INBDE Bootcamp High-Yield Pediatric Dentistry PDF

k INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Tooth development Stages in orde...

k INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Tooth development Stages in order: Eruption Primary teeth Permanent teeth Maxillary Eruption age Mandibular tooth Eruption age Maxillary tooth Eruption age Mandibular tooth Eruption age tooth Central 7 - 8 years Central 6 - 7 years Central 8 - 12 months Central 6 - 10 months Lateral 8 - 9 years Lateral 7 - 8 years Lateral 9 - 13 months Lateral 10 - 16 months Canine 11 - 12 years Canine 9 - 10 years Canine 16 - 22 months Canine 17 - 23 months 1st premolar 10 - 11 years 1st premolar 10 - 12 years 1st molar 13 - 19 months 1st molar 14 - 18 months 2nd premolar 10 - 12 years 2nd premolar 11 - 12 years 2nd molar 25 - 33 months 2nd molar 23 - 31 months 1st molar 6 - 7 years 1st molar 6 - 7 years 2nd molar 12 - 13 years 2nd molar 11- 13 years Palmar notation for eruption sequence: ABDCE 3rd molar 17 - 21 years 3rd molar 17 - 21 years Developmental disturbances Supernumerary teeth Congenitally missing teeth Most common supernumerary tooth is a Primary mesiodens between 8 and 9, often ○ Most common: maxillary lateral incisor palatally positioned Permanent Can block eruption of permanent teeth ○ Most common to least common: Third molars Mandibular 2nd premolars Maxillary lateral incisors  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Developmental disturbances Dilaceration Enamel hypocalcification Abnormal bend in root Mineralization or maturation defect that causes Often occurs due to trauma of primary tooth white spots in enamel Can be caused by fluorosis CC BY 3.0 Primary tooth anatomy General differences Thinner enamel and dentin Whiter and more translucent crown Larger pulp Roots more divergent Root trunk shorter More prominent cervical bulge Enamel rods directed more occlusally Crown is wider mesiodistally and in the gingival third shorter incisogingivally Primary maxillary teeth Primary mandibular teeth Tooth Features Tooth Features Maxillary central incisor Widest anterior tooth M-D Mandibular central incisor Smallest tooth B-L Width > height Mandibular lateral incisor No significant facts Maxillary lateral incisor No significant facts Mandibular canine No significant facts Maxillary canine Widest anterior tooth B-L Mandibular first molar CEJ dips more in mesial half Maxillary first molar Prominent cervical ridge ML cusp is highest, sharpest CEJ dips more in mesial half MB cusp is largest Maxillary second molar Widest overall tooth B-L Mandibular second molar Widest overall tooth B-L  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Primary tooth treatments Fluoride varnish Sealants Topical treatment Placed in occlusal pits and fissures Prevents caries and halts decay in smooth incipient lesions Physical barrier against caries and halts decay in incipient lesions Amalgam Composite Prep should extend into pits and fissures More conservative prep than amalgam Effective option for pediatric patients Dry field required May fail at the gingival margin Stainless steel crowns Strip crowns For extensive caries (past axial line angles), or after pulpotomy or pulpectomy For primary incisors with large proximal caries Minimal occlusal and proximal reduction Provides function until primary tooth exfoliates Silver diamine fluoride (SDF) Pulp signs Arrests active caries Pain, sensitivity Effective for smooth surface, cavitated lesions Mobility For high caries risk children and children with rampant decay Fistula, abscess Furcation radiolucency (necrosis) Root resorption Indirect pulp cap Direct pulp cap For deep caries close to pulp, but no pulp exposure For small pulp exposure (trauma or carious) Calcium hydroxide (CaOH) or resin modified glass ionomer (RMGI) CaOH at the base and RMGI on top Can cause internal root resorption, so rarely done Pulpotomy Pulpectomy Removal of deep caries and inflamed pulp from coronal pulp chamber of tooth Removal of all pulp tissue in a tooth, both coronal and radicular For teeth with pulp exposure that are vital and restorable For teeth with pulp exposure that are non-vital and restorable Formocresol, zinc oxide eugenol, stainless steel crown Primary second molars for space maintenance Zinc oxide eugenol, stainless steel crown Extraction For teeth that are nonrestorable, undergoing root resorption, have furcation involvement, and/or associated with swelling Often necrotic primary first molar  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Space