Flashcards
Pedo Exam
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- 1List differences between primary and permanent teeth- crown of primary teeth smaller/bulbous than permanent teeth.
- primary molars: more bell shaped, more extreme cervical constriction. sharp lingual inclination of buccal surfaces, distinct ridge at CEJ. narrow occlusal table, more liable to fracture in class II resto
- pulp: large during time of eruption, decreases in size as child grows.
- enamel/dentin: thinner than permenant
- enamel rods: perpendicular to DEJ, not inclined apically - 2What is common site of failure for amalgam restos? What should the outline form for amalgam restos look like?isthmus region: area must be wide and deep enough without weakening cusps/damage to pulp.
width should not be more than 1/2 of Intercuspal dimension of tooth.
depth: 0.5mm pulpally from DEJ
pulpal floor: flat
no sharp pulpal/axial line angles
bevelled line angles, rounded angles, proper extension, proximal boxes should converge occasionally. - 3describe different types of class I occlusal prepsIncipient lesions: can be restored with minimal cavity preps, following decay. if good isolation/moisture control, you can use PRR (preventative resin resto). If no moisture control, use amalgam + varnish and restore when it fully erupts.
Pits and Fissures: do not undermine marginal ridges, walls are convergent occlusally.
deep seated: enamel overhangs must be cut back first, then do full prep, line with CaOH if there is pulp exposure. - 4T/F: 70-80% of cavity preps in primary teeth are class II with DO resto of md molar being most common describe how to do class II amalgam prep on primary md molarTRUE
1) establish outline form: 0.5mm into dentin, parallel walls
2) establish isthmus width: 1/2 distance between cusp tips or 1/3 BL width of entire tooth
3) proximal box: BL direction, wider at gingival margin. break contact
4) gingival seat should be 1.0 mm narrowest point should be axial wall.
5) round pulpaxial line angles. refine with 330
6) use slow round bur to remove gross caries, remove undermined enamel and cusp cap if needed. - 5Describe considerations for doing class I preps on mx molars? Describe considerations for doing class II preps on mx molars?- cross oblique ridge (OR) only if undermind, if so, avoid large pulp horn (PH) in middle of buccal surface on primary mx molars.
- 1st M: if distal fissure carious, connect with occlusal portion via modified step prep: lingual surface of tooth, pulpo axial line angle bevelled,
- 2nd M: mesio occlusal prep on mx second molar remains within central fossa should only be extended of OR is undermined. DO prep should extend across entire central fossa - 6Describe class II preps describe modified class IIIwhat: proximal surfaces of anterior teeth
when: teeth have tight contact, crowding
minimal caries: do class II as long as incisal edge is not compromised: be careful due to size of PHs, break contact cervically. trim labial/lingual portions with small chisels. add retention grooves at mesial /labiogingival angles.
lingual lock: to improve accessibility and aesthetics. Depth= 1.0 mm into dentin. amalgam choice of material for distal cuspids, resin works too. - 7What are common errors in preps of primary teeth?flare of box too wide, inverted cone outline lost, gingival/pulpal extension of proximal box too deep (Pulp exposure), penetration of proximal surface enamel at constriction, failure to extend out to grooves/fissures, failure to follow cusp outline, isthmus too wide, angle between axial and buccal walls too wide, axial wall does not follow contour of tooth, narrowest part of isthmus over axial wall.
- 8What types of linings do we use for amalgam preps What types of linings do we use for composite prepsshallow prep = varnish
medium = Ca(OH)2 + varnish layer
deep = Ca(OH)2 + zing eugenol cement + varnish
deep: Ca(OH)2 or GI lining without varnish - 9What types of matrix bands should be usedextra thin, stainless steel for bicuspid or molar
- 10Are pins recommended for amalgam restos? When is a SSC recommended? What instruments are req'd?not really, use a stainless steel crown
child with multiple carious lesions
56 bur, tapered diamond, ball and socket, contouring, crimping pliers. - 11Describe steps in putting on a SCC1) reduce occlusal surface by 2mm (could be flat)
2) remove caries with round slow speed
3) put in any linings: dycal
4) angle diamond 10-15 degrees, prepare mesial/distal surfaces
5) round off any corners
6) pick SCC, check crown height to ensure proper occlusion, if high, reduce with scissors
7) apply crown from lingual to buccal
8) use ball and socket for to produce bulge around crown. smooth this buldge with band contouring pliers to reduce gingival diameter and smooth surface. Finally, use crimping pliers to at gingival margin to create proper fit.
9) cement with GI or polycarboxylate cement
10) check occlusion, clean cement - 12When do you use a preformed SCC crown? What are the advantages vs. disadvantages?extensive destruction of clinical crown, molars with pulp therapy, large class II with risk of isthmus fracture, circumferential caries at gingival margin.
