Pedodontics

• Introduction to Pedodontics Question and Answers
• Practice Management Question and Answers
• Growth & Development Question and Answers
• Development of Dentition Question and Answers
• Development Dentition & Its Disturbances Question and Answers
• Phychological Development & Behaviour Management Question and Answers
• Dental Caries Question and Answers
• Preventive Approach to Caries Control Question and Answers
• Fluorides Question and Answers
• Pediatric Restorative Dentistry Question and Answers
• Pediatric Endodontics Question and Answers
• Malocclusions Question and Answers
• Pediatric Consideration for Oral Surgery Question and Answers
• Dental Care for the Special Child Question and Answers
• Hard and Spot Tissue Oral Lesions in Children Question and Answers
• Pedodontics Miscellaneous Question and Answers

Miscellaneous Short Essays

Question 1. Young Permanent Teeth.
Answer:

Young Permanent Teeth Characteristics:

• Less convergence of buccal and lingual surfaces
• Curved occlusal surface
• Enamel thickness is more i.e. 2-3 mm
• Larger in dimension
• Enamel rods are oriented gingivally
• Bulbous roots
• Smaller pulp chamber
• Less degree of pulpal cellularity and vascularity
• Restricted apical foramen
• Localized infection

Young Permanent Teeth Importance:

• Erupts at the age of 5-6 years
• Defects in enamel formation
• Susceptible to plaque accumulation
• Deep pit and fissures
• Irregular enamel rods
• Need of fluoride application

Question 2. Dental HOME.
Answer:

Introduced by Nowak

Dental HOME Features:

• Acceptability
• Family-centered
• Continuous
• Comprehensive
• Co-ordinated
• Compassionate
• Culturally competent

Dental HOME Advantages:

• Early intervention
• Create awareness among parents
• Create positive attitude in children since 1st year of his life
• Emphasizes on preventive approaches

Question 3. Dental Health Education.
Answer:

• It is a process that informs, motivates, and helps people to adopt and maintain healthy practices and lifestyles, advocate environmental changes as needed, to facilitate the goal, and conduct professional training and research.

Dental Health Education Contents:

• Human biology
• Nutrition
• Hygiene
• Family health care
• Control of diseases

Read And Learn More: Pedodontics Short Essays Question And Answers

• Mental health
• Prevention of accidents
• Use of health services

Dental Health Education Ways:

• Audio-visual aids
• Individual approach
• Group discussion
• Lectures
• Workshops
• Panel discussion
• Dramas
• Seminars
• Mass approach

Question 4. Morphological differences between primary and permanent dentition.
Answer:

Question 5. Cleft lip and palate.
Answer:

Cleft lip and palate Classification:

• • Davis and Ritchie Classification:
    • Group 1 – Prealveolar clefts – Involves only lip
    • Group 2 – Post alveolar clefts
    • Involves palate and alveolar ridge
    • Group 3 – Alveolar clefts
    • Involves the palate alveolar ridge and lip
  • Veau’s Classification (1931):
    • Group 1 – Involves only soft palate
    • Group 2 – Involves palate up to incisive foramen
    • Group 3 – Involves palate, lip, and alveolar ridge unilaterally
    • Group 4 – Involves palate, lip, and alveolar ridge bilaterally
  • Kernahan’s Stripped Y’ Classification:
    • Block 1 and 6 – Lip
    • Block 2 and 5 – Alveolus
    • Block 3 and 4 – Hard palate anterior to incisive foramen
    • Block 7 and 8 – Hard palate posterior to the incisive foramen
  • Lahshal Classification:
    • L- Lip
    • A-Alveolus
    • H – Hard palate
    • S – Soft palate
    • H – Hard palate
    • A-Alveolus
    • L – Lip

Cleft lip and palate Treatment:

• The cleft palate is treated at different stages

1. Birth-Initial assessment:

• Pre-surgical orthopedics
• It is done by extra-oral strapping across the pre-maxilla
  • 3 months – Primary lip repair
  • 9-18 months – Palate repair
  • 2 years – Speech assessment
  • 3-5 years – Lip revisional surgery
  • 8-9 years – Initial interventional orthodontics
  • 10 years – Alveolar bone grafts
  • 12-14 years – Definitive orthodontics
  • 16 years – Nasal revisional surgery
  • 17-20 years – Orthognathic surgery

Question 6. Infant oral health care.
Answer:

• Infant oral health care is a foundation on which a lifetime of preventive education and dental care can be built in order to help acquire optimal oral health into childhood and adulthood

Infant oral health care Goals:

• To identify, intercept and modify the potentially harmful parenting practices that may adversely affect the infant’s oral health
• Parent education right from the prenatal period highlights the importance of their role in the prevention of the disease for their child
• Parent orientation to perceive dental services as an integral part of an infant’s overall health program
• Periodic evaluation of the orofacial development and oral health by the clinician

Infant oral health care Significance:

• Infant oral health care is important due to the following reasons
• Infectious diseases of the oral cavity
• Traumatic injuries to the developing dentition
• Habits such as thumb sucking
• Child abuse and neglect
• Care of the alternatively abled children
• Problems of speech and language

Question 7. Prophylactic odontomy.
Answer:

• Prophylactic odontoma was proposed by Hyatt in 1936
• He advocated the placement of small amalgam restorations in pits and fissures of newly erupted teeth before the appearance of clinical signs of decay
• Later when they fully erupt, a small occlusal cavity should be prepared and filled with amalgam
• He recommended eliminating all susceptible fissures by cutting a shallow minimal width class I cavity in the enamel and then filling it with amalgam

Prophylactic odontoma Advantages:

• Small filling, minimal pulpal irritation
• Painless technique

Prophylactic odontoma Disadvantages:

• Use of cutting instruments
• The tooth is always subjected to unnecessary reduction

Question 8. Chronology of permanent dentition.
Answer:

Question 9. Child abuse and neglect
Answer:

1. Child Abuse

• It is defined as the non-accidental physical injury, minimal or fatal, inflicted upon children by persons caring for them
• It is an overt act of commission of a caretaker-physical, emotional or sexual

Child Abuse Types:

• Physical abuse
• Educational abuse
• Emotional abuse
• Sexual abuse
• Failure to thrive
• International drugging or poisoning
• Munchausen syndrome by proxy

2. Neglect

• Neglect is an act of omission or failure to provide food, shelter, clothing, health care, safety need, dental care, and supervision

Neglect Types:

• Emotional neglect
• Health care neglect
• Physical neglect

Question 10. Brushing techniques
Answer:

Miscellaneous Short Answers

Question 1. Anticipatory Guidance.
Answer:

• Introduced by Nowak in 1995
• It is a proactive, developmental^ based counseling technique that focuses on the needs of a child at each stage of life
• Provide insight into the development of a child
• Consider various milestones of dental development
• Make the parents more at ease during a childhood visit
• This prevents many dental problems from occurring

Question 2. Bruxism.
Answer:

• It is a habitual grinding of teeth either during sleep in the night or unconsciously during day time.

Bruxism Causes:

• Occlusal disturbances
• Emotional disturbances
• Occupational

Bruxism Features:

• Attrition of teeth
• Loosening and drifting of teeth
• Gingival recession
• Hypertrophy of muscles
• Sensitivity of teeth
• Facial pain
• Trismus

Bruxism Treatment:

• Use of occlusal splints

Question 3. Horizontal Scrub Brushing Technique.
Answer:

• Position of Bristle – 90° to the tooth surface
• Brushing motion – Horizontal strokes
• Effective in – Supragingival cleansing
• Use – On a regular basis
• Disadvantage – Ineffective in interproximal cleansing

Question 4. Fone’s method of Brushing.
Answer:

• Position of Bristle – 90° to the tooth surface
• Effective in – Supragingival cleansing
• Used in – taught to children by their parents

Fone’s Method of Brushing Technique:

• The child is made to stand in front of the mirror
• Ask the child to make large circles in front of the mirror
• Gradually decrease the size of the circle up to it reaches the oral cavity

Question 5. Electronic/Powered toothbrush.
Answer:

• The head of a powered toothbrush is smaller than that of a manual toothbrush

Electronic Pattern:

• Reciprocating – back-and-forth movement
• Arcuate – up and down movement
• Elliptical – combination

Electronic Uses:

• Parental brushing of children’s teeth
• For physically handicapped patients
• For mentally retarded patients
• Aged patients
• Patients with poor dexterity

Question 6. Disclosing agents.
Answer:

• It is prepared in liquid, tablet or lozenge form that contains a dye or other coloring agent
• It is used to identify bacterial plaque deposits for instruction, evaluation, and research

Disclosing agents Agents Used:

• Iodine containing solutions
• Skinners solution
• Tincture of iodine
• Bismarck Brown
• Merbromin
• Erythrosin
• Fluorescein
• Two-tone

Disclosing agents Purpose:

• Patient’s education
• Self-education
• Evaluating the effectiveness of treatment

Question 7. FDI system.
Answer:

• It is a two-digit system introduced by the federal dentaire international (FDI)

1. For permanent dentition:

• The first digit indicates the quadrant and is num¬bered from 1 to 4
• The second digit indicates the tooth number starting from the central incisor as 1 to the 3rd molar as 8
• Thus
  • 18 17 16 15 14 13 12 11/ 21 22 23 24 25 26 27 28
  • 48 47 46 45 44 43 42 41/ 31 32 33 34 35 36 37 38

2. For primary dentition:

• The first digit indicates the quadrant and is num¬bered from 5 to 8
• The second digit indicates the tooth number starting from the central incisor as 1 to the 2nd molar as 5
• Thus
  • 55 54 53 52 51/61 62 63 64 65
  • 85 84 83 82 81/ 71 72 73 74 75

Question 8. Dentrifices for children.
Answer:

Commonly available kid’s toothpaste in India are

• Kidodent: It contains sodium mono fluorophosphate 0.38% w/w, xylitol, fluoride content 500 ppm
• Bubble: Contains sodium mono fluorophosphate 0.35% w/w, fluoride content 500 ppm
• Initiate: Contains sodium mono fluorophosphate 0.38% w/w, xylitol, fluoride content 500 ppm

Question 9. Bitewing radiograph.
Answer:

• Bitewing films are used to record the crown of maxillary and mandibular teeth in one film
• These are one of the best currently available methods to detect early interproximal caries

Bitewing radiograph Sizes:

• Size 0- For posteriors
• Size 1- For anteriors

Bitewing radiograph Uses:

• They are particularly valuable for detecting inter-proximal caries in the early stages of development
• Visualize the alveolar crest and assessment of periodontal disease in an easier way
• They are especially effective and useful for detecting calculus deposits in interproximal areas
• Useful in periodic check-ups of the teeth for detection of new caries and of early periodontal change

Question 10. MTA.
Answer:

• Mineral trioxide aggregate has been recently recommended as pulp capping agent in primary teeth
• It has been proved that it is better than formocresol

MTA Disadvantages:

• Pulp canal obliteration
• It is costly

Question 11. Mandibular primary first molar.
Answer:

Buccal Aspect:

• It has a straight outline
• The Crown constricts at the cervix
• The distal portion is shorter than the mesial portion
• The mesial cusp is larger than the distal cusp
• Roots are long and slender

Lingual Aspect:

• Crown and root converge lingually
• The distolingual cusp is rounded
• The mesiolingual cusp is long and sharp

Mesial Aspect:

• Mesiolingual and mesiobuccal cusp are seen
• The mesial marginal ridge is well developed

Distal Aspect:

• The distal root is rounded, shorter, and tapers apically

Occlusal Aspect:

• The mesiolingual cusp is largest and well developed
• The buccal developmental groove divided the two buccal cusps
• The central developmental groove separates mesiobuccal and mesiolingual cusps
• Two supplemental grooves are seen

Question 12. SLOB technique.
Answer:

SLOB technique Method:

• Two radiographs are taken
• First one with proper technique and angulation
• The second radiograph is taken by either changing the ver¬tical or horizontal angulation

SLOB technique Interpretation:

• When the dental structure or object seen in the second radiograph appears to have moved in the same direction as the shift of the position-indicating device , the structure is said to be positioned lingually
• If the object appears to have moved in the opposite direction, then the object is said to be positioned buccally
• SLOB rule: Same side Lingual Opposite side Buccal

Question 13. Panoramic radiography.
Answer:

Definition:

• It is a technique for producing a single tomographic image of the facial structures that induce both the maxillary and mandible dental arches and their supporting structures

Panoramic radiography Indications:

• As a substitute for full mouth intraoral periapical radiograph
• For evaluation of tooth development for children, the mixed dentition and also the aged
• For assist and assess the patient for and during orthodontic treatment
• To establish the site and size of lesions
• Prior to any surgical procedures
• For the detection of fractures
• For follow-up of treatment, the progress of pathology or postoperative bony healing
• Investigation of TMJ dysfunction
• To study the antrum
• For an overall view of the alveolar bone levels
• Assessment of underlying bone diseases
• Evaluation of developmental anomalies
• Evaluation of bone level before inserting implants

Panoramic radiography Limitations:

• Areas of diagnostic interest outside the focal trough may be poorly visualized
• Poor diagnostic value in terms of magnification, distor¬tion, loss of details
• There is an overlapping of teeth in the bicuspid area of the maxilla and the mandible
• In cases of pronounced inclination, the anterior teeth are poorly defined
• The density of the spine causes a lack of clarity in the central portion of the film
• Formation of ghost images due to soft tissue shadows and air spaces

Question 14. Personal Protective Equipment.
Answer:

1. Hand washing:

2. Gloves:

• Protects against contamination
• Changed between patients and for the same patient if it is worn/torn

Gloves Types:

• Surgical
• Latex
• Vinyl
• Double gloves for HBV and HIV [Hepatitis B Virus and Human Immunodeficiency Virus]

3. Face masks:

• Protects from inhalation of aerosols
• Prevents spatter from patient’s mouth
• Prevents splashes of contaminated solution
• Changed once per hour/between patients / whenever it becomes moist

4. Protective clothing:

• Reusable/disposable gowns with long sleeves, high neck, and long knee length

5. Eyewear:

• Prevention against Hepatitis B
• Prevent bacterial/viral contact

Question 15. Affected and Infected Dentin.
Answer:

Infected Dentin

• Irreversible denatured collagen
• Infiltrated with bacteria
• Notremineralizable
• Should be removed
• Darker
• Softer
• Lacks sensation
• Indistinct cross bands
• Stained with:
• 0.2% propylene glycol
• 10% acid red solution
• 0.5% basic Fuschia

Affected Dentin:

• Reversible denatured collagen
• Not infiltrated
• Remineralize
• Left
• It is cannot be stained with any solution
• Distinct cross bands sensitive behind
• Harder Lighter while cavity preparation

Question 16. Diffusion hypoxia
Answer:

• When soluble gases like nitrous oxide are breathed in large quantities they can be dissolved in body fluids rapidly
• This can lead to a temporary increase in the concentration of oxygen and carbon dioxide in the alveolus, causing an increase in their respective partial pressures
• When a patient is recovering from nitrous oxide sedation large quantities of the gas cross from the blood into the alveolus
• Thus for a short period of time, the oxygen and carbon dioxide in the alveolus are diluted by this gas
• This could potentially cause the partial pressure of oxygen to decrease and could temporarily lead to hypoxia
• This effect would only last a couple of minutes
• It can be avoided by increasing the fractional inspired oxygen concentration when recovering from nitrous oxide anesthesia

Question 17. Advantages of school dental health
Answer:

Aims at the prevention and maintenance

• Less initial cost
• Fewer man hours
• Treatment of early lesions
• Maintains topical and other preventive measures
• Bills are equalized and regularly spaced
• The child develops the habit of visiting the dentist regularly
• Establish a positive impression of dentists on the community
• Periodontal disease is interrupted at/near the beginning
• Confines dental disease to small early increments

Question 18. Classification of mouthguards
Answer:

1. Stock mouth protectors

• They are preformed and ready to wear
• Inexpensive

2. Mouth formed – boil and bite type

• May offer a better fit
• Made from thermoplastic material
• It is placed in hot water to soften then placed in the mouth and shaped around the teeth using finger and tongue pressure

