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Psychological Development And Behaviour Management Important Notes

1. Theories of child psychology

2. Behavioural theories

3. Mahler’s theory

• It is divided into 3 stages
  • Normal autistic phase 01 years
  • Normal symbiotic phase 4 weeks to 4 years
  • Separation individualization phase 536 months

4. Operant conditioning

• According to this theory, the consequence of behavior itself acts as a stimulus and affects the future behavior
• There are 4 types of operant conditioning by Skinner
• They are
  • Positive reinforcement
  • Negative reinforcement
  • Omission
  • Punishment

5. Cognitive theory

• It is based on how children and adolescents think and acquire knowledge
• According to Piaget, the environment does not shape child behavior but the child and adult actively seek to understand the environment

6. Hierarchy of needs

• According to Masler, the needs of the person are arranged in a hierarchy and as one general type of need is satisfied, another higher-order need will emerge
• The desires from most biological needs to the more psychological ones become more important only after basic needs have been satisfied

7. Behavioural management techniques

1. Nonpharmacological techniques

• • Communication
  • It is of 2 types verbal and nonverbal
  • The voice that is used should be constant and gentle
  • The tone of voice can express empathy and firmness
  • Nonverbal is by body language and smiling. Eye contact, by touching the child or by giving a hug
• Behavior shaping
  • Desensitization
  • It involves teaching the patient how to induce a state of deep muscle relaxation and describing imaginary scenes relevant to his fear
  • Modeling
  • Introduced by Bandura
  • Here the child is allowed to observe one or more individuals who demonstrate positive behavior in a particular situation
  • Contingency management
  • The presentation or withdrawal of reinforces is termed as contingency management
  • Reinforces always increase the frequency of a behaviour
• Behavior management
  • Audio analgesia
  • An auditory stimulus such as pleasant music has been used to reduce stress and also to reduce the reaction to pain
  • Biofeedback
  • It involves the use of certain instruments to detect certain physiological processes such as BP associated with fear
  • Voice control
  • It is the modification of intensity and pitch of one’s own voice in an attempt to dominate the interaction between the dentist and child
  • It is used in conjunction with some form of physical restraints and the Home technique
  • Hypnosis

Read And Learn More: Pedodontics Short Essays Question And Answers

• • Humor
  • It helps to elevate the mood of the child which helps the child to relax
  • Coping
  • It is the mechanism by which a child copes up with the dental treatment by establishing a close or trusting relationship ^
    with the doctor or nurse
  • Relaxation
  • Implosion theory
  • It mainly comprises of Home, physical restraints, and voice control
  • Aversive conditioning
  • It is a safe and effective method
  • Parental consent is required prior to its use
  • Two methods used for it are HOME and physical restraints

2. Pharmacological techniques

• • Premedication
  • Conscious sedation
  • General anesthesia

8. Drugs used for behavioral management

9. Home

• It is Hand Over Mouth Exercise
• Introduced by Evangeline Jordan
• Indications
  • 3-6 years of age
  •  A child who can understand simple verbal commands
  • A healthy child displaying uncontrolled behavior
• Contraindications
  •  Children under 3 years of age
  •  Handicapped/ immature/ frightened child
  •  Physical, mental, and emotional handicaps

10. Tell, Show, Do technique

• Introduced by Addleson
• Effective in children more than 3 years of age
• First, the dentist tells the child what is going to be done in simple words
• Second the dentist demonstrates the exact procedure to the child
• Finally, the dentist performs the procedure exactly as it was described and demonstrated
• Indications
  • Children more than 3 years of age
  • Fearful child
  • First visit

11. N₂O sedation

• Contraindications:
  • COPD
  • Asthma
  • Respiratory infection
  • Sickle cell anaemia
  • Otitis media and epilepsy

12. Types of physical restraints

• Active performed by dentists/ parents/ staff
• Passive by restraining device

13. Stages of development according to cognitive theory

• Sensorimotor stage 0-2 years
• Preoperational stage 2-6 years
• Concrete operation stage 7-12 years
• Formal operation stage 11-15 years

Psychological Development And Behaviour Management Long Essays

Question 1. Explain Psychological development of a child according to Sigmund Freud.
Answer:

Sigmund Freud gave a psychoanalytical theory explaining the psychological development of a child. He describes 6 psychosexual stages and at each stage he included the development of sexual desires.

Sigmund Freu Stages:

• Oral Stage
  • It is a dependent stage where the infant depends on adults to fulfill his needs
  • But if the child’s needs are not fulfilled he develops a negative and aggressive behavior
• Anal Stage
  • During this stage, maturation of neuromuscular control occurs
  • The child obtains a sense of control over its voluntary functions, a sense of independence.
  • If it fails, the child develops abnormal behavior like stubbornness.
• Urethral Stage:
  • It is a transitional stage between the anal and a phallic stage
  • The child obtains and is satisfied with the control over its urinary sphincter
  • If it fails to develop, the child becomes competitive
• Phallic Stage:
  • Period 3rd5th year of life
  • Development of Oedipus complex and Electra complex where the young boys are attracted towards mother, while girls are attracted towards her father respec¬tively.
  • The child has unusual sexual feelings for the opposite sex
  • He carries out his sexual activities without any embarrassment
• Latency Stage:
  • This stage ends in puberty
  • A child develops a well-balanced control over his desires
  • The child adapts to the changing environment
  • Lack of this behavior results in immature behavior of the child.
• Genital Stage:
  • Period 1113 years to adulthood
  • The child realizes the sense of maturity, sense of individuality, sense of ability to reproduce, and sense of independence.
  • The child develops social environment by communicating and interacting with the surrounding
  • The child accepts the social expectations and lives according to it.

Question 2. Define behavior management. Discuss in detail nonpharmacological techniques of behavior management.
(or)
What is behavioral management, describe in detail the techniques employed in treating an apprehensive 4 years old child.
Answer:

Definition:

• Behavior management is defined as the means by which the dental health team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude.

Non Pharmacological Techniques

1. Communication: This can be used in both cooperative and uncooperative child

Non-Pharmacological Techniques Types:

• Verbal by speech:
  • Using kind words
  • With a friendly nature
• Nonverbal:
  • Smiling face
  • Eye contact
  • Giving a hug
  • Touching the child
• Combination:

2. Behavior Shaping:

It is the procedure which slowly develops behavior by reinforcing a successive approximation of the desired behavior until the desired behavior comes into being.

