Pedo Quiz 2 Flashcards
(173 cards)
1
Q
What is the history of sealants?
A
1955 - Buonocore described the technique of acid-etching as a simple method of increasing the adhesion of self-curing methyl methacrylate resin materials to dental enamel. He used 85% phosphoric acid to etch enamel for 30 seconds.
1965 - Bowen develops the bis-GMA resin, which is the chemical reaction product of bisphenol A and glycidyl methacrylate. This is the base resin used in most of the current commercial sealants.
2
Q
Based on current research, the ADA agrees that BPA in dental sealants and composites poses a small known health threat. True or False?
A
False. Based on current research, the American Dental Association agrees with the authoritative government agencies that the low-level of BPA exposure that may result from dental sealants and composites poses no known health threat.
3
Q
The cariostatic properties of sealants are attributed to the physical obstruction of pits and grooves. True or False?
A
True
4
Q
Bonded resin sealants are underused in preventing pit-and-fissure caries on at-risk surfaces. True or False?
A
True.
Bonded resin sealants, placed by appropriately trained dental personnel, are safe, effective, and underused in preventing pit-and-fissure caries on at-risk surfaces. Effectiveness is increased with good technique and appropriate follow-up and resealing as necessary.
Sealant benefit is increased by placement on surfaces judged to be at high risk for, or surfaces that already exhibit, incipient caries lesions. As with all dental treatment, appropriate follow-up care is recommended.
5
Q
Caries risk, and therefore potential sealant benefit, may exist in any tooth with a pit or fissure, at any age, including primary teeth of children and permanent teeth of children and adults. True or False?
A
True
6
Q
Placing sealant over minimal-enamel caries has been shown to be ineffective at inhibiting lesion progression. True or False?
A
False, has been shown to be effective
7
Q
Placement of a low-viscosity, hydrophilic material-bonding layer as part of or under the actual sealant has been shown to enhance its long-term retention and effectiveness. True or False?
A
True
8
Q
Glass-ionomer materials have been shown to be effective as pit-and-fissure sealants but can be used as transitional sealants. True or False?
A
False, they have shown to be ineffective as pit-and-fissure sealants, but they can be used as transitional sealants effectively.
9
Q
What are the steps to the sealant technique?
A
Identify susceptible tooth Clean tooth with rotary brush Etch the tooth Clean and dry Apply bonding agent Apply sealant Polymerize and check for voids Adjust occlusion
10
Q
What are the steps to the preventive resin technique?
A
Identify occlusal caries Remove only caries Etch the tooth Clean and dry Apply bonding agent Apply composite resin and sealant Polymerize and check for voids Adjust occlusion
11
Q
What are the steps to a class I cavity preparation for amalgam?
A
Remove caries Remove overhanging tooth structure Pulpal floor into dentin Extend for prevention Clean and dry Fill with amalgam Contour Adjust occlusion
12
Q
What are the steps to a class I cavity preparation for composite?
A
Remove only caries Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin and sealant Polymerize and check for voids Adjust occlusion
13
Q
What are the steps to a class II cavity preparation for amalgam?
A
Remove caries Remove overhanging tooth structure Pulpal and axial floors into dentin Extend for prevention Clean and dry Place matrix and wedge Fill with amalgam Contour Adjust occlusion
14
Q
What are the steps to a class II cavity preparation for composite?
A
Remove only caries – box prep possible Place matrix and wedge Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin and sealant Polymerize and check for voids Adjust occlusion
15
Q
What are the steps to a class III cavity preparation for composite?
A
Remove only caries – dovetail and bevels prn Place matrix and wedge Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin(s) Polymerize and check for voids Adjust occlusion
16
Q
What are the steps to a class IV cavity preparation for composite?
A
Remove only caries – dovetail and bevels prn Place matrix and wedge Etch the tooth Clean and dry Apply bonding agent - polymerize Apply composite resin(s) Polymerize and check for voids Adjust occlusion
17
Q
What are the steps to a class V cavity preparation for composite?
A
Identify caries Access and remove only caries - #330, #4 Consider bevel and additional retention Isolate carefully near the gingival margin Etch the tooth Clean and dry Apply bonding agent Apply composite resin Polymerize and check for voids Contour and polish for esthetics
18
Q
What are the six full coverage indications for primary teeth?
A
- Restorations for teeth with extensive and/or multiple caries lesions
- Restorations for hypoplastic teeth that cannot be adequately restored with bonded restorations
- Restorations for teeth with hereditary anomalies, such as dentinogenesis imperfecta or amelogenesis imperfecta
- Restorations for pulpotomized or pulpectomized teeth with increased danger of fracture of the remaining coronal tooth structure
- Restorations for fractured teeth
- Restorations for primary teeth to be used as abutments for appliances or attachments for habit breaking and orthodontic appliances
19
Q
What are the steps for a posterior stainless steel crown preparation?
