Practice Questions Continued
Hepatitis B - IgM positive
Acute infection (<6mo)
Physical propertiies
Hybrid (40-300 nm) > nano (20-75 nm) >> micro (40 nm)
Nanofilled resin
(20-75 nm) Decreased interstitial spacing; increased filler loading; better physical properties; longer retention, surface polish ability
Microfilled resin based composite
(40 nm) 50-60% - decreased strength, decreased wear, increased shrinkage, increased esthetics (anterior)
Hybrid
(40-300 nm) 40 nm and 200-300 nm particles - 50-75% filler - anterior, posterior, decreased wear, decreased shrinkage, decreased thermal expansion, increased strength, increased polish ability
Chronic Hepatitis B
+ HBsAg and + Anti-HBc
Acute HBV
+ HBsAg, + Anti-HBc, + IgM Anti-HBc
Platelet Count Recommendations
- 2. Platelet Count: 2 cascades for clot - one side forms fibrin and other side has platelets o 75,000/mm^3. No additional support needed but the pediatric dentist should be prepared to treat prolonged bleeding by using suture, hemostatic agents, pressure packs, etc. o 40,000-75,000/mm^3. Platelet transfusions may be considered pre- and 24 hours post-operatively. Localized procedures to manage prolonged bleeding may include sutures, hemostatic agents, pressure packs or gelatin foams o <40,000/mm3; defer care, dental emergency à platelet transfusion
Methemoglobinemia
- 1 or more ferrous ions in 4 heme groups are oxidized to ferric ions (Fe3+) o You oxidize those groups in methemoglobinemia
Pachyonchia Congenita (Jadassohn-Lewandowsky)
- Almost everyone with pachyonychia congenita shows some signs of hypertrophic nail dystrophy, which causes the fingernails and toenails to become thick and abnormally shaped. Most affected children also develop very painful blisters and calluses on the soles of the feet and, less commonly, on the palms of the hands. This condition is known as palmoplantar keratoderma. Severe blisters and calluses on the feet usually first begin to form in childhood when they first start to walk, and can make walking painful or impossible. - Some babies with pachyonychia congenita have prenatal or natal teeth, which are teeth that are present at birth or in early infancy. - In some cases, pachyonychia congenita can affect the voice box (larynx), causing hoarseness or breathing problems.
Hyperdontia
- Apert - Cleidocranial dysplasia - Gardner - Crouzons Syndrome - Down syndrome - Sturge Webber - Orofaciaodigital syndrome - Cleft lip/palate
0.4 mL in NaF varnish. The amount of fluoride varnish is approximately ho many mg?
10 mg of Fluoride
Composite radiopacity
- Borosilicate glasses, glasses containing barium, strontium, zinc, zirconium (radiopacity)
Contraindication to Midazolam
- Caution with benzodiazepines and (May increase effect) o Grapefruit juice o Erythromycin, clarithryomycin o Azole antifungals, ketoconazole, itraconazole o Antivirals indinavir, nelfinavir, ritonavir o Some antidepressants (fluoxetine, fluvoxamine, trazodone) o Valproic acid o Narrow angle glaucoma (increased intraocular pressure)
Meperidine
- Contraindicated o MAO inhibitors, SSRIs, tricyclic antidepressants (seizures/HTN crisis) o With seizure disorders (proconvulsant active metabolite) o Severe asthma (histamine release)
If contaminated with saliva, re-etch how long:
10 seconds
Macroglossia Syndromes
- Down syndrome - Neurofibromatosis, type 1 (see pigmented lesions) - Mucopolysaccharidosis (multiple types) - Multiple endocrine neoplasia, type 2B - Beckwith-Weidemann syndrome - Duchenne muscular dystrophy (hypotonicity of tongue) - Cretinism - Pierre Robin Sequence
Microdontia
- Ectodermal dysplasia - Chondroectodermal dysplasia (Ellis-van Creveld) - Hemifacial microsomia - Down syndrome - Crouzon syndrome - Pituitary dwarfism
Anodontia
- Ectodermal dysplasia - Crouzon syndrome (craniofacial dysostosis): also hyperdontia - Achondroplasia - Chondroectodermal dysplasia (Ellis-van Creveld) - Williams syndrome - Non-syndromic cleft lip/palate - Achondroplasia - Incontinentia pigmenti - Orofaciodigital syndrome I Rieger syndrome
Mechanism of Action of N2O
- Inhibition - N - methyl - D aspartate (NMDA) of the excitatory glutamate receptor - Stimulation of the gamma aminobutyric acid (GABA) and alpha-amino-3-hydroxyl-5-methyl-4-isoxazole-proprionate receptors - May promote release of endogenous opioid neurotransmitters (endorphins/dynorphines)
What is the minimum number of personnel required for a child undergoing deep sedation?
3???
Taurodontism
- Klinefelter syndrome (XXY) - Tricho-dento-osseous syndrome (TDO) - Mohr syndrome (orofaciodigital syndrome II) - Hypohydrotic ectodermal dysplasia - Amlogenesis imperfecta type IV - Down syndrome - Williams Syndrome - Smith-Magenis syndrome
Stylopharygeus
3rd branchial arch
Involuntary Ventilation
- MEDULLA CHEMORECEPTORS sense acidity generated by carbonic acid from CO2 entering the brain o = hypercapnic drive - central response to CO2 - Carotid/aortic arch bodies sense low O2 tension o = hypoxemic drive
Displacement of Teeth
- Melanotic neuroectodermal tumor of infancy - Hemifacial hyperplasia - premature exfoliation and eruption of teeth - Peripheral ossifying fibroma - Leukemia - mobility of teeth - Nasopalatine duct cyst - root divergence - Peripaical cyst (radicular cyst) - Cementoblastoma - Central ossifying fibroma - Juvenile ossifying fibroma - displacement of teeth, root divergence, root resorption
Chloral Hydrate
- Metablized by the liver to chlortriethanol (an alcohol) - Alcohol metabolized by liver = drunk kids o Increase in livers' metabolic enzymes may interact with other therapeutic agents
Resin Based Sealant
- Monomer: Urethane dimethacrylate (UDMA) or bisphenol A-glycidyl methacrylate (bis-GMA) o Bis-GMA is a product of bisphenol A and glycidyl methacrylate o Bis-GMA used in sealant - can detect BPA after placement because of how it reacts chemically
Muscular Dystrophy - Most common form
- Most common form of muscular dystrophy - Becker (BMD) which is milder form as opposed to Duchenne (DMD)
Immigrants
3x increased caries rate risk
Effective dose of pan equals what of intramural?
4
Memory Restructuring
4 components 1. Visual reminders 2. Positive verbal reinforcement 3. Concrete examples 4. Sense of accomplishment
Lymphoid Tissue
5 y/o - 125%
At what age does fear decrease?
5 years
Fluoride release in GI for up to how many years?
5 years
ADA Maximum amalgam creep
5%
Sodium hypochlorite
5% concentration - antimicrobial; biocompatible, non-irritating to pulp Similar to FC at 12 mo
Molecular Basis for Odontoblast Stimulation:
- TGF-Beta (transforming growth factor beta) is sequestered in dentin matrix during tooth development - TGF-Beta may be released when caries or acid etchant causes dissolution of matrix - Growth factors interact with pulp to cause proliferation and differentiation of mesenchymal cells to form reparative dentin Calcium hydroxide has similar effect - high pH causes slight demineralization and releases TGF-beta leading to reparative dentin and apexification
Erythema Multiforme
- Trigger allergic reaction to specific medications - Erythmea multiforme (EM) is a typically mild, self-limiting, and recurring mucocutaneous reaction characterized by target lesions of the skin and mucous membranes - Great variability between episodes - Typical age is between 7 and 21 years. More females than males - EM is characterized by symmetrically distributed skin lesions Etiology: Herpes simplex virus (HSV) is the infectious agent in 60-70% of cases
Fetal alcohol syndrome
- indistinct philtrum
Kri Paste
- iodoform, camphor, parachlorophenol and menthol
Tooth Size Discrepancy
5% of population Most common teeth are upper LI and 2nd premolars For good CL 1 occlusion with ideal OB and OJ teeth must be proportional in size
Acute lymphonodular pharyngitis similar to mononucelosus
Acute lymph nodular pharyngitis is RNA (Coxsackie A virus) vs mononucleosis (EBV is DNA)
Molar incisor hypoplasia has been attributed to:
Ameloblast dysfunction after full matrix completion
Prothrombin Time (PT)
10-12 seconds Evaluation of extrinsic common pathways of coagulation Prolonged deficiencies in factors V, VII, X, prothrombin and fibrinogen Used for: monitor warfarin, evaluate liver disease, Vitamin K deficiency and DIC
Tylenol
10-15 mg
Shark Teeth
10-20% prevalence - if arch perimeter is too small...
Sports
10-40% of dental injuries in children (7-11 y/o sport injuries) 25% of dentoalveolar injuries can still occur with mouthguard
When to make a radiograph to determine PA lesion and/or root resorption after trauma:
2-3 weeks
Has a word for almost everything
2-3 y/o
When do clinical symptoms occur for Hep B after exposure?
2-4 mo clinical symptoms. Jaundice can occur after 3 months.
Filled sealant vs unfilled sealant
Definitely use a bonding agent vs unfilled sealant may not be necessary to use bonding agent
Amount of radiation/year
3.6 mSv/year (83% natural (cosmic; terrestrial; internal (radon, ingestion of food); 17% is artificial Radon is radioactive gas that comes from uranium. In the soil. Gas that goes through cracks and we breathe that!