3. Custom fitted

• They are individually designed and made in a dental office or laboratory
• It is expensive as it requires special material for use
• It provides the most comfort, best fit, and protection

Question 19. Objectives of dental health education
Answer:

• To cultivate the desirable health practices and health habits
• To develop a healthy attitude
• To develop dental health consciousness
• To teach rules of prevention of diseases
• To eradicate diseases through health drive programs
• To improve the oral condition
• To influence the parents and other adults through the health educative program for better habits and attitudes in children

Question 20. Ankyloglossia
Answer:

It is a result of a short, tight, thick, lingual frenulum

Ankyloglossia Classification:

• Based on the anatomical appearance
  • Type 1: Frenulum attached to tip of the tongue in front of the alveolar ridge in low lip sulcus
  • Type 2: Attaches 2-4 mm behind tongue tip and attaches on the alveolar ridge
  • Type 3: Attaches to mid-tongue and middle of the floor of the mouth, usually tighter and less elastic. The tip of the tongue appears “heart-shaped”
  • Type 4: Attaches against the base of the tongue, is shiny and very inelastic
• Based on the distance of the insertion of the lingual frenum to the tip of the tongue
  • Normal: 16 mm
  • Class 1 (Mild): 12-16 mm
  • Class 2 (Moderate): 8-12 mm
  • Class 3 (Severe): 4-8 mm
  • Class 4 (Complete): 0-4 mm

Ankyloglossia Significance:

• In majority of the cases it resolves spontaneously
• They are asymptomatic
• It may lead to
  • Difficulty in breastfeeding, articulation problems
  • Gingival recession
  • Open bite
  • Abnormal facial development

Ankyloglossia Treatment:

• Frenectomy
• Frenuloplasty

Question 21. Characteristic features of abused child
Answer:

Definition

• It is defined as the non-accidental physical injury, minimal or fatal, inflicted upon children by persons caring for them
• It is an overt act of commission of a caretaker-physical, emotional or sexual

Abuse child Characteristics

• There are no spontaneous smiles and almost no eye contact among abused children
• Lack of cleanliness
• Presence of short stature with respect to age
• Malnutrition
• Overdressed children
• Periorbital ecchymosis, scleral hemorrhage, ptosis, deviated nasal septum, cigarette burn marks, and hand slap marks
• Fractured anterior teeth

Question 22. Bite marks
Answer:

Definition

• It is a mark caused by teeth alone or in combination with other oral parts or consists of teeth marks produced by the antagonist teeth which can be as two op-posing arch marks

Bite marks Classification

1. Depending on the binding agent

• Human
• Animals
• Mechanical

2. Depending on the material bitten

• Skin
• Perishable items
• Non-perishable items

3. Depending on the degree of biting

• Definite bite marks
• Amorous bite marks
• Aggressive bite marks

Bite marks Characteristics

• An elliptical or ovoid pattern containing tooth and arch marks
• Presence of 4-5 teeth marks reflecting the shape of their incisal or occlusal surfaces
• Presence or absence of each tooth
• The peculiar shape of each tooth
• Mesiodistal dimensions
• Arch form and size
• Relationship between the upper and lower jaws

Malocclusions Definitions

1. Habits: It is a frequent or constant practice or acquired tendency, which has been fixed by frequent repetition

2. Preventive orthodontics: It is defined as the action taken to preserve the integrity of what appears to be normal occlusion at a specific time

3. Serial extraction: It is defined as the correctly timed, planned removal of certain deciduous and permanent teeth in mixed dentition stages.

4. Space maintainers: Space maintainers can be defined as appliances used to maintain space or regain minor amounts of space lost, so as to guide the unerupted tooth into a proper position in the arch.

5. Myofunctional appliances: Defined as loose fitting/passive appliances which harness natural forces of orofacial musculature, that are trans¬mitted to teeth and alveolar bone.

6. Space regainers: Appliances used to regain the space lost due to early loss of primary teeth are called space regainers.

Malocclusions Long Essays

Question 1. Define and classify space maintainers. Write in detail about the lingual arch space maintainer.
Answer:

Space maintainers Definition: Space maintainers can be defined as appliances used to maintain space or regain minor amounts of space lost, so as to guide the unerupted tooth into a proper position in the arch.

Space maintainers Classification:

• Removal Space Maintainers
  • Cast partial and wrought partial
  • Active or passive
  • Functional or non-functional
• Fixed Space Maintainers
  • Bonded or Banded
  • Active or Passive
  • Functional or non-functional

Lingual Arch Space Maintainer

It is a fixed, non-functional, passive mandibular arch appliance

Lingual Arch Space Maintainer Fabrication:

• Stainless steel wire is adapted over the lingual surfaces of teeth
• Bands are anchored over the first permanent molar
• The wire is soldered to the band

Lingual Arch Space Maintainer Indications:

• Bilateral loss of posterior teeth
• Minor movement of the anterior teeth
• Maintenance of leeway space
• Space regaining

Lingual Arch Space Maintainer Contraindications: Before the eruption of the mandibular incisors

Lingual Arch Space Maintainer Disadvantages:

• Loss of cementation and solder
• May cause untoward movement

Lingual Arch Space Maintainer Variations:

• Looped lingual archwire
• Lingual horizontal tube
• Ellis loop lingual archwire
• Lingual arch with canine spur

Question 2. Define space maintainers and space management. Write in detail about the eruption guidance appliances.
Answer:

• Space Maintainers and space management Definition: Space maintainers, can be defined as appliances used to maintain space or regain minor amounts of space lost, so as to guide the unerupted tooth into a proper position in the arch.
• Space management is defined as the process of maintaining a space in a given arch previously occupied by a tooth or a group of teeth

Eruption Guidance Appliance/ Distal Shoe appliance: Introduced by Willet

Eruption Guidance Appliance Indications:

• Premature loss of second primary molar
• Bilateral space loss

Eruption Guidance Appliance Contraindications:

• Inadequate abutments
• Poor patient control

Read And Learn More: Pedodontics Short Essays Question And Answers

• Congenital missing first molar
• Systemic diseases

Eruption Guidance Appliance Classification:

• Fixed:
  • Functional
  • Non-functional
• Removable:
  • Fabrication
  • Depends on the distance between the distal surface of the primary molar to the mesial surface of the permanent molar
  • The crown is fabricated over the permanent molar
  • It has a mesial gingival extension
  • This extension should be constructed to extend 1 mm below the marginal ridge
  • Such an extension guide the eruption of underlying permanent teeth.

Question 3. Define serial extraction. Write about indication, contra-indications, and various methods of it.
Answer: It is defined as the correctly timed, planned removal of certain deciduous and permanent teeth in mixed dentition stages.

Serial extraction Indications:

• Class 1 with anterior crowding
• Lingually placed lateral incisors
• Severe anterior proclamation
• Unilateral loss of canine
• Abnormal resorption of deciduous
• Absence of primate spaces
• Ankylosis
• Ectopic eruption

Serial extraction Contraindications:

• Mild to moderate crowding
• Congenital absence of teeth
• Extensive caries
• Deep bite or Open bite
• Severe class 2, 3
• Cleft lip and palate

Serial extraction Method:

1. Dewel’s method (CD4):

2. Tweed’s method (D4C):

Serial extraction Advantages:

• Minimizes the use of mechanotherapy
• Reduces complexity of treatment

Question 4. Define and classify oral habits. Discuss thumb-sucking habits, their effects on the oro-facial complex, and its management.
Answer:

Definition: It is a frequent or constant practice or acquired tendency, which has been fixed by frequent repetition

Oral Habits Classification:

• Obsessive:
  • Intentional
  • Masochistic
• Non-Obsessive:
  • Unintentional
  • Functional
• Useful Habits and Harmful Habits:
• Pressure habits and Biting habits
• Empty habits and meaningful habits
• Compulsive habits and non-compulsive habits

Thumb Sucking Habit:

• Thumb Sucking Habit Etiology:
• Avoidance of parents
• Working mothers provide less time to the child’s nour¬ishment
• With siblings, child may feel neglected by the parents
• The insecurity felt by the children
• Weaning of bottle feeding
• Age: neonate feeling insecurity develop a habit of thumb sucking

Effects On Oro Facial Complex:

• Labial tipping of maxillary anterior
• Proclination of maxillary anteriors
• Increased overjet
• Lingual tipping of mandibular anterior
• Anterior open bite
• Supra eruption of posteriors
• Narrowing of the maxillary arch
• Hypotonic upper lip
• Hyperactive mentalis activity

Thumb Sucking Habit Management:

1. Psychological approach:

• Dunlops beta hypothesis
• Dunlop suggests that the child should be asked to sit in front of the mirror and to suck his thumb
• This becomes effective when the child is asked to do it when he is engaged in an enjoyable activity

2. Mechanical aids:

• Habit-breaking appliances:
  • Passive removable appliances are a palatal crib and clasps on posteriors create interference during habit
• Fixed appliances:
  • Bands on molars fabricated by heavy gauge stainless steel wire
• Other aids:
  • Bandaging the thumb
  • Bandaging of elbow

3. Chemical aids:

• Pepper
• Quinine
• Asafoetida

Question 5. Define and classify space maintainers. Describe fixed space maintainers for bilateral loss of deciduous teeth.
Answer:

Space maintainers Definition: Space maintainers can be defined as appliances used to maintain space or regain minor amounts of space lost, so as to guide the unerupted tooth into a proper position in the arch.

Space maintainers Classification:

• Removal Space Maintainers
• Fixed Space Maintainers
• Space maintainers for bilateral loss of Deciduous teeth

1. Band and Loop:

• The loop is solder to the band
• It should contact the mesial abutment at the contact point
• The band is used for anchorage over the distal abutment
• Space present within the loop permits the eruption of underlying permanent teeth

2. Lingual Arch:

• Stainless steel wire is adapted over the lingual surfaces of teeth
• Bands are anchored over the first permanent molar
• Wire is soldered to the band

Variations:

• Looped lingual archwire
• Lingual horizontal tube
• Ellis loop lingual archwire
• Lingual arch with canine spur

3. Distal shoe space maintainer: Introduced by Willet

Distal shoe space maintainer Design:

• Depends on the distance between the distal surface of the primary molar to the mesial surface of permanent molar
• The crown is fabricated over the permanent molar
• It has a mesial gingival extension
• This extension should be constructed to extend 1 mm below the marginal ridge
• Such an extension guide the eruption of underlying permanent teeth.

4. Nance palatal arch/nance Space holding appliance:

• Consists of bands on the upper molars
• Extend the wire from the lingual surfaces to the deepest and most anterior point in the middle of the hard palate
• An acrylic button is present on the slope of the palate

Question 6. Describe the classification, etiology, and effects of tongue thrusting habit. Write about its management.
Answer:

Tongue thrusting habit Classification:

• Physiologic – Comprises normal swallowing
• Habitual – Present even after correction
• Functional – Adaptive function
• Anatomic – Persons having a large tongue

Tongue thrusting habit Etiology:

• Persistence of infantile swallowing pattern
• Presence of upper respiratory tract infection
• Motor disability
• Missing incisors
• Bottle feeding
• Presence of other oral habits
• Macroglossia
• Hereditary

Tongue thrusting habit Effects:

1. Extraoral:

• Incompetent lips
• Backward mandibular movement
• Speech problems
• Increase in anterior facial height

2. Intraoral:

• Anterior open bite
• Increase in overjet
• Proclamation of interiors
• Posterior open bite
• Posterior crossbite

Tongue thrusting habit Management:

1. Myofunctional exercises:

• Ask to position the tongue in the rugae area for 5 minutes and swallow
• Place the tongue on the spot, salivate, squeeze against the spot, and swallow

2. Pre-orthodontic trainer:

Tongue tags are used to position the tongue while tongue guards prevent the habit

3. Speech therapy:

• Ask the child to repeat simple multiplication tables of sixes
• Ask the child to pronounce words with ‘S’ sounds

4. Mechanotherapy:

• Nance Palatal Arch Appliance:
  • The acrylic button of the appliance used to guide the tongue in position
• Removable Appliance:
  • Hawley’s appliance is used with modifications
  • They are
    • Absence of acrylic portion from gingival mar¬gin of lingual surfaces of maxillary anterior
    • The crib is incorporated, its loops are reduced gradually as the patient starts correct positioning of the tongue
• Fixed Appliance:
  • Crowns and bands over first permanent lar along with lingual bar “
• Oral Screen:
  • Modified with the addition of wire loop bar¬rier to prevent tongue thrusting

5. Surgical treatment: Orthognathic surgical procedures are carried out

Malocclusions Short Essays

Question 1. Myofunctional appliances.
Answer:

Definition: Defined as loose fitting/passive appliances which harness natural forces of orofacial musculature, that are transmitted to teeth and alveolar bone.

Myofunctional appliances Uses: Intercept and treat jaw discrepancies

Myofunctional appliances Changes:

• Increase/decrease jaw size
• Change spatial jaw relationship
• Changes direction of jaw growth
• Accelerates desired growth

Mode Of Action Of Functional Appliance.

• Force Application

• Force Elimination by
  • Bite planes – Effects:
    • Disocclude the posterior teeth
    • Differential eruption of posteriors
    • Intrusion of incisors
    • Downward and backward mandibular rotation
    • Reduces mandibular prognatism
  • Shields/Screens – Effects:
    • Prevents muscular forces on dental alveolar structures
    • Allows unrestricted growth of the jaw
  • Construction bite – Effects:
    • Displaces mandible from its rest position
    • Stretches muscles
    • Displaces mandible in the sagittal and transverse plane

Question 2. Mixed dentition analysis.
Answer:

Moyer’s Mixed Dentition Analysis: To evaluate the amount of space available in the arch for erupting permanent canine and premolar

1. Mixed dentition analysis Procedure:

Mixed dentition analysis Inference:

• Compare tooth sizes of 3, 4, and 5 and the arch lengths available
• Predicted value > arch length available → Crowding

2. Radiographic method:

• Determine the width of unerupted teeth
• Erupted teeth in a radiograph and on a cast
• Formula Y1 = XI * Y2 / X2
• i.e. Width of the unerupted tooth to be determined
• Width of tooth erupted on cast * Width of tooth erupted on the radiograph
• Width of erupted tooth in the oral cavity on the radiograph

Question 3. Nance’s Arch Holding Appliance.
Answer:

Nance’s Arch Holding Appliance Indications:

• Bilateral loss of deciduous molars
• Combined with habit-breaking appliances

Nance’s Arch Holding Appliance Contraindications:

• If either of the molars has not erupted
• Palatal lesions

Nance’s Arch Holding Appliance Disadvantages: Tissue hyperplasia and infection due to poor oral hygiene

Nance’s Arch Holding Appliance Design:

• Consists of bands on the upper molars
• Extend the wire from the lingual surfaces to the deepest and most anterior point in the middle of the hard palate
• An acrylic button is present on the slope of the palate

Question 4. Clinical Features of Mouth Breathing.
Answer:

Extraoral

• Increased facial height Increased mandibular plane
• Retrognathic mandible
• Long and narrow face
• Narrow nose
• Short and flaccid upper lip
• Speech deformities
• Decreased sense of smell and taste

Intraoral

• High palatial vault
• Retroclined interiors
• V-shaped palate
• Posterior crossbite
• Constricted maxillary arch
• Decrease overbite
• Hyperplastic gingiva
• Marginal gingivitis
• Deep pockets

Question 5. Band and Loop.
Answer:

Band and Loop Indications:

• Premature loss of primary first molar
• Unerupted premolar

Band and Loop Contraindications:

• Extreme crowding
• High caries activity

Band and Loop Modifications:

• Loop on only one side of the arch
• Addition of occlusal rest to prevent slippage of appliance gingivally
• Fabrication of a crown instead of a band
• Reverse – by the anchoring band on the mesial abutment

Question 6. Space Regainers./Fixed space regainers.
Answer: Appliances used to regain the space lost due to early loss of primary teeth are called space regainers.