A
A. Mesial reduction B. Distal reduction C. Occlusal reduction D. Rounding of the line angles E. Occasional reduction of buccal bulge F. Remove remaining caries G. Pulp therapy if necessary H. Snap fit is the goal
20
Q
What are the keys to selecting a posterior stainless steel crown size?
A
A. Smallest crown that fits appropriately
B. Correct occlusogingival crown length which includes no interference with occlusion and 0.5 – 1 mm subgingival
C. Trim and contour for adaptation to tooth and follow natural contours of marginal gingival tissue
D. It is possible to shape and contour the stainless steel crown to the remaining tooth structure
21
Q
How does preparing a primary tooth for a posterior zirconia crown differ from a SSC?
A
A. Increased mesial reduction vs. SSC B. Increased distal reduction vs. SSC C. Increased occlusal reduction vs. SSC D. Rounding of the line angles E. Reduction of buccal bulge more likely F. Remove remaining caries G. Pulp therapy if necessary H. Passive fit is the goal
22
Q
What are the keys to selecting a posterior zirconia crown size?
A
A. Smallest crown that fits appropriately
B. Correct occlusogingival crown length which includes no interference with occlusion and 0.5 – 1 mm subgingival
C. Must prepare the tooth to fit the crown
D. It is NOT possible to shape and contour the zirconia to the remaining tooth structure
23
Q
It is NOT possible to shape and contour the SSC to the remaining tooth structure. True or False?
A
False. You can with SSC but not with Zirconia
24
Q
What are the steps to preparing an anterior primary tooth for a crown?
A
Mesial reduction Distal reduction Incisal reduction Rounding of the line angles Reduction of cingulum Remove remaining caries Pulp therapy if necessary
25
What are the three main anterior crown options for primary teeth?
1. Composite strip crown
2. Veneered stainless steel crown
3. Zirconia crown
26
Dental caries is 5 times more common than asthma and 7 times more common than hay fever. True or False?
True
27
51 million school hours per year are lost in U.S. due to dental-related illness. # 2 chronic childhood disease behind Asthma. True or False?
False, caries is the #1 chronic childhood disease. • Dental problems (toothache) most common reason a child misses school
• Several studies show caries prevalence of children under 4, in U.S. ranging from 38-49%.
• Increasing in poor and near poor U.S. preschool children
• This disease is largely untreated in children under age 3
28
What are the two main types of anesthetic at the school for kids?
2% Lidocaine with 1:100,000 epi.
4% Articaine with 1:100,000epi.
Each carp 1.7 ml
29
What are the calculations for Lidocaine, the max dosage that can be used?
Lidocaine 2% (34mg/1.7ml cartridge)
4.4mg/kg x _____kg =___mg (not to exceed300mg total dose) A 46 lb. 20 kg child can receive 2.4 carp.
So if a 46 lb kid (20 kg) walked in, you would multiply
20 kg X 4.4mg/kg = 88mg. And because there are 34 mg in one carpule, you could give them 2.4 carp max
30
What are the calculations for Articaine, the max dosage that can be used?
Articaine 4% (68mg/1.7ml cartridge)
7mg/kg x _____kg=mg ____mg(not to exceed 500mg total dose) A 46lb 20kg child can receive 2.1 carp.
So if a 46 lb kid (20 kg) walked in, you would multiply
20 kg X 7mg/kg = 140mg. And because there are 68mg in one carpule, you could give them 2.1 carpules
31
How many milligrams of Lidocaine 2% are in 1 carpule?
34 mg per 1.7 ml cartridge
32
How many milligrams of Articaine 4% are in 1 carpule?
68 mg per 1.7 ml cartridge
33
What is the maximum dosage (mg/kg) for Lidocaine 2%?
4.4mg/kg
34
What is the maximum dosage (mg/kg) for Articaine 4%?
7mg/kg
35
What are the maximum total dosages of mg for both Lidocaine 2% and Articaine 4%?
300 mg for Lidocaine and 500 mg for Articaine
36
What size of needle does he recommend for each shot, maxillary and mandibular?
- I would suggest using either short or xshort for maxillary injection, using local infiltration directly above tooth being treated.
- Use 27 gauge long for mandibular injection using inferior alveolar and long buccal injection
- Use Xshort or short for palatal and Xshort for PDL
37
What causes enamel/intrinsic erosion?
Caused by gastric acid and acid regurgitations due to medical or psychological issues (e.g.Acid reflux, anorexia, bulimia, etc.)
38
What is Bulimia?
Eating food then regurgitating it up, allows stomach acids to dissolve teeth, lingual surfaces are eroded
39
What causes extrinsic erosion?
Occurs when dietary acids (e.g. sugar, diet sodas, fruit drinks, carbonated drinks, energy drinks, etc.)
contribute to the mouth’s being in a very acidic state.
40
At what pH level does tooth enamel begin to demineralize?
Tooth enamel begins to demineralize at pH levels below 5.5. Soda has a average pH of 2.5.