Adv: minimal contouring, good adaptation to tooth, no need to trim length, PD response is great, easy manipulation.
Dis: may not find a crown that fits properly. - 13When do we use Direct Resin Crowns (DRR)? What is the technique what is recommended during this technique?anterior primary teeth with large lesions, fractures, discolouration.
1) use anesthetic + Rubber dam
2) select crown form that first MD
3) reduce MD surfaces with diamond taper feather edge just below gingival margin
4) reduce incisal edge 1-1.5 mm, remove caries, perform pulpectomy if needed.
5) slight undercut at labiogingival margin extended to lingual for retention.
6) CaOH or GI on exposed dentin
7) trim crown, check incisal height
8) hole in mesial/distal insisal angles
9) fill crown form, put it in 1mm below gingival margin and cure after you get proper occlusion. minimal finishing
rubber dam/excellent moisture control - 14Describe all options of tx for primary incisors
- 15What is the criteria for preventative resin restos? What is the techniqueocclusal caries lesions that do not involve all pits and fissures, proximal surface caries-free, incipient lesions confined to small area, cooperative child, tooth can be isolated with RD
1) anesthesia, rubber dum, pumice tooth to remove debris
2) use flame shaped bur to remove stain
3) remove caries, pulp protection if needed
4) acid etch, bonding resin, thin layer of bonding resin to occlusal surface + fissure sealant, cure.
5) sealant must extend into all pits and fissures. check occlusion - 16what is the criteria for posterior composite resins? Describe the techniqueclass I/II caries, adequate crown/tooth structure, excellent moisture control, cooperative pt, tooth for space/function
1) prepare similar to other amalgam preps
2) adapt matrix/wedge
3) Total etch time = 20-30 seconds, rinse, primer, bonding, place in 2mm increments and cure (in gingival seat first).
4) Remove matrix band, but leave wedge in place until resto is done. - 17What are the indications for sealing of acid etching.1) Sealing of Pits and Fissures - newly erupted teeth with history of caries in primary dentition
2) Resto of Fractured Teeth
3) Splinting - fixing teeth that have been loosened held back in place with splint.
4) Veneering
5) Resin Bonded Bridges
6) Direct Bond Space Maintainer
7) Atraumatic Resto Technique - removal of caries with hand instruments
8) Air Abrasion
9) Tunnel/Slot Preps - not recommended for PRRs. high rate of failure.
10) lasers - not recommended - 18Indicate the anesthesia considerations for primary teethinfiltration for all primary teeth, blocks used for permenant molars and sometimes md second primary molars.
dismiss pt biting on cotton roll to prevent lip or cheek trauma due to biting. - 19how to apply a rubber dam on primary teethpunch holes from most posterior tooth central incisor on contra lateral side.
place the clamp on tooth first. place most posterior hole over the clamp and under wings. attach rubber dam frame. place all other teeth through holes. floss and invert, ligate floss. - 20Indicate clamps that go onto different primary teeth
- 21Describe different pulp therapy drugs1) Zn O and Eugenol: used widely, may result in inflammatory response and delayed healing
2) CaOH: not very successful, high rate of failure because primary pulps are old and dont have repair potential
3) formalin containing compounds - high success rate, no repair of pulp - 22How do you do an intra oral examTexture, color, mucous membranes
Lips, cheek, fauces, vestibule, hard and soft palate, gingiva, tongue, floor of mouth
Color of gingiva
Bone of mandible and maxilla palpated for cysts or tumors
Look for bony exostoses or tori
Clean teeth prior to checking teeth for caries and gingival attachments
Chart caries, restorations and erupted teeth
Sharp explorers, clean mouth mirrors and good illumination - 23What are the different things you look for in an extra-oral examgeneral appearance-pale, cyanosed, anemic
status of extremities-physical disabilities
height and weight-developmental pattern-chronological versus
physiological age
pulse rate, rhythm and volume
rate of respiration and temperature-elevated resp, pulse rate and temp may
just mean that the child is anxious
lymph nodes-submandibular, submental pre-auricular and occipital
head and neck asymmetries
TMJ, mandibular movements - 24What would you look for in a radiographmissing teeth supernumerary
root morphology, # , size, dilacerations, divergence
ankyloses, reduced periodontal space, lamina dura, cementum to bone
impaction, submergence
relative position of permanent teeth
root resorption and pattern and extent
unusual pathology and cysts tumors and supernumeraries
caies, pulp chamber morphology, interdental alveolar bone and rarefaction
amount of alveolar bone support - 25What are the steps you need to take before giving local to childEnsure that amount of LA is measured for pt weight
Tell-show-do : Show needle to child with cap on –tell them you will give them sleepy medication for tooth
Tell what is going to happen and that they might feel a pinch
topical anesthetic
Infiltrate buccally and lingually
Distraction strategy- use children’s words, keep talking, tell a story or use tone of voice to control situation
Positive reinforcement - 26What type of anesthetic technique do you use for md molars What type of technique do you do for md anteriorsIAN or long buccal block
mandibular foramen is more towards posterior border of ramus and slightly below the plane of occlusion
Local infiltration on buccal and lingual aspect of tooth. - 27What analgesic do you prescribe/avoid in childrenFor pain give analgesics acetaminophen- NOT ASPIRIN
- 28What is a formocresol pulpotomy indicated in? How do you test pulp vitality? When is the formocresol pulpotomy contra indicatedpulp is cariously or traumatically exposed but remains VITAL.