1. Fixed Space Regainers:

• Open Coil Space Regainer:
  • The molar band is fitted to the 1st permanent molar
  • Molar tubes are soldered over it
  • Stainless steel wire is bent into U shape
  • Select the open coil spring and it is slide on the wire

2. Gerber Space Maintainer:

• U assembly welded to the tube is fitted in the tube
• U bend contact the tooth mesial to the edentulous area

3. Horizontal lingual arch:

• The wire is adapted along the lingual surfaces of teeth
• Canine spurs are added to it

4. Lip Bumper:

• The wire is adapted along the labial surfaces of teeth
• U bent is incorporated just before it enters the mo¬lar tube
• The acrylic portion is present in the anterior region

5. Removable Space Regainer:

• Free End Loop:
  • Labial wire with a back action loop spring is used
• Split Block:
  • Acrylic block is splittedbuccolingually and joined by wire in the form of a loop
• Slingshot:
  • Wire elastic holder with hooks is used
• Jack screw:
  • Incorporate and expand screw

Question 7. Crossbite.
Answer: It is an abnormal labiolingual relationship between one or more teeth

Crossbite Classification:

• Anterior and Posterior
• Unilateral and Bilateral
• True and Functional
• Combination

Crossbite Causes:

• Tooth size-jaw size discrepancy
• Skeletal discrepancy
• Palatally placed teeth
• Supernumerary teeth
• Presence of any pathology
• Decreased muscle tone
• Ectopic eruption
• Cleft palate
• Premature contacts
• Mouth breathing habit

Crossbite  Treatment:

• Anterior Crossbite:
  • Removal of premature tooth contact:
  • Tongue blade therapy:
    • Lower incisors are used as fulcrums
    • The tongue blade is placed at 45° behind the tooth
    • Push the locked teeth
    • Used for 1-2 hours daily for 10-14 days
  • Lower inclined plane:
    • Catlan’s Appliance:
      • An acrylic inclined plane is fabricated
      • It is cemented over the lower anterior teeth
      • It is fabricated at 45° to the long axis of the lower incisors
  • Stainless steel crown: For lower incisor
  • Composite inclines: Build up over lower teeth
  • Removable Hawley’s appliance:
    • Adam’s clasp over molars
    • Z springs incorporated into acrylic resin
  • Fixed appliances:
    • Auxiliary springs used along lingual or palatal arches
• Posterior Crossbite
  • Occlusal equilibrium: Removal of occlusal interfer-ences
  • Removable W arch appliance:
  • Cross elastic appliance:
    • Bands are adapted over teeth
    • A hook is welded to bands to engage elastic
  • Removable Hawley’s appliance:
    • Skeletal Correction: Use of expansion appliances

Question 8. Midline Diastema.
Answer: It is the spacing present between the maxillary anterior

Midline Diastema Etiology:

• Ugly duckling stage
• Thumb sucking habit
• High frenum attachment
• Supernumerary teeth i.e. mesiodens
• Tooth size – a material discrepancy
• Presence of pathology

Midline Diastema Treatment:

1. Removable appliances:

• Acrylic plate along with finger springs
• Hawley’s appliance
• Split labial bow

2. Fixed appliances:

• Closed coiled springs
• M shaped elastic

 

Question 9. Anterior crossbite.
Answer:

Anterior crossbite Definition: It is defined as malocclusion resulting from the lingual position of the maxillary anterior teeth in relationship with the mandibular anterior teeth.

Anterior crossbite Etiology

• Persistence of deciduous teeth
• Arch length- tooth material discrepancy
• Presence of habits such as thumb-sucking and mouth breathing
• Retarded development of the maxilla
• Narrow upper arch
• The collapse of the maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws

Anterior crossbite Management

1. Use of removable appliances

• Use of tongue blade
  • It is used to treat single-tooth anterior crossbite
  • It resembles ice cream stick
  • It is placed inside the mouth contacting the palatal aspect of the tooth in crossbite
  • Rest the blade on the mandibular tooth
  • The patient is asked to rotate the oral part of the blade upwards and forward
  • Repeat the exercise for 1-2 hours for about 2 weeks
• Catlan’s appliance
  • It is a lower inclined plane constructed on a maxillary arch
  • Have 45° angulation
  • Forces the maxillary teeth to a more labial position
• Use of Z spring
  • Used to treat anterior cross bites involving one or two maxillary teeth
  • Used when there is adequate space for labialization

2. Use of fixed appliances

• Multilooped archwires or nickel-titanium archwires are used for corrections
• Indications
• Dental anterior crossbites involving one or more teeth
• Requirement of more tooth movement along with correction of crowding and rotations
• Patients who exhibit minimal overbite

Malocclusions Short Answers

Question 1. Gebner’s space regainer.
Answer:

• Gerber appliance may be fabricated directly in the mouth or in a relatively short appointment period and requires no lab work
• A seamless orthodontic band or crown is selected for the tooth to be destabilized
• This space regainer consists of U-shaped hollow tubing soldered or welded to the mesial aspect of the first molar to be moved distally
• U-shaped rods with open coil springs of adequate length are fitted into the above tubing so that they contact the mesial aspect of the first molar to be moved distally
• The forces generated by compressed coil springs bring about a distal movement of the first molar

Question 2. Inclined Plane/Catlan’s appliance.
Answer:

Inclined Plane Use:

• Treatment of anterior crossbite
• Palatally displaced maxillary incisor

Inclined Plane Design: Acrylic/metal covering the maxillary incisor at 45° angulation

Inclined Plane Disadvantage:

• Problem in speech
• Dietary restriction
• Supra eruption of posteriors

Question 3. Treatment of Anterior Crossbite.
Answer:

Crossbite: Condition where one/more teeth may be malposed abnormally, buccally or lingually or labially with reference to the opposing tooth/teeth.

Crossbite Classification:

• Single tooth crossbite
• Segmental cross bite

Crossbite Treatment:

• Use of tongue blade
• Catlan’s appliance
• Z spring
• Screw appliances
• Face mask
• Frankel 3
• Chin cup appliances

Question 4. Space Regainers.
Answer: Appliances used to regain the space lost due to early loss of primary teeth are called space regainers.

1. Fixed Space Regainers:

• Open Coil Space Regainer
• Gerber space maintainer
• Horizontal lingual arch
• Lip bumper

2. Removable space regainers:

• Free end loop
• Split block
• Slingshot
• Jack screw

Question 5. Lingual arch space maintainer.
Answer: It is a fixed, non-functional, passive mandibular arch appliance

Lingual arch space maintainer Indications:

• Bilateral loss of posterior teeth
• Minor movement of the anterior teeth
• Maintenance of leeway space
• Space regaining

Lingual arch space maintainer Contraindications: Before the eruption of the mandibular incisors

Lingual arch space maintainer Disadvantages:

• Loss of cementation and solder
• May cause untoward movement

Question 6. Oral Screen.
Answer: Introduced by Newell in 1912

Oral Screen Principle:

• Application of muscular forces to teeth or
• Elimination of forces to teeth

Oral Screen Indications

• Interception of habits
• Treatment of mild malocclusion
• For muscular exercises
• Correction of mild anterior proclamation

Question 7. Transpalatal arch.
Answer:

Transpalatal arch Indications Unilateral space loss

Transpalatal arch Contraindications Bilateral space loss

Transpalatal arch Appliance:

• Used in the maxillary arch
• Wire crosses the palate
• Bands are fabricated over molars
• Wire are soldered to the bands

Question 8. Lip Bumper.
Answer: Combined removable fixed appliance

Lip Bumper Mode Of Action: Force application/elimination

Lip Bumper Uses:

• Interception of lip-biting habits
• Increases arch length
• Reduces crowding
• In the case of hyperactive mentalis activity
• For augmentation of anchorage
• For visualization of 1st molar
• Used as space regainer

Lip Bumper Designs:

• Stainless steel wire from one molar to the opposite molar passing away from anterior
• An acrylic portion from canine to canine

Question 9. Angle’s Classification.
Answer:

• Class 1 – The mesiobuccal cusp of the upper first permanent molar coincides with the mesial groove of a lower first permanent molar.
• Class 2 – The distobuccal cusp of the upper first permanent molar coincides with the mesial groove of the lower first permanent molar
• Class 3 – The mesiobuccal cusp of the upper first permanent molar coincides interdentally between the lower first and second permanent molar

Question 10. Factors considered before placement of space maintainers.
Answer:

• Patient’s cooperation
• Appliance integrity
• Space required
• Space available
• Position of incisors
• Crowding severity
• Depth of curve of Spee
• Position of midline
• Leeway space

Question 11. Tanaka and Johnston Analysis.
Answer:

• Half the mesiodistal width of 4 lower incisors + 10.5 = Mandibular 3 + 4 + 5 in one quadrant
• Half the mesiodistal width of 4 lower incisors + 11.0 = Maxillary 3 + 4 + 5 in one quadrant

Question 12. Masochistic Habits/Self-Mutilating Habits.
Answer: Repetitive acts that result in physical damage to the individual

Masochistic Habits Etiology:

• Syndrome associated
• Superimposed on a pre-existing lesion
• Secondary to habit
• Unknown etiology

Masochistic Habits Types:

• Frenum thrusting
• Bobby Pin Opening

Question 13. Bruxism
Answer: It is a habitual grinding of teeth either during sleep in the night or unconsciously during day time.

Bruxism Causes:

• Occlusal disturbances
• Emotional disturbances
• Occupational

Bruxism Features:

• Attrition of teeth
• Loosening and drifting of teeth
• Gingival recession
• Hypertrophy of muscles
• Sensitivity of teeth
• Facial pain
• Trismus

Bruxism Treatment: Use of occlusal splints

Question 14. Inclined plane
Answer:

Inclined plane Use:

• Treatment of anterior crossbite
• Palatally displaced maxillary incisor

Inclined plane Design:

Acrylic/metal covering the maxillary incisor at 45o angulation

Inclined plane Disadvantage:

• Problem in speech
• Dietary restriction
• Supra eruption of posteriors

Question 15. Dunlop’s beta hypothesis
Answer:

• It is used for thumb-sucking habit
• Dunlop suggests that the child should be asked to sit in front of the mirror and to suck his thumb
• This becomes effective when the child is asked to do it when he is engaged in an enjoyable activity

Malocclusions Viva Voce

1. Space maintainers are contraindicated in crowded occlusions
2. Nance is called the father of serial extraction
3. A lip bumper is also called a modified vestibular screen
4. Maximum space is lost during six months of extraction
5. Space regained by space regainers should be maintained until adjacent permanent teeth have erupted completely
6. Reverse band and loop is indicated where there is premature loss of the primary second molar and the permanent molar have not erupted fully
7. A lingual arch space maintainer is the most effective appliance of space maintenance and minor tooth movement in the lower arch
8. Self-injurious habits are also called masochistic habits
9. Masochistic habits have a higher incidence in mentally retarded children
10. Nail biting is a sign of internal tension
11. Mouth breathing habit is diagnosed by mirror test, water holding test, butterfly test, and rhinometry.
12. Tongue thrusting habit often self-corrects by 8-9 years of age
13. Bluegrass appliance is used to manage thumb suck-ing habits in children between 7-13 years of age

Dental Caries Definitions

1. Early childhood caries

Davies defined early childhood caries as a complex disease involving maxillary incisors within a month after the eruption and spreading rapidly to another primary teet

2. Rampant caries

It is an acute widespread caries with early pulpal involvement of teeth which are usually immune to decay

3. Nursing bottle caries

Caries caused by prolonged use of a bottle filled with any liquid other than the water

Dental Caries Important Notes

1. Keys triad

It includes a host (tooth), Agent, and substrate factors

2. Infected v/s affected dentin

3. Lactose content of

• Breast milk – 7.2%
• Bovine milk – 4.5%
• Milk powder – 7%

4. Differences between nursing and rampant caries

5. Classification of early childhood caries

• Type 1 – Mild to moderate
  • Caries in molars and incisors
  • Seen in 2-5 years of age
• Type 2 – Moderate to severe
  • Labiolingual caries with maxillary incisors with or without molars
  • Seen soon after 1st tooth erupts

Read And Learn More: Pedodontics Short Essays Question And Answers

• • Mandibular incisors unaffected
  • Caused by inappropriate bottle feeding
• Type 3 – Severe
  • Involve all teeth
  • Seen in 3-5 years of age

Dental Caries Long Essays

Question 1. Define early childhood caries. Write notes on the window of infectivity, etiology, pathogenesis, clinical features, and management of early childhood caries.
Answer:

Definition: Davies defined early childhood caries as a  Frequent bottle feeding at night complex disease involving maxillary incisors within a month after the eruption and spreading rapidly to other primary teeth

Window Of Infectivity:

• Introduced by Caufield
• He monitored levels of mutans S. in the oral cavity from birth to 5 years.
• As the deciduous teeth erupt, the oral cavity provides a natural habitat for the survival of MS/mutans strepto-coccus
• MS are the only organism present during this period
• It is limited to 7-31 months
• Later other organisms appear in the oral cavity
• This results in the competition of MS with other organisms
• Survival of MS becomes difficult

Etiology:

• Frequent consumption of liquids containing fermentable carbohydrates
• Poor feeding practices without appropriate preventive measures
• Frequent bottle feeding at night

Pathogenesis:

Clinical Features Of Early Childhood Caries:

It occurs in the following stages

1. Very mild: Shows slight demineralization usually at the gingival crest and no cavitation

2. Mild: Show demineralization in a gingival third of the tooth and moderate cavitation

3. Moderate: Shows cavitation on multiple tooth surfaces

4. Severe:

• Consists of widespread destruction of tooth and partial to complete loss of the clinical crown
• Caries progresses from decalcification of upper primary incisors to primary molars and canines

Management:

1. Very mild cases:

• Preventive measures are undertaken to arrest the progression of the caries process
• It involves
  • Diet counseling
  • Oral hygiene measures
  • Fluoride application

2. Mild cases:

Extensive and invasive treatment with multiple pulp therapies

3. Moderate and severe cases:

• Need pharmacological intervention
• Need multiple appointments and many local anesthetic injections to carry out pulp therapy and stainless steel crown
• Some teeth may need restorations while some others may need stainless steel crowns with or without pulp therapy

Question 2. Define rampant caries. Describe etiology, clinical features and management of it.
Answer:

Definition: It is an acute widespread caries with early pulpal involvement of teeth which are usually immune to decay

Rampant caries Etiology:

• Multifactorial in nature
• Excessive sticky carbohydrates
• Decreased salivary flow
• Hereditary

Rampant caries Clinical Features:

• It can be present at all ages
• Both dentitions is effected
• It involves all teeth including mandibular incisors
• Rapidly new lesions develop in addition to the present old lesions
• Carious tooth are with pulpal involvement

Rampant caries  Management:

• Teeth affected require pulpal therapy
• Pulpotomy is carried out

Rampant caries Method:

• Anesthetize and isolate the tooth
• Remove the carious part
• The entire roof of the pulp chamber is removed
• With the help of a spoon or excavator cut out the coronal pulp
• Next, irrigate the pulp with water
• Control the bleeding with the help of moist cotton pellets
• Dry the pulp chamber
• Now, place cotton moistened with 1.5 concentration of Buckley’s formocresol
• Maintain it for 5 minutes
• Now remove it and dry the pulp chamber
• Restore it with a thick paste of ZOE
• A zinc polycarboxylate cement is placed over it
• Finally, restore with stainless steel crown

1. (a) Cariously involved primary molar
2. (b) Access cavity and removal of coronal pulp tissue
3. (c) Placement of a cotton pellet moistened with formocresol
4. (d) Pulp chamber filled with ZOE and crown is built up with glass ionomer before placement of stainless steel crown

Question 3. Define early childhood caries. Write about diet counseling and diet chart.

