Dental Pulse PEDODONTICS |, REFERENCE BOOKS TAKEN: 1. DENTISTRY FOR THE CHILD AND ADOLESCENT by McDONALD - 8th & 9th EDITIONS, 2. DENTISTRY FOR THE CHILD AND ADOLESCENT by McDONALD ~ 5th EDITION 3. TEXTBOOK OF PEDODONTICS by SHOBA TANDON - 1st & 2nd EDITIONS 4. TEXTBOOK OF PEDODONTICS by FINN ~ 4th EDITION 1, CHILD PSYCHOLOGY Hand over mouth exercise (HOME) is effective behavioral 4) Nota primary emotion modification technique in the age group of (HaN-94) a) 3 to 6 years b) Under 3 years 7. In managing a seven year old child, the dentist should «) 6 to 9 years 4) Above 9 years keep in mind that a child at this age is {COMEDK-04) 8) Frequently negative b) Susceptible to Praise According to frankel behavioral rating scale, a negative child is the one 2) Who shows reluctance to accept treatment with some evidence of negative attitude b) Who accepts treatment but at times cautiously ¢) Cries forcefully but accepts treatment 4) Who refuses treatment and cries forcefully (uPsc -01) Best time to see a 3-year-old child in the dental office a) Early in the morning b) Just before lunch ¢) dust after lunch d) Any time (Pst-03) Paradoxical excitation in children caused by 2) Barbiturate b) Narcotic ¢) Nitrous oxide 4) None of the above (Pst-01) N20 more than 30 ~ 40% causes a) Diffusion hypoxia —-b) Anoxia ¢) Amnesia 4) Ataxia (P6I-03) Fearis 8) A primary emotion acquires soon after birth b) A primary emotion acquired in utero ¢)_A primary emotion acquites several years after birth ), Generally uncooperative 4) Prone to sensation anxiety (wan-s7, 98) Nitrous oxide is contraindicated in ) coPD b) Asthma ) Sickle cell anemia d) All the above (MAN -98) Reinforcement technique is based on 8) Social learning Freudian psycho analytical theory ©) Skinner's theory d)-Massle’s theory (MAN -2K) The aim of the first session with a child patient is to all except 1) Establish general communication with the patient and parents b) Start restorative procedures )_ Obtain background information of child 4) Take radiographs (MAN -2k), Most realistic approach in managing a difficult child in dental clinic is 4) Disregard the behavior of child bb) Make child familiar with clinical atmosphere ” 2) 8 BS) A 4) A 5) © 8) 7a) 0 en 8 aea | 2) Physical methods to make child accept for treatment 4) None of the above (NAN -98) PEDODONTICS 22, 1) Suffering from Down's syndrome (6cer-14) ‘Jean paiget put forth the theory of 12, Vidya, a3 years old comes for her pre dental visit. he isa). Psychoanalytic theory of psychosexual development highly intelligent with family members of high L.0. you) Social Learning would do most probably what type of treatment c) Cognitive development d) Cultural adaptation. 18) Radiographs and topical flouride (KAR -99) 8) Get the patient accoustomed to the dental clinic 23. Which type of fear is the most usually difficult to «)_ Employ desensitization overcome? 4) Employ behaviour modification 2) Long standing objective fears (MAN -02) 'b) Long standing subjective fears 13. Cognitive theory of child development was given by c) Short term objective fears 2) Sigmund feud b) Erk eikse 4) Short term subjective fears c) Jean piaget d) Brenner c (KAR -01) (6CET-14, MAN -01) 24. Frankel behaviour rating system does not include 14, “Tellshow-do” technique of child management was following behaviour: ‘introduced by a) Definitely positive b) Definitely negative ) Bandura ) Addleston 6) Positive 4) Indifferent «} Coope 4) Wright (KAR -02) (COMEDK-05, KCET -07) 25. The best way to help a frightened child to overcome his 15. Best method of communicating with a fearful deaf child fe 8) Speaking loudly) Normal conversation pace 8) entity the fear 6) Ignore the fear <)_Use sign language 6) Ridicule the frightened chitd 4) Speake with prominent tip movements 4) Divert the patients attention (KAR -98) (AIPG -98, 91) 16, A drug which is not used to provide conscious sedation 26, fing can result in Paradoxical ina child is 2) Nitrous Oxide ) Chloral Hydrate ) Phenobarbitone 6) Hydronyzine €) Lincomyein 6) Nitrous Oxide 4) Amphetamin (1aR -99) {AIINS -2K, 99) 17. How is @ two year old positioned for an emergency 27. According to Stone and Church's classification, John, age ‘examination of a fractured incisor? 4, can be classified developmentally as: a) On the dental assistants lap. a) Toddler b) Preschooler 8) On the parents lap. ) Middle years child a) Adolescent «) On the dental chair 4) In the papoose board («aR -02) (KAR -97; AIPG -02, COMEDK- 06) 28. A child's behaviour is traced to have dental difficulties 18, Baste fear of a 2-year-old child during his frst visit to. from his mother. The most satisfactory method of the dentist is related to handting the situation is a) Fear of an injection 1a) Introduce another child as a good example b) Fear of separation from parent >) Modify his fear by familiarization )_Fear of dental instruments ) Use small amounts of barbiturates 4) Not understanding the reason for dental treatment 4) Use firmness (AIIMS 91; AIPG -98) {ATINS -02) 19. Peer pressure is maximum in: 29. Apes of the pedodontic triangle is formed by 2) Todaters ) Puberty a) Mother ) Child «) Teenagers 4) Children betow 12 years €) Dentist 4) None of the above (AIPG -03, KAR -01) (a2 -39) 20. Before sedating a child it is 30. HOME Is 4) Not essential to take the consent 2) Aversive technique —b) Remodelling 8) Essential to take the written consent 6) Psychologie improvement «) Needed to consult the pediatrician 4) None d) Essential for the parents to be present (PGI -02) (AIPG -97) 31. The age of the child considered to be in the pre 24. The touch taste smell method of behaviour management cooperative stage of development is {is usually used in children who are 2) 10 years old ) 8 years old 2) Deat ) Blind ) 2 years old 6) & years old «)_ Suffering from cerebral palsy les) ¢ Ales) 8 GoM § Mle) ¢ wpa) 8 lane z) 8%) 0 25) A 26) 8 27) B75) 8 29) B30) A 31) C BSS) —ate Ad Dental Pulse _ Which ofthe following are considered effective methods 41. Extinguish of fears on successive dental visits fs an for the management of fears? example of a) Reassurance, shaming, scolding 2) Modeling ») Reinforcement 8) Ridiculing, overpotection, rejection 6) Assocation 4) Desensitization ) Indifference, reconditioning, over correction 4) Reconditioning, Explanation, Reassurances 42, Making the child observe when a dentist is working on a co-operative child is an example 33. Which ofthe following are associated with a diagnosis of a) Nodeling 1) Reinforcement slowness of mental development in a child? €) Assocation 4) Desensitization 2) Family history 3) Metabolic disease ) Pregnancy & detvery history 43, Paychological basis of “Tell-show-do” technique is 4) Allof the above 2) Desenstization due to familiarity 1) Overcoming the influences of over indulgence 34, The four-year-old child who iz aggressive in his behaviour) Distraction from unpleasant things in the dental stress situation is usually manifesting ad) All ofthe above basic 2) Spoiled nature b) Fear reaction 44. Best approach for managing of 6 years old child with «) Reaction to under affection tamper tantrum 4) Resentment against dentisty a) Tell show do ») Voice control ¢) Premedication 4) Fostponing appointment 35. Mothers in the operatory are discouraged fora variety of reasons, what would be an exception? 45. A technique of child management towards a desired 2) Afearful 3-year-oldb) A spoiled S-year-old behaviour is called ©) Am apprehensive 2-yer-old 3) Shaping ) Extinction 4) An overprotected year-old 6) Chaining 4) Assocation 36. A child whose siblings are also your patients, become 46. Shy and submissive child isthe result of parents who are a management problem. What would be your least a) Over indulgent) Over protective successful approach to his management ) Unaffectionate —d)Empathetic a) Praise the child 8) Compare the child with other children you have treated, 47. Which ofthe following statement is true «) Tell the child how lucky he isto have you as a dentist. 2) Sigmoid Freud ~ Psychoanalytic theory 4d Place your hand ever the child's mouth and speak in ab) eanpiaget -- Cognitive theory controlled voice. ¢) Favioy — classical conditioning €) All the above 37. Which typeof parental behaviour would not be associated with the only child? 48. One ofthe following is nota component of Psychic structure. 2) Over protection) Over authority a) &g0 ») Super ego «) Over anxiety €) Over indulgence €) Super Id @ 38. A drug which creates a mild stage of central depression 49. The phallic stage defined by Freud is seen inthe following s0 that the patient, though awake, exhibits a lessened age group degree of cortical excitability and thus behaves in a a) T-2years ») 23 years more calm and phlegmatic manner is 6) 15 years 4) 3-6 years a) Sedative b) Anesthetic «) Hypnotic €) Analgesic 50. Which ofthe following is not a psychodynamic theory 2) Paychosenual theory by feud 39. Voice control has the effect of b) Psychosocial theory by Eric Erickson 4) Fightening the child ) Cognitive theory by piaget 1) Making child know his imits of misbehavours 4) Social learning theory of bandura «)_ Making child forcefully accept dental treatment 4) AlLof the above. 51. Fear of closed spaces like “Dental clinics” is called as 2) Nyclophobia ') Zoophabia 40. A child patient demonstrating resistance {n the dental _«)_ Xenophobia, 4) Claustrophobia office is usually manifesting (P61 2UNE- 13) a) Anviety 1) Anger 52. Which of the following uncooperative behaviour is seen )Inborn fear 6) Immaturity in physically abused child a) Timid / Shy ) Stoic 2D) 0 SM) A 3) C6) B57) BB) A 38) 8 MO) A a) 0 a) A 4) AM) 8 45) A 46) 8 47) 048) C49) O50) D 51) Dz) 8a | ©) Whining type €) Historcat PEDODONTICS 63. The fear of a 6 year old related to dentistry fs primari a) Subjective b) Objective 53. The term audio analgesia is also known as ) Subjective & objective d) Psychological 2) Hypnosis 1) Voice contol (aatms-02) «) HOME / hand over mouth exercise 64. According to Piaget, the period of concrete operations is «) White's nose 2) Birth to 18 months —b) 12 years and onward ) 18 months to 7 years) 7'to 12 years 54, HOME technique should not be applied to (cOMEDK-08) 8) 5 years old child 65. The following is not 2 communicative management +) Who exhibits hysterical behaviour during treatment but technique according to American Acadenyy of Pediatric mentally sound dentistry’s standards «) Child who can understand simple verbal commands but a) Voice Control ») Positive Reinforcement exhibiting inconsolable behaviour ) Physical Restraint a) Distraction 4) Immature frightened child (cOMEDK-08) 66. A child has to be given premedication for behaviour 55. Recording to American association of mental deficiency modification, which is the most preferred route? assification scheme, a trainable mentally retarded 2) Oral 3) Intravenous child has an 10 range of €) Intramuscular 4) Intramucosal 2) 52-68 b) 36-51 (atPG-09) ¢) 20-35 d) Below 19 67. Definition of AUTISTIC child is? 2) Tncapacitating communication and emotional problem 56. Which of the following is true about physical restraints ) Most severly handicapping condition 4) Papoose board is for restraining body ©) Disorder in one or more psychological processes 5) Use af restraining device isa passive method 4) Chronie recurrent and Paraxysmal changes in neurologic ) Posey straps are used for restraining extremities function 4) All of the above (a1P6-09) 68. The fears that are produced by direct physical stimulation 57. The period of infancy usually refers to: of the sense organs are 4) First 2 years ater birth 2) Subjective Fears) Suggestive Fears ») First 3 year ater birth ) Objective Fears). Imitative fears «) First 6 months after birth (coMEDK-10) 4) First 3 years after birth 69. Hand over mouth technique was frst deseribed by (COMEDK -08) a) Dr. Evangetine Jordan b) Addelson and Gold Fried 58 When the cry of child is characterized by a siren like) Dr Goldman 4) Dr. Gv. Black vocabulary it is called as (KceT-10) 2) Compensatory b) Frightened 70. Behaviour modification includes all of the following ) Hur ) Obstinate excrr - (KAR-06) a) Tell-Show-Do ») Desensitization 59, Hand over mouth technique was first described by: ©) Modeling d) Home 4) Dr. Evangeline Jordan b) Addelson and Gold fried (KceT-09) «)DrG.\Black 4) Dr. Goldman 71. The principle that ‘the stimulus must be altered to eicit (AI-05) "a change in the response is applied in 60. Achild manages an uncooperative child by demonstrating __a)-Reinforcement )Aversive Conditioning the procedures on another cooperative child. This way of | c)_Retraiing «) Modeling child management is (coMEDK-10) 8) Modelling b) Desensitisation 72. Fear of Strangers and Fear of Separation from parents for «) Tell show do 4) Aversive conéitioning the children will be diminished by (AP-07) a) First Birthday 5) Fifth Birthday 61, Midazolam dose in children is (through Im) 6) Third Birthday 4) Seventh Birthday 2) 0.5 mg/g b) 0.25 mg/kg (coMEDK-10) 6) 0.1 mg/g d) 25 mg/kg 73. If the use of a technique on a child is objectionable (61-05) enough that the child will cooperate in order to avotd it, 62. Stimulus Response Theory (SR theory) is also known that technique will come under 28) Physical Restraint 8) Pharmacological Domain). Physical Domain 8) Aversive conditioning ) Aversive Domain a) Rewardcoriented Domain «) Behaviour shaping) Tender Love and Care (TLC) (COMEDK-10) (comeDk-07) Sys) 0 SS) Ss) 0 SHOES) 0 (SAT 6) A eG) ¢ ayn 66) D 65) C66) A 67) A 68) C69) A 70) D 71) C72) C73) € Se?) ==((22FA 74, Dental Pulse [A severely incapacitating disturbance of mental and ‘emotional development that causes problem in learning, _ ©) Animism 4) Conservation (KCET-2012) ‘communication, and relating to others is 85. In restraining of child everything involved except ) Autism 1b) Learning disability a) Avoidance ») Discrimination ) Mental retardation d) Dyslexia )_ Pedi wrap and papoose board (COMEDK-10) @) Aversive conditioning 75. Bahaviour management techiques were labeled as (A1P6-2012) “Embarrassment of riches” in 1977 by - 86. Which ofthe following is flse about conscious sedation? 4) Jimmy R.inkham —-b) Gerald ZWright 2) Patient retains ability to maintain a patent airway ©) David Wchambers 4) 3.C. Brauer 1b) Responds appropriately to physical stimulation (COMEDK-09) )_ Responds appropriately to verbal commands 76. Which of the following extremes of parental behaviour ) None of the above were manifested either in extreme dominance or (Kar -2013) indulgence - 87. Learning disability is otherwise called as 8) Over anxiety b) Rejection 2} Infantile psychosis _b) Minimal brain dysfunction <)_ entifcation 6) Overprotection €) Childhood schizophrenia (COMEDK-09) 4) Attention deficit disorder 77. Joseph Wolpe developed the following behaviour (COMEDK -2013) management technique - 88, Which of the following is commonly used for 2) Modeling b) Tellshow-Do immobilization of the head in a non-compliant patient? «) Desensitization dl) Voice control 2}, Papoose Board ») PedicWrap (COMEDK-09, 11) ) Forearm-body support) All ofthe above 78. “Whistle” is a word substitute for explaining the (KAR -2013), following instrument in children ~ 89, Universally used method of behaviour management a) High speed hand piece b) Suction apparatus in pediatric dentistry for both cooperative and ©) Low speed hand pieced) Air syringe uncooperative children is {(comEDK-09) a} Voice control ») Behaviour shaping 79. A-mother who does NOT encourage her child to cope up ) Implosion Therapy) Communication with new situations thereby making him shy and timid is (COMEDK -2013) an example of an 90, When a dentist says “I cannot fix your teeth if you do a) Overprotective mother b) Under affectionate mother rot open your mouth wide”, he is employing Authoritarian mother 4) Rejecting mother 2) Problem onnership —b) Voice control (Kcer-2011) ) Tolerance 4) Alexbiity 80, The first book on child dentistry was published by (COMEDK -2013) 8) GW Wright b) doseph Hurlock 91. Wright's clinical classification of children’s cooperative ©) Granuldy «) Robert Buna behaviour has categories (KceT-2011) a3 6 a1. ‘enforcing good behaviour displayed by the 38 a2 child with verbal praise applies the (KAR -2013) 4) Operant conditioning theory 92. Which of the following anesthetic agent is frequently 5) Classical conditioning theory used for conscious sedation? <)_Psychoanalytical theory 2) Nitrous oxide and oxygen 4) Social learning theory b) Choral hydrate (Kcer-2011) ©) Diazepam 4) Ether 82, An effective state of consciousness in which joy, sorrow, (KAR -2013), fear, hate or the likes are expressed is termed as 93. A two way process of exchanging or shaping ideas, ) Behavior b) Emotion feeling and information is called as «) Condition ) Complex 2), Education ') Communication (comeDk-2011) )_ Interview ) Suggestion 83, A parent asks the dentist, ‘Is the treatment necessary?’ (COMED-16) afterinitia examination and explanation about treatment 94. Id, ego and super ego are part of required. The behaviour of the parent is termed as 2a). Piaget’s theory a) Neglectful b) Manipulative b) Freud's psychoanalytical theory «) Hostile 4) Overprotective c) Stone and Churchill's theory (comeDK-2011) ) Brickson’s theory 86, Sensorimotor stage of cognitive development is (COMED-16) characterized by a) Egocentricism b) Symbotic play 7% A075) ¢ 6) D7) © yA 7) A BO) B81) A m2) Be) Cc (eA) B 5) A 86) 0 87) B88) C89) D 90) A 91) A 92) A 53) B94) Ba | 95. 96. 97. 98. 99. 100. Office personnel who are at higher risk of NO toxicity, to. Prevent them the most sensitive test for nitrous oxide detection. 2) Lamilar flow. b) Dosimeter )_Infrered spectrophotometer 4) High suction speed (ALIMS Nov-14) Self-inflicted bites are seen in? 2) Lesch-Nyhan syndrome b) Friese Maria syndrome ©) Cockanye syndrome —d) Brodie syndrome (Por DEC-2013) Egocentrism and animation is found in the following stage of cognitive development? 1) Sencorimotor stage b) Preoperative stage ) Operational staged) Concrete operational (Por DEC-2013) 10 25-50 is suggestive of? a) Imbecile b) Idiot ©) Moron 4) Genius (PGT UNE-13) 3 year old girl having delayed milestones, playing with herself, difficulty in learning is likely to be suffering from 2) Mental retardation b) Autism ©). Specific Learning Disorder 4) ADHD (AIMS MAY -14) A child of 10-11 years of age cannot follow the ‘demonstration of tooth brushing technique. Then he has 10 level below? 2) 36-51 b) 90-110 ¢) 70-75 a) 52-68 (ALIMS Nov-14) PEDODONTICS RSs) — 95) © 9) & OB 98) A (98) B10) ADental Pulse _ 1, CHILD PSYCHOLOGY - ANSWERS ‘X [Shobha Tandon 1st ed 152] Hand over mouth exercise (HOME) is the behaviour modification method of “aversive conditioning’. Indicatio + 3-6 years + Acchild who can understand simple verbal commands. * Children displaying uncontrollable behaviour. Healthy child displaying uncontrollable behaviour. Contraindicatio © Child under 3 years of age. © Handicapped / immature / frightened child Physical, mental and emotional handicap. [Mc Donald 6th ed 39/ Shobha Tandon 1st ed 139] Frankel’s behaviour rating scale 'N [Shobha Tandon 1st ed 132] Fear is a primary reaction due to a known danger while anxiety is @ reaction to unknown danger. Types of fe ‘© Innate fear - Without stimuti or previous experience. ‘© Subjective fear - Fears transmitted (suggested) ‘to the individual by family, friends, ete ‘© Objective fear - Fears due to own experience and direct stimulation of sense organs. Best method of communicating | Use af Euphemisms with a fearful deaf child (word substitutes) or reframing Basic fer of a 2:year-old eh | oF separation rom Definitely |» Refuses treatment during is first visit to the | Fem o negative (--) |» ries forcefully dentist elated to ce Negative (-) | Reluctant to accept treatment and Type of fear 6 ts old child In| ive fear displays evidence of slight negativism. dentistry is B Positive («) | Accepts treatment but during Type of fear isthe most usually | Lang standing treatment may become uncooperative. dificult to overcome subjective fears Definitely |» Good rapport withthe dentist Thebestway tohelpa ightened | Identification of the positive (r+) | + Unigue behaviour atid to overcome his fear | fear ‘K [Ne Donald th ed 46] ‘X [Mc Donald Sth ed 339) Barbiturates may cause paradoxical hyperexcitability rather than sedation in some children. Nitrous oxide causes diffusion hypoxia when the sedation is reversed at the end ‘of the procedure. This can be prevented by maintaining 100% ‘oxygen for 5-10 min, after sedation procedure. Ketamine produces dissociative type of anaesthesia in children. ‘C [Shobha Tandon 1st ed 159] The dose of 40% N20 + 60% 02 is commonly used for N20 conscious sedation. 53-25% |» Moderate sedation. 1,0 causes | « piminution of fear and ansety. Marked relaxation. 25-45% | Dissociation sedation and analgesia. No causes |» Floating sensation. * Reducing Bink ate + Euphorie state (laughing 985) 45-65% |» Total anaesthesia. NO causes |» Anaigsia is complete. + arked amnesia, Effective methods for the | * Reconditioning, ‘management of fears are Explanation The four-year-old child who is aggressive in his behaviour fn the dental stress situation is usually manifesting a basic Achild patient demonstrating resistance in the dental office | Anxiety is usually manifesting Spoiled nature 1’ [Mc Donald 8th ed 296/ Shobha Tandon Ast ed 155] Contraindications of N20 sedation: = coPD © Asthma ‘+ Respiratory infections ‘© Sickle cell anemia (for general anaesthesia, all anemias are contraindicated) ‘© Otitis media and epilepsy.a | 10. a1 12. 2a. “C [Shobha Tandon 1st ed 126] Child psychology theories can be classified as: I. Psychodynamic theories © Psychosenual theory - ‘+ Psychosocial theory ~ Sigmund Freud Eric Erickson © Cognitive theory = Piaget IL, Behavioural theories + Hierarchy of needs ~ Master ‘© Social learning theory ~ Bandura ‘© Classical conditioning Paviow Operant conditioning - Skinner Which of the following is NOT a behavioural theory? a) Cognitive b) Hierarchy of needs ©) Social learning 4) (Classical conditioning (KAR -2013) ‘8! [Me Donald 5th ed 3] The aim ofthe frst visit with a child includes the options A, Cand O The treatment should be started in subsequent visi ‘except in acute conditions like an abscessed, badly carious or painful tooth, etc ‘B [Me Donald 5th ed 43] ‘8! [Me Donald 8th ed 37] The 10 formula used by Binet was the following Mental age T0=~GFronologic age x 100 fe Below 69 | Mentally retarded. Below 90 | Low average. 90-110 | Average. Most of the children belong to this age. ‘Above 110 | High average or superior. After Binet test, more than 300 tests have been devised to measure intellectual development and the best known and best standardized of these tests are Wechsler intelligence seales. According to the intelligence quotient classification, 2 score of 120-139 is (KAR -2013) ‘Ans. Superior Binet's 10 formula is 4) Mental age/ chronological age x 100 b) Chronologic age/ mental age x 100 c) Mental age / dental age x 100, 4) Mental age / psychological age x 100 (KERALA-2015) (¢ [Shobha Tandon 1st ed 126] PEDODONTICS 414, ‘B [Shobha Tandon Ast ed 148) Tell'Show-Do ‘Addleslon Modelling Bandura Desensitization Joseph Wolpe HOME ‘Jordan Dental home Concept | Arthur nowak 15. ‘B’ [Shobha Tandon Ast ed 147] Verbal communication is best for children above 3 years of age. Voice should be constant, gentle and should express empathy and firmness, Use of Euphemisms (word substitutes) or reframing is very important while dealing with the child patient, 16. ‘D’ [Mc Donald 8th ed 302] Agents used for sedation in children a cues +N0+0, + Frequently utilized method + Diazepam Benzotizepines | 7 an + Barbiturates Seca PHS |S chirahysate * Meperidine Narcotics + Fentanyl + Hydroyzine * Promethazine (phenergam) Aatinistamines | chlorpromazine + Diphentycremine Dissociative agents | + Ketamine 17. °B [Check Explanation Below] Lap to lap position is the recommended position for performing oral hygiene procedures in 1 ~ 3 yrs child 18. ‘B [Me Donald 8th ed 47] 19. ‘C [Shobha Tandon 1st ed 173] Peer pressure could show up in teen’ life early, but it will have its maximum impact when kid enters the teenage years 20. ‘D’ [Me Donald ath ed 290] Before sedating a normal child It is important to take informed consent and have the parents present during procedure. A child with previous medical history however requires consultation with the child's physician. 21, ‘BY [Mc Donald 8th ed 550] In treating dental problems of visually improved children, use of touch, taste and smell method is beneficial over TSD (Tell-Show-Do) 22. [Shobha Tandon ist ed 126] Bes) ———( A 23. 24. 25. 26. ar. 28. 29. 30. a1, 32, 33. 34, Dental Pulse e ‘D’ [Shobha Tandon 1st ed 139] “W [Me Donald 5th ed 339] ‘W [Check Explanation Below] Newborn / neonate | Birth to 28 days Tafancy Tilt year Toddler 1-3 years Pre-school 36 years School age (6 = 10 years © Boys - 14-16 years, ‘Adolescents Girls - 10-14 years y ‘W [Me Donald 8th ed 35] Pedodontic teatment triangle Is based on a one-to-two telationship ic., dentist-child patient and family. The child is at the apex of the triangle and is the focus of attention of, both the family and the dentist. [Shobha Tandon ast ed 139] “C [Me Donald &th ed 35) [A 2-year old child is often referred to as inthe stage of “the terrible twos’ or “pre-cooperative stage”. ‘D’ [Check Explanation Below] Reconditioning has proved to be a successful psychological ‘tool to alter behaviour. Explanation to the child of the ‘event for which he has fear is helpful in the management of fear, Reassurance is an honest manner by itself restores confidence and reduces fear. ‘D' [Shobha Tandon 1st ed 539] Etiological factors of mental retardation fo Natal Post natal ‘Maternal and fetal | Birth |» Cerebral infections injuries | trauma Eg: Rubella © Infection |» Meningitis * Genetic diseases = Cerebral | © Poisoning fg: Down's syndrome |” trauma | ¢ watnatrition * Fetal alcohol syndrome Metabolic disorders Phenyl ketonuria and galactosemia are two metabolic diseases associated with retarded mental development and they can be treated by appropriate nutrition measures [Shobha Tandon ist ed 144] 35. 36. 37. 38. 39, 40. aa. 42. 43. _ “C [Check Explanation Below] Due to separation anvdety, parents in most cases should accompany the child for treatment upto atieast 2 years of age. 'B! [Me Donald 8th ed 41] Comparison of one child's behaviour with another is not only damaging to child's ego, it will cause the dentist to lose the child's respect. Y [Shobha Tandon 1st ed 144] Cees Over protective Over indulgent | Aggressive, demanding, display temper tantrums ‘Authoritative | Evasive and dawdting. Rejecting Aggressive, disobedient. Under affectionate | Well behaviour, cries easly ‘N [Shobha Tandon 1st ed 154] Sedation is the act of calming, allays excitement without producing sleep. Sedative drugs decreases the responsiveness to any level of stimulation and causes some decrease in ‘motor activity and ideation. Hypnotic is a drug that produces and/or maintains sleep, similar to normal arousable sleep. This isnot to be confused with ‘hypnosis’ meaning a trans Uke state in which the subject becomes passive and highly suggestible, [Me Donald Sth ed 52] ‘N [Shobha Tandon 1st ed 134] 'D’ [Shobha Tandon 1st ed 148) Desensitization is an effective method for reducing ‘maladaptive behaviour. It is accomplished by teaching the child a competing response such as relaxation and then introducing progressively more threatening stimuli 'N [Shobha Tandon 1st ed 148] Modelling is based on social-learning principle allowing 2 patient to observe one or more models demonstrating positive behavior in a situation. ‘© Live models ~ siings, parents Filmed models © Posters © Audio visual aids 'N [Shobha Tandon 1st ed 148) Indications for TSD (TELL- SHOW- DO): ‘© Child more than 3 years of age. Fearful child. First visit TSD is the most popularly used technique for modifying behaviour by desensitization in children.ee | 46 45. PEDODONTICS The non-pharmacologie technique that has remained ‘erophobia Height a comer stone of behaviour management is (AP-14) era ro 2) TelLShow-De_b) Averse conditioning : : 6) Hand Over Houth Exercise Zoophobia Animals €) olce contol Nenophobia Stanger ‘a [Me Donald th e4 44) eu a Voice contol is the effective communicative technique [Cawstophobia | Closed space Using sudden and firm commands to stop the disuptive [Agoraphobia Open space behavior and to get the child’ attention ‘Arachnophobie | Spider 'K [Mc Donald 8th ed 45] Anthropophobia | People Behavior shaping is 2 form of behavior modification | Eynophobia og technique based on principles of social learning. It is the procedure that slowly develops desired behavior. The behavior shaping techniques are: * Desensitization (TS0) Modelling * Contingency management 46. 