history of cold/hot stimuli + bleeding for less than 5 min indicates vitality
non-vital pulps, loss of root structure, excessive mobility, draining fistula, non-restorable crown, pathology in furcation area. - 29How do you carry out the formocresol pulpotomy1. Proper diagnostic PA
2. LA-nerve block or infiltration/RD
5. Prepare prep, remove all peripheral caries, except the dentin overlying pulp-ensures a clean operating field.
7. Remove roof of pulp chamber with No.56, Exposed coronal pulp is amputated with a sharp spoon excavator or round bur at the entrance to the root canals, Debris removed with warm water spray and vacuum suction
9. Control bleeding with dry cotton pellet but if greater than 5 min means that pulp is non vital so you have to use another technique
10. Moisten a cotton in Dilute Buckley’s Formocresol and place in contact with pulp stumps for 5 min
11. Diluting Formocresol to make 1/5 FC(20%)
12. FC is highly caustic and toxic and will cause soft tissue burn, so be careful not to soak the pellet in FC but to just simply moisten it
13. Remove cotton after 5 min
14. Make putty like paste with:
o 1 drop formocresol, 1 drop eugenol and pure zinc oxide powder OR
o 1 drop eugenol and pure Zinc oxide powder
Fill to top with ZOE, finish with amalgam or SCC - 30What are post-op procedures after extractionsAs soon as tooth is extracted, apply pressure to the buccal and lingual alveolar plates, to compress expanded bone and control bleeding
Remove granulation tissue that is present
Apply pressure to the socket with gauze for 5-10 min
Sutures are not usually required
May pack with GELFOAM or SURGICEL which will act as scaffolding for the initial clot formation.
In the event that multiple teeth in one quadrant were extracted or if a flap was raised then sutures would be required. Resorbable 3-0 plan gut suture on a cutting needle is material of choice.
DO NOT DISCHARGE PT. UNLESS BLEEDING HAS STOPPED!! - 31What are post-op procedures after extractions1. Bite on guaze for 30 min
2. Avoid self-inflicted injurt to anaesthetized area.
3. Don’t rinse for 24 hours
4. Cold/luke warm soft diet/fluids for 24 hours (no straws)
5. No brushing for today
6. If multiple extractions, then external cold compress (20 min per hour) for pain and to reduce swelling
7. Child should rest for remainder of day
8. If pain after LA worn off, take Acetaminophen, NOT ASA (Reye’s syndrome)
9. If bleeding begins, bite on gauze for 20 to 30 min,
If this doesn’t worn, bit on a cold tea bag (tannic acid aids in coagulation)
If bleeding still persists, call dentist. - 32Describe Antibiotic Regimes for Pediatric Pts
- 33How much enamel does polishing remove and what does Fl topical treatment add50 microns
- 34when do infants have to start brushing their teeth when do they use tooth paste how often should kids brush What are benefits of water Fl What is the RDI, MI, optimum water levelswhen child has 4 row by row teeth
when they know how to spit
4x/day after every meal
1) reduces tooth decay 2) reduces cost of dental tx 3) is safe 4) benefits everyone
0.05-0.07 mg/kg/day, 1.5 ppm, 0.5-0.8 ppm - 35What is Fl action on HAP What are benefits of Fl What is the pre and post eruptive benefitso Contains outward diffusion of minerals
Blocks glycolysis in plaque bacteria, Stabilizes crystalline structure of enamel, critical pH of enamel by converting hydroxyapatite, fluorapatite, Precipitation of protective CaF layer, Systemic application enhances deposition at inner tooth surface
o At 1ppm, 20-40% reduction in caries activity
o Cheap! 70c/person/yaer
o Provides topical and systemic exposure supersaturated solution of CaF which favors remineralization)
APF – acidulated phosphate fluoride = 1.3% APF is what we give in a topical fluoride application
o Most effective way to reduce tooth decay
o Reduces the cost of den tx
Pre: increases enamel resistance to acid demineralization prior to post eruptive enamel maturation
Post: o decreases acid production by blocking bacterial glycolysis - 36When do you extract 2 rows of teethwhen permenant teeth have same incisal edge height as primary teeth
- 37Describe FRANKL's behaviour scale
- 38What are the non-pharm ways to shape kids behaviourtell show do, modeling using other child/parent, using parents (allowed to be in room as long as kid cooperates), restraints with parental consent
- 39When is N20 Used for sedation When is oral sedation used When is general used?safest, mildly anxious patients, does not replace local. Reduces fear/inc. pain threshold. CI: extremely anxious, URI/Ear infection, glaucoma, psychiatric disorder
extremely anxious, limit extend of tx, amnesic props, appropriate dosage, may not effect after 2 appts.