Tylenol 3
30 mg codeine, 300 mg acetaminophen
Wash time
30 seconds
Iodoform paste
30% CaOH, 40% iodoform; 22% silicone oil
Xylitol
-5 carbon sugar alcohol 4-10 g/day - frequency of 3x/day shows no effect not metabolized by cariogenic bacteria Accepted by AAPD as a non-cariogenic sugar substitute Available in the form of gum, lozenges, toothpaste, oral wipes, and syrup To be effective, requires frequent high doses (15 gm/daily) Data inconclusive for caries reduction and for MS reduction - Xylitol resulted in reduction of mother-child transmission of MS but doses that are required is not practival
Treacher Collins Syndrome
30% have cleft lip and/or palate
Localized Aggressive Periodontitis
...AA . First molar & incisors and no more than two other teeth, Inflammation NOT a prominent feature; NOT A LOT OF DENTAL PLAQUE Higher in African Americans circumpubertal onset, robust serum antibody response to infective agents: the dominant serotype antibody is IgG2 Treatment: scaling and root planing or extraction of primary teeth; antibiotic therapy: amoxicillin and metronidazole for 7-10 days or azithromycin for 3-5 days
University of Michigan Sedation Scale
0 = awake and alert 1 - minimally sedated; tire/sleepy 2 = moderately sedated - somnolent/sleeping; easily aroused with light tactile stimulation or a simple verbal command 3 = deeply sedated - deep sleep, arousable, only tip significant physical stimulation 4 = unarousable
Neuropeptides in pulp
Important in induction of neurogenic inflammation - most import common calcitonin G related protein
Flumazenil
0.01 mg/kg and can be repeated up to a total of 1 mm. Onset of reversal occurs up to 1-2 minutes Flumazenil reversal dose not to exceed a cumulative dose of 0.05 mg/kg or 1 mg whichever is lower IV preferred but can be IM or submucosal - onset of reversal effect doesn't occur for up to 1-2 minutes
Flumazenil
0.01 mg/kg max: 0.05 mg/kg or 1 mg (whichever is lower)
Anaphylactic reaction epinephrine dose
0.01 mg/kg of 1:1,000 subcutaneously
Estimated exposure of 4 conventional dental bitewings
0.04 MSVs (0.04 microsieverts)
Microfilled
0.04 um = 40 nm - historically 50% filled by volume (much smaller filler and smaller amnt of filler
Beginning 6 most of pregnancy
0.05% NaF and 0.12% CHX resulted in decreased MS and delayed colonization among offspring
OTC Fluoride rinse has 220 ppm
0.05% NaF x 45%
naloxone
0.1 mg/kg Reverse effects at mu and kappa receptors 30-45 minutes only
What medication will you use Naloxone to reverse?
0.1 mg/kg with 2.0 mg max. Demerol not a choice... Meperidine!
Dose of naloxone
0.1 mg/kg; 2 mg
Less dimensional change with amalgam than composite
0.2% amalgam vs 2% with composite
Recommended daily systematic dose for children between 6 mo and 3 yrs?
0.25 mg
Phenergan (Promethazine dose)
0.25-1 mg/kg (max 25 mg) q4-6h Contraindicated in narrow angle glaucoma thrombocytopenia. Photosensitivity Onset 15-60 min Duration 4-6 hrs Fatal Myoglobinemia Blackbox warning for promethazine (phenergan) for fatal respiratory depression in children <2 years
Veneers of Perm Teeth
0.3-1.0 mm tooth structure typically cemented with photopolymerized or dual-polymerized resins (usually cemented with resin cements)
Phentolamine Mesylate
0.4 mg/1.7 mL Reduces anesthesia by approximately 50% Not recommended less than 6 y/o or less than 15 kg
PPM
1 mg/L
Down's Analysis
1 to 1 of 150. This patient has increased tendency for Class III occlusion
Steiner Analysis Proclination/Retroclination
1 to NA - 4 mm and 22 degrees 1 to NB - 4 mm and 25 degrees
Alveolar fracture
1 week, 3-4 weeks, 6-8 weeks, 1 year and yearly for next 5 years
Dental radiographic exposure is what percent of total health care dosage?
1%
98-99% O2 in arterial blood is bound to hemoglobin
1-2% is dissolved in plasma, producing arterial O2 tension (PaO2) This is what enters the body tissue When it enters cells, it is replaced instantaneously by O2 released from hemoglobin SaO2 (O2 saturation of hemoglobin) and PaO2 are therefore related
Letterer-Siwe
1-3 y/o; Most severe; skin, visceral, and bone involvement
Chloral Hydrate Dosage
1-50 mg/kg (max 1 g; gastric irritant; onset 30-60 mins; peak 60 mins; duration 5 hrs Demerol - 1 mg/kg; opioid 2-4 hrs; decrease seizure threshold Hydroxyzine - 1-2 mg/kg antihistamine, antiemetic, vistaril, ataraxic; bronchodilator, 2-4 hrs - IV/SC --> tissue necrosis, hemolysis
Silver
Increases strength and expansion
Congenital Syphilis
30% patients develop dental hypoplasia Not all patients with Hutchinson's teeth or mulberry molars will have congenital syphilis
GoGn - SN angle
32 degrees = norm Determines vertical growth Steep mandibular plan angle suggestive of dolichofacial pattern
Full-mouth series
35-388 uSv
Pierre Robin Triad
1. Micrognathia ( small lower jaw) 2. Glossoptosis ( tongue tends to fall back and downwards) 3. Airway compromise
Comparing Parental Satisfiaction
36% showed inflammatory/color mismatch Parents reported high satisfaction 89% would highly recommend the crowns
Indications for Prophylactic Antibiotics
1. Prosthetic cardiac valve 2. Previous infective endocarditis 3. Cardiac transplantation recipients who develop cardiac valvulopathy CHD (except for the conditions listed below, antibiotic prophylaxis is NO LONGER recommended for any other form of CHD 4. Unrepaired cyanotic CHD (including palliative shunts, and conduits) 5. Completely repaired CHD with prosthetic material or device either by surgery or catcher interventinon during first 6 months after procedure to allow time for endothelial covering of material 6. Repaired CHD with residual defects at site or adjacent to the site of a prostehci patch or prosthetic device which inhibits endotheliaziation 1. 1.
SSCs in Permanent Teeth
1.5-2.0 mm reduction (more than primary teeth)
Scammon's Curve
Lymphoid - peaks at 10 years (200%) Neural - by age 5y/o pretty much plates - rapid growth and slows down at 8-10 y/o General and Genital puberty growth
Failure rate of class II amalgams ranged from 2-7x that of SSCs with amalgam restorations failuree rate being 4x more than that of SSC restorations
1.5-9 failed amalgam for every failed SSC Main reason for failure are crown loss and perforation
Primary molar anatomy
1/3 of max first molars have fusion of palatal and distobuccal roots 2nd maxillary molars have 3 canals (70%) or 4 canals (30%) 1st mandibular molars - 3 (80%) or 4 20%) canals; medial root with 2 canals AND distal root with 1 or 2 canals 2nd molars have 2 roos and 4 canals
Bond strength of Glass Ionomer Cement?
10 mPa
Hand-Schuller-Christian
1. malignant 2. scalp rash 3. lytic skull lesions 4. DI 5. exopthalmos in child in the age of 3+
Anterior composite crown preparations
1.0 mm Facial reduction; 0.5 mm lingual reduction; 1-1.5 mm incisal reduction
Infant compression
1.5 inches 4 cm
Esthetic Posterior SSCs
1.5-2 mm oclusal reduction 1-1.5 mm circumferential reduction, including removeal of bulges and heights of contour Avoid over tapered preparation Failure to seat to height of adjacent unprepared tooth: - Inadequate occlusal reduction - Excessive crown length - Gingival ledge - Inadequate M/D space
Female pubertal growth
10.5-11, peaks at 12-13; ends at 15 y/o
100% solution = 1 g drug /mL
1000 mg/mL
The amount of fluoride in 0.4% SnF is approximately
1000 ppm
LED lights vs Halogen lights
1000-2000 mW/cm2 (20 sec) Halogen lights 400-1000 mW/cm2 (40 secs) (350 is absolutely minimal but you should have higher - usually ours over 1000; halogen units are lower
Upper Incisor to SN
104 degrees
Palatal fusion
11 weeks in utero
Right side of face is magnified more on a cephalometric radiograph
11% vs 6%. Film locked on left side & beam located on right side
Survival rate of zirconia crowns
12 mo - 93% 24 mo - 85% 36 mo - 76% failure Failure type: Two main reason for failure: Infection = 61% Loss of crown = 35%
Male pubertal growth
12.5-13.5, peaks at 14-16. Ends at 17-18 y/o
Max amount of fluoride that can be given in a RX
120 mg
Steam Autoclave
121 C; 15 psi; 15-20 mins Positive: Rapid turn, good penetration Negatives: corrosion, ,dulling of unprotected instruments
Binet - child who performs task of a 10 year old who is chronologically 8 years of age has an IQ of...
125 ((Mental age/chronological age) x 100)
Craniofacial lymphoid tissue at 5 years of age
125%
Occlusal palne to SN
14 degrees
occlusal plane to SN
14 degrees = normal
Safest time for dental tx
14-20 weeks gestation Uterus is below the umbilicus (woman is more comfortable)
Dry time
15 seconds
Pierre Robin Syndrome
15-25% heart disease; primary anomaly in mandibular development (hypoplasia of mandible prior to 9 weeks)
Annual background radiation in US per person, and percent from medical and dental diagnostic imaging
3600 Microsieverts with 20% of radiation coming from medical/dental imaging; 1% from dental radiographic imaging
Dry heat oven:
160 C; 1-2 hours Positives: does not corrode Negatives: Long cycle, destroys heat-sensitive
Talking 1-2 words
18 months old
Rapid heat transfer
180 C; 6-12 mins Positive - short cycle Negative - cannot sterilize liquids
Formocresol
19% formaldehyde; 35% cresol; 15% glycerin, water
S. Mutans - Window of Infectivity
19-30 months; has been found in children as young as 10 months One study found S. mutans in 53% of 6-12 months of children
Epineprhien vasoconstrictor
1:100,000 = 10 ug/mL Max dose = 200 ug (approximately 11 cartridges 2% lido with 1:100,000 epi)
4% of articaine
1:100K epi - 60 min vs 190 min max infiltration; 90 min pulp vs 230 min for mandibular block 0.5% bupiviaine 1:200K epi 40 min pulp, 340 min soft tissue max infiltration 240 min pulp and 440 min soft tissues
Meckel's and Reichert's Cartilage
1st and 2nd branchial arches
Sphenomandibular
1st branchial arch
ANB
2 degrees A point up to nation and down to B point
How much crowding with eruption of mandibular lower incisors?