Means:

• Desensitization:
  • Developed by Joseph Wolpe
  • It is a procedure which teaches a child gradually desired behavior by introducing stimuli from less threatening objects to more threatening objects
• Modeling:
  • Introduced by Bandura
  • It makes the patient to observe other child patients or models to develop the desired behavior
  • The model should initiate the same situation
  • Live models, if used, it should involve a person who has a greater impact on the child like siblings, parents, etc.
• Contingency management:
  • It modifies the child’s behavior by introducing/withdrawing the reinforce
• Types Of Reinforcement:
  • Positive toys, patting back
  • Negative withdrawal of the mother

3. Behavioral management:

• Audio Analgesia:
  • The use of mild, soft music in the dental clinic reduces a child’s anxiety
• Biofeedback:
  • This method uses various means of investigation like blood pressure that detect the level of anxiety
• Humor:
  • This relieves the anxiety of the child
  • Simultaneously, transmits essential information
• Coping:
  • Measures like friendliness, support, and reassurance are used to master and reduce the stresses of patients.
  • A child may totally accept the stressful condition or may keep thinking about the procedure in his mind at the same time, he is calm.
• Voice control:
  • Modification of intensity of voice is done to obtain desired behavior from the child
  • Dentists should have adequate knowledge of changing the tone from gentle to firm.
• Relaxation:
  • It is time-consuming
  • It involves a series of exercise which is taught to the child
  • Children need to perform it at least 15 minutes per day
• Hypnosis:
  • It is an altered state of consciousness
  • Creates heightened suggestibility to obtain the desired behavior
• Implosion therapy:
  • It involves the administration of a combination of various means to such that the child has no other choice but to cope up with the situation
• Aversive conditioning:
• It is a safe and effective method
• Use to manage extremely negative behavior
• It involves
  • Home
  • Physical restraints

Question 3. Classify theories of child psychology. Discuss in detail the cognitive theory of child psychology.
Answer:

Theory of child psychology Classification:

1. Psychodynamic theories:

• Psychosexual theory by Sigmund Freud
• Psychosocial theory by Erik Erikson
• Cognitive theory by Jean Piaget

2. Theories of learning and development of behaviour:

• Hierarchy of Needs by Maslow
• Social learning theory by Bandura
• Classical conditioning by Pavlov
• Operant Conditioning by Skinner

3. Margaret and Mahler’s theory of development Cognitive Theory:

• Proposed by Jean Piaget
• It involves three functional variants
  • Assimilation: The child observes anything in the environment and tries to recognize it and relate it to the previous experiences
  • Accommodation: Here the child develops new strategies or concepts due to the changing concepts.
  • Equilibrium: The child carries out adjustments in the basic assumptions.

Cognitive Theory Stages:

• Sensorimotor stage (Birth18 months)
  • During this stage, the child relies on seeing, touching, sucking
  • The child uses their senses to learn things
• Preoperational stage (18 months7years)
  • Preconceptual stage (18 months 4 years)
  • Intuitive period (47 years)-During this child’s thinking is self-centered or egocentric
• Concrete operational stage (712years):
  • The child develops reasoning power
  • He organizes his thoughts comprehensively
• Formal operational stage (1213 years):
  • The child develops an ability to solve a problem

Cognitive Theory Merits:

• It is a comprehensive theory

Cognitive Theory Demerits:

• It underestimates a child’s ability
• Underestimates environmental role
• Overestimates age differences.

Question 4. Define behavior science and behavior management. Discuss factors affecting child’s behavior.
Answer:

Definition:

1. Behavior Science:

• It is the science which deals with the observation of behavioral habits of man and lower animals in various physical and social environment.

2. Behavior Management:

• It is defined as the means by which the dental team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude.

Factors Affecting Child’s Behavior:

1. Factors involving the Child

• Growth and Development:
  • A child with deficient physical and mental development cannot react to the social expectations
  • As a result of rejection by the society to such child, it leads to psychological trauma to the child
• Nutritional factors:
  • Increased intake of sugar causes irritable behavior
  • Hypoglycaemia causes criminal behavior
  • Skipping breakfast leads to impaired performance
•  Past dental experiences:
  • Any unpleasant experiences are associated with uncooperative behavior
• School environment:
  • 50% of a child’s behavior is affected by school
  • Teachers as well as seniors influence child’s behavior
• Socioeconomic status:
  • High socioeconomic status child develop normally and gets spoilt
  • Low socioeconomic status child has tensed behavior

2. Factors involving the Parents

• Home environment:
  • All family members one or the other way influ¬ence’s child behavior
  • A child’s behavior also depends on the emotional status of the mother during pregnancy
• Family development:
  • More parental involvement leads to spoilt behavior of the child
•  Maternal behaviour:
  • A child’s behavior is influenced by the emotional status as well as the nutritional status of the mother

3. Factors involving the Dentist:

• Dental office environment:
  • Make the reception room comfortable
  • Provide books for all ages
  • Walls, appointment cards and other accessories should be attractive
  • Avoid light of instruments or sight of blood
• Effect of dentist’s activity and attitudes:
  • Dentists should avoid jerky movements
  • He/she should be fluent
• Effect of dentist’s attire:
  • The presence of a white colored cloth may evoke a negative behavior
  • Presence or absence of parents:
  • A mother’s presence is essential for a preschool child, handicapped child
  • Mother’s absence for an older child
• Presence of an older sibling:
  • An older sibling serves as a role model

Question 5. Define conscious sedation. Describe nitrous oxide-oxygen sedation.
Answer:

Conscious Sedation:

• Definition: A minimally depressed level of consciousness that retains the patient’s ability to maintain an airway independently and respond appropriately to physical stimulation and verbal command

Nitrous Oxide 0₂ Mixture:

• It is the most widely used form
• Route Inhalation of gas
• The administration of it is carefully titrated to the patient’s need.

Pharmacology:

• With the increase in patient’s anxiety, tidal volume increases from 68 liters
• Nitrous oxide is carried in a free state with less solubil¬ity in blood
• It is a weak anesthetic gas.

Conscious Sedation: Stages:

Plane 1: Moderate Sedation and Analgesia

• Patient experience:
  • Dizziness
  • Tingling
  • Relaxation
  • Impairment of vision and hearing
  • Fear and anxiety

Plane 2: Dissociation sedation and analgesia

• Patient feels
• Dissociation from his environment
• Reduced blinking capacity
• But however, the patient responds

Plane 3: Total anesthesia (Analgesia)

• Complete analgesia is achieved with marked amnesia
• It is subdivided into
• Lightest plane
• Samnolent state
• Deepest plane

Plane 4: This results in loss of contact with hazards

Adverse Effects:

• Effects DNA synthesis
• The patient may develop pernicious anemia

Contra-Indications:

• Patient with upper respiratory tract infection
• Pneumothorax
• Pregnancy

Question 6. Define behaviour management. Enumerate fundamentals of management technique and explain aversive conditioning.
Answer:

• Definition: Behavior management is defined as the means by which the dental health team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude.

Fundamentals Of Behaviour Management:

• To establish effective communication with the child and the parent
• To gain the confidence of both the child and the parent and make them accept dental treatment
• To teach the child and the parent about the positive aspects of preventive dental care
• To provide a relaxed and comfortable environment for the dental team to work in while treating the child

Aversive Conditioning:

• It is a safe and effective method
  • Used for management of extremely negative behavior
  • Parental consent must be obtained prior to its administration
  • It includes 2 methods

1. Home:

• Hand Over Mouth Exercise
• Introduced by Evangeline Jordan
• In this method, the dentist firmly places his hands over the child’s mouth
• Next, he kindly explains child by being close to the child’s ear
• Once desired cooperation is obtained by the child, he is complimented for his good and cooperative behavior

2. Physical restraints:

• Used as a last resort for uncooperative patients
• The child is seated in the mother’s lap and the child’s movement of head, hands, and feet which shows refusal of treatment, are restricted

Physical restraints: Types:

• Active Without using a restraining device
• Passive With the use of a restraining device

Used Equipment:

• For body:
  • Pedi wrap
  • Towel and tapes
• For extremities:
  • Velcro straps
  • Posey straps
• For the head:
  • Head positions
• For mouth:
  • Mouth blocks
  • Mouth props

Question 7. Define behaviour management. Describe Wright’s classification of the behavior of children in the dental clinic. Write in detail about communication as a behavior management technique
Answer:

Behavioral Management:

• Behavior management is defined as the means by which the dental health team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude.

