PEDIATRIC DENTISTRY PEDIATRIC DENTISTRY, Exams of Dentistry

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Pediatric Dentistry Exam I

What is the most important function of the primary dentition? -

• Space maintenance for the permanent teeth T/F The primary 2nd molar is replaced by the permanent 2nd molar. The primary dentition has 12 less teeth than the permanent dentition with five teeth per quadrant. -
• False: it is replaced by the permanent 2nd premolar
• True What are the 5 functions of the primary dentition? -
• Space maintenance
• Mastication
• Growth of jaws: stimulated through mastication and forces imposed on the PDL allows for continuous bone turnover
• Speech: however, they are not required for speech, only aid in speech
• Esthetic function: more of an issue for parents than patients Growth of the jaws is stimulated through which 2 processes? - mastication and developing height of dental arches How do primary teeth compare to permanent teeth in size? Which 2 buzzwords compare the size of primary teeth to their perm. counterparts? -
• Primary teeth are smaller in all dimensions when compared to their permanent counterparts
• Think in terms of "shallower and narrower" What 2 words describe primary incisors? - Short and wide

How do primary molars compare to permanent molars in shape (crown and roots) 8? -

• Bulbous and squatty
• Narrower occlusal table
• Bulge at gingival margin
• Cervical constriction
• Broad, flat contact areas which extend nearly to the gingival crest
• Longer, thinner roots in proportion to crown size with "ribbon shaped" canals
• Roots flared M-D and curved to accommodate the tooth bud
• Enamel and dentin are thinner relatively to larger pulp Which primary tooth has the most pronounced bulge at the gingival margin? -
• Primary 1st mandibular molar on the MB How does the enamel of primary teeth compare to permanent teeth? -
• Enamel always thinner in primary teeth with a uniform thickness of 0.75 - 1.0 mm
• Primary teeth are also whiter How do enamel rods of primary teeth compare to permanent teeth? -
• primary enamel rods at the gingival 1/3 do not slant gingivally but rather incline occlusally How does the dentin of primary teeth compare to permanent teeth? -
• Dentin is thinner in proportion to tooth size How do the pulp chambers of primary molars compare to permanent molars (2)? How do they change with age? -
• Proportionately larger primary pulp chambers
• Primary pulp horns extend further into the crown and follow the outline of the crown
• Becomes smaller with age

Which pulp horn of the primary dentition is especially prominent? -

• MB pulp horn of the primary mandibular 1st molar Which primary molar resembles no permanent tooth? Describe its shape (3). -
• Primary mandibular 1st molar
• Has prominent MB cervical crown dip
• large cervical bulge
• longer MD than BL The primary mandibular second molar resembles what permanent tooth? Describe it. -
• Permanent mandibular first molar
• Has 5 cusps with a mesial root that can be bifurcated
• MB cusp is largest The primary maxillary first molar resembles what permanent tooth? Describe its shape. -
• The crown resembles a maxillary premolar with 3 roots
• This tooth has a prominent buccal "reach-out" on the MB in the occlusal 1/3 of the tooth to make contact; this tooth is triangular in shape from the occlusal The primary maxillary second molar resembles what permanent tooth? Describe its shape. -
• Resembles the permanent maxillary first molar
• It is rhomboidal in shape from the occlusal with a prominent oblique ridge When charting the presence/absence of permanent and primary teeth, how should you indicate that a tooth is present? -
• Circle the letter or the number of the tooth on the chart but DO NOT circle the entire tooth What is the purpose of the first dental visit for a new child? What should the tone be? -