41
What is the pH of Coca-Cola and how many tsp of sugar does it have per 12 oz?
pH 2.53, 9.3 tsp sugar/12 oz. And there are usually 5.69 grams in 1 tsp, so Coke has more than 50 grams of sugar
42
What are the signs of enamel erosion once the enamel wears down?
• Teeth may become further worn down
• Teeth become discolored because the enamel has worn away and the dentin is exposed
• The edges of the front teeth may look transparent
• Tooth sensitivity can occur when the enamel is worn away both on the lip and tongue surfaces of the
teeth. The dentin is softer than enamel, and it is more sensitive to touch, air, biting forces and acid exposure
43
What is external root resorption?
External resorption is the breakdown or destruction and subsequent loss of the root structure of a tooth. This is caused by living body cells attacking part of the tooth.
Root resorption of secondary teeth can occur as a result of pressure on the root surface. This can be from trauma, ectopic teeth erupting in the path of the root, chronic inflammation. Most common cause is Orthodontics!
44
What is ectopic root resorption?
Whenever the crown of one tooth, comes close or in contact with the root of another tooth, resorption can take place
45
What is internal root resorption?
Internal resorption is an unusual condition were the dentin and pulpal walls begin to resorb centrally within the root canal. The cause can sometimes be attributed to trauma to the tooth, but other times there is no
known etiology.
46
Internal resorption often happens with reaction of materials and methods used in
pulpotomies in primary teeth. True or False?
True
47
Why do primary teeth tend to move within the bone as opposed to fracturing when trauma occurs?
Because the bone structure surrounding primary teeth isn't as thick and dense as around permanent teeth. With permanent teeth, it is just the opposite.
48
What is an acute alveolar abscess?
• It is a chemical bacterial and mechanical irritation but usually due to bacteria invasion from death of pulp tissue.
• Tenderness of the tooth. Patient has throbbing severe pain with swelling of the overlying soft tissue. When swelling become extensive, it result into cellulite and the
patients facial appearance changes.
49
What is cellulitis?
• Cellulitis is a diffuse infection of the soft tissues
• Occurs more frequently in younger children
• Caused by primary or permanent pulpal necrosis
• Characterized by considerable swelling of face or neck due to collateral edema and a
spreading fascial infection
• Appear acutely ill, may have high fever with malaise and lethargy
• Very painful, have a hard time sleeping and eating
50
Cellulitis occurs more often in adults. True or False?
False, in younger children
51
What is a chronic alveolar abscess?
Due to long standing, low grade infection of the periradicular bone, chronic alveolar abscess develops. Generally no clinical signs and symptoms occur in case of chronic alveolar abscess. Discharge may be there from sinus opening in case of chronic abscess.
52
What is gingivitis?
In the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
53
What is periodontal disease?
Periodontal disease is a chronic inflammatory disease that destroys bone and gingival tissues that support the teeth. Periodontal disease affects nearly 75% of Americans and is the major cause of adult tooth loss.
54
What are the characteristics of soft tissue injuries?
• Mouth injuries are common, especially in children, and may involve the teeth, jaw, lips, tongue, inner cheeks, gums, roof of the mouth (hard or soft palates),
neck, or tonsils.
• Lips often cushion the teeth during a fall, bearing the brunt of the injury and resulting in bruises and lacerations. Viral & bacterial infections, cancers, fungal
infections
- A lot of the times they are self-inflicted, like post local anesthesia trauma from biting on tongue, aspirin burn, electrical burn
55
What are some benign lesions of the mouth?
Benign Epithelial Tumors
- Firm; non-tender; fixed to the surface; rough or cauliflower surface; pale.
Papilloma,Verruca vulgaris
- Overlying mucosa is normal unless traumatized; usually well-circumscribed, asymptomatic, slowly growing. Fibroma, irritation fibroma, epulis fissuratum (by lip of denture)Many other types
56
What two cancers cause greater than 50% of all childhood cancers?
Leukemia's (blood cancers) and brain cancers
57
What is the most common type of Leukemia in children?
ALL - Acute Lymphoblastic Leukemia, approximately 1/3
58
What are the two most common malignant solid type tumors in kids?
Brain tumors
1. Gliomas
2. Medulloblastomas
59
What are examples of other malignant solid tumors that are less common in kids?
* Neoroblastomas
* Wilms tumor
* Sarcomas
* Rhabdomyosarcoma
* Osteosarcoma
60
What are odontomas?
Odontomas are composed of all mature Components of dental hard and soft tissue: Enamel, dentin, and pulp tissue. Because of their slow growth and well differentiation, they are generally considered to represent harmartomas rather than true neoplasms
61
What are the clinical features of odontomas?
* They are the most common odontogenic tumor
* They often interfere with eruption of Perm teeth
* They begin to develop as normal dentition starts to develop and cease when the teeth stop development
* There is no sex predilection
* They occur in young age group, with the average age being second decade of life
62
What are the differences between compound odontomas and complex odontomas?