8! [Shobha Tandon 1st ed 144] 47.’ [Shobha Tandon ist ed 122] 48. ‘C [Shobha Tandon 1st ed 122] Psychic structure proposed by Freud is composed of Id, Ego nd Superego. The stages of development of Freuds theory are: 52, ‘B [Shobha Tandon 1st ed 141) cc rr hts classifi Hysterical / Pre-school children at their fist dental Uncontrolled _| visit characterized by temper tantrums. Seen in spoilt or stubborn child. the ery Defiant / | of the child is characterized by siren like Obstinate vocabulary Timid J shy | Over protective child, Stoic Physically abused child Whinning type | Complaining type Tense co- | Borderline between positive and negative operative | behavior Oral |= Mouth is the site for identifying needs.| 53. ‘D’ [Shobha Tandon 1st ed 150] stage | Satisfaction of oral desires. Audio analgesia or white noise is a method of reducing pan FR Ear Setting nips in development of rat This technique conssts of providing a sound stimulus such as pleasant music to reduce stress and reaction to pai. ‘Anal zone becomes the primary zone of| pleasure. Gratifcation ‘is derived ftom) 54. py {Shobha Tandon 1st ed 152) ‘Anal_—_| expelling of withholding feces + Ot 4 stage | » Overemphasis by parents on toilet training | $5. ‘B’ [Mc Donald 8th ed 37] (234) | will result” in compulsive, obstinate nes personality, Less controled toilet training results in impulsive personality later. 52-68 _ | Wild — can be educated in special cases. Phallic |.» child develops attraction towards opposite 36-51 | Noderate = can be trained to perform stage | sex parent. It is called os Oedipus complex self-help sills (COMEDK-08) (2-5yrs) | im boys and electra complex in gis. 20-35 [Severe - Abilities limited to simple language and basic help skill This stage coresponds with the development 2 Latency | of mixed dentition and character formation, 19 | Profound ~ Custodial care required stage | Naturation of ego. takes place. Further development of personality and sis occur ‘ecording to Stanford-Binet intelligence scale, the Genitat | Sense of identity develops. can satisy degree of mental disability with a range of 36-51 is genital potency and realizes goals for termed as (cET-14) stage reproduction. a) Severe b) Moderate «) Profound é) mild 49,‘ [Shobha Tandon 1st ed 124] 56. ‘D’ [Shobha Tendon 1st ed 152] 50. ‘D' [Shobha Tandon 1st ed 122] Physical restraine are last resort for handling uncooperative Option 0's an example of behavior theory. or handicapped patients, Tt can be ~ Active ~ restraints performed by dentist or parents 54,’ [Shobha Tandon 1st ed 137] or statt. Phobia is isolated fear ofa single object or situation, + Passive — with the aid of restraining device. Bes) ———( A 57. 59. 60. 61. 62. 83. 64, 65. Dental Pulse * Papoose Board = Pedi wrap Bean bag Towels and tapes = Posey straps Veco straps ** Mouth blocks ‘= Mouth props + Banded tongue blades Head positioner and Forearm body support are the restraints used in un-cooperative patients. ‘8 [Mc Donald 8th ed 237] ‘D' [Shobha Tandon 1st ed 130, 131] 'X [Shobha Tandon ist ed 151] [Shobha Tandon ast ed 148] ‘C [Me Donald 8th ed 304] Dosage of Midazolam in children # Oral - 0.25 to 1.0 ma/Ag to a maximum single dose of 20mg. + IM 0.1 to 0.15 mg/kg to a maximum dose of 10mg. + Syrup ~ 2ma/mt + Injectable ~ 1mg/l and 5mg/m vals ‘C [Mc Donald 8th ed 45] Behaviour learning is the establishment of a connection between @ stimulus and a response. For this reason, it is sometimes called Stimulus-Response (S-R) theory ‘ (Finn 4th ed 22 - 23] For most of children, fear of dentistry is subjective and is not the result of previous dental care ‘D [Shobha Tandon 1st ed 127] According to Piaget Cognitive theory, the sequence of development has been categorized into 4 major stages. ‘+ Sensorimotor stage (0 to 2 yrs) ‘© Pre-operational stage (2 to 6 ys) ‘© Concrete operation stage (7 to 12 yrs) ‘© Formal operation stage (11 to 15 yrs) 'C [wwwaapd.org/media/policies_ guidelines) ‘The recommended techniques by American Academy of Pediatric Dentists standards are: ‘© Tell-show-do © Voice control ‘© Non-verbal communication ‘© Distraction ‘© Positive reinforcement _ 66. ‘A’ [Mc Donald 8° ed 298) 85% dentists utilize this route. ‘Done with Nitrous oxide (conscious sedation) By far, the most universally accepted and easiest method. + No discomfort, patient readily accepts it. ‘IF taste is objectionable drug may be mixed with a palatable liquid. 3. Tntramuscular ‘© Not preferred especially in younger age group. ‘May be used if patient refuses to take orally 4. Intravenous ‘Difficult to accomplish in very young children due to smaller vein size. ‘© Route of choice in physically impaired and cognitively, disabled patients 5. Submucosal + Site usually is buccal vestibule, especially area of ‘axillary primary molar or canine teeth. 67. ‘A’ [Me Donald 8" ed 543] 68, ‘C'[Shobha Tandon 20ed 136] 69, ‘A’ [Shobha Tandon 2% ed 153] HOME technique was introduced by Evangeline Jordan in 1920. 70, ‘D' [Shobha Tandon 2” ed 153] HOME and physical restraints are methods of aversive conditioning. 74, °C [Me Donald 8% ed 46] The negative behaviour of child may be the result of previous dental visitor the effect of improper parental orientation. So the stimulus must be altered to elicit a change in the response. Ifthe original stimulus and the new one are very similar, then the response will be similar, This is known as Stimulus generalization. To offset the generalization, the ental team must demonstrate a ‘diference: For example, use of N,0 - 0, sedation when retraining children offers a difference 2. ‘© [Me Donald 8" ed 46] 74, ‘A’ [Me Donald 8° ed 543)a | 75. 76. 1 78. 79. 80. a1. 82. 83. 84. °C [Me Donald 8° ed 49, Reference Point No.18] DW chambers article “Behaviour management technique for pediatric dentists: an embarrassment of riches” Journal ‘of Dent Child 1977. The theory of chambers is that voice control is most effective when used in conjunction with ‘other communications. Other quotes: ‘= Me Elroy 1895: Although operative dentistry may be perfect, the appointment is failure if the child departs in tears. ‘+ Greenbaum: Physical contact helps children to relax. ‘+ Wepman and Sonnerberg: proposed Problem ownership [shobha Tandon 2~ ed 147] 'C [Shobha Tandon 2“ ed 150] ‘Joseph Wolpe in 1975 proposed desensitization as behaviour modification technique. ‘A’ [Refer synopsis/ Mc Donald 8" ed 44] [Shoba tendon 1" ed 145] ‘8! [Pinkham 3" ed 4) ‘The fist comprehensive textbook on dentistry for children is published in 1924 by Joseph Murloc. ‘x [Shoba Tandon 1” ed 125] Individuals response is changed as a result of reinforcement for extinction of previous response, Hence, satisfactory outcome will be repeated while unsatisfactory outcomes will diminish in frequency, Positive reinforcement, negative reinforcement, omission and punishment are the four different types of operant conditioning, ‘8! [Shobha tendon 1° ed 130] Development of emotions depend on maturation in the nervous system and the endocrinal system. Difference in ‘emotional responsiveness between children and adults ‘appear partly due to cortical immaturity and partly due to difference in endocrine output. °’ [Shobha Tandon 2nd ed 130] + Deer etree bh stage 1] + tnfntscorinate sesary experiences Sersrimtor | (sch as seeing. and feang) ith sage Phyl and motor ato + beginning of ymbale tought (ly) Deer Bete 2-7 years + Lota inadequate mental operations Stge-2 | sretallmarkof te stage Pe sonny |" eseentism and animism ae the pe lintadons of hs tage + Cansatin and conservation ate both involved preoperative ought PEDODONTICS 85. 87. + Occurs between 7-12 years + Important process during this stage are: Stage -3 + Seriation Concrete + Transitivity operational | - Classification stage = Decentering = Reversibility = Conservation =__Elimination of egocentrism Commences around 11 years (puberty) Stage 4 and continues to adulthood raat * Development of logical reasoning ‘operational | * Can consider a hypothetical situation stage. Uses deductive or inductive logic to ‘make decisions or solve problems + Development of adult egacentrism “A [Shobha Tandon 2nd ed 154] “D’ [Shobha Tandon 2nd ed 157] Conscious sedation: Minimally depressed level of consciousness that retains the patient’ abitity to maintain airway independently and respond appropriately to physical stimulation and verbal command. Deep Sedatio ‘controlled state of depressed consciousness, accompanied by a partial loss of protective reflexes, including inability to respond purposefully to a verbal command. General anesthes! Controlled state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including inability to maintain airway and does not respond to physical stimulation or verbal command. “B’ [Principles and practice of dentistry By MS Muthu & NN Sivakumar 1st ed 374] Educators have termed the children affected with minimal brain dysfunction as learning disability. The signs of learning disability aret ‘© Short attention span © Distractibitity ‘+ Hyperactivity © Avhwardness ‘+ Wild speech impairment Nowadays the term learning disability is applied to children who exhibit a disorder in one or more of the basic physiologic processes involved in understanding or using spoken or written language. Learning disability includes dyslexia (difficulty in reading), dyscatculia (difficulty in calculations), developmental aphasia, brain injury, and minimal brain dysfunction. Tt affects boys mare than girls. One of the problems of learning disability which causes ‘management problems is hyperactivity. ae) ——88. a9, 90. on 92. 93. 94, Dental Pulse [A special diet called as Feingold diet has been said ‘to be useful in treatment of hyperactivity but remains controversial ‘€ [Shobha Tandon 2nd ed 154] Head positioner and Forearm body support are the restraints used in un-cooperative patients. ‘D [Shobha Tandon 2nd ed 149] Communication: © Universally used with both cooperative cooperative children ‘+ Forms basis for establishing relationship with the child. ‘It should start from the first entry into the reception area and non- ‘X [Me Donald 9th ed 36] Problem ownership: © Negative messages like ‘You must sit still; undermine the rapport between child and dentist. “You" messages carry the implication that the child is wrong, ‘Instead “I” messages increase the flow of information. a. I cannot fix your teeth if you do not open your ‘mouth wide. This is called problem ownership ‘When dentist says, “I can not fix your teeth if you do not open your mouth wide”, he is employin (MHCET-15) 4) Voice control b) Behaviour shaping {) Negative reinforcement _d) Problem ownership 'X [Shobha Tandon 2nd ed 143] Cooperative Relaxed child with minimal behaviour apprehension Usually seen in 0-3 years child, Lacking i cooperative abiy | stl Hl hin and mental wandicap, Has potential to cooperate, but Potentially ‘a sm, the ne a Pra ieee In question No.52, Wright's un-cooperative (negative) behaviour is explained, 'K [Shobha Tandon 2nd ed 160] ‘B! [Check Explanation Below] Communication is 2 two way process of sharping or ‘exchanging experiences, information, ideas, opinion, feeling etc, Between the source of communication and receiver through some mutually agreeable or known media (verbal or non verbal). ‘B! [Check Synopsis] 95. 96. 97. 98. 99. _ “C [ADA guide to dental therapeutics 555] Nitrous Oxide is a commonly used drug in pediatric entity. It is considered as an environmental hazard for dental personnel if chronically exposed to ambient nitrous oxide. N,0 levels should be controlled so that no worker Is exposed to a time weighted average concentration of NO greater than 25 ppm. The N,0 leak can be diagnosed with 3 portable infrared spectrophotometer. As N'O has a distinctive infrared spectrum, which comprises a finely detailed structure superimposed on two main peaks, it can be detected with infrared spectrophotometer. 'N [Me Donald 9th ed 389) Self-mutilation by biting has been associated with several emotional disturbances such as Lesch-Nyham syndrome (Ls), congenital insensitivity to pain and autism. Lesch-Nyhan Syndrome is an linked recessive disease, It js a disorder of purine metabolism causing hyperuricemia, neurological disorders, and impaired kidney function, retardation of mental and motor development. The most distressing aspect of this syndrome is the self-inflicted damage resulting in partial to complete amputation of fingers, nose, lips and tongue. B’ [Check Explanation of Q.No.84] [Mc Donald 9th ed 469] Gene eetn Intellectual disability [10 Tdiot 25 Imbecile 25-50 Moron 50-70 Poe cae) SC LCC Cee a Child can speak well enough ils 55-69 52-67 | for most communication needs Communicates at Moderate | 40-56 36-51 | a basic level with others = Mute or Severe or | 39nd |.35 and | communicates profound | below | below | grunts «Little or no stills “B [Me Donald 9th ed 475] Autism is an incapacitating disturbance of mental and emotional development that causes problems in learning and communicating. This life-long developmental disability manifests itself during the first 3 years of life, dificult to diagnose and has no cure, The children have poor muscle tone, poor coordination, drooling, hyperactive kneejerk andoY 100. strabismus. They tend to pouch food instead of swallowing, along with desire for sweetened foods which makes them susceptibility to cares, ‘ (Me. Donald 9th ed 473] 10 of 36-51 is moderate mental disability might have difficulty in following demonstration of tooth brushing technique. PEDODONTICS Ree) —(rn Dental Pulse _ Sr 2. CARIES AND RESTORATIVE. DENTISTRY The pulp horn that is most likely to be exposed during 10. cavity preparation on deciduous molars is 4) Nesiabuccal of frst molar )_Distobuceal of first molar ©) Nesiabuceal of second molar 4) Distobuceal of second molar (PGI -03, AIPG -01,02) In a preschool child, early carious involvement of the maxillary anterior teeth, maxillary and mandibular first primary molars and mandibular canines is called a) Dental caries b) Feeding caries a. Incidence of caries in patients with Downs's syndrome is 4) Same as general population b) Less as compared to general population ©), Greater as compared to general population 4) None of the above (MAN -02) A stainless steel crown should normally extend below the gingival crest approximatel a) Imm b) 1.5 mm c) 2mm d) 25mm (KAR -01) 6) Milk caries €) Nursing caries 12. Most common cause of failure of class II restoration in (MAN -94) children i 3. Parents should begin cleaning a child's mouth a) Narginfetlure ) Proximal box facture 2) By the time first tooth erupts 6) Inadequate width 4) Too much width ) When all deciduous teeth erupt (atPs -97) ©) When all anterior teeth have erupt 13. GIC is done for primary teeth mainly because 4d) When incisors and first molars have erupt 2) Its colour (PGE -02, MAN -94) _—_b) Its adhesion to dentin and enamel 4, Restoration of chotce in endodontically treated primary __—_c)_ Fluoride release secondary molar in 9-year-old child ie 4) All of the above 4) Stainless steel crown b) Cast gold crown (atP6 2K) ©) Amalgam 4) Zine Oxide eugenol 14, In a case of rampant caries the ideal procedure to (WAN -98) "perform in the first visit is: 5. Iron content in 3m stainless steel crowns is 8) Diet contra instructions a) 20% b) 40% 1) Topical fluoride application ©) 60% 4) 10% 6) Grose excavatin and restoration of teeth (MAN 01) d) None of the above 6. The difficulty in adopting a stainless steel crown to a (KAR -02) primary mandibular first molar is. 415. Which of the following series act as the best space 4) Wide bucco lingual contact maintainer in a chile's mouth? 8) Buceal cervical ridge showing constriction 2) Restored deciduous tooth ©) Prominent oblique ridge ) Aergiie partial denture 4) AlLof the above ©) Distal shoe space maintainer (AIPG -03, MAN -02) di) Band and loop space maintainer A gingival wall is difficult to obtain in primary molar (atins -92) when it extends too far gingivally in class If cavities 16. In diet counseling to reduce caries, because 8) Sugar is estricted to meals time 4) Facial pulp horn may be exposed b) Suga is stricted to one times a day 5} Tnelnation of cervical enamel rods oecusally )Restrieted to only liquid sugars «) Of marked cervical constriction 4) Restricted to fibrous food. 4) Prime contact is broad and flat (Pst -02) (MAN-97) 47. The term ‘rampant cares’ applies to a mouth havin 8, Whatis the name forthe form of caries, which is rapidly a). 5 or more lesions/year b). 10 or more lesions/year progressing? 6) 20r more lesions/year 4) 12 or more lesions /vear 2) Rampant caries) Nursing bottle eaies (kA 24) «) Aeute dental caries) Chronie dental caries 18, 3 year old gict has a central incisor removed because of (HAN -99) "trauma. What is the best appliance to use to replace the AlLare true of nursing bottle carries except missing tooth? 2) Maxillary central incisors are most effected a) removable appliance 5) Mandibular central incisors are least effected ) Fixed tingual wir with a tooth attached <)_Pacifying sugar solutions are the cause )_A fixed lingual wire only 4) Breast milk does not cause the canltion 4) Hawley appliance with replacement tooth (aN -98) (KAR -02) TOAD) 0 SuAD4 A Beno) 8 Moe A Gobi) 8 Gla 2) 8) cm) C5) A) A) Bw)PEDODONTICS 19. The first teeth become involved in nursing bottle caries) Crimping usually ares (Pat -2x) 2) Mandibular canines) Masilay anterior teth 29. In preparing a primary molar fora stainless steel crown, 6) Mandibular anterior teeth the surface requiring the least amount of reduction te 4) Maxillary and mandibular teth 2) Occlusal 8) Lingual (61-01, AR-2K) 6) esi. 4) Fadat 20. The bacteria responsible for causing nursing bottle (KAR 02, PGLAUNE- 13) caries are 30. To prepare a cavity ona mandibular fist mola in a child 5) Lactobacius only wa should gives 5) Streptococcus Lactobacillus 2) Mental nerve Block _b) Lingual neve block ¢)Streptococeus,Lactbacils & Veilonelis 6) Inferior alveolar nerve black and long buccal nerve block 4) Strereptococcus, Lactobacillus & Neisseria ) Long buccal nerve block (4ar -24) (nuns -29) 24. Stainless stel crown was introduced by 34. The proximal wall ofa dass cavity ona deciduous mal 2) Humphrey 6) Stewart 2) Follow diections of enamel rods ¢) Mac Donald 8) Pinhal 5) Converge toward occlusal surface (KAR -99) ©) Diverge toward occlusal surface 22, Teeth that are most resistant to nursing bottle caries 4) Undermine enamel whichis very thin 2) Mailaryantriorsb) Masilary molars (APG -01, ALINS -99) 6) Mandibular anterors 4) Mandibular molars 32, Nursing bottle caries results from (AP 98) 3) Drinking human milk b) Drinking non-human mitk 23. Imprimary teeth, gingival seat in a clas I preparation 6) Drinking mik with sweetening aditve 2) Left unbevelled 4) Improper feeding posture b) Beveled so as to remove caries (PGI -98) ) Beveled so as to remove unsupported enamel rods 33. In treating a case with rampant caries: 4) Beveled same as permanent tooth 4) Restrict intake of sweets only (761-95, 01) _) Allow no sugar for 21 days 24, (A high-risk dental cares individual is on preventive) Allow no sugar for? days schedule the suger exposure should be: 8) None ofthe above 2) Reduced to mealtimes (APG -01, pcr -01) b) Reduced to no exposure permanently 34, The rubber dam is particularly adaptable to the primary ©) Reduced to no exposure for 21 days second molar because the: 4) Reduced to meal time exposute for 21 days 2) Declso cervical height favours its retention (PGI -01) ) Cervical constriction of the crown favours its retention 25. The most important morphologic or histological _¢)-Mesiobuceal bulge favours its retention Consideration in cavity preparation in primary teeth isd) Smaller diameter of the crown (as compared to permanent thes teeth) favours its retention 2) Size of primary molars (AIPG -02) b) Thickness of enamel and dentin 35, Gingivitis i at ts peak in children at ag 6) Direction af theroots below thecemento enameljuncion a) 3~ 4yeas 3) 6~7 years 4) Direction ofthe enamel ods atthe cervical region ©) N= isyears——d) 15-18 years {AIPG -03) (aR -98) 26, The source of calcium ions of a calcific bridge ina 36, Ina 9 — year old which permanent tooth surface will tooth in which calcium hydroxide pulpotomy has be show greatly increased cares tncldance: perfermed is 2) Labial surface of central incisor 2) Blood vessel borne b) Derided cals 5) Ocelsal surface of cena incor 6} Dentin 4) From the calcium hydroxide 6) Hesil surface of central incisor (AUINS-26) 4) Occlusal surface of ater incisor 27. The primary reason for replacing teeth destroyed due (rc1-01) to nursing bottle syndrome fst, 37. Ina 9- year-old child caries is commonly seen on: 2) ‘Speech and aesthetics b) Form and funtion 2) Oelosal surface of lower parmanert first molar ©) Incising and mastication 5) Ocelsal surface of upper permanent frst molar 4) Ach perimeter requirements inthe transitional dentition c) Distal surface of lower permanent fist molar (AIPG-81) ——_d) Mes surface of upper peimanent first molar 28. Retention in a stainless stel crown is achlevedpriarly by: (rot -88) 2) chamfer 6) cement 38, The presence of higher amounts of protne-rich proteins 6) Paral itl and mesial walls (PRP) can have what Kind of effect. on caries causation? 2) Carles promoting since they help in bacterial adherence ee) © AA CBA) se) A AAT a) Caw x) co) 8 2) C33) Be) BS) ce) a) A 8) (sss) =Dental Pulse b) Make tooth surface resistant to caries since it enhance fluoride action 12) Ithas role during tooth mineralization only therefore no effect on cares 48. _ 4) All ofthese (aP-06) Which of the following sugars contributes Least to the dental caries: 4) Aid in super saturation of saliva therefore make tooth a). Fructose ») Galactose resistant to cares 6) Sucrose 4) tol (APG -04) 39. The thickness of rubber dam for children 49, What i the Ph of calcium hydrox 3) 6x6" b) 3x3” a7 ») 20 o) 5x5" ¢) axe" 9% 34 (AP -02) (comED-05) 40. Pit and fissure sealants are bound to tooth surface by 50. Carisolv which is a chemicomechanical substance used 8) Chemical bond) Mechanical Retention for caries remov «) Adhesive bond 8) It contains glycine and lysine 4d) Chemical and mechanical bond b) Te does not contain 0.5 Natl (PSt-01) _—) thas pl of?) Ik contains enythrocin dye 41. Aspartame is a (51-06) 2) Non-calorie sweetener b) Caloric sweetener 51. Rubber dam was introduced by ) Sugar complex) None of the above a) Tomy Hanks ) S.C. Barnum (AIPG 08) c) Hedstorm 4) GW. Black 42, Fiber-optic trans-llumination (FOT1) method of caries (xcet-07) diagnosis is based on the principle of: 52. All the following criteria contribute to a successful direct 4) When Laser beam falls on carious enamel, it gives @ pulp capping procedure except bluish hue 5) Haemorthage from the exposure site is easly controled 8) A fluorescent dye is taken up by carious dentine which) The exposure site is small, les than 0.5mm in diameter can be viewed easily ) Exposure site is the consequence of infected dentin ) There is a different index of tight transmission for extending into the pulp decayed or sound enamel ) Exposure occured in a clean uncontaminated field 4) The conductance of normal and decayed tooth tissue is (xcer-07) different. 53. Pulp vitality n ease of trouma is: (WAR -04) a) Recheck after 10-15 days 43, Ina child, irvtation in gingiva after insertion of stainless _b) Within 24 hours steel crown is due to ) Within 1 week 4) Within 65 days a) Metal ions released from stainless steel (cet-07) 5) Due to accumulation of plague between gingiva and 54. The CAT in pediatric dentistry is eronn 2) Caries Activity Test b) Caries Advancement Test ©) Cements leach out Caries Rsk Assessment Tool 4) Improper placement ) Child Aptitude Test (AatP6-2012) (comeok-08) 44. Arch criminal in care 55. Who discovered stainless stee a) Sucrose b) Complex carbohydrate a) Adams C2. Schwarz A «) Yylitat 4) Glucose c) Brearley 4) Backofen WA and Gales 6.F (Pst -99) (KceT-08) 45, Stainless steel crowns are contraindicated in: 56. Rigafede syndrome is seen in: a) Medically compromised patient a) Infant 1b) Adolescent ) After endodontic therapy o) Adult 4) ld age ©) Rampant caries d) Amelogenesis imperfecta (CET-07, PGE JUNE. 13) (AIPG-06) 57. Keys triad does not include 46. Class IL cavity preparation for amalgam restoration in a) time ) substrate deciduous teeth requires: «) tooth 4) fora 4) More buccolingual extension (BHU-07) 5) More mesiodistal extension 58, S-ECCin a child 2,3 or 6 years of age is characterized by: <) More gingival €) More cervical 2) Early involvement of maxillary and mandibular molars & (A1P6-05) the mandibular canines 47, Mechanism of action of pit and fissures sealant is by: ) Mandibular incisors, maxillary & mandibular molar 8) Blocking the nutrient supply to bacteria 6) Mandibular incisors & maxillary canine 8) King miero-organism causing caries 4) Mandibular premolars & maxillary premolars «)Neutralising acid produced by bacteria (wcer-07) Ben) 8 W)lAU@) © aye) A S)UAD 6) A [AUAD <8) 0 layne 50) 051) 8 52) C53) A 54) C55) C56) A 57) A 58) Aa | PEDODONTICS 59. Strip crowns are indicated in pediatric patients with ©) Clinical separation of primary and secondary dentin 2). Extensive caries in anterior teeth 4) Conventional rotary method of cavity preparation ) Extensive caries in posterior teeth (KCET=10) ) Elis clas I fracture 69, The primary reason for replacing teeth destroyed due to 4) Grossly destructed anterior teeth nursing bottie syndrome is (uPsc-09) a) Speech and esthetics _b) Form and function 660. Pulpal infection in primary mandibular posterior teeth is )_Incising and mastication first manifested on a radiograph in the area? 4) Arch perimeter requirements in the transitional dentition 2) OF bifureation b) At the apex of the root (KceT-10) Around the permanent tooth bud 70, Ona primary 2nd molar caries occur most commonly on 4) Near the crest of alveolar bone a) Occlusal pit and fissures (arP6-09) b) Proximal caries below contact point 61. Which aminoacid is absent in Carisolv ©) Buceal surface 2) Glycine b) Glutamie acid 4) Promixal caries above contact point «) Leucine a) lysine (AIMS-08) (AIPG-09) 71. The most aesthetic and frequently placed crown for 62. Stainless steel crowns are contraindicated in primary incisors is - 4) Medically compromised patient (VSO, ASD) 4) Stainless steel crown ) After endodontic therapy b) Open face stainless steel crown } Rampant caries -d)_Amelogenesis imperfecta ) Pre-fabricated veneered steel crowns (KcET-10) 4) Strip crowns 63, Preventive resin restoration is used (KceT-09) 4) Used in cavitated pit and fissure sealants which require 72, Suitable technique used for diagnosis of posterior restoration ‘interproximal caries in children 8) Used in non cavitated pit and fissure sealants 2) Bite wing with Bisecting angle te } Indep caries b) Bite wing with Paralleling technique 4) In non-accessible proximal areas ) Bite wing with RVG) Panoramic Radiography (alP6-2012) (AIINS-09) 64, Caries assessment in children; which one is not high risk 73. A 4-year-old presents with Labio Lingual caries affecting factor nly maxillary incisors and involving molars 4) White opalescent area on the tooth 5) General hypoplasia |) The diagnosis would be }_ Initial demineralization a) Type ete 1b) Type Ir €cc 4) Child with special problems/needs ) Type HIE €CC——d)_ Rampant caries (alP6-2012) 65. The type of laser used in pulpotomy procedure is B) The most probable cause of such a condition is 2) Nd:YAG laser b) Carbon dioxide laser 8) igh salivary pH )_ Argon laser )ErYAG laser 1b) Consumption of eariogenie food (cet=10) ) Inappropriate use of feeding bottle 66, Most important morphologic or histologic consideration 4) Low birth weight in cavity preparation in primary teeth is 2) Size of primary molars ©) The number of Streptococcus mutans Colony forming 5) Thickness of enamel and dentin units (CFU) per unit of saliva will be )_ Direction of roots below CEI 2) Negligible ) 100000 4) irection of enamel rods cervcally «) 10000-10,00,000 <) >10,00,000 (KceT-10) (comeo-2012) 67. There are hard dark brown lesions on the labial surface of | 74. Who gave the term ECC (Early Childhood Caries) all four primary cuspids in seven year old child, the teeth a) Davies ) Moss are not painful and scraping with spoon excavator yields ) Winter 4) Dilley ‘only a few flecks of dried discoloured dentin, what are (COMEDK -2013) these lesions? Caries in a 4 year old child is best assessed by 2) Active carious lesions _b) Artested carious lesions a) Previous caries experience «)_ Local enamel hypoplasia b) Matemal caries ) Abrasions ©) School fucridation 4) Daily fluoride mouthwash (4-08) (ATINS MAY 13) 68. Caries excavation using carisolv 76. In Caries Assessment Test (CAT) which condition doesn’t 2) Conventional preparation design come in highest risk category? 