• Purpose: to introduce yourself to the patient and their parent and vice versa, communicate well to begin building trust with the patient, and be a low-key and easy appointment for everyone
• The tone should be easy going and run smoothly How can good communication be established during the dental visit? - Explain clearly what the visit will entail and what the parents and child can expect What are the 5 areas covered under Data gathering? -
• Chief complaint
• Medical hx
• Dental hx
• PT's social history
• Radiographs What 7 components of the medical history do you need to know about your patient's general health? -
• Medical conditions/illnesses: asthma, ADD, ADHD, heart problems
• Current medications including OTC & herbal
• Allergies: drugs, sedative agents, food, latex
• Hospitalizations: reason, date, & outcome
• Surgeries: reason, date, & outcome
• Immunization status: including tetanus
• Traumatic injuries: reason, date, outcome When taking the medical history of adolescents, what 6 additional factors should be looked at? -
• Nutritional and dietary considerations
• Eating disorders
• Alcohol and Substance abuse
• OTC meds and supplements
• Body art

• Pregnancy How often should the medical history be updated? -
  • Should be updated at every visit When reviewing the dental history of the patient, what 11 factors should be addressed? -
  • Previous dental experiences?
• Family history of caries?
• Dental pain & infection?
• Diet and habits
• Behavior of child during previous treatment
• Date of last radiographs
• Oral hygiene practices
• Fluoride use
• Oral habits (thumbsucking)
• Trauma history
• Dental home (an established dental practice with routine recall) Generate appropriate questions to evaluate the following components of the dental history:
• Previous dental experiences
• Family history of caries
• Dental Pain and infection
• Diet and Habits
• Behavior of child during past treatment -
  • What did you think about your last visit?
• Do your brothers or sisters have cavities?
• Does anything hurt in your mouth? Where?
• Do you drink a lot of soda or juice? How much?
• Previous behavior: ask parent

Generate appropriate questions to evaluate the following components of the Dental History:

• Date of last radiographs
• OH practices
• Fluoride exposure
• Trauma history -
  • Has Jimmy ever had an x-ray? When? (to parents)
• How many times a day do you brush your teeth?
• What water do you drink? Bottled or tap water?
• Have you ever fallen and knocked out a tooth? When reviewing the social history of the patient, what 3 should be addressed? -
  • SES
• Single vs. two parent home
• Foster care A patient that is allergic to penicillin should be given _____ instead. A patient with tree nut allergy is predisposed to having an allergy to _____. A patient with fruit allergy is predisposed to having an allergy to _____. -
  • Clindamycin
• Fluoride varnish
• Latex What is anticipatory guidance? -
  • Providing the parent information about what may be coming up in the child's future and how diseases/treatments will progress to help them avoid risk factors for disease The Clinical examination should be focused on what? A ______ examination should precede other diagnostic procedures. -
  • Chief complaint

• Visual examination What 7 factors make up the comprehensive clinical evaluation? -
  • Vital signs: HR, BP, RR
• Extra-oral exam: general impression of health
• Intra-oral exam: soft and hard tissues
• Radiographic assessment
• Caries Risk assessment: high, moderate, low
• Behavioral assessment
• Charting caries What are the 6 main components to the extra-oral exam? - Motor functions Speech Head & neck symmetry Lymph nodes TMJ Swellings, bruises, lesions, and scars When seeing a new patient, why is it important to take HR and BP along with noting any other abnormalities? -
  • This provides you with a baseline for all future appointments and lets you refer back to your notes to determine whether there is something going on with the patient at future appointments Why is it important to assess the developing occlusion? -
  • Some occlusal factors will alter the restorative treatment plan (even if the parents have no orthodontic concerns) What 3 can be determined through radiographic assessment? -
  • Dental age

• Developmental abnormalities
• Development of premolars (watch for maxillary canine impaction) T/F Most children normally present with moderate gingivitis. A Frankl score of 1 indicates the patient was well behaved. The behavior of a child rarely changes throughout multiple dental visits. -
  • True
• False: a Frankl score of 1 means the child was a very poorly behaved patient; a score of 4 means the child was an excellent patient
• False: the behavior of a child should improve throughout a single appointment and with subsequent appointments After a thorough medical history and comprehensive evaluation, a ____________ should be made. Give an example. -
  • Diagnosis
• "Tooth A has MO caries, C has stainless steel crown" Following a diagnosis, the ____________ and ____________ should be presented to the parents. Detail what this involves. -
  • Treatment planning & informed consent
• During the treatment planning presentation, all alternatives should be presented along with a preventive plan. This is also when you would speak with the parents about using nitrous, oral sedation, or sedation in the OR What is treatment planning based on (3)? -
  • clinical findings
• parent's preferences
• child's behavior When delivering your treatment plan to parents what 4 components should be included? -
  • Anticipatory guidance