Compound
• It is a collection of small radiopaque masses, some or all may be tooth look-like structures “denticles”
• Occurs most frequently (62%) in the anterior region of the maxillae and usually associated with the crown of an unerupted canine
• Usually asymptomatic and discovered during routine radiograph exam when there is a delayed eruption of permanent tooth
Complex
• Is composed of haphazardly arranged dental hard and soft tissue.
• It has no resemblance to a normal tooth. It tends to occur in the posterior region
of the mandible (70%).
• There might be a missing tooth if it arises from a normal tooth follicle.
63
How are odontoma's treated?
* Odontoma’s are treated by simple local excision
* Excellent Prognosis
* They don’t recur and are not invasive
64
What is gemination?
One Bud, One tooth, One root canal.
Gemination- attempted division of a single tooth germ, appears as a bifid crown on a single root. Crown is usually wider than normal. Shallow groove extending from incisal edge gingivally. More frequent in primary teeth
65
What is fusion?
Two teeth, dentin union
Fusion- represents the union of two independently developing primary or permanent teeth. Usually limited to front teeth. Fused teeth will have separate pulp chambers and separate pulp canals. Sometimes absence of permanent tooth when primary teeth fuse.
66
What is concrescence?
Fusion of teeth involving only cementum
67
What is dens invaginatus (dens in dente)?
* Developmental anomaly is a lingual invagination of enamel
* Probable communication between the cavity of the invagination and pulp chamber
* Can occur in primary and permanent teeth, most common is maxillary permanent lateral incisor
* Common presentation is pulp necrosis and dental abscess
* Teeth are usually normal shape
* Cover with sealant or restoration
68
What is cherubism, and the other name for it?
(Familial Fibrous Dysplasia)
• Cherubism is a rare childhood disease affecting jaw development. The Children have “chubby faces”
• Usually inherited as an autosomal-dominant feature, reduced penetrance in females.
• Radiographically, multilocular areas of bone destruction (“soap-bubble lesions”)
• Primary teeth may exfoliate early due to loss of alveolar bone support or resorption
• Permanent teeth are usually ectopic being displaced by growing lesion
• Stabilizes or even regress after puberty
69
What are the three stages of amelogenesis?
* First stage- enamel matrix is secreted by ameloblasts
* Second stage- tooth undergoes calcification
* Third stage- enamel maturation, with crystal growth and removal of water and protein, continues until eruption
70
What is the order of calcification of the permanent teeth?
```
First molars = birth
CI = 3-4 months
Mandibular LI = 3-4 months
Canines - 4-5 months
Maxillary LI = 10-12 months
First premolars = 18-24 months
Second premolars = 24-30 months
Second molars = 30-36 months
Third molars = 7-10 years (max first)
```
71
What kind of nutritional deficiencies can cause Hypoplasia?
* Deficiencies in Vitamin A, C, and D, calcium, and phosphorus
* Unknown about high fevers and antibiotics
* One study by Sarnat and Schour showed 66% of hypoplastic disturbances (from birth through end of first year, 33% from 13 to 34 months)
72
What are the characteristics of hypoplasia and patients who have cleft lip and palate?
Mink studied 98 patients between 1.5-18 years
• 66% with maxillary primary anterior teeth had one or more teeth with hypoplasia
• 92 % with erupted maxillary anterior permanent teeth had one or more teeth with enamel hypoplasia
73
What is Molar-Incisor Hypomineralization (MIH)?
Interference with dental development at birth, or while the enamel of the permanent first molars and permanent incisors is forming may result in a qualitative effect on the mineralization of one to four of the permanent first molars with or without involvement of maxillary and mandibular permanent incisors
Mechanisms are unclear, possible causes have been reported to include asthma, pneumonia, upper respiratory tract infections, otitis media, antibiotics (amoxicillin), dioxins in mothers milk, tonsillitis, exanthematous fevers of childhood
74
What is the critical time for hypoplasia caused by Fluoride dental fluorosis?
Critical time is between birth to 4-5 years of age which is when central and lateral incisors and first molars are calcifying
75
What are pre-eruptive caries?
Occasionally the defects on the crowns of developing permanent teeth are evident radiographically, even though no infection of the primary tooth or surrounding area is present.
Such a lesion often does resemble caries when it is observed clinically, and the destructive lesion progresses if it is not restored.
As soon as lesion is reasonably accessible it should be restored.
76
What is taurodontism?
This anomaly is characterized by a tendency for the body of the tooth to enlarge at the expense of the roots. The pulp chamber is elongated and extends deeply into the region of the roots.
The clinical significance of the condition becomes apparent only if vital pulp therapy or root canal therapy is necessary.
77
What is Dentinogenesis Imperfecta, and another name for it?
Hereditary Opalescent Dentin
Dentinogenesis imperfecta is a heredity (isolated autosomal-dominant trait) developmental disturbance of the dentin originating during the histo-differentiation stage of tooth development. May be seen alone or in conjunction with the systemic hereditary disorder of the bone, osteogenesis imperfecta.
The teeth have a variable blue-gray to yellow-brown discoloration due to defective, abnormally colored dentin shining through the translucent enamel.
