AAPD GUIDELINES & RELEVANT
PEDIATRIC DENTISTRY READINGS
EXAM QUESTIONS WITH VERIFIED
ANSWERS
This drug is used to manage hypotension. It stimulates norepinephrine release from
sympathetic nerve endings. It also acts directly on alpha- and beta-adrenergic
receptors, leading to vasoconstrction and increased rate and contractility of the
myocardium. It constructs veins to a greater extent than arteries, which enables it to
increase preload more than afterload - ANSWER-ephedrine
sudden elevations in diastolic pressure greater than 120 mmHg - ANSWER-
hypertensive crisis
How do you manage sinus tachycardias? - ANSWER-tachycardia can be a reflex
response to hypoxia or hypotension so assess these first; then administer IV fluids to
support blood pressure in the event that the increased hr is attempting to sustain the
blood pressure. If tachycardia persists then a selective beta-1 receptor antagonist
like esmolol can be given to decrease sympathetic stimulation to the heart.
The use of further nitroglycerin is contraindicated when the systolic pressure is less
than - ANSWER-90mmHg
Which of the following is the approximate FIO2 provided by a nonrebreather mask
with a reservoir delivering 8 L/min oxygen?
A. 60%
B. 70%
C. 80%
D. 100% - ANSWER-B. 70%
"When using any mask, the flow rate should be at least 6 L/min to avoid feelings of
suffocation. Provided the mask has a reservoir, this flow rate will deliver an oxygen
concentration of 60%, and each additional L/min will increase FIO2 by ap-
proximately 5%."
Which of the following is correct regarding admin- istration of epinephrine?
A. 0.3 mg is contained in 3 mL of a 1:1000 con- centration
B. 0.5 mg is indicated for a patient in cardiac arrest
C. 0.5 mg is contained in 5 mL of a 1:10,000 con-
centration
D. 0.1 mg increments using a 1 : 1000 con-
centration should be used for intravenous injec- tions when managing severe
anaphylactoid re- actions - ANSWER-A. 0.3 mg is contained in 3 mL of a 1:1000
concentration
,During your assessment you find that Mrs. Jones is unconscious and apneic. If your
first attempt to ventilate with a BVM is unsuccessful, your next intervention before
attempting further ventilation may include any of the following EXCEPT:
A. retilting the head, repositioning the mask
B. inserting an oropharyngeal airway
C. performing a jaw thrust
D. inserting an LMA - ANSWER-D. inserting an LMA
"When attempting to ventilate a patient with apnea, a reasonable stepped approach
is to attempt ventilation with a BVM alone, followed, if necessary, by insertion of an
oropharyngeal airway. If this proves futile, one must consider advanced airway
adjuncts such as tracheal intubation or insertion of a laryngeal mask airway (LMA)."
Your patient loses consciousness prior to intravenous sedation, but is breathing and
has a pulse. The blood pressure is 80/50 mm Hg and the pulse rate is 84 beats per
minute. Each of the following is appropri- ate for managing this situation EXCEPT:
A. administer supplemental oxygen
B. administer atropine, 0.5 mg IV, IM, or SLI
C. administer ephedrine, 10 mg IV or 25 mg SLI
or IM
D. administer 250-500 mL IV fluid - ANSWER-B. administer atropine, 0.5 mg IV, IM,
or SLI
"If bradycardia is present, ie, heart rate less than 60 beats per minute, administer
atropine until the rate is within normal limits."
Office-based deep sedation/general anesthesia techniques require at least how
many individuals? - ANSWER-Three (AAPD 226)
When the intent is minimal sedation for adults, the appropriate initial dosing of a
single enteral drug is no more than ... - ANSWER-the maximum recommended dose
(MRD) of a drug that can be prescribed for unmonitored home use. (ADA guidelines
pain control & sedation)
T/F Nitrous oxide/oxygen may be used in combination with a single enteral drug in
minimal sedation. - ANSWER-True (ADA guidelines pain control & sedation)
term that describes any technique of administration in which the agent is absorbed
through the gastrointestinal (GI) tract or oral mucosa [i.e., oral, rectal, sublingual]. -
ANSWER-enteral (ADA guidelines pain control & sedation)
term that describes a technique of administration in which the drug bypasses the
gastrointestinal (GI) tract [i.e., intramuscular (IM), intravenous (IV), intranasal (IN),
submucosal (SM), subcutaneous (SC), intraosseous (IO)]. - ANSWER-parenteral
(ADA guidelines pain control & sedation)
term that describes administering a single additional dose of the initial dose of the
initial drug that may be necessary for prolonged procedures during minimal sedation.