5) Clinical separation of sound and carious dentin a) Isolated with spot lesion on tooth 3) A 60) A 6) A 62) A 6) A 6) C 8) A 66) 8 GB 68) 8 6) A 7) A 71) 072) C738) 8 738) C730) 74) A 75) A 76) A hone) —0 A AAA Dental Pulse 7 78. 78A. 788. 78C. 79. 80. a1. b) Enamel Hypoplasia ©) Child with spectal care need 4) Visible plaque on anterior teeth (AIMS MAY 13) Mother of 10 month old child came with a complaint of non-eruption of teeth, how will you perfectly satisfy their parents. a) Wait and watch 5) You will do OPG which shows developing tooth buds. PA skull view which shows developing tooth buds 4) Paediatric consultation (AIMS may 13) [A year old child was brought to a physician, his mother was complaining of cranky child who does not eat well and does not sleep well too. On general examination, his teeth were several decayed and had signs of malnutrition. The doctor refer him to a pedodontist. What did the dentist suspect? 4) Early Childhood Caries ‘b) Radiation caries ©) Primary herpetic gingivostomatitis 4) PFAPA syndrome In the first appointment, the dentist will a) Start the endodontic treatment of the grossly decayed teeth b) Examination the teeth and take radiography ©) Extract the root pieces, 4) Start the restoration of decayed teeth Which among these is not the aetiology of this condition? 4) Bed-time breast feeding b) Honey coated pacifiers ©) Frequent medication 4) Viral infection (comen-14) For selection of stainless steel crown which of the following is not the criterion? 4) Nesial distal diameter ) Light resistance during seating ©) Occlusal morphology 4) Crown height (PotDec-13) Chemotherapeutic plaque control methods involves the use of a) Floss b) Disclosing agent ©). Dentiftices 4) Sugar substitutes (KERALA-2015) The methods of modifying stainless stee primary teeth were given by 4) Garcia-Godoy b) Humphrey ©) Mink and Hill {d) Michelle and Johnson (KERALA-2015) crowns for _ 7 A 76a) A 788) B 7ac) D (79) © 80) =) ¢a | PEDODONTICS 2. CARIES AND RESTORATIVE DENTISTRY - ANSWERS ‘X [Shobha Tandon 1st ed 289] The mesiobuccal pulpal horn ofthe primary first molars occupies 2 prominent portion ofthe pulp chamber. tis the largest pulp hom in beth the maxillary and mandibular frst primary molar and is commanly exposed during cavity preparation, [ieee * Specific form of rampant caries Y [Shobha Tandon ast ed 207] een) ‘+ Acute widespread caries with early pulpal involvement of teeth which are usually immune to de ‘= Pacifiers dipped in hhoney or sweeteners. "AGE OF OCCURANCE «Seen in infants and |» Seen at all ages including toddlers adolescence. DENTITION INVOLVED Affects primary | © Affects primary and dentition permanent dentition. EroLogy * Botte feeding before |* Multifactorial sleep. ‘+ Frequent snacking, excessive sticky refined carbohydrate intake * Specific pattern of involvement is seen ‘Maxillary incisors + Prolong breast- ' Genetic background feeding. «= Decreased salivary flow ‘CHARACTERISTIC FEATURES ‘Surfaces considered immune to decay ie, proximal surfaces of mandibular incisors are affected. * Early stages can be ‘managed by topical fluoride. * Directed towards ‘maintenance of teeth till the transition followed by the ‘+ Rapid appearance of new molars are involved. | lesions, TREATMENT ‘= Presence of multiple pulp exposures would require pulp therapy. ' Long term, treatment may be required when permanent dentition is invalved. 3. 'X [Me Donald 8th ed 528) 5. 1 9. 10. ‘= As an abutment for space maintainer or prosthetic appliance. ‘= As temporary restoration of a fractured tooth. © In cases of bruxism, ‘= In cases of single tooth cross bite by using reverse stainless steel crown. Indications for use of stainless steel crowns in primary teeth are all EXCEPT (MHCET-15) 8a) Restoration of hypoplastic teeth b) Following pulpotomy or pulpectomy procedure ) Teeth which are not restorable 4) Asan abutment for space maintainer 0’ [Shobha Tendon 1st ed 317] Composition of stainless steel crowns: ‘© Stainless steel (18-8) austentic type of alloy is used. Ege Rocky mountain and unitek, 67% 17% 12% 0.08 ~ 1.15% ron - Chromium Nickel = Carbon ‘© Nickel base crowns Eg: Ieonel 600 and 3M crowns 10% 16% 2% 2% Iron - Chromium = Nickel = others 'C’ [Check Explanation Below] Gingivaly the enamel rods have an occlusal direction in primary teeth so bevel is not required as there will be no unsupported enamel rods. It is difficult to obtain gingival wall when lesion extends too far gingivally in primary molar due to the presence of marked cervical constriction. N [Me Donald 8th ed 208] 0’ [Mc Donald 8th ed 209] [Me Donald 8th ed 194] The incidence of dental caries is low in Down's syndrome Bess) — [Shobha Tandon 1st ed 317] Indications for stainless steel crown: Extensive decay in primary and young permanent teeth. © For teeth with developmental (such as enamel dysplasia or dentinogenesis imperfecta) or hypoplastic defects. After pulp therapy. + AS preventive restorations in patients, who are highly susceptible to caries. hile incidence of periodontal disease is much higher (MCET- (07). ANUG occurs more commonly and there will be high prevalence of Bacteroids melaninogenicus in the plaque, 411,‘ [Mc Donald 8th ed 380) Tooth preparation for stainless steel crown: © Occlusal - 1.5-2mm reduction ‘= Buccal and lingual ~ 0.5mm, least reduction——( 144 12. 13. 14 15. 16, v. Dental Pulse Proximal ~ 1-1.5mm reduction. + Gingival termination - 0. Gingival finish Line ~ Feather edge ‘mm into sulcus ‘8 [Me Donald 5th ed 412] Most common cause of failure of class I restoration in primary teeth is due to proximal box fracture while in permanent teeth, it is due to marginal failure. “C’ [Mc Donald 8th ed 342] Advantages of GIC a + Tooth colored material + Adherence to both enamel and dentin. * Fuoride release. The main reason for its use in primary teeth isthe capability of releasing fluoride. ‘C [Shobha Tandon 1st ed 206] First visit: ‘Lesions should be excavated and restored with Z0E. Drainage of abscess. = Radiographs © Diet chart should be given to record Parent counseling * Also topical fluoride administration. for 1 week. Second visit: (one week after first week) © Analysis of diet chart © Isolate sugar factors from the diet chart and control sugar exposure (diet instructions) Caries activity tests Third visits ‘+ Endodontic treatment. + Edtraction of unrestorable teeth followed by space maintenance. * Crowns. # Recall every 3 months. 'X [Shobha Tandon st ed 342] “X [Me Donald 8th ed 220] It is better to avoid in between meal snacks and promote mid meal snacks. Refined sugar added to diet in the form of meal time supplement results in no caries activity while sugars taken in between meals resuts in significant caries activity. The frequency of ingestion of sugar containing foods is Important in causing caries than to the total amount of sugar consumed, ‘B [Me Donald 5th ed 229] ‘The term rampant caries should be applied to a caries rate ‘of 10 or more new lesions per year. The distinguishing characteristics of rampant caries are the involvement of 18, 19. 20. 26, 26. ar. 28. 9. 30. 31, 32. _ proximal surface of lower anterior teeth and the development of cervical type of caries. ‘B [Mc Donald 8th ed 638/ Finn 4th ed 274) Space closure rately occurs in the primary incisor area. A space maintainer is necessary to reproduce esthetics, re- establish function orto prevent abnormal speech and tongue habits. The type of anterior space maintainer selected should depend on age, cooperation and cleanliness of the mouth, 'B' [Shobha Tandon 1st ed 205] “C [Shobha Tandon 1st ed 189] ‘+ S.Mutans is important in initiation of caries. ‘© Lactobacillus is important in propagation of caries. ‘+ S-mutans cause proximal or smooth surface caries and lactobacillus cause pit & fissure caries. ‘+ Actinomyces cause root surface ca [Me Donald 8th ed 379} 'C [Shobha Tandon Sth ed 207], 'X [Shobha Tandon Sth ed 280] In permanent teeth the gingival seat is beveled at 15-20° to remove the unsupported enamel rods (resistance form) as the enamel rods run cervically in the gingival region, The enamel rods have an occlusal direction in the gingival region in primary molars, So the gingival wall is left bevelled as there are no unsupported enamel rods. ' [Mc Donald 8th ed 220), ‘B [Shobha Tandon 1st ed 289] The primary teeth has thin enamel and dentin with large pulp chambers. The thickness of enamel is about 1mm in primary teeth whereas it is about 2-3 mm in permanent teeth { [Shobha Tandon 1st ed 341] [Me Donald 8th ed 638) C [Shobha Tandon 1st ed 319] ‘B' [Shobha Tandon 1st ed 425] It is usually not necessary to reduce the buccal or tingual surfaces of steel crown. In some cases, however, it may be necessary to reduce the distinct buceal bulge, paticuarly on the first primary molar ‘C [Mc Donald 8th ed 273] 'B' [Shobha Tandon 1st ed 281] “C [Mc Donald 8th ed 209)a | 34. 35. 36. 37. 38. 39. 40. a 42. 'C [Shobha Tandon 1st ed 658] Chronic marginal gingivitis is the most prevalent type of ingivat change in childhood. Tt reaches in its severity to peak at the onset of puberty. About 90% of children are affected by gingivitis by the time they reach 15 years of age. © Y [Shobha Tandon 1st ed 191] Ea + H00, + Urea Buffering action + Proteins + Lysozyme Breaks bacterial cell walls + Lacto peroxidase _| Oxidation of susceptible bacteria. * statherin to hydronypatite, aid in Proine-ich supersaturation of saliva, make proteins tooth resistant to caries. “C [Me Donald th ed 367] 5x5" - Rubber dam size for children, + 6x6" - Adult size rubber dam, Contraindications + A child with upper respiratory infections and nasal obstruction ‘Presence of some fixed orthadontic appliance. * Recently erupted tooth, + Patients with allergy to latex. ‘8! [Shobha Tandon 1st ed 238] Pit and fissures sealants retain primarily by micro- mechanical retention. [Me Donatd 5th ed 299] Caloric sugar substitutes ‘Sorbitol, xylitol, lactitol, Lycasin, invert sugar. Saccharin (Kerala-15), Aspartame Non caloric sugar substitutes ‘C [Shobha Tandon 1st ed 199] Fiber optic transillumination is based on the principle that there is a different index of light transmission for decayed and sound tooth. Decay is shown as darkened shadow along the path of dentinal tubules. ‘Argon laser light illumination discloses a dark, fiery, orange red colour. ‘is based on fluorescence. It detects the precavitation stage and also the amount of decalcification DIAGNOdent PEDODONTICS 43. 44, 45. 46. ar. 43. 49. 50. “B [Shoba Tandon 2nd ed 372] [Me Donald 5th ed 229] « [ShobI Tandon 1st ed 318] °K [Shobha Tandon 1st ed 288] Factors that change pattern of cavity cutting design in deciduous teeth are: a) Direction of enamel rods b) Cervical constriction in proximal area that influence proximal box preparation fications of Class in deciduou: ‘© Due to presence of broad contact areas, the gingival floor should be wide to place the margins in self cleansing areas. ‘© Due to cervical constriction, gingival wall should not be too gingival ‘+The width of isthmus should not exceed 1/3rd of the ‘ntercuspal distance (MCET-14), + Because of occlusal direction of enamel rods at the cervical area, the gingival seat should not be beveled. ‘+ Care should be taken to avoid the mesiabuecal pulp horn in case of small first molars. ‘+ Estman pattern bur - modified aerotor burs with metallic stopper at 1.5mm from tip are use. [Me Donald 8th ed 355] ‘D' [Me Donald ath ed 251] Xylitol, mannitol, sucralose and aspartame are different sugar substitutes that have been suggested for use in chewing gum to decrease plaque accumulation and pH ‘C [Shobha Tandon ist ed 306, 340] Calcium hydroxide was introduced ty Herman for pulp capping. It is very alkaline in nature with a pH of 11 ~ 433, which ensure the inability of bacteria to thrive in its presence, If placed too close to pulp, it will cause necrosis, of adjacent pulp tissue and inflammation of the contagious tissue. Dentin bridge formation occurs at junction of the necrotic tissue and the vital inflammed tissue, Also when it is applied as liner, the excess calcium fons present in the cement would be available to the pulp and would encourage remineralization with the pulp chamber. ‘D’ [Check Explanation Below] As the sound created by rotary instrument to remove demineralized dentin is frightening to child patient, chemo-mechanical caries removal (CMCR) techniques are introduced. In these techniques, chemicals are used to soften the demineralized dentin by hydrolyzing the partially degraded collagen fibres CCARIDEX and CARISOLY are two examples. CARIDEX contains two solutions, Solution I contains sodium hypochlorite and Solution II contains glycine, aminobutyric BSS) —51. 52. 53. 54. 35. 56. Dental Pulse acid (ABA), Sodium chloride (NaCl), and NaOH. When both solutions are mixed, a final reaction produced called “emona chloro OL-2 amine butyric acid” is formed. It is applied for deep cavities to remove dimineralized dentin. CARISOLY is supplied in 2 syringes in gel form. It has a provision to determine when to stop the procedure is available ie, discolouration is no longer seen when entire carious dentin is removed. The first syringe contains sodium hypochlorite (0.5 w/v) and the second syringe contains lyine, leucine, glutamic acid and erythrosine dye, The pH of the solution is 11 Concentration of Naoct in Carisolv Ans. 0.5 ~ 1% (AIIMS -2012) ‘B [Shobha Tandon 1st ed 284] ‘C [Me Donald 8th ed 397] ‘X [Mc Donali’s 8th ed 459 - 462] After injury, vitality tests should be performed on the injured ‘tooth as well as on the tooth in the immediate area and in the opposing arch, The best prediction of continued vitality of pulp of a damaged or traumatized tooth is the vital response to electric pulp testing at the time of intial examination Homever, a negative response is not reliable evidence of pulp death because some teeth may recover vitality after atime. ‘When the electric pulp tester is used, the dentist should first determine the normal reading by testing an uninjured tooth ‘on the opposite side of the mouth and recording the lowest number at which the tooth responds. IF the injured tooth requires more current than does a normal tooth, the pulp may be undergoing degenerative change. If less cutentis needed to clicita response from a traumatized tooth, pulpal inflammation is usually indicated. However, without exception a thorough ‘examination should be conducted and the patient should be re-examined at 2 weeks and again at 1 month after injury. ‘© [Me Donald's th ed 217 - 218, Tab.10-1] The American Academy of Pediatric Dentistry (AAPD) has adopted e policy statement on cares risk assessment and 2 caries risk assessment tool (CAT). To know more about CAT please reer Me Donald 8th ed. Pg. 218, “C [estainlesssteet.com] ‘The development of stainless steel was the brain child of Harty Brearley (in 1913); when he was working on a project to prevent rifle barels from corroding. ‘Note: Humphrey has introduced stainless crowns to Pediatrtc Dentistry in 1950 ‘X [Me Donald's 8th ed 183] Rigafede disease is characterized by lacerations of lingual surface of tongue because of the sharp incisal edges of the natal and neonatal teeth. 57. 58. 59. —e Rigafede disease is associated with (AIIMS May-14) 4) Natal teeth ') Permanent incisors €) Multiple impacted teeth d) Primary incisors 'K [Shobha Tandon ist ed 187] |) Keys triad include + host / tooth = microflora + substrate to meet the requirements of microflora fi) Newbrun caries tetrology includes a fourth factor, “TIME” tw the existing Keyes concept. ' [Mc Donalét’s &th ed 209] S-EC¢ (Severe early childhood caries) in a child of2-« years age is typical and follows a definite patter. There is early carious involvement of maxillary anterior teeth, the maxilary and ‘mandibular fst primary molars and sometimes the mandibular canines. The mandibular incisors are usually unaffected 'K’ [Shobha Tandon 2" ed 358} ESTHETIC PREFORMED CROWNS: i) Polycarbonate: + They save time, + Easy to tim, = Can be easily adjusted with pliers Strip crowns: ‘© These are crown forms which are filled with composites and bonded on the tooth and the crown is then removed. ‘© Most commonly used crovns in pediatric dental practice + Easy to repair Ped jacket crown: ‘+ Made of tooth colored copolyester material which is filed with resin and left on the tooth after polymerization instead of being removed. ‘+ Available in only one shade. ‘+ Cannot be trimmed easily, Euks crowns: ‘© Crowns include stainless steel shell sized to cover a tooth portion of a patient and a polymeric coating including a polyester/epoxy hybrid composition. v) New Millenium crowns: ‘© Similar to pedo jacket crowns. Made up of laboratory enhanced composite resin material and bonded to the toath. = Can be trimmed easily, ‘+ Very brittle and expensive, if ) vi) Nusmite crowns: ‘+ Indicated when full coverage restoration is needed {for longevity. ‘+ Durable, colour stable and less time consuming.a | 60. a 62. 63. 64, 65. 66. vil) Cheng crowns: Crowns with pure resin facing which makes them stain resistant, Less time consuming, requires single patient visit. viii) Dura crowns These pre-veneered crowns that can be placed with poor moisture or hemorrhage control but they are not easy to fit and require a long learning curve x) Pedo Pearls: These are aluminum crown forms coated with a tooth colored epoxy paint. They are relatively soft which may hamper Long term durability. 'W [Shobha Tandon 2~ ed 333] ‘+ Inprimary teeth, the eartist changes furation involvement. ‘© In permanent teeth, the earliest change is widening of periodontal ligaments. ‘NY [www.omegatrading.gr/carisolv.htmn|] ‘A’ [Shobha Tandon 2~ ed 364] In children with cardiac problem, prophylaxis has to be taken before tooth reduction. ‘ [Shoba Tandon 2nd ed 344] Preventive resin restoration is used in borderline or ‘questionable caries. The resin seals the carious areas from the oral environment. “C [Me Donald 8th ed 257] 'R’ [Shobha Tandon 2~ ed 408] 1. VITAL PULPOTOMY TECHNIQUE: 1, Devitalization a) Single sitting # Formacresol + Electrosurgery Laser ~ Nd: YAG b) Two stage + Paraformaldehyde + Gysi trio paste 2, Preservation 8) Glutaraldehyde ») Ferric sulphate 9 MTA 3. Regeneration a) Bone morphogenetic protein 1, NON-VITAL PULPOTOKY (MORTAL): 1) Beechwood cresol 2) Formoeresal PEDODONTICS 67. 68. 69. 70. nm 72. TBA. 738. 736. Th. [Shobha Tandon 2% ed 186] ‘A’ [Me Donald 8% ed 210] ‘A’ [Shobha Tandon 1 ed 196] | Wot oak : 2° molar > 1 molar > canine > Lateral incisor > Central ‘Surfaces involved in descending orde Occlusal > Molar interproximal > incisor interproximal ‘D' [Shobha Tandon 2% ed 358] ‘C’ [Sturdevant 4* ed 105-106] + Bitewing radiographs are the most typical method for evaluation of proximal smooth surfaces for evidence of demineralization. © Overall accuracy for a bitewing to detect caries is estimated to be 40-65%, panoramic radiographic sensitivity for caries is 18% but is 43% when combined with bitewing radiograph. Bisecting angle technique and paralleling technique are essentially used for taking periapical radiographs. 'B' [Shoba Tandon 2nd ed 216, 217] Classification of early childhood caries: a) Type 1 ECC (Mild to moderate ‘© Caries in molars and incisors Seen 2-5 years of age b) Type 2 ECC (Moderate to severe) © Labiolingual caries with maxilary incisors with oF without molars ‘+ Seen soon after first tooth erupts ‘+ Mandibular incisors unaffected ‘Caused by inappropriate bottle feeding ©) Type 3 ECC (Severe) * Involve al teeth Seen in 3-5 years of age [Shoba Tandon 2nd ed 216, 217] 'D' [Shoba Tandon 2nd ed 216, 217] ‘K [Shobha Tandon 2nd ed 217) Terminology Eatly childhood caries Davies Nursing caries Winter ‘Nursing Bottle Caries Tsamtsouris RIECOD (Rampant infant and | Asroyitg carly childhood dental decay) BSS) —Dental Pulse oad 79. 'C [Shobha Tandon 2nd ed 364]] Criteria for Selection of stainless steel crowns: 76. ‘X [Mc Donald 8th ed 218] ‘+ Can be selected prior to the tooth preparation by the oe rmarrri N-D dimensions of the tooth to be restored (measured with a Boley guage). If selection not done before tooth reduction, after the tooth reduction itcan be selected as a trial and error procedure which approximates the M-D width of the crown, The smallest crown that completely covers should be chosen, ‘+ Light resistance to seating ‘© Proper occlusal height ‘D’ [Me Donald 8th ed 252] Tooth brush, floss, dentifrice, disclosing agents come lunder mechanical methods of plaque control. Sugar substitutes lke xylitol, mannitol, sueralose and aspartame, enzymes, antiplaque agents like chlorhexidine comes under chemotherapeutic methods of plaque control. ‘©’ [Refer Synopsis Point 122] In 1950, Stainless Steel crown was first introduced by William Humphrey. In 1971, Mink and Hill reported several ways of modifying the stainless steel crown when they are either too large or too small 77. 'K (Check Explanation Below] Delay in eruption by around 6 months for deciduous dentition is considered normal. The first tooth (mandibular central incisors) erupt at age of 6 months. The age of the child in question is 10 months. So wait and watch for further few months is best method. 7BA. ‘K [Me Donald 8th ed 209] [AAPD defines ECC as the presence of one or more decayed (cavitated or non cavitated), missing (due to caries) of filled tooth surfaces in any primary tooth in a child of 71 ‘months or younger. Etiology ‘Frequent or prolonged bottle or breast feedings ‘Inappropriate feeding pattern * Child put to bed with a nursing bottle with milk or sugar-containing-beverage. ‘78B. ‘B’ [Check Explanation of Q.No. 14] 7 'D [Mc Donald 8th ed 209/ Shoba Tandon 2nd ed 220]ee | PEDODONTICS 3, TRAUMATOLOGY Injuries to primary teeth occur mostly at 2) 6-12 months b) 3 ~4 years ©) 5~6 years d) 1% 2 Se years (MAN -01) In an apexification procedure, any excess calcium hydroxide periapically: 4) Will cause necrosis in the Perlapical tissues b) Will resorb on its own ) Will be removed by multinucleated giant cells 4) Will have to be removed by apicoectamy (KAR ~2K) 8 year-old child had fractured his maxillary central incisor 10-months ago. The pulp shows no response. There is no Periapical lesion in the radiograph. The treatment of choice i: 4) Ca(OH)2 pulp capping b) Formocresol pulpotomy ¢) Conventional root canal treatment «d) Complete debridement and apexification (ATIMS -98,99) ‘Apexogenesis of incompletely formed root is: 4) Induce the formation of apical 1/3 of root 5) Closure of apical formation in a developing tooth ) Induce the formation af apical 2/3 of root 4) Deposition of celular cementum at open apex (KAR -98) Which of the following medicaments is indicated to obturate the canals of a primary tooth in which a pulpectomy was performed: 2) Guttacpercha b) Calcium hydroxide ©) Zine oxide-eugenol 4) Calcium hydrowide-CMCP paste (AIPG -97), ‘A 11-year-old child comes to the dental office one hour ‘after injury to @ maxillary central incisor. The tooth is vital and lightly mobile, Radiographic examination reveals a fracture at the apical third of the root. What is the best treatment at this point of time: 1) Render palliative therapy b) Extract the tooth €) Relieve the occlusion and splint the tooth 4) Perform immediate root canal treatment and splint (ATINS -03) Babu, a 7 % years old child, reports with a fracture of central incisor with an open apex, there is large pulpat ‘exposure. The treatment of choice is: 1) Smooth the edges and protect the exposed portion with ‘TOE dressing ») Pulpectomy and calcium hydroxide dressing «) Pulpotomy and calcium hydroxide dressing 4) Direct pulp capping calcium hydroxide dressing (AIP6 -01), ‘A(4 year old child sustained a fracture in central incisor ‘one month ago. On examination a necrotic pulp was seen with no other pathological findings. The treatment of choice is 2) Watchful observation b) Extraction followed by space maintainer ©) Pulpectomy and root canal filling with gutta percha 4) Endodontic treatment and root canal filing with ZOE. (AIMS =24) ‘A child who has an avulsed tooth ‘ hour back should carry the tooth to the dentist in: a) Cold milk »b) Norma saline ) Wrapped in a wet handkerchief 4) Buccal vestibule arts -99) A permanent tooth bud, which has been accidentally removed during extraction of a deciduous tooth, should a) Discarded b) The socket curetted and the tooth bud replanted ©) Pulpectomy of the tooth bud and placed into the socket 4) Place deep into the socket from where it was removed. (ALIMS -99, AP -04) Apexification is the treatment of choice for a permanent tooth with wide open apex when 4) The pulp is necrotic b) The pulp is vital ©) The pulp and root canals are calcified d) There is a traumatic pulp exposure during cavity preparation (COMEDK-04) ‘Treatment for Ellis class III fracture of anterior tooth in a 12-year-old patient reported after 72 hours is ) Pulpotomy 1b) Root canal treatment ) Direct pulp capping 4) Indirect pulp capping (COMEDK-04, 05) for teeth with root fracture is best when The progno: the fracture occurs in the a) Coronal one third of the root ) Middle one third ofthe root ©) Apical one third of the root 4) Coronal half of the root (COMEDK-04) Ellis and deway classification of traumatic fractures are how many ag b) 5 93 a) 4 (als 04) Mineral trioxide aggregate used in apexification: a) Forms an integral part of the root canal filing »b) Dissolves as the apical barrier formation progresses. c) Has not yielded good results 4) Is available in a paste form, (KAR -04) In class IIT Ells fracture a) Only enamel is involved b) Enamel and dentine ate involved ) Enamel, dentine and pulp are involved 4) Non-vital pulp (COMEDK-04) >) ¢ 3) 0 4) 8 © 8) By) cw) A 5) A 16) 7 © 8) 0 9) A 10) 0 yA SSD =Dental Pulse _ 17. AAO years old child has intrusion of permanent maxillary __c)_To determine stage of root development central incisor. The choice of treatment is 4) AlLofthe above a) Put toth in its place an splint it (a1INS-08) 8) Allow toath to erupt omits own (spontaneous eruption) 28. Traumatic injury to primary tooth leads to intruston, «) Treat t orthodontically d) Do nothing after how much time the teeth usually e-erupts? (P6I-99, ATINS MAY- 14) a) 30 Days ») 3 Months 18. Ina 2 year old child maxillary deciduous central incisor) 6 Months 4) 12 Months is intruded by 4mm. Treatment is, (1-08) 2) Remove the intruded incisor 29. For reimplantation of avulsed tooth 8) Resorption of the intruded incisor 2) Curettage of socket is done ©) Make patient comfortable and observe 1b) Curettage of root surface is done 4) Resorption and splint ) Mild debridement of socket with saline (PGI-2K) ——_) Root surface is treated with antibiotics 19. Which type of injury i Least common in children? ((snou-2010) 2) Tatasion 1) Avutsion 30. Which of the following is the emergency treatment of «) Subluation 4) Complicated crown fracture choice in case of traumatic injury to tooth? (PG1-2011) a). Full veneer crown preparation with stainless steel crown 20. Exarticulation of teeth means 1b) A Stainless steel or preformed orthodontic band around a) Intrusion b) Extrusion the tooth «Sublimation 4) Aualsion )_ An Aci etched composite restoration (P61-02) 4) Ain retained composite restoration 21. Contuston usually result from (1-08) ) Gut injury 1) Crush injury 31. In root fracture of the apical one-thrid of permanent ©) Blunt trauma 4) Penetrating injury anterior teeth, the teeth usually (KAR -99) a) Discolor rapidly 22. Source of calcium in dentinal bridge is 8) Remain in Function and are vital 2) Blood 1) Caleium hydroxide €) Undergo pulpal necrosis and become ankyosed ©) Sativa 4) cr €) re indicate for extraction and prosthetic replacement (ALLMS-08) 23, The Xray of a traumatized tooth is important because 32. Which medium of storage for avulsed tooth is best for 4) To determine root fracture prolonged extra oral periods? 