Answer:

Definition:

Davies defined early childhood caries as a complex dis-ease involving maxillary incisors within a month after the eruption and spreading rapidly to other primary teeth

Steps:

• Introduce diet diary
• 24-hour diet record is prepared
• A six days diet diary is advised
• Analyse complete records
• Isolating the sugar factors
• Patients education
• Consumption of sugar substitutes

Visits:

• First appointment:
  • A diet diary of 6 consecutive days is prepared
  • The form of particular food taken, its approximate amount along with snacks, candies, syrups, chewing gums consumption is recorded
  • Identify the sugar-containing food items
  • Mark such items with red Xs while others with blue Xs
  • Explain the patient about the harmful effects of sugar-containing substances and explain to decrease the red Xs items while increasing blue Xs items
  • Teach him as a game
  • Suggest the sugar substitute like peanuts, walnuts

• Recall Visits:
  • Recall appointments are carried out at regular intervals during the next months
  • During these visits evaluate the patient’s progress and provide reinforcement

Dental Caries Short Essays

Question 1. Caries risk assessment.
Answer:

• Caries is a complex multifactorial disease
• Caries risk assessment is performed by doing a combination of the following analysis

1. Dietary analysis:

• The patient is asked for
  • Quantity of sugar intake in the form of fermentable carbohydrates
  • Frequency of intake
  • Intake of acidic beverages
  • It includes sports drinks, fruit juices, and soft drinks
  • These provide energy to acidogenic and aciduric bacteria
• Frequency of snacking

2. Dental clinical analysis:

• The dental examination determines risk indicators and risk factors
  • Risk indicators include:
    • Visible cavitated caries lesion
    • White spots on teeth
    • Brown spots on teeth
  • Risk factors include:
    • Visible plaque or biofilm
    • Exposed root surface
    • Deep pits or grooves
    • Prosthesis uses
    • Poor quality of existing restorations
  • Bacterial biofilm analysis:
    • It helps to determine patient’s risk level
    • It includes
    • S. mutans count in saliva or plaque
    • Lactobacilli count in saliva or plaque
    • Adenosine triphosphate activity of the biofilm bacteria

3. Salivary analysis:

• It includes
  • Salivary flow rate
  • Salivary buffering capacity
  • Salivary pH

Question 2. Caries susceptibility tests.

Answer:

1. Synder’s Test:

It is used for Lactobacillus count

Procedure:

• Paraffin-stimulated saliva is collected in test tubes
• It is inoculated into glucose and agar media
• pH 4.7-5.0 is maintain along with color indicator bromocresol green
• The color change indicates pH change and is compared to the standardized color chart and scored
• Recordings are carried out at the end of 24 hours, 48 hours, and 72 hours

Result:

2. Lactobacillus Test:

• Described by Hadley in 1933
• Procedure:
  • Collect paraffin-stimulated saliva (5-10 ml)
  • Dilute to 1:10 dilution by pipetting 1 ml of saliva into 9 ml tube of sterile saline solution
  • Similar again to 1:100 dilution using a 1:10 diluted sample
  • Mix thoroughly
  • Spread 0.4 ml of each dilution over agar plates
  • Incubate for 3-4 days at 37° C
  • Count the number of colonies

Result:

3. Swab Test:

• Procedure:
  • The oral flora is sampled by swabbing the buccal surfaces of the teeth with a cotton applicator
  • It is subsequently incubated in the medium
  • The change in pH following a 48-hour incubation period is read on a pH meter

Interpretation:

4. Salivary Reductase Test:

• Procedure:
  • Paraffin-stimulated saliva is collected in a collection tube
  • It is then mixed with the dye Diazo-resorcinol
  • The caries conduciveness reading or color change is done after 15 minutes
• Resultt:

Question 3. Methods of Caries Detection.
Answer:

Visual Examination:

• It compresses the detection of white spot
• Discoloration or cavitation

Tactile Examination:

• Usually, explorer is used for occlusal caries
• Findings
  • Softness at the base
  • Catch by an explorer
  • Tug back or resistance to removal

Use Of Floss:

• Used for proximal caries or with patients complaining of food lodgement between the teeth
• Passing the floss through carious lesion results in fray-ing of it

Radiographs:

• A radiograph detects the carious lesion as a radiolucent area
• Its extent depicts the extent of caries

Caries Detection Advances:

• Digital Radiography
• Xeroradiography

Fiber Optic Transillumination:

• It is based on the difference in the transmission of light for decayed and sound tooth
• An area of decay shows darkened shadow as compared to sound tooth.

Ultrasonics:

• It is based on the use of sound waves
• Echo produced are of the different amplitude of both normal and decayed tooth
• A decayed tooth produces an echo of higher amplitude

Dyes:

• Different dyes are used for the detection of caries
  • Ex. Calcein – for enamel caries
  • Fuschin – for dentin caries
• Layers of dentin can also be differentiated as basic fuschin stains that only infected dentin and not affected one

Question 4. Strip Mutans Test – By Jenssen and Bratthal.
Answer:

• It is used to count the presence of streptococcus mutans in the oral cavity
• Streptococcus mutans can be considered as an indicator of caries activity
• But as caries is a multifactorial disease, this test gives only a relative information
• Patients with streptococcus mutans in their oral cavity may show no sign of caries
• While the patient with caries lesion may not have any number of streptococcus mutans

Principle:

It is based on the fact that bacitracin inhibits the growth of all other oral streptococci except mutans on the mitis salivary medium

Uses:

• Patient selection
• Evaluates the effect of mouth rinses
• Helpful in health education
• Patient as well as parents education

Question 5. Nursing bottle Caries.
Answer:

Nursing bottle Caries Definition:

• Caries caused by a prolonged use of a bottle filled with any liquid other than the water

Nursing bottle Caries Etiology:

• Bovine milk, milk formulas
• Sweeteners like honey-dipped pacifiers
• Micro-organisms like Streptococcus mutans
• Fermentable carbohydrates
• Hypoplasia of teeth
• Decreased salivary flow
• Malnutrition

Nursing bottle Caries Clinical Features:

• All teeth except the mandibular anterior are affected.
• This is because of the position of the tongue that man¬dibular interiors are spared.
• Initially, caries appear as a dull, white area along the gingival margin.
• This progresses to the cervical margin to form a ring-like lesion.
• Finally, whole crown of the tooth is destroyed.

Nursing bottle Caries Treatment:

• First visit:
  • Excavate and restore all carious lesions
  • Pulp therapy is done if required
  • Drainage of abscess
  • Topical fluoride application
• Second visit:
  • Diet counseling
  • Evaluating the restoration and if required re-restoration done
• Third visit:
  • Endodontic treatment
  • Extraction of unrestorable teeth
  • Recall the patient after every 3 months

Question 6. Role of Diet in Dental Caries/Nutrition and Dental Caries.
Answer:

The presence of fermentable carbohydrates results in loss of caries immunity

Factors Responsible For It:

• Frequency of intake of carbohydrate
• Physical and chemical forms of it
• Route of administration
• Presence of other food constituents

Various Dietary Studies:

• Vipeholm study by Gustafsson et.al in 1959
• Hopewood House study by Sullivan in 1958
• Turku Sugar study by Scheinin in 1975
• Seventh-day Adventist Children Study
• Hereditary Fructose Intolerance

Results:

• An increase in carbohydrates increased the level of dental caries
• The risk of caries is greater for sticky food
• The risk of caries is greater if sugar is consumed between meals
• Monosaccharides and disaccharides are more harmful than polysaccharides
• Frequent use of xylitol in between meals produces an anti-cariogenic effect
• Caries activity varies between individuals
• Caries incidence increases with increased frequency of intake of carbohydrate
• Other dietary constituents like vitamin A, D, K, B complex, calcium, fluoride, etc. has an inhibitory effect on dental caries.

Question 7. Steps in diet counseling
Answer:

Diet counseling Steps:

• Introduce diet diary
• 24-hour diet record is prepared
• A six days diet diary is advised
• Analyse complete records
• Isolating the sugar factors
• Patients education
• Consumption of sugar substitutes

Diet counseling Visits:

• First appointment:
  • A diet diary of 6 consecutive days is prepared
  • Form of particular food taken, its approximate amount along with snacks, candies, syrups, chewing gums consumption is recorded
  • Identify the sugar-containing food items
  • Mark such items with red Xs while others with blue Xs
  • Explain the patient the harmful effects of sugar-containing substances and explain to decrease the red Xs items while increasing blue Xs items
  • Teach him as a game
  • Suggest the sugar substitute like peanuts, walnuts
• Recall Visits
  • Recall appointments are carried out at regular intervals during the next months
  • During these visits evaluate the patient’s progress and provide reinforcement

Question 8. Affected vs infected dentin
Answer:

Infected Dentin

• Irreversible denatured collagen
• Infiltrated with bacteria
• Not remineralize
• Should be removed
• Darker
• Softer
• Lacks sensation
• Indistinct cross bands
• Stained with:
• 0.2% propylene glycol
• 10% acid red solution
• 0.5% basic Fuschia

Affected Dentin

• Reversible denatured collagen
• Not infiltrated
• Remineralize
• Left behind while cavity preparation
• Lighter
• Harder
• It is sensitive
• Distinct cross bands
• Cannot be stained with any solution

Dental Caries Short Answers

Question 1. Stephen’s curve.
Answer:

• Within 2-4 minutes of rinsing with a solution of glucose or sucrose, plaque pH is reduced from about 6.5 to 5 and gradually returns to its original value within 40 minutes
• This when graphically plotted is the curve called as Stephan curve

Question 2. Caries tetralogy.
Answer:

Caries tetralogy consists of

1. Tooth:

• Composition:
  • Highly mineralized-less caries formation
  • High solubility leads to more caries formation
  • Increased permeability of enamel surfaces causes increased caries
  • An increase in mineral content leads to increased resistance to caries
• Morphology:
  • The presence of deep, narrow, and retentive pits and fissures leads to high caries incidence
• Position:
  • Malaligned, rotated teeth are more prone to caries due to more plaque accumulation

2. Saliva:

• pH:
  • A rise in pH neutralizes acid attacks on the tooth surface during caries progression
• Composition:
  • Bicarbonate ions- cause neutralization
  • Ammonia- causes rise in pH
• Quantity:
  • Reduction of saliva leads to
  • Rampant caries
  • Exacerbation of aeries
• Viscosity:
  • Extremely viscous saliva leads to caries-free mouth
  • Abundant, thin, watery saliva exhibit ram¬pant caries
• Antibacterial properties:
  • Lysozyme- lyses cariogenic and non-cariogenic bacteria
  • Salivary peroxidase- inactivates bacterial enzymes
  • Immunoglobulin- IgA protects against caries

3. Diet:

• Fibrous food
  • Keep teeth clean
  • Stimulates salivary flow
  • Reduces caries incidence
• Soft and sticky food increases caries incidence
• Dietary constituents that reduce incidence of car¬ies are
  • Phosphates
  • Traces of molybdenum and vanadium
  • Vegetables
  • Vitamins
  • Minerals
  • Fats

4. Saliva:

• Under normal conditions, the saliva is supersaturated in terms of calcium and phosphorous with respect to the enamel surface
• This prevents the hydroxyapatite from dissolving in the oral environment

Question 3. Pre-eruptive caries.
Answer:

• Occasionally, defects on the crowns of developing permanent teeth are evident radiographically even though no infection of the primary tooth or the surrounding area is apparent
• Muhler referred to this condition as pre-eruptive caries
• Such a lesion often does resemble caries when it is observed clinically and the destructive lesion progresses if it is not restored
• As soon as the lesion is reasonably accessible, the tooth should be uncovered by removal of the overlying primary tooth or by surgical exposure
• The caries-like dentine is then excavated and the tooth is restored with a durable temporary or permanent restorative material
• In some cases, the lesion may be so extensive that indi¬rect pulp therapy is justified

Question 4. Hopewood House Study.
Answer:

• By Sullivan in 1958
• This study was conducted among children between 3 and 14 years of age residing at Hopewood House for longitudinally 10 years.

Hopewood House Study Features:

• Absence of meat
• Rigid restriction of refined carbohydrate

Hopewood House Study Results:

• 53% of children at Hopewood House were caries-free
• 0.4% children of state were caries-free
• 75% of children had gingivitis and poor oral hygiene.

Question 5. Critical pH.
Answer:

• It represents the demineralization-remineralization cycle
• At critical pH of 5.5 or below
  • Hydrogen ions (H+] react with the phosphate group present in the oral cavity
  • Results in the formation of hypophosphate
  • Due to this, hydroxyapatite crystals dissolve and is termed as demineralization
  • At neutral pH
  • With the adequate presence of Calcium and phosphorus, dissolution is inhibited

Question 6. DMFI Index.
Answer:

• Used for measuring dental caries
  • D – Decayed
• Indicates the number of permanent teeth that are decayed
  • M – Missing
• Indicates the number of missing permanent teeth due to decay
  • F – Filled
• Indicates the number of permanent teeth that have been attacked by caries due to which have been re¬stored

DMFI Calculation:

Total DMFT = D+M+F

Question 7. Incipient Caries.
Answer:

• Early carious lesions present on smooth surfaces
• It is seen as a ‘white spot’
• Only sub-surface demineralization is involved
• It cannot be diagnosed radiographically
• However, it can be diagnosed with DIAGNOdent
• It should be differentiated from the developmental effects of enamel formation
• On wetting, the carious lesion disappears

Question 8. Alban’s test
Answer:

Alban’s test Procedure:

• A 5 ml of agar is removed from the refrigerator but not heated
• Unstimulated saliva is added to it
• The tube is then incubated for 4 days and color change is noted
• Color changes are scored 0 to 4

Alban’s test Result:

• 0- Indicates no color change
• 1- The color changes to yellow in the top l/4th of the tube
• 2 – Color changes to half of the tube
• 3 – Color changes to 3/4th of tube
• 4 – The entire length of the agar has changed to yellow

Dental Caries Viva Voce

1. The critical pH at which demineralization starts is about 5.2 to 5.5
2. Caries triad involves the tooth, microflora, and a suit-able local substrate
3. Caries tetralogy includes a fourth-factor time
4. Trace elements like selenium, cadmium, lead, and barium have been found to increase the caries experience

Dental Care For The Special Child Important Notes

1. Handicap child

Handicap person is one who over an appreciable period is prevented by physical or mental conditions from full participation in the normal activities of their age groups including those of a social, recreational, educational, and vocational nature.

2. Classification of handicaps By Nowak

• Physically handicapped
• Mentally handicapped
• Congenital defects
• Convulsive disorders
• Communication disorders
• Systemic disorders
• Metabolic disorders
• Osseous disorders
• Malignant disorders

3. Cerebral palsy

• It is a non-progressive lesion which occurs in the developing brain before, during or after birth
• Its classification is mainly of the anatomical and physiological type

4. Cleft lip and palate

5. Clinical features of cleft lip and palate

• Hypoplastic maxilla
• Shallow gingivo labial sulcus
• Nose deformity
• Hypoplastic teeth
• Sup [ernumerary teeth
• Congenitally missing teeth
• Geminated, fused, conical teeth
• Feeding difficulties
• Posterior crossbite

6. Rule of 10 for cleft management

Timing of cleft lip repair should be when hemoglobin is 10 gm%, age 10 weeks, weight 10 lbs, and total leukocyte count less than 10,000 per mm3

Dental Care For The Special Child Long Essays

Question 1. Define handicap. Classify handicapping conditions. Describe pedodontic management of orofacial cleft patients, management of hemophilia, and management of Cerebral palsy.
Answer:

Definition: Handicap person is one who over an appreciable period is prevented by physical or mental conditions from full participation in the normal activities of their age groups including those of a social, recreational, educational, and vocational nature.