management Spaces Primate space Interdental space Leeway space Between primary maxillary lateral incisor and canine, Space between primary incisors to provide room for Difference in size between primary molars and between primary mandibular canine and first molar permanent incisors permanent premolars Approaches Root development Space management: holding space before loss of primary teeth Eruption of tooth begins when the crown is fully formed Tooth will erupt through bone when root is ⅔ formed Space maintenance: maintaining space after primary teeth are lost prematurely Tooth will erupt through gingiva when root is ¾ formed Space regaining: regaining space after premature loss of primary teeth and mesial drift of permanent teeth, maximum of 3 mm Appliances for early loss of primary teeth Incisors: pediatric partial, usually unnecessary as permanent incisors erupt early Canines: loss of arch length → lower lingual holding arch, upper Nance appliance First molars: band and loop, upper Nance appliance, lower lingual holding arch Second molars: loss of leeway space → distal shoe, upper Nance appliance, lower lingual holding arch Rule of 7 Space closure Premolars typically erupt around age 10 or 11 Space closure occurs in the first 6 months after loss of a tooth If the primary molar is lost before age 7, premolar eruption will be delayed Most movement occurs in the first 4-8 weeks If the primary molar is lost after age 7, premolar eruption will be accelerated Ectopic eruption Ankylosis Permanent tooth that erupts in the wrong path Most common primary tooth: mandibular first molar Wisdom teeth and canines are the most common teeth to erupt ectopically Signs: tooth is below occlusal plane, non-mobile, hollow to percussion, loss of PDL space  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Soft tissue Healthy gingiva Gingivitis Compared to adults, children have: Mostly plaque-induced Redder gingiva Parents should help children with oral hygiene until age 8 Rounded, rolled margins Aggravated by mouth breathing, crowding, erupting teeth, braces Flabby consistency Peak effect at puberty Less stippling Deeper sulcus Acute necrotizing ulcerative gingivitis Reduced attached gingiva More common in adults < 2 mm of attached gingiva Signs: painful, fever, bad breath, bleeding gums, blunt papillae, ulcers on the gingiva Commonly caused by teeth erupting buccally out of the arch Tx: debridement, antibiotics, mouth rinse Tx: orthodontics, keratinized tissue graft Eruption cyst High frenum Commonly occurs at incisors and mandibular first Tx: close diastema first, then frenectomy molars May self correct Sign: bump on alveolar ridge, confirm with Can cause recession radiograph Tx: monitor or excise Periodontitis Uncommon in children Localized aggressive periodontitis: common in African American children, permanent first molars and incisors Generalized aggressive periodontitis: entire dentition, due to plaque and calculus Prepubertal periodontitis: primary molars Trauma to primary teeth Trauma facts Ellis classification Incidence in boys > girls Class I: simple fracture (enamel) Most common age: 8-12 Class II: crown fracture (enamel, dentin) Often maxillary anteriors Class III: crown fracture (enamel, dentin, pulp) High incidence with increased overjet Class IV: nonvital tooth, with or without crown involvement Most common cause of pulp calcification If traumatized tooth has an open apex → more likely to stay vital Class V: avulsion Class VI: root fracture, with or without crown fracture Class VII: displacement of tooth, no crown fracture  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Trauma to primary teeth Medical history to acquire Mouth guards Root resorption Crown fracture Bleeding disorders Stock Often a result of trauma Enamel → smooth Tetanus coverage Mouth formed Can be internal or external root resorption Enamel and dentin → restore Head injury Custom fabricated by dentist Enamel, dentin, pulp → pulpotomy, Updated radiographs pulpectomy, or extract Root fracture Concussion Subluxation Intrusion Coronal fragment nondisplaced or No displacement or increase in mobility No displacement Primary tooth is displaced apically nonmobile → no treatment Primary tooth has sore PDL Increase in mobility Can sometimes be displaced labially Coronal fragment is displaced or mobile → Soft diet Soft diet Primary teeth will usually spontaneously extract or reposition, splint 4 weeks Oral hygiene instruction Oral hygiene instruction reerupt May cause damage to permanent teeth Extrusion Avulsion Lateral luxation