• Preventive plan
• Restorative plan w/ alternatives
• Behavior management techniques When a new patient arrives at the pediatric clinic, what 3 forms must be given to and signed by the parent? -
  • Pediatric health history form
• Pediatric ODRA
• Consent form As a general rule, ______ grade terminology should be used to describe all dental lingo and procedures to the parent. Give examples of "lay mans" terms of the following:
• Radiographs
• Composite
• Prophy
• Pulpotomy -
  • Eighth grade
• X-rays, white filling, cleaning, kiddie root canal/nerve treatment T/F never use euphemisms when describing procedures to children - false - this may help with an anxious child What are the four questions that should be asked if a patient has asthma? -
  • Is it well controlled?
• When was the last attack?
• Have you ever been hospitalized for it?
• Do you carry a rescue inhaler? If so, bring it with you to all of your appointments Why is it important to get a thorough background of the patient's asthma history (and all PMH)? -

• Visiting the dentist can be very stressful and may trigger an asthma attack in a child with poorly controlled asthma Why is taking good radiographs very important in a child? -
• This is typically the first thing you do with a child; if you take the radiographs correctly without scaring the child, it builds trust Which behavioral management tech can be used for taking radiographs of children? - "Tell-Show-Do" T/F Take the most difficult film first when taking radiographs on children. Use lots of positive reinforcement when taking radiographs on children. Bitewing radiographs are the easiest radiograph to take. -
• False: take the easiest film first
• True
• False: occlusal radiographs are the easiest to take What 4 steps should be done before placing radiographic film into a child's mouth? -
• Tell-show-do
• Have child focus on an object in the room so they don't follow the x-ray tube head
• Have x-ray tube close to the final angle
• Convential film may be bent to avoid causing the child pain What terminology can be used for x ray, xray machine, and to instruct the child to sit still when taking radiographs? -
• camera
• "Can you be as still as a statue while i take pictures"
• elephant nose What are 3 tricks that can be used to distract the PT when taking films? -

• pointing the toes
• breathing through nose
• following secondhand on a clock Which film sizes can be used for anterior occlusal radiographs in the primary and mixed dentition and how? -
• Size 2 and size 4
• Size 2 is used to take anterior occlusal films of both maxillary and mandibular anterior primary teeth and during the mixed dentition stage involving permanent anterior teeth When is Size 0 film used for pediatric radiographs? -
• Used for bitewings before full eruption of the permanent 1st molars (less than 6-7 age) When are size 1 films used? T/F most clinics may not have this size. -
• when size 2 is uncomfortable for bitewings
• true When is Size 2 film used for pediatric radiographs (4)? -
• Mx & Md anterior occlusals (primary and during mixed dentition involving perm. anterior teeth)
• Anterior periapical
• Bitewings
• Posterior periapical after full eruption of permanent 1st molars When is Size 4 film used for pediatric radiographs? -
• Large Occlusal radiographs when size 2 is too small T/F Size 4 films are not available in digital? - True

Which anterior occlusal radiograph is performed first and why? - Maxillary occlusal b/c PTs head is straight/parallel to floor and not tilted like in mandibular occlusal; therefore, it is easier for PT. What are the 5 indications for taking anterior maxillary & mandibular occlusal radiographs? -