Wright’s Classification:

1. Cooperative

• Cooperative behavior Minimal refusal
• Lacking cooperative ability Seen in preschoolers and handicapped
• Potentially cooperative Patient exhibit inherent fears

Uncooperative:

• Uncontrolled/Hysterical Child shows temper tantrums
• Defiant behavior/obstinate Seen in stubborn children
• A tense cooperative Child accepts the treatment but at the same time is tensed
• Timid/shy Child is shy but cooperative
• Whining type Child keeps on complaining
• Stoic behavior Cooperative without any facial expression

Communication As Behavior Management:

• This can be used in both cooperative and uncoopera¬tive child

Behavioral Management Types:

• Verbal by speech:
  • Using kind words
  • With a friendly nature
• Nonverbal:
  • Smiling face
  • Eye contact
  • Giving a hug
  • Touching the child
• Combination:

Psychological Development And Behaviour Management Short Essays

Question 1. Psychic triad/ld, Ego, Superego.

Answer:

Proposed By Freud

1. Id:

• It is basis of the pleasure principle
• It is a reservoir of desires
• It represents the mental state of the child
• It is present at birth
• The child tries completely to fulfill his desires to obtain immediate pleasure and satisfaction

2. Ego:

• It develops in the 2nd to 6th month of life
• It is based on the reality principle
• The child begins to differentiate between his dreams and his surrounding environment
• The child tries to modify his desires according to the reality

3. Superego:

• It is the restrictions on the individual which prevent him to go wrong
• It includes regulations by the parents, society, and culture
• It creates a feeling of shame and guilt on doing a wrong thing that is against the society

Question 2. Stimulus Response Theory.
Answer:

• It is a form of behavior shaping
• It is a procedure which very slowly develops behavior by reinforcing successive approximations of the desired behavior until the desired behavior is achieved.
• For example, when shaping behavior, the dental assistant or dentist is teaching the child how to behave
• Young children have to be communicative and cooperative
• Gradually the patient adapts to the procedure

Question 3. Modeling.
Answer:

• Introduced by Bandura
• It is a method of behavior modifications
• It reduces the anxiety of the child’s patient by demonstrating the same situation in a less threatening manner

Methods:

• Live models
• Filmed models
• Posters
• Audiovisual aids

Advantage: Doesn’t require any additional equipment

Requirement:

• The selection of the model should be such a person that has a greater impact on the child like siblings, parents, etc.

Question 4. Fear in Dentistry.

Answer:

Fear in an unpleasant emotion/effect consisting of psychophysiological changes in response to realistic threat or danger to one’s own experience

Dentistry Types:

1. Innate fear: Fear present since birth
2. Objective fears: Acquired by an unpleasant past situation
3. Subjective fear: It is parent’s oriented

Features:

• Fear lowers the pain threshold
• Tense muscles
• Anger
• Weakness
• Increased heartbeat
• Urge to urinate
• Dryness of the mouth
• Rapid breathing
• Dilatation of pupils
• Hair standing on end

Question 5. Maternal’s influence on child’s psychology.
Answer:

• There is a mother-child interdependency that initiates at infancy and builds well into the preschool period
• Bayley and Schaefer indicate that most of the relevant mother-child relationship fall into two categories

1. Autonomy versus control
2. Hostility versus love

• • Mothers who allowed enough autonomy and expressed affection had children who were friendly and cooperative and those who ignored their children did not have children who exhibited these positive behavioral features
  • Highly anxious parents tend to affect their child’s behavior negatively
  • The effect is greatest with those under 4 years of age
  • Mother-child behavior interactions

Question 6. Home.
Answer:

• It is a technique of aversive conditioning
• It was first described in the 1920s by Dr. Evangeline Jordan

Home Objectives:

• To gain the child’s attention enabling communication with the dentist so that appropriate behavioral expectations can be explained
• To eliminate inappropriate avoidance responses to dental treatment and to establish appropriate learned responses
• To enhance the child’s self-confidence in coping with the anxiety of dental treatment
• To ensure the child’s safety in the delivery of quality dental treatment

Home Technique:

• In this method, the dentist firmly places his hands over the child’s mouth
• Next, he kindly explains child by being close to the child’s ear
• Once desired cooperation is obtained by the child, he is complimented for his good and cooperative behavior

Home Indications:

• In the case of a healthy child who is able to understand and cooperate but who exhibits defiant, obstreperous or hysterical avoidance of behaviour to dental treatment
• For normal children who are hysterical, belligerent
• Used for children with sufficient maturity to understand simple verbal commands

Home Contraindications:

• In children who due to age, disability, medication or emotional immaturity are unable to understand and cooperate
• When it will prevent the child from breathing

Home Variations:

• Hand over mouthairway unrestricted
• Hand over both mouth and nose
• Towel held over mouth only
• Dry towel held over mouth and nose
• Wet towel held over mouth and nose

Question 7. Desensitization.
Answer:

• It is form of behavior shaping
• Introduced by Joseph Wolpe
• It is helpful in patients who had unpleasant past experience
• It is done by teaching the child a competing response such as relaxation and then introducing more threatening stimuli
• It is an effective method
• The patient learns to substitute proper and cooperative responses instead of uncooperative response

Question 8. Anxiety v/s fear
Answer:

Psychological Development And Behaviour Management Short Answers

Question 1. Frankel Behaviour rating scale.
Answer:

• Definitely negative (- -)
  • Child refuses any kind of treatment
  • He opposes it by forcefully crying
• Negative (-)
  • Reluctant to accept treatment
• Positive (+)
  • Accepts treatment
  • However, if the patient has any bad past experi­ence, he becomes uncooperative
• Definitely positive (++)
  • Very cooperatively accepts the treatment
  • Realizes the importance of treatment

Question 2. Voice Control.
Answer:

• It is a form of behavior management
• It includes modification of intensity and pitch of one’s own voice
• Dentists should have adequate knowledge of when and how to change the tone from gentle to firm
• This results to change the patient’s attitude
• The child cooperates to the treatment as well as obeys the den­tist.

Question 3. Tell Show Do technique (TSD).
Answer:

Methods of desensitization:

TSD Indications:

• First visit,
• Fearful child
• Apprehensive child
• It is effective in children more than 3 years

Method: 

• Tell Explain the treatment procedure to the patient using less threatening manner
• Show Treatment procedure is demonstrated through models
• Do Carry out the treatment

Question 4. Contingent management.
Answer:

• Contigency management technique is based on the operant conditioning theory of BF Skinner
• It is a method of modifying behaviour by presentation or withdrawal of the reinforcers
• These reinforce are the pleasant or unpleasant stimuli mentioned in the operant theory in child psychology
• Contigency management includes:
  • Reinforcement of positive or negative
  • Omission/ time out
  • Punishment

Question 5. Ketamine.
Answer:

• It is an agent used for sedation
• Route Intramuscular
• Dose 10 and 50 mg/ml

Ketamine Indications:

• Dissociative anesthesia
• As an analgesic

Question 6. Subjective fear.
Answer:

• A child develops subjective fear based on somebody else’s experience without actually undergoing dental treatment himself
• Parents may tell the child about an unpleasant or pain-producing situation undergone by them and this fear may be retained in the child’s mind

Question 7. Communication.