5) To assess the stage of root development 2) Hank’s Balanced salt solution «) Asa base for future comparisons ) ile 4) Allo the above ¢) Distiled water) Saliva (comeDk-2010) 24, In an inferior alveolar nerve block given to a child, the 33. After more than 1 hour of extra oral time an avulsed positon of the needle as compared tothat in anadultismore tooth is soaked in sodium hypochorite solution, than it 4) Superior 8) Inferior should be soaked in ©) Buccal ) Lingual 8) 10% MaF for 20 min.) 2% NaF for 10 min (AIMS 2K) c) 8% SnF2 for 10 min.) 24% SnF2 for 10 min 25. The most frequent cause of fracture of a root tip (61-2011) during extraction of a primary molar is, 34. The best alternative storage medium for avulsed teeth in a) Ankylosis of the tooth case culture media are not availabe is ) Improper use of cow horn forceps 2) ile ») Water c) Presence of supernumerary premolar €) Saline 4) Blood 44) Root resorption between apex and bifurcation (KcET-09) (AP-98) 35. In pediatric fracture of the body of the mandible which 26. The change in colour of a traumatized primary incisor of the following is true of fracture line? usually results from all the following except. a) Downrards and forwards 4) Laceration of periodontal res ) Downwards and backwards 8) Diffusion of bilverdin into the dentinal tubules ¢) In a zigzag Line due to the presence of tooth buds ) Development ofa heavy layer of secondary dentin €) In straight line from above downwards 4) Internal resorption of dentin within the crown (aIP6-2012) (TNPSC 99) 36. Avulsed tooth is not kept in water because 27. The radiographic examination of a traumatized tooth is 2) eter fs a hypotone solution causes rapid cll ysis essential - ) Water i a hypertonic solution causes rapid cel ysis 2) To establish basetne data ) Water is a hypotonic solution causes shrinkage of cells 8) To find associated root fracture 7 8%) © i) D0 ai) em) A wy) Dm) 8 |e) D2) A aD za) C29) c 30) C31) 8 32) A 33) B34) A 35) A 36) Aee | a7. 38. 39. 4d) Water is a hypertonic solution causes shrinkage of cells (Pct-2011) A child suffers from trauma which causes lateral luxation fof the primary central incisor. The incisor is not in ‘occlusion and does not cause interference. What should be done? 2) Theincisor should be allowed for passive and spontaneous reposition itself b) Immediate reposition and splinting «)_ Reduce the opposite tooth 4) Reduce both the affected and the opposite tooth (AIPG-14) After trauma of permanent maxillary central incisor metallic sound is heard on percussion, this is due t a) Subluvation b) Lateral luxation ©) Exttusive luxation d) Concussion (NEET -2013) Which of the following is most likely to occur after ‘trauma in primary dentition? 2) Intrusion b) Extrusion ) Complicated Crown fracture 4) Subluxation (Por 0EC-2011) PEDODONTICS (Ss) = 3) x) 8 3) 0——(" 1-44 10. Dental Pulse _ 3. TRAUMATOLOGY —- ANSWERS. ‘D’ [Shobha Tandon 1st ed 492] Chilaten in the age group of 3 ~ 2 % years sustain injuries to the primary dentition most frequently. This is the age when a child learns to toddle and i relatively uncoordinated. 8 - 11 years children sustain injuries to the permanent dentition more frequently. © ‘D’ [Shobha Tandon 1st ed 357,520] Treatment modalities for fractures involving pulp in permanent teeth, * Exposure of less than tmm. * Exposure not over 24 hrs. ‘© Minimal hemorthage. = Open apex. ‘= Relatively large exposure. ‘Patient seen within 72 hrs * Moderate hemorrhage. = Open apex. * Nonvital immature permanent teeth. ** Degenerated pulp. = Pulp exposure greater than 72 hrs. Pulp capping Pulpotomy Apesification| Pulpectomy [Shobha Tandon 1st ed 357] ‘C [Shobha Tandon 1st ed 353] Option ‘0’ Calcium hydroxide - CNCP paste is used for Apexification. ‘C [Shobha Tandon 1st ed 521] Fractures oceurring in the apical third have the best prognosis. The teeth usualy remains vital Coronal root fractures have the poor prognosis. After radiographic and clinical assessment, these teeth are usually subjected to digital reduction and stabilization by splinting ‘C [Shobha Tandon 1st ed 520] ‘D [Shobha Tandon 1st ed 516] ‘K (Me Donald 8th ed 487] Isotonic saline or pasteurized whole bovine milk are the most favourable storage medium. If neither of these solutions are readily available human saliva is preferable. Balanced Hant’s solution (or) SAVE-A-TOOTH solution is an isotonic salt solution used for carrying the avulsed tooth, There is no treatment for avulsed primary tooth. Option ‘0’ is the correct answer for carrying the avulsed permanent tooth in adults ‘D [Shobha Tandon 1st ed 474] a 12. 2B. 16, 15. 16. 7 18. 19. 20. 'N [Shobha Tandon 1st ed 357] '8' [Shobha Tandon 1st ed 520] 'C [Shobha Tandon ast ed 521] [Shobha Tandon ast ed 500) Ellis and Deway classification Class 1 _| Fracture involving enamel. Glass 2 _| Fracture involving enamel and dentin. Glass 3 _| Fracture involving dental pulp. Glass 4 | Non vital tooth. Class 5 | Avulsion. Glass 6 | Root fracture with or without crown fracture. Fane iia of tots who cro Class & | Fracture of crown enmasse, Glass 9 _| Deciduous tooth fractures. 'N (Shobha Tandon 1st ed 362) Materials used for Apexi ‘technique: Calcium hydroxide ‘© Caleium hydroxide + CMCP ‘+ Mineral trioxide aggregate ‘C [Shobha Tandon 1st ed 300] '8' [Shobha Tandon 1st ed 522] Re-eruption potential is high in young permanent teeth, hence the tooth should be left for 3 months. If it does nat re-erupt, orthodontic extrusion is the choice of treatment. “C [Shobha Tandon 1st ed 518] Partially intruded primary teeth should he left undisturbed as they usualy re-erupt naturally. If the intruded tooth is found impinging on the permanent tooth bud, extraction of the tooth fs indicated. ‘D’ [Me Donald 8th ed 479] Luxation injuries like intrusion and avulsion are more common in the first 3 years of life. Most common traumatic injury in child? (PGI-2012) a) Root fracture 1) Luxation ©) Complicated crown fracture 4) Crown root fracture 1 [Shobha Tandon 1st ed $18] to the periodontal tissues are clas Injury to supporting tissues without loosening or displacement but with ‘marked reaction to percussion. ied as: Concussiona | a. 22. 23. 26. ‘Rbnormal loosening but without Subluxation displacement of the tooth. Displacement of the tooth into Intrusion the alveolar bone accompanied by (Conta distocatin) | racture ofthe alveolar socket. Patial displacement of the toath Eawesion cut ofits socket. Baarticularion Complete displacement of tooth (complete avulsion) | out of socket. ‘C [Shobha Tandon 1st ed 502] Laceration | Shallow or deep wound in the mucosa caused by a sharp object. Contusion | Bruise produced by impact from blunt object. ‘Abrasion | Superficial wound produced by rubbing or scrapping. [Shobha Tandon 1st ed 341] ‘0’ [Shobha Tandon 1st ed 506] ‘8! [Shobha Tandon 1st ed 467] In children, the mandibular foramen lies about 0.5em below the occlusal plane, due to the underdeveloped ramus of the mandible. Therefore, during inferior alveolar nerve block, the needle is inserted in a position inferior to the occlusal plane, 26. 28. Mc Donald 8th ed 471] Et of trauma to the tooth Internal hemorrhage: Rupture of capillaries lead to escape of RBC and subsequent breakdown resulting in pigments called biliverdin and bilirubin hich discolour tooth, ‘Congestion of blood within pulp chamber leads to colour change after several weeks. ‘The tooth appears pink as the pulp shows trough the enamel. Pulp undergoes autolysis and necrosis with deposition of blood pigments. Partial or complete obliteration of the pulp ‘chamber and canal may occur. The crowns of ‘teeth may have a yellowish opaque colour, [shobha Tandon 2" ed 576] ‘C [Shobha Tandon 2“ ed 591] If intruded tooth is found to be impinging on the permanent ‘tooth bud, extraction of tooth is indicated. Apart from this, the treatment usualy involves a “wait and watch” policy. These teeth usually re-erupt within 6 months. If after 6 ~ 12 months the tooth has not shown any sign of movement, then ankylosis should be considered and extraction of tooth i performed, PEDODONTICS 29, 'C' [Shobha Tandon 2" ed 597] 30, 'C [Shobha Tandon 2™ ed 588, 589] ‘As the extent of injury is not mentioned, we have to go for conservative treatment only. Intermediate treatment: After a period of rest, if tooth remain vital, an esthetic restoration can be given during growth and development. This will serve the purpose until a final restoration can be made. Enamel and dentin fracture: Involvement of dentin necessitates restoration to seal the exposed dentinal tubules. A layer of GIC or Ca (0H), Lining cement may be applied as soon as possible following the trauma, This may be covered by composite to maintain the integrity of the protective coating. 31, ‘8 [Shobha Tandon 2” ed 589] nt teeth: Refer Endo synopsis Primary teeth: ‘© Apical 1/3" fracture ~ remains vital and resorbs normally. © Middle 1/3" fracture ~ becomes motile and will probably require extraction. Coronal 1/3" fracture - extraction with care to avoid damage of developing permanent tooth bud. 32, ‘A’ [Shobha Tandon 2% ed 597] If tooth is not reimplanted immediately in dental office, HBSS is best storage medium. 33. 'B [Grossman 12th ed 382] 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. 34. ‘A’ [Shobha Tandon 2* ed 597] 35. 'N' [JISPPD September 2006 Pg 157] For fractures of the body of mandible in pediatric patients, the fracture lines extend downwards and forwards from the upper border of mandible. Where as in the adult, direction of fracture line is usually downward and backwards. 36. 'R [Mc Donald 8th ed 488) Water is hypotonic and its use leads to rapid cell \ysis and increased inflammation on replantation, 37. ‘K [MC Donald 8th ed 481] Primary teeth that are displaced (lateral luxation) but not intruded should he repositioned by the dentist or parent as, soon as possible after the accident, to prevent interference with occlusion. But in this question the incisor is not in occlusion and does not cause interference. So option A will bee the correct answer. RSS? =(A AAA Dental Pulse 38, 39. ‘B [Endodontics Principles and Practise by Torabinajed 175] Luxat Coneussion | Subluxation Extrusion ‘Abnormal mobility zs v = Tenderness to percussion v v v = Percussion sound Normal Dall Dall Metallic Clinical dislocation = Ss v v Radiographic dislocation = = v v v ‘D [Dent traumatotogy; 2010; 26(3):254-61 Management of traumatized anterior teeth by Hargreeves 152. ‘The majority of dental injuries in the primary and permanent entitions involve the anterior teeth, especially the maxillary central incisors. Various studies have quoted that concussion, subluxation, followed by luxation are ‘the most common injuries in the primary dentition, while uncomplicated crown fractures are most common in the permanent dentition. The common luxation injuries in primary dentition is intrusion.Sr , 4 PEDIATRIC ENDODONTICS 4 5. 2 Which of the following materials is the most ideal for indirect pulp capping? 2) Calcium hydroxide) Zinc oxide eugenol cement ©) Zinc oxide ponder only d) Zinc exyphosphate cement (HAN -95) Pulpless primary incisor (abscess caused by trauma) in 4 year old patient can be effectively treated by 2) Patpectomy ) Extraction )_ S:minute formocresol pulpatomy 4) day formocresol pulpotomy (MAN -97, KAR -97) The simplest form of pulp therapy is 2) Apicocectomy b) Pulp capping ) Pulpectomy 4) Pulpotomy (WAN -94, KCET - 07), The most successful treatment for a vital primary second molar with a large carious and pulpal exposure is ) Indirect pulp treatment ) Pulpotomy with formocresot ©), Pulpotomy with calcium hydroxide 4) Pulp capping with calcium hydroxide (KAR -O1, MAN -97) Ideal root canal filling for primary teeth 2) Calcium hydroxide-iodine mixture ») Zine oxide-eugenol ©) Gutta percha 4) Ferrie sulphate (MAN -01) The effect of formocresol on the pulp following of @ ry tooth is 2) Calcified bridge is formed b) Massive infiltration of inflammatory cells ) Surface fixation of pulpal tissue accompanied by degeneration of odontoblasts 4) Pulp remains vital throughout and relatively unchanged however, all microorganisms are destroyed (MAN -99) The % formaldehyde in buckely’s formocresol is a) 15% b) 19% ©) 25% 4) 20% (MAN -01) A 4 year child's radiograph shows small radiolucency f primary lower second molar. There is bleeding on opening the root canal. The most likely treatment to be is 1) Pulpectomy and stainless steel ») Pulpotomy )_ Extraction of the tooth 4) Observe no treatment necessary (WAN -02) Pulp therapy which sweet name associated with 2) Formocresol pulpotomy b) Beech wood cresol pulpotomy ‘) Non vital pulpotomy d) Pulpectomy (MAN -02) PEDODONTICS 10. a 12, 2B. 14 15. 16. aw. The best filling material in deciduous teeth for RCT: 8) Gutta-percha b) Calcium hydroxide ) Zinc Oxide Eugenol di) Amalgam (PGI -95, AIPG -02) Indirect pulp the 1) Removes all the layers of carious dentin bb) Removes all the bacteria from carious lesion ) Is successful with teeth having clinical evidence of pulpal or periapical patho: 4) Is dependant on reminerals reparative dentin formation ion of affected dentin and (KAR -01) During restoration, mechanical exposure of mesiobuccal pulpal horns in the primary max. ast molar with moderate caries lesion on the mesial. Distal surfaces, the treatment now should be: a) Pulp capping-with dycal-restore with silver amalgam ) Pulpotomy-restore with stainless-steel crown ©) Pulpectomy-restore with stainless-steel crown 14) Pulp capping-with dycalrestore with stainless steel (KAR -02) 3 year old child has a central incisor that has turned bluish black. There is a small radiolucent area at the apex of the tooth, Ideal treatment is a) Extraction b) Pulpotomy with formocresol ©) Pulpectomy; fil with zine oxide eugenol 4) Pulpotomy with calcium hydroxide (KAR -02) Which of the following is a contraindication for pulp capping and pulpotomy: a) Accidental exposure in a vital tooth ) If there is inflammation of the radicular pulp and pain ©) Greatly curved and tortuous roots 4) None of the above (Pct -01,02) The success of the calcium hydroxide pulpotomy is determined by the a) Formation of calcific bridge b) Formation of hard base to support restoration ©) Continuation of raot formation and Apexogenesis 4) All ofthe above (KAR -97, AIPG 98) [A boy 10-year-old, fractured his central incisor 1 % year back. His pulp test is negative. What is the treatment: a) Debridement of pulp space and apexification b) RCT )_Debridement and pulpotomy 4) Observe, no treatment (ats -2k) Which of the following is an indication of indirect pulp capping? a). Lingering sensitivity to hot and cold bb) Throbbing of the affected teeth after thermal stimulation y 32) a) & 3) 8 4 8 8) A 6) Bo) cw) B15) C16) A 17) c c 7s) § BAD) © aD RSS? =——( 1-44 Dental Pulse 6) No history of spontaneous pan 26. The mort important citeron of success tna puipotomy 4) Senivty to peeusson ina young permanent central incisor would be whether (KAR 01) a) Theuncompleted root end would complete its development. 18. Grek plpotomy retest: 2) The vec en remained open if et fly develope when 2) ari ulpotomy Cervical palpotomy Uentnent was sated 6) Gutaraldehydepulpotomy €) A brge of secondary dentin became radogapically 8) Fomecrsa pulpotemy demonstabla (KAR -02) d) Pulp stones were in evidence several months after treatment 19. On the day following a formocresol pulpotomy of 2 (alee 37) mandibular molar, a three year old patient retumed with 27. High rate of failure after direct pulp capping tn primary 2 arg ulcer near the midline ofthe lower ip. Whats teethis due to the probable couse of the ulcer? 2) tow vaseaariy of pulp 2) Up tng bythe patent, 2) High elar content of pulp 0) Allergy t the anaesthetic solution 2) Litge number ef unmyet nated reves 6) Presse bythe rubber dam frame 4} Narfow ebbon shaped ot canals 8) Levlage a fomecreot onthe tp (4cer-2012) (AIPG -01, ALIMS -01) 28, The failure of a calcium hydroxide pulpotomy done on a 20. the cotton applied to the pulpal stumps in the primary Ist malar is due tor, formecresel pulpotomy technique should be 2) Imermal resorption b) Eternal resorption 2) sight dampened with formocresol 3) Pulp catcfcaton a) Pulp Ress 2) Satuated wt formocresol (Pst-01, Tse 9) 6) lef for 2 ours nthe ety 29. lange exposure of pulp within 24 hour is treated by 8} Sealed unt the net appontient 2) ulpetomy 3) Pulpectomy (AIMS -2k, ATP -97) 6) Inde PC 4) Dect Pe 21. Following amputation ofthe coronal portion of the pulp or 01 ofan immature permanent frst molar the stump should 30. In formocresol, rato of formalin to cresol be capped with a) 38 oes 2) Fomecresal ») Calcium chloride jie az 6} Thymol in oxide) Callum yoni (Ps1-03) (ONP6-97) 31. Pulp mummifiation i indicated in 22. Indvect pulp capping procedures om primary molars ave) Names toth indicated went 2) Deep cates on asymptomatic vial tooth 2) Removal of decty hs exposed the pulp 6) Traumatic exosue of a tal tooth b) A tooth has a ge longstanding lson witha history 6) Traumatic exposure of ital toth with open wie apex of continuous pin (atlns 99) 6) Thecarouslesonhas just penetrated the dentnoenarel 32. The ideal restoration following pulpotomy ina primary junction tooth 4 Te clot eso a spect of ducing an rpeeue a) amalgam 1) alas tonomer ofthe ply 6) omposte 4} Stainless tel crown (nrs-97) CINPSC-99) 23. Treatment fr pulp Less young tooth is 33. Mandibular deciduous tooth with por prognosis alveolar 2) aperogenes by “Apetcaton tbscess and necrti pulp the treatment af eoice 2) lpotony ¢) Mimmiteation 2) exrecton i act (ae 2603) 0) Apleouctony 4). Draiage of abscess 24, Pulpectomy and pulp capping are more successful in (PsI -99) primary teeth because off 24. The amount of pulp tstue to be removed during a 2) Treeased odontoblast atvtyin the young formocresol pulpetomy should Be ) Ineeased blood supply through the wide apex 2) lf fal the cnoat polp 6) increased volume of pup in pinay teeth 3) The entre coronal pup down both eral contction 4} Lasser amount of collogen Res In young ofeach ost canal (AIMS -92) c) Coronal pulp down to the area of bifurcation 25. 5 hours ago a 7-yearold boy had a fall He fractured 6) Down tthe apex ofeach root canal his maxillary right central incisor at gingival level. The tepored pulp fest vital. reatmentofchoce f=” 35. The medicament that may be ustd on a direct pulp 2) Palpotomy iy Plpectomy Capping procedure te 6} Baraction ofthe tooth d) Pulp caping oy Hien 5) Pulpdent (AIPG -92) c) Dycal d) Allof the above BAL) A LALA) Dea) 8 TE) A AT a 8 TTA eA) cS) C2) DAM) BB)a | PEDODONTICS 36. To stimulate root apex formation in incompletely 46. An 8-year old child with novmal tooth calcification and developed young permanent anterior teeth. Frank eruption has primary mandibular second molar extracted. suggests a technique that uses The resulted space shouldbe: 2) Dilute formocresol b)- Buckley's formocresol 2) Maintained until the premolar rot is 2/3 developed 6) Beech wood ciesol_ 4) Ca(OH), and CHCP 5) Closed slightly to accommodate the smaller premolar ¢) Tgnored, because the second premolar will erupt in a 37. Im order to ensure successful indiect pulp capping, the shot time most important criterion is 4) Left untreated, because the difference in size between 2) Removal of all cares the primary molar andthe premolr will compensate for ®) Placement of a temporary restoration with excellent any drifting that might occur sealing properties (arc-06) «) Usean agen that stimulates secondary dentin formation 47. The percentage of glutaraldehyde, as a medicament 4) Wone ofthe above during primary tooth pulpetony fe 8) 40% 3) 3.0% 38. The objectives of indirect pulp capping include the «) 1.5% 4) 20% following except (UPSC-09), (a) Preserve vitality of the pulp 48. Which of the following can be used as best Root End b) minate the removal of deep caries Filing Material? 6) Prevent direct exposure ofthe pulp 2) MTA b) 208 4) Promate secondary dentin oration 6) Amalgam 4) Calcium Hyeroxde (atPs-20) 39. The prognosis of direct pulp capping is best in 49. Obturation of deciduous tooth can be done with= 2) Mechanically exposed primary tooth a) Gutta percha b) Todoform paste b) Cariusly exposed permanent tooth 6) silver points ) Mechanically exposed permanent tooth ) Thermoplasticied gutta percha 6) Caruty exposed primey tooth (icer-0) 50. Who developed the complete pulpectomy technique for 40. Sealant programme is done to: primary molars? 2) All individuals in flordated and non furidated areas 2) Pinkham b) Starkey 5) Young and adolescent in non fuoridated areas 6) Me Donald ) Finn 6) Only children in non furdated areas (coweok.2031) 4 Tels not necessary in children Uvng in furidated area $2. Radlographically first time, chronic pulpal infection af {AP-08) primary molars noted ass, 41, The Buckley's solution is composed of: a) Periapically bony changes 2) esol, fomaldehyde, water and gycein 8) Root resorption b) Formaldehyde, resorcinol, water c)_ Changes in bony furcation area ¢) Todoform, glutaraldehyde, 20€ d) Widening of apical periodontal ligament 4) Chloraldehyde, parachloral, methanol water (AIIMS MAY 2022) 42. The KRU paste is composed of: 2) “Tedofor, camphor parachorophenol and menthol 5) Tedoform and 20€ ‘c) Parachlorophenol, camphor and menthol 4) Calcium hyroxide and iodoform (At0Ns-06) 43. Ina 3yr old patient the cement used after pulpectomy is: 2) ca(oh2 ) ZOE f) Ga(OH}2+ CHP a) Active transport (1-08) 44. Formocresl saturated cotton pellet is placed over the amputated pulp stumps for: 2) tminute ) 2 minutes ©) A nutes 4) 5 minutes (comeox-o5) 45, The “Pulse oximetry” used inthe determination a) Rate of flow b) Oxygen saturation ¢) Blood volume d) Blood coefficient (AUINS-06) 3B) 8 BB 38) CATA) AAA) Ba) BA a) 0) A) B50) BS) (SSss0) =Dental Pulse _ 4, PEDIATRIC ENDODONTICS — ANSWERS °K [Shobha Tandon 1st ed 335] In ct Pulp Capping re Indications: Indications: © Used when pulpal |» Small pulpal exposures inflammation has! been | less than 1mm. Judged to be minimal 6 Light red bleeding from and complete removal of | exposure site that can caries would cause a pulp| he controled by cotton exposure pile * Traumatic exposures in dry, clean field reported within 26 hrs. Materials: Materials: + Calcium hydroxide (ideal) | © Calcium hydroxide = 208 * Isobutyl cyanoacrylate * Resin bonding agents, + Antibiotics += Corticosteroids Contraindications: Contraindications: * Soft leathery dentin | Pain at night © Non restorable tooth | Spontaneous pain tooth Signs of pulpal or | mobility periapical pathology like | Excess bleeding at the sensitivity to hot, cold | exposure site and percussion, etc. Pulp capping procedure is indicated in all of the following EXCEPT (KERALA-2015) 4) Small accidental exposure b) Pin point caries exposure surrounded by sound dentin ©) Radiographic evidence of radicular disease 4) Minimal or no bleeding at the exposure site a [Shobha Tandon ist ed 516] ‘8 [Mac Donald 8th ed 393] 4. [Shobha Tandon 1st ed 342] Option “0 direct pulp capping and option “C’ calcium hydroxide pulpotomy are contraindicated in primary teeth en ce PERMANENT TEETH Vital tooth with small pulpal | Direct pulp capping exposure © Vital, Immature tooth with | Calcium hydroxide large pulp exposure puulpotomy © Non vital, immature tooth | Apexification ‘= Non vital, mature tooth Root canal treatment PRIMARY TEETH «Vital tooth with deep caries. | Indirect pulp capping * Vital tooth with large pulpal exposure Formacresol * Vital tooth with carious pulp | pulpotomy exposure (AP -07) * Pulp less tooth with 2/31d root length available * Pulp less tooth with minimal | Pulpectomy periapical or bifurcation radiolucency Tooth with poor prognosis i.e., vertical root #, displacement, luxation or any condition causing | *"#etion damage to permanent tooth 'N (Shobha Tandon 1st ed 354) Sine) ‘ommonly used filing material * Overfilting cause mild foreign body ZOE paste | reaction. ‘= There is difference between its rate of resorption and that of tooth root. * Ttresorbs rapidly and have no undesirable effects on succedaneous teeth KRI paste ‘Contains bactericidal action ‘= Contains igdofarm camphor. Maisto paste | + Similar to KR with additions. ‘Ik is composed of calcium hydroxide (30.3%), fodoform (40.4%), silicone Vitapex oil (22.4%) and other substances not described (6.9%) + Nearly ideal primary tooth fling material * Contraindicated, a it is not a resorbable Guttapercha | * Conte Which of the following root filling materials is contraindicated for use in deciduous teeth? (KAR -13) 4) Calcium hydroxide) Zine oxide eugenot RT paste 4) None of the above ‘A radiopaque mixture of 30.4% calcium hydroxide and 40% iodoform commonly used as obturating material of primary tooth? (PGI Dec-13) a) Vitapex b) Maisto paste ©) KRT paste d) Walkshof’s pasteee | 6 10. an. 12. 3. 14. “C [Mac Donald 8th ed 399, 404] ‘COMMONLY USED MATERIALS IN PULPOTONY Gene Tissue fixation | Calcium bridge | Better and non isevident | formation occurs _ | reversible fixation Potent Have germicidal | Excellent germicide _| activity antimicrobial Vital tissue | Vital pulp remains Vital pulp remains remains at apex Reported Causes internal | Less pulpal toxicity and | resorption in necrosis spical__| primary teeth leakage due to ‘small molecule size Bridging makes | No periapical further endodontic | leakage due treatment to large sized complicated. molecules. ‘B [Shobha Tandon Ast ed 342] Buckley’ formocresol consists of 19% formaldehyde, 35% cresol and 15% glycerine and water. The formaldehyde to cresol ratio is 1:2. ‘'X [Shobha Tandon 1st ed 347] ‘X [Shobha Tandon Ast ed 342] ‘Sweet technique | Multivisit formocresol pulpotomy 5 minute technique | Single sitting formocresol pulpotomy 2 stage technique _| Para formaldehyde pulpotomy Mortal or nonvital | Beechwood cresol pulpotomy pulpotomy Cvek pulpotomy Partial pulpotomy ‘C [Shobha Tandon 1st ed 353] ‘D' [Shobha Tandon ist ed 335] ‘8! [Shobha Tandon 1st ed 339,342] Direct pulp capping and calcium hydroxide pulpotomy are contraindicated in primary teeth as they cause internal resorption. Formocresol pulpotomy is the technique of choice in this situation followed by stainlese steel crown, 'C [Shobha Tandon 1st ed 348] ‘B! [Shobha Tandon 1st ed 336,342] Contraindications for pulpotomy: © Spontaneous pain % Haemorthage that is bright red and is not easy to control Internal resorption. * Existence of abscesses or fistulas in relation to the teeth PEDODONTICS 15. 16. a7. 18. 19. 20. 21. 22, 23, 24, 25. 26. ar. 28. °C [Mac Donald 8th ed 404/ Shobha Tandon 1st ed 357) ee et is the physiologic process of root development in vital infected tooth. (enon * Itisthe method of inducing the development of root apex in immature pulp less toath by formation of osteocementum or bone. * Indicated in normal pulp or pulp with minimal inflammation * Complete normal pulp (rect pulp capping) * Normal pulp in root portion (calcium hydroxide pulpotomy) ‘= Indicated in cases where pulp has undergone eversible pulpal necrosis { [Shobha Tandon 1st ed 520] That means, the boy had fractured his central incisor at 8 "% years and so the tooth is still immature (open apex). Apexification is the technique of choice for non-vital permanent teeth with incompletely formed roots. 'C (Shobha Tandon ist ed 336] 'R [Check Explanation Below] Cvek partial pulpotomy is indicated when exposure is less than 3mm and less than 48 hours, Only 2-3 mm of pulp is removed from exposed site. The principle behind this is the tooth becomes weaker when entre pulp is removed. ‘R [Shobha Tandon 1st ed 469] The numb feeling following the anaesthetic procedure may result in lip biting by the child patient. “K [Shobha Tandon 1st ed 344] The cotton pellet should be slightly dampened with formocresol and left for about 5 min. over the pulpal stumps. ‘D’ [Mac Donald 8th ed 398 / Shobha Tandon ist ed 348] “D’ [Shobha Tandon 1st ed 335] 'B’ [Shobha Tandon 1st ed 357] “K [Shobha Tandon 1st ed 342/ ac Donald 8th ed 398) \ [Shobha Tandon 1st ed 357] ‘B [Text 494) High cellular content of primary pulpal tissue may be responsible for increased failure rate of direct pulp capping in primary teeth. Undifferentiated mesenchymal cells may differentiate into odontoclastic cells. kof Pediatric Dentistry by Raymond 2nd ed ‘A [Shobha Tandon 1st ed 339] BSS) —32, 33. 34, 35. 36. 37. 38, 39. 40. a 42, a. 44. Dental Pulse 1k [Shobha Tandon Ast ed 520] 4s. ‘C [Shobha Tandon 1st ed 342] ‘C [Shobha Tandon 1st ed 344) Pulp mummifcation 2 two stage dvitaisation pulpotony. Tes used to devtalize the exposed primary vital tooth. The medicaments contain paraformaldehyde and fix the entire coronal and radiclar pulp sue ‘D’ [Shobha Tandon 1st ed 317] 1K [Shobha Tandon 1st ed 47] ‘B [Shobha Tandon 1st ed 344] ‘D’ [Shobha Tandon 1st ed 341] Calcium hydroxide (PH 11) is generally accepted as the materia of choice fr pulp capping. When applied there is Coagulative necrosis of adjacent pulp and inflammation of the contiguous tissue, Dentin bridge formation occurs atthe junction of necrotic tissue and vita inflamed tissue, Dycal, life, prisma VLC, Hydrex are modified compounds of calcium hydroxide with less alkalinity and thus less caustic on the pul. ‘D’[Shobha Tandon 1st ed 360] ‘B [Shobhe Tandon 1st ed 335] Its important to seal of emsining microorganisms from their substrate i, sucrose from the dit and effectively to arrest the carious proces. “6 'B’ [Shobha Tandon 1st ed 335] No ‘technique advocate. pamnarnt retmition of cares especially those near the pulp. Objectives of Indirect pulp capping: + Reduction of pulp hyperemia “7. + Reduction of anaerobic bacteria ‘© Remineralization of precarious dentin. 