The additional dose should not exceed one-half of the initial dose and should not be
administered until the dentist has determined the clinical half-life of the initial dosing
has passed. The total aggregate dose must not exceed 1.5x the MRD on the day of
,treatment. - ANSWER-supplemental dosing (ADA guidelines Use of Sedation and
General Anesthesia)
What is the minimum fasting period required for a patient who has ingested clear
liquids (water, fruit juices without pulp, carbonated beverages, clear tea, black
coffee) according to the guidelines for elective sedation? - ANSWER-2 hours
(AAPD217)
What is the minimum fasting period required for a patient who has ingested breast
milk according to the guidelines for elective sedation? - ANSWER-4 hours
(AAPD217)
What is the minimum fasting period required for a patient who has ingested infant
formula according to the guidelines for elective sedation? - ANSWER-6 hours
(AAPD217)
What is the minimum fasting period required for a patient who has ingested
nonhuman milk according to the guidelines for elective sedation? - ANSWER-6
hours (AAPD217) "because nonhuman milk is similar to solids in gastric emptying
time, the amount ingested must be considered when determining an appropriate
fasting period"
What is the minimum fasting period required for a patient who has ingested a light
meal (ie toast and clear liquids) according to the guidelines for elective sedation? -
ANSWER-6 hours (AAPD217) "Meals that include fried or fatty foods or meat may
prolong gastric emptying time. Both the amount and type of foods ingested must be
considered when determining an appropriate fasting period"
Of the drug classes used for sedation and anesthesia, which is the most powerful
respiratory depressant? - ANSWER-opioids (like meperidine aka demerol)- reversal
agent = naloxone
reflex closure or spasm of the glottic muscles including the false and true vocal cords
- ANSWER-laryngospasm
*in a conscious or moderately sedated patient, it is very transient and followed by a
cough to clear the foreign material or secretions that irritated the tissues of the larynx
and triggered the spasm
How do you respond to a laryngospams during sedation? - ANSWER-"The airway
should be suctioned followed by a forceful jaw thrust to open the airway, and the
BVM should then be placed with enough force to establish a tight mask seal. Gentle
continuous pressure from the bag should be applied until ventilations are
successful." "Once the patient has regained consciousness, the laryngeal spasm
should resolve following vigorous coughing" If the cords fail to relax or severe
hypoxemia develops administer succinylcholine
This is associated with major allergic (anaphylactoid) reactions; involves swelling of
the laryngeal mucosa as well as neighboring pharyngeal mucosa and tongue.
Generally presents as stridor or high-pitched crowing sounds during ventilation -
ANSWER-laryngeal edema
, How do you manage laryngeal edema? - ANSWER-administer epinephrine (most
conventional dose is 0.3 mg IM)
Lower airway obstruction due to contraction or spasm of bronchial smooth muscle.
May result from a type I anaphylactic allergic reaction or an anaphylactoid reaction,
independently or in combination with laryngeal edema, or as a consequence of the
hyperreactive airway typical in patients with asthma. Presents with dyspnea and
wheezing. - ANSWER-bronchospasm
How do you manage bronchospasm? - ANSWER-Administer selective beta-2
agonist like albuterol; bronchial smooth muscle is under automnomic nervous control
and requires beta-2 sympathomimetics for relaxation
The AAPD recommends referral to establish a dental home at what age? -
ANSWER-"Referral by the primary care physician or health provider has been
recommended, based on risk assessment, as early as six months of age, six months
after the first tooth erupts, and no later than 12 months of age" (AAPD 24)
AAPD values health promotion and disease prevention, including effective
anticipatory guidance beginning with comprehensive dental care in a dental home
starting at what age? - ANSWER-Age one / 12 months (AAPD 12); Referral by the
primary care physician or health provider has been recommended, based on risk
assessment, as early as six months of age, six months after the first tooth erupts,
and no later than 12 months of age (AAPD 24)
When is the safest time to perform dental treatment during a pregnancy? -
ANSWER-During the second trimester - 14th to 20th weeks (AAPD 137) "The risk of
pregnancy loss is lower in the second trimester compared to that in the first
trimester, and organogenesis is complete"; "Even though the second trimester is
usually optimal, dental treatment can be accomplished safely at any time during
pregnancy
The AAPD Reference manual recommends a child of moderate caries risk should
receive a professional fluoride treatment at what frequency? What about a child at a
high caries rate? - ANSWER-"Children at moderate caries risk should receive a
professional fluoride treatment at least every six months; those with high caries risk
should receive greater frequency of professional fluoride applications (e.g, every
three to six months)" (AAPD 119)
When are "caries-conducive" dietary practices established? - ANSWER-"Caries-
conducive dietary practices appear to be established early, probably by 12 months of
age, and are maintained throughout early childhood" (AAPD 120)
What is the most common cause of injury to permanent teeth? - ANSWER-falls; "The
most common injuries to permanent teeth occur secondary to falls, followed by traffic
accidents, violence, and sports" (AAPD 120)
The AAPD recommends stopping sucking habits by what age? - ANSWER-Age
three (AAPD 120)
PEDIATRIC DENTISTRY READINGS
EXAM QUESTIONS WITH VERIFIED
ANSWERS
This drug is used to manage hypotension. It stimulates norepinephrine release from
sympathetic nerve endings. It also acts directly on alpha- and beta-adrenergic
receptors, leading to vasoconstrction and increased rate and contractility of the
myocardium. It constructs veins to a greater extent than arteries, which enables it to
increase preload more than afterload - ANSWER-ephedrine
sudden elevations in diastolic pressure greater than 120 mmHg - ANSWER-
hypertensive crisis
How do you manage sinus tachycardias? - ANSWER-tachycardia can be a reflex
response to hypoxia or hypotension so assess these first; then administer IV fluids to
support blood pressure in the event that the increased hr is attempting to sustain the
blood pressure. If tachycardia persists then a selective beta-1 receptor antagonist
like esmolol can be given to decrease sympathetic stimulation to the heart.