Answer:

Basic ways of communication are

1. Verbal communication:

• It is through conversation
• By involving the child in a conversation
• It is best initiated for younger children with com elementary comments followed by questions that elicit an answer other than yes or no

2. Nonverbal communication:

• Body contact is form of it
• The act of placing a hand over the child’s shoulder while sitting on a chair side stool conveys a feeling of warmth and friendship
• Sitting and speaking at eye level allows for friendlier and less authoritative communication

Psychological Development And Behaviour Management Viva Voce

1. Oedipus complex describes the desire in young boys to have sexual relations with the mother
2. Electra complex describes the development of attrac¬tion in young girls towards their father
3. Fear is a reaction to a known danger
4. Anxiety is a reaction to unknown danger
5. Chloralhydrate is an extremely well-known and widely used drug for conscious sedation
6. Head positioner and forearm body support are restraints in uncooperative patients
7. Dose of 40% N₂O + 60% O₂ is commonly used for sedation
8. Joseph Wolpe proposed desensitization

Developing Dentition And Its Disturbances Important Notes

1. Developmental disturbances affecting the shape of teeth

2. Developmental disturbances affecting the size of teeth

3. Developmental disturbances in the number of teeth

4. Developmental disturbances affecting the structure of teeth

• Amelogenesis imperfecta
  • It is a disorder of enamel formation
  • Stages
    • Stage 1 – Hypoplastic type
    • Stage 2 – Hypomaturation type
    • Stage 3 – hypo calcification type
    • Stage 4 – Hypomaturation, Hypoplastic type
  • Dentinogenesis imperfecta
    • It is an inherited disorder of dentin formation characterized by excessive formation of defective dentin
    • Types
      • Type 1 – associated with osteogenesis imperfecta
      • Type 2 – without osteogenesis imperfecta
      • Type 3 – Bradywine type
• Dentin dysplasia
  • It is an autosomal dominant inherited disorder causing defective dentin formation
  • Types
    • Type 1 – affects radicular dentin
    • Type 2 – affects coronal dentin

5. Enamel hypoplasia

• It is the incomplete or defective formation of the organic enamel matrix of teeth
• Types

6. Syndromes

Developing Dentition And Its Disturbances Short Essays

Question 1. Teething.

Answer:

• It means, in common terms, the eruption of primary dentition.
• Eruption of primary dentition begins in the 5th – 6th month of a child’s life.

Clinical Features:

• Local Features:
  • Hypermia overlying erupting teeth.
  • Flashing in the skin of the adjacent cheek.
• General Features:
  • Irritability
  • Crying
  • Loss of appetite
  • Sleeplessness
  • Increased salivation
  • Increased thirst
  • Cough
• Systemic Problems:
  • Fever
  • Diarrhea
  • Vomiting
  • Cholera
  • Infantile paralysis
• Local Problems:
  • Eruption hematoma
  • Eruption sequestrum
  • Ectopic eruption
  • Transposition

Management:

• Preventive Measures:
  • Maintain the child’s oral hygiene.
  • Wiping the gums with cotton soaked in antiseptic.
  • Balanced diet/Nutritious diet.
• General Measures:
  • Use of teething objects
    • Toasted bread
    • Hard fruits
    • Teething necklaces
    • Pacifiers
• Medical Management:
• Topical application of glycerine, benzoyl alcohol.
• Use of mild purgatives.
• Use of soluble acetylsalicylic acid tablets
• In homeopathy, use of Chamomilla.

Question 2. Local and Systemic causes of delayed eruption.

Answer:

1. Local Causes:

• Aberrant tooth position
• Lack of space
• Early loss of deciduous
• Ectopic eruption
• Congenital anomalies
• Ankylosis of teeth
• Retained teeth
• Supernumerary
• Tumour
• Cyst
• Abnormal habit

2. Systemic Causes:

• Hypopituitarism
• Hypothyroidism
• Hypovitaminosis
• Cleidocranial dysostosis
• Achondroplasia
• Osteopetrosis
• Down’s syndrome
• Amelogenesis imperfecta

Question 3. Natal and Neonatal Teeth / Precociously Erupted Teeth.

Answer:

• Natal teeth are those teeth which are present at birth.
• Neonatal teeth are those teeth which erupt during the first 30 days.
• The prevalence of natal and neonatal teeth is very less.
• About 85% are mandibular primary incisors.
• They always occur in pairs.

Etiology:

• Disturbances in the position of the tooth germ.
• Febrile incidence affecting the increased rate of eruption.
• Hormonal stimulation.
• Hereditary
• Syndrome associated

Incidence:

• The teeth affected are:
  • 85% – mandibular incisors
  • 11% – maxillary incisors
  • 3% – mandibular cuspids
  • 1% – maxillary cuspids

Question 4. Causes of Enamel Hypoplasia.

Answer:

1. Focal Enamel hypoplasia

• It occurs either due to the spread of infection from deciduous teeth or trauma to deciduous teeth.
• This causes damage to the ameloblast cells forming the crown of the underlying permanent successor.

2. Generalised Enamel Hypoplasia

1. Nutritional Deficiency:

• Deficiency of Vitamin A, C, and D often causes injury to the ameloblast cells.
• Hypocalcemia secondary to Vitamin D deficiency.

2. Systemic Conditions:

• Childhood infections
• Rickets
• Congenital hypoparathyroidism
• Birth injuries that cause transient cessation of ameloblastic activity
• Children of low birth weight exhibit enamel hypoplasia resulting from oxygen and mineral depletion to the ameloblast cells.
• Mottling, a type of enamel hypoplasia, is produced due to fluoride toxicity.

Question 5. Supernumerary Teeth.

Answer:

The presence of any extra tooth in the dental arch in addition to the normal series of teeth is called a supernumerary tooth.

Location:

• They can occur in any location.
• These are common in the maxilla.

Types:

• Mesiodens – Located between two upper central incisors.
• Distomolars – Located on the distal aspect of regular molar teeth.
• Paramolars – These are extra molar teeth, which are usually located either in the buccal or lingual aspect of normal molars.
• Extra lateral incisors – Common in the maxillary arch.

Features:

• They may be either single or multiple in numbers.
• They are either erupted or impacted.

Effects:

• Supernumerary teeth may produce crowding.
• These are directly/indirectly responsible for increased caries incidence and periodontal problems.
• Multiple supernumerary teeth occur due to syn¬dromes.
• Impacted supernumerary teeth are associated with cyst-like dentigerous cysts.

Treatments:

• Nonfunctional supernumerary teeth need to be extracted.

Question 6. Pulp Stones.

Answer:

These are nodular calcified bodies having an organic matrix and they occur frequently in relation to the coronal pulp.