48 + Formation of eparatve dentin. + Pulp vitality maintained “C [Shobha Tandon 3st od 336] ‘W [Mc Donald 8th ed 355) 49. Flourides are least effective in preventing pit and fissure caries. Expanding the use of PBF sealants would substantially 50. reduce the occurrence af dental cries in population beyond that slready achieved by fluorides and other preventive 51. 'K [Shobha Tandon 1st ed 344] ‘K [Shobha Tandon ast ed 353] ‘B [Shobha Tandon 1st ed 520] ‘D' [Shobha Tandon 1st ed 344] _ 8 [Shobha Tandon 1st ed 332, 333) Newer methods of pulp testing methods: ') Laser Doppler Flawmetry: © Measures the velocity of RBC in capillaries ‘© Itis considered as non-invasive, objective, painless alternative to traditional neural-stimulation methods and is a promising test for young children. ‘© It produces regular signal uctuations for vital teeth, and imegular fluctuations for non-vtal teeth. ‘© This instrument has demonstrated its value for ‘ongoing assessment of post-traumatized permanent fi) Pulse oximetry in evaluation of vitality ‘A direct measurement of pulp circulation fs the only real measure of pulp vitality. ‘© Pulse oximetry is completely objective and requires no subjective response from patient and it directly measures blood oxygen saturation levels. if) Dual wavelength spectrometry: ‘+ It measures blood oxygenation change within the capillary bed of dental tissue and thus not dependent con a pulsatile blood flow. Iv) Hughes probeye camera: + This is used in detecting temperature change as small as 0.1°C and is used to measure vitality ' [Mc Donald 8th ed 635, Fig. 27-9] Early loss of second primary molar is invariably followed by mesial drifting of the first permanent molar and possible impaction of the second premolar. Also maxillay molars sometimes, rotate mesially. ‘D' [Shobha Tandon 2" ed 409] ‘A’ [Shobha Tandon 1* ed 361] MIA is a new material developed for endodontics that appears to be a significant improvement over the other materials for procedures in bone. It allows the overgrowth of ‘cementum and facilitate the regeneration ofthe periodontal ligament. 'B [Shobha Tandon 2" ed 417] ‘BY [MeDonald 8” ed 401) “C [Shobha Tandon 2nd ed 394] In primary molar teeth, earliest radiographic change is in the form of 2 furcal radialucency, bone loss or root resorption {depending on the chronicity of the infection. In permanent teeth, earliest change is widening of PL.ee | 5, DISEASES OF CHILD Al of the following statements about acute leukemia in children are true EXCEPT 4) It characteristcally causes gross gingival swelling b) Ttmay be manifested by mucosal pallor PEDODONTICS bb) Dehydration occurs more rapidly and severely in children ©) Leuecoeytapenia develops more frequently in children 4) Incidence of bleeding disorders fs greater in children AIPG -92) ) Ttean cause obvious purpura 10. Flabby white lesions occur bilaterally on buccal mucosa 4) Ibs usually of the lymphoblastic variety of a five-year-old child. The lesions are symptomatic (MAN -94) the child's mother says this condition is seen in few 2. A child patient suspected of leukemia is suffering from other members of the family. The lesions are most likely: periapical abscess line of treatment is a) Leukoplakia b) Lichen planus 1) Endodontic therapy ©) Submucous fibrosis) White sponge nerves ») Extraction ofthe involved toath (APG ~95, 24) {) Obtain a blood count before extraction 11, What unfavourable oral sequel is associated with 4) Obtain medical consultation before treatment. prolonged use of antibiotics in children? (KAR -98, MAN -95) a) Aphthous ulcers ——_b). Acute necrotising gingivitis 3. A preschool child has a definite yellow pigmentation c) Herpes simplex infection of the primary teeth. Under ultr 4) Monitiasis: have a faint overall yellow-green autofluorescence. (MAN -38) The most likely diagnosis is 12, A 3-year-old child reports with fever. He has reddish a) Amelogenesis imperfecta yellow ulcers of the facial mucosa and tongue. He is most b) Hypoplasia of the primary teeth probably suffering from: {Pigmentation associated with Erythroblasticfetalis a) Erosive lichen planus 4) Tetracycline pigmentation b) Acute herpetic gingivostomatitis (MAN -95) ©) ANUS: A) 09 3) D4 A BA 6) A © 8 A O) B10) 0 MD 32) 63) 8 mw) B15) D6) C1) 18) _¢ FSS) =>is A AAA Dental Pulse Yo 19, The neonatal teeth in infants are 28, Which isthe typical facies of Down syndrome? a) Teeth of normal series usually a) Hypoplastic maxilla b) ‘Prognathic maxilla 5) Supernumerary teeth 6) Retrognathic mandible d) Prognathie mandible ©) Only alee structures (ahs -94) 4) Only Keratinised structures 29. Down's syndrome fs associated with all of the following (nirsc-99) | except 20, The teeth present in the oral cavity of a new born area). Retrognathia Periodontal disease called ©) Premature exfoliation of teeth 2) Ghost teth ) Infante teeth 4) Retained deciduous teth ) Camel pearls d) Natal teeth (AP -99) (PGI-97) 30. What are conditions occur more frequently in children 24, Parrot like repetitive speech is found in with cerebral palsy? 2) Ais 1b) Cerebral palsy 2) Maloclusion 1) Bruxism ©) Marfa’ syndrome d) Mental retardation 6) Dental cares and periodontal disease (%61-97) 4) Allofthe above ate correct 22, A mother and her 4 year old son are seated alone in (KAR -97) 2 reception area with the child staring off into space, 31. Handicapped patients are usually taken care of by rocking and constantly twisting a strand of hatr about) Their families 1b) Insurance companies his fingers. Upon entry of another person, the child <). Sponsors of care programs begins to beat his fit against the side of his face and) Themselves behaves as though he does not hear his mother speaking (KAR -99) to him. This behavior is most characteristic of 32, In treating mentally retarded children, generally finds a) An autistic child b) Amentally retarded child that they: c) First dental appointment anxieties of a 4 year old child a) Respond inconsistently 4) Achld with a chronic seizure disorder 8) Can be controlled in ways similar to normal chiléren (AIINS -03) ——_¢)- Respond similarly to norma children ofthe same mental 23, A 3-year-old child presents with only deciduous canine age and molars. The child has ight fine hair ight complexion) lof the above and overall appearance of an older person. The fin (KAR =2K), suggest: 33. Head shape in Down's syndrome is typically a) Cleidocranial dysostosis b) Osteogenesis imperfecta a) Mesocephalic 'b) Dolicocephatic ©) Grouzan’s diseased) Ectodesmal dysplasia 6) Brachycephalic ——d)Acephatie (alP6 -92) (coneDK -03) 24, In a type of cerebral palsy characterized by sudden 34, Patients with Down's syndrome normally have: violent involuntary contraction of a muscle or group of a) ‘0 score above 80 b) Brachycephalic skull muscles there is 6). Stiff muscles 4) Allof te above a) Spasticity b) Ataxia {AIPG -04) ©) Athetosis 4) Rigidity 35, Most common malignant tumor in chil 2), Osteosarcoma 1) ving sarcoma 25. Which of the following statements about cerebral palsy c) Metastatic carcinoma d) Osteoma is corect (ars-08) a) Disturbances of balance and equilibrium - Ataxia 36. When natal teeth are present the most common and 5) Slow, warm like, constant inveluntary uncontrolisle preferable approach isto purposeless movement = Athetosis 2) Extract the teeth «) Hypertoniemuscles showing marked resistance to passive _b) Grind the sharp incisal edges motion = rigidity 6) Take radiograph and determine the stats of adjacent 4) Allofte above unerupted teth 4) Retain the teeth if possible 26. The two most common types of cerebral palsy are (KAR-04) a) Spasticity and tremor b) Athetosis and rigidity 37. According to Stanford-Binet test, non trainable type of ©) Spaticity and Athetoss mental retardation has an 10 of: 4) Ataxia and Athetoss 2) Below 20 b) Between 36452 6) Above 51 4) Between 90 ~ 130 27. Down's syndrume patients shows: (coMED-05) 2) Early exfoliation of deciduous teeth 38. Which of the following is nota type of cerebral palsy: b) Microdontia of teeth over retained teeth a) Spasticity ‘b) Autism: c) Periodontitis: d) All of the above c) Ataxia d) Athetosis: (ates -97) (Kcet-07) A %) 0 AA”) A Bo) A ye) © ep) A BOA 30) Dm) A 32) 33) C34) B35) A 36) D7) A 38) Ba | PEDODONTICS 39, The patient’s ability to maintain an independent airway, ©) Hypodontia ) Microdontia and respond appropriately to physican stimulation and verbal commands is seen in 46. In interproximal plaque, pH drops for 2) General Anesthesia b) Deep Sedation 2) 20 minutes ') 60 minutes ©) Conscious Sedation ©). 120 minutes 4) 180 minutes 4d) Deep Sedation and General Anesthesia (AIPG-2012) (COMEDK-08) 47. After treating the cleft palate the occlusion is, 40. Kanner's syndrome is also known as a) Normal occlusion 3) Autism b) Osteogenesis imperfecta ) Unilateral and bilateral crossbite ) Trigeminal neuralgia d) Diabetes melitus type I ) Anterior open bite d) Anterior deep bite (KcET-08) (AIPG-2012) 44. The most common cause for gingival fistula in children is: 48. In 8 years old child the drug of choice in the treatment 2) Acute apical abscess b) Acute periodontal abscess of ANUG (Acute necrotizing ulcerative gingivitis) «) Periapical cyst 4) Chronic apieal lesion a) Amino alycoside ——b) Penicillin (AP-08) ) Tetracycline 4) Ciprofioxacin 42. Chronic periapical infection in primary molars is first (a1PG-2012) noted as 49. Which ofthe following may develop asa result of juvenile 2) Rarefaction of bony furcation diabetes mellitus? ) As internal resorption a) Ataxia b) Aphasta )_ As rarefaction of Periapical tissues ©) Deafness 4). Blindness «d) Widening of Periodontal ligament space (ncer-14) (AP-08) 50. Difficulty in grasping objects is characterised by which 43. Alveolar grafting in a patient of cleft should ideally be type of cerebral palsy place a) Dyskinetie b) Atari 2) Before maxillary expansion, cross bite correction and ©) Spastic ) Mixed before cuspid eruption (6cer-14) ») Before maxillary expansion, cross bite correction and 54. In which of the following patient, there is 10-20 fold after cuspid eruption increased risk of leukemia during infancy? }_ After maxillary expansion, cross bite correction and after 2) Piesre Robbin syndrome cuspid eruption b) Fragile X syndrome 4) After maxillary expansion, cross bite correction and ©) Down syndrome) None. before cuspid eruption (PGI JUNE-2011) (arP6-09) 44, All are seen in a child with cerebral palsy except? 4) Rluorosis b) Increased caries ) Increased sativation d) Trauma (ArPG-09) 45. A 10 years patient diagnosed as a case of ddown’s syndrome having mosaicism variety. (COMEDK-2011) 'A) Which type of Head shape is commonly seen? 2) Otigocephaly ) Doticocephnaty ) Brachy cephaly ——d)_ Mesto cephaly 8) Often 10 of the patient will be 2) 1- 140-170 —b) Ta-120-139 ¢) Ta-t10-119 4) 10-25-50 (©) The syndrome is usually associated with 2) Congenital heart lesions 8) Respiratory disorders «}_Endocrinal abnormalities 4) Cleft tip and Palate D) Following dental problem are usually association with it, except 2) Retarded eruption ) Late shedding of deciduous teeth ©) A A) D2) A (GB) D4) A MSAD O 458) 0 ABC) A 450) B 148) © 47) 8 3) 8 49) D 50) B51) C Seo =——( Ah Dental Pulse _ 5. DISEASES OF CHILD —- ANSWERS. ‘RK [Shobha Tandon 1st ed 549, 667] Leukemia in children is mostly of acute lymphoblastic variety. Gross gingival hyperplasia does not occur with lymphoblastic type. It is mostly the characteristic feature of monocytic and myeloblastic variety. ‘D’ [Shobha Tandon 1st ed 667] ‘D’ [Shobha Tandon 1st ed 719/ Mc Donald 8th ed 153] Pn Blue green colour of primary teeth only. tis due to excessive hemolysis of RAC. The staining occurs due to diffusion of| bilirubin and bitiverdin into the dentin. Purplish brown pigmentation. The ‘other features are red colored urine, hypersensitivity to light and blisters on, hands and face. Yellowish gray to dark brown. It is due to tetracycline, which is the drug of choice in this disease Yellow or yellow brown pigmentation in dentin and to a lesser extent in enamel that are calcifying during the time, the drug is administered. The teeth fuoresce yellow under UV light. Exythroblastosis fetalis Porphyria Cystic fibrosis Tetracycline 'X [Shobha Tandon 1st ed 548] ‘K [Shobha Tandon st ed 658] “X [Shobha Tandon 1st ed 552] Cystic fibrosis is a multisystem disease involving the exocrine lands. The features are chronic duct obstruction, airway infection and maldigestion, Defective gland secretions ‘cause water and electrolyte imbalance. ral implications associated with CF include enamel hypoplasia and tooth discoloration (due to tetracycline treatment), salivary gland involvement, reduced incidence of dental caries, reservoir for potentially pathogenic respiratory bacteria, mouth breathing, and anterior open bite associated with nasal and sinus obstruction. Dental Management: Patients with pulmonary involvement may be more comfortable if appointments are kept short. They also may prefer to be maintained in an upright sitting position while being treated, since it often is necessary for them to clear secretions from the bronchi and trachea by coughing frequently. 10. a 12, 2B. 4. 15. 16. w. 18. 19. 20. 22. Which of the following is correct fibrosis? a) J Caries ») Tooth discoloration with fluoride ©) | Mouth breathing ) Treatment is carried out in laying down position ut Cystic (PGI June-13) “C [Shobha Tandon 1st ed 661] 1" [Shafer 4th ed 825) 1’ [Shobha Tandon 1st ed 682] '8' [Shobha Tandon 1st ed 661] 8 8° [Shobha Tandon 1st ed 661] 1’ [Shobha Tandon 1st ed 682] ‘C [Shobha Tandon st ed 107] ‘+ Natal teeth - Teeth present at birth ‘© Neonatal teeth - Teeth that erupt within 30 days after birth. 90% of the precociously erupted teeth are deciduous teeth (mandibular incisors) and 10% are supernumerary teeth, Natal teeth are more common than neonatal teeth, “C [Shobha Tandon 1st ed 91] “© [check Explanation Below] (Eerste [Reereleretet ee [Devt pees | Predeciaous anton [Dents acts | Teething problem Difficult eruption | Eruption gingivitis [Shobha Tandon 1st ed 107) 1’ [Shobha Tandon 1st ed 107] 'N (Shobha Tandon 1st ed 554] Autism is a disturbance of mental and emotional development that causes problem in learning, communication and is manifested in the fist three years of life Children have poor muscle tone, language disturbance, parot like repetitive speech, extreme loneliness and aggressive or destructive behaviour to fearful situations. [Mc Donald 8th ed 543]ee | 23. 0 [We Donald 5th ed 123] 24, ‘W [Shobha Tandon 1st ed 542) Cerebral aly is & non progesive lesion which occurs in the developing rai before, ding or after bith. ts Classification fe mainly of aratonieal and physiological type, Seen in 70% ces spasticity | sudden violent involuntary contraction of muscles with marked hypertonicity. 7 Seen in 5% cases asta |* 32, 0 he, pps iota Basal ganalia is ivoied. Disturbances in balance and equim, Aaa | « yard resistance to pasve novenents Settee verten 25, ‘D’ [Shobha Tandon 1st ed 542] 26. ‘C’ [Shobha Tandon 1st ed 542) 27. ‘0 [Shobha Tandon 1st ed 540] nee IN SY ME * Brachycephalie with flat ociit ed '* Open sutures with large anterior fontanelle. yes | Uowads and outwards slanting with tick eicanthal folds. Hands and] © Short and broad arms. feet |» ast and 2nd toes are widely spaced Skin [© Dry, rough with hyperkeratosis. Muscles | © ypotonie with hypermobility. ta. [+25-s0 * Hyporlastc maxilla # Macroglssia Dental | «Clas II tendency Problems | » Scrotal/fissured tongue *+ Anterior and posterior cossite + anus * Microdontia + Conical teeth = Delayed eruption est] * Over retained deciduous teeth + Prepubertal periodontitis * Decreased incidence of cries Shobha Tandon Ast ed 539] 29. [Shobha Tandon 1st ed 540] 30. ‘0’ [Shobha Tandon 1st ed 543] PEDODONTICS 32, 33. 34, 35. 36. 37. 38. 39, “D’ [Mc Donald ath ed 194] “'C [Shobha Tandon 1st ed 539] Y [Shobha Tandon Ast ed 540] “K [Me Donald 8th ed 168] Leukemia (accounts for about 34% of childhood cancer cases) and Brain and CNS tumors (27%), are most common malignant tumours in children, In bone tumours (which account for about 4% of childhood cancers), osteosarcoma {is most common (3%) followed by ewing’ssatcoma (1%) “D’ [Mc Donald ath ed 183] The preferable approach is to leave the tooth in place and to explain the parents about the desirability of maintaining this tooth in the mouth because of importance in the gronth and uncomplicated eruption of the adjacent teeth. Within a relatively short time, the prematurely erupted tooth will become stabilized and the other teeth in the arch will erupt. (Extraction is emotionally dificult for the parents and sometimes, incomplete removal of odontogenic Cellular remnants may subsequently develop atypical tooth like structures that require addtional treatment) [child of 2 month age is having rootless tooth like structure in lower front region at the level of gingiva, treatment of choice. (AIIMS May-14) 1) Extraction immediately under LA ») Reassure the patient root wil develop later ) Extraction under GA «) None ‘K [Me Donald 8th ed 37] "B [Me Donald ath ed 543] Autism is an incapacitating disturbance of mental. and emotional development that causes problems in learning, communicating and relating others. The disease manifests itself during the first 3 years of life and is dificult to diagnose. Itis believed to be caused by a physical disorder of the brain. The affected children will usually have 10 scores between 50 and 70. The affected children will have multiple medical and behavioural problems that make dental treatment difficult. They have poor muscle tone, poor coordination, drooling, 2 hyperactive knee jerk, and strabismus and 30% eventually develop epilepsy Because of poor tongue coordination, children with autism tend to pouch food instead of swallowing. uring provision of treatment the use of papoose board or pedi-wrap and preappointment conscious sedation are necessary sometimes. 'C [Shobha Tandon ist ed 154] ‘A minimally depressed level _ of consciousness that retains the patient’s ability to maintain an irway independently and respond appropriately to physical stimulation and verbal command. Conscious sedation BSS) —40. 41. 42. 43. 44. 454. 458. 4c. 450. Dental Pulse ‘A contiolled state of depressed consciousness, accompanied by a partial loss of protective reflexes ‘including inability to respond purposefully to @ verbal command. ‘controlled state of unconsciousness, ‘accompanied by partial or complete loss of protective reflexes, including inability to maintain an airway independently and respond purposefully to physical stimulation or verbal command. Refers to delivery of anesthetic care Jn which patients are discharged home ton the day of treatment. Deep sedation General anaesthesia “Ambulatory 7 ‘Outpatient or day care anesthesia ‘ [worw.whonamedit.com/synducfm/3458.html] Kanner’s syndrome is a serlous disorder of early childhood presenting in 2nd of 3rd years of life. The principal clinical featutes are lack of responsiveness to other human with detachment from parents or others; absence or abnormality of language development and speech behaviour abnormality, with temper tantrums and repetitive activities. Many of the children are mentally retarded and 50% show marked delay in motor milestones, The child appears alert and attractive inspite of odd behaviour. Kanners syndrome 45+ {is also known as Kanner’ autism or Asperger's syndrome or infantile autism. The two associated persons with this syndrome ave Kanner and Asperger. ‘D’ [Me Donald 8th ed 410] “7 '® [Ingle 5th ed 863) 6 ‘D’ [Mc Donald 8" ed 699-702] A successful alveolar cleft bone graft satisfies several objectives. In addition to giving bony support for the teeth 4% adjacent to the cleft and providing bone through which teeth can erupt, it offers maxillary arch continuity and aids in closure of oranasal fistula It is preferable to expand the collapsed segments to as ‘optimum an arch form as possible before bone grafting Pregraft expansion also widens the clef site, allowing better access for nasal oor closure ‘N [Shobha Tandon 2° ed 635] ‘C [Shoba Tandon 1* ed 539] ‘0’ [Shobs Tandon 1 ed 540} 'K [Shoba Tandon 1* ed 540] Congenital heart lesions are found in upto 50% of down syndrome patients. Eg: Atrial septal defect, ventricular septal defect 50. 3B [Shobs Tandon 1" ed 540] Down syndrome is associated with premature exfoliation of marked mobility of teeth in chilshood or adolescence, _ Other conditions that are associated with premature exfoliation are: = Acatalasia ‘© Chediak- Higashi syndrome + Coffin-Lowry syndrome, © Ehlers-Danlos syndrome types IV and VIII ‘© Hajdu-Cheney syndrome = Hyperpituiterism, © Hyperthyroidism, Juvenile diabetes ‘© Papillon-Lefevre syndrome = Progeria © Singleton-Merten syndrome ‘© Histioeytosis x groups = Leukemias Which of the following conditions is NOT characterized by periodontal destruction around primary tooth? (Pot June-2014) a) Hypophosphatasia —_b) Cystic fibrosis €) Ehlers-Danlos syndrome_d) Steven-jhonsan syndrome ‘C [Me Donald 8th ed 220) Acidity of plaque located in interproximal areas, may remain below critical pH for up to 2 hours after carbohydrate ingestion, '8' [Me Donald 8th ed 708, 709] 8 [Shoba Tandon 2nd ed 770] Penicilin is the antibiotic of choice in ANUG. Erythromycin can be given in patients allergic to penicillin, ‘D’ [MC Donald 8th ed 550] st natu of bli Diabetes Leukaemia Hypertension Premature birth Haemorthagic disorders Glucoma in childees Prenatal causes: Syphilis Rubella TB meningitis Cataracts Optic atrophy 'B’ [Mc Donald 8th ed 544] Poor sense of balance and uncoordinated voluntary movements like stumbling or staggering gait or difficulty in arasping objects are features of Ataxic cerebral palsy. Also check Q. No. 24SEE A PEDODONTICS 51. “C [Me.Donald 9th ed 474] The increased risk of leukemia for people with Down syndrome has been estimated as 10-20 fold higher than for general population. The school aged children are most Likely to experience acute lymphoblastic leukemia, Ree) —Wan Dental Pulse —e rr 6. MISCELLANEOUS 4. Chromosomal abnormalities are features of all except 11. _Oligodontia occurs when there is defect in which stage of 2) Down's syndrome b) Cleft palate ©) Most cases of chronic myeloid leukemia ») Histo differentiation 4) Turners syndrome ©) Morpho differentiation d) Mineralisation (AIMS -93) (kar -98) 2 Routine radiographic examination of a 6-year-old 12. Osteosarcoma presents a radiographic picture resembling child discloses a supernumerary tooth between central 2) Sunburst appearance b) Cotton wool appearance incisors. The dentist should ©). Soap bubble appearance 4) Delay removal of the supernumerary tooth until its «) Ground glass appearance eruption (AIPG -96) b) Wait until the child is 12 years 13, A distinct proliferative clinical entity originating as a ©) Remove if the tooth develops a cyst response of oral tissue to local irritation that occurs at 4) Removal as soon as possible without injury t the central any age and on the gingiva is incisors. a), Mucocele b) Hemangioma (HAN -97) ) Traumatic neuroma 4) Pyogenic granuloma 3. Mandibulofacial dysostosis is also known as (AIIMS -94) a) Treacher Coltns syndrome 14, According to Berley the most ankylosed tooth is 5) Piere robin syndrome 2) Primary incisor ——b). Primary canine ) Apert syndrome) None of the above ©) Primary maxillary molar 4) Primary mandibular molar (AIP6 -2k) (AlPG-2o12) Abnormality in morphodifferentiation stage of tooth 15. Median palatal cyst is development results in: a), Radicular cyst b) Residual st ) Mottled enamel ——_b)‘Mesiodens )Fissual cyst 4) None ofthe above «)_ Dens in dente 4) Dentinogenesis imperfecta (AIPG -97) (AIINS -92) 16. Ranula isa: Dentin genesis imperfecta occurs in which state of tooth 2) Type of epulis ») Sublingual thyroid development €) Thyroglossal est a) Initiation b) Histodifferentiation 4) Cystic swelling in the floor of the mouth ©) Morphodifferentiation ¢) Maturation (kar -97) (ALIS -89) 17. Etiology of mucocele is related to Supernumerary teeth are in all except a), Mechanical trauma to the minor salivary gland excretory 8) Ectodermal dysplasia b) Gardner’ syndrome duct «) Cleft palate cases 4) Cleidocranial dysostosis, b) Salivary caleuli in the exeretory duct of major salivary (AIPG -2K) sland Which of the following isnot seen in cleft lip and palate? ) Acute infections) Smoking tobacco 4) Enamel hypoplasia b) Developmental cysts (A1P6-01) } Supernumerary teeth 4) Missing teeth 418, A patient feels that his molar is extruded from the socket (AIINS -95) and is tender to percussion. This can be due to: The oral findings in erythroblastosis fetalis is mainly: 2} Periapical cyst ') Periapical granuloma ) Dentinal dysplasia b) Hypoplastic teeth ) Periapical abseess 4). Furcation involvement «) Pigmented teeth dl) All of the above (AIP6-01) (AIIS -93) 19. Cellulitis is defined as inflammation of The 2nd common most supernumerary teeth is a) Skin ) Subcutaneous tissue a) Mesiodens ©) Deep fascia 4) Muscle 8) Distal to 3rd molar in maxila (kar -99) «) Distal to mandibular 3 molar 20, A bacterium not associated with caries process is, 4) Pare molars 4) Streptococeus mutans b) Staphylococcus aureus (ar -2k) )_ Lactobacillus acidophilus 10. The developmental cause of cleft ip is failure of 4) Actinomyces 4) Palatine processes to unite (nese 99) 5) Maxillary processes to unite 21, The acid in saliva is neutralized by <) Maxillary processes unite with the fontonasal process 3) ©, ») HCO, i) Maxillary processes unite with the palatine process. ©) HPO, 4) Proteins (Ps1-97) 78) 09 SA ¢ SB) A DB 8) co) Bm c aA a) A 13) 04) 5) C46) D7) A 18) C19) C2) B21) Ba | PEDODONTICS 22. The fascal spaces involved in Ludwig's angina are: b) Warping of alveolar bone in area 4) Unilateral ~Submandibular and subtingual spaces ) Ankylass of succeeding permanent tooth buds 8) Bilateral - Submandibular and sublingual spaces 4) A change in path oF eruption of succeeding tooth ) Unilateral ~ Submandibula, sublingual and submental {AIPG -02) spaces 32. In 8 years old child 22 not erupting due to lower incisal 4) Bilateral ~ Submandibulr, sublingual and submental crowding and presence of retained deciduous lateral spaces incisors: (AIPG-96) a) Disc cuspids ) Extract the 22 23. The correct 10 for a child is 6) Extract the deciduous teeth 8) 0-19 for 0- 2 years ) Any af the above 8) 20 -49 for 2— 4 years (at -93) «) 50-69 for 8 12 years 33. If the second deciduous molar is lost prematurely, 4) 90-210 for 8~ 12 years maximum space loss occurs in (Man 26) a) Ast 6 months 1b) 3:9 months 24, It is recommended that the brushing of a preschool) 6-12months 4) 12-18 months chil’s teeth: (Pst-2K) 2) Be performed by the child himself 34. In pediatric distraction osteogenesis which of the ©) Be performed by the child's parent following must be done? )_Be performed only after all primary teeth have erupted a) Rate faster ) Rhythm faster 4) Not be done €)_Latency period increased «) Consolidation period increased 25. Ina child having gingival swelting, brushing is best done (aec-2012) withthe help of 35. A O-year old patient exhibits Lingually locked left 48) Soft 2-3 row brush with rounded bristles permanent maxillary central incisox Supporting bone 8) Brush with square cut bristle ends and a medium texture is in harmony with tooth size and there are no basic «)_ Brush with angular cut bristle ends and a soft texture discrepancies in other relationships. The most probable 4) Natural briste brush etiological factor is: 2) Prolonged retention of primary maxillary left central 26. Least cariogenic sugar is: incisor 2) Fructose ») Glucose ) Premature extraction of primary maxillny right central «) Sucrose 4) Xyito incisor 6) Pronounced lbioverson of permanent mandibular left 21. The last primary tooth to be replaced by a permanent central incisor successor is 4) Premature extraction of primary left maxillary central 4) Maxilary canine b) Mandibular canine incisor } Maxillary 1st molar) Mandibular 2nd molar (AIPG -92, ALIMS- 2012) 36. Early loss of deciduous teeth causes: 28. First organism to appear in oral cavity 2) Early eruption of permanent teeth 2) Streptococcus sanguis b) Strep. salivaius b) Delayed eruption of permanent teeth ) Strept. mutans) Lactobacil ) Missing permanent teeth 4) Crowding of permanent teeth 29, An 11 year old child has discomfort in tooth 55. On (aree-93) jon his gums are slightly inflamed but the tooth 37. Primary objective for not extracting primary teeth is: Thece is a big class-I filling but no pain with a) To prevent arch length deficiency cold. The most probable diagnosis ist b) Mastication and speech 2) Exfoliating tooth b) Acute pulpitis ¢) To prevent development of aberrant oral habits «} Internal resorption d) Traumatic ocelusion ) All ofthe above (Pst -95) 30, A-5 year-old child is given an extended course of 38. Inthe primary dentition, the anatomic structure used to tetracycine drug which of the folowing teeth are likely determine the molar relationship is: to be affected? 