2 mm of lower incisor crowding normal as mandibular incisors are erupting 3-6 mm spacing leads to 0% crowding in permanent teeth <3 mm spacing leads to 20% crowding in permanent teeth No spacing leads to 50% crowding in permanent teeth Crowding in primary teeth leads to 100% crowding in permanent teeth
F/u for extrusion
2 weeks, 4, weeks 6-8 weeks, 6 mo, 1 yr and yearly for next 5 years
Max velocity or peak height velocity of growth is attained approximately
2 years after pubertal onset
Which systemic condition associated with geographic tongue?
2%; etiology unknown. Some believed to be contributing factors: ATOPY, STRESS, AND HORMONAL CHANGES Systemic conditions associated with geographic tongue: PSORIASIS! Typically anterior 3/4s of tongue
Medican fan beam CT scan (maxilla and mandible)
2,000 uSv
Acute Lymphocytic Leukemia
2-3 most common radiographic changes associated? Areas of developing teeth Often around periapcal region of tooth (periapical lesion) Ill-defined radiolucent/radiopaque areas NO expansion of bone but Premature loss of teeth Somewhat similar to hypophosphatasia symptoms
Recurrent Apthous Stomatitis
2-48 hrs before ulcer appears NO gingivitis Pro-dromal MOST COMMON ULCERATIVE DISEASE OF ORAL MUCOSA Typical age of canker sores - teenagers and up. Very rare in babies! Not keratinized. Often COMPLEX DIFFERENTIAL DIAGNOSIS: cyclic neutropenia, churn's, SLE, several factors possible etiology Major (>1 cm), minor (most common) <1 cm, herpetiform (looks like herpes) Ulcers = round, well defined with erythematous margin and shallow ulcerated center covered by yellow pseudomembrane Last for 7-10 days Approximately 20% affected by RAS; in children, prevalence of RAS as high as 40% and influenced by presence of RAS in one or both parents Onset of RAS seems to peak between ages 10-19 y/o before becoming less frequent in advanced age Children have a 90% chance of developing RAS if parents suffered RAS during childhood Immunologic factors - elevated IL2, elevated IFN alpha, local dysregulated cell-mediated immune response - accumulation of CD8 - T cells
Intruded primary teeth usually reerupt within
2-6 months (sometimes it can take up to 1 year)
Permanent tooth with carious predecessor
2.3 times the odds of having a demarcated opacity compared with a permanent tooth with a sound predecessor Thought to be related to periapcial infection
How much of the upper arm should the BP cuff cover to obtain correct readings?
2/3-3/4
Higher risk age for an electrical burn is
20 months
Etch time
20 seconds
% 3rd molar agenesis
20%
Spontaneous Bleeding
20,000 plateletsg
What is the bond strength of enamel agents?
20-22 mPA
Limiting BPA
20-45% monomer remains unpolymerized after curing and can leach into saliva Found on liquid layer on outer surface of material, where oxygen inhibits polymerization Gargling with water for 30 seconds reduced salivary BPA to baseline for 9 composite eresin Pumice on a cotton ball or rubber trophy cup was effected in elminaitned bis-DMA, bisGMA and TEGDMA, compared with dry cotton or wet cotton, or water spray
Nano
20-75 nm - include silane coated and ZrO
9 y/o adenoid
200% size of adult
Perinatal
20th week of gestation to 28 days after birth
1 - NB (deg) norm
25 degrees (if 0 and 18 degrees - retroclined and retrusive)
Total energy needs for pregnant woman
2500 kcal/day
Ethylene oxide
25C - 10-16 hours; Positive: Suitable for most materials including dental appliances Negatives: Very long cycle, requires ventilation
Weeks 8-40
2nd and 3rd trimester - maturation of organ systems
Benign Cemtentoblastoma
2nd/3rd decade (usually before 18 y/o) Slow growing mesenchymal neoplasm Composed principally of cementum-like tissue and attached to the apex of tooth root More common in males than females Continuous with root, which is resorbed Pulp vitality unrelated but the involved tooth is OFTEN PAINFUL Lesion is well-defined and radiopaque with cortical border and then a well-defined RADIOLUCENT BAND INSIDE THE CORTICAL BORDER DDX: Florid cements-osseous dysplasia
Diazepam
3 active metabolites - Nordiazepam, Temazepam, and Oxazepam
Minimum 3 months wait after trauma prior to ortho movement of teeth
3 months
People inside a child's family should understand most of child's speech by
3 y/o
Brain growth
3 y/o - 80% 7 y/o - 90%
Enamel pearl
3% Mesial or distal of maxillary molars Buccal or lingual in mandibular molars
Paresthesia
3% LA and less = 1:1.2 mil
Missing teeth
3-10% 3rd molars
Child at what age understands who, what where, when and why questions?
3-4 y/o
Dental cephalometric radiograph
3-6 uSv
Maxillary canine impaction
3:1 Female to Male; 2% population
People outside of a child's family should understand most of the child's speech by
4 y/o
Articaine
4% w/ 1:100,000 epi pKa = 7.8 High tissue diffusion (liposolubility) due to thiophene substitution for benzene ring Use in pediatric patients under 4 y/o is not recommended
Ibuprofen
4-10 mg/kg q6-8h
Normal RBC
4-6 million/mm3
2 years old
4-6 minutes (Childhood development experts generally say that a reasonable attention span to expect of a child is two to three minutes per year of their age. That's the period of time for which a typical child can maintain focus on a given task. Average attention spans work out like this: 2 years old: four to six minutes.
Age vocalizes excitement and displeasure?
4-6 mo
Speech and language milestones:
4-6 mo old sounds include P, M, B 4-5 year olds and sounds that are difficult to pronounce L, S, R, V, Z, Ch
Moderate autism range
40-55 and mild 55-70
Vitamin D supplementation
400 IU/d (10 ug) recommended for ALL infants from birth to 12 months of age, independent of their mode of feeding to prevent Rickets Beyond 12 months of age, all children and adults should met their nutritional requirement for Vitamin D through diet and/or supplementation, w which is at least 600 IU/d (15 ug)
Vitamin D
400 IU/d for all infants birth to 12 months independent of feeding to prevent Rickets
Recommended level of Vitamin D supplementation for infants under 12 months is
400 IU/day
Sealants are underutilized
41% of 9-11 years 43% of 12-19 y had a least one sealant
24.4-28.8% silver and 5.0-5.9% fluoride
44,800 ppm (ammonia helps to stabilize it) Silver and fluoride ions penetrate 25 microns into enamel and 40-200 microns into dentin CLEARED (not approved) by FDA for dentin hypersensitivity SDF forms silver protein conjugates in decayed surfaces. Increases resistance to acid dissolution and enzymatic digestion. Inhibits proteins that break down exposed dentin organic matrix: matrix metalloproteinases; cathepsins, and bacterial collagenases Hydroxyapatite and fluoroapattie form on the exposed organic matrix, along with the presence of silver chloride and metallic silver
Photoinitiators in command-cure dental products are most activated by which wavelength light?
450-469 nanometers
Wavelength of camphorquinone:
450-500
Exhaust ventilation of N2O
45L/min outside the building
Cone beam CT (dento-alveolar
5 - 38.3 uSv
Child compression
5 cm or 1/3 depth
Adult compression
5 cm or 2 inches
E-Cigarettes
5 mL vial contains 100 mg of nicotine Lethal dose is 10 mg for children and 30-60 mg for adults 0.7 mL nicotine per pod is equivalent to 1 pack of cigarettes (/200 puffs)
Plays cooperatively with peers
5 y/o
Buccal bifurcation cyst (BBC)
5-13 y/o Delayed tooth eruption and swelling at the affected area is commonly observed Inflammatory odontogenic cyst that develops on the buccal region of first or second primary mandibular molar In some cases, partial tooth eruption with crown buccal tilting and deep periodontal pockets is observed Well-defined radiolucent area, often corticated around roots of involved teeth. Usually the lamina dura is not affected.
Incisor segment in children often result in crowding upon eruption of incisors. E space will assist in correcting this problem in approximately what percent of the time?
50%
Hemifacial Microsomia
50% have cardiac pathology (VSD, PDA) Associated with Goldenhar syndrome (condition present at birth, mainly affects dev of eye, ear and spine)
Need for additional restorative treatment composite vs. amalgam
50% higher for resin than amalgam Composite required 7 times as many repairs as amalgam restorations
Daily brushing of all children with ALL should cease when ANC falls below which of the following?
500
Recommended level of calcium supplementation for a toddler 1-3 years old
500 mg
Flush Terminal Plane
56% shift to class I permanent molar relationship 44% stay end on or shift to full class II permanent molars
Y - axis
59 degrees
Caries relationship to asthma
5x more common
Initiation of primary dentition at how many weeks in utero?
6 weeks
Child obesity
6-11 y/o - quadrupled 12-19 y/o - doubled
Tidal volume for children and adults
6-7 mL/kg
At 90% oxygenated on pulse ox, what is the partial O2 pressure?