Types:

1. True Pulp Stones:

• Composed of predominantly dentin and have dentinal tubules.

2. False Pulp Stones:

• They are composed of concentric layers of calcified material.

According to their location

1. Free Pulp Stones:

• These are surrounded on all sides by pulpal tissue.
• They are not attached to the dentinal wall.

2. Attached Pulp Stones:

• These are attached to the dentinal wall of the pulp chamber.

3. Interstitial Pulp Stones:

• These are surrounded by reactionary or secondary dentin.

Associated Symptoms:

• The affected tooth is vital.
• Mild, neurologic pain is present.

Significance:

• The presence of pulp stones may cause difficulties during endodontic treatment.

Question 7. Amelogenesis is imperfect.

Answer:

• Amelogenesis imperfecta is a developmental defect of the enamel with a heterogenous etiology that affects the enamel of both the primary and permanent dentition

Etiology

• Genetic mutation
• It is an autosomal dominant trait

Clinical Features:

• It has a wide range of clinical appearance
• Enamel appears pitted with horizontal and vertical ridges
• There is defective maturation of the crystal structure
• Affected teeth are mottled, and opaque with white brown-yellowish discoloration
• They have enlarged pulp chambers

Types

• Hypocalcified type
• Hypomaturation type
• Hypoplastic type

Treatment:

• Veneering or capping of teeth

Question 8. Down’s Syndrome/ Trisomy 21

Answer:

• It may occur due to trisomy of chromosome 21

Predisposing Factors:

• Advanced maternal age.
• Placental abnormalities

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• Chromosomal aberration.

Features:

1. General:

• Skull:
  • Brachycephalic skull
  • Presence of a third fontanelle
  • Flat nasal bridges
• Eye-Oblique palpebral fissures:
  • Cataracts, scanty eyelashes
• Neck:
  • Short and broad
• Hands:
  • Broad and short
  • Multiple loops on fingertips.
• Muscles and joints:
  • Hypotonicity and hyperextensibility.

2. Oral Manifestation

• Mouth
  • Open mouth
  • Drooling of saliva
• Tongue
  • Fissured tongue, macroglossia
• Lip
  • Dry, fissured
• Occlusion
  • Anterior open bite
• Palate
  • The high palate, clefts, bifid uvula
• Teeth
  • Retarded eruption
  • Hypodontia, microdontia
  •  Low incidence of caries
• Periodontium
  • Poor oral hygiene
  • Impaired phagocytosis

Developing Dentition And Its Disturbances Short Answers

Question 1. Ectopic Eruption.

Answer:

• The direction of the improper eruption of the permanent tooth can be termed as ectopic eruption.

Effect:

• It causes resorption of the primary tooth.
• Commonly Affected Teeth:
• Maxillary first permanent molar
• Mandibular anterior teeth

Question 2. Dilaceration.

Answer:

• Definition: It is an abnormal angulation or bends in the root of a tooth.

Etiology:

• An injury displacing the calcified form of the tooth germ.
• Secondary to the presence of a pathological condition.

Common Site:

• Dilaceration is commonly seen in the permanent maxillary incisors.

Question 3. Gemination and fusion.

Answer:

Question 4. Talon’s Cusp.

Answer:

• It refers to an accessory cusp-like structure projecting from the cingulum area of the maxillary or mandibular anterior teeth.

Etiology:

• It occurs as an outward folding of inner enamel epithelial cells and transient focal hyperplasia of the peripheral cells.

Features:

• It projects from the palatal surface of teeth and extends up to the incisal edge.
• In some cases, they are quite sharp while others have rounded and smooth tips.

Question 5. Taurodontism.

Answer:

• It is an abnormal enlargement of the body and pulp chamber of a multirooted tooth that leads to apical displacement of the pulpal floor.

Etiology:

• Hereditary
• Defect in the functioning of Hertwig’s epithelial root sheath.

Features:

• The commonly affected tooth is the third molar.
• It may be unilateral or bilateral.
• The tooth has short roots with an elongated pulp chamber.
• It lacks cervical constriction.

Question 6. Mammelons.

Answer:

It is any of the three rounded protuberances found on the incisal edges

• They occur on the newly erupted incisor.
• They are only present on permanent incisors.
• Soon after eruption, they are worn down by use.

Question 7. Premature loss of deciduous teeth.

Answer:

It refers to the loss of a tooth before its permanent successor is sufficiently advanced in development and eruption to occupy its place.

• Early loss of deciduous teeth can cause migration of adjacent teeth into the space.
• This prevents the eruption of the permanent successor.
• This further leads to malocclusion.
• For example:
  • Loss of a deciduous second molar can cause a forward shift of the permanent first molar.
  • This blocks the eruption of the second premolar which results in its impaction or deflection to an abnormal position.

Question 8. Retained Deciduous Teeth.

Answer:

• It refers to a condition where there is undue retention of deciduous teeth beyond the usual eruption age of their successor.
• This prevents the normal eruption of its successor.
• Prolonged retention of deciduous anterior results in lingual/palatal eruption of their permanent successors.
• Prolonged retention of buccal teeth results in buccal/lingual eruption of their permanent succes¬sors/their impaction.

Etiology:

• Absence of underlying permanent teeth.
• Hypothyroidism.
• Ankylosed deciduous teeth.
• Non-vital deciduous teeth.

Question 9. Ankylosis.

Answer:

• It is a condition wherein a part/whole of the root surface is directly fused to the bone with the absence of the periodontal membrane.

Etiology:

• Trauma to the tooth perforates the periodontal membrane.
• Certain infections.
• Endocrinal disorders.
• Congenital disorders.

Question 10. Eruption Sequence.

Answer:

1. Deciduous Teeth

• They erupt around 6-7 months of age
• Primary dentition is usually established by 3 years of age.
• Sequence is A-B-D-C-E

2. Permanent Teeth

• They may exhibit variation
• Frequently seen a sequence of eruptions is:
• 6-1-2-4-3-5-7  or 6-1-2-3-4-5-7

Question 11. Submerged Teeth.

Answer:

• Teeth that is located below the occlusal plane of the rest of the teeth in the arch.
• Commonly affected teeth are deciduous teeth.
• If the permanent teeth have erupted, it locks the sub-merged deciduous molar which usually becomes ankylosed.
• If the permanent teeth has not yet erupted, it gets impacted or may erupt buccally/lingually.
• A submerged tooth occurs because of the congenital absence of an underlying tooth.

Question 12. Turner’s Tooth.

Answer:

• In case of infections affecting the deciduous teeth, it spreads to the crown of underlying permanent teeth by affecting the ameloblast cells.
• Such an affected tooth is called “Turner’s Tooth”

Types: Depending on the severity of injury:

• Mild injury – Results in pitted areas on the enamel surface.
• Severe injury – Results in yellowish/ brownish discoloration of the surface.

Question 13. External Root Resorption.

Answer:

Pathological resorption initiated on the root/external surface of the tooth is called external root resorption.

Causes:

• Periapical inflammation.
• Reimplanted teeth.
• Impacted teeth.
• Cysts/Tumour
• Excessive occlusal forces

Effect:

• Nonvital tooth
• Teeth is easily fractured.

Question 14. Turner’s syndrome.

