with alkaline solution, such as sodium bicarbonate mixed in water
  3. Can also rinse with liquid sugar free antacids, water, or milk


The use of the dental explorer to probe enamel is not recommended, but it is recommended for removing plaque and debris to permit visual inspection of pits and fissures.  True or False?

True.  he primary concerns that led to the discontinuation of the probing procedure were (1) the insertion of the probe into the suspected lesion inevitably disrupts the surface layer covering very early lesions, thereby eliminating the possibility for remineralizing the decalcified area; (2) the probing of lesions and suspected lesions results in the transport of cariogenic bacteria from one area to another; and (3) frank lesions requiring restoration are generally apparent visually without the need for probing.


What percentage of 8th graders and 12th graders use Vicodin for non medical purposes?

8th graders - 2.7%

12th graders - 9.6%


What is the ppm number that dietary fluoride supplements should never reach higher than?

0.6 ppm


The dentist should not attempt to decide what the parents/child will accept.  True or False?

True.  The duty is to inform


Sodium fluoride was proven to be more effective than stannous fluoride (the original) at reducing caries.  True or False?



Single annual applications of fluoride varnish on children have been found to have no clinical benefit.  True or False?



What is the most common sequence of eruption of permanent teeth in the maxilla?

  1. First molar
  2. Central incisor
  3. Lateral incisor
  4. First premolar
  5. Second premolar
  6. Canine
  7. Second molar


The crown of the primary maxillary second molar is considerably larger than that of the first molar.  True or False?

True.  Its roots are also longer.


What has povidone-iodine as well as xylitol been shown to do as part of the caries process?

Suppress S. mutans


What is the primary objective of pulp therapy in the primary dentition?  And what are the 8 main key points in achieving this?

Prevent or eradicate infection and to maintain the integrity and health of the teeth and their supporting tissues.

  1. Prevent space loss and malocclusion
  2. Aid in mastication
  3. Preserve the primary tooth in the case of hypodontia
  4. Prevent possible speech problems
  5. Maintain esthetics
  6. Prevent aberrant tongue habits
  7. Prevent potentially damaging psychosocial effects
  8. Maintain normal eruption patterns and timing


What are some characteristics of rampant dental caries?

  • “suddenly appearing, widespread, rapidly burrowing type of caries, resulting in early
  • involvement of the pulp and affecting those teeth usually regarded as immune to 
  • ordinary decay.”
  • same mechanism as normal caries
  • sudden onset suggests overwhelming imbalance in oral environment with accelerated 
  • imbalance
  • need to differentiate between chronic neglect and acute onset
  • connection with emotional disturbances (young teenagers, candy binging, etc.)
  • may be related to anxiety related or drug induced xerostomia


What are the nutritional considerations for kid 0 to 3 years old?

  • starch is a challenge for infants, need more water to clear waste so dehydration is a concern
  • breastfeeding exclusively works until about 4­6mo, then add in baby food
  • consider beginning Fe supplements at 4mo
  • no cow milk for infants
  • toddlers have 50% of calories from fat, gradually reduced as they age


What are the important social and psychological development topics that are important to talk about at a pediatric appointment?

  1. Eating disorders
  2. Previous hospitalizations
  3. Physicians Consult
  4. Communicable Diseases/Immunizations


Is the inner or outer surface of enamel more resistant to demineralization by acid?

The outer surface is more resistance, so the greatest amount of demineralization actually occurs 10 to 15 mm beneath the enamel surface.  


The manner of cleaning the teeth before an in-office fluoride treatment can influence the cariostatic activity of the fluoride applications.  True or False?

False, it didn't matter if they cleaned before or just rinsed with water, etc.


What are the materials used for a primary tooth pulpotomy?

  • Devitalization / FixationFormocresol (1:5 dilution, bacteriacidal, 65-95% success depending on the source, standard which alternatives are measured, toxicity?)
  • PreservationFerric sulfate (may mask pulpal signs) and Chlorhexidine
  • Regeneration - MTA
  • ZOE (IRM) is the gold standard for sealing and filling the coronal pulp chamber
  • *Although the medicaments and materials may change, the access opening technique will remain the same.


What are the oral effects of Anorexia Nervosa?

  • Nutritional deficiencies may lead to glossitis, gingivitis, a reduction in the amount and pH of the saliva, and an increase in dental caries susceptibility. Dental erosion may be evident on the palatal aspect of anterior and posterior teeth (perimolysis) secondary to the use of sports drinks, caffeinated/carbonated drinks, wine, vinegar and lemon juice used to quell sensations of hunger. Anorexics who engage in self- induced vomiting may exhibit epithelial erosion, gingivitis, and dental erosion on the palatal surfaces of the maxillary anterior teeth.