Handicapping conditions Classification:

• By Nowak
  • Physically handicapped
  • Mentally handicapped
  • Congenital defects
  • Convulsive disorders
  • Communication disorders
  • Systemic disorders
  • Metabolic disorders
  • Osseous disorders
  • Malignant disorders

Management Of Cleft Patients:

1. At Birth:

• Fabricate feeding plate
• Pre-surgical orthopedics to prevent the collapse of dental arches

2. 3-5 months:

• Lip repair
• Teeth alignment
• Palatal expansion

3. 12 months:

• Speech therapy
• Palatal repair
• Hearing repair

4. 2-6 years:

• Caries prevention
• Restorative care

5. 6-7 years:

• Early orthodontic intervention
• Removal of supernumerary teeth
• Correction of crossbite

6. 8 years:

• Bone grafting procedure
• Relieve crowding and ratiocination of interiors

7. 9 years: Bone graft alveolar cleft

8. 10-12 years: Preventive measures

9. 12-15 years:

• Final orthodontic treatment

Read And Learn More: Pedodontics Short Essays Question And Answers

• Review speech therapy

Management Of Hemophilia:

• Examine the hemostatic levels
• Various tests are carried out such as
  • Bleeding time
  • Clotting time
  • Prothrombin time

Protocol:

Management Of Cerebral Palsy:

• Take a thorough medical and dental history
• Maintain a calm and friendly environment
• Treat the patient in the wheel chair if possible
• Stabilize the patient’s head throughout the procedure
• Elevate the patient’s back
• Use physical restraints
• Use of mouth props and finger splints
• Avoid lights and noises
• Avoid gag reflex
• Use of rubber dam
• Use of Gauze shields
• Premedication
• General anesthesia as a last resort
• Preventive measures

Dental Care For The Special Child Short Essays

Question 1. Dental Management of Von-Willebran D disease.
Answer:

Question 2. Autism.
Answer:

It is a severely incapacitating disturbance of mental and emotional development that causes problems in learning, communicating, and relating to others

Autism Etiology:

• Organic brain damage
• Lack of environmental stimulation
• Defective metabolic processes

Autism Features:

• Poor muscle tone
• Poor coordination
• Drooling of saliva
• Epilepsy
• Preference to soft and sweetened diet
• Increase caries index
• Children tend to pouch food
• Child shows tantrums
• Experience extreme loneliness
• Mutism
• Language disturbance
• Mental retardation

Autism Management:

• Use of tell show do technique and positive reinforcement
• Pre-operative sedation with muscle relaxants and nitrous oxide-oxygen analgesia
• Psychotherapy
• Family Counseling
• Use of papoose board or pedi wrap as physical restraints

Question 3. Oral hygiene measures in handicapped children.
Answer:

• Home dental care for handicapped children should begin in infancy
• The dentist should instruct the parents to gently cleanse the teeth daily with a soft cloth or finger brush or an infant toothbrush
• For older children who are unwilling or physically unable to cooperate, the dentist should teach the parent or guardian correct toothbrushing techniques
• If a child is institutionalized, the staff should be instructed in the proper dental care regimen for the child
• A soft multi-tufted nylon brush should be used
• A powered toothbrush will be helpful
• Mouthrinses can be used
• Modification on the brush handle may be necessary

Question 4. Cerebral palsy.
Answer:

• Cerebral palsy is the most severely handicapping condition affecting childhood
• It is a group os non-progressive disorders resulting from the malfunction of the motor centers and pathways of the brains
• Characterized by paralysis, weakness, incoordination or other aberrations of motor function

Cerebral palsy Types:

• Spasticity
• Athetosis
• Ataxia
• Rigidity
• Tremors

Cerebral palsy Dental Problems:

• Dental caries
• Poor oral hygiene
• Periodontal diseases
• Malocclusions
• Bruxism
• Decreased vertical dimensions
• TMJ disorders
• Trauma especially in the maxillary anterior

Cerebral palsy Treatment:

• Maintain a calm, friendly, and professional atmosphere
• Thorough medical and dental history should be noted
• The patient’s head should be stabilized throughout the procedure
• Use physical restraints
• Avoid abrupt movements, lights, and noises to minimize reflex reactions
• Local anesthesia can be used
• Rubber dam used to protect the working area from hyper-active tongue movement
• Gauze shields are used during extraction to avoid tooth aspiration
• Premedication can be used to reduce hypertonicity
• General anesthesia should be used as a last resort

Dental Care For The Special Child Short Question And Answers

Question 1. Hank’s Balanced salt solution/storage media for avulsed teeth.
Answer:

1. Water: Least desirable because of hypotonic environment causes rapid cell lysis

2. Saliva:

• Not ideal
• Has incompatible osmolality, pH, and the presence of bacteria

3. Milk:

• Best media
• pH and osmolality is compatible to the vitality of PDL cells

4. Cell culture media: Not readily available

5. Hanks balanced salt solution (HBSS): Contains a pH-preserving fluid, and trauma-reducing suspension

Dental Care For The Special Child Viva Voce

1. Incidence of cleft lip alone – 25%
2. Incidence of cleft palate alone – 25%
3. Cleft lip and palate together – 50%
4. Combined cleft lip and palate is more common in males
5. Isolated cleft palate is more common in females
6. Unilateral cleft are more common than bilateral
7. Rule of 10 is a guide for the timings of cleft lip repair
8. IQ score in Down’s syndrome- 25-50
9. IQ score in autism-50-70
10. 30% of autism may develop epilepsy
11. Congenital heart disease are found in 50% of Down syndrome patients

Pediatric Consideration For Oral Surgery Important Notes

1. Injuries to the periodontal tissues are classified as:

2. Other injuries

3. Sequel of trauma to a tooth

• Internal hemorrhage
• Hyperaemia
• Internal resorption
• Pulpal necrosis
• Canal calcifications

4. Balanced Hank’s solution (HBSS)

• It is one of the media for preserving the avulsed tooth
• It is an isotonic salt solution
• Available as a “SAVE A TOOTH” solution

5. Drugs

• The safe dose of local anesthesia in a child
• With adrenaline – 7 mg/kg body weight
• Without adrenaline – 4.5 mg/kg body weight

6. Drug dosage

Pediatric Consideration For Oral Surgery Long Essays

Question 1. Classify traumatic injuries. Write in detail about the management of Ellis Class 3 fracture of the maxillary right central incisor.
(or)
A 7-year-old child reported trauma on the central incisor. Explain the investigation and treatment options based on the diagnosis.
(or)
Classify traumatic injuries to teeth and supporting structures. Explain Ellis Class 3 in detail
Answer:

Traumatic Injuries Classification:

1. Ellis Classification:

• Class 1 – Simple crown fracture involving enamel
• Class 2 – Crown fracture involving enamel and dentin
• Class 3 – Crown fracture involving enamel, dentin, and pulp
• Class 4 – Nonvital tooth due to trauma with or without loss of crown structure
• Class 5 – Teeth lost due to trauma
• Class 6 – Root fracture
• Class 7 – Displacement of a tooth without fracture
• Class 8 – Fracture of crown en masse and its replacement
• Class 9 – Traumatic injuries to primary teeth

2. WHO Classification:

1. Injuries to the Hard Dental Tissues and Pulp:

• Crown infraction
• Uncomplicated crown fracture
• Complicated crown fracture
• Uncomplicated crown root fracture
• Complicated crown root fracture
• Root fracture

2. Injuries to the Periodontal tissues:

• Concussion
• Subluxation
• Intrusive luxation
• Extrusive luxation
• Lateral luxation
• Exarticulation

3. Injuries of the Supporting Bone:

• Comminution of alveolar socket
• Fracture of the alveolar socket wall+

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• Fracture of the alveolar process
• Fracture of the mandible and maxilla

4. Injuries to Gingiva or oral mucosa:

• Laceration
• Contusion
• Abrasion

Management Of Ellis Class 3 Fracture:

Assess the extent of the injury

1. Pulpectomy:

2. Extraction of tooth:

In the presence of periapical pathology

Question 2. Classify traumatic injuries and describe in detail about the management of Ellis class 2 fracture injuries.
Answer:

Ellis class 2 fracture Class 2 Fracture:

It is a fracture of the crown involving enamel and dentin without pulp exposure

Ellis class 2 fracture Management

• Thorough cleanse the area
• Examine the fractured teeth
• Assess the extent of exposed dentin
• Place calcium hydroxide on the exposed dentin
• Restore the tooth with a temporary restoration
• Wait for the reattachment of the crown fragment
• Once it is achieved, restore with a permanent restoration like composite resin or full coverage crown

Pediatric Consideration For Oral Surgery Short Essays

Question 1. Root Fracture.
Answer:

Root fractures are relatively uncommon in permanent dentition

Root Fracture Diagnosis:

• Clinical examination reveals a slightly extruded tooth often displaced lingually
• Radiographs will show a rot fracture on the proper angulation of the X-ray beam

Management Of Root Fracture:

• Determine the position of fracture radiographically
• If the fracture is present in the apical third  no treatment is required
• It resorbs on its own
• Fractures involving the middle third of the root are extracted
• Fractures that communicate with the gingival margin are extracted
• While extraction, avoid damage to the underlying tooth germ

Question 2. Mucocele.
Answer:

It is an extravasation type of cyst

Mucocele Cause: Trauma to the minor salivary gland

Mucocele Features:

• Superficial lesion – small, raised, bluish
• Deep-seated lesions – small but diffuse, covered by normal mucosal color
• The lower lip is commonly affected.

Mucocele Treatment: Excision of the lesion

Question 3. Luxation Injuries and their Management.
Answer:

Luxation Injuries:

• This leads to the displacement of teeth
• It can be
  • Intrusive
  • Extrusive
  • Lateral

Luxation Injuries Management:

1. Mild injury:

• No occlusal interference
• The child is kept on soft diet
• Maintain oral hygiene

2. Palatally luxated teeth: Teeth is positioned palatally manually and splinted

3. No improvement present: Extract the tooth

4. Buccally luxated teeth: Extract the teeth

Question 4. Anesthetic preparation of Child.
Answer:

• Patients should be told about the procedure in a less threatening manner
• The instrument tray should be kept behind the chair, away from the sight of the patient
• The needle should be hidden with a finger
• Explain to the child the sensation of pinching that is experienced after an LA injection
• Explain to the child the difference between pressure and pain
• Explain the sensation of numbness

Question 5. Treatment of avulsion of permanent teeth.
Answer:

Question 6. Inferior alveolar nerve block in children.
Answer:

• When deep operative or surgical procedures are undertaken for the mandibular primary or permanent teeth, the inferior alveolar nerve must be blocked
• The mandibular foramen is situated at a level lower than the occlusal plane of the primary teeth of the pediatric patient
• Therefore, the injection must be made slightly lower and more posteriorly than for an adult patient

Inferior alveolar nerve block Technique:

• The thumb is laid on the occlusal surface of the molars with the tip of the thumb resting on the internal oblique ridge and the ball of the thumb resting on the retromolar fossa
• The ball of the middle finger is rested on the posterior border of the mandible for firm support
• The Barrel of the syringe is directed between the two primary molars on the opposite side of the arch
• Inject the solution
• Depth of insertion- about 15 mm
• Solution deposited-1 ml approx

Question 7. Treatment of intrusion of the permanent central incisor
Answer:

Management of intrusion depends on the degree of intrusion which has been taken place

• After the desired approach is carried out, suture the gingival laceration
• Splint for 2-3 weeks after the tooth has come to normal position
• Soft diet for 14 days
• Follow-up period of 1 year

Question 8. Local anesthetic drug delivery systems.
Answer:

• Local infiltration
  • LA is deposited near small nerve endings
• Field block
  • LA is deposited near a large branch of peripheral nerve
• Nerve block
  • LA is deposited near the main trunk
• Intraligamentary
  • Most commonly used for single tooth o LA needs to be given under high pressure
• Intraseptal
  • Used to reinforce analgesia produced by infiltration
  • Used for mandibular primary molars
• Intrapapillary
  • Produces analgesia of palatal/ lingual tissues
• Intrapulpal
  • Used in pulp therapy

Pediatric Consideration For Oral Surgery Short Question And Answers

Question 1. Inferior Alveolar Nerve Block.
Answer:

• Move your finger over mesiobuccal fold up to the coronoid process of the mandible
• Feel the pterygomandibular depression
• Insert a syringe with a 15/8 inch 25 gauge needle parallel to the occlusal plane of the mandibular teeth
• Penetrate tissues of pterygomandibular depression
• Aspirate
• Slowly deposit 1-1.8 ml of solution

Question 2. Topical Anaesthesia.
Answer:

• It is anesthesia that is obtained by the application of a suitable agent to an area of either skin or mucous membrane.
• Topical Anaesthesia Methods:
• Spraying the area with 10% lignocaine hydrochloride
• Ointments containing 5% lignocaine hydrochloride and emulsions containing 2% lignocaine hydrochlo¬ride are used

Question 3. Antibiotics in Pediatric Dentistry.
Answer:

• Penicillin: Amoxycillin – 20 – 40 mg/kg/day
• Cephalosporin: Cephalexin – 50 – 100 mg/kg/day
• Macrolides: Erythromycin – 30 – 50 mg/kg/day
• Metronidazole: 5 mg/kg TID

Question 4. Composition of LA solution.
Answer:

• Local anesthetic- ester or amide
• Vasoconstrictor- Epinephrine
• Anti-oxidant- Sodium metabisulphite
• Preservative- Methylparaben
• Fungicide- Thymol
• Salt- Sodium chloride
• Vehicle- Distilled water or Ringer’s lactate solution

Question 5. Antibiotic prophylaxis for endocarditis.
Answer:

Question 6. Mouth guards.
Answer:

• American Dental Association and the Academy for Sports Dentistry recommend properly fitted mouth guards for a variety of sports and recreational activities which predispose the participants to oral injuries
• Mouth guards are designed to protect the lips and intraoral soft tissues from bruises and lacerations
• They also protect the teeth from any kind of fractures or luxation injuries and the jaws from any dislocation and fractures

Mouthguards Classification:

• Type 1- Stock mouthguards
• Type 2- Mouth-formed mouthguards
• Type 3- Custom fabricated mouthguards

Mouth guards Other forms:

• Jaw joint positioner
• Anatomically designed mouthguard

Question 7. Non-accidental injury.
Answer:

• Nonaccidental injuries are nothing but child abuse and neglect
• These are not accidental injuries but they are inflicted by people who are responsible for the care of the child
• The child is considered to be abused if they are treated in a way that is unacceptable in a given culture

Question 8. Drugs used for conscious sedation.
Answer:

Various agents used for conscious sedation are

1. Inhalation: Nitrous oxide

2. Oral route:

• Hydroxyzine oral or IM- 0.6 mg/kg and 1.1 mg/kg
• Promethazine- oral/IM- 0.5 mg/kg and 1.1 mg/kg
• Diazepam- oral 0.2-0.5 mg/kg, rectal 0.25 mg/kg

3. Intramuscular:

• Ketamine- IM/IV-1-5 mg/kg
• Midazolam- oral – 0.25-1 mg/kg, IM 1-1.15 mg/kg

4. Intravenous: Midazolam

Question 9. Eruption hematoma
Answer:

• It is also known as an eruption cyst
• It is a dentigerous cyst occurring in the soft tissues
• Eruption hematoma Clinical Features
• Occurs more frequently and ruptures spontaneously
• Seen in children of different ages
• Deciduous and permanent teeth may be involved
• Common in anterior and first permanent molar
• The lesion appears circumscribed, fluctuant, often translucent swelling of the alveolar ridge over the site of the erupting tooth

Pediatric Consideration For Oral Surgery Viva Voce

1. Re-eruption potential is high in young permanent teeth
2. Partially intruded primary teeth should be left undisturbed as they usually re-erupt naturally
3. Luxation injuries are more common in the first 3 years of life
4. Fractures occurring in the apical third have the best prognosis
5. Isotonic saline/ pasteurized whole bovine milk are favorable storage media
6. If an intruded tooth is found to be impinging on permanent tooth bud, extraction of a tooth is indicated
7. Water is hypotonic media
8. If the tooth is not reimplanted immediately in a dental office, HBSS is the best storage media
9. If more than 1 hour is the extra-oral dry time, the avulsed tooth should be immersed in 2% sodium fluoride solution for 20 minutes

Hard And Soft Tissue Oral Lesions In Children Important Notes

1. Epulis

• It is a pink, pedunculated, submucosal mass usually arising from the anterior maxillary alveolar ridge Problems:
• Feeding difficulty
• Breathing problems are rare
• Treatment
• Local excision

2. Normal gingiva in child

Hard And Soft Tissue Oral Lesions In Children Short Essays

Question 1. ANUG.
Answer:

• It is an inflammatory destructive disease of the gingiva

Anug Etiology:

• Bacteria- fusospirochaetal organisms and bacteroids intermedius
• Predisposing factors
  • Local predisposing factors:
    • Pre-existing gingivitis
    • Injury to gingiva
    • Smoking
  • Systemic predisposing factors:
    • Nutritional deficiency
    • Debilitating diseases
    • Psychosomatic factors

Anug Clinical Features:

1. Intraoral signs:

• Punch out crater-like depression
• Covering of pseudomembranous slough
• Gingival hemorrhage
• Fetid odor
• Increased salivation- pasty saliva
• Sensitive to touch
• Radiating gnawing pain
• Increased pain on having spicy foods
• Metallic foul taste

2. Extraoral signs:

• Lymphadenopathy
• Fever
• Loss of appatite
• Lassitude
• Leucocytosis

Anug Treatment:

1. Antibiotic coverage:

• Penicillin 500 mgTDS
• Metronidazole-200-400 mg BID

Question 2. Localized Aggressive Periodontitis/Juvenile.
Answer:

An uncommon form of severe periodontitis

Juvenile Etiology:

• Actinobacillus actinomycetemcomitans
• Capnocytophage

Read And Learn More: Pedodontics Short Essays Question And Answers

• Defective neutrophil functioning

Juvenile Pathogenesis:

 

Juvenile Features:

• The teeth involved are permanent incisors and the first molar
• Attachment loss
• Alveolar bone loss
• Lack of inflammation
• Presence of deep pockets
• Excessive mobility
• Regional lymphadenopathy
• The presence of plaque is inconsistent with the disease process

Juvenile Radiographic Features:

• Vertical bone loss
• Arc-shaped bone loss
• Mirror image is formed as a result of bilateral involvement of arch

Juvenile Treatment:

• Scaling and root planning
• Subgingival irrigation
• Administration of tetracyclines

Question 3. Scorbotic Gingivitis.
Answer:

Scorbotic Gingivitis Etiology:

• Vitamin C deficiency

Scorbotic Gingivitis Features:

• Gingiva
  • Color – bluish red
  • Consistency – soft and friable
  • Surface – smooth and shiny
  • Size – Increased
  • Bleeding on probing present
  • Interdental papillae – Ulceration and necrosis
    • Foul breath
    • Bone loss
    • Loosening of teeth

Scorbotic Gingivitis Treatment:

• Ingestion of vitamin C tablets in the form of nutrition
• Oral prophylaxis

Question 4. Classification of Gingival and Periodontal disease in Children.
Answer:

1. Gingival diseases:

• Dental plaque-induced gingival diseases
• Associated with dental plaque only
• Modified by systemic factors

2. Periodontal diseases:

• Incipient chronic periodontitis
• Aggressive periodontitis
• Periodontitis as a manifestation of systemic diseases
• Necrotizing periodontal diseases

Short Question And Answers

Question 1. Acquired Pellicle.
Answer:

• It is thin film derived mainly from salivary glycoprotein which forms over the surface of a cleansed tooth crown.
• It is free from micro-organism
• It cannot be easily removed
• It reforms very quickly on clean tooth surfaces

Question 2. Causes of gingival hyperplasia.
Answer:

1. Inflammation:

• Acute
• Chronic

2. Drug-induced:

• Phenytoin
• Cyclosporins

3. Systemic diseases:

• Conditioned enlargeents
  • Puberty
  • Regnancy
  • Non-specific
• Systemic diseases
  • Leukemia

4. Neoplastic:

• Benign tumors
• Malignant tumors

5. False enlargements

6. Idiopathic

Question 3. Phenytoin induced gingival hyperplasia.
Answer:

Phenytoin Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in maxilla
• The site involved- marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has tabulated surface
• Firm to resilient in consistency
• No tendency to bleed
• Question 4. Acute herpetic gingivostomatitis.
  Answer:
• It is an acute infection of the oral cavity
• Acute herpetic gingivostomatitis Etiology:
• It is caused by herpes simplex type-1 virus
• Acute herpetic gingivostomatitis Clinical Features:
• Age- occurs during childhood
• Headache
• Fever
• Nausea, anorexia
• Lack of tactile and sensory sensation
• Sore throat
• Drooling of saliva
• Bilateral cervical lymphadenopathy
• Irritability
• Myalgia
• Site involved
  • Gingiva
  • Hard palate
  • Dorsum of tongue
  • Lips
  • Vermillion border
  • Perioral skin
  • Nasopharynx
• Present as shiny erythematous gingival swelling
• Reddening of the oral mucosa
• Formation of numerous small, dome-shaped or pinhead-type vesicle
• Size-2-3 mm in diameter
• Vesicles contain clear fluid and rupture to form ulcers
• Ulcers are multiple, small, circular, punctuate, shallow and painful
• Have red margins and yellowish or greyish floor
• Small ulcers fuse to form diffuse, large, whitish ulcers
• They are surrounded by a red halo
• Gingival margins are red, swollen, and painful and have punched-out erosions
• Difficulty in taking food
• Difficulty in mastication
• Difficulty in swallowing
• Increased bleeding
• Soreness of the oral cavity
• Sensitive to touch
• Numerous vesicle formations over the tonsillar area and posterior pharynx

Question 5. Juvenile periodontitis.
Answer:

• Rapid loss of attachment and bone loss occurring in an otherwise clinically healthy patient with the number of microbial deposits inconsistent with the disease severity and familial aggregation of diseased individual

Juvenile periodontitis Etiology:

• Hereditary
• A. actinomycete contains
• Capnocytophaga

Juvenile periodontitis Types:

1. Localized aggressive periodontitis

Juvenile periodontitis Clinical features:

• Age- 20 years
• Sex – common in females
• Lack of inflammation
• Deep pockets
• A small amount of plaque
• Mobility of first molars and incisors
• Midline diastema
• Root sensitivity
• Deep dull radiating pain
• Periodontal abscess
• Lymphadenitis

2. Generalised aggressive periodontitis

• Characterised by generalised interproximal attach¬ment loss affecting at least three permanent teeth other than first molar and incisors

Generalized aggressive periodontitis Clinical features:

• Age – puberty to 30 years of age
• Site – all teeth are affected
• Severely inflamed tissue
• Spontaneous bleeding
• Suppuration
• Deep pockets
• Attachment and bone loss
• Weight loss
• Mental depression
• General malaise

Hard And Soft Tissue Oral Lesions In Children Viva Voce

1. Unique characteristics of attached gingiva are: inter-dental clefts and tricuspid papilla
2. The probing depth of clinically normal gingiva is 2-3 mm
3. Chronic marginal gingivitis is more prevalent
4. Eruption cyst is most frequently seen in the primary second molar
5. Eruption sequestrum is seen in children at the time of eruption of first permanent molar
6. Penicillin is drug of choice in ANUG
7. Sulcus depth around primary teeth ranges from 1.4 mm to 2.1 mm
8. The periodontal ligament is wider in deciduous teeth as compared to permanent

Pediatric Endodontics Definitions

1. Pulpotomy

• It is defined as the complete removal of the coronal portion of the dental pulp, followed by the placement of a suitable dressing or medicament that promotes healing and preserves tooth vitality.

2. Pulpectomy

• It involves the removal of the roof and contents of the pulp chamber in order to gain access to the root canals which are debrided, enlarged, and disinfected.

3. Indirect Pulp capping

• It is the procedure involving a tooth with a deep carious lesion where carious dentin removal is left incomplete and the decay process is treated with a biocompatible material to avoid pulp tissue exposure

4. Apexification

• It is a method of inducing the development of root apex in an immature pulpless tooth by the formation of osteocytes- tum or bone

5. Apexogenesis

• It is the physiologic process of root development in the vital infected tooth

Pediatric Endodontics Important Notes

1. Pulpotomy techniques

• Vital Pulpotomy
  • Devitalization
    • Single sitting-formoterol
    • Two-stage – paraformaldehyde
  • Preservation
    • Glutaraldehyde
    • Ferric sulfate
    • MTA
  • Regeneration
    • Bone morphogenetic proteins
• Nonvital Pulpotomy
  • Beechwood cresol
  • Formocresol

2. Direct v/s indirect pulp capping

3. Root canal filling materials

4. Pulpotomy materials

5. Apexogenesis v/s apexification

6. Contraindications of Pulpotomy

• Spontaneous pain
• Hemorrhage that is bright red in colour and not easy to control
• Internal resorption
• Existence of abscess or fistula

7. Composition of Buckley’s solution

• 19% – Formaldehyde
• 35% – Cresol
• 15% – glycerine
• Water

8. Mummifying paste

• Introduced by Hobson

Composition

• Paraformaldehyde – active devitalizing agent
• Lignocaine
• Propylene glycol
• Carbowax
• Carmine

Pediatric Endodontics Long Essays

Question 1. Define pulpotomy. Describe indications and contra-indications for pulpotomies. Explain formocresol pulpotomy procedure.
Answer:

• Pulpotomy: It is defined as the complete removal of the coronal portion of the dental pulp, followed by the placement of a suitable dressing or medicament that promotes healing and preserves tooth vitality.

Pulpotomy Indications

• Vital teeth that are free of radicular pulpitis are considered suitable for pulp capping
• Pain, if present is neither spontaneous nor persistent
• The tooth is restorable and possesses at least two-thirds of its root length
• There is no evidence of internal resorption, inter radicular bone loss, abscesses or fistulas
• The hemorrhage from the amputation site is easy to control

Pulpotomy Contraindications

• The tooth crown is non-restorable and tender on percussion
• Highly viscous hemorrhage seen at the radicular canal orifices
• Mobility or radiolucency with marked root resorption exists
• Persistent toothaches and coronal pus

Pulpotomy Technique:

• Anesthetized and isolate the tooth
• Remove the carious lesion
• The entire roof of coronal pulp is removed
• With the help of a spoon or excavator cut out the coronal pulp
• Irrigate the pulp chamber
• Control the bleeding with the help of a moist cotton pellet
• Dry the pulp chamber

Read And Learn More: Pedodontics Short Essays Question And Answers

• Now place cotton moistened with 1.5 concentration of Buckley’s formocresol solution into the canal
• Keep it for 5 minutes
• Now remove it and dry the canal
• Restore the tooth with a thick paste of zinc oxide eugenol
• Place the base of zinc polycarboxylate cement over it
• Finally, permanently restored with stainless steel crown

Pediatric Endodontics Short Essays

Question 1. Materials used for pulpotomy.
(or)
Pulpotomy medicaments
Answer:

• Devitalizing Agents
  • Formocresol:
    • Potent germicidal
    • Maintains tissue vitality
    • May lead to periapical leakage
  • Gysi Triopaste:
    • Composition:
      • Tricresol
      • Cresol
      • Glycerin
      • Paraformaldehyde
      • Zinc Oxide
  • Easlick’s paraformaldehyde paste:
    • Paraformaldehyde
    • Procaine base
    • Powdered asbestos
    • Petroleum jelly
    • Carimine to color
• Preservative Agents:
  • Glutaraldehyde:
    • Better tissue fixation
    • Excellent antimicrobial
    • Maintains pulp vitality
    • This leads to minimal pulpal necrosis
  • Ferric Sulphate:
    • Favorable pulpal response
    • Causes internal resorption
  • MTA (Mineral Trioxide Aggregate):
    • Biocompatible
    • Better sealing
    • Promotes regeneration
• Regenerative Agents:
  • Bone Morphogenic protein:
    • Induce differentiation of adult pulp cell into odontoblast
    • This leads to dentin bridge formation

Question 2. Apexification.
Answer:

• It is a treatment of non-vital immature teeth to induce root end closure by suitable medicament

Apexification Procedure

Question 3. Obturating materials.
Answer:

1. Zinc oxide Eugenol paste:

Introduced into the root canal with the help of a syringe

• Zinc oxide Eugenol paste Problems:
  • Underfilling – frequently accepted
  • Overfilling – causes mild foreign body reaction
  • Differences occur between its rate of resorption and that of tooth root
  • Iodoform paste/KRI paste
• Zinc oxide Eugenol paste Composition:
  • Iodoform
  • Camphor
  • Parachlorophenol
  • Menthol

Zinc oxide Eugenol paste Properties:

• • Resorbs rapidly
  • Extruded periapical KRI. the paste is replaced with a normal tissue
  • Has long-lasting bactericidal potential
  • Has good success rate

2. Calcium Hydroxide:

• Easy to apply
• Rapidly resorbed
• Has no toxic effects
• It is radiopaque

3. Collacote:

• It is a soft, white, biocompatible
• Can be applied to bleeding canals
• Provides scaffold for bone growth

Collacote Composition:

• Synthetic collagen

4. Endoflas:

• Composition:
  • Zinc oxide
  • Barium sulfate
  • Iodoform
  • Calcium hydroxide
  • Eugenol
  • Pentachlorophenol
  • It prevents microleakage
  • Placed after the elimination of inflammation

Question 4. Obturation Techniques.
Answer:

1. With the help of a syringe:

• An endodontic pressure syringe loaded with Vitapex is used
• Introduce the syringe up to 1/5th the distance from the apex of the canal
• Slowly inject the material

Question 5. Apexification and Apexogenesis.
Answer:

Question 6. Indirect Pulp Capping-
Answer:

• Definition – It is the procedure involving a tooth with a deep carious lesion where carious dentin removal is left incomplete and the decay process is treated with a biocompatible material to avoid pulp tissue exposure

Indirect Pulp Capping Indications:

• Irreversible pulpitis
• Presence of adequate bone support
• Root length available at least 2/3rd of its total length
• Internal resorption

Indirect Pulp Capping Contraindications:

• Mobile tooth
• Non-restorable tooth
• Presence of cyst
• Less than 2/3rd of root length remaining
• Perforation of the pulpal floor

Indirect Pulp Capping Procedure:

Question 7. Formocresol v/s Glutaraldehyde.
Answer:

Question 8. Pulpectomy in 85.
Answer:

• Pulpectomy – It involves the removal of the roof and contents of the pulp chamber in order to gain access to the root canals which are debrided, enlarged, and disinfected.