Enamel frequently fractures from the teeth leading to rapid wear and attrition of teeth. Difficult to treat in both primary and permanent dentition.
78
What is dentinogenesis imperfecta type I?
* Dentin defect in Osteogenesis Imperfecta
* Primary dentition more severely affected than permanent
* Great Variability within a family
* Fragile bones, Blue sclera, pre-senile deafness, macrocephaly, triangular (acorn) skull
* Post natal growth deficiency
* Roots are thin and tapered- pulp canal ribbon like
* Primary dentition more severely affected
79
What is dentinogenesis imperfecta type II-AD?
• Hereditary Opalescent Dentin
• One of most common inherited defects in man-1:8,000
• Sporadic cases rare
• Almost complete penetrance
• Involves both dentitions equally, correlation of severity, color and attrition high
within a family
• Treatment complicated by the lack of proper root structure for support of
crowns and fixed appliances
• Implants are possible since in this type the facial bones are not involved
80
What is dentinogenesis imperfecta type III?
* Brandywine Type –AD inheritance
* Opalescent color of the teeth
* Both dentitions are involved
* Bell shaped appearance of teeth
* Shell tooth appearance on x-ray- hollow appearance
81
What is dentin dysplasia? Types I and II?
* Dentin dysplasia is a rare disturbance of dentin formation that Sheilds and Colleagues categorized into two types:
* TYPE I: radicular dentin dysplasia. Both primary and permanent teeth are affected. Autosomal- dominant trait. Root canal and pulp chambers are absent except for chevron-shaped remnant in the crown. Color is either normal or slightly opalescent or blue brown.
* TYPE II: coronal dentin dysplasia.Autosomal-dominant trait, Primary dentition appears opalescent with obliterated pulp chambers. Permanent dentition has normal color with thistle tube pulp configuration with pulp stones.
82
What is amelogenesis imperfecta and the different types?
* Amelogenesis Imperfecta is a developmental defect with a heterogeneous etiology that affects the enamel of both primary and permanent teeth. Four broad types:
* HYPOCALCIFIED TYPE: Most common type, 60% have open bite, soft enamel with normal thickness, pitted surface, moth eaten appearance
* HYPOPLASTIC TYPE: (has pits) Hard thin enamel, small teeth, occasionally tapered Possible systemic causes, associated with many different syndromes i.e. Down syndrome,Treacher Collins, sometimes from infections, trauma, primary over-retention, Fluorosis, Cerebral Palsy, Sturge Weber syndrome
* HYPOMATURATION TYPE: Normal enamel thickness but with low radiodensity and quite soft, fractures and flakes away, brown color due to porous surface, snow capped teeth, Radiographically hard to tell enamel from dentin.
* HYPOMATURATION/ HYPOLASIA/ TAURODONTISM: combination
83
What is anodontia?
Complete failure of teeth to develop is very rare. Anodontia may be part of ectodermal dysplasia.
84
What is hypodontia?
Agenesis of some (fewer than 6) teeth (not including 3rd molars)
Most common teeth missing, maxillary lateral incisors & mandibular second premolars
85
What is oligodontia?
Congenital condition when more than 6 permanent teeth are missing, usually familial, although can occur sporadically, can be part of syndrome or can occur isolated. Propensity for the last tooth in each series to be absent, namely third molars, mandibular 2nd premolars, maxillary lateral incisors, maxillary 2nd premolars, and mandibular central incisors. Can be unilateral or bilateral.
There are more than 200 syndromes, including many of the ectodermal dysplasia's, in which tooth agenesis may be a major feature.
86
What are the characteristics of palatally displaced canines?
Impacted or palatally displaced canines occur in 85% of unerupted canines. The other 15% erupt bucally.
Not typically associated with dental crowding.With apparent genetic and environmental factors playing various roles in these cases, the etiology appears to be multifactorial.
87
What is ectodermal dysplasia?
• When several primary teeth fail to develop, other ectodermal deficiencies are usually evident.
• There are more than 170 types of ectodermal dysplasia with various anomalies of ectodermal derivatives, including both primary and permanent teeth. Hair, nails, skin, and sweat glands.
• Children with missing primary and permanent teeth may have some or all of the signs of a type of
ectodermal dysplasia.
• Skeletal structures are normal.
• The absence of teeth predisposes the child to a lack of alveolar process growth.
• Making construction of a partial denture is difficult.
• Generally normal mental capacity and normal life span.
88
What are the four most affected tissues with ectodermal dysplasia and what are the frequencies?
Hair = 91% = Tricodysplasia
Teeth = 80% = Hypodontia
Nails = 75% = Onchodysplasia
Sweat glands/Skin = 42% = Dyshidrosis
89
What do the teeth look like in ectodermal dysplasia? How many teeth do they usually have, and which ones?
