Pediatric Dentistry: A Comprehensive Guide for Students, Exams of Orthodontics

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ch.57 pediatric dentistry

with a fractured anterior tooth, the dentist may delay restorative treatment for 3-6 weeks to avoid any further damage to trauma to the pulp. during this recovery period, the dentist will: -

• provide temporary relief by covering all exposed dentin with calcium hydroxide to prevent thermal sensitivity
• places an interim covering resin material radiographs and a vitality test show - the status of the injured tooth and if the pulp is still vital/alive traumatic intrusion is: - the result of an injury in which the tooth is forcibly driven into the alveolus so that only a portion of the crown is visible teeth that are intruded should be allowed to: - re-erupt naturally and will often require endo treatment at a later time when a primary tooth is intruded what can also be damaged later in life - the developing permanent tooth what is an avulsed tooth washed in? - saline solution then inserted into the alveolus extrusion and luxation - displacement of teeth out of bone position due to injury
• severe damage to the periodontal ligaments usually occurs with these injuries with extrusion and luxation, the dentist repositions displaced teeth when? - as soon as possible what is used for extrusion and luxation to stabilize the repositioned permanent teeth? - a temporary splint of resin material or ligature wire primary teeth tend to undergo ________ ___________ more quickly after extrusion/luxation and they tend to be more mobile - root resporption what would the dentist instruct a patient who has an avulsed tooth to do? -
• recover the tooth immediately
• wrap the tooth in moistened piece of cloth/towel
• go immediately to the dentist's office to a child, what should you refer anesthesia as? - "sleepy juice" ways to create a positive/painless experience early for children getting anesthetic pain control? -

• "sleepy juice"
• have topical/syringe prepped and covered with patient napkin
• position patient facing chin up
• have a poster/TV on the ceiling
• transfer syringe behind patients head
• continue talking to the patient as distraction when applying anesthetic to a child where should you place your arm? - place your arm closest to the patient across the patient to provide security and support at the conclusion of a procedure including anesthetic with a child, it is important to instruct the parent and patient that: -
• patients lip may be numb and will feel funny
• not to chew/bite on the lip when working with children, what should you refer to a dental dam as - "rain coat"
• the child will understand the tooth needs to stay dry advantages of using a dental dam in pediatrics -
• decreases time of the procedure
• keeps child from talking
• provides protections from saliva and debris
• protects patient from aspiring dental materials two types of matrices used when primary teeth are being restored? -
• T-Band
• spot welded band pulp therapy - An attempt to stimulate and preserve pulpal regeneration in primary teeth. two factors that most commonly affect the pulpal health of teeth are -
• deep caries
• traumatic injuries deep caries are more likely to affect what area of teeth? - posterior teeth trauma is more likely to affect what area of teeth? - anterior teeth indirect and direct pulp capping can be indicated for a: - newly erupted permanent tooth to promote pulpal healing and stimulate the production of reparative dentin pulp capping - placement of medication to sedate and treat inflamed pulp pulpotomy -

Removal of pulp exclusively in the coronal portion of the dental pulp the goal of a pulpotomy - to remove the portion of the pulp that is inflamed while maintaining the healthy vital pulp tissue within the canals of the primary tooth why would a dentist choose to use a stainless steel crown? - to maintain primary teeth through adolescent years

• cover severely decayed/endodontically treated teeth without the cost and time investment of a fixed prosthesis two types of crowns used in pediatric dentistry -
  • pre trimmed
• precontoured pretrimmed crowns - have straight side but undergo festooning to follow a line parallel to gingiva crest
• must be trimmed and contoured to fit the tooth precontoured crowns - Are already festooned and contoured.
• some trimming may be necessary what endodontic treatment would most likely be performed on a primary tooth? - pulpotomy or pulp therapy an injury to the tooth of a young child can have long term consequences including: - discoloration and possible loss of the tooth injuries to primary teeth usually occur around what ages - 1 - 2 and a half
• toddler stage the most frequently injured teeth in young children in the toddler stages are: - the maxillary central incisors causes of dental injury in children: -
  • bike accidents
• sport injury
• automobile accidents
• child abuse three types of mouthguards -
  • commercial mouthguards
• mouth formed protectors
• custom fitted vacuum formed guard athetosis - Type of involuntary movement of the body, face, and extremities

