CLINICAL CASES IN PEDIATRIC
DENTISTRY, 2ND EDITION EXAM
What is the probability that natal teeth are members of the normal complement of
primary teeth ? - Correct Answers -The overwhelming probability is that a natal or
neonatal tooth is a member of the 10 primary teeth in the arch, with fewer than 10% in
most surveys being supernumeraries.
Where do natal teeth most often occur in the mouth ? - Correct Answers -Most natal
teeth occur in the mandibular arch in the incisor region, and more than half of the time
they occur in pairs.
What is the potential risk of using topical anesthetics in infants prior to extraction of a
natal tooth ? - Correct Answers -Methemoglobonemia is a rare risk if topical anesthesics
like benzocaine or prilocaine are used in infants. Oral sucrose can be considered prior
to the extraction of a mobile natal tooth to soothe the neonate.
What are the potential etiologies of natal teeth ? - Correct Answers -Etiologies are
usually attributed to a superficial position of the primary tooth bud, but also may include
genetic factors, endocrine disorders, infection, and conditions such as cleft lip and
palate and Hallerman-Streiff Syndrome
What are characteristics of other neonatal oral lesions that would help differentiate a
natal tooth ? - Correct Answers -The other congenital oral abnormalities, which might be
mistaken for a natal tooth, include a keratin-filled body such as a Bohn's nodule or a
mucous retention cyst. However , they are softer in consistency.
What areas should be covered in anticipatory guidance related to oral hygiene ? -
Correct Answers -A thorough coverage of oral hygiene includes frequency and duration,
a technique demonstration with the child, review of devices, dentrifice use, location at
home, positioning ideas, and problem solving such as how to fit oral hygiene into the
family's daily routine.
What is the dietary pattern that is considered normal for a child from six months to 12
months ? - Correct Answers -A child may be breast or bottle fed for the first six months
of age. In the next six months, breastfeeding may be stopped or continued, depending
on the needs and wishes of the mother and child. Some solid food is introduced in this
period as well and bottle feeding ends with a transition to a cup at meal times. At 12
,months, the child should be self-feeding and drinking from a cup on a trial basis since
the process is initially messy.
When do habits become a concern in the preschool child ? - Correct Answers -Habits
are emotionally satisfying in the first few years if lie and become detrimental when they
cause dental changes, which can occur at any time. Allowing a habit to continue is a
balance between its benefit to the child and any effect it may have on oral health. Most
habits are lost by the third year of life. However, parents should be counseled on the
potential effects of habits and be encouraged to wean the child from pacifiers or fingers
as soon as is feasible.
What factors are considered when determining the recall interval in infant oral health ? -
Correct Answers -Caries risk factors not only determine what anticipatory guidance
information is to be provided to parents, but also how frequently a child is seen again.
The reliance of a child on parental care makes it important to assess outcomes in areas
such as oral hygiene, diet, and anticipated parental compliance. No fixed interval is right
for every child. However, in general the higher the caries risk the more frequent the
recall. Also, the dentist should recommend a reasonable recall period to allow parents
the time to effect improvement.
How would preventive recommendations change if the child did not have access to a
fluoridated municipal water supply? - Correct Answers -Supplemental fluoride in the
form of prescribed drops, tablets, or rinses should be considered as a preventive
recommendation for the child who lives in an area where the municipal water supply has
no fluoride concentration. the amount of fluoride that is prescribed is based on the
child's age and known amount of fluoride concentration (ppm) in the child's main water
supply.
What are four risk factors believed to be indicative of an elevated susceptibility to dental
caries ? - Correct Answers -Many risk factors have been identified including: the
mother/caregiver has active caries, low socioeconomic status, recent immigrant status,
more than three between-meal, high carbohydrate snacks or beverages per day, or
special health care needs
What are the clinical risk factors believed to be indicative of an elevated susceptibility to
dental caries ? - Correct Answers -The clinical risk factors which can be assessed on
examination are: child has white spot lesion or enamel defects, visible cavitation,
existing restorations, or significant plaque accumulation
What are some of alternatives to a night-time bottle that can be offered to help parents
trying to break the bedtime habit of their child ? - Correct Answers -To eliminate a bottle
habit, parents can substitute water or gradually dilute the contents of the bottle over
several nights with water. They can clean the teeth well and take the bottle away when
the child falls asleep. A pacifier or other object can be substituted for the bottle. The
parent can read or rock the child to sleep.
, What are considerations regarding the intake of fruit juice during infancy ? - Correct
Answers -Human milk or infant formula is recommended is the only nutrient fed to
infants until approximately six months of age, and it is optimal to completely avoid the
use of juice in infants before one year of age.