* Most common oral finding
* Multiple missing teeth-all teeth maybe missing
* Conical and peg shaped teeth, especially canines and incisors
* Lack of development of the alveolar process
* Commonly 4-14 teeth present
* More teeth in maxilla
* Most commonly missing
* Mand. Incisors and premolars
* Max.premolars
* Most commonly present
* Max. central incisors
* Max canines
* Max. and mand. first molars
90
What are the characteristics of instrinsic discoloration of teeth?
The primary teeth occasionally have unusual pigmentation. Certain conditions arising from the pulp can cause the entire tooth to appear discolored.
Factors causing these conditions include
• blood-borne pigment,
• blood decomposition within the pulp often caused by trauma, and drugs used during procedures such as root canal therapy
91
What are the characteristics of discoloration in Hyperbilirubinemia?
In several conditions, excess levels of bilirubin are released into the circulating blood. If teeth are developing during periods of hyperbilirubin, they may become intrinsically stained.
Two most common are: EYRTHROBLASTOSIS FETALIS: Transplacental passage of maternal antibodies against red blood cell antigens of the infant, which leads to increased rate of red blood cell destruction.The fetus develops anemia with a resultant increase in the bilirubin content of the amniotic fluid.The Primary teeth may have blue- green or brown colored teeth. May fade with time.
BILIARY ATRESIA: Rare liver disease which allows bilirubin to build up in blood and staining of primary teeth.
92
What are the characteristics of discoloration in cystic fibrosis?
Cystic Fibrosis is an inherited, chronic, multisystem, life-shortening disorder characterized primarily by poor digestion and obstruction and infection of the airways.
Zegarelli and colleagues have suggested that tooth discoloration in persons with cystic fibrosis is a result of either the disease alone, or therapeutic agents, especially tetracycline's, or a combination of both.
93
What are the characteristics of discoloration in tetracycline therapy?
Tetracycline is deposited in the dentin, and to a lesser extent in enamel of teeth, that are calcifying during the time the drug is administered. The location of the pigment in the tooth can be correlated with the stage
of development of the tooth and the time and duration of drug administered. Color is usually yellow to brown and grey or black.
94
What is macroglossia?
Macroglossia refers to larger-than-normal tongue size and may be either acquired or congenital.
• An abnormally large tongue is characteristic of hypothyroidism.
• Macroglossia has also been sighted as a characteristic of Down Syndrome.
• Both allergic reaction and injury can cause severe enlargement of the tongue.
95
What is ankyloglossia?
A short lingual frenum extends from the tip of the tongue to the floor of the mouth and onto the lingual gingival tissues
- Limits movement of tongue and causes speech difficulties
- Surgical correction if interferes with feeding as an infant
- In older kids, a reduction in the frenum should be recommended only if local conditions or speech problems warrant treatment
96
What is fissured tongue and geographic tongue?
Benign Migratory Glossitis
- Fissured tongue sometimes is seen in Down Syndrome and Hypothyroidism.The fissures on the dorsum of the tongue are usually symmetrical. They rarely need treatment.
- A wandering type of lesion and the most common tongue lesion is known as Geographic Tongue. Red, smooth areas devoid of filiform papillae appear on the dorsum of the tongue. Every few days, a change can be noted in the pattern of the lesions. It looks like the lesion is moving around the tongue. The condition is self-limiting and no treatment is needed.
97
What is white coated tongue?
A white coating of the tongue is usually associated with local factors. The amount of coating on the tongue varies with time of day and is related to oral hygiene and diet. The coating consists of food debris, microorganisms, and keratinized epithelium found on and around the filiform papillae
98
What is white strawberry tongue?
The condition has been observed in cases of scarlet fever and Kawasaki disease in young children
99
What is black hairy tongue?
Rarely seen in children, but occurs in young adults and has been related to the oral and systemic intake of antibiotics, smoking, and excessive ingestion of dark drinks such as coffee and tea.
100
What is indentation of the tongue margin called?
Crenation - The markings are caused by the tongue’s position against the lingual surfaces of the mandibular teeth.
101
What are the characteristics of an abnormal labial frenum?
A maxillary diastema is frequently seen in pre-school children and those in the mixed-dentition stage. It is important to determine whether the diastema is normal for their particular time of development or is related to abnormal maxillary labial frenum. The exact attachment site is variable. It can be several millimeters above the crest of the ridge, on the ridge, or the fibers may pass between the central incisors and attach to the palatine papilla.
Generally it is best to delay considering an abnormal labial frenum as cause of diastema until all the maxillary anterior teeth including canines have erupted.
However, one can carry out a simple diagnostic test during late mixed dentition stage. Pull upwards and outwards with upper lip, if heavy band of tissue goes between the incisors and causes blanching of the palatine papilla it is safe to predict the frenum is abnormal and needs treatment. The abnormal frenum also caused toothbrush problems, interferes with movement of the lip, and may interfere with speech.
102
When should a frenectomy be considered?
The decision regarding treatment of the labial frenum should be made only after careful evaluation and determination that treatment will be better than no treatment.
103
What are the characteristics of tongue piercing?