60 mm Hg
Ellis Van Creveld
60% ASD Microdontia; pre-natal tooth eruption Multiple frenulum and abnormal attachments
Radicular Cyst
60% maxilla; especially around incisors and canines Well-defined cortical border - if secondarily infected, the inflammatory reaction may result in loss of cortical bone Cyst - degeneration of pulp necrosis so associated with non-vital teeth. Periapical cyst, dental cyst Originates from the rest of Epithelial Cells (malaise) in the PDL are stimulated to proliferate and undergo cyst degeneration by inflammatory products from a non-vital tooth
AP Changes
61.6% class 1 34% class 2 4.1% class 3
Mesial Step
68% to Class I permanent molar relationship; 19% class III molar relationship
Cone beam CT (craniofacial)
68-599 uSv
Erythema multiforme
7-21 y/o; FEMALES; EM characterized by symmetrically distributed skin lesions Herpes Simplex Virus (HSV) is the infectious agent in 60-70% of the cases Lips, alveolar mucosa, and palate
Articaine 4% 1:200K épi for 70 kg adult
7.0 mg/kg MRD For children 4-12 y/o the recommended dose is 5 mg/kg
Incisor Liability
7.6 mm in maxilla 6.0 mm in mandible To accommodate for incisor liability: compensation for incisor liability in primary dentition - Interdental spacing (allows for room for perm teeth to come in); Maxillary primate space Compensation for incisor liability: - Interdental spacing - Labial eruption of permanent incisors ------Increased proclamation of permanent incisors (increases arch perimeter) to allow for more room for incisors to erupt - Increased inter canine width (canines move distally) --------4 mm in maxilla and 2-3 mm in mandible
Estimated blood volume in a 4 year old child is approximately
70 cc/kg
What kVP to use?
70 kvP
Cranial bone growth
70% by age 7 y/o
Maxillary spacing vs mandibular spacing
70% vs 63%
Use of gloves reduces contamination by...
70-80%. Thus pre-wash hands
EEC Ectrodactyly Ectodermal Dysplasia
75% have cleft lip and/or palate
Intrusion 3-7 mm
75% pulp necrosis
Molar relationship
76% of children - flush 14% medial step 10% distal step
Accessory canals
77% of max and mandible primary molars had one or more extra foramina near the furcation
2nd inter transitional period
8 to 9 or 10 y/o From complete eruption of incisor until the beginning of replacement of primary canines and molars Maxillary Arch - "Ugly Duckling" Stage Diastema Loss of primary space Mandibular arch: transition crowding and loss of primate space Vertical skeletal growth Bone remodeling in maxillary tuberosity and madnibualr ramus Maxillary canine developing
Stages of Tooth Development
A = Bud - initiation B = Cap - Proliferation C = Bell; Histodifferentiation and morphodifferentiation D = Dentinogenesis - apposition E = (Amelogenesis) - calcification F = Crown formation - calcification G = Root formation and eruption - eruption H = Root completion - eruption
A patient with a functional posterior cross bite has
A TRUE BILATERAL CROSSBITE (Maxilla constricted)
What is baclofen?
A centrally acting muscle relaxant that can cause CNS depression used in Cerebral Palsy Other oral anti spastic drugs (benzodiazepines, dantrolene, baclofen)
Turner Syndrome
A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. Premature eruption of permanent molars; micrognathia; malocclusion; wide webbed neck; infertility
SNB -
80 degrees >80 degrees = prognathic <80 degrees = retrognathic
By 24 months of age
80% of children have been infected with Mutans Streptococci
SNA -
82 degrees
SNA/Steiners
82 degrees
Dental fear
9-20% of children report dental fear Fearful children are 2x as likely to behave negatively
Dental panoramic radiograph
9-26 uSv
IMPA
90 degrees
IMPA angle
90 degrees
Congenital epulis
90% female
Maternal levels of MS
<10^3 - low 10^3 - 10^5 - medium >10^5 - high
Low risk S. Mutans
<10^3 - low risk; 10^3-10^5 - moderate risk; >10^5 is high risk
Mild mandibular crowding
<2 mm can resolve spontaneous Maxillary diastema has high likelihood of resolving spontaneously (wait until maxillary canines eruption to reassess - only about 6% will still have diastema
Standard set of drinking water by Environmental Protection Agency and the measure recommended by the Centers for Disease Control and Prevention for dental unit water used in nonsurgical procedures is how many colony forming units per milliliter (CFU/mL)?
<500
Intraoral radiograph (per exposure)
<8.3 uSv
Phentolamine Methylate
>6 y/o and >15 kg (more effective in MD)
What bond strength is needed in stress bearing areas?
>70%
Capnography
A - B - exhalation of dead space B-C - exhalation of lower airway C-D - exhalation of alveoli D-E - inspiration End-tidal CO2 is recorded at point D
US-FDA Drug Categories:
A - studies on humans - safe use (NaF varnish) B - no risk to humans - acceptable to use during pregnancy (lidocaine (anesthetic of choice; prilocaine) C - used with caution during pregnancy D/X - not to be used during pregnancy - Avoid ASPIRIN, TETRACYCLINE, ERYTHROMYCIN ESTOLATE
Hypomaturation-hypocalcified with taurodontism
AI - Type IV
Apert syndrome
AKA - Acrocephalosyndactyly
Moderate Sedation/Analgesia (Conscious Sedation)
A drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Minimal Sedation (Anxiolysis)
A drug induced state during which patient responds normally to verbal commands. Although cognitive and physical coordination may be impaired, airway reflexes and ventilatory and cardiovascular functions are unaffected
Moderate Sedation
A drug induced states where patient responds purposeflly to verbal commands
Switch from D to F film reduces radiation by how much?
A factor of 2
Children
A function of gender and age BMI >25 - overweight (10% or more over the ideal BMI 30+ = obese BMI 40 + = morbidly obese
Most common consumer sport product dental injury:
A large national survey confirmed the bicycle as the most common consumer sports product related to dental injuries in children, followed by playground equipment, other riding equipment (skates, inline skates), and trampolines.3 The use of the trampoline provides specialized training for certain sports.
Opsonization
A process in which antibodies contribute to immunity through: coating the surface of a pathogen to enhance phagocytosis
Beckwith-Wiedman Syndrome
A ridge in the forehead caused by premature closure of bones - METOPIC RIDGE
Standard deviation
A statistical measure of the average deviation of values from the mean in a sample
Codein
Acts indirectly on CNS (morphine acts directly on CNS) Principal pathway for metabolism of codeine occurs in the liver, although some metabolism occurs in intestine and brain
LAP in permanent dentition associated with which bacteria?
AA
Aggressive Periodontitis
AA A: localized 1st molars and incisors and not more than 2o other teeth - tetracycline or amoxicillin + metronidazole Generalized: 1st molars and incisors plus more than two other teeth
Adolescent =
AAP: 10 and up to 24 years. The American Academy of Pediatrics divides adolescence into three age groups including early (ages 11-14), middle (ages 15-17), and late (ages 18-21).
4-6 ounces of juice from day (from a cup, not sippie/bottle)
AAP: - Juice - should be consumed as occasional treat with scheduled meals and snacks - No juice before 1 year of age - For children 1-3 years o Limit juice to <4 oz with snacks or meals; fruit is preferred - For children 4 to 6 years o Limit juice to <6 oz with snack or meals - For children 7-12 years o Limit juice to 8 oz daily - Typical juice box is 6 oz with 22 g sugary (88 calories from sugar)
Mucopolysachharidosis type 2
AKA Hunter Syndrome MONGOLIAN SPOTS! (The Mongolian Hunter!) - Macroglossia · Progressive coarsening of facial features · Papular skin lesions · Macrocephaly · Short necks · Widely spaced teeth and enlarged tongue § Abnormal bones in the spine § CLAW HAND (difficult to perform regular and good hygiene) § Cloudy corneas § Deafness § Halted growth § Heart valve problems § Joint disease, including stiffness
DiGeorge/Shprintzen Syndrome
AKA Velocardiofacial Autosomal dominant; immune deficiency (thyme hypoplasia - decreased T-cell maturation) 50% hypocalcemia Cardiac defect Autosomal dominant § Deletion in chromosome 22q11.2 leading to 3rd/4th pharyngeal pouch maldevelopment; associated with cleft palate, cardiac malformations and dysmorphologic facial features § Thymic hypoplasia/agenesis leading to deficient T-cell maturation Developmental delay and learning difficulties are observed in 70-90% of patients with 22q11.2DS. In infancy, developmental milestones are achieved later than expected for age. Delayed language acquisition is often seen in older children.
Chediak-Higashi syndrome
AR; NYSTAGMUS; photophobia; oculocutaneous albinism - Giant granules in neutrophils, infections, oculocutaneous albinism - Caused by defect in microtubule polymerization
ASA Classification
ASA I - healthy/normal child ASA II - child with mild systemic disease eg. controlled asthma, controlled diabetes ASA III - child with severe systemic disease - active wheezing, diabetes mellitus w/ complications, heart disease that limits activity ASA IV - child with severe systemic disease that is a constant threat to life e.g. status asthmaticus, severe BPD, sepsis ASA V - child who is moribund and not expected to survive without the procedure e.g. cerebral trauma, pulmonary embolus, septic shock
Non-cyanotic
ASD, VSD, PDA, coarctation of aorta, aortic stenosis, pulmonary stenosis
What lab tests elevated after exposure to Hep B
AST after 2 months
Specificity
Ability to determine a true negative (FALSE POSITIVE = Type 1 error)
Sensitivity
Ability to determine a true positive (false negative = Type 2 error)
Disturbances in the bell stage result in
Abnormal structure of the dentin or enamel
Problem with zirconia crown
Abrasion of opposing teeth Parents generally satisfied with all 3 restoration types Overall satisfaction was zirconia crown > Strip crown > pre-veneered SSC
Photostimulable Phosphor Plates
Absorbs radiation and releases it as an electrical current; Contains barium doped fluorohalid
Precautions for systemic fluconazole for oral candidiasis
Absorption is decreased at increased gastric pH
Turner Syndrome
Accelerated eruption of teeth - specifically first molars Early eruption Posterior cross bite; Cystic hygroma -pathonomnic finding in utero
Loss of primary tooth AFTER age of 8 y/o
Accelerates eruption of successor
Hurler Syndrome
Accumulation of non-cellular material in parenchymal and mesenchymal tissues J-shaped sella turcica
Ferric Sulfate
Acidic pH (<1.0) - produces hemostasis Forms a protein complex and occludes capillaries Antibacterial against numors oral bacteria
6th generation
Acidic primer - thin it and place bond with no phosphoric acid etch...