• A screening/baseline film prior to eruption of all 4 permanent incisors
• Delayed primary teeth exfoliation or delayed eruption of permanent teeth
• Diagnosis of traumatic injuries
• Diagnosis of caries
• Pathology assessment List the 3 criteria for diagnostic film of Anterior Occlusal radiographs. -
• Apices of all erupted Primary incisors visible + 1mm of bone past the apices
• Incisal edges of all Permanent incisor buds visible
• Normal bone must be visible around all periapical areas of suspected pathology What are some things you can tell a child to stay still during a radiograph? What can you say to help position their chin correctly for a mandibular occlusal? -
• "Play as still as a statue"
• "Try to touch your chin to the ceiling" Describe the technique when taking Maxillary occlusal radiographs on children (4)? -
• A-T line parallel to floor and film parallel to the A-T line
• Long axis of Size 2 film from ear to ear
• Film extends 1mm beyond the incisal edges
• Tube head positioned over the tip of the nose at a 60° angle What would be the difference between taking a conventional film vs digital film of a maxillary occlusal? - For conventional: place film with white side up (white in the light)

For digital: place metal button away from beam (black in hole/non-button side) In both cases, 1 mm of film extends beyond incisal edges Describe the technique when taking mandibular occlusal radiographs on children 3? -

• Long axis of size 2 film from ear to ear
• Tip child's chin up 45 degrees and position tube head at the tip of the chin
• Total angulation of patient's head and tube head is -60 degrees (x ray tube head tilts 15 degrees) Which film sizes are used for anterior periapical radiographs (primary and mixed)? - Size 2 (same as anterior occlusals) When would anterior periapical radiographs be taken instead of anterior occlusal radiographs in children? -
• Anterior periapicals are taken after eruption of permanent incisors
• (still taken for diagnosis of trauma or caries) List the 2 criteria for diagnostic film of anterior periapical radiographs. -
• Apices of permanent incisors visible + 1mm of bone past the apices
• Normal bone must be visible around all periapical areas of suspected pathology How should the film and tube head be positioned when taking anterior maxillary periapical radiographs on children (5)? -
• A-T line parallel to floor
• Long axis of Size 2 film anterior to posterior
• Film extends 1mm beyond the incisal edges
• Center film on midline
• Tube head positioned 55° above tip of the nose How should the Film and Tube head be positioned when taking anterior Mandibular Periapical radiographs on children? -

• A-T line up from floor 30°
• Long axis of film anterior to posterior
• Film extends 1mm beyond the incisal edges
• Center film on midline
• Tube head at -25°, under tip of chin Which tool may be used for anterior PAs instead of precision instruments? - Snap-a-ray What is the #1 reasons why BWs are taken? -
• interproximal caries What are the 7 indications for taking pediatric bitewing radiographs? Include film size. -
• Diagnose interproximal decay
• diagnose occlusal caries and relationship of caries to pulp
• Diagnose pathology/eruption disturbances
• Diagnose periodontal disease
• Primary dentition: only take if the contacts are closed (Size 0)
• 1 R and 1 L bitewing in the mixed dentition (Size 1 or 2)
• 2R and 2 L bitewings taken after eruption of permanent 2nd molars (Size 2) How should BWs be taken on an 8 year old? -
• take 1L and 1R BW with a size 1 (use size 2 if 10 - 12 years old) How should BWs be taken on a 13 years old? -
• take 2 right and 2 left with a size 2 film What are the 3 criteria for diagnostic BWs? -
• interproximal area seen, without overlap, on at least one film

• distal of cuspid and mesial of most posterior tooth should be clearly visible
• furcation areas of both maxillary and mandibular teeth visible (ABCs - A = area, B = Bone, C= Contacts How should the film and tube head be positioned when taking pediatric bitewing radiographs (4)? -
  • Film placed in bitewing tab
• Occlusal plane parallel to floor -* Tube head positioned slightly above plane of occlusion at 10° due to tooth curvature*
• Tube head moved more mesially than in adults Why do you not take BW radiographs on a young child with open contacts? -
  • You can visualize the interproximal region and do not need a radiograph for caries detection T/F periapical pathology of primary teeth are best seen with BWs? - false - radiolucency appears at furcation for primary teeth not apically as in permanent teeth What are the 5 indications for posterior periapical radiographs? -
  • assess presence of furcation radiolucency in primary dentition
• pathology or eruption disturbances
• periapical pathology in permanent dentition
• before performing pulp therapy
• to follow-up pulp therapy List the 2 Criteria for diagnostic film of posterior periapical radiographs. -
  • Apices of all erupted teeth + 1mm bone
• Normal bone must be visible around all periapical areas of suspected pathology Which films can be used for posterior periapical radiographs? - Same as for bitewings