The use of further nitroglycerin is contraindicated when the systolic pressure is less
than - ANSWER-90mmHg
Which of the following is the approximate FIO2 provided by a nonrebreather mask
with a reservoir delivering 8 L/min oxygen?
A. 60%
B. 70%
C. 80%
D. 100% - ANSWER-B. 70%
"When using any mask, the flow rate should be at least 6 L/min to avoid feelings of
suffocation. Provided the mask has a reservoir, this flow rate will deliver an oxygen
concentration of 60%, and each additional L/min will increase FIO2 by ap-
proximately 5%."
Which of the following is correct regarding admin- istration of epinephrine?
A. 0.3 mg is contained in 3 mL of a 1:1000 con- centration
B. 0.5 mg is indicated for a patient in cardiac arrest
C. 0.5 mg is contained in 5 mL of a 1:10,000 con-
centration
D. 0.1 mg increments using a 1 : 1000 con-
centration should be used for intravenous injec- tions when managing severe
anaphylactoid re- actions - ANSWER-A. 0.3 mg is contained in 3 mL of a 1:1000
concentration
,During your assessment you find that Mrs. Jones is unconscious and apneic. If your
first attempt to ventilate with a BVM is unsuccessful, your next intervention before
attempting further ventilation may include any of the following EXCEPT:
A. retilting the head, repositioning the mask
B. inserting an oropharyngeal airway
C. performing a jaw thrust
D. inserting an LMA - ANSWER-D. inserting an LMA
"When attempting to ventilate a patient with apnea, a reasonable stepped approach
is to attempt ventilation with a BVM alone, followed, if necessary, by insertion of an
oropharyngeal airway. If this proves futile, one must consider advanced airway
adjuncts such as tracheal intubation or insertion of a laryngeal mask airway (LMA)."
Your patient loses consciousness prior to intravenous sedation, but is breathing and
has a pulse. The blood pressure is 80/50 mm Hg and the pulse rate is 84 beats per
minute. Each of the following is appropri- ate for managing this situation EXCEPT:
A. administer supplemental oxygen
B. administer atropine, 0.5 mg IV, IM, or SLI
C. administer ephedrine, 10 mg IV or 25 mg SLI
or IM
D. administer 250-500 mL IV fluid - ANSWER-B. administer atropine, 0.5 mg IV, IM,
or SLI
"If bradycardia is present, ie, heart rate less than 60 beats per minute, administer
atropine until the rate is within normal limits."
Office-based deep sedation/general anesthesia techniques require at least how
many individuals? - ANSWER-Three (AAPD 226)
When the intent is minimal sedation for adults, the appropriate initial dosing of a
single enteral drug is no more than ... - ANSWER-the maximum recommended dose
(MRD) of a drug that can be prescribed for unmonitored home use. (ADA guidelines
pain control & sedation)
T/F Nitrous oxide/oxygen may be used in combination with a single enteral drug in
minimal sedation. - ANSWER-True (ADA guidelines pain control & sedation)
term that describes any technique of administration in which the agent is absorbed
through the gastrointestinal (GI) tract or oral mucosa [i.e., oral, rectal, sublingual]. -
ANSWER-enteral (ADA guidelines pain control & sedation)
term that describes a technique of administration in which the drug bypasses the
gastrointestinal (GI) tract [i.e., intramuscular (IM), intravenous (IV), intranasal (IN),
submucosal (SM), subcutaneous (SC), intraosseous (IO)]. - ANSWER-parenteral
(ADA guidelines pain control & sedation)
term that describes administering a single additional dose of the initial dose of the
initial drug that may be necessary for prolonged procedures during minimal sedation.