Answer:

It is caused by missing X chromosome

Clinical Features:

• Heart-shaped facies
• Prominent ears
• Webbing of posterior neck
• Low posterior hairline
• Congenital lymphedema
• Broad chest
• Hypogonadism
• Short stature
• Auditory defects
• Amenorrhea
• Sparse pubic hair
• Hypoplastic nails
• Pigmented nevi

Question 15. Microdontia.

Answer:

It refers to the teeth that are smaller than normal

Types:

1. Truly generalized microdontia

• All teeth are smaller than normal

2. Relative generalized microdontia

• Normal or slightly smaller than normal

3. Microdontia affecting a single tooth

• It affects the maxillary lateral incisor and third molar

Treatment:

• No specific treatment is indicated

Question 17. Riga feds disease.

Answer:

• In 1881 and 1890 Riga and Fede described this lesion
• Hence it is known as the Riga-Fede disease
• It is one of the complications of the natal teeth
• In this condition laceration, traumatic ulceration of the ventral surface of the tongue, and frenulum of the lip due to the sharp incisal edge of the natal teeth are seen
• The more appropriate and descriptive term is neonatal sublingual traumatic ulceration

Treatment:

• Teeth may have to be removed
• Inflamed tissue around teeth should be controlled by applying chlorhexidine gluconate gel three times a day

Question 18. Munchausen syndrome by Proxy.

Answer:

• In Munchausen syndrome by proxy, children below 6 years of age and too young to reveal the deception exhibit parentally fabricated or induced illness

Clinical Features:

• Bleeding from various sites
• Recurrent sepsis from injecting contaminated fluids
• Chronic diarrhea from laxatives
• Fever from rubbing or heating thermometers
• Rashes from rubbing the skin or applying caustic substances

Question 19. Fusion

Answer:

• Fusion arises through the union of two normally separated tooth germs
• Depending upon the stage of development of the teeth at the time of the union, fusion may be either complete or incomplete
• It may occur between a normal tooth and a supernumerary teeth
• Associated with spacing and periodontal conditions

Question 20. Dens invaginatus

Answer:

• It refers to folding or invaginatus on the surface of the tooth towards the pulp before calcification of the tooth

Types:

1. Coronal type

• In it invagination occurs on the crown portion of the tooth
  • Type 1 – invagination occurs within the crown of the tooth
  • Type 2 – invagination extends below center- name junction
  • Type 3 – invagination extends through the root

2. Radicular type

• Invagination occurs in the root portion of teeth

Clinical Forms

• Mild
• Intermediate
• Extreme

Significance

• Susceptible to
• Caries
• Pulpitis
• Pulp necrosis
• Periapical cyst
• Periapical abscess

Developing Dentition And Its Disturbances Viva Voce

1. The eruption sequence of primary dentition is ABDCE
2. The eruption sequence of permanent dentition is 6124357 or 6123457
3. Natal teeth are teeth present at birth
4. Neonatal teeth are seen within the first 30 days of birth
5. The most common complication of natal teeth is Riga- Fede disease
6. Fusion is the joining of two tooth buds
7. Concrescence is the joining of two teeth by cementum
8. Dentinogenesis imperfect is an autosomal dominant trait
9. Dentin dysplasia is characterized as rootless teeth

Development Of Dentition

Definitions

• Primate spaces/ Simian spaces / Anthropoid spaces
  • These are spaces present mesial to the maxillary canines and distal to the mandibular canines
• Incisal liability
  • The difference between the amount of space needed for the accommodation of incisors and the amount of space available is called incisal liability.
• Leeway space of Nance
  • The differences between the combined mesiodistal width of deciduous canine and molars to the combined mesiodistal width of permanent canine and premolar is called the leeway space of Nance

Development Of Dentition Important Notes

1. Gum pads

• These are alveolar processes present at the time of birth
• They are developed in two parts – labiobuccal and lingual portion
• Both parts are separated by a dental groove
• Gum pads are divided into 10 segments by a transverse groove
• The groove between the canine and first deciduous molar called lateral sulci determines inter arch relationship.

2. Shift of lower molars from flush terminal plane to Class 1 occurs by

• Early shift – by utilizing primate spaces
• Late shift – by utilizing leeway space

3. Eruption sequence of deciduous teeth

• Lower central incisor
• Upper central incisor
• Lower lateral incisor
• Upper lateral incisor
• First molars
• Canines
• Second molars

4. Incisal liability values

• Mandibular arch – 5 mm

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• Maxillary arch – 7 mm

5. Leeway space values

• Mandibular arch – 3.4 mm
• Maxillary arch – 1.8 mm

Development Of Dentition Short Essay

Question 1. Gumpads.

Answer:

• The alveolar processes at the time of birth are known as gum pads.
• They are pink, and firm.
• These are covered by a dense layer of fibrous periosteum.
  • Shape: They are horse-shoe-shaped.
  • Portions:
  • Gumpads divide into the labio-buccal portion and the lingual portion by a dental groove.
  • Gumpads are divided into ten segments by certain grooves called transverse grooves
  • Transverse groove between the canine and the first deciduous molar segment is called the lateral sulcus which helps in the assessment of interarch relationship.

Upper and Lower Gumpads:

• Upper gum pads is wider and longer.
• When both are approximated contact occurs in the first molar region and a space exists in the anterior region.
• This space helps in suckling.

Question 2. Terminal Plane/ Molar relationship

Answer:

The mesial-distal relation between the distal surfaces of upper and lower second deciduous molars is called the terminal plane.

Types:

1. Flush Terminal Plane:

• Here, the distal surfaces of the upper and lower second deciduous molars are in the same vertical plane.
• It is a normal feature.

2. Mesial Step:

• In this type, the distal surface of the lower second deciduous molar is more mesial to the distal surface of the upper second deciduous molar.
• Thus the permanent molars erupt directly into Angle’s class 1 occlusion.

3. Distal Step:

• Here the distal surface of the lower second deciduous molar is more distal to the distal surface of the upper second deciduous molar.
• Thus the erupting permanent molar may be in Angle’s Class 2 occlusion.

Question 3. Primate Spaces.

Answer:

• The spacing usually occurs in deciduous dentition.
• It is important for the normal development of dentition.
• The absence of these spaces leads to the crowding of teeth after the eruption of permanent teeth.
• It helps in the placement of canine cusps of opposing arches.

Site:

• Mesial to the maxillary canines.
• Distal to the mandibular canines.

Synonyms:

• Physiological space.
• Developmental space.

Question 4. Early and Late Mesial Shift.

Answer:

The shift in a lower molar from a flush terminal plane to a Class 1 relation can occur in 2 ways:

1. Early Shift:

• The forward movement of the first permanent molar utilizing the primate space is called early shift.
• The eruptive force of the first permanent molar pushes the deciduous first and second molars forward in the arch to close the primate space and thereby establish a Class 1 molar relationship.

2. Late Shift:

• Occurs in the late mixed dentition period.
• When the deciduous second molars exfoliate the permanent 1st molars drift mesially utilizing the leeway space.
• This is called a late shift.