What are elements of a systematic approach to GERD in a child this age (16 months
old) ? - Correct Answers -The immediate and long-term treatment plans hinge on
successful medical management of GERD. Close interaction with the child's physician is
necessary. After a comprehensive assessment , diet modification, medication, and/or
surgery may be indicated. Depending on the stage deterioration of the dentition , local
noninvasive measures should be considered first, followed by definitive restorative care
if needed. Fluorides figure prominently in this intervention to remineralize enamel.
What are the contraindications to application of SDF ? - Correct Answers -Symptomatic
teeth, necrotic teeth, history of allergy to silver, and a relative contraindication of
desquamative gingivitis or mucositis
What steps should be taken to minimize the risk of toxicity when using SDF in a very
young child ? - Correct Answers -Limit to one drop of 38% SDF per 10 kg of child body
weight and limit application to a maximum of five teeth at one session although no
toxicity or systemic adverse events have been reported with 38% SDF
What is the mechanism of action of SDF ? - Correct Answers -The high concentration of
fluoride promotes remineralization and inhibits demineralization, while silver ions are
bactericidal and inhibit biofilm formation.
Describe the components of motivational interviewing. - Correct Answers -Motivation
interviewing aims to provide an empathic, supportive, yet directive counseling style to
enhance motivation for positive behavioral change, based on partnership, acceptance,
compassion, and evocation. Open ended questions are frequently used.
What particular clinical situations are most appropriate for a nonoperative disease
management approach as opposed to definitive care ? - Correct Answers -Children who
are uncooperative or who have cavitated lesions on teeth nearing exfoliation and
children with special health care needs for whom the risks of traditional care and
behavior guidance strategies outweigh the potential benefits are the most appropriate
candidates for nonoperative disease management.
What are current recommendations for inclusion of fluoride dentrifice in toothbrushing
for children under three years of age ? - Correct Answers -Caregivers should begin
brushing children's teeth as soon as they erupt by using no more than a smear or "grain
of rice" sized amount of fluoride dentrifice
What are properties of GIC that make them ideal for ITR ? - Correct Answers -Glass
ionomers have several properties that make them ideal for this procedure. They are less
sensitive to moisture in the cavity, release fluoride, and are adherent to dentin, and
DENTISTRY, 2ND EDITION EXAM
What is the probability that natal teeth are members of the normal complement of
primary teeth ? - Correct Answers -The overwhelming probability is that a natal or
neonatal tooth is a member of the 10 primary teeth in the arch, with fewer than 10% in
most surveys being supernumeraries.
Where do natal teeth most often occur in the mouth ? - Correct Answers -Most natal
teeth occur in the mandibular arch in the incisor region, and more than half of the time
they occur in pairs.
What is the potential risk of using topical anesthetics in infants prior to extraction of a
natal tooth ? - Correct Answers -Methemoglobonemia is a rare risk if topical anesthesics
like benzocaine or prilocaine are used in infants. Oral sucrose can be considered prior
to the extraction of a mobile natal tooth to soothe the neonate.
What are the potential etiologies of natal teeth ? - Correct Answers -Etiologies are
usually attributed to a superficial position of the primary tooth bud, but also may include
genetic factors, endocrine disorders, infection, and conditions such as cleft lip and
palate and Hallerman-Streiff Syndrome
What are characteristics of other neonatal oral lesions that would help differentiate a
natal tooth ? - Correct Answers -The other congenital oral abnormalities, which might be
mistaken for a natal tooth, include a keratin-filled body such as a Bohn's nodule or a
mucous retention cyst. However , they are softer in consistency.
What areas should be covered in anticipatory guidance related to oral hygiene ? -
Correct Answers -A thorough coverage of oral hygiene includes frequency and duration,
a technique demonstration with the child, review of devices, dentrifice use, location at
home, positioning ideas, and problem solving such as how to fit oral hygiene into the
family's daily routine.
What is the dietary pattern that is considered normal for a child from six months to 12
months ? - Correct Answers -A child may be breast or bottle fed for the first six months
of age. In the next six months, breastfeeding may be stopped or continued, depending
on the needs and wishes of the mother and child. Some solid food is introduced in this
period as well and bottle feeding ends with a transition to a cup at meal times. At 12
,months, the child should be self-feeding and drinking from a cup on a trial basis since
the process is initially messy.