Procedure:

Question 9. Bleaching.
Answer:

• It is a procedure by which the discoloration of teeth are managed by the application of a bleaching agent

Bleaching Types:

1. For vital teeth:

• For non-vital teeth

2. Extracoronal bleach:

• Intracoronal bleach

Agents Used:

• Superoxol
• Sodium perborate
• Sodium peroxide
• Hydrogen peroxide

Question 10. Define Apexogenesis and write in detail about the procedure of Apexogenesis.
Answer:

Apexogenesis

• It is the physiologic process of root development in the vital infected tooth

Apexogenesis Indications

• Traumatized or palpably involved vital permanent tooth

Apexogenesis Contraindications

• Presence of degenerative changes in radicular pulp
• Purulent discharge
• Necrotic debris in the canal
• Periapical radiolucency

Apexogenesis Technique

• The operated area is anesthetized
• A rubber dam is applied
• Remove all carious portions of the tooth and open up the pulp chamber
• Remove coronal pulp leaving behind the radicular portion
• Rinse thoroughly all the debris
• Control bleeding by placing a moist cotton pellet over the amputated pulp
• Calcium hydroxide is placed over the pulp
• Restore with a temporary restoration
• Follow-up radiographs are taken to check the root development periodically
• Once root formation is completed, conventional root canal treatment is done

Pediatric Endodontics Short Answers

Question 1. Glutaraldehyde.
Answer:

• Better tissue fixation
• Excellent antimicrobial
• Maintains pulp vitality
• Leads to minimal pulpal necrosis

Question 2. Obturation.
Answer:

• Obturation of primary teeth is done with resorbable material that will give way for the erupting permanent tooth

Obturation Procedure

• First, a thin mix of zinc-oxide eugenol is used to coat the walls of the canals using a reamer
• First, the reamer is rotated clockwise inside the canal for 10-15 rotations
• Use a thick mix of zinc oxide eugenol and fill the canal using leptospiral
• Seal the pulp chamber with a temporary restoration
• Recall after a week, if the patient is totally asymptomatic, restore permanently with stainless steel crown

Question 3. Vitality test.
Answer:

Heat Test:

• Done by
  • Hot gutta-percha
  • Hot burnisher
  • Hotair
  • Hot compound
  • Hot water
• Result:
  • No response – necrosed pulp
  • Mild response – Normal pulp
  • Painful response – Pulpitis
• Cold Test:
  • Done using ethyl chloride spray, pencil sticks of ice, carbon dioxide snow at -78°C
• Electric Pulp Test:
  • Most useful tool
  • Execute neural elements of pulp
• Other methods:
  • Anesthetic test
  • Transillumination
  • Test cavity

Pediatric Endodontics Viva Voce

1. Direct pulp capping and calcium hydroxide Pulpotomy are contraindicated in primary teeth as they cause internal resorption
2. Pulp testing gives false results if root formation is incomplete or the tooth has a temporary crown or splint
3. If an injured tooth requires more current than normal it indicates pulp death
4. If less current is needed it indicates pulpal inflammation
5. Tooth tested immediately after trauma may give a negative response
6. A laser Doppler flow meter and pulse oximeter determine vitality based on the blood supply to the pulp
7. Calcium hydroxide-iodoform mixture- vitapex is considered as nearly ideal filling material
8. KRI paste has long-lasting germicidal potential
9. ZOE paste is a commonly used filling material in primary teeth
10. Gutta-percha is contraindicated as it is not resorbable

Pediatric Restorative Dentistry Important Notes

1. Advantages of GIC

• Tooth-colored material
• Adherence to both enamel and dentin
• Fluoride release

2. Calcium hydroxide

• It was introduced by Herman for pulp capping
• It is very alkaline with pH 11-13 which ensures the inability of bacteria to thrive in its presence
• If placed too close to pulp, it will cause necrosis If adjacent pulp tissue and inflammation
• Dentin bridge formation occurs at the junction of the necrotic tissue and vital inflamed tissue
• When it is applied as liner the excess calcium ions present in the cement would be available to the pulp and would encourage remineralization with the pulp chamber

3. Modification in class 2 cavity preparation in primary teeth

• Due to the presence of broad contact areas, the gingival floor should be wide to place the margins in self-cleansing areas
• Due to cervical constriction, the gingival wall should not be too gingival
• The width of the isthmus should not exceed l/3rd of the intercuspal distance
• The gingival seat should not be beveled
• Avoid mesiobuccal pulp horn in case of small first molars

4. Esthetic preformed crowns

• Polycarbonate crowns
• Strip crowns
• Pedo jacket crowns
• Fuks crown
• New Millenium crown
• Nusmile crowns
• Cheng crown
• Dura crowns
• Pedo pearls

5. Rubber dam

• It was developed by Barnum
• A latex rubber dam is available in 5 *5 or 6 6 size
• Non-latex rubber dam is available in 6 * 6 size

Pediatric Restorative Dentistry Long Essays

Question 1. Classify stainless steel crowns, and mention their indications. Give a stepwise description of resto¬ration with it.
(or)
Mention uses, advantages, disadvantages, and preparation for stainless steel crown for tooth 85.
Answer:

Stainless steel crown Classification

1. Based on composition:

• Stainless steel crown:
  • These alloys are made up of authentic steel with the composition
    • 17-19% chromium
    • 9-13% nickel
    • 0.08-0.12% carbon
• Nickel-base crown:
  • Contains
  • 76% nickel
  • 15.5% chromium
  • 8% iron
  • 0.04% carbon
  • 0.35% manganese
• Tin-base crowns:
  • 96% tin
  • 4% silver
• Aluminum base crown:
  • Contains
  • 1.2%-manganese
  • 10% magnesium

Read And Learn More: Pedodontics Short Essays Question And Answers

• • 0.7% iron
  • .3% silicon
  • 0.25% copper

2. Based on morphology:

• Untrimmed/ uncontoured crowns
  • The sides are straight and longer
• Pretrimmed crowns
  • The sides are straight but shorter
• Precontoured crowns
  • Crowns are more rounded in the gingival margin

Stainless steel crown  Uses/ Indications:

• Teeth with extensive caries
• Presence of developmental defects of teeth
• Teeth with hypoplastic defects
• Restoring teeth after pulpal therapy
• As a preventive restoration
• It is used as an abutment
• As temporary restoration of a fractured tooth
• In the presence of parafunctional habits
• Malocclusion – Single tooth cross bite
• For replacement of prematurely lost anterior

Stainless steel crown Advantages:

• Good life span
• Good retention and resistance
• Acceptable
• Cost-effective

Stainless steel crown Disadvantages:

• It may lead to
• Ledge formation in interproximal region
• Tilting of crown
• Poor marginal adaptation

Stainless steel crown Preparation:

• Occlusal reduction is done up to 1.5-2 mm
• Proximal walls are made converging occlusal
• Next, buccal and lingual surfaces are made at least 0.5 mm
• Buccal and lingual surfaces converge occlusal
• Rounding of line and point angles Even the occlusal third of buccal and lingual surfaces are made rounded seating of crown > Initially seat the lingual portion by applying gentle pressure in a buccal direction
• Examine the gingival margins of the crown
• Contour the crown along the tooth anatomy
• Finishing and polishing of the crown is done
• Finally, cementation with zinc phosphate, zinc polycarboxylate or GIC is done
• Excess cement is removed using Explorer and knotted dental floss

Pediatric Restorative Dentistry Short Essays

Question 1. Tooth preparation for stainless steel crown.
Answer:

• Tooth preparation mainly involves 3 steps

1. Occlusal preparation:

• Bur is used to reducing the occlusal surface by 1.5-2 mm following the cuspal outline
• Cusp are reduced preserving as much tooth structure as possible
• It is done prior to proximal reduction

2. Proximal reduction:

• Wooden wedges are used in the interproximal embrasures to reduce the risk of damage to adjacent teeth
• Bur is swept buccolingually across the proximal surface

3. Roundening of line angles:

• All line angles created are rounded by moving the bur at the angle of 45 degrees

Crown Selection

• Crown is selected by
• Adequate mesiodistal diameter
• Light resistance to seating
• Proper occlusal height

Crown Seating

• The selected crown should be placed on the lingual side and rotated to the buccal side
• The crown should fit loosely with 2-3 mm of excess on the gingival side

Adapting The Crown

• Pliers are used to contouring the gingival edges to tighten the fit of the crown
• Poorly adapted crowns will serve as a collection area for bacteria and can cause recurrent caries

Finishing

• After adaptation, the crown margin should be trimmed using green stone in a counterclockwise direction at 45 degrees angle

Question 2. Class 2 Cavity Preparation for primary 2nd molar.
Answer:

1. Occlusal Form:

• Extend the cavity margins to include all carious lesions
• Cavity margins should be such that it can be easily assessed and include self cleansable area
• Initial pulpal depth is maintained as 0.5 mm into the dentin

2. Proximal Reduction:

• Proximal ditch cut is given
• Provide 0.2-0.3 mm proximal clearance
• The depth of the axial wall is maintained to 0.5 mm in dentin
• The gingival seat is not beveled

Resistance Form – Features:

• Flat pulpal floor
• Box-shaped cavity
• Rounded internal line angles
• 90o cavosurface angle
• Width of cavity not more than l/3rd of intercuspal distance
• Adequate bulk of the restorative material
• The reverse curve is provided

Retention Form:

• Converging occlusal walls
• Preservation of uninvolved marginal ridge
• Dovetail provided over the uninvolved marginal ridge
• An inverse taper of 5 degrees is given

Convenience Form:

• It is the form of cavity that facilitates access for instrumentation, condensation, adaptation, and finishing
• Removal of any remaining defects
• Removal of infected dentin

Finishing Of The External Walls:

• Pulp protection:
  • In the case of a deep cavity, the pulp is protected with the help of bases
• Final Step:
  • Cleaning and inspecting the cavity preparation

Question 3. Baume’s Classification.
Answer:

• It is for the classification of dental caries
• It consists of

1. Pit and Fissure lesions:

• Pit and Fissures are the depression prevented over the occlusal surfaces of posterior teeth
• If they are narrow, they can be self cleansable
• But, however, widened pit and fissures are more prone to caries
• Such pit and fissure can be prevented by pit and fis¬sure sealants

2. Smooth Surface Caries:

• These involve the proximal surfaces of posterior teeth
• These are common in deciduous teeth due to the presence of open contacts
• Open contacts results in food lodgement
• The stagnant of food in these areas leads to demin¬eralization of the calcified tooth structure
• This further leads to the development of caries

Question 4. Matrices.
Answer:

Matricing is the procedure of creating a temporary wall opposite to the axial wall

Matrices Objectives:

• Creates good proximal contour
• Good adaptation of restoration is provided
• Improves the accessibility
• Holds the material while it is setting
• Avoid contamination of restoration
• To some extent, it displaces gingiva

Matrices Types:

1. For class 1 cavity:

• Double-banded Tofflemire

2. For class 2 cavity:

• Single banded Tofflemire
• Ivory No. 1
• Ivory No. 8
• Automatic
• S-shaped matrix band
• T-shaped matrix band

3. For class 3 cavity:

• Transparent celluloid strips

4. For class 4 cavity:

• Celluloid strips
• Crown form matrices

5. For class 5 cavity:

• Window matrix

Question 5. Atraumatic Restorative Treatment.
Answer:

• It is a procedure that involves conservative tooth preparation and restoration it by using only hand instruments

Atraumatic Restorative Method:

• Remove the carious lesion with the help of spoon exca¬vator
• With the help of a hatchet remove the unsupported enamel
• Clean the cavity
• Isolate the cavity
• Condition the cavity by placing a drop of GIC liquid with the help of wet cotton
• Wiped out and rinse the cavity immediately to remove the excess of polyacrylic acid
• Now, dry the cavity
• Manipulate Glass ionomer cement
• Place the cement as a thick mix, into the cavity, con-dense it with finger pressure
• Apply a layer a varnish over it to protect it against con¬tamination
• Atraumatic Restorative

Atraumatic Restorative Advantages:

• Conservative
• No need of complicated procedures
• Minimize the risk of iatrogenic errors

Question 6. Polycarbonate Crowns.
Answer:

• These are temporary crowns which can be given as fixed prostheses to deciduous anterior teeth

Polycarbonate Crowns Contraindications:

• Severe bruxism
• Deep bite
• Excessive abrasion

Polycarbonate Crowns Advantage:

• Easy and quick
• Can be easily adjusted

Polycarbonate Crowns Technique:

• Select the crown according to the dimension of the tooth
• Proceed with the tooth preparation
• Facial and lingual reduction – 0.5-1 mm
• Proximal reduction – 0.5-1 mm
• Incisal reduction – 1-2 mm
• Examine the preparation
• Check for the adaptation of crown
• Trim and Finish the margins of the crown
• Finally, the cementation of the crown is carried out

Question 7. Glass Ionomer Cement (GIC).
Answer:

Glass Ionomer Cement Advantages:

• Chemical bonding
• Esthetic
• Fluoride releasing property

Glass Ionomer Cement Disadvantages:

• Susceptible to erosion
• Less wear resistance
• Brittle in nature

Glass Ionomer Cement Classification:

• Type 1 – Luting
• Type 2 – Restorative
• Type 2-1 – Restorative esthetic
• Type 2-2 – Restorative reinforced
• Type 3 – Lining or base

Glass Ionomer Cement Composition:

• Powder:
  • Silica
  • Alumina
  • Aluminum fluoride
  • Calcium fluoride
  • Aluminum phosphate
  • Sodium fluoride
• Liquid:
  • Polyacrylic acid
  • Tartaric acid
  • Water

Glass Ionomer Cement Uses:

• Asa sealant
• As liners and bases
• For luting of brackets
• Restorative material
• As temporary restoration
• As core build-up
• For atraumative restorative treatment

Glass Ionomer Cement Properties:

• Compressive strength – 150 MPa
• Tensile strength – 6.6 MPa
• Hardness – 49 kHN
• Fracture toughness
• Solubility – 0.4%
• Adhesion – Chemical bonding
• Esthetic
• Bio-compatible
• Fluoride release

Glass Ionomer Cement Setting time:

• Type 1 – 4.5 min
• Type 2 – 7 min

Powder Liquid Ration 1:5:1 OR 3:1:

• Modifications:
  • Fiber reinforced GIC
  • Metal reinforced GIC
  • Cermet cement
  • Resin modified GIC

Pediatric Restorative Dentistry Short Answers

Question 1. Rubber dam sheet
Answer:

• They are available in 5″ X 5″ or 6″ X 6″ sizes
• Available thicknesses are:
• Thin- 0.15 mm
• Medium- 0.20 mm
• Heavy- 0.25 mm
• Extra heavy 0.30 mm
• Special heavy – 0.35 mm
• It is available in green, blue, black, pink, and burgundy colours and mint, banana, and strawberry flavors
• The rubber dam sheet has a darker side and a shiny side
• The shiny side should always be towards the tissue so that the dam can pass easily over them with minimal irritation
• The dull side should be towards the occlusal aspect so that it does not reflect the light from it

Question 2. Tunnel cavity preparation.
Answer:

• Tunnel cavity preparation is a modification of class 2

Tunnel cavity Indications:

• Small cavities
• Cavities that are placed 2-2.5 mm below the marginal ridge

Tunnel cavity AIMS:

• Access via occlusal aspect
• To preserve the strength of the marginal ridge
• To prevent the formation of a proximal cavity

Tunnel Cavity Procedure:

• Caries is removed by using slow-speed round bur
• The proximal wall is not fractured if it is not involved
• The remaining caries is removed with a spoon excavator
• The cavity is restored using G1C

Question 3. Semi-permanent restorations.
Answer:

• Semi-permanent restoration are used to restore the lost tooth structure and stabilize it
• Polycarbonate and stainless steel crowns are used as semi-permanent restorations

1. Polycarbonate crowns:

• They are heat molded acrylic resins used to restore anterior teeth
• They do not resist strong abrasive forces, leading to occlusal fracture and de-bonding or dislodgement

2. Stainless steel crown:

• It is used in primary and young permanent teeth
• It was introduced by Humphrey in 1950
• It is more frequently used in deciduous dentition

Question 4. Rubber dam.
Answer:

• Used for isolation

Rubber dam Purpose:

• Retraction of soft tissue
• Improves efficiency of the treatment
• Improves properties of restorative material
• Provides clean and dry field
• Prevents contamination

Rubber dam Contraindication:

• Asthmatic patient
• Newly erupted teeth
• Patients with allergic to late

Rubber dam Components

• Rubber dam sheet
• Rubber dam frame
• Rubber dam punch
• Rubber dam forceps
• Dental floss
• Rubber dam napkin
• Clamps

Question 5. Saliva Ejectors.
Answer:

• Prevent pooling of saliva in the floor of the mouth

Saliva Ejectors Types:

1. Metallic – Can be autoclaved
2. Plastic – Disposable

Saliva Ejectors Advantages:

• Provides adequate dry field
• No dehydration of oral tissues

Question 6. Pulpal Differences between primary and permanent teeth.
Answer:

Question 7. Celluloid/Strip Crowns.
Answer:

• Esthetic crown

Strip Crowns Technique:

• Anaesthetise and isolate the tooth
• Selection of celluloid crown
• Tooth preparation
• Incisal reduction – 1.5-2 mm
• Proximal reduction – 0.5-1 mm
• Labial reduction – 1 mm
• Lingual reduction – 0.5 mm
• Rounding of line angles
• Trim the crown margin
• Place the ventholes
• Fill the crown with composite
• Etch and dry the tooth
• Apply bonding agent
• Seat the crown upto polymerization of the resin
• Strip the celluloid crown using the explorer
• Check for occlusion
• Finishing and polishing done

Question 8. Intermediate Restoration.
Answer:

Intermediate Restoration Features/Requirements:

• Nonirritant
• Esthetic
• Easy to apply and remove
• Maintain periodontal health
• Should have adequate strength

Intermediate Restoration Cement Used:

• Zinc oxide eugenol
• Zinc Phosphate
• Zinc polycarboxylate
• Glass ionomer
• Calcium hydroxide