Tongue piercing, a deliberate trauma to the tongue is a popular body piercing. Possible complications include but not limited to tooth chipping, dental abrasion, gingival recession, swollen infected tongue.The ADA and AAPD both oppose tongue piercing due to the potential for pathological conditions and sequelae associated with these practices.
104
All space needs to be maintained. True or False?
False
105
There is more potential to lose space on the maxillary arch than the mandibular arch. True or False?
True, because it is more plastic
106
Upper and lower arches tend to lose space over time. True or False?
True
107
With the loss of the upper 2nd permanent molars early, the 3rd molars usually will not move into the 2nd molar position. True or False?
False, they will
108
No space maintenance is needed when primary incisors are lost after the eruption of the primary cuspids. True or False?
True
109
If you lose a permanent incisor before the permanent canines have come in, you will have a major space loss. True or False?
True
110
The loss of a 2nd primary molar early usually results in the 1st permanent molar moving into its place resulting in space loss. True or False?
True
111
Band and loop spacers placed over SSC's are not well retained and generally need to be re-cemented multiple times. True or False?
False. Cementing a band and loop spacer to a SSC with glass ionomer cements are very retentive
112
Band spaces usually close on their own without any assistance. True or False?
True, arches like to close on their own
113
Loss of a primary cuspid early usually will lead to a midline shift toward the incisors. True or False?
False, it will lead toward the lost cuspid
114
Some 1st primary molars that are lost early need no space maintainers to maintain the space. True or False?
True, no need if the occlusion is locked in
115
If in doubt whether to maintain space or not, one should maintain space until you are sure what to do. True or False?
True
116
When fitting bands you should move from each size to the next carefully in order to get the exact size. True or False?
False, I think this is a waste of time
117
You should not remove the spacer right when the new permanent tooth erupts and you can see it in the mouth. True or False?
False, you should
118
What are the five main types of space maintainers?
1. Band and loop
2. Crown and loop
3. Lower lingual arches
4. Upper nance spacers
5. Upper modified trans palatal arches
119
When do we use a band and loop space maintainer?
* Place when the 1st primary molar is lost early and the first permanent molar has not erupted.
* Fit the band as well as possible with retention.
* Use a pre-etched band if possible.
* Placing a crown on the 2nd primary molar may be necessary in some cases.
120
When do we use a lower lingual arch space maintainer?
When permanent incisors have erupted and we put it on the permanent first molars when primary 2nd molars have been lost early
121
When do we use an upper nance space maintainer?
Same thing as lower lingual arch but for when maxillary teeth are lost early, like primary molars. Can be hard to clean.
122
When do we use a trans palatal arch maintainer?
Same as for the upper nance, not as stable though, but easier to clean.
123
We should consider using a SSC for the anchor tooth on a distal shoe even if there is no caries, makes it stronger. True or False?
True
124
The distal shoe should be made after 24 hours post extraction. True or False?
False, should be made right then.
125
Space maintenance is usually not needed for the loss of a first primary molar after eruption of the permanent first molar and laterals without crowding and good interdigitation. True or False?
True
126
Space maintenance is usually not needed with the early loss of a second primary molar or first and second primary molar together in children without crowding. True or False?
False, space maintenance should definitely be considered.
127
Space maintenance should be considered when:
a) a primary incisor is lost prematurely
b) a first primary molar is lost just prior to the eruption of the first bicuspid in that quadrant
c) a second primary molar is lost just prior to the eruption of the second bicuspid
d) leeway space will be needed to resolve permanent incisor crowding
D
128
Space maintenance should be considered when:
a) upper primary incisors with spacing are lost prematurely
b) a second primary molar is lost just prior to the eruption of the second bicuspid
c) lower primary incisors with spacing are lost prematurely
d) two primary first molars in the same arch are lost prematurely prior to the eruption of the first permanent molars
D
129
A distal shoe space maintainer:
a) is used to maintain space when primary incisors are lost
b) is usually needed when a second primary molar is lost before the eruption of the first permanent molar
c) is used to maintain the space when a primary canine is lost prematurely
d) is NOT placed immediately after the premature loss of a second primary molar before the eruption of the first permanent molar
B
130
Some general principles of space loss in children are:
a) there is little tendency for space loss when a lower primary incisor is lost prematurely
b) there is a tendency for more space loss in the maxilla than the mandible
c) space can be lost from the premature loss of a first primary molar by the distal movement of the primary cuspid in that quadrant
d) all of the above
D
131
When choosing to maintain space the dentist should place the spacer:
a) if the placing of the space maintainer would boost revenue in the office
b) if there is a tendency to lose valuable space and the space will be needed
c) if the dentist's boat payment will be coming due this month
d) none of the above
B
132
Valuable space is NOT likely to be lost when:
a) an upper primary incisor is lost prematurely with adequate spacing and after the eruption of the primary cuspid in that quadrant
b) an upper permanent incisor is lost prematurely before the eruption of the permanent canine in that quadrant
c) an upper second primary molar is lost prematurely before the eruption of the permanent first molar in that quadrant
d) a lower primary second molar is lost before the eruption of the first molar
A
133
Teeth move through the alveolar bone with braces by:
Osteoblasts adding bone on the tension side of the tooth and osteoclasts removing bone on the pressure side
134
Modern edgewise brackets have a prescription designed into the slot of the bracket which controls what three things:
1) tip
2) torque
3) facial/lingual offset
135
Third order bends are placed in square arch wires to control:
a) torque
b) tip
c) facial/lingual offset
d) rotations
e) all of the above
Torque, he flips his bracket upside down to do this
136
Many class III malocclusions generally have:
a) class III molars and an anterior cross bite
b) class I molars and flared upper incisors
c) class II molars and tipped back upper incisors
d) class II molars and flared upper incisors
A
137
Minor tooth movement is generally accomplished with which appliances?