Question5. Self-Correcting Anomalies.
(Or)
Transient malocclusions

Answer:

Question 6. Eruption and shedding sequence of primary teeth

Answer:

Eruption:

• The eruption was used to denote the tooth’s emergence through the gingiva
• Then, it become more completely defined to mean con- tenuous tooth movement from the dental bud to occlusal contact
• The order of eruption of deciduous teeth is as follows
  • Lower central incisor
  • Upper central incisor
  • Lower lateral incisor
  • Upper lateral incisor
  • First molars
  • Canines
  • Second molars

Shedding

• The physiologic process results when disturbances in the form, color, arrangement, and structure of the teeth might have occurred
• The first sign is seen in deciduous central incisors and first molars by the age of 4-5 years
• Resorption of incisors begins primarily on the lingual side while that of molars starts from the inner surfaces of the developing permanent tooth germ

Development Of Dentition Short Answers

Question 1. Late mesial shift.

Answer:

• Occurs in the late mixed dentition period.
• When the deciduous second molars exfoliate the permanent 1st molars drift mesially utilizing the leeway space.
• This is called late shift.

Question 2. Features of primary dentition.

Answer:

• Both the dental arches are half-round in shape or ovoid
• Almost no curve of Spee is present
• Shallow cuspal interdigitation
• Slight over jet
• Deep bite
• The vertical inclination of the incisors
• Spaced dentition
• Different maxillo-mandibular relations like flush, mesial, and distal terminal planes

Question 3. Ugly Duckling Stage./ Broadbent phenomenon.

Answer:

• Given by Broadbent.
• It is a transient malocclusion seen in the maxillary incisor region between 8-9 years of age.
• This is seen during the eruption of the permanent canine.
• As the developing permanent canine erupts, they displace the roots of the lateral incisors mesially.
• This transmits the forces onto the roots of the central incisor which is also displaced mesially.
• This results in midline spacing.
• This situation is so named as the child looks ugly.
• This corrects itself when the pressure is transferred from the roots to the coronal area of the incisors.

Question 4. Leeway Space of Nance.

Answer:

• The combined mesiodistal width of the permanent canines and premolars is usually less than that of the deciduous canines and molars.
• This space is called the Leeway space of Nance.

Value:

• It is greater in the mandibular arch.
• It is 1.8 mm in the maxillary arch and 3.4 mm in the mandibular arch.

Significance:

• This space is utilized for mesial drift of the mandibular molars to establish Class 1 molar relation.

Question 5. incisal Liability.

Answer:

• Permanent incisors replace deciduous incisors.
• Permanent incisors are larger ones.
• The difference between the amount of space needed for the accommodation of the permanent incisors and the place available for it is called incisal liability.

Value:

• It is a 5 mm in the mandibular arch and 7 mm in the maxillary arch.
• It is overcome by:
  • Utilization of physiologic spaces.
  • Increase in inter-canine width
  • Change in incisor inclination.

Question 6. Growth Spurts.

Answer:

• A sudden increase in growth is called a growth spurt.
• It is different for boys and girls.
• It is believed due to hormonal secretion.

Timings:

• Just before birth
• One year after birth
• Mixed dentition
  • Boys: 8-11 years
  • Girls: 7-9 years
• Adolescent growth spurt
  • Boys: 14-16 years
  • Girls: 11-13 years

Question 7. Food guide pyramid

Answer:

• It is a pyramid-shaped guide of healthy foods divided into sections to show the recommended intake for each food group
• The first food guide pyramid was published in Sweden in 1974.

Question 8. Molar incisor hypomineralization

Answer:

• Molar Incisor Hypomineralisation is a type of enamel defect affecting the first molars and incisors in the permanent dentition.
• It usually occurs in children under 10 years old.
• It is caused by the lack of mineralization of enamel during its maturation phase, due to interruption to the function of ameloblasts.

Features:

• MIH often presents as discoloration on one to four affected permanent molars and the associated incisors.
• The enamel of the affected teeth appears yellow, brown, cream or white and thus are sometimes referred to as ‘cheese molars’.
• There is a difference in enamel translucency in the affected teeth
• The development of tooth decay is very rapid due to the less mineralised enamel
• MIH only becomes visible once the permanent molars start to erupt

Etiology:

• Children born preterm and those with poor general health or systemic conditions in their first 3 years
• Environmental changes
• Exposure to dioxin by prolonged breast-feeding could lead to an increase in the risk of MIH
• Respiratory diseases and oxygen shortage of the ameloblasts
• Oxygen shortage combined with low birth weight

Development Of Dentition Viva Voce

1. Primate spaces help in the placement of canine cusps of the opposing arch.
2. Initiation of primary dentition occurs in 6 weeks of IU life
3. Broadbent coined the term ugly duckling stage
4. Mandibular central incisors is first tooth to erupt in primary dentition
5. Nance determined the leeway space
6. The ugly duckling stage is seen between 8-9 years

Growth And Development

Definition

1. Growth

• According to Todd, growth refers to an increase in size

2. Development

• It is naturally occurring unidirectional changes in the life of an individual from its existence as a single cell to its elaboration as a multifactorial unit terminating in death

Growth And Development Important Notes

1. Growth Theories

• Genetic theory by Brodie
  • Proposed that genes control all the factors of growth and development
• Sutural theory by Sicher
  • Proposed that sutures cause most of craniofacial growth
• Cartilaginous theory by Scott
  • It states that the determinant of craniofacial growth is by the growth of cartilage
• Functional matrix theory by Melvin Moss
  • It is divided into a functional matrix and a skeletal unit
• Van Utnborg concept
  • Suggested five factors that control growth
    • Intrinsic genetic factors
    • Local epigenetic factors
    • General epigenetic factors
    • Local environmental factors
    • General environmental factors

2. Functional matrix theory

• Functional matrix
  • It consists of teeth, organs, glands, muscles, nerves, and vessels
  • It is divided into
    • Periosteal matrix
    • All nonskeletal units adjacent to skeletal units
• Capsular matrix
  • Neurocranial capsule – sandwiched between skin and dura mater
  • Orofacial capsule – surrounds and protects or nasopharyngeal space
• Skeletal unit
  • Comprised of bone, cartilage or tendon
  • It consists of micro skeletal unit and macro skeletal unit

Growth And Development Short Essays

Question 1. Functional matrix theory.

Answer:

• Melvin Moss combined sutural theory and cartilaginous theory and introduced this concept

Hypothesis:

• It claims that the origin, form, position, growth, and maintenance of all skeletal tissues and organs are always secondary, compensatory, and necessary responses to chronologically and morphologically prior events or processes that occur in specifically related non-skeletal tissues, organs or functioning spaces

Components:

• Skeletal Unit
• Microskeletal
• Macroskeletal

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• Functional Matrix
• Periosteal Matrices
• Capsular Matrices

Skeletal Unit:

• All skeletal tissues associated with a single function are called the skeletal unit
• When a bone is comprised of several contagious skeletal units, it is termed as “Micro skeletal unit” Example. Maxilla, Mandible
• When adjoining portions of a number of neighboring bones are united to function as a single cranial component, termed as “Macro skeletal unit” Example. Calvarium

Functional matrix:

• Consists of muscle, glands, nerves, vessels, fat, teeth, and functional spaces
• Divided into
  • Periosteal matrices

Acts directly and act upon skeletal units
↓
Transformation in their size and shape
↓
Resulted due to bone deposition and resorption

• • Capsular matrices
    • Acts indirectly and passively on bone
    • Expansion of capsule
    • Results growth of bones within it
    • Example. Growth of facial bones due to the expansion of the oro-facial capsule

Question 2. Scammon’s Growth Curve.