Question 9. Reparative Dentin.
Answer:

• It is formed as a response to external stimuli
• It is irregular with cellular inclusions
• Has decreased permeability
• Formed by secondary odontoblasts that are differentiated from mesenchymal cells of the pulp
• Helps in the prevention of diffusion of noxious agents from the tubules

Question 10. Calcium Hydroxide.
Answer:

Calcium Hydroxide Use:

• Intracanal medicament
• Pulp capping agent

Calcium Hydroxide Effect:

• Bactericidal
• Stimulate secondary dentin formation
• Denature proteins
• Aids in the dissolution of necrotic pulp
• Increases alkalinity
• Destroys micro-organisms in inaccessible areas

Calcium Hydroxide Available Form:

• Powder and liquid
• Paste form

Question 11. Gamma 2 phase(γ₂).
Answer:

• γ₂ phase is SngHg
• It is the weakest phase
• Its hardness is 10% that of
• Least corrosion resistance

Pediatric Restorative Dentistry Viva Voce

1. GIC was developed by Wilson and Kent
2. Stainless steel crown was introduced by Humprey
3. The finish line for the stainless steel crown is feather edge
4. The crown should extend 1 mm below the gingival crest
5. In the primary dentition, a rubber dam is routinely placed over c,d,e
6. The universal clamp used for stabilizing the rubber dam during mixed dentition is 5.5 # 206

Fluorides Important Notes

1. APFgel

• APF solution/ Brudevold’s solution is prepared by dissolving 20 gms of NaF in 1 liter of 0.1 M phosphoric acid and to this 50% hydrofluoric acid is added to adjust pH 3 and fluoride ion concentration at 1.23%
• APF gel is prepared by adding gelling agents like methylcellulose and hydroxyl ethyl cellulose and pH is adjusted between 4-5

2. Sodium fluoride

• It is chemically stable
• Has pleasant taste
• No irritation to the tissues
• Cheap
• The method of application is known as the Knutson technique
  • Knutson and Feldman recommended this technique
  • In this 4 applications of 2% NaF at weekly intervals in a year 3,7,11 and 13 years is done

3. Stannous fluoride

• It is an unstable solution due to the formation of Sn(OH)₂
• So it requires fresh solutions to be prepared for each patient

4. Nalgonda technique of defluoridation

• It was developed by National Environmental Engineering Research Institute at Nagpur in 1961.
• Involves the addition of aluminate or lime, bleaching powder, and filter alum to fluoride water

5. Fluoride varnishes

• Commonly used are
  • Duraphat – fluoride concentration is 22600 ppm
  • Fluor protector – fluoride concentration is 7000 ppm

6. Fluoride toxicity

Fluorides Long Essays

Question 1. What is topical fluoride? Explain about APF gel and Sodium fluoride.
Answer:

Topical Fluoride:

• It refers to the use of systems containing relatively large, concentrations of fluoride that are applied locally, or topi¬cally, to erupted tooth surfaces to prevent the formation of dental caries

Sodium Fluoride- 2%:

• Preparation: It is prepared by dissolving 20 gms. of Sodium fluoride powder in 1 liter of distilled water.

Sodium Fluoride Application (Knutson Technique):

• Clean and polish the teeth
• Isolate both the arches
• Dry the teeth thoroughly
• Apply 2% NaF with cotton applicators
• Maintain it for 4 minutes
• Repeat it for the remaining quadrant
• Avoid eating, drinking/rinsing for 30 minutes
• Repeat applications at weekly intervals
• Recommended ages – 3,7,11,13

Sodium Fluopide Mechanism Of Action:

Apf (Acidulated Phosphate Fluoride) – 1.23%:

Method Of Preparation (Brudevold’s Solution):

• It is prepared by dissolving 20 gms. of sodium fluoride in 1 liter of 0.1M phosphoric acid
• Followed by the addition of 50% hydrofluoric acid
• A gelling agent methylcellulose or hydroxyethyl cellulose is added to the solution

Brudevold’s Solution Application:

• Oral prophylaxis
• Isolate the teeth
• Dry the teeth
• Apply APF solution by loading in a tray
• Maintain it for 4 minutes

Brudevold’s Solution Frequency: – Twice in a year

Brudevold’s Solution Mechanism Of Action:

Question 2. Write in detail about the mechanism of action of fluoride in preventing dental caries. Add a note on topical fluorides for home use.
Answer:

Mechanism Of Action Of Fluoride

1. Fluoride incorporation in enamel

• Pre-eruptive incorporation:
  • Fluoride gets incorporated in the fluid-filled sac surrounding the developing tooth
  • Then it enters the developing tooth
• Post-eruptive incorporation:
  • Fluoride enters the enamel surfaces
  • Conversion of carbonated apatite and hydroxyapatite to fluorapatite and fluoro- hydroxyapatite takes place

2. Remineralization of acid

• Equilibrium exists between minerals of tooth enamel and minerals of saliva
• This is disturbed by the organic acid produced by carbohydrates
• There is a drop in pH
• Minerals leach out
• This is prevented by the remineralization by fluoride
• Fluoride penetrates into enamel rods
• It forms larger crystals that are more acid resistant

Topical Fluorides

1. Dentrifices:

• Fluoride compounds in dentifrices
  • Sodium fluoride
  • Stannous fluoride
  • Mono fluorophosphate
  • Amine fluoride

Topical Fluorides Indications:

• Dental caries prevention
• Caries risk patient
• Desensitization

Topical Fluorides Mechanism:

• Monofluorophosphate gets deposited in the crystalline lattice and intra- crystalline transposition
  • Fluoride is released
  • This replaces the hydroxyl group to form fluorapatite
• Mono fluorophosphate may exchange with the phosphate group in apatite crystals

Topical Fluorides Adverse Effects

• Detergents and flavoring agents
  • Irritate stomach
  • Cause vomiting
• Abrasive
  • Interfere with complete intestinal absorption of fluoride
• Regular ingestion of fluoride by children <6 years
  • Dental fluorosis

2. Mouth Rinses:

• Described by Bibby et al in 1946

Contra-Indications:

• Children less than 6 years of age
• Persons with problems in oro-facial musculature due to which they cannot rinse

Sodium Fluoride Mouth Rinses:

• Formulated at
  • 0.2% concentration- for weekly use
  • 0.05% concentration- for daily use
• Preparation
  • Prepared by dissolving 200 mg sodium fluoride tablet in 5 teaspoons of fresh clean water
  • It can be used for 4 members (2 adults and 2 children)

Mechanism:

• Fluoride forms fluorapatite from hydroxyapatite
• Fluoride inhibits bacterial metabolism and plaque acid formation

Mouth Rinses Indications:

• If the concentration of fluoride in drinking water is
• 0. 3 ppm or less
• Patients with increased caries risk
• School fluoride programs

Mouth Rinses Advantages:

• 30-40% reduction in caries incidence

3. GELS:

• Include
  • Neutral sodium fluoride and acidulated phosphate fluoride with a fluoride concentration of 5000 ppm
  • Stannous fluoride with a concentration of 1000 ppm

GELS Method of Use:

• Brushing for 1 minute with the gel
• Placing several drops in each tray and held in contact with the teeth for 5 minutes

GELS Disadvantages:

• Violate the principle of delivering low concentration of fluoride
• Cause fluoride toxicity
• Tedious to use

Fluorides Short Essays

Question 1. School water fluoridation.
Answer:

• Initiated as a pilot study in 1954 at St. Thomas Virgin Islands, United States
• It is used only if the surrounding areas from which the students come have a low fluoride content
• The concentration of fluoride in the school water is 4.5 ppm in contrast to 1 ppm of the community water supply
• This is to compensate for the reduced water intake

School water fluoridation Advantages:

• About 40% of reduction in DMFT was observed
• No effort is required by the recipient
• Effective public health measure
• Target population-school children
• Quite economical

School water fluoridation Limitations:

• Need for cooperation from school authorities
• Children may not attend all school days
• There is intermittent fluoride exposure
• Limited pre-eruptive benefits to primary teeth
• Possible confrontation by antifluoridation groups
• The cost of installation, supplies, and maintenance compete with other needs of the school budget
• Custodial and backup personnel are required to be trained

Question 2. Defluoridation.
Answer:

• Defluoridation is the process of removing excess naturally occurring fluoride from drinking water in order to reduce the prevalence and severity of dental fluorosis

Defluoridation Methods

1. Ion Exchange Resins:

• Carbion
  • It is a cation exchange resin of good durability and can be used on sodium and hydrogen cycles
• Defluoron 1:
  • A sulfonated sawdust impregnated with 2% alum solution
• Defluoron 2:
  • It is a sulfonated coal using aluminum solution as regenerate

2. Nalgonda Technique:

• This technique is developed in India in 1975
• By National Environmental Engineering Research Institute
• It was constructed in the district of Nalgonda in Andhra Pradesh in the town of Kathri

Nalgonda Technique Procedure:

• Raw water is collected in a tank
• Add alum solution to it

Read And Learn More: Pedodontics Short Essays Question And Answers

• Next, depending on alkalinity add lime
• Stir gently for 10 minutes
• Results in the formation of floes
• Allow it to settle

Nalgonda Technique Advantages:

• Can be used at domestic and community levels
• Manually operated
• Cost-effective
• It meets with standards laid down by the Bureau of Indian Standard

Question 3. Fluoride Toxicity.
Answer:

• It refers to the symptoms manifested as a result of overdosage or excessive administration.

Fluoride Toxicity Types:

1. Acute: Due to single ingestion of large amounts of fluoride
2. Chronic: Due to long-term ingestion of smaller amounts

Fluoride Toxicity Symptoms:

• GIT disturbances
  • Nausea
  • Vomiting
  • Diarrhea

Pain:

• Abdomen
• Extremities
• Difficulty in speech
• Thirst
• Perspiration
• Weak pulse
• Coma
• Convulsion
• Cardiac arrhythmia

Pathological Changes:

• Oral corrosive changes
• Hemorrhagic stomach contents
• Changes in intestine

Fluoride Toxicity Management:

• Administration of Milk or egg
• Lime water
• Aluminum hydroxide gels
• Inducing vomiting

Question 4. Fluoride Varnish.
Answer:

• Commonly used
  • Duraphat
  • Fluorprotector

Fluoride Varnish Composition:

• It is a dichlorosilane-ethyl diflurohydroxysilane
• The Fluoride content is 22.6 mg F/ml.

Fluoride Varnish Application:

• Oral prophylaxis
• Dry the teeth
• Apply varnish with a single tufted small brush first on the lower arch, then on upper
• Maintain it for 4 minutes
• Avoid rinsing, drinking, and eating for 1 hour.

Fluoride Varnish Dose:

• 0.5 ml of dura phat containing 11.3 mg F fluoride
• 0.5 ml of floor protector containing 3.1 mg F fluoride

Fluoride Varnish Mechanism Of Action:

• On application of varnish, results in a reservoir of fluoride ions around the enamel
• Results in deeper penetration of fluoride and formation of fluorapatite

Question 5. Fluoride Dentrifices.
Answer:

Commonly Used Agents:

• Sodium mono fluoro phosphates
• Sodium fluoride

Fluoride Dentrifices Indication:

• Prevention of caries
• Caries – risk patients
• Desensitization

Fluoride Dentrifices Mechanism Of Actions:

Fluoride Dentrifices Procedure:

• Selection of proper dentifrices
• Place a pea size amount of dentifrice on the toothbrush tips
• Proceed with correct brushing.

Question 6. Dean’s Index.
Answer:

Question 7. Topical Fluorides.
Answer:

• Definition: It is used to describe those delivery systems which provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition

Topical Fluorides Indications:

• Caries active individual
• Children shortly after tooth eruption
• Those who take medication that reduces salivary flow
• After periodontal surgery
• Patients with fixed or removable prosthesis
• Patients with eating disorders
• Mentally and physically challenged individual

Topical Fluorides Classification:

1. Professionally applied products:

• Dispensed by a dental professional
• It includes
  • Sodium fluoride
  • Minimum 4 applications with 2% gives caries reduction of about 30%
• Stannous fluoride
• Used as 8% concentration
• Acidulated phosphate fluoride gel
• Fluoride varnishes
  • Duraphat
  • fluoroprotector

Composition:

• It is a dichlorosilane-ethyl difluoro hydroxy silane
• Fluoride content is 22.6 mg F/ ml

2. Self-administered:

• Fluoride dentifrices
• Sodium fluoride
• Fluoride mouth rinses
• Dentrifices containing monofluorophosphate

Question 8. Miller’s acidogenic theory
Answer:

• Postulated by WD Miller in 1889.
• It states that
  • Acids formed due to the fermentation of dietary carbohydrates by oral bacteria lead to progressive decalcification of the tooth structures with subsequent disintegration of organic matrix
• It states that the process of dental caries involves two stages
  • Initial stage
    • Acid production due to fermentation of carbohydrates by plaque bacteria
  • Late stage
    • Decalcification of enamel followed by dentin by acids
    • This causes total destruction of enamel and den-tin
• According to Miller, the process of caries involves four factors
  • Dietary carbohydrates
  • Micro-organisms
  • Acids
  • Dental plaque

Fluorides Short Answers

Question 1. Duraphat.
Answer:

• It is a fluoride varnish

Duraphat Composition:

• It is a dichlorosilane-ethyl diflurohydroxysilane
• The Fluoride content is 22.6 mg F/ml.

Duraphat Application:

• Oral prophylaxis
• Dry the teeth
• Apply varnish with a single tufted small brush first on the lower arch, then on upper
• Maintain it for 4 minutes
• Avoid rinsing, drinking, and eating for 1 hour.

Duraphat  Dose:

• 0.5 ml of dura phat containing 11.3 mg F fluoride

Question 2. Mechanism of fluoride varnish.
Answer:

• On application of varnish, results in a reservoir of fluoride ions around the enamel
• Results in deeper penetration of fluoride and formation of fluorapatite

Question 3. Brudevold’s technique.
Answer:

• It is a method of preparing APF gel
• It is prepared by dissolving 20 gms. of sodium fluoride in 1 liter of 0.1M phosphoric acid
• Followed by the addition of 50% hydro fluoride acid
• A gelling agent methylcellulose or hydroxyethyl cellulose is added to the solution

Question 4. Choking off phenomenon.
Answer:

• It is seen on the application of 2% of sodium fluoride
• When sodium fluoride is applied a layer of calcium fluo¬ride gets formed
• This interferes with the further diffusion of F to react with hydroxyapatite
• This is called choking-off phenomenon

Question 5. Sodium Fluoride Mouth washes.
Answer:

Sodium Fluoride Mouthwashes Preparation:

• Dissolving 200 mg NaF tablet in 5 teaspoons of fresh clean water

Sodium Fluoride Mouthwashes Method Of Use:

• Rinse daily with 1 teaspoon after brushing
• Rinse for 60 seconds
• Then expectorant

Sodium Fluoride Mouthwashes Advantages:

• 30-40% reduction in DMFT

Question 6. Shoe Leather survey.
Answer:

• Conducted by Dr HTrendley Dean
• It was conducted in 97 localities
• It was done with the help of a questionnaire

AIM:

• To find the level of fluoride at which the tooth starts to blemish

Question 7. Dental Fluorosis.
Answer:

Etiology:

• Excessive intake of fluoride during tooth development

Features:

• Lustreless enamel
• Opaque white patches
• The mottled, striated, and pitted surface
• Yellow/brown stains
• Enamel hypoplasia

Fluorides Viva Voce

1. Safely tolerated dose – 8-16 mg/kg body weight
2. Toxic dose – 16-32 mg/kg body weight
3. Lethal dose – 32-64 mg/kg body weight
4. Fluoride varnishes are applied once in six months
5. Knutson’s technique is recommended at the age of 3, 7,11, and 13 years
6. APF solution is also known as Brudevold solution
7. The premolar is most commonly affected tooth by fluorosis
8. Duraphat is the most effective varnish in caries reduction
9. Chronic toxicity includes dental fluorosis and skeletal fluorosis