a) temporary anchorage devices
b) sectional wires, 2X4 wires, expanders, LLA's and removables
c) FORSUS correctors and headgear
d) full arch appliances
B
138
Cellulitis only involves primary dentition. True or False?
False, both permanent and primary pulpal necrosis
139
Periodontal disease affects nearly 50% of Americans. True or False?
False, 75%
140
Because of their slow growth and differentiation odontomas represent hamartomas rather than true neoplasms. True or False?
True
141
What is the most common odontogenic tumor?
Odontomas
142
Odontomas often interfere with the eruption of primary teeth. True or False?
False, most often with permanent teeth
143
Odontomas are far more common in women than men. True or False?
False, there is no sex predilection
144
Where do compound odontomas typically occur, and at what percent?
In the anterior region of the maxillae, 62%, and with crown of an unerupted canine
145
Where do complex odontomas typically occur, and at what percent?
In the posterior region of mandible, 70%
146
Odontomas do not recur and are not invasive. True or False?
True
147
Gemination is more common in permanent teeth than primary teeth. True or False?
False, more common in primary teeth
148
Fusion usually happens with anterior teeth rather than posterior teeth. True or False?
True
149
Fused teeth will have separate pulp chambers and separate pulp canals. True or False?
True
150
What is the most common tooth for a dens in dente?
Maxillary permanent lateral incisor
151
What percent of cleft palate patients with maxillary primary anterior teeth have hypoplasia of teeth?
66%
152
What percent of cleft palate patients with maxillary anterior permanent teeth have hypoplasia of teeth?
92%
153
During what stage of tooth development does dentinogenesis imperfecta occur?
During the histo-differentiation stage
154
Dentinogenesis imperfecta type I affects the permanent dentition more than the primary dentition. True or False?
False, affects the primary worse
155
Type I Dentinogenesis imperfecta is associated with osteogenesis imperfecta. True or False?
True
156
Implants are more feasible with type II Dentinogenesis imperfecta because the facial bones are not involved. True or False?
True. Type II is hereditary opalescent dentin.
157
How do the teeth appear differently with type I-III dentinogenesis imperfecta?
type I = roots are thin and tapered, pulp canal ribbon like, primary dentition involved more
type II = lack of proper root structure, similar to type I, both dentitions equally
type III = bell shaped appearance of teeth, shell tooth appearance on x-ray, hollow appearance
158
What are the differences between type I and type II dentin dysplasia?
Type I = radicular dentin dysplasia, both dentitions affected the same, root canal and pulp chambers are absent except for chevron in crown, color is normal or slightly opalescent or blue brown
Type II = coronal dentin dysplasia, primary dentition is opalescent with obliterated pulp chambers, permanent has normal color with thistle tube pulp configuration with pulp stones
159
What percent of amelogenesis imperfecta (hypocalcified) have an open bite?
60%
160
Which amelogenesis imperfecta types have hard vs soft enamel?
Hypoplastic has hard thin enamel, the other two have soft enamel.
161
Two of the amelogenesis imperfecta have normal thickness, which one is really thin?
Hyoplastic, also associated with the syndromes is this one
162
What is the most common type of amelogenesis imperfecta?
Hypocalcified, the one with the open bite
163
What are the most common teeth missing for hypodontia?
Maxillary lateral incisors and mandibular second premolars
164
What are the percentages for the buccal/palatal displacement of impacted canines?
85% palatally
| 15% bucally
165
Impacted canines are not usually associated with dental crowding. True or False?
True
166
Which teeth are commonly missing in ectodermal dysplasia?
Maxillary premolars and Mandibular incisors and premolars
167
What are the two most common causes of discoloration with hyperbilirubinemia?
1. Erythroblastosis fetalis
| 2. Biliary atresia
168
What makes cystic fibrosis cause tooth discoloration?
Either the disease or therapeutic agents like tetracycline, or both
169
Tetracycline is deposited into the enamel mainly, during the calcifying stage. True or False?
False, mainly dentin
170
Macroglossia is associated with hypothyroidism. True or False?
True
171
What do first order bends control?
In and out, bucco-lingual/labio-lingual, and rotational
172
What do second order bends control?
Control tip, mesio-distal movements
173
What do third order bends control?
Control torque