Answer:

It indicates that the growth of different tissues are different at different age.

Body tissues are classified into 4 types:

1. Lymphoid tissue:

• It proliferates rapidly in late childhood and reaches 200% of adult size
• It is for the protection of children against infection
• At the age of 18, this tissue undergoes involution.

2. Neural tissue:

• It grows very rapidly and reaches adult size by 6-7 years of age.
• Later very little growth occurs.
• This facilitates the intake of further knowledge.

3. General tissue:

• This exhibit an “S” shaped curve.
• Rapid growth occurs up to 2-3 years of age.
• This is followed by a slow growth between 3-10 years.
• After the tenth year, a rapid phase occurs up to 18-20th years.

4. Genital tissue:

• It consists of reproductive organs
• They show negligible growth until puberty
• They grow rapidly at puberty reaching adult size

Growth And Development Viva Voce

1. Functional matrix theory by Malvin Moss explains the origin, form, position, growth, and maintenance of all skeletal tissues and organs
2. Van Limb org’s theory emphasizes on five factors that control growth i.e. intrinsic genetic factors, local and general epigenetic factors, and local and genetic environmental factors
3. Chondro-cranial growth is mainly controlled by intrinsic genetic factors
4. Sutural and periosteal growth is governed by non genetic environmental factors

Practice Management Short Essays

Question 1. Pediatric Practice Management.

Answer:

1. Office:

• Reception Area:
  • Educated receptionist
  • The receptionist should offer correct information in a friendly manner in response to the inquiries.
  • Should speak clearly in a well-modulated tone.
  • Should converse in an efficient manner.
  • The area should have an attractive And comfortable environment.
  • Neutral colors should be applied on the walls.
  • Decorate with posters related to circus, and nursery rhymes to relieve fear And anxiety.
  • An aquarium is placed.
  • Soothing, muffled music is played.
  • Attractive books And toys for children should be available.
• Appointment Schedules:
• • Scheduling must be efficiently maintained by the receptionist
  • Scheduling must be according to the patient’s And parent’s comfort.
  • Morning appointments are preferable as the child will be fresh And active.
  • Length of the appointment should be as short as possible.
  • Longer appointments should be scheduled first.

2. Ancillary Personnel:

• Assistant is extremely important.
• It decreases the length of dental appointments.
• Results in less fatigue to the dentist.

3. Administration:

• Fees must be revised.
• It must be according to:
• Work load on the dentist
• Annual production hours
• Working days per year

4. Infection Control Measures:

• Personal protective measures for the dental personnel for protection against cross infection.

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• Sterilization of instruments.

5. Clinical Maintenance:

• Ventilated clinic.
• The clinic must be constructed farther from the noisy And polluted environment but the same time it must be easily reachable by the patients.

6. Extra Room:

• Health Education room
  • Oral hygiene instructions are given
  • Dietary counseling given
• Consultation room
  • For providing detailed information And a review of major diagnosis.
  • It should not exceed more than 45 minutes.

Question 2. Discuss the child’s first visit to the pedodontic clinic.
(or)
Question 2. Describe management of the child in the dental office.

Answer:

Steps In Management Of Child:

• Assess the oral health of the child.
• Inquire/Record the medical, dental, And family history of the patient.
• The patient is made to rest in a supine position with legs slightly elevated.
• The Assistant’s arm is held slightly above the child’s chest.
• Dentist operates in a sitting position on a comfortable stool.
• All instruments are placed near the dentist but far from the sight of patient.
• Everything needed for any specific procedure should be within easy reach without leaving the chair.
• All instruments are handed to And removed from the dentist’s hand by the assistant called “four-handed dentistry”.

Procedure:

• Emergency procedures are carried out to relieve pain And infection.
• Introduction of preventive plaque control program.
• Restorative therapy is started at the third visit
• Next orthodontic Andprosthodontic care is done.
• Recall for any further complicated procedures.

Question 3. Setup of pedodontics clinic

Answer:

• A dental office serving pediatric dental practitioners should consider the age range of the patients using the facilities
• An attractive and comfortable environment should be designed for both children and parents
• Neutral colors such as beige or light shades of green or blue for the wall decor promote a tranquil feeling and permit the use of attractive colored accessories
• Decorations depicting definite settings such as circus, outer space or nursery rhymes add to the warmth and fantasy of the office and tend to dispel fear
• An aquarium is always a source of entertainment and may be placed either in the reception room or in the treatment room
• Soothing, muffle music in the reception room has a comforting effect on both the parent as well as the patient
• Children are attracted to toys and comic books
• Selected toys, building blocks and wall-attached activity centers have proved to be the main attraction for them

Introduction To Pedodontics

Definitions

1. Pediatric Dentistry

• It is an age-defined specialty that provides both primary comprehensive, preventive therapeutic oral health care for infants and children through adolescence, including those with special health care needs

Introduction To Pedodontics Important Notes

1. Pedodontic treatment triangle

• It is based on a one-to-two relationship i.e. dentist-child patient family
• A child is at the apex of the triangle

Introduction To Pedodontics Short Essays

Question 1. Define pedodontics and write about the scope of pedodontics.

Answer:

Definition:

By American Academy of Pediatric Dentistry:

Pediatric Dentistry is an age-defined specialty that provides primary comprehensive, preventive therapeutic oral health care for infants children through adolescence including those with special health care needs.

Scope Of Pedodontics:

• It refers to the range of activities considered in the practice of Pedodontics.

Pedodontics involves:

• Dental needs of the child patient
• Basics in pediatric medicine
• General oral pathology
• Growth development
• Child psychology
• Restoration of carious teeth
• Treatment of dental pulp
• Maintenance of tooth space
• Preventive dentistiy

Present Trends:

• Preventive dentistry
• Public health dentistry
• Child psychology

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• Clinical dentistry
• Preventive interceptive Orthodontics
• Special care dentistry
• Genetics

Forensic Pedodontics:

Introduction To Pedodontics Short Answers

Question 1. Pedodontics Treatment Triangle.

Answer:

• Given by Wright in 1975.
• It describe the difference between child adult patient.

• The child is at the apex of the triangle.
• The ratio is 1:2 in child patients.
• Dentists have to communicate with patients as well as the child’s parents.
• It is a two-way conversation i.e.
  • Dentists communicate with patients, and patients communicate with the dentist
  • Children communicate with parents, and parents communicate with the child
  • Parents communicate with the dentist, dentist communicates with a parent.
• In the modified pedodontics triangle, society is placed in the center.

Question 2. Maintenance Phase.

Answer:

Depending on oral hygiene status 3-6 months recall visit is planned.

It is for the following:

• Evaluating oral health status of patient.
• Carry out caries activity test.
• Oral hygiene instructions are given.
• Parent re-counseling.
• Followup procedures

Introduction To Pedodontics Viva Voce

1. Robert Bunon is a father of pedodontics