uncooperative pt, handicapped, extensive work req'd, hospital setting, clearance from MD. oral or nasal tube. - 40What is the dose of lidocaine you can give How do you prepare pt for injections- Lidocaine 2% epi 1:100,000
- Dose by weight 4.4 mg/kg of lidocaine
Have everything ready to go, Self-confidence, Age appropriate language, Praise px
o Explain to px what you need to do
Don’t use: Needle, pain, injection
Use: Sleep juice, pinch
o Communicate with your pxs
Distraction will aid on success
Child’s eyes to follow yours
Assistant pass syringe out of px’s vision
• Use peripheral vision to bring syringe to px’s mouth
Have assistant to lean across chair to control px’s hands
Once you are in, stay in
- Continuous distraction
- Head stabilization - 41How do you anesthesize the md in kidsIANB
• Preferred for extensive restorative txmt, pulp therapy and extractions
• Jo note: For kids, ramus is lower.
• After placing topical, place thumb pads on anterior border of ramus
• Wrap fingers around external posterior ramus
• Insert needle at level of occlusal plane
o Advance to bone, the back up and aspirate, Inject slowly
Mental foramen/long buccal
• Px might behave better than with
IANB
• Not adequate for restorative txmt of 2nd primary M
• For extractions, inter-papillary injections are necessary - 42What is the most common types of caries in children where are infantile caries where are snacking cariesECC: 60-90%
nursing/bottle: upper incisors and molars. starts on lingual so parents dont see often.
snacking: upper posterior - 43How much Fl does full strip of toothpaste have for chld/adult tooth brusheso Full strip of toothpaste on a Child Size Toothbrush
0.75-1.0 g = 0.75-1.0 mg F
o Full strip of toothpaste on a Adult Toothbrush
1.0 g = 1.0 mg F - 44What are the levels of FL supplementso The best intake is 0.05-0.07mg/kg/day
- 45What are toxic levels of fluoride ingestion what is prevelance of fluorosis• Probable Toxic Dose (PTD)
o 5 mg/kg fluoride
o For a 2 year old (12 kg), PTD is 60 mg. The child would need to ingest one full 60 mL tube of toothpaste (family size)
• Certain lethal Dose (CLD)
o 32-64 mg/kg F
o 2 yr old child would need to ingest 10 tubes of toothpastes
be ~48% - 46describe technique for maxillary occlusal radiographstandard PA film, pt head in Frankfurt Horizontal Plane, film placed between front teeth with long axis towards corners of mouth and 1/8" anterior to labial surface of upper teeth, pt bites down firmly but gently, central beam oriented +60 degrees to horizontal plane with tip of cone touching tip of nose
- 47describe technique for bitewingsb.) size O film for primary dentition, standard PA film for mixed dentition attached to bitewing tab; pt head in FHP, film placed lingual to md teeth and guided into palatal vault as pt closes, chin in retruded position, central ray aimed at centre of film and occlusal surfaces at +10 degrees to horizontal
- 48Describe technique for upper periapical viewb.) size O film for primary dentition, standard PA film for mixed dentition attached to bitewing tab; pt head in FHP, film placed lingual to md teeth and guided into palatal vault as pt closes, chin in retruded position, central ray aimed at centre of film and occlusal surfaces at +10 degrees to horizontal
c.) size O for primary, standard PA for mixed; FHP, film in Rinn holder and film firmly in palate as pt closes, central ray on zygomatic bone angled at +40 degrees & right angle to handle of Rinn holder - 49describe technique for lower periapical viewb.) size O film for primary dentition, standard PA film for mixed dentition attached to bitewing tab; pt head in FHP, film placed lingual to md teeth and guided into palatal vault as pt closes, chin in retruded position, central ray aimed at centre of film and occlusal surfaces at +10 degrees to horizontal
c.) size O for primary, standard PA for mixed; FHP, film in Rinn holder and film firmly in palate as pt closes, central ray on zygomatic bone angled at +40 degrees & right angle to handle of Rinn holder
d.) size O for primary, standard PA for mixed; FHP, film in Rinn holder and lower edge of film against lingual surfaces of md posterior teeth, pt closes, central ray at 0 degrees with tip of x-ray tube touching cheek above lower border of md and right angle with handle of Rinn holder
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- Flashcards on Pedo Exam, created by ghaznia.khan on 24/05/2015.
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