When do habits become a concern in the preschool child ? - Correct Answers -Habits
are emotionally satisfying in the first few years if lie and become detrimental when they
cause dental changes, which can occur at any time. Allowing a habit to continue is a
balance between its benefit to the child and any effect it may have on oral health. Most
habits are lost by the third year of life. However, parents should be counseled on the
potential effects of habits and be encouraged to wean the child from pacifiers or fingers
as soon as is feasible.
What factors are considered when determining the recall interval in infant oral health ? -
Correct Answers -Caries risk factors not only determine what anticipatory guidance
information is to be provided to parents, but also how frequently a child is seen again.
The reliance of a child on parental care makes it important to assess outcomes in areas
such as oral hygiene, diet, and anticipated parental compliance. No fixed interval is right
for every child. However, in general the higher the caries risk the more frequent the
recall. Also, the dentist should recommend a reasonable recall period to allow parents
the time to effect improvement.
How would preventive recommendations change if the child did not have access to a
fluoridated municipal water supply? - Correct Answers -Supplemental fluoride in the
form of prescribed drops, tablets, or rinses should be considered as a preventive
recommendation for the child who lives in an area where the municipal water supply has
no fluoride concentration. the amount of fluoride that is prescribed is based on the
child's age and known amount of fluoride concentration (ppm) in the child's main water
supply.
What are four risk factors believed to be indicative of an elevated susceptibility to dental
caries ? - Correct Answers -Many risk factors have been identified including: the
mother/caregiver has active caries, low socioeconomic status, recent immigrant status,
more than three between-meal, high carbohydrate snacks or beverages per day, or
special health care needs
What are the clinical risk factors believed to be indicative of an elevated susceptibility to
dental caries ? - Correct Answers -The clinical risk factors which can be assessed on
examination are: child has white spot lesion or enamel defects, visible cavitation,
existing restorations, or significant plaque accumulation
What are some of alternatives to a night-time bottle that can be offered to help parents
trying to break the bedtime habit of their child ? - Correct Answers -To eliminate a bottle
habit, parents can substitute water or gradually dilute the contents of the bottle over
several nights with water. They can clean the teeth well and take the bottle away when
the child falls asleep. A pacifier or other object can be substituted for the bottle. The
parent can read or rock the child to sleep.
, What are considerations regarding the intake of fruit juice during infancy ? - Correct
Answers -Human milk or infant formula is recommended is the only nutrient fed to
infants until approximately six months of age, and it is optimal to completely avoid the
use of juice in infants before one year of age.
What are elements of a systematic approach to GERD in a child this age (16 months
old) ? - Correct Answers -The immediate and long-term treatment plans hinge on
successful medical management of GERD. Close interaction with the child's physician is
necessary. After a comprehensive assessment , diet modification, medication, and/or
surgery may be indicated. Depending on the stage deterioration of the dentition , local
noninvasive measures should be considered first, followed by definitive restorative care
if needed. Fluorides figure prominently in this intervention to remineralize enamel.
What are the contraindications to application of SDF ? - Correct Answers -Symptomatic
teeth, necrotic teeth, history of allergy to silver, and a relative contraindication of
desquamative gingivitis or mucositis
What steps should be taken to minimize the risk of toxicity when using SDF in a very
young child ? - Correct Answers -Limit to one drop of 38% SDF per 10 kg of child body
weight and limit application to a maximum of five teeth at one session although no
toxicity or systemic adverse events have been reported with 38% SDF
What is the mechanism of action of SDF ? - Correct Answers -The high concentration of
fluoride promotes remineralization and inhibits demineralization, while silver ions are
bactericidal and inhibit biofilm formation.
Describe the components of motivational interviewing. - Correct Answers -Motivation
interviewing aims to provide an empathic, supportive, yet directive counseling style to
enhance motivation for positive behavioral change, based on partnership, acceptance,
compassion, and evocation. Open ended questions are frequently used.
What particular clinical situations are most appropriate for a nonoperative disease
management approach as opposed to definitive care ? - Correct Answers -Children who
are uncooperative or who have cavitated lesions on teeth nearing exfoliation and
children with special health care needs for whom the risks of traditional care and
behavior guidance strategies outweigh the potential benefits are the most appropriate
candidates for nonoperative disease management.
What are current recommendations for inclusion of fluoride dentrifice in toothbrushing
for children under three years of age ? - Correct Answers -Caregivers should begin
brushing children's teeth as soon as they erupt by using no more than a smear or "grain
of rice" sized amount of fluoride dentrifice
What are properties of GIC that make them ideal for ITR ? - Correct Answers -Glass
ionomers have several properties that make them ideal for this procedure. They are less
sensitive to moisture in the cavity, release fluoride, and are adherent to dentin, and