2) Mesiobuccal cusp of the primary second molar 2) Canine and premolars 5) Distobuccal cusp of the primary fst molar ») Canine, premolars and second molars ) Distal plane ofthe primary second molars «) Central incisors ad lateral incisors ) Mesiobuccal cusp of the primary second malar and the 3) embyasure between the primary mandibular second molars (atts -92) (kaR-02) 31. Prolonged retention or a primary tooth may caus 39. Distal shoe space maintainer is mainly indicated 2) Resorption of rts of adjacent teeth 2) Guide eruption of premolars 0%) 0m) 8%) A 6) D7) A 2) B29) A 3) B31) 0 m2) © 3) A) 8 35) A 36) B37) A 38) C39) B (SSss0) =Dental Pulse _ 0) Guide eruption of mandibular fist molar 47. An ankylosed primary molar may result in all of the ) Present space closure in maxillary premolar area following except? 4) None of the above 4) loss of arch length b) Serious problem of extraction (ATINS-96) _c) Delayed eruption of succedaneous tooth 40. Atbirth child shows marked convex profile. This is due to: dl). Failure of calcification of the permanent successor 2) Protruded maxilla b) Retruded mandible (AP -2013) ) Large size maxilla ¢) Small sized mandible 48. A nine-year old child has a Lingually locked 21. most (AIINS -03) probable caus 41, An B-yearold patient with all primary molars still) Premature loss of 51 b) Premature loss of 61 present exhibits a cusp to cusp relationship of permanent c) Prolonged retention of 61 maxillary and mandibular first molars. The dentist 4) Pronounced faciversion on eruption of 31, should: (PSL -99, P12) 8) Continue regular recalls 49, The time of greatest sensitivity ofan organ or system to 8) Plan serial extractions for more normal adjustment of the environmental influence or hereditary pattern occlusion 2) Growth spurt ') Critieal growth period ) Refer the patient to an orthodontist for consultation ©) Growth trend 4) Growth precedence 4) Disk the distal surfaces of primary mandibular second (wan-2k) molars to allow normal adjustment of permanent molars 50. The intrauterine fusion of the primary palate (ip (AIMS 03) "alveolus and palate anterior to the incisive foramen) 42. Treatment of U/L cross bite in 5 year old child is done: occurs at 2) As eatlyas possible) After eruption of molars a) 2a nks b) 4-8 wks ) After al deciduous teth are shed ©) B12 wks 4) 13-47 wks 4) No treatment required (a-96) {AIIMS -95) 51, The change observed in the arch Length of child between 43. In an B-year-old child 1st molar is extracted due to 3 to 18 yrsis, caries. The treatment of choice is: 2) vm ») 11mm a) RPD 8) Space maintainer ©) mm 4) 34mm ©) Surgical repositioning of 2nd molar (aIP6-99) 4) Waitfor the 2nd molar to drift mesialy on its own 52. Height of maxilla i increased by the (AIPG -89,PGI-99) a). Growth at mavilary sutures 44. In which of the following situations is space most) Growth af alveolar process difficult to manage? ¢) Growth atthe palatal vault 2) A9.5-year-old patient with loss of maxillary Ist molar 4) Any ofthe above 8) A S-yearold patient with loss of a primary maxilary central incisor 53. Interdental spacing found in the maxillary arch of the 6). A6-year-old with loss of primary 1st molar deciduous dentition is, 4) A S-yearold with loss ofa primary mandibular second a) 2mm b) 4mm nolar 6) 6mm 4) 8mm (AIINS -91,P61-2K) 45, AS yrs old child with unilateral posterior cross bite of 54. Fusion of mandibular symphysis occurs at: maxillary teeth with functional shift of mancible te 2) At birth ') At 18 months by c) At years 4) In intrauterine life 2) Without waiting for permanent tooth eruption (AIINS -96) 8) After eruption of permanent molars 55. From a clinical standing, the most significant overall, ©) Ato ys of age sexual differences are seen in the achievement of 4) After all permanent teth eruption 2) Facial height ») Faciat Width (AP 04) c)Falal Length 4) None ofthe above 46. Clinician should avoid using cow-horm forceps. for (xaR -98) extraction of primary molars because 56. The stage of relatively rapid eruption from the time a 2) thas poor grip due to peculiar morphology of primary tooth first penetrates the gingiva until it reaches the nolar ocelusal level is calle ) Tt cause damage to gingival tissue 28) Pre emergent spurt b) Post emergent spurt ) It possess great possibilities oF injury to the crypt ofthe c) Occlusal equilibrium) lacerations permanent tooth 4) Greater chances of spitting the concerned tooth while 57. By what age does the startle and grasp reflex disappears? etracting a) 1 year 1b) 1 Me years (comeD-14) —c) years 4) 3 years (A1-08) mo) * WA) 0 Mos) A Me) 0 aes) A (Se st) A 52) 8 53) 8 s4) 8 55) A 56) B57) CPEDODONTICS 58. The easiest and the most natural method of brushing 69. Which of the following molar relationship isthe most technique recommended for pre-school and young common in primary dentition? children: a) Mesial step b) Distal step 5) Vertical ol method €) Flush terminal planed) Cant say b) Bass method (Kcet-07) 6) Modified Stlman’s technique 70. With what percent Level of a normal range of factor VITT 4) Cela ser technique would children's suffering from Heamophila would lead (COMED-05) normal tite? 59. In the absence of a second premolar the roots of the 0) 1-5 5) 10-15% primary second molar will most Uikely 0) 15-25% 4) Over 25% ') Resorb at normal site (coMEDK-07) ») Resorb moe slowly than normal 71. Dentist did restoration in 41 years old child; found 6) Resotb more apy than normal primary molar in various stages of exfoliation with 4) Show no resorption asthe intiatr force is absent Entetor crowding he should give next appointment (HP-07) a) Ater3monthsb) After 6 months 60. The most difficult form of e child maltreatment to ¢) After 1 year 4) When all permanents erupt identify and treat is (AIIMS-07) 2) Sena abuse b) Physical abuse 172, Pulse onymetry ic used to determine: 6), Emotional abuse 2) Rate of Hood flow b) Oxygen saturation 4), Munchaasen sycrome by poy 6) Blood volume) Blood corefcent (coneo-06) (AIINS-o7) 61. Salivary low rate is considered less when the flow is 73. Non invasive method to measure blood flew is below: a) Electric pulp test b) Percussion 2) 0.5 mi/min b) 1 ml/min ©). Radiograph d) Laser Doppler flowmetry ) 5 ml/min a) 2 ml/min (AIINS-07) (061-05) 74, Maximum increase n number of microorganisms in the 62. Distal shoe was first advocated by whom in 1929? mouth is seen at a) Wilson b) Willet a) Birth b) Eruption of deciduous teeth ¢) Wilhelm d) Roche c) Eruption of permanent teeth (AIPG-06) 4) Shedding of deciduous teeth 63. Maximum amount of space loss occurs due to early Lose (a-08) 2) Malay Ist molar b).Maxilary 2nd mola 75. In orthodontics proximal cartes of deciduous. molars 6} Mandibular 1st molar) Mandibular 2nd molar cause: (PGI-06) a) Reduce arch length —_b) Transverse arch deficiency 64. The numberof fontanelles present at birth &} Increase arch length a) Loss of tooth 22 b) (ALIMS mar -2032) 6 d) 8 76, Riga-Fede disease is caused by (arc-o7) 2) A saprophytic fungus that normally occurs in nal 65. Vertical inclination of permanent teath to primary teeth: b) Immunosuppressve state 2) Primary mre vertical than permanent 6) Abrasion of tongue bythe teeth during suckling b) Permanent more vertical than primary @) Arecurtent vial infection which remains latent in neve c) Both are in the same plane tissue d) None of the above (KCET-08) (761-06) 77. The best time to begin the counseling of parents and 66. The type of space maintainer advised when there Is establishing » childs. preventive programme actualy bilateral loss of teeth: starts 2) Distal shoe ) Band & Loop 2), Before the bith ofthe eid €) and & Ber 8) Infants-(02 ys) d) Lingual arch holding appliances c) Toddlers (1-3 yrs.) d) Pre School-(3-6 yrs.) (kcéT-07) (KceT-08) 67. Calcium hydroxide was introduced into endodontics by 78. In case of conscious sedation for children aged 6 2) Nygaard Ostby b) Hermann months to 3 years, clear liquids should be stopped. (OR) 6) Sehlder 4) Hunter According to AAPD gudelines, for a child undergoing (COMEDK-o7) sedation procedure, the humon breast milk should be 68, Theapproximate age at which the child begins towalkisat: stopped atleast hours before the procedure 8) 0-2 months b) 3-6 months a) 4 hrs. before the procedure ) 7-8 months d) 9-12 months b) 6 hrs. before the procedure (ConEDK-07) ——_c) Bs. before the procedure Ss) 8 oa) A eee) 8 ees) A ee 8 aw ®) Cm) 0 7) Am) 8 7) DM) B75) Ae) CM) AB) A hor) ——— (1A 79. Dental Pulse 4) 10 hrs, before the procedure (KcET-08) Computerized Controlled Local Anesthetic delivery system is known as a) Peri Press ©) BAND by WAND ) EDA (comenk-o8) 88, _ Tooth eruption generally occurs when root development is complete by a) 30% ofthe future total length ) 10% of the future total length )_ 75% of the future total length 4) 100% Complete (COMEDK-2010) 80, Lesch - Nyhan syndrome is associated with 89. At what age, Maxillary intercanine dimension is 4) Masochstie behaviour af child essentially complete in boys and girls during growth? 8) Physical abuse of child 8) 15 years in boys and 10 years in girls ©) Low LO, of child patient 1b) 10 years in boys and 12 years in girls 4) None ofthe above )_18 years in boys and 12 years in girls (BHU-07) —__d) 15 yeats in boys and 25 years in girls BA. Best time to see a 3 year old child in the dental office (comeDk-2010) 2) Early in the morning) dust before lunch 90. Toddlers are «) ust afterlunch —d) Any time a) dust born b) 0-1 year ol (KcET-08) —c) 3 year old 4) 3-6 years old 82. The faciatingual dimension of Band and loop space (COMEDK-2010) maintainer should be approximately 91. The best indication for Transpalatal Arch is when 2) 8mm 5) 10 mm a) There is bilateral missing of 2* deciduous molar ©) 4mm é) 5mm ) One sie of arch is intact and several primary teeth on (cET-08) the other side are mising 83, The prefered route for anaesthesia for a child patient) ilateral molar distalisaton is required are all except? Second primary molar is extracted or lost before the 2) Oral ) Intravenous eruption of 1" permanent molar ©) Submucosal ¢) Intradermal (uPsc - 09) (AIPG-09) 92, At which stage congenital defects are more pronounced, 84. Inperforming mandibular nerve block fora child patient, especially when certain teratogenic agents interfere the most probable cause of failure of anaesthesia is? during the development of embryo? 2) More concentration of LA. is required 2) 4 to 8 Week 5) Because of different angulation of needle ) Initiation stage-before 4 week «)_ Because of position of mandibular foramen ) 5®t0 6% month of intrauterine life 4) None of the above 4) allthe above said phases (AlP6-03) (cET-10) 85. According to Finn, the best method of brushing in Mixed- 93. True about knee to knee method for examination of Dentition and Young Adult dentition phase is? infant patient is all except 4) Bass Sulcular Method b) Horizontal Serub Method 4) Parent supports head of infant and operator hold hands «) Modified Stiliman’s Method 5) Can be used at home for brushing teeth of infants 4) Fone’s Method )Gloved finger and lighting pen can be used commonly seen (P61-08) ——_¢) Done in 18 manths old baby 86. Routine radiographic appearance of a child discloses (a1P6-2012) 4 supernumerary tooth between central incisors. The 94. Rubber dam is particularly adaptable to primary second dentist should molar because the 8) Delay removal of supernumerary tooth until its eruption a). Occluso-cervcal height favors its retention 8) drat immediately without any damage to permanent teth 5) Cervieal constriction of crown favors its retention )_ Remove if the tooth develops in to a cyst )Mesio-buccal bulge favors its retention 4) Wait until the child is 12 yeas 4) Small diameter of crown favors its retention (a1IMs-09) (KcET-10) 87, 8.5 - year old child is given an extended course of 95. Change in arch length from mesial surface of permanent tetracycline drug. Which of the following teeth are ikely 1" molars between the ages of 6 to 18 years is? tobe affected 2} Increased by 0-1 mm b) Decreased by 0-1 mm 8) Canines, premolars and second molars ) Increased by 3-4 mm d) Decreased by 3-4 mm 8) Canines, premolars (PsI-08) ) Cental incisor and lateral incisor 96. Which ofthe following sugar substitute is bactericidal? «)) Fist Molas 2) Kyl 1) Mannitol (AIIMS-09) Sorbet 4) Giyeeral (1-08) 7B #0) A ByTATI 2) A [eye 8 eS) es) 8 le UAT 68) c¢ ene 50) C91) 8 92) A 93) A 94) 8 95) B96) A$y PEDODONTICS 97. During development of speech function, the fist speech 107. Seizure especially seem in children with no aura fs sounds acquired are a) Grandmal epilepsy b) Petitmal epilepsy 2) Bilabials b) Consonants: c) Infantile epilepsy d) Tonic-clonic epilepsy 6). Sibitants d) Nasolabials (AleG-10) (COMEDK-2010, KCET-11) 108. Pacifier sucking is an example of- 98, For development of a mandibular incisor, which of the a) Digit sucking 3b) Non-nutitive sucking following gene is responsible 6) Iplicatve sucking) Nutritive sucking 2) SKI 3) BARK (COMEDK-08, PGI DEC- 13) ) APC 4) abe 4309, For a 3-yrold child a removable space maintainer is (NCET-10) fabricated. Whats the biggest cisadvantage of this appliance 99, In stainless steel crown on a deciduous molar with over) Irtaton to supporting tissues hanging margins, gingival pain and inflammation occurs) ificut to clean due to? 6) Child may not tolerate wearing the appliance 2) Plaque retention) Excess cement 4) Function wil be compromised €) Crown margins causing iitation (comeDk-08) 4) Engaging undercut 110. During administration of NSAIDS in children the most (AIPG-16, ALIMS MAY- 14) important of dose administration is? 100. f child patient is very aneasy and not able to hold X-ray lm, a) Weight ofthe child b) Age of child then inthis case who cam hold the film in patient's mouth? 6) Nature ofthe drug) Chronicty of pain. 2) Dentist ) Auxillary personnel (a1PG-2011) ) Parents 4) child only 4121. On a primary 2* molar caries occur most commonly on (a1PG-08) a) Occlusal pt and issues b). Buccal surface 101. Recently added in the centre of paediatric treatment c) Proximal caries below contact point triangle is 4) Proxima caries above contact point 2) Type of Treatment) Society (a1ec-2011) c) Child response d) Facilities in clinic 112. Veracity is (KC#T-09) a) Truthfulness ) Reneficence 102. Nitrous oxide that fs used as anaesthetic agent has ©). Autonomy 4) Non maleficence mechanism of action as? (comeo-2012) 2) Gasseran ganglion block 113. All of the following represent potential obstacles for 8) Block peripheral nerves ily oral hygiene fora child with special needs except «) Reversible (indirect) depression of CNS 2) Perioal sensitivity) Limited manual dexterity 4) Block nerve endings 6) High gag efter) Low pain threshold (16-09) (KCET-2012) 103, Deciduous teeth are lighter in color than permanent tooth 114, During the fabrication of band for band and loop space 2) Due to color of surounding tissues maintainer, where should be the band be placed for final. 8) Dentin is thinner incase of primary teeth positioning of the band? «) Due to difference in crystaliine structure 5) istatingual aspect ofthe maxillary teeth and distofecal 4) There is difference in vefractory indices aspect ofthe mandibular teeth (ATIMS-08) _b)Distofacil aspect of the maxillary teth and mestofacal 104, Porter's arch is recommended as a remainder appliance aspect of the mandibular teeth in children with «) Mesiolingual aspect of the maxillary teeth and 2) ipbiting habit) Thumb sucking habit distoingual aspect ofthe mandibular teeth «) Tongue thwsting habit d) Mouth breathing habit 4) istafacil aspect ofthe maxillary teth and distolingual (UPsc-09) aspect ofthe mandibular teeth 105. As compared to adult a child's tooth brush has following (coneo-2012) specifications 4115. There is intrusion of 51 im a 3 year 7 month ald child 2) Soft bristes b) Hard bristles and radiographs shows foreshortened image, Probable ) Smaller head sized) Smaller bristles size treatment is (AIPG-10) a) Waitand watch ——_b)- Immediately extract 106. The reasons for maxillary permanent canine impaction c) Splint could be all EXCEPT. 4) Immediate reposition surgically 2) Long developmental period (AIPG-2012, AIINS MAY- 16) 5) Dubious course in eruption 4146, Preventive pit and fissure sealant in children should )Occuptes several deveopmental positions in succession haves 4) Asymmetrical development 2) High compressive strength (KCET-09) —_b) Low viscosity BAT 98) A BOAT 100) € HOI 102) ) AOR) 104) 8 (OB) OO 106) 0 AoA 308) 8109) C440) A111) C42) A313) 04M) A115) A116) B BRS) —(6 A AAA Dental Pulse a7. 18. 119. 120. Hybrid composite with filler 4) None of the above. (Neer -2013) ‘Although each carious lesion is individual & influenced by multiple factors, the carious process is generally: ) Continuous b) Rapid ©) Intermittent 4) Slow (Neer -2013) The important fatty acid present in breast milk which is important for growth is: 4) Docosahexaenoefc acid b) Plamitic acid ©) Uinoleic acid 4) Linolenic acid (AIMS -2013) Regarding OPD general anaesthesia in dental chair absolute contraindication are all except? ) Children with minimal dental needs ) Serious medical disease ©). Edema of floor of mouth 4) Trismus (AIIMS-12) The respiratory rate (breath per minutes) for 3-5 year ‘old children will be a) 30-35 by 20-25 3 92 a) 1218 (KERALA-2015) _ iim 118) A aa) A 120) 8ee | 6. MISCELLANEOUS — ANSWERS 2 ‘8! [Shobha Tandon 1st ed 574] PEDODONTICS ‘= Mandibular premolars Downs syndrome Tisomy 21 Maxillary lateral incisors Eielieratavccconel risen YO) 10. ‘C’ [Shobha Tandon 1st ed 574] OCHS YAS [HODES Failure of fusion between maxillary process Chronic myeloid leukemia | Philadelphia chromosome (9, 22) ETT! with redial! nasal process (Rontonssal process) {He Donald sth ed 657] ‘Oblique | Failure of fusion between maxillary process [Shobha Tandon 1st ed 595] sa relate ies DES ‘Mid line cleft | Failure of fusion of medial nasal processes. [Me Donald 8th ed 53] Cleft palate _| Failure of fusion of palatal shelves. = Missing teeth TE Obtn 414. 'K [Me Donald 8th ed 52] aceT RNR 412, 'W [Mc Donald 8th ed 168] * Supernumerary tooth Co + Odontoma 413, ‘D’ [Me Donald 8th ed 151] Histoifferentiation | ° Anelogeness imperfecta 14, ‘D’ [Me Donald 8th ed 184-187] + Dentinogenests imperfecta = Peg teeth, dense in dente 415. 'C [Shafer 4th ed 72] Norphoditferentiation | © Microdontia 6. [Me Donald ath ea 155) + Macrodontia. eee 1 — * Hypoplasia 17, ‘K [Me Donald 8th ed 155] Se poe Mucocele is primarily an extravasation cyst whereas Ranula is a retention cyst. [Me Donald 8th ed 53] 18. ‘C [Mc Donald 8th ed 105] (Shafer 4th ed 807] 19, 'C’ [Me Donald 8th ed 106] [Shobha Tandon Ast ed 581] Cellulitis isa diffuse inflammation of soft tissues that tends ical feat and to spread through tissue spaces along fascial planes. © Hypoplastic maxilla, 20, 'B’ [Shobha Tandon tst ed 189] * Shallow gingivo labial suleus. + Nose deformity (tip deviated to normal side) 21. 'B’ [Shobha Tandon 1st ed 194] + Hypoplastic teeth (laterals and canine on clet side) 29, +p [Shafer 4th ed 516] + Supemumerary teeth. + congenitally missing teeth, 23, ‘D’ [Shobha Tandon Ast ed 538] + Geminated, fused, conical teeth 24, ‘B’ [Me Donald 8th ed 252] + Feeding difficulties 25. ‘K [Me Donald 8th ed 239] Posterior cross bite. ‘C [Shafer 4th ed 729] [Shafer ast ed 49] * Mesiodens + Maxillary 4th molar # Mandibular 4th molar + Maxillary paramolars ‘The four basic methods of tooth brushing are: ‘+ Horizontal reciprocating (scrub method) ‘+ Vertical sweeping (roll and physiologic methods) ‘© Circular (Fones method) ‘© Vibratory (Charters, Bass and Stillman methods) Horizontal scrub method is the best method of brushing for the primary dentition or preschoolers. This is according to Kimmelman and Tassman, (SSS) =26. 27. 28. Dental Pulse According to Finn, Fones method is the best method of brushing for the mixed and young adult dentition, ‘D’ [Me Donald 5th ed 298] 'K [Mc Donald &th ed 177] ‘B [Shobha Tandon Ast ed 528] 30. 31, 32, 33. 34, fic onmd oe 25) eee 3 months postpartum Leo = 9 months postpartum ae ‘mei ppan | Fem mies ci, Tetracycline analogs causing less tooth staining: ‘D’ [Bhalajhi 3rd ed 92] ’C’ [Check Explanation Below] ‘W [Shobha Tandon 1st ed 386] mandibular lengthening. The factors that affect the quality of distraction regeneration include the latency, rate, rhythm, and consolidation period. _ The following accelerates regeneration of bone: ‘© Decreased latency period ‘+ Only little rate of 0.5mm per day (High rates produce fibrous union) ‘+ Increased rhythm ‘+ Decreased consotidation period [Bhalajhi 3rd ed 92) 3rd ed 91) ‘K [Shobha Tandon 1st ed 381,382] “C [Shobha Tandon 1st ed 110] The mesio-dista relation between the distal surfaces of the upper and lower second deciduous molars can be of three types. Flush terminal |The distal surface of upper and lower plane second. deciduous molars are in one vertical plane Wesial The distal surface of the lower second terminal | deciduous molar is more mesial than that lane of the upper Distal The distal surface of the lower second ‘terminal plane | decous molar is distal to that of upper. 8’ [Shobha Tandon 1st ed 396] Distal shoe space maintainer is indicated, when there is premature loss of the second primary molar or at the time of extraction of primary second molar (COMEDK-08), prior to eruption of the frst permanent molar. The appliance provides greater control of path of eruption of the unerupted tooth and prevents mesial migration Types of Distal Shoe space maintains © Removable ‘+ Willet’s fixed distal shoe space maintainer ~ list fixed distal shoe space maintainer (AIPG-06), ‘+ Roche's feed distal shoe space maintainer - Its a type of crown and bar or band and bar appliance. It is the ‘most commonly used appliance. Distal shoe space maintainer (Intra: is conteaindica din ‘+ Patients with heart diseases. ‘+ Patients with poor oral hygiene eolar) appliance ‘+ Hemophilic patients. 1 [Shobha Tandon ast ed 55] { [Shobha Tandon 1st ed 404]ee | 43. 46. 45. 46. 47. 48. 49. 50. ‘D’ [Mc Donald 8th ed 644] The first permanent molar is the most important unit of mastication and the loss of a mandibular first permanent molar can result in a reduction in chewing efficiency as great as 50%. After the loss of first molars, the second molars start to rift mesially. A greater degree of movement will occur in children in 8 to 10 years age group (i.., loss of frst molar before the eruption of second molar) If the loss occurs after the eruption of second permanent molar only tipping ofthe tooth occurs. Ifthe frst permanent molars are removed several years before the eruption of the second molars, there is chance for bodily movement of second molar mesially and there is an excellent chance that the second molars will erupt in an acceptable position. [Shobha Tandon 1st ed 404] “C [Check Explanation Below] CCow-horn forceps is contraindicated for the extraction of deciduous molars because of the areat possibilty of injury to the crypt of the permanent tooth bud, which lies below the bifurcation of the deciduous roots. ‘0’ [Shobha Tandon 2nd ed 444] ‘© [Bhalajhi 3rd ed 92] ‘X [Shobha Tandon 1st ed 65] Growth spurts does not take place uniformly at all times The periods of sudden acceleration of growth spurts are known as growth spurts, The following are the timings of growth spur ust before birth © One year after birth, + Mixed dentition growth spurt © Adolescent growth spurt = Boys: 14-16 years = Girls : 11-13 years ‘8! [Shobha Tandon 1st ed 574] Embrologicaly, the area ofthe lip and palate is divided into primary palate and secondary palate. 1) Primary palater It includes the central portion of upper lip (philtrum), alveolus bearing fair incisors and the palate anterior to the incisive foramen. Primary palate develops from median nasal process and fuses with maxillary process between 4-7 weeks of intrauterine life b) Secondary palate: It includes the palate behind the incisive foramen. Fusion of secondary palate takes between 7 to 12 weeks of intrauterine life PEDODONTICS 51, 52. 53. 54, 55. 56. 57. 58. 59. 61. °K [Shobha Tandon 1st ed 114] During the period of transition (6 Ye to 8 Ye years) Interdental spacing |» 4mm in maxillary arch of primary dentition | » 3mm in mandibular arch Intercanine arch |» 4.5-6mm in maxilla width increases by | # 4mm in mandible Tntercanine arch [© 3-4 mm. length increases [Shobha Tandon Ast ed 69] ‘B'[Shobha Tandon tst ed 124] ‘8 [Shobha Tandon Ast ed 52], ‘W’ [Shobha Tandon 1st ed 65] [Shobha Tandon Ast ed 92] ‘© [Shobha Tandon 1st ed 57] Startle reflex is initiated by a sudden noise or any other stimulus in which the elbows are flexed and the hands remain closed. In Grasp reflex, when the babys palm is stimulated, the hand closes. Both normally disappear by 26 months. ‘D [Mc Donald 8th ed 245] B’ [Shobha Tandon 1st ed 97] It s clear that pressure from the erupting successional tooth plays a key cole in shedding of deciduous teeth. Although this pressure obviously has a key role in initiating tooth resorption, other factors like forces of mastication, etc., are also involved, So, whenever there is missing of successional tooth germ, shedding of deciduous tooth is delayed, 0’ [Me Donald ath ed 26] Munchausen syndrome by proxy or pediatric condition falsification or facttious disorder by proxy fs perhaps the most difficult form of child maltreatment to identify and treat. In this condition the patents relates a fictitious history, produces false signs or symptoms and fabricate illnesses in child. The children are present with persistent and recurrent illness that cannot be explained, signs and symptoms that are rare, unusual or bizarre and do not make any sense clinically, 'N [Me Donald 8th ed 213] Indicators of salivary gland hypofunction: ‘© Aunstimulated salivary flow (USF) rte of less than 0.1ml per minute is diagnostic of salivary gland hypofunction. ‘© Ifthe USF rate is less than O.1ml per minute, the next step is to measure the stimulated salivary flow (SSF) ‘The patient is asked to chew unflavored paraffin for 45, chews or 1 minute and the amount of saliva is measured. The normal SSF rate is 1 to 2 ml and a SSF rate of less ‘than 0.5 ml is considered abnormal, (SSss0) =(1A 62, 83. 64. 66. 67. 68. Dental Pulse ‘ [Shobha Tandon Ast ed 396] The fixed distal shoe space maintainer was first reported by willets. The most commonly used one was described by Roche. The major difference between the two appliances is the gingival extension. The Roche variety is crown / band and bar appliance with a V shaped gingival extension while the Willets one had a bat type. The depth of intragingival ‘extension should be about 1 - 1.8mm below the mesial marginal ridge of the molar. ‘B [Shobha Tandon 1st ed 385] Some important points about space maintenance: ‘Teeth erupt, when three fourths af the root is developed. + Loss of primary molar before 7 years of age will lead to delayed emergence of the succedaneous tooth, whereas the loss after 7 years of age lead to an early emergence, + Erupting premolars require é to § months to move through ‘mm of bone as measured on a bite-wing radiograph. © Several studies have found that maximum space loss ‘occurred in the maxillary region due to premature loss of second deciduous molar. The rate of space closure fs about 1.5 mm per year in ‘maxilla and Imm per year in mandible Distance travelled in bone by erupting premolars in 4-5 months? (ATIMS Nov-14) a)imm b) 2mm 3mm 4) 4mm ‘C [Shobha Tandon 1st ed 50, 51] + Anterior fontanelle - Posterior fontanelle * Sphenofd fontanelle *Mastoid fontanelle - [Shobha Tandon ist ed 114-15, Fig 3.18) ‘D' [Me Donald 8th ed 642] ‘B [Shobha Tandon ist ed 340] ‘D' [Shobha Tandon 1st ed 64] The approximate age at which a child begins to talk is 24 months. Speech retardation may be considered if the child does not talk by 24 months (ATPG-05) ‘C [Shobha Tandon 2nd ed 113] Most common molar relationship in primary teeth is flush terminal plane (49.2%) followed by mesial step (26.7%) and distal step (23.3%). _ 1 [Shobha Tandon 1st ed 562) 70. ‘+ Frequent bleeding episodes “+ Hemarthrosis © Deep hematomas hematuria < 1% (severe) and Occasional. spontaneous joint bleeding Significant hemorrhage only after a major insult [iota me 172. 