How should the film and tube head be positioned when taking maxillary posterior periapical radiographs on children (3)? -

• Film placed in Snap-a-ray
• Occlusal plane parallel to floor
• Tube head positioned below pupil on A-T line at 40° How should the film and tube head be positioned when taking mandibular posterior periapical radiographs on children? -
• Film placed in Snap-a-ray
• Occlusal plane parallel to floor
• Tube head positioned below border of mandible at -10° If an infection is present in primary molar teeth, where will it be located? -
• Typically, infections and abscesses are found in the furcal regions of teeth due to their thin cementum in this region When is the Snap-A-Ray used? -
• Only for PA radiographs (anterior and posterior PAs) What are some euphemisms used when taking radiographs? -
• "Open wide like a (favorite animal)_"
• "Bite down like you're chewing _(favorite food)"
• "I'm going to take a few pictures with my magic camera" T/F Routine examination alone is adequate to prevent oral disease. Some patients may require examinations and preventive services at more frequent intervals than 6 months. -
• False: Oral health promotion is needed, including anticipatory guidance and adjunctive interventions (fluoride application) which should be done at all new patient exams and recall exams

• True When is the first examination recommended for children? The most common interval between examinations is how long? -
  • At the time of eruption of the 1st tooth and no later than 12 months
• Recall exams every 6 months How should OHI (oral health instructions) be given to children (3 steps)? -
  • Have child demonstrate their own technique first
• Give positive feedback
• Tell and show the child and parent how to brush A _____ size amount of toothpaste should be used. Tell children that they should brush _____ times a day with ______ toothpaste. Children older than _____ should be taught how to floss. -
  • Pea-size
• 2 times a day with fluoride toothpaste (1,000 ppm F-)
• 9 years old; prior to this age, parents should be flossing their children's teeth Which motion should be used to brush teeth? - Circular or small scrubbing motion T/F prior to 9 yrs old, flossing is not needed? - false - parents should be taught how to floss their child's teeth A __ of fluoridated toothpaste can be used for children under 2 years old. This amount decreases the risk of __? - -Smear -Fluorosis A pea-size amount of toothpaste is appropriate for children of which ages? -

• 2 to 5 years What are the 4 advantages of toothbrush prophy? -
• Toothbrush is familiar to child
• No noise from handpiece and instruments
• No removal of fluoride-rich layer of enamel
• Easy to demonstrate proper brushing technique What are the 3 disadvantages of toothbrush prophy? -
• May not remove adherent stains, nor polish and smooth
• No feedback on how child may cope with operative procedure
• Parents may not feel a thorough job was done What is a euphemism to get kid to brush their teeth? - Brush so you can remove bugs from your teeth What are the 2 advantages of rubber cup prophy? -
• Removes plaque and stains
• Introduces child to dental procedures and gives feedback on coping skills What are the 2 disadvantages of rubber cup prophy? -
• Removes Fluoride-rich layer of enamel
• Noisy, messy, and unfamiliar compared to toothbrush prophy What are the 4 reasons for doing a prophy? -
• Remove plaque and stains
• Demonstrate proper OH
• Facilitates a thorough clinical exam
• Introduces child to dental procedures

Which method should be used for doing a prophy? - tell - show - do (TSD) Explain how you would perform a RC prophy using TSD on a child. -

• "Hi (child's name) today, I'm going to use my magic toothbrush and toothpaste to get rid of all the tiny bugs from your teeth. I'll also need the help of my mini-vacuum and tooth shower"
• After telling them, use the rubber cup on child's fingernail to show them how you will tickle their teeth. (Note: children like choices so let them choose their flavor of paste)
• Use a small amount of paste with slow speed to clean teeth one by one. Rinse after completion of each arch and suction to remove paste and water Give a euphemisms for the following objects:
• Prophy cup
• Rubber cup handpiece
• Prophy paste
• Suction (2)
• Air-Water Syringe -
• Prophy cup: Magic toothbrush
• Rubber cup handpiece: Tooth tickler
• Prophy paste: toothpaste
• Suction: Mr. Thirsty, mini-vacuum
• Air-water syringe: tooth shower After teeth prophy what should be done next? - Fluoride application Dietary analysis is part of ____ _____ assessment? -
• Caries risk assessment

What 3 pathological factors contribute to the caries process? -

• Acid-producing bacteria
• Frequent consumption of carbohydrates
• Low saliva flow What 3 protective factors help prevent the development of caries? -
• Saliva flow
• Fluoride
• Antibacterials Ideally, __________ ___________ starting at the first dental visit should give parents the information they need to prevent caries from occurring. -
• Anticipatory guidance What 4 specific things should you ask a parent about their child's diet? Will parents always be upfront about this? -
• Juice consumption
• Sippy-cup use
• Snacking
• Frequency of snacking & use
• No; parents will sometimes feel guilty if their child has caries and may try to hide some of the less desirable dietary practices You suggest to a parent that their child shouldn't snack between meals. The parent informs you that this is impossible. What snacks would you suggest (3)? What is a positive way to suggest a dietary change to a parent from juices and soda? -
• Fruit, yogurt, cheese
• "How about trying to drink more milk and water instead of juice and soda?" What technique should be used for the parent to help them stay on track for providing proper OH to child? -

• Set achievable goals and review them at the next visit What should be done after the Prophy (and is usually the last procedure done at the NPE/recall visit)? Why should it be done after the prophy? -
• Fluoride application
• Prophy removes the fluoride rich layer on the enamel surface & would remove application of fluoride if done prior to the prophy T/F Professionally applied fluoride treatments should be based on caries risk assessment. A prophylaxis is an essential prerequisite to topical fluoride application. -
• true
• false, b/c fluoride will still be effective in presence of plaque What are the 4 available options for fluoride application? Give a euphemism for each. -
• Varnish: tooth vitamins
• Foam: tooth bubbles
• Gel: tooth sparkles
• Rinse: tooth bath What type of fluoride do we use here at BCD? What are the advantages to this type of fluoride application? -
• Varnish (tooth vitamins)
• Advantageous b/c it adheres to the tooth surface, improving fluoride uptake into surface enamel and is easier for younger patients who cannot tolerate gel-tray in their mouth for 4 minutes What are the 3 steps to application of fluoride varnish? -
• Get Informed Consent from the parent before beginning with fluoride application
• Remove excess moisture from teeth (dry teeth)
• Apply a thin layer to the entire tooth surface (no drying necessary afterwards)

What instructions should be given to the parent after fluoride application (3)? -

• Instructions to parent: no rinsing, eating/drinking for 30 min after application though 4-6 hours is better
• No toothbrushing, crunchy food or hot drinks for 4-6 hours
• No toothbrushing that night but resume normal OH the next day (tell child "get out of jail free card") What is the advantage to using Fluoride Foam? How long is it placed in the mouth? -
• Greater coverage with less material so less chance of toxicity
• Placed for 4 minutes The toxic dose of fluoride is _____ mg/kg. Fluoride varnish contains ______ mg of fluoride per mL. A dispensing circle of fluoride varnish contains _____mL. -
• 5 mg/kg
• 22.62 mg/mL
• 0.5 mL How much of a dispensing circle should be used for the following cases?
• Primary dentition
• Mixed dentition
• Full dentition -
• Primary: 0.25 mL (½ of the circle)
• Mixed: 0.40 mL
• Full: 0.50 mL (full circle) How much fluoride is present in half and full circle of fluoride varnish? - Half cup: 0.25 mL x 22.62 mg F/ml = 5.56mg F Full cup: 0.50 mL x 22.62 mg F/ml = 11.31mg F Calculate the maximum dose in mg of fluoride for a 10lb child. -