The additional dose should not exceed one-half of the initial dose and should not be
administered until the dentist has determined the clinical half-life of the initial dosing
has passed. The total aggregate dose must not exceed 1.5x the MRD on the day of
,treatment. - ANSWER-supplemental dosing (ADA guidelines Use of Sedation and
General Anesthesia)
What is the minimum fasting period required for a patient who has ingested clear
liquids (water, fruit juices without pulp, carbonated beverages, clear tea, black
coffee) according to the guidelines for elective sedation? - ANSWER-2 hours
(AAPD217)
What is the minimum fasting period required for a patient who has ingested breast
milk according to the guidelines for elective sedation? - ANSWER-4 hours
(AAPD217)
What is the minimum fasting period required for a patient who has ingested infant
formula according to the guidelines for elective sedation? - ANSWER-6 hours
(AAPD217)
What is the minimum fasting period required for a patient who has ingested
nonhuman milk according to the guidelines for elective sedation? - ANSWER-6
hours (AAPD217) "because nonhuman milk is similar to solids in gastric emptying
time, the amount ingested must be considered when determining an appropriate
fasting period"
What is the minimum fasting period required for a patient who has ingested a light
meal (ie toast and clear liquids) according to the guidelines for elective sedation? -
ANSWER-6 hours (AAPD217) "Meals that include fried or fatty foods or meat may
prolong gastric emptying time. Both the amount and type of foods ingested must be
considered when determining an appropriate fasting period"
Of the drug classes used for sedation and anesthesia, which is the most powerful
respiratory depressant? - ANSWER-opioids (like meperidine aka demerol)- reversal
agent = naloxone
reflex closure or spasm of the glottic muscles including the false and true vocal cords
- ANSWER-laryngospasm
*in a conscious or moderately sedated patient, it is very transient and followed by a
cough to clear the foreign material or secretions that irritated the tissues of the larynx
and triggered the spasm
How do you respond to a laryngospams during sedation? - ANSWER-"The airway
should be suctioned followed by a forceful jaw thrust to open the airway, and the
BVM should then be placed with enough force to establish a tight mask seal. Gentle
continuous pressure from the bag should be applied until ventilations are
successful." "Once the patient has regained consciousness, the laryngeal spasm
should resolve following vigorous coughing" If the cords fail to relax or severe
hypoxemia develops administer succinylcholine
This is associated with major allergic (anaphylactoid) reactions; involves swelling of
the laryngeal mucosa as well as neighboring pharyngeal mucosa and tongue.
Generally presents as stridor or high-pitched crowing sounds during ventilation -
ANSWER-laryngeal edema
, How do you manage laryngeal edema? - ANSWER-administer epinephrine (most
conventional dose is 0.3 mg IM)
Lower airway obstruction due to contraction or spasm of bronchial smooth muscle.
May result from a type I anaphylactic allergic reaction or an anaphylactoid reaction,
independently or in combination with laryngeal edema, or as a consequence of the
hyperreactive airway typical in patients with asthma. Presents with dyspnea and
wheezing. - ANSWER-bronchospasm
How do you manage bronchospasm? - ANSWER-Administer selective beta-2
agonist like albuterol; bronchial smooth muscle is under automnomic nervous control
and requires beta-2 sympathomimetics for relaxation
The AAPD recommends referral to establish a dental home at what age? -
ANSWER-"Referral by the primary care physician or health provider has been
recommended, based on risk assessment, as early as six months of age, six months
after the first tooth erupts, and no later than 12 months of age" (AAPD 24)
AAPD values health promotion and disease prevention, including effective
anticipatory guidance beginning with comprehensive dental care in a dental home
starting at what age? - ANSWER-Age one / 12 months (AAPD 12); Referral by the
primary care physician or health provider has been recommended, based on risk
assessment, as early as six months of age, six months after the first tooth erupts,
and no later than 12 months of age (AAPD 24)
When is the safest time to perform dental treatment during a pregnancy? -
ANSWER-During the second trimester - 14th to 20th weeks (AAPD 137) "The risk of
pregnancy loss is lower in the second trimester compared to that in the first
trimester, and organogenesis is complete"; "Even though the second trimester is
usually optimal, dental treatment can be accomplished safely at any time during
pregnancy
The AAPD Reference manual recommends a child of moderate caries risk should
receive a professional fluoride treatment at what frequency? What about a child at a
high caries rate? - ANSWER-"Children at moderate caries risk should receive a
professional fluoride treatment at least every six months; those with high caries risk
should receive greater frequency of professional fluoride applications (e.g, every
three to six months)" (AAPD 119)
When are "caries-conducive" dietary practices established? - ANSWER-"Caries-
conducive dietary practices appear to be established early, probably by 12 months of
age, and are maintained throughout early childhood" (AAPD 120)
What is the most common cause of injury to permanent teeth? - ANSWER-falls; "The
most common injuries to permanent teeth occur secondary to falls, followed by traffic
accidents, violence, and sports" (AAPD 120)
The AAPD recommends stopping sucking habits by what age? - ANSWER-Age
three (AAPD 120)