'B! [Shobha Tandon 1st ed 332] Since pulp vitality is purely a function of vascular health, a direct measurement of pulp circulation fs the only real measure of pulp vitality. Pulse oximetry is completely a objective test, requiring no subjective response from the patient that directly measures blood oxygen saturation levels. ‘D’ [Shobha Tandon 1st ed 332] Laser Doppler flowmetry is a noninvasive objective painless alternative to traditional neural ~ stimulation methods. It measures the velocity of red blood cells in capillaries and therefore a promising pulp vitality test for young children For vital teeth the flowmeter fas produced regular signal and the non-vital teeth showed no such synchronous signs but produced iregular signals. 74, ‘B [Shobha Tandon 1st ed 212] The oral cavity of the infants is invaded by a variety of transient microorganisms. Streptococcus is found to. be consistently present within few hours after birth, The eruption of primary teeth bring about @ qualitative and quantitative changes in the microflora. There will be colonization of “poineer bacteria” which then gives a substrate to attach the secondary invaders. 75. ' [Shobha Tandon 2nd ed 448] Proximal caries cause loss of tooth structure from the mesial and distal surfaces of tooth. This causes the tooth to shift Into the space created by the dental caries causing decrease in the arch length, 76. “C [Mc Donald 8th ed 183) [Me Donald 8th ed 290] Dietary instructions should be as follows: ‘+ Clear liquid should be stopped upto 3 hours before the procedure for children aged 6 months and older. ‘+ No milk or solids for 6 hours fr children aged 6 months to 3 years and for 6 to & hours for children 3 years and older. © Vomiting during or immediately after a sedative procedure is a potential complication that can result inee | 79. 80. a1. 82. aspiration of stomach contents leading to laryngespasm fr severe ainay obstruction or aspiration pneumonia, It also creates unfavourable disruption of the office routine. © Secondly, the drug uptake is maximized when the stomach Is empty as most of the conscious sedation agents are administered ‘8 [Me Donald 8th ed 281] WAND is a computer-controlled anesthetic delivery system. The dosage is controlled by computer. Block, infiltration, palatal and periodontal ligament injections are all reported to be more comfortable with Wand technique than conventional techniques. ‘Wand system of local enesthesia involves the following method of drug delivery (aP -2013) Ans. Computer controlled injection system ‘ [Nelson Pediatrics 18th ed 630] Masochistic behaviour is nothing but deriving pleasure or sexual gratification from being abused or dominated. It is seen in children suffering from Lesch-Nyhan syndrome ‘or HGPRT (hypoxanthine - guanine ~ phosphoribosyl transferase) isthe result of mutation in a recessive structural gene. Mental retardation, self mutilation and sudden aggressive behaviour which is indeed an inherited defect ‘of metabotism., There will be abnormally high production of uric acid, which present at a raised level in saliva, Because of this, there will be iritation of buccal mucosa, accounting to some extent for the biting of lips and tining of mouth. Extraction of primary teeth may be required sometimes. ‘X [Shobha Tandon 1st ed 30] Moming appointments are preferable in a young patient because the child willbe fresh and active. The length of the appointment should be as short as possible (preferably less than 30min.) ‘X [Pinkham 4th ed ed 426] |) The Band-and-loop appliance is indicated in © Unilateral (oss of primary first molar before or after eruption of permanent first molar. Bilateral loss of 2 primary molar before the eruption of the permanent incisors ‘i) A properly placed band is seated approximately 1mm below the mesial and distal marginal ridges. iff) The loop should be parallel to the edentulous ridge 1mm of gingival tissue and should rest against the adjacent tooth at the contact point. iv) The faciolingual dimension of the loop should be approximately 8mm. V) The loop is made up of a 3é6mil wire. PEDODONTICS 84, 85. 86. 87. 83. 89, 90. 91. 92, 93. 94, ‘D" [Mc Donald 9” ed 264-66] ‘© Inhalation: Nitrous oxide and oxygen sedation, ‘© Oral: Most universally accepted and eastest method, ‘+ Intramuscular: Less preffered over the oral route. Oral and intramuscular sedation requires prolonged time to reach the peak effect. ‘© Submucosal/ Subcutaneous: Host suitable method for pediatric patient for whom quick administration and onset is desirable ‘+ Intravenous: Eventhough most efficient, this technique ‘is testrcted to certain types and ages of patients, “B [Shobha Tandon 2% ed 532] Mandibular foramen is situated at lower level than occlusal plane of primary teeth, Therefore, injection must be made slightly lower and more posteriorly than for an adult patient, ‘D' [Finn 4% ed 540) Fones technique is @ simple technique taught to young children. In this method, with the teeth in occlusion, the buceal and labial surfaces are brushed with a large circular ‘motion. The lingual and occlusal surfaces are brushed with an in-and-out horizontal brushing action. ‘B [Me Donald 5 ed 657] Each case involving a supemumerary tooth must be diagnosed and evaluated according to its own pecularities, but in general such teeth are removed as ealier as possible “A’ [Me Donald 8” 4135) [Shobha Tandon 2% ed 93] ‘8 [Shobha Tandon 2% ed 463] Option ‘& in bilateral loss of the deciduous molar, Nance palatal arch is indicated. For Option ‘0’ distal shoe space maintainer is indicated. ‘A’ [Shobha Tandon 2% ed 48] “A [Me Donald 8th ed 15, 16] One method of examining a child is the knee to knee method. In this the dentist and parent are seated face to face with their knees touching. Ther legs form the ‘examination table The child head is towards dentist and legs straddle (cross) the parents body. This can also be used for demonstrating oral hygiene procedures to the parents ‘B’ [Shobha Tandon 2% ed 324] (SS =(2 A 95. 96. 97. 98. 99. 100. 101 102. 103. Dental Pulse “B' [Me Donald 7° ed 642] ‘Average dimensional dental arch changes between 5 = 18 years for maxillary and mandibular arches are as follows (Moorrees 1959) Cee ‘© Bicanine - 3 mm increase ‘Arch width ‘ Bimolar ~ 2 mm increase ‘1mm decrease because of Uprighting of incisors ‘Arch length Slight decrease because of Uprighting of incisors Increase of 1 mm ‘Arch width ‘Arch length ‘Arch cireumference ‘A’ [Pedodontic ~ A elinical practice by Koch 4 ed 108] 'R’ [Shobha Tandon 1* ed 60] 'R’ [Critical reviews in Oral Biology & Medicine 1977, 8(1) Pg 4-39] MS homeobox gene family plays an important role in tooth development. Lack of MSX exhibits arrest in tooth development at the bud stage. ‘ [Shoba Tandon 2nd ed 368) Overhanging margins, rough and unpé result in plaque retention there by leading to inflammation of gingiva ished restorations B' [Shobha Tandon 2 ed 5] Child, dentist and parents form the pedodontic treatment triangle (Wright, 1975) with the child at the apex. Modified pedodontic triangle consists of society in the centr, ‘C' [Me Donald 8" ed 295] N.0 produces non specific Central Nervous System (CNS) depression. Although it is classed with inhalational general anesthetics, it produces limited analgesia and so surgical ‘anesthesia is achieved at higher concentartions only. ‘D! [Shobha Tandon 2* ed 324] Deciduous teeth are light bluish white in colour; also called as milk teeth as thet refractive index is same as mile. 1 Permanent teeth are darker in colour ranging from yellowish white to grayish white. Colour of permanent teeth is determined by differences in translucency of enamel. _ 104, ‘8° [Me Donald 8” ed 657] Porter appliance or soldered ‘W’ lingual arch simultaneously function as a reminder appliance in some posterior crossbites associated with thumb sucking, 105. ‘' [Me Donald 7 ed 249] In evaluating the best tooth brush head and handle for children, Dt. Updyke concludes that it is best to use a smaller head and a thicker handle than the adult siz brush to aid in access to oral cavity and assist the child's grip of the handle, 106. 107. ‘B" [Shobha Tandon 2” ed 639] Epilepsies are @ group of disorders characterized by chronic recurrent, paroxysmal changes in neurologic function caused by abnormalities in the electrical activity of the brain, Absence or petitmal epilepsy consists of: ‘© Sudden cessation ofthe ongoing conscious activity without convulsive muscular activity or loss of postural control. ‘© Brief lapses of consciousness or awareness may occur. Usually lasts for fen seconds to minutes. ‘© Occurs in children of 6 ~ 14 years. 108. ‘B" [Shobha Tandon 2” ed 501] Acquiring a digit sucking habit can be prevented by encouraging the baby to suck a dummy. 109. 'C' [Shobha Tandon 2" ed 465] [K.D Tripathi 6% ed 61) 4111, °C [Pinkham 4th ed 286] Primary frst molars in both arches are less susceptible to ‘occlusal caries because ofthe relative lack of deep pits and fissures on that tooth as compared with primary second molars. The broad contact area between primary first and second molars contributes to a high proportion of proximal caries aceurting at those surfaces. The distal surface of the primary second molar has no approximating tooth until the permanent first molar erupts. Thus, itis relatively unaffected by caries until age 6 or 7, after which it becomes more susceptible. Caries susceptibility of primary teeth (in descending order) 2° molar > 1° molar > canine > lateral incisor > central incisor order). 1° molar > 2" molar > Max. 2 PM > Max. 1° PM & Mand. 2" PM» Max, central lateral incisor > Max. canine & Mand, 1° PM > Mand. central & lateral incisor » Mand. canine Surfaces involved in descending order (in primary teeth) Occlusal > molar interproximal > incisor interproximal. (Proximal surfaces were affected more in ist than in second primary molars.)a | PEDODONTICS Who 2) 112. ‘A’ [SS Hiremath 1st ed 249] 113. 'D’ [Shoba Tandon 2nd ed 629] 114. ‘A’ [ClassWeb.IntellitecCollege.com] 115, ‘A’ [Shoba Tandon 2nd ed 591] 116, '8" [Shobha Tandon 2nd ed 259] Requisites of an efficient sealants * Low viscosity allowing peetation ito dep and nanow Adequate working time © Resistance to wear * Good adhesion to enamel © Cariostatic action {nimum ieritation to tissues 127. ‘C’ [Essential of dental caries by Edwina kidd 3rd ed 135 Caries processis dynamicintermittentratherthan continuous, with episodes of demineralization and redeposition 118, ‘A’ [Molecular basis of nutrition by Tom sanders, Peter ‘emery 72] DHA, an Omega-3 fatty acid, is crucial for optimal development of brain in infancy and childhood. Eventhough linoleic and linolenic acid are present in breast milk, DHAis very important. 119. 'A’ [Me Donald 8th ed 278] Contraindications of GA * Serious medical disease. ‘© Healthy and co-operative patients with minimal dental needs. 120. [Check Explanation Below] Age of children Res Birth to 6 weeks 6 Months ‘Years Years ‘Adultsfin A AAA Dental Pulse Yo PEDODONTICS — SYNOPSIS I. Scientists in Pedodontics 3. Window of infectivity: As the primary teth erupt they provide a vgn haitate Rom palcarles pase which enable S.mutans to colonize the oral cavity avoiding Fal childhood eres Davis Competition. nth other indigenous bec This. it ‘Nursing caries Winter et al called window period and is established by 19-33 months oss bonie ces at (WHCET-15) of age. ater ths peodSmutas may have ei : tialy in establishing because It needs to compete with Acidogenic theory Miller other indigenous bacteria. The second window of infectivity eager Engrs! is present in permanent dentition between 12 var of ae Paychosoil th tie ik oe aa 4 Trace elements like selenium, cadmium increases the caries Cognitive theory Piaget Ice te Hierarchy of needs Hasler Stent ear Classical conditioning theory Paviow Infected der iors CRSA TT sara Highly demineralized [Tntermediatelydemineratired aera asia Unreninentiabls | Reminenliable sc ana eerie cacti HOME techiave| eden Stine by 1% ai ed] rae eae Stainless steal crowns | Hemrey Pewienagocall Cust foc fr FRY [gyn Shel e eevied [Sil eo einen Caries triad Keyes 6. Lactose content of breast milk - 7.2% Caries tetrad Newbrun pene ee 4.5% Prophylactic odontomy Hyatt ik powder - 7% Eaeeaee Bodecler 2. Materaly derived streptococcus mutans disease (HDS HD) rela = isthe synonym of eary childhood caves Main method of te ees transission by Kissing Father of serial vtcton ance 8. CARIDEX tis chemoxmechanical system of cries emova clea Hoda aa Te consists of 2 solitons, Solution 1 contains sodium Ieee and solution 2 contains Ghee, amioocbetyc Marie Dei sodum ehorde and sodium hytong. 1 Deaf matin deren Aa 5 soya suas 2 fas d= st ot), Ae laste aco aa interaction is essential for initiation and progression of lc sweeteners | Lacttel caries. Glow e © Sorbitol Tooth ‘ Composition — Surface enamel dL veasmi resistant to caries than subsurface (© Saccharin: ee eee enamel. Hteners |. asparatame (Nutra sweetner) + Morphology - Pit & fissures, anes 10, Morphology of fissures: U,TandK type + resiton ~ Maaignment. = Malalignment 11. 'V and ‘U' shaped fissures are self cleaning, caries resistant Agent Oral bacteria particularly the species of ‘and require non invasive techniques, steptococcs,Nelssera, Actinomyces and Veillenella, 12. Tand K shaped fissures are caries susceptible and require Siesta) ewercyichinoetionspigciatarm| invasive echngue reseeal Zavtooment [Save ad plage 13, Dental cripple means a child who has ost many seth$$$] renovonmies synopsis IIL, Treatment modalities for traumatized primary incisor Trauma Pans Enamel only Observation * Smoothen rough edges * Apply fluoride Enamel and dentin only | Ca (OH), or GIC lining * Acid etch composite resin © Open faced stainless steel crown * Polycarbonate crown Enamel, dentin and pulp | Formocresol pulpotomy, pulpectomy © Open faced S.S, crown {Gf devital or reversible pulpitis) © Composite resin # Strip crown Root fracture Observation, extraction, splinting * Space maintainer if required Aulsion| None Space maintainer if required Displacement Observation, extraction © Immobilization * Space maintainer if required Intrusion If there is no damage to permanent tooth crypt, wait to . re-erupt. If damage occurs extraction fs indicated IV, Treatment modalities for ized per went inciso ee ra Observe * Smoothen ugh edges (Clas 1) Brae eee Enamel and Dentin | Ca (OF), liner ® Acid etch composite resin (Class «To retain the restoration temporary crowns tke acrylic, poly carbonate and open faced S.S. crowns are used. Enamel dentin and | Open apex Pulp (Class 11) | pirect pulp capping, Ca(OH), | Temporary crown, as mentioned above pulpotomy, Apexification iia ae * Acid etch composite ‘ Direct pulp capping pulpectomy | # Jacket crown Root fracture % Cervical one-third; RCT; Extraction |» Gold core with PFM crown «Middle one third; splint Space maintainer + Apical one third: splint + Fixed prosthetic appliance ‘Avulsion = Reimplant, splint for 10-14 days, _ observe Displacement > Mild ~ observe ae Severe - splint Concussion with | Mild - observe * Relieve from occlusion mobility + Severe = splint # Immobilization ‘Andresen or WHO classification of anterior tooth fractures: VI. Vitality testi £73.60 | Fractures of enamel {873.61 | Fracture of enamel and dentin 1. Itcan be elicited by ‘© Heat test with gutta-percha 873.62 | Pulp exposures D ftutahionte 873.63 | Root fractures + Ice £873.64 | Crown and root fracture Electric pulp tester £873.66 | Concussion or luxation ‘= Carbon dioxide snow £873.67 | Intrusion or extrusion 873.68 | Avulsion 873.69 | Soft tissue injury 2. Tue vitality of tooth depends on its blood supply. But electric ‘and thermal tests rely on nerve supply for testing vitalityDental Pulse 3. Pulp testing gives false readings if root formation is incomplete or the tooth has a temporary crown or splint. 4, The teeth in the immediate area as well as those in the apposing arch should be tested. 5. If injured tooth requires more current than that for a normal tooth to give response indicates pulp death. 6. If less current isneeded to elicit a response from a traumatize tooth indicates pulpal inflammation 7, Tooth tested immediately after trauma may give negative response as the tooth may be in a state of shock. So the tooth should be retested in a week or 10 days. 8. Laser Doppler Flow meter and pulse oximeter determines vitality based on blood supply to the pul. 9. Presence of calcification and pulp stones gives. False negative results. 10. Moist gangrenous pulp remnants gives false positive results. Vil. fullmoth sve iowa a a re aes ae) 2 |. eT s6yn[ 6 [+ [2 [2 eays| 9 | «| 2] woe le [a | « | = VIL. Recent techniques of Local anaesthesi 1, EMLA ~ Eutectic Mixture of local anaesthesia + It is developed to diffuse through intact skin and to reduce the pain during needle injection through skin * Composition: 5% cream contains 25n9/9 lidocaine and 25y9/a prilocaine. © Itis applied to skin atleast 1 hour before injection. ‘Iti contraindicated in children below 6 years of age. 2. DENTL PATCH: These ate controled releasing devices. Topical agent is incorporated into a matrix, which will adhere to mucosa and allow slow release of anaesthetic drug Fg: Lidocaine transoral delivery system in 10% and 20% concentrations. 3, JELINDECTIONS: ‘Also called as Needle less anaesthesia. Can penetrate mucous membranes / skin under pressure without causing excessive tissue trauma yriget, Made. % _ WAND: It is computer controlled injection system (AP-2013). Dosage is controlled by computer. ens: ‘© Trans Electronic Nerve Stimulation, ‘© Electronic stimulation of nerve endings is used for anaesthetic effect. ‘+ Indicated in needle phobic patients and where local anaesthesia is ineffective, scious sedation’ General anaesthesia ‘At several visits the Generally a single sitting, procedure may be once ina lifetime performed. procedure, Patient is cooperative but _ | Patient is uncooperative. anxious and fearful. Patient is conscious and airway is maintained. No premedication and investigations are required. Ventilation is required. Basie investigations are must be premedication is required. NPO strict. NPO not required. Behaviour management: Pre co-operative stage: Non cooperative 2 year old children are referred to as in the stage of pre cooperative behaviour Behaviour problem: A potentially cooperative child is called as behaviour problem, These children can be made cooperative by applying behaviour modification techniques. Preappointment behaviour modification: Anything that ts said of done to positively influence the child behaviour before the child enters a dental operatory Euphemisms: These are word substitutes Dental t gy Word substitute Rubber dam Raincoat ‘Alignate Pudding Sealant Tooth paint Topical fluoride Cavity fighter Suction ‘Vacuum cleaner ‘Study models Statues High speed Whistle Low speed Motoreycle Retraining: Its a technique of making a negative behaviour child who had previous unpleasant dental experience cooperative by demonstrating a difference such as performing N,0 ~ 0, sedation,| x REINFORCEMENT: © Positive reinforcers is one whose contingent presentation increases the frequency of behaviour. Eg: Gifts. ‘+ Negative reinforcer: is one whose contingent withdrawal increases the frequency of behaviour. Eg. Withdrawal of mother. * Social reinforces: Praise, positive facial expression, shake hand. # Material reinforces: Toys, games. Bio-feedback: involves the use of certain instruments to detect certain physiological processes associated with fear CLEFT LIP AND PALATE * failure of fusion between median nasal process and maxillary process. * failure of mesodermal migration between the two layered epithelial membrane, * failure of fusion of two palatal shelves. © Rupture of inclusion cyst at the site of| fusion. «failure of the tongue to drop down, = 1 in 750 infants (FINN) © Cleft lip alone ~ 25% * Cleft palate alone - 25% Cleft lip and palate - 50% Cleft Lip palate Incidence Male excess is reported in combined cleft lip and palate and female excess in isolated cleft palate patients. Unilateral defects more common than bilateral that too left side preponderance. Etiology: © Genetic factors (monogenic) Environmental factors + Gene-environment (polygenic) interactions Protocol for dental care: At Birth: + Feeding plate + Pre surgical orthopaedics 5 months: Alignment of primary teeth © Palatal expansion with simple fixed appliance like W-arch and Arnold expander + Cleft tip repair 12 months: * Pedodontic review + Cleft palate repai Speech pathologists first assessment PEDODONTICS SYNOPSIS XI 2 = 8 years ‘© Pedodontic review ‘© Orthodontic consultation ‘© Preventive measures = Restorative care ‘+ Review by ENT, plastic surgeons 8-15 ‘© Suitability about bone grafting ‘© Orthodontic treatment ‘+ Speech pathologist review ‘+ Review by plastic surgeon Clef tip repair: “Rule of 10” is a guide for timings of cleft lip repair that is the hemoglobin should be 10gm%, age 10 weeks weight 10 lbs, total leukocyte count less than 10,000 per mm3, |. Types of repair ‘© Willae’s rotation advancement flap ‘© Tennison Randall triangular flap Cleft palate repair: Repair of cleft between 1 1% year of age gives the best result. it, Types of repai © Langenback repair ‘+ Veu iardillKllner V-Y push back palatopalsty FORMULAE FOR CALCULATING DRUG DOSAGE: 8) Depending on AGE Ghild age y Adult dose © Youngs - ‘Age + 12 © Cushings GIG AME Adult dose ‘Age to the + Comtings next birthday x Adult dose Ea ) Depending on BODY WEIGHT Child weight (in lbs) adult dose 150 Clarks rule ‘Augsberges rule: 0.7 x Weight in lbs = % of Adult dose ) According to British National Formulae: year T years 12 years Seo =Dental Pulse 4) Depending on Body Surface Area (BSA) * According to Forbes Rule BSA in me? of child Child dose ~ ge PSA nme of erly adutt dose Standard BSA for males is 1.7m®. So BSA in me? of child Child dose = —BSA nae of eld peut dose MISCELLANEOUS: 1. In pedodontic triangle formed by child, dentist and parents, the child is always present at the apex ofthe triangle. 2. Size of intraoral filmst © Size 0s used for bitewing and periapical radiographs of small children, © Size 1 is used for radiographing the anterior teeth in adults. * Size 2 is used for anterior occlusal radiograph, periapical radiograph and bitewing survey in mixed and permanent dentitions 3 Occlusal films used for visualizing 57X76mm films | the entie maxillary or mandibular arches. i Used for THI and lateral oblique 41.5 7 inches film | 75 Used for lateral cephalograms, 8X10 inches films | saranasal sinus view, et. 6X 12 inches film_| Used for 0.7.6. 4. Fantanelles present a birth ‘ Present etsy wo, paral bones Manele | Coses 18 ~ 26 months afer bith. “Present between two parietal bones Posterior and the occipital bones. fortanelie | « Closes @ months after birth. Sphenoid or | * Present between the frontal, parietal, anteroateral_| temporal andthe sphenoid bones. fontanele | + Closes 3 months after birth. Posterolateral | * Present between the parietal, occipital, ormastaid | and the temporal bore. fontanelle |» Closes between 1 ~ 12 months. 5. Buccal pad of fat or corpus adiposum or Bichat’s fat pad is the child’ reserve of energy, 6. Syndromes associated with natal and neonatal teeth a * Chondraectodermal dysplasia, Steiff syndrome + Hallermann = congenita, * Ellisvan Creveland and Rigafede syndrome, and pachyonchia 10, u. 1 13 1% _ % of Baumes clasifcation of mixed dentition period ‘© Flush terminal plane = — «60% - 70% + Nesial step — 20% - 25% Distal step = 5%- 8% Theories of child psychology: L._Paychodynamic theories Psychosexual theory (or) Freud psychoanalytical theory Psychosocial theory (ar) Developmental | Eric Erickson tasks theory Cognitive theory Piaget 1. Behavioural theories Cognitive Hierarchy ofneeds | Masler Social learning theory Bandura Classical conditioning Pavlov Operant conditioning ‘Skinner Psychosexual theory by sigmond Freud consists of thee parts a) Id: Id is the most primitive part of personality from ‘which other tro systems develops, It operates on pleasure principle and attempts to obtain pleasure b) Egor It develops from Id in 2nd to 6th month of life Ego is governed by reality principle. The ability to Understand that their impulses cannot always be gratified immediately comes with development of ego. ) Superego: The superego represents the internalized representation of the values and morals of the society as taught to child by the parents and other elders. It strives for perfection Oedipus complex: It describes the desire in young boys to have sexual relation with the mother. Electra complex: It describes the development of attraction {in young girls towards their father The principles involved in classical conditioning by Paviow are generalization, extinction and discrimination. According to Mahler's theory, the period of childhood is divided into three stages. ‘+ Normal autistic phase (0 ~ 1 years) ‘+ Normal symbiotic phase (4 wks to 4 yrs) ‘+ Separation individualization phase (5 to 36 months) Operant conditioning: Individual response is changed as a result of reinforcement or extinction of previous responses. Hence, satisfactory outcome will diminish in frequency According to this theory, the consequence of behaviour Itself acts as stimulus and affects the future behaviour.—————— 16. v. 18, 18. 20. The four basic types of operant conditioning described by Skinner ares 2) Positive reinforcement 1b) Negative reinforcement ©) Omission 4) Punishment 21, Cognitive theory by Piaget: Piaget formulated this theory on how children and adolescents think and acquire knowledge, He derived his theories from direct observation of children by 22, {questioning them about their thinking. According to Piaget, the environment does not shape child behaviour but the child and adult actively seek to understand the environment. Hievarchy of needs by Master: Masler believed in self actualization theory ie, the need to understand the totality ‘of a person. According to him the needs are arranged in hierarchy and as one general type of need is satisfied, ‘another higher order need will emerge. The desires from most biological needs to the more psychological ones become ‘important only after basic needs have been satisfied 2 Psychosocial theory or developmental tasks theory by Erik Erickson: Erickson concentrated on child's development covering the entire span of life cycle ftom infancy to childhood through old age. Erickson described & stages of lifecycle which are turning points/periods, Social learning theory by Bandura: I is considered as the mast ‘complete, clinically useful and theoretically a sophisticated form of behaviour therapy because it provides more explanatory ‘concepts and encompasses a broader range of phenomena, The four types of and sien Uke wa © There is lot of temper tantrum with ‘accompanying kicking, biting, ete. Ik represents the child's external response to anxiety. = Usually accompanied by a torrent of tears with convulsive breath catching sobs. ‘The frightened child is not crying to have his way but his fear has overcome his reasoning, © Usually accompanied by small whimper. ‘Initially a child in discomfort shows a single tear filling from the corner of the ‘eye and running down the child's cheek without making any sound or resistance to the treatment procedure In this, tears may be the only manifestation, the child is. simply reacting to stimulus of pain, Obstinate ery Frighten cry Hurt ery PEDODONTICS SYNOPSIS © Ikis characterized by loud, high pitched] 24, ‘This nota cy at all. ‘= Tt isa sound that the child makes with Compensatory | the drill When the dril stops, the ery ey stops. ‘© There are no tears, no sobs, just a constant whining nois Fear ie a reaction to known danger while anxiety is reaction to-unknown danger. Tues of fe ‘© is the fear that results without stimuli or previous experience. Innate fear “It is dependent on vulnerabiity of the individual, Subjective | Fear transmitted to individuals from family fear experiences, peers (friends or media, etc. Objective fear| Fea! due to previous experience, events, objects re haviouw beh Overprotective: sve, anv rare Shy, submissive, anxious ‘Aggressive, demanding, display of Over indulgent | semper tantrums Under Usually well behaved, but may be affectionate __| unable to cooperate shy, may cry easily Rejecting Aggressive, overactive, disobedient. ‘Authoritarian | Evasive and dawdling Behaviour management can be classified into Non- pharmacological approach and Pharmacological approach. a) Non-pharmacological / psychological approach: 1. Communication 2. Behaviour modification (Shaping) ‘+ Densensitization © Modelling = Contingency management 3. Behaviour management ‘© Audio analgesia = Bio feed back © Voice control + Hypnosis © Humor © Coping + Relaxation © Implosion therapy ‘© Aversive conditioning RSs) —25. 