avulsed - Torn away or dislodged by force Pediatric dentistry - The specialized area of dentistry that focuses on providing oral healthcare according to the needs of infants, children, adolescents, and individuals with special needs a pediatric dentist would have to continue school for an additional _____ - ______ years after dental school in accredited pediatric program based in a dental school setting - 2-3 years what is an open bay concept - Many practices are designed with the open bay concept, in which several dental chairs are arranged in one large area. The advantage of this design is that it provides reassurance by allowing pediatric patients to see other children who are receiving care.

• non confined/structured space what is the purpose of a quiet room - an isolated/separate area for children whose behaviors require special attention or may be upsetting other children chronological age - The child's actual age in terms of years and months. mental age - refers to the child's level of intellectual capacity and development emotional age - The child's level of emotional maturity. a child at the chronological age of 6 may have a mental age of 8 meaning mentally the child is comprehending information at the level of an___________ and the emotional age of a 4- year-old so they're reacting at the level of a ________ - 8 year old and 4 year old In the restoration of an indirect pulp cap, ____________ is placed first. - calcium hydroxide Special needs patients with _________ often have anomalies in dental developments such as late eruption, periodontal disease, malocclusion, and mouth breathing. - down syndrome The services routinely provided in a pediatric dental office include: - surgical procedures restorative procedures preventative procedures The age groups served by a pediatric dental practice include: - birth through adolescence

When sizing a stainless steel crown, it must: - Fit snugly on the prepared tooth & have both mesial and distal contact During the examination of very young children, they may be allowed to: - sit on their parents lap The teeth most frequently injured by toddlers are the: - maxillary incisors _________ occurs when the injured tooth has been forced inward. - intrusion When approaching a child who is nervous about a procedure, the dental assistant should ______________ to put the child at ease. - use "tell, show, do" frankl scale - Scale designed to evaluate pediatric patient behavior which takes place during the initial examination guidelines for child behavior -

• be honest with the child
• helpful "child languages"
• "tell, show, do"
• give positive reinforcement helpful child languages - tooth decay - sugar bugs anesthetic - sleepy juice suction - straw needle - pinch ways to include a child in a procedure -
• let them pick the eyewear
• let them point to the tooth to start with
• choose their own fluoride flavour
• hold the saliva ejector during procedure Frankl scale rating 1 - definitely negative
• refusal of treatment, crying forcefully, extreme negativism frankl scale rating 2 - negative
• reluctant to accept treatment, uncooperative, some negative attitude frankl scale rating 3 - positive
• acceptance of treatment, cautious at times, willingness to comply, follows directions

frankl scale rating 4 - definitely positive

• good rapport with dentist, interested in procedure, laughing and enjoying voice control - speaking calmly but firmly is a firmer management style most frequently used sedation - nitrous oxide second most commonly used sedation - antianxiety agents administered orally how can holding a child's hand during a procedure prevent possible injuries? - if the child was to quickly reach for the syringe during an injection or for the dentists arm while using the handpiece what is a problem with having a parent in the room to keep a child calm? - if the parent is anxious or nervous it may create more nervousness in the room and to the patient protective stabilization - Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. Make sure to get informed consent. papoose board - type of device that "hugs" on wraps gently around the child's arm, legs, and middle section during a procedure
• velcro straps fasten over the child and restrain movement
• an be adapted for younger children or special needs patient
• parents must be aware and provide consent
• child must also be informed
• immediate documented explanation why such actions were taken what should be provided to the parents when protective stabilization is used on their child? - immediate and documented explanation should be given as to why such actions are to be taken children should start seeing the dentist when they are how old? - one year of age who will be the first to identify malocclusion, crooked or crowded teeth and habits that can affect dentition later in life in children? - the pediatric dentist preventive treatment allows - the dentist to prevent or eliminate irregularities and malposition in the developing dentofacial region

preventative orthodontics includes: -

• control of decay to prevent loss of primary teeth
• use of space maintainer to save space for the eruption of permanent teeth
• use of appliances to correct oral habits (thumb sucking)
• early detection of genetic and congenital anomalies
• supervision of the natural exfoliation of primary teeth interceptive orthodontic treatment includes: -
• extraction of primary teeth that may be causing misalignment or crowding of permanent dentition
• correction of cross bite using removable or fixed appliance
• correction of jaw size discrepancy with a removable appliance Space maintainer are used to - reserve the space until the permanent tooth erupts thumb sucking appliance is used to - interfere with the finger position during thumb sucking
• causes child discomfort when they try to suck their thumb
• corrects oral habits that may cause damage to permanent dentition supervision of the natural exfoliation (shedding) of primary teeth is: - radiograph images showing the shedding of primary teeth and eruption of permanent teeth if primary teeth are retained too long what can happen? - they may cause the permanent teeth to erupt out of alignment or to be impacted palatal expansion appliance is used to: -
• widens the maxillary arch correct jaw discrepancy with a fixed or removable appliance what are common emergencies in pediatric dentistry? - fractures of the anterior teeth and the dentist should see the child/patient as soon as possible what is completed at an emergency visit? -
• complete documentation of the accident
• clinical exam
• vitality testing
• radiographic images the extent of the damage done to a permanent tooth when a primary tooth undergoes traumatic intrusion cannot be determined until - it erupts The success rate for replantation of permanent teeth is highest when the tooth is replanted within _____ of the avulsion. - 30 minutes

procedure of avulsed tooth replantion -

• local anesthetic administered
• radiographs are taken (often PA's and occlusal)
• clotted blood is removed from socket with surgical curette
• avulsed tooth is washed in saline solution and inserted into the alveolus
• tooth is splinted into place with wire/splints
• post-op radiographs
• endo treatment is performed 6-8 weeks after replantation by law all healthcare professionals are required to report any case in which they suspect - a child being neglected or abused reporting of suspected child abuse may be done through - telephone, in person, or in writing with specific information to file a report the name of the person reporting child abuse/neglect will not be named, dental team members are not legally required to report it but have a - moral responsibility to report known or suspected abuse or neglect cases to the dentist Child abuse must be suspected as the cause when a child presents with unexplained signs such as: -
• injuries at various stages of healing (indicating trauma has occurred over time rather than a single accident)
• repeated injuries
• chipped or injured teeth
• scars on inside of lip or tongue
• tears of labial frenum
• battering or other injuries around head or neck
• facial bruising/swelling or facial structures
• fractured nose
• bite marks
• injuries not consistent with the explanation provided by parent what to include when reporting child abuse -
• name, address, gender, and weight of child
• name and address of the adult who has custody of child
• description of the current physical and emotional abuse or neglect of child
• evidence of previous injuries
• infor that may assist establishing causes of injuries
• sketches/photos documenting the nature and location of injuries What is placed on an avulsed permanent anterior incisor to keep the tooth stable after replantation? - a splint What instrument is used to crimp a stainless steel crown prior to seating it? - contouring pliers What is the term used to describe a tooth that has been forcibly driven into the alveolus? - intrusion is forcibly driven inwards

Underdeveloped nasal and maxillary bones, flattened back of the head, and almond-shaped eyes are characteristics of individuals who have: - down syndrome The most commonly injured teeth due to trauma in children are _______ teeth. - the anterior teeth a more susceptible to trauma if a patient is at high risk for decay, how often should radiographs be taken? - radiographs should be taken every 6 months Is an appliance that is placed to stop a patient from sucking the thumb considered interceptive or preventive orthodontics? - it would be preventative What happens when a tooth is avulsed? - the tooth comes out a tooth that is torn away or dislodged by force is said to be - an avulsed tooth fluoride varnish is applied as a - rinse what procedure is recommended for protecting the pits and fissures? - sealants who in the office is legally required to report child abuse? - the dentist