Alveolar fracture Primary tooth is displaced coronally Separation of primary tooth from alveolus Primary tooth is displaced laterally Alveolar bone fractured, usually with Extract if mobile or extruded > 3 mm Do not reimplant primary teeth Extract if extremely displaced lateral luxation Monitor if < 3 mm Monitor Option to reposition, splint 4 weeks if Reposition, flexible splint 4 weeks May need endo extremely displaced Monitor May need endo  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Child behavior Frankl rating scale Suggestions to parents 1 = definitely negative → refuses treatment, cries forcefully, and/or very fearful Establish a dental home in first 6-12 months Drink from cup by age 1 2 = negative resistance → reluctant and somewhat uncooperative but accepts care First dental visit by age 1 Brush teeth with smear of toothpaste before age 2 3 = positive acceptance → reserved but accepts care and follows directions Brush teeth with pea of toothpaste age 2-5 4 = definitely positive → shows enjoyment/ interest in the appointment and cooperates Behavioral methods Basic techniques Animal assisted therapy: adjunctive use of animals to improve patient’s functioning Functional inquiry: questionnaire or interview of the parent Anticipatory guidance: counseling for patients and parents, focused on prevention Knee to knee exam: for infants, done with parents Aversive conditioning: punishing behavior i.e. voice control, constraints Picture exchange communication system: uses pictures to communicate Behavior shaping: develops behaviors by providing positive reinforcement Pre-visit imagery: provides a positive context of dentist Direct observation: watch videos or observe a patient who is cooperative Systematic desensitization: exposes parts of a dental appointment gradually Distraction: diverts attention Tell-show-do: verbalize, demonstrate, proceed Familiarization: dental appointment that focuses on introducing the dental setting Voice control: change in volume, tone, or pace to achieve attention or compliance Advanced techniques Conscious sedation: state of depressed consciousness, responds to commands or touch General anesthesia: state of unconsciousness, sleep-like state Protective stabilization: use of a papoose or another person to restrict movement of child Sedation Local anesthesia Minimal sedation Maximum dose of local anesthesia is 4.4 mg/kg Anxiolysis Common blocks in children: Nitrous oxide < 50%, with or without medication ○ anterior superior alveolar Most common side effect of nitrous oxide is nausea ○ posterior superior alveolar Contraindications: < 2 years old, uncooperative, severe asthma with wheezing ○ inferior alveolar Moderate sedation Conscious sedation Nitrous oxide > 50%, with or without medication Deep sedation IV sedation Medications such as midazolam, propofol, ketamine General anesthesia “Put under” Medications such as ketamine, propofol, thiopental  INBDE Bootcamp High-Yield Pediatric Dentistry | Bootcamp.com Child behavior Fluoride for high caries risk children Behavioral conditions Attention-deficit/hyperactivity disorder Boys > girls Recommendations for fluoride supplementation Treated with psychostimulants Management techniques Fluoride level of drinking water in PPM Age of child ○ morning appointments ○ protective stabilization Type < 0.3 PPM 0.3-0.6 PPM > 0.6PPM ○ multiple short visits Birth- 6 Drops No supplements No supplements No supplements ○ nitrous oxide months Autism 6 months- 3 Drops 0.25 mg per day No supplements No supplements Affects how someone interacts with and perceives others years Repetitive behavior, heightened senses Management techniques 3- 6 years Tablets, 0.50 mg per day 0.25 mg per day No supplements ○ Tell-show-do lozenges ○ systematic desensitization ○ picture communication 6- 16 years Mouth rinse 1.0 mg per day 0.50 mg per day No supplements ○ voice control Infant teeth Early childhood caries Natal teeth: present at birth “Baby bottle syndrome” Neonatal teeth: present within the first 30 days after birth Any child < 6 with caries Often in children who consume juice, chronic antibiotic use Thumbsucking Child abuse & neglect Increases overjet, anterior open bite, maxillary constriction, and posterior crossbite Most common in children ages 0-3 Appliance indicated by age 5-6 to prevent the effects Abuse: can be physical or emotional listed above Neglect: not providing the basic needs of a child ○ Crib appliance Dentists are considered mandated reporters and must report any suspected abuse or ○ Bluegrass appliance neglect