26. 27. 28. 23. 30, al. Dental Pulse b) Pharmacological methods of behaviour management 1, Premedication 2, Conscious sedation 3. General anaesthesia Communication: 2 types - verbal and non-verbal. Verbal ‘communication is best for younger children more than 3 years of age. Voice that is used should be constant and ‘gentle. Tone of voice can express empathy and firmness. Non-verbal communication is by body language - smiling, eye contact, by touching the child or by giving a hug. Desensitization: The technique usually involves teaching the patient how to induce a state of deep muscle relaxation and describing imaginary scenes relevant to his fea. Indications of desensitization ae Chil’ initial visit, ‘+ At subsequent appointments when introducing dental ‘procedures which are new to the patent. 1 When treating referral patients. how, igue (I i # Introduced by Addleson. ‘+ Effective in children more than 3 years of age ‘© First, the dentist tells the child, what is going to be done in simple words. Second, the dentist demonstrates the exact procedure to the child and finally the dentist performs the procedure exactly as it was described and demonstrate. Modelting: ‘+ Introduced by Bandura ‘+ Here, the child patient is allowed to observe one or smote individuals, who demonstrate a positive behaviour in a particular situation, Therefore, the patient will frequently imitate models behaviour when placed in a similar situation Contingency management: ‘The presentation or withdrawal of reinforces is termed as contingency management. Reinforces (either positive or negative) always increase the frequency of a behaviour. [A positive reinforcer is one, whose contingent presentation increases the frequency of a behaviour, A negative reinforcer is one whase contingent withdrawal increases the Frequency ‘of a behaviour. Audio analgesia or white noise is a method of reducing pain, Auditory stimulus such as pleasant music has been used to reduce stress and also to reduce the reaction to pai. k involves the use of certain instruments to detect certain physiological processes (such as B.P.) associated with fear, The subject is taught to control the signals therefore itis useful in anxiety and stress related disorders 2 33 34. 35 38. 37. 38, 30 _ Humor helps to elevate the mood of the child which helps the child to relax oping is the mechanism by which the child copes up with the dental treatment by establishing a close or trusting relationship with the doctor or nurse. \oice control - It is the modification of intensity and pitch of one's own voice in an attempt to dominate the interaction between the dentist and child. The dentist may speak in 8 loud voice in order to gain a child's attention. Once he gains the child's attention, he may speak softer, adjusting his voice to the activity of the child. Voice control is used in conjunction with some form of physical restraints and HOME technique. Implosion therapy mainly comprises of HOME, voice control and physical restraints. Avetsive conditioning fs a safe and effective method of managing Frankel's extremely negative behaviour. The dentists should obtain parenteral consent prior to its use. Two common methods used in clinical practice are HOME and physical restraint. HOME (Hand Over Mouth Exercise + Introduced by Evangeline Jordan. ‘© Indicated in healthy 3 - 6 years old child, who can understand simple verbal commands. ‘© Contraindicated in children under 3 years of age and in physically or mentally handicapped children. Drug Inhalation No * Hydroyzine + Chlorlhysrate Orat + Promethazine (Several drugs used) | « Diazepam + Tiiazolam * Chlorpromazine + Ketamine Tnamuscular | ee Thntravenous Midazolam Since nitrous oxide is 34 times more soluble in blood than ‘oxygen, “Diffusion hypoxia” may occur as the sedation is reversed at the termination of the procedure. The nitrous oxide escapes into the alveoli with such rapidity that oxygen present becomes diluted; thus the 02 - CO2 exchange is, disrupted and a period of hypoxia is created. It is therefore recommended that the patient be maintained on 100% ‘oxygen for 5 ~ 10 minutes,—————— 40, a. 42. 4. 46, 45, 46. a. Drug ect N20) Diffusion hypoxia Should be used with caution in children with a history of sleep apnea or a fanily history of Sudden Infant Death Syndrome (SIDS) + Tn conscious sedation Its most often {sed in combination with meperidine and promethazine a combination known as “ytic cocktail’ * Should not be used with CNS depressants because of its own CNS depressant action. + Thrombophiebitis + Ataxia and prolonged (NS effects Two times more potent than Diazepam with minimum possibility ‘of thrombophlebitis, but causes respicatory depression. Boarbiturares are CNS depressants and may paradoxically cause. hyper excitability then sedation in some children. They are not commonly used for conscious sedation. Promethazine Chlorpromazine Diazepam Midazolam Barbiturates CChloral hydrate is extremely well known and widely used drug for conscious sedation. Ephebodontics is the dentistry for adolescents. Occult or hidden caries lesions are not clinically diagnosed bout detected only on radiographs. These lesions are not associated with microorganisms different to those found in ‘other carious lesions. It is believed that increased fluoride ‘exposure encourages remineralization and slows down progress ofthe caries in the pit and fissure enamel while the cavitation continues in dentine, and the lesions becomes masked by relatively intact enamel surface. These hidden lesions are called as Ruoride bombs or fluoride syndrome. Caries triad by Keyes include the tooth, microflora, and a suitable local substrate to meet the requirements of the pathodontic flora, Caries tetralogy (Newbrun) includes a fourth factor time to the existing concept of Keyes. ‘The critical pH at which demineralization stats is about 5.2 1055 Trace elements tike selenium, cadmium, lead and barium have been found to increase the caries experience. Recent method of illustrating the interaction of factors contributing to the development of caries is “Cariegram” (introduced by Barthall [PGI-11]) which is a pie circle diagram divided into 5 sectors, in five colours. PEDODONTICS SYNOPSIS a, 43. 50. 51 52. 53. 54. 55. 56, 5. 58. 59 The principle of FOTL (Fiber Optic Tansillumination) is that there is a different index of light transmission for decayed and sound tooth. Since tooth decay has a lower index of light transmission than the sound tooth structure, an area of decay shows up as a darkened shadow. The use of FOTT is, proved to be effective in the anterior region. DIAGNOdent is a new method of caries detection, which js based on the principle of fluorescence. The system has a range of -9 to 99 with -9 being the value where the tooth is the healthiest. The advantage lies inthe early, precavitation stage of caries detection. Dyes used in caries detection are: = Caleein + tygo 1-22 = Fuschin ‘Acid red system + a Aminoacridine J Denna cares BIS-GMA is the base resin to most of the commercial sealants, Cyanoacrylates are the frst introduced pit and fissure sealants. Rubber dam was developed by Barnum. Latex rubber dam sheet is available in 5" x5" or 6" x 6" size while non-latex rubber dam is available only in 6” x 6” size In primary dentition, rubber dam is routinely placed over c,d, which used fine particles of poder fred at high speed in a controlled manner instead of the traditional high and low speed drills. Advantages of this technique are that no vibrations or pain sensation, and also no need for anaesthesia in most cases. GIC was developed by Wilson and Kent [ART Restorations or atraumatic restorative treatment is the placement of restorative material such as GIC in large ‘occlusal cavity, Once the bacterial involvement is eliminated and further ingress prevented, it is possible for the tooth structure to heal Stainless steel crowns were introduced by Humphrey. Composition of stainless steel crowns (Rocky, Mountain, Unit © Chromium 17-19% © Nickel 10-13% + Iron or © Other elements 4% Composition of Nickel-base crown (Inconel 600) © Nickel 72% © Chromium 14% Tron 6-10% ‘© Other elements 4-8 %60. 61. 62, 63. 64. 65. 66. or. 68. 69. Dental Pulse Indications of stainless steel crowns: Extensive decay in primary and young permanent teeth, ‘For teeth with developmental or hypoplastic defects. After pulp therapy. + As preventive restorations in patients, who are highly susceptible to caries. * As an abutment for space maintainer or prosthetic appliance. + As temporary restoration of a fractured tooth. In cases of bruxism, In cases of single tooth cross bite by using reverse stainless steel rove. Occlusal reduction | 1.5 - 2mm Primal reduction | 1 — 1.5mm Buccotingual Very minimal or no reduction reduction The finish line for stainless steel crowns is Feather edge finish ine, The crown should extend Imm betow the gingival crest. ZOE paste is probably the most commonly used filling material for primary teeth. Underfling and difference between its rate of resorption and that of the tooth root are disadvantages of ZOE paste. KRI paste (Iodoform paste) have a long lasting bactericidal potential. Since fodoform paste does not set into hard mass, it can be removed if re-treatment is required. Vitapex is a combination of calcium hydroxide and iodoform mixture. Ts easy to apply and resorbs ata slighty faster rate than that of root It has no toxic effects on permanent tooth bud. For these reasons, the calcium hydroxide ~ iodoform mixture is considered as a nearly ideal filling materia. Since gutta-percha is not a resorbable material its use is contraindicated in the primary teeth, Composition of commonly used root canal materials for primary teeth. Vitapex Calcium hydroxide + Todoform :. Zno + Todoform + Thymol + Chiorphenot Maisto paste | camphor + Lanotin Todoform + Camphor + Parachlorophenol RI paste | [o“ofom Wialkhoff paste | Parachlorophenol + Camphor + Menthol Hotz lingual arch and lip bumper are fixed space regainers| used for moving the molar distally. i Mental age Is calulated 28 Grotegietage * ‘age * 100 10. n. n re me 15. 16 ” 18. B. 80. _ 10.classifcation guide: SE 120 - 139 | Superior 110 - 119 | High average ene = Gerber space Moves posterior tooth, distally and Cee PaRaae Lip bumper (or) | Used for bilateral distal movement of Lip plumber first permanent molars. wg | meee, fo pes gto Sat Rhinomanometty or inductive plethysmagraphy is useful to detect the extent of mouth breathing Universal clamp used for stabili mixed dentition period is 5.5 # 206. 19 rubber dam during The prevalence of gingivitis in children has been reported to be as high as 99% The two unique characteristics of the attached gingiva in children are interdental clefts and the retrocuspid papilla, The inter dental clefts are normal anatomic features found Jn the interadicular zones underlying the saddle areas. The retrocuspid papilla is found approximately imm below the free gingiva on the attached gingiva lingual to mandibular canine (MAN- 05). It occurs in 85% of children and apparently decreases with age. The so called probing depth of a clinically normal gingival sulcus in humans is 2 te 3 mm, The sulcus depth around primary teeth is comparatively greater than that found around the permanent teeth, The mean value ranges from 1.4mm to 2.1mm (2.1 + 0.2mm) Chronic marginal gingivitis is the most prevalent type of gingival change in childhood. Epulis is @ pink, pedunculated, submucosal mass usually arising from the anterior maxillary alveolar ridge. It can present with feeding difficulties. Breathing problems are ‘are, Mote common in males. Treatment is local excision The periodontal ligament of the deciduous teeth is wider than that of the permanent dentition,| a, 82, 83, a4, 85. 86. 87, 88, 89. 90, et 92. 93. 94, CChieloscopy is used in identification of suspects by use of lip prints ‘Space maintainers are contraindicated in crowded occlusions. In a pedodontic triangle, the child is always present at the apex of triangle Veruca vulgaris or common wart is exophytic papillomatous lesion ‘distinguishable clinically fom oral squamous cell, papillomas. Eruption cyst is a blood filled cyst most frequently seen in primary second molar or frst permanent molar regions. The eruption sequestrum is seen in children at the time of eruption of the frst permanent molar. The mandibular primary molars are the teeth most often observed to be ankylosed, ‘The term rampant caries should be applied to a caries rate of 410 oF more new lesions per yea. Under laboratory conditions, sucrose is more likely to cause rampant multisurface cavitation than glucose, fructose, sorbital and starch, etc. {tis generally recommended that parents begin cleaning the ‘infant's mauth by the time the first tooth erupts. Folacin, also known as folic acid, is essential for the formation and maturation of both red and white cells. Caloric sugar_substitutes not fermented by plague * Mattitot © lycasin © Invert sugar © Coupting sugar + Sorbose © Palatinose Saccharin and aspartame ate two artificial sweeteners ‘commonly available. Saccharin is 100 times sweeter than sucrose and contains no calories. ‘Aspartame, commonly known asnutra sweet, isa combination ‘of the aminoacids, aspartic acid and phenylalanine. Its 200 times more sweeter than sucrose. The frst choice of a clamp for a first permanent molar is Ivory No. 7, which can be used for maxillary or mandibular teeth, ‘The use of hypnosis in dentistry is referred as hypnodontics ‘The term hypnodonties was coined by Richardson, ‘Algophobia is phobia of pain, PEDODONTICS SYNOPSIS 95. 96. 97. 98. Cystic fibrosis is a multi-system disease involving most of the exocrine glands, Tt is characterized by high viscous secretions causing duct obstruction (cystic degeneration of pancreas occurs due to duct obstruction), airway infection and maldigestion caused by pancreatic insufficiency Defective gland secretions cause abnormal water and electrolyte transport across epithelial cells resulting in chronic respiratory and GI disease. High percentage of children with cystic fibrosis have teeth that are dark in colour. The tooth discoloration may be as a result of the disease alone or therapeutic agents, especially tetracyclines (given to treat recurrent infections), or a combination of the two factors. Calcium hydroxide was introduced by Herman in 1930, Calcium hydroxide should be retained for 6 - & weeks when used in indirect pulp capping. Ca(0H)2 pulpatomy is nat idicated in primary teeth due to chance of occurting internal resorption. 1) The mesiobuccal pulphorn of permanent maxillary ‘st molar is commonly exposed during cavity preparation. ) Mesiolingual pulphoon of permanent mandibular ‘st molar is commonly exposed during cavity preparation. ©) Mesiobuccal pulphorn of primary tst molars is commonly ‘exposed during restorative procedures on primary molars. (Sse) =AAA AA ental ee o. 100. ‘Smallest primary tooth Lower central incisor ‘Smallest primary molar Maxillary 4st molar Molar tubercle of Zucker candle fs present in Primary maxillary 1st molar (well developed cervical ridge in upper Ist molar is called ‘molar tubercle of Zuckercandle) ‘The primary molar resembling permanent presmolas is Primary maxillary 1st molar Primary maxillary 2nd molar resembles Petmanent maxilary 1st molar Primary mandibular 2nd molar resembles Permanent mandibular 1st molar Primary molar which does not resemble any of the permanent teeth is Primary mandibular 1st molar The long and sharp mesiolingual cusp is an outstanding feature of Deciduous 1st mandibular molar Fifth cusp or cusp of carabeli is present in Primary maxillary 2nd molar Primary molar in which anatomy of pulp contraindicates an MOD preparation is Mandibular 1st molar Breast feeding should be stopped at what age of child 1 years Cervical mesio buccal ridge is feature of Mandibular primary 2st molar Primary tooth most susceptible to caries Mandibular 2nd molar Teeth least commonly involved in nursing bottle caries Mandibular it Teeth more involved in nursing bottle caries Maxillary incisors Differences between deciduous teeth and permanent tee Deciduous teeth Number - 20 Perm: Number - 32 Premolars ~ Absent Premolars ~ Present Deciduous teeth are smaller in all dimensions than the corresponding permanent teeth except deciduous second molars. Larger in all dimensions than corresponding primary teeth. Develops directly from dental lamina Develops as lingual or distal extensions of dental lamina Usually they are not covered within bony crypts. They are completely covered in thelr bony crypts. ‘Al the primary teeth erupts into oral cavity atthe age of 2% - 3 yyeats. For root completion it takes 1 - 1b years after eruption i.e, root formation of primary teeth is completed by 3 ~ 4 years of age. All the permanent teeth except 31d molars erupts into oral activity at the age of 12 - 13 years. For root completion it takes 2 - 3 years after eruption i.e, root formation of permanent teeth is completed by 14 ~ 16 years of age. ‘Al the teeth develop and erupt almost in the horizontal plane ‘and occupy a more vertical position in the jaws. Permanent teeth develop in different planes. Life span of deciduous dentition ranges from 12 ~ 14 years ‘Average life span of permanent teeth is about 60 years of lietime. Relation between upper and lower teeth is tooth-to-tooth relation (Edge to edge contact) Relation between maxillayy and mandibular teeth is intercuspation relation. esiodistal diameter of crown is more than their cevico incisal length Cervico incisal length is more than the mesio distal dimension {Crowns converge occlusaly so that occlusal table is narrow. Occlusal table is broad, Marked cervical constriction of crowns is seen. Crowns have a bulbous contour. Cervical constriction is not well marked. Mamelons are absent. Mamelons present in newly erupted teeth.| PEDODONTICS SYNOPSIS ROOTS ‘When compared with permanent teeth, the roots of primary teeth are longer and more slender in comparison with their crown size. They are conical in shape. ‘There is absence of root trunk with bi or tfurcation beginning almost near cervix. Permanent teeth have prominent root trunk, Roots of primary molars flare more as they approach the apices, ‘than permanent molars. This isto afford necessary room for development of permanent tooth buds within the confine oftheir rots, Flaring of roots is less. Enamel cap is thinner (about mm) and has more consistent depth. They are less mineralized and appear white. Enamel thickness is more and these are more mineralized. It is more prone to acid attack; thus rapidly dimineralized by dental caries. Enamel is comparatively less prone to acid attack. ‘The enamel rods at the cervix slope ocelusally Enamel rods at cervix are inclined gingivally Organie content of enamel is more Organic content of enamel is very les. As the primary teeth are less mineralized, the acid etching time ‘is more for primary teeth. The acid etching time is less for permanent teeth. Enamel develops partly before birth and partly after birth. The boundary between two portions of enamel in deciduous teeth is marred by an accentuated Line of retzius, which is known neonatal tine or ring. Neonatal line is not seen in permanent teeth except in permanent 1st molars. Dentinoenamel junction is less scalloped. Dentino enamel junction is scalloped with convexities towards pulp or dentin, The thickness of dentin is less when compared to permanent teeth, Ratio of thickness of dentin in primary and permanent teeth isn Dentin is less mineralized. Dentin is more mineralized. Number of dentinal tubules are less Prenatal and postnatal dentin is separated by neonatal line Number of dentinal tubules are more about 50,000 to 90,000 per mm? towards pulpal surface of dentine Neonatal lines are absent except in first permanent molars, PULP. Pulp volume is larger compared to tooth volume. Mesial pulp horn is prominent and high in multi rooted teeth, Pulp volume is less compared to tooth volume. There is no marked cervical constriction between pulp and root canals. Tere is marked constriction between pulp chamber and root canals. Number of accessory canals are more throughout the root canals, and also in the furcation area. So infection tends to spread into furcation area before spreading to periradicular area. Number of accessory canals are comparatively less. Position of apical foramen varies with age due to resorption. So length of root canal is variable, Position af apical foramen is fixed, sa length of root canal is also fixed. Reparative capacity of pulp 1s less. So formation of reparative and secondary dentin is less. Reparative capacity of pulp is more. Hence reparative dentin and secondary dentin formation is more. Nerves terminate at pulpodentinal junction and their branches enter the dentinal tubules and end below dentino enamel junction. Nerve terminals traverse the whole length of dentinal tubules and end in the dentine enamel junction PERIODONTAL LIGAMENT Area of periodontal ligament is less. ‘Area of periodontal ligament is more. Laminadura is relatively thick Laminadur relatively thin, Se? =|. Teeatment of submerged tooth: 102. 103. 104, 105. 106. 107. 108. 108. 00. a. Dental Pulse © If permanent tooth bud is present, surgical extraction of involved tooth, only after the patient had crossed the normal exfoliation time. ‘IF permanent teeth bud is not present, fixed prosthesis fs planned, only after curve of spee fs established. ‘The term rampant caries was defined by MASSLER. The term ‘early childhood caries was defined by DAVIES. ‘The presence of higher amounts of proline rich proteins aid {in super saturation of saliva and make the tooth resistant to caries (AIPG-2004). The new name for early childhood caries is “maternally derived streptococcus mutans disease” (MOSMD) (AIPG — 2004). Milk Lactose content Bovine milk 45% ilk products Te ‘Human mitk_| 7.4% (High risk of nursing caries) Critical pl for caries is 5.6. Below this, oly demineralization ‘occurs and no mineralization is seen. So the number of sugar intakes is important than the amount of amount of sugar intake. Ideal time to start brush is when tooth starts erupting, Time required for evaluating success of apexification procedure is 3 years. Time required for evaluating success of apexogenesis procedures fs 9 - 12 months or 1 years First child abuse case is reported in 1871 and the vietim is girl named Mary Allen. “Battered Child Syndrome” is a type of physical abuse reported by “Henry Kenpe” in 1962, Clinical features include- + Fractures of tong bones *Subdural hematoma © Failure to thrive Soft tissue swellings Skin bruising Retinal hemorrhages “Mun Chausen’s Syndrome” js a parenterally induced condition, Its due to emotionally distubed parents (think that the child is il and take to doctor frequenty). It is inastly ue to own parents. Clinical features include - Bleeding from various sites + Recurrent sepsis due to injection of contaminated solutions. * Chronie diarthea due to administration of laxatives. Recurrent fever. © Skin rashes ua, us. as, 1s. 16. a7, 118, _ Child abuse is a acute condition, while child neglect is a chronic condition. Drug dosages in children: {The body water content and body fat content are higher Jn case of children, So water and fat soluble drugs take larger time to act. fi) Safe dose of LA. with adrenaline is 7mg/kg body weight. ithout adrenaline is 4.5 mg/kg body weight. fil) Safely tolerated dose (STD) of fluorides is 8 ~ 16 ma/ka body weight. Certainly lethal dose of fluoride is 32 ~ 64 mg/kg body weight (4 times than STD value) In “Basket-Crown technique” of stainless steel crowns, a window is prepared on the labial side for improvement in esthetics, Reverse stainless steel crown technique” is used to correct cross bite. In this technique, the Lingual portion of the crown acts asa inclined plane. Factors which change the design of cavity in deciduous teeth + Overall size of tooth. ‘© Thickness of enamel and dentin, Large pulp horn. ‘+ Buccal bulge and cervical constriction r contacts, ‘© Wider dentinal tubules (so sensitivity is more, which can be prevented by using coolants during cavity, preparation, slow speed of instrument, biocompatible restorative material with suitable base. Special instruments for pediatric restorative dentistry: |) The aerotor burs are provided with metallic stopper at 1.5mm from tip. It is known as “Estman Pattern bur" fi) Interoccusal distance of patients very less, s0 accessibility {s dificult, So pedo size hand piece and burs are used ‘Normal length of bur ‘© edo size bur — 19mm — 16mm il) Burs used specialy for child patients ‘Pear shaped bur No. 330 ~ Serves the purpose of, round and straight fisure bur. ‘Inverted cone bur No. 34. The main factors which change the design of class IK cavity Jn pedo patients are - ‘© Direction of enamel rods. ‘© Cervical constiietion in proximal area will influence proximal box preparation. Modification of class IK cavity in deciduous teeth: ‘© Maximum depth is 2.5mm. ‘+ Due to cervical constriction, gingival wall should not be too gingival as it will be too close to pulp chambers.| 19. 120. 121. tee. 123. 126, Depth of gingival floor should not be more than Imm. + The proximal box width fs more in deciduous teeth, so that margins are located in selfcleansing areas. * Téeal width of isthmus should be 1/3rds of intercuspal distance Le,, atleast 1.5mm # AlUintemmal angles should be rounded, © Width of gingival floor ofthe box should be mm. + Retention grooves are prepared on buccoaxial wall and Finguo axial wall, but never in pulpal wall. The bucal and lingual axial walls should be convergent towards proximal side. In chemico-mechanical caries removal, chemicals are used to soften the demineralized dentin ‘by hydrolyzing the partially degraded collagen fibres. CARIDEX contain 2 solutions. The 1st solution contains sodium hypochlorite, The 2nd solution contains glycine, aminobutyric acid, sodium chloride and sodium hydroxide. When both solutions are mixed, a final reaction product called “N-monochloro amino butyric acid” is obtained, wich will soften the dentin Polycarbonate crowns are tooth coloured esthetic crowns for ‘anterior deciduous teeth’, It isa thermoplastic resin and is made up of aromatic linear polyesters of carbonic acid. Mink and Hill Technique: * It is a technique for modification of stainless crowns according to tooth size © For a layer tooth, a cut is given on the buccal side and widen so that the mesiodistal diameter of the crown becomes more. 12s. + Fora smaller tooth, a cut is made and a piece is removed and then the crown is compressed. Welding is done to join the overlapping segments Different types of medicaments in pulpotomy: A) Devitalisation ‘© Formocresol * Mummifying paste 126. B) Preservation © Ca(oH)2, Fe2(S04)3 + Glutaraldehyde + Electrocautery ©) Res ‘© Bone morphogenic protein ‘© Tricalcium phosphate ration Formocresol pulpotomy: 1) Also called “Sweet-Pulpotomy", which is a 4-visit procedure. b) The original Buckley’ formula contains equal parts of formaldehyde and cresol PEDODONTICS SYNOPSIS 18, ©) Buckley's formula of formocresol using today is 1/5 concentration je., 20% formacresol. Its composition is ~ © Cresot - 35% Formaldehyde - 19% © Water & glycerin 15% 4) A pellet of cotton slightly dampened with 1:5 concentration of Buckley's formula is placed in contact with the pulp stumps and is allowed for 5 minutes. ©) Chain of reactions within 5 mins. ‘© Formoctesol bonds with aminoacids of pulp and make it non-vtal * Ttalso inactivates the enzymes (like hyaluronidase) of pulp. ‘+ All these results in lation of pulp. ‘© Finally, the pulp becomes inert and resistant to all ‘enzymatic reactions. ) Zones after formocresol application ‘© Zone of fixation ‘© Zone of atrophy ‘© Zone of inflammation ‘© one of vital pulp 4g) Since formocresol is caustic, care must be taken to avoid contact with gingival tissues, Mummifying paste: 4) Introduced by Hobson. b) Composition: ‘+ Paraformaldehyde - Active devitalizing agent © Lignocaine ‘= Propylene glycol © Carbowax © Caramine Filling materials and medicaments for pulpectomy: ‘+ Zn0E ~ Resorbable and easily available. Ca(OH), Todoform paste (does not set) Todoform and Ca(OH), combinations (sets) available as VITAPEK, METAPEX.. ‘© Poly antibiatic paste Guttapercha is non-resorbable and so contraindicated in deciduous teeth. One of the media for preserving avulsed tooth is “BALANCED HANK'S SOLUTION”, Its isotonic salt solution. Its available under trade name “SAVE - A ~ TOOTH” solution. (Ss) =