Fixation followed by degeneration
Acidophilic zone of fixation Pale staining zone of atrophy - fewer cells & fibers Broad zone of inflammatory cells extend apically Mutaengeic and bactericial acitivty
Histologic zone of formocresol (FC)
Acidophilic zone of: fixation (coronal); pale staining zone: atrophy (middle); broad zone of inflammatory cells (apical)
Formocresol fixation
Acidophilic zone; pale staining zone of atrophy (fewer cells and fibers), broad zone of inflammatory cells
Bacteria that causes black stain on teeth
Actinomyces
Diazepam
Active metabolites (desmethyldiazepam) leads to long half life
Ectopic Maxillary Frist Molar
Active surveillance - less than 1-1.5 mm resorption -->2/3 spontaneously self-correct
Med consult indicated
Acute otitis media; recent tympanic membrane graft; acute severe head injury (intracranial pressure) Sickle cell disease (maintain oxygen saturation) Congestive heart failure Severe COPD (chronic hypercarbia)
Benign Tumors
Adenomatoid Odontogenic Tumors Ameloblastic Fibromas Compound Odontoma Complex Odontoma
Von Willebrand's Disease
Affected gene localized to chromosome 12
RMGI
After tooth preparation dentin conditioning varies according to manufacturer: Polyacrylic acid removal of smear layer Self-etching adhesive with light cure
Calculate daily caloric intake:
Age, sex, physical activity level
% of people missing third molars?
Agenesis of one or more third molars was observed in 25%, with a higher, although not significant, frequency in women (28.1%). ... Distribution showed a prevalence of 2 missing third molars (10.3%), followed by 4 (7.6%), 1 (5.8%), and 3 third molars (1.3%).
Gow-Gates Block
Aim towards trigs. Hit bone near condyle, back off and inject solution
Anatomic differences - pediatric vs adult airway
Airway narrowest at cricoid cartilage until 8 y/o (vs epiglottis) Larynx located more cephalic (C2-6 in a child vs C4-5 in an adult) Head and tongue proportionately larger in infants Floppy/long epiglottis Vocal cords angled upward, more anteriorly Short trachea, flexed neck Airway more reactive; infants prone to developing laryngospasm
Lateral nasal process
Alar portion of the nose
Dental lamina gives rise to
All teeth (primary and permanent
Eosinophils
Allergen reaction
Intruded Primary Tooth
Allow 2-6 mo for natural re-ruption. If it does not re-erupt at all in approximately 6 mo, extract or if primary rot tip is displaced towards permanent tooth bud
Halothane
Allows rapid induction used for maintenance Decreases tidal volume, increases respiration Decreases BP, no changes in HR
Amalgam
Alloy of: Silver (Ag) Tin (Sn) - critical to setting reaction, controls dimensional change Copper (Cu) - prevents corrosion, reduces fracture. Allows little corrosion to improve margin Zinc (Zn) - acts as a scavenger for oxygen, forming Zn oxide in place of Cu/Ag/Sn oxides (weaken restoration) Approximately 50% mercury (Hg) - wets alloy and initiates reaction (when >54% Hg, strength is reduced)
Glucagon
Alpha cells of pancreas (islets of langerhans)
Candidiasis in an immunosuppressed patient
Also see xerostomia
Voice control
Alteration in tone, volume and pace
Langerhans Cell Histiocytosis
Alveolar bone expansion occurs in mandible; may result in - pain, loose teeth, jaw fracture X-ray appearance of teeth = "floating in air" due to radiolucent areas in bone Precocious eruption or exfoliation fo primary teeth (early tooth loss) Gingival ulcers, oral ulcers
Gamma 2 Phase
Amalgam, purpose of tin in amalgam Gamma 2 (tin-mercury) phase = the weakest phase Highly corrodible Is eliminated by copper
Articaine
Amide with ester side chain - 90% plasma, 10% cytochrome p450
Dental trauma
Among 5 year old children, 1/3 have had trauma to primary teeth - most common is luxation; most common at 18-30 mo Among 12 yr olds, 20-30% have had dental injuries; most common is uncomplicated crown fracture; peak incidence at 9-10 years
If you have an allergy to beta lactase - give what?
Amoxicillin with clauvonic acid - CLINDAMYCIN
Adderall detromethamphetamine
Amphetamine CNS stimulant, xerostomia, potentiata TCA; MEPERINDE CONTRAINIDICATED (MA - says NO!) Increases blood pressure
Orthodontic Treatment
An overjet in excess of 3 mm is associated with an increased risk of incisor injury, with large overjets (>8 mm) resulting in trauma in more than 40% of children
Scardovia Wiggsiae; s. mutans; veiollonella parvula; S. Cristatus; Actinomyces gerenscerieae
Anaerobic culture found disease associated with these bacteria
Mature teeth <60 min avulsed
Ankylosis 71-84.4% over 1-10 yrs Inflammatory root resorption 27.6-41.5% over 1-10 years Tooth loss 1.9-50.3% over 1-10 years
Prognosis of immature teeth with dry time <60 minutes; physiologic medium at leaset 5 minutes
Ankylsois and inflammatory root resorption most likely. At 10 years 54% tooth loss
Maxillary Central Incisor
M/D crown width is typically greater than crown height
Squamous papilloma
Benign proliferation of stratified squamous epithelium MORE COMMON PLACE: tongue, lips, and soft palate Solitary lesion! Proliferation of keratinized stratified squamous epithelium in finger like projections with fibrous-vascular connective tissue cores
Cements for zirconia
Resin RMGI GI Ensure fill crowns form 3/4 full Cement all crowns at same time of same tooth type Remove excess cement
Treacher collins
Deformed pinnae, receiving chin, large fish-like mouth Mandible - small and short ramus; abnormally shaped Complete absence of ramus, glenoid fossa, and TMJ 60% dental anomalies: tooth agenesis; enamel malformation, ectopic eruption of first molars
In chemically polymerized resin-based composites, the initiator present in one paste of the two paste system is
Benzoyl peroxide - Chemically cured sealants set by means of a tertiary amine (activator), which is mixed with benzoyl peroxide, producing free radicals which initiations polymerization (if you don't use a light cure process
Platelet Quality
Bernard Soulier Syndrome - GP1B
Previous caries experience
Best and most consistent predictor of future caries Active decay and/or fillings and stainless steel crowns
Microabrasion
Best for isolated brown/white areas in otherwise normal enamel Enamel micro abrasion; hydrochloric acid (6.6%) in slurry of silicon carbide Microparticles (Ultradent) 1 mm thick increments. Apply heavy pressure with slow speed using polishing cup.
N2O
MAC 104% Blood/gas coefficient 0.47 - poorly soluble in blood Found in liquid and gas equiliriburm in pressurized cylinders Cylinder pressure (750 psi) is liquid gas equpiliburm until 3/4 released
Vit D deficiency and/or low calcium intake in children causes Nutritional Rickets (NR)
Disorder of defective chondrocyte differentiation and defective osteoid mineralization Vitamin D Status: Sufficiency > 50 nmol/L Insufficiency, 30-50 nmol/L Deficient <30 nm/L TOXICITY: 25 hydroxyvitamin D>250 nmol/L
Microabarasion
Best for isolated brown/white areas in otherwise normal enamel Enamel micro abrasion: hydrochloric acid (6.6%) in slurry of silicon carbide particles 0.1 mm thick increments. Apply heavy pressure with slow speed using polishing cup Follow with fluoride treatment Fluorosis is NOT good for ICON - just by one time application you can get nice results
Albuterol
Beta 2 agonist - bronchodilator - relaxes bronchial smooth muscle Corticosteroids - anti-inflammatory maintenance Flovent/PUlmicort; Leukotriene receptor antagonist - Singulair
Insulin
Beta cells of pancreas
Vit D
Better with Vitamin K2 (menanquinones) (safe and reasonable alternative to bisphosphonates to reduce bone loss
Posterior Superior Alveolar Nerve Block
Beware because in close proximity with maxillary artery so beware that you don't knick that!
Buffering capacity is main determinant of pH
Bicarbonate is major buffer and its concentration increases as salivary flow increases
Space maintainer ideal for bilaterally lost first molars in all primary dentition
Bilateral B&L - place LLHA once perm incisors present
Chondroectodermal Dysplasia/Ellis-van Creveld!
Bilateral manual postaxial polydactyly 40-50% cardiac defects Chondrodysplasia Occasionally congenital heart malformations Fusion of middle of upper lip to maxillary gingival margin 25% natal teeth
Mechanism of benzodiazepines
Binds to GABA receptor. GABA is inhibitory and increases chloride (-) to prevent depolarization
Supplemental O2
E-cylindres Contains 2000 PSI when full Should be replaced below 750 psi Time remaining estimate: PSI x 0.3/ L/min = time remaining in min
Meperidine vs. Morphine
Oral Morphine is about 10 timesmore potent than oral meperidine and about twice more potent as parenteral meperidine (mg for mg)
Pharmacokinetics
Oral abosrtipion - 30-60 mins Affected by presence of food Lipophoboic drugs are less absorbed than lipophilic drugs
Cornelia de Lange Syndrome
GERD (85%); beahvioral issues (self-injury, compulsive repetition, autistic-like behaviors); partial joining of second and third toes) Delayed eruption CLASS 2 DIVISION 1 PROGNATHIC MAXILLA W/ PROTRUDED MAXILLARY ANTERIOR TEETH
Activa
Bioactive materials Chemically bonds to teeth No Bis-GMA and no BPA derivatives Release calcium, phosphate, and more fluoride than glass ionomer (per ACTIVA product info) Reportedly greater deflection to break through composite or RMGI Light cure (20 sec), chemical cure (2 min)
Risk Factors
Biologic or etiologic factors that either cause or promote disease: Cariogenic bacteria; diet high in refined carbohydrate; hypo salivation
Erythromycin
GI issues
NPO Guidelines
Breast milk - 4 hours prep Non-human milk up to 6 hours Formula - up to 6 hours Clear liquids - up to 2 hours
Hyperdontia and osteomas of the jaw
Gardner syndrome
GIC Composition - Calcium or strontium alumino-fluoro-silicate glass and polyacrylica cid (water soluble)
Calcium and aluminion ions binds to polyacrylic acid, initiating a gel phase. Fluoride is released.