• 10lb / 2.2kg/lb = 4.5kg
• 4.5kg x 5mg/kg = 22.5mg, the toxic dose T/F The informed consent process allows the parent to participate in and retain autonomy over the healthcare received. Any adult over the age of 21 may provide informed consent for a patient. -
• True
• False: it must be a parent or legal guardian T/F Obtaining informed consent is effectively completed by getting a signature. Informed consent may decrease the practitioner's liability from claims associated with miscommunications. -
• False: it is the process of communication between the doctor and parent that is the most important aspect
• True What are the 6 items which must appear on the consent form? -
• Name & DOB
• Name, relationship to patient, and legal basis for adult to consent
• Treatment, alternatives, and risks
• Potential adverse sequelae of procedure
• Area for parent to indicate all questions have been asked
• Signature for dentist & parent/guardian What are the 5 steps to getting informed consent? -
• Present diagnosis in simple terms
• Presentation of alternative treatments
• Explanation of benefits/hazards
• Ask if parent understands
• Obtain signature and give parent copy

Explain one way for telling parent of a class 2 carious lesion on tooth #A - "your child has a cavity in a baby molar, right here in back" (point at number A) Explain how you would present treatment alternatives to the parent for the class 2 carious lesion on tooth #A - "we can fix this by placing a tooth colored filling or we can place a silver filling. If you decide not to treat this tooth the cavity can grow and potentially cause pain, more cavities or in severe cases infection and damage to the permanent molar" What is one of the last steps in the PT visit? - Giving post-op instructions inside the cubicle/clinic What is the primary effect of local anesthetic agents (2)? -

• Penetrate nerve cell membrane and block receptor sites to control sodium ion influx
• Blocks the generation and propagation of nerve impulses _____ is the most commonly used Local Anesthetic (LA) used in pediatric dentistry. It's duration of action is short due to its _____ properties. _____ is used to increase its duration of action. -
• Lidocaine (Xylocaine)
• Vasodilatory properties
• Epinephrine (vasoconstrictor) The standard local anesthetic is ___% lidocaine with ____ epi. - 2% lidocaine w/ 1:100,000 epi Duration of 2% Lido w/ 1:100,000 epi is _____ for pulpal tissues and _____ for soft tissues. -
• 60 minutes
• 3-5 hours

T/F

The physiology of pain changes as we age. Why should long-acting anesthetics be avoided in children? Which long acting anesthetic should be avoided in children? -

• False: the physiology of pain is similar across all ages
• increased risk of self-inflicted tissue damage post-operatively
• Bupivicaine (Marcaine) What should you do while waiting the 5 minutes for the local anesthesia to work? -
• Talk with the kid, never stop talking
• Figure out what they like & you can use that later during the procedure to help them know what you're doing & reassure them they are doing great How long should you wait prior to checking for adequate anesthesia after administration? What happens if you check it too soon? -
• At least 5 minutes
• It can cause unnecessary pain in the child and can cause them to become anxious How do you test for anesthesia? -
• Use an explorer gently at first and then with more pressure to find out if adequate anesthesia has been achieved Failure of LA is usually due to _____ but may also be caused by _____ or _____. -
• Operator error (wrong site, not enough LA)
• Accessory innervation
• Local infection, inflammation (acidic environment prevents uptake of LA) How should local anesthesia be administered if you must anesthetize an infected site, how do we provide adequate anesthesia? -
• Administer local anesthesia to a site proximal to the inflammation, such as a nerve block