Glass Ionomer materials
Calcium fluoroaluminosilicate or Strontium Fluoroaluminosilicate glass powder Aqueous-based poly acrylic acid solution Suggested in situations where isolation is difficult Chemical bond with hydrogen bonds
Chemical Cure of Sealants (used to be done this way)
Chemically cured sealants et by means of a TERTIARY AMINE (activator) which is mixed with BENZOYL PEROXIDE, producing free radicals which initiates polymerization Unpolymerized monomer can increase potential for PULPAL IRRITATION and contribute to MICROLEAKAGE Some sealants contain filler - silicone dioxide microfill OR quartz,
Compomers
Resin matrix with fluoride release of glass ionomer Hydrophobic REQUIRES BONDING AGENT! Fluoride release is low Less retention than resin sealant
Glass Ionomer (GI)
Calcium fluorosilicate or strontium fluoroaluminosilicate glass powder Aqueous-based polyacrylic acid solution Suggested in situations when location is difficult Main mechanism of adhesion is mechanical and chemical bond Glass ionomer cement may be used as interim preventive agent when there are indications for placement of a resin based sealant but concerns about moisture control may compromise such placement
What is the initiator in composite:
Camphorquinone
In office Nonvital Bleaching
May apply carbamide peroxide cells with or without tooth access open May be used if the "walking bleach" techniques is not effective Usually requires 3-4 visits
Phenergan
Black box warning for fatal respiratory depression in children <2 years
Observational studies
May be prospective, retrospective, or cross sectional NO control No intervention
Camphorquinone
Camphorquinone has an absorbance range between 400 and 500 nm wavelength, with a maximum at 468 nm [84]. This is in the blue region of the visible spectrum, and is the reason that camphorquinone appears yellow in white light
Mercury
Can be passed through to fetus and detected in milk Amalgam separate is mandated!
Sotos Syndrome
Cerebral gigantism - facial features; learning disability and overgrowth ID and behavior issues (ADHD, compulsive behaviors, phhobias, obsessions), hypotonia; scoliosis, seizure, heart or kidney defects, hearing loss, and problem with vision PREMATURE ERUPTION OF TEETH
High level disinfection - destroys all microorganisms but not necessary all spores - liquid immersion
Chemical sterilant Glutaraldehyde Glutaraldehyde with phenol Hydrogen peroxide Hydrogen peroxide with paracetic acid
Hydroxyzine
May cause bronchodilator Possible extra-pyramidal activity yielding jerky limb movements NON-REVERSIBLE
Sterilization - Liquid Immersion
Chemical sterilant, glutaraldehyde, glutaraldehyde with phenol; hydrogen peroxide, hydrogen peroxide with paracetic acid Heat sensitive critical and sub-critical
N2O and Bleomycin
Bleomycin,ananti-neoplasticantibiotic, is frequently used in combinationwith other anti-cancer therapy in the treatment of malignant germcell tumors and malignant lymphomas,including Hodgkin'sdisease. Patients whoare receiving or havereceived bleomycintherapy are at increasedrisk of developingpulmonarytoxicity if admini- stered oxygen, and the resulting interstitial pneumonitis maybe fatal. Nitrous oxide-oxygenpsychosedationshould not be used in patients whohave received such therapy becauseof the highoxygencontentof the gasesusedin the inhalation sedation technique.
Main difficulty of RCT
Blinding issues
Reticuloendothelial System (RES)
Bone Marrow, liver, spleen - responsible for removing old or defective RBCs
Bone healing from pulp revascularization
Bone healing - 1.2 mm per month of periapcal bone regeneration/deposition
An IQ of 80 would fall into which of the following?
Borderline and slow learner
N2O Contraindicated in:
Chronic obstructive pulmonary disease SEvere emoțional disturbances Drug-related dependencies First trimester of pregnancy Treatment with bleomycin sulfate Methylenetetrahydrofolate reductase deficiency
N2O Effects
Circumoral numbness; tingling hands and feet
Macrolide antibiotics (erythromycin)
May elevate theophylline levels
Distal Shoe
Contraindicated in children at risk for infective endocarditis Requires incision site CI in patient with poor OH, lack of cooperation, or medical conditions
Peforated crowns can be patched with composite, GI, or RMGI
Resin patches may have greater microleakage
Growth magnitude and duration are greater for the anterior maxilla than the forehead but less than what?
Anterior mandible
Pacifier non-nutritive sucking habit:
Anterior open bite
Which predictor more likely results in TMD in children?
Anterior open bite An anterior open bite is a very common finding in patients with TMJ degenerative diseases.
Cri-Du-Chat
Anterior open bite, GERD
Roots of Primary Teeth
Anterior roots narrower M/D than B/L Branch directly from crown, with no identifiable root trunk Larger apical foramina, many accessory canals
2nd facial plan to complete growth
Anterior-posterior dimension
Clonidine
Anti-hypertension; xerostomia; potenitation CNS depression; arrhythmias
Discharge air and water for 20-30 seconds after each patient
Anti-retraction valves in water lines
Bias and Confounding
Any systematic error in a study which results in an incorrect estimate of the association between disease and exposure Confounding: results when there is a mixing effect of the exposure and disease with a "third factor
Crouzon
Aortic coarctation, PDA Normal intelligence Maxillary hypoplasia
Features of leukocyte adhesion deficiency
Appears immediately following eruption of primary dentition; rapid destruction of bone; patients have a history of other chronic infection (URI, otitis media, skin), highly acute inflammation Leukocyte surface glycoprotein defect resulting in poor leukocyte adherence
Rett Syndrome
Appears only in females and is characterized by multiple deficits following a period of normal functioning after birth Apraxia At onset, Rett's Disorder is characterized by deceleration of head growth, loss of purposeful hand skills, loss of social engagement and language, and poor physical coordination Gingivitis is the most common alteration of soft tissues
What to do to reduce drooling?
Appliances, botox, sever gland, redirect gland
Maxillary growth
Apposition of bone at sutures; displaces maxilla downward and forward Apposition of bone at maxillary tuberosity (increases arch depth) Resorption at anterior surface of maxilla (maintains position of anterior surface)
Rett syndrome
Apraxia - a disorder of brain and nervous system in which a person is unable to perform tasks or movement when asked, even though request is understood; willing to perform task;, etc. EXCESSIVE SALIVA DROOLING ID and learning ability; SEIZURES (up to 80%) Loss of social engagement; GERD
Meckels Cartilage
Arch I - mandibular arch (comes from that) - Mandibular process (first branchial arch) fuse in midline; maxillary process form from the mandibular arch which eventually fuse to form lip and nose Arch 2 - Reichart's cartilage comes from hat
Late Medial Shift
Arch length decreases - 2-3 mm in the mandible
Early loss of primary second molars
Arch length reduction - blocked out second premolar is result
Natal/neonatal teeth
Are rarely supernumerary teeth
Pre-pubertal growth peak
Around ages 6-7 y/o Pubertal growth peak - 11.5 y/o for females and 14.5 y/o in males Growth modification in female earlier than boys
Articaine
Articaine contains a thiopene ring with an ester group
Transverse Changes - Intercanine width
As incisors eruption push lateral so increase When permanent canines erupt in maxilla it erupts labially so erupt wider in maxilla so increase in arch perimeter bc increase in interning width Mandible - increase intercnaine width with incisors eruption but levels off Internacanine width is complete Mandible - 9-10 yrs of age (earlier for girls than boys Maxilla - 12 years in girls; 18 years in boys
What respiratory issue are they (patients with CP) prone to and why?
Aspiration pneumonia. Approximately 25 percent of children with CP struggle with aspiration (when something other than air is taken into the trachea or lungs.) Weakness or spasticity in the muscles of the digestive tract may also cause breathing problems, as that can contribute to aspiration.
Asthma
Aspirin and other NSAIDs should be avoided in aspirin sensitive people Approximately 10-28% of children with asthma may be intolerant to aspirin
Vitamin E Acetate
Associated with EVALI - may interfere with normal lung functioning
Adenomatoid Odontogenic Tumor
Associated with crown of unerupted tooth (especially canine)
Respiratory
Asthma (recent or frequent hospitalization, poor control) Recemtn pneumonia or other URI Chronic lung disease (Cystic fibrosis, COPD) Home O2 requirement
IgE Atopic Triad
Asthma, eczema, food allergy (may suggest IgE hyper responder caution)
Beyond 12 months, should meet requiemrents
At least 600 IU/d (15 ug)
Decrease in FRC increases incidence of what?
Atelectasis
Acyanotic Lesions
Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent ductus arteriosus (PDA), Coarctation of the Aorta, Aortic stenosis, pulmonary stenosis
Papillon-LeFevre Syndrome
Attachment and bone loss resulting in premature loss of primary and permanent teeth Inflammation can be severe May involve AA infection
3 years old
Attention span 4-8 minutes
4x more common in males
Autism
Know autism spectrum - difference between Aspergers, PDD, Rett syndrome
Autism Disorder - before age of 3 y/o in one of the following domains: 1. Social interaction 2. Communication 3. Restricted, repetitive and stereotyped patterns of behavior, interests and activities
Associated with increased paternal age:
Autism and Crouzon Syndrome
1st order bending of orthodontic arch wire bending achieves
BUCCAL/LINGUAL CORRECTION (horizontal forces)
Urinalysis - Renal function: best lab test for renal function
BUN Test = blood urea nitrogen Urea nitrogen is what forms when protein breaks down Creatinine in blood and urine - creating is a breakdown product of creatine, which is an important part of muscle
Seaparates cranium from face
Ba - NA
Immune Thrombocytopenia Purpura
Autoimmune disorder caused by an excessive destruction fo platelets by the spleen (sometimes need to remove the spleen bc that's where the platelets are getting killed) You Destry your own platelets... A considerable proportion of children achieve remission btw 6-12 mo ITP is diagnosis of exclusion. In most cases, no tx necessary
Feelings of shame develop from failure to develop which of the following?
Autonomy
Von Willberand Inheritance Pattern
Autosomal Dominant
Dentinogenesis Imperfecta (Hereditary opalescent dentin)
Autosomal dominant Type 1 - DI + OI (COL1A1, COL1A2) Type 2 - Isolated DI (1/8000) - DSPP Type 3 - DI of the Brandywine type - DI + pulp exposure Bulbous crown, normal size, constriction fo cervical area, short and slender roots, occlusal attrition
Treacher Collins
Autosomal dominant (TCOF1, 90%), Autosomal recessive (police gene, RARE)
Multiple Endocrine Neoplasia, Type 2B
Autosomal dominant; marfanoid body, narrow facies, full lips
Junctional EB
Autosomal recessive - blister formation within the LAMINA LUCIDA (generalized enamel hypoplasia) below the basement membrane Genetic mutation involving Collagen VII Dystrophic or absent nails (in dominant form) Scar formation (in recessive form) Normal life span
Cystic Fibrosis
Autosomal recessive disease affecting body secretory glands responsible for supplying mucous and sweat Newborn screening: immunoreactive trypsinogen (IRT), if positive repeats in two weeks, if positive again SWEAT CHLORIDE TEST (gold standard, but not always definitive) Median survival age = 40 years Digestive - pancreatic enzyme supplements Vitamin supplements - fat - soluble, A, D, E, K Iron supplements Increased caloric intake to 120-150% RDA Dental findings: INCREASED enamel defects DECREASED caries - may be related to oral antibiotics and/or elevated salivary pH Increased calculus Gingivitis Mouthbreaking/malocclusion Increased risk for candidiasis Treatment: Consultation with physician to assess patient ability to tolerate treatment in routine setting Short appointments - later in day because of mucous accumulations at night and increased coughing in morning
Cystic fibrosis
Autosomal recessive, affecting GI and respiratory systems Usually characterized by COPD, exocrine pancreatic insufficiency, and abnormally high sweat electrolytes In addition to thickened sputum and pancreatic enzyme dysfunction, males often have azospermia secondary to obstruction of the vas deferens by thickened secretions
Cystic Fibrosis
Autosomal recessive, salty tasting skin, CFTR gene mutation; Immune reactive tyrsinogen (IRT) positive test; repeat in two weeks. If positive again, sweat chloride test is gold standard
Chediak Higashi
Autosomal recessive; severe gingivitis and periodontitis; Oculocutaneous ALBINISM Photophobia Nystagmus, peripheral neuropathy recurrent inf neutrophils with giant granules
Leukocyte Adherence deficiency
Autotomsal recessive; steam cell transplant; OH routine, antibiotic therapy, eco of affected teeth
Microhybrid vs. Flowable
Average <1 um (1000 nm) typically 70-80% filler) Flowable - 45-75% filler
Munchausen Syndrome by Proxy
Average age at time child presents: 27 years Most are in healthcare related field Perpetrator with history of child maltreatment Psychological dx: personality disorder, depression, and factitious disorder toward self
Peutz Jeghers
Axial freckling + perioral & intraoral macules + intestinal polyps = Autosomal dominant, high risk of cancer
Liver transplant, which med will result in leukopenia?
Azithromycin (thrombocytopenia, leukopenia, anemia)
A patient has received a liver transplant. Which of the following medications will result in leukopenia?
Aztithropine (AZA) - thrombocytopenia, leukopenia, anemia
Remaining dentin thickness
Bacteria in cavities with RDT < 0.25 mm results in more severe pulp inflammation than when RDT is greater Best to have >0.5 mm
Formocresol
Bactericidal
Management of Apnea
Bag-mask ventilation --> reposition airway-->perform jaw thrust--> everything else the same as obstructed airway
Remodeling
Balance of apposition and resorption
Which injury is most frequently associated with dental injuries in 7-12 year olds?
Baseball
Airways of Pediatric vs. Adult
Based on cadaveric studies, it has been a commonly held belief that the pediatric airway is funnel-shaped with the narrowest portion of the airway being found at the level of the cricoid. This was contrasted to the adult airway, where the narrowest portion is the glottis and the airway is described as cylindrical.
Tanakta and Moyers
Based on lower incisors
Time from apnea to onset of hypoxemia is function of aunt of O2 in functional residual capacity
Basis for oxygenation patient prior to GA intubation and for O2 supplementation during sedation Obese children and adults have reduced FRC and despite preoxygentation, Weill experience significant desaturation within 3-4 minutes
Which sport is most frequently associated with dental injuries in 13-17 year olds?
Basketball
Handheld X-ray System
Battery as source of energy. X-rays who are leaving handheld - weaker than x-rays leaving wall mounted so less scatter radiation. 0.28 uSv vs 7.86 uSv for wall mounted
Child's airway is challenging
Because AIRWAY RESISTANCE!
Basement membrane or basal lamina
Becomes DEJ; interaction btw epithelial and mesenchymal
No juice
Before age 1 y/o
Oral Electrical Burns and Treatment
Begin commissural splints 5-10 days after burn Deliver appliance w/I 14 days Wear appliance for 24 hours for minimum of 6-8 mos (put to 12 mos) Younger children = worst outcome Eschar: necrotic tissue that sloughs off 7-10 days later
Prevention of ECC
Begins during pre & peri-natal periods
Complement system
Belongs to innate immune system. Why do we have complement? Is any systemic condition associated with defective complement system? Primary deficiency of C1q, C1r, C1s or C4 is closely linked to development of systemiclupus erythematosus (SLE) or rheumatoid arthritis (RA), thought to be due in part to the inability of complement to clear immune complexes and dying cells.
Local allergic reaction in the office
Benadryl 1-2 mg/kg q6h for 24 hrs IM epinephrine 1:1000 0.01 mg/kg due to hyper IgE
Males
Benign cementoblastoma Autism Ewing sarcoma
Painful lesions
Benign cementoblastoma (pulp vitality unrelated but involved tooth often painful) Ewing's sarcoma - swelling, pain, loose teeth, paresthesia ,and trismus are clinical features with this tumor
Unilateral posterior cross bite is one of the most frequent malocclusions in the deciduous and early mixed dentitions, with a reported incidence of 7% to 23%. In the early stages, such crossbones are associated with a lateral functional shift of the mandible in approximately 80% of the case
Both statements are true.
Pubertal Growth Spurt
Boys - 11-17 y/o Girls - 9-15 y/o Serial cephalometric tracings taken 6 months apart can be superimposed to ensure growth has taken place Hand wrist radiograph can determine when growth of long bones is complete and faoial growth also likely finished
Primary effects of LA complications
Bradycardia and myocardial depression
Neural crest cells
Branchial arches -->arches I - mandibular arch --> mandibular and maxillary process Arches II - VI
Treatment options for ectopically erupting molars
Brass ligature; Humphrey appliance; halter man appliance
Hydrogen peroxide, carbamide peroxide, sodium perborate
Breakdown of hydrogen peroxide is accelerated (breakdown of pigments) within the teeth by heat, the addition of sodium hydroxide, or light 10% carbamide peroxide = 3.3% hydrogen peroxide Know about 1/3 strength 38% carbamide peroxide = 13% hydrogen peroxide Meta-analysis - showed no significant difference in color change with or without light
Children with URI have an irritable airway and are at increased risk for laryngospasm, bronchospasm, posintubation croup, pneumonia, and episodes of desaturation
Bronchial hyperactivity may last 4-6 weeks after an URI; it is recommended to delay treatment for at least 6 weeks. If urgent emergency surgery is necessary a LAM may reduce complications associated with an irritable airway
Kidney problems - Renal Failure
Brown tumor = hyperparathyroidism; kidney problems, scattered multinucleated giant cells
Phosphate buffer system
Buffer capacity from pH 8 to pH 6 and mostly UNSTIMULATED SALIVA
Buffered LAs
Buffered LAs were more likely to achieve successful anesthesia than nonbuffered LAs (in adult participants with pulpally involved teeth) However with IAN may not make huge difference in teeth w/o pulpal involvement NO statistical difference in mean onset or in injection pain for IAN for non-pulpally involved teeth No diff in anesthesia success, speed on onset, pain of injection for non-pulpally involved teeth and for IAN block.
Primary functions of saliva:
Buffering ; cleansing action; maintenance of saliva that is super-saturated in calcium phosphate Aids in remineralization
Floating Tooth appearance
Burkitts lymphoma Leukemia Langerhans Cells histiocytosis (disseminated and localized
8 weeks in utero vs 12 weeks
By 8 weeks, cartilage of chondrocranium has been to develop (endochondral ossification) By 12 weeks, the midline cartilage has begun to ossify and the bones of the cranial vault, maxilla, and mandible have begun to form by intramembranous ossification the
Maxilla
By age 9 or 10 slows down in terms of AP growth of maxilla Mandible - follows general - at puberty when grow in height, mandible will start to catch up to maxilla
Early colonization of S Mutans are associated with...
C-section
CPR
CAB (compressions, airway, breathing) Start compressions within 10 secs of recognition of cardiac arrest. Rate of 100-120 bpm Ratio of 30:2 breaths for single rescuer for adults and child and 15:2 if two rescuers for child Rescue breathing (adults 10-12/min q5-6 secs) (child - 12-20/min q3-5 secs) Advanced airway 10/min (6 sec) Deep compressions Adult - at least 2 inches Adolescent 1/3 chest, 2 inches Infants - 1.5 inches To check pulse: >1 yr = carotid < 1 yr = brachial or femoral Foreign Body Airway Obstruction: > 1 yr = abdominal thrust < 1 yr = back slaps and chest thrusts
Study of early childhood caries using culture-independent approach found that Actinomyces species may be important in caries INTIATION
CARIES INITIATION
Universal Precautions
CDC
Main neurotransmitter of pain in the pulp
CGRP
What neuropeptide is most common in the pulp
CGRP (calcitonin)
Glass Ionomers bonding to enamel & dentin via what mech
CHELATION. Requires proper DENTIN conditioning. Polyacrylic acid removes smear layer
Associated with swelling of major salivary glands?
CHX, Catecholamines, Iodine compounds (not erythromycin)
Cariogenic Bacteria: Gram + Cocci Gram - Cocci
COCCI:Non mutans and mutans streptococci RODS: Actinomyces and lactobacillus
CPP-APP Uptake into Tooth and Remineralization
CPP-ACP = MI Paste = Toothmuse No Fl present Mechanism: calcium phosphopeptide binds to amorphous calcium phosphate and stabilizes it On acid challenge, calcium and phosphate ions are release thus maintaining a supersaturated mineral environment It reduces demineralization and enhances remineralization
Radiation dose of CBCT vs. regular radiograph vs CT scan
CT > CBCT > Regular radiograph
Marfan Syndrome
CT disorder affecting skeletal system; arachnodactyly (spider-like fingers); Chest that sinks in our sticks out (pigeon breast) Hypermobile joints MITRAL VALVE PROLAPSE; aorta may stretch or become weak (aortic dilation or aortic aneurysm) Dental findings: high arched plates; narrow jaws; crowding (important to ask about congenital problems (heart valve hyper elastic = may qualify for antibiotic prophylaxis) Small lower jaw (micrognathia)
Mineralizing plural medicament
Ca(OH)2
Calcification/Eruption Times Permanent Teeth
Calcification begins at: M1 - Birth CI - 3-4 mo LI - MX - 10-12 mo; MD - 3-4 mo Canines - 4-5 mo PM1 - 18-24 mo PM2 - 24-30 M2 - 30-36 mo M3 - MX - 7-9 yrs; MD - 8-10 yrs Crown (enamel) complete at: M1 - 30-36 mo (same time that M2 beginning to calcify) CI - 4-5 yrs LI - 4-5 yrs PM 1 - 5-6 yrs Canines - 6-7 yrs PM 2 - 6-7 yrs M2 - 7-8 yrs
Calcium
Calcium >500 sufficient Insufficient 300-500 mg/d Deficient <300 mg Birth -6 mo - 200 mg/d 6 mo - 12 mo - 260 mg/d Children >12 mo - 500 mg/d
GIC cement
Can cause POST-OP SENSITIVITY due to low initial pH and relatively slow set
Children age 4 y/o
Can draw - line, circle, cross, square (NOT TRIANGLE)
Flumzenil
Can lower seizure threshold and may lead to sympathetic stimulation 0.01 mg/kg 20-30 minutes only
Continuous variables
Can only have number values (no "gaps) between numbers. Adding and averaging makes sense with these variables. Comparison of means (t-test and ANOVA) correlation, and linear regression are most often used. Examples: probing depth, BMI, viral load, etc...
PVS
Can release hydrogen, so generally recommended tow air 60 minutes before pouring impression (fine detail reproduction, high tear strength and high elastic recovery)
Rocuronium
Can render birth control ineffective
Oral complications of bone marrow transplant
Candidiasis, mucositis, herpetic infection, and xerostomia
Early loss of primary first molars
Canine and incisor dislocation towards the extraction site (1.5 mm in mandible Medial movement of primary second molar (1 mm in maxilla) Mesial eruption of maxillary first premolars (blocked out canines)
Reliable and valid
Cant be valid without being reliable
Erythromycin...contraindicated with which seizure medication?
Carbamazepine (Tegratol) Erythromycin interferes with liver microsomal metabolism of carbamazepine, causing decreased carbamazepine clearance, an elevated serum carbamazepine level, and clinical toxicity. Erythromycin-induced carbamazepine toxicity usually manifests as drowsiness, lethargy, ataxia, vomiting, and nystagmus.
Azithromycin
Cardiac
Pierre Robin Sequence
Cardiac Defects
During GA, the myocardium is sensitized to epinephrine
Careful using LA when using halogenated gas
Vertical Caries Transmission
Caregiver (mother) to child
S Mutans
Cariogenic Properties: Acidogenicity - ability to produce acid Aciduricity - ability to grow at low pH respectively Adherence to teeth Metabolism - Lactic Acid and Extracellular Polyglucose
Cartilage growth
Cartilage grows by INTERSTITIAL and APPOSITIONAL
The Nasal Septem Theory
Cartilage is primary target of genetic activity Cranial base, nasal septum, mandibular condyles drive growth
Retrospective studies
Case Control
Calcium Hydroxide
Catalyst paste - CaOH2, zinc oxide, zinc stearate in ethylene toulein sulfonamide Base paste - calcium tungstate, calcium phosphate, zinc oxide in glycol salicylate
CYP450 system
Catalzyed in the liver CYP450 enzymes (CYP3A4 and CYP2D6) - Hydrocodone, oxycodone, codeine Herbal medicine - inhibition of CYP450 system: St. John's wort, Ginkgo, ginger, Ginseng, Garlic = increased or decreased medication (midazolam, cyclosporine, tacrolium)
Local Anesthetics Durin gPregnancy
Category A - Adequate and well-controlled studies have failed to demonstrate risk to fetus (NaF) Category B - either 1 - adequate and well controlled studies failed to demonstrate a risk but animal studies have shown adverse effect OR human studies are lacking but animal studies have failed to demonstrate risk - (Lidocaine and Prilocaine) Category C - No adequate and well-controlled studies have been performed in pregnancy women, but animal studies are lacking or have shown risk to fetus. Potential benefits may warrant use despite potential risk
Herpangina
Caused by Coxsackie virus A Typically spreads via the fecal-oral route or respiratory droplets Sore throat and high fever = COMMON
Third Hand Smoke
Causes cognitive defects
CaOH not for pulpotomy on primary teeth
Causes internal resorption
More radiosensitive cells
Cells with high mitotic rate Those cells who undergo many future mitosis Cells with very primitive differentiation
What is the sign of good healing in avulsed teeth?
Cemental Healing
Mesenchyme of dental follicle
Cementoblastoma
Dental sac gives rise to
Cementum and PDL
Steiner Analysis
Cephalometric analysis useful in evaluating the degree of maxillary and mandibular incisor protrusion relative to the surrounding skeletal structures Position of maxillary and mandibular incisors is related to Nasion-A point (N-A) and Nasion-B point (N-B) lines using both angular and linear measurements
Cerebral Palsy
Cerebral palsy (CP) is caused by abnormal development of the brain or damage to the developing brain that affects a child's ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases. The brain damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child's life, while the brain is still developing. Congenital CP CP related to brain damage that happened before or during birth is called congenital CP. The majority of CP (85%-90%) is congenital. In many cases, the specific cause is not known.
Skinner
Changes in behavior are a result of individual response to events (stimuli) in the environment (i.e. a reinforcer strengthens desired response)
Nonvital Bleaching
Changes in enamel, dentin or pulp can cause alteration in light transmission through the tooth Endo procedure are initiated due to pulpal issues that can cause staining Endo materials can causes staining when it wasn't there before
Which of the following indicates renal failure?
Characterized by decreased GFR; most valid; increased BUN; increased serum creatinine; decreased creatinine clearance; proteinuria Oral changes: - Pallor of mucosa/anemia - Red/organe discoloration of mucosa (carotene-like pigments) - Xerostomia, parotid infections and candidiasis - Ammonia-like breath odor (high urea content) - Metallic taste - Uremic stomatitis (red burning mucosa covered with grey exudate that may ulcerate) seen with high BUN levels - Petechiae and ecchymosis Osseous changes - lytic bone lesions among others Hemodialysis can lessen the severity or reverse many of these changes
Stickler Syndrome
Characterized by distinctive facial appearance, eye abnormalities, hearing loss, and early-onset arthritis Related to Pierre Robin Sequence CT disorder; bone, heart defects, eyes, ears CP, bifid uvula,
Carisolve
Chemomechanical removal of carious dentin gel based chemic-mechanical caries removal system (0.95% sodium hypochlorite soon and a gel containing three amino acids (glutamic acid, leucine, lysine), sodium chloride, Na-CMC Sodium hypochlorite provides a pH of 11 and purified water acts as a vehicle May lead to excess caries removal if IPT is the goal NOt routinely taught in dental schools
Multinucleate Giant Cell
Cherubism, Noonan like syndrome, neurofibromatosis type 1, Browns tumor (hyperparathyroidism)
Dichotomous Outcomes (categorical)
Chi Square test; Mantel-Haenzel Test, Logistic Regression Odds ratios
Alone breast milk is NOT cariogenic
Child at decreased risk for large number of acute and chronic diseases
Modified Maintenance of Wakefulness Test
Child remains awake in a darkened calm environment for 20 minutes
Piaget
Child's cognitive structure increases in sophistication with development from innate reflexes (sensorimotor, preoperational, concrete operations, formal operations)
Acetaminophen
Children <12 years: 10-15 mg/kg/dose every 4-6 hours as needed (maximum 75 mg/kg/24 hours, but not to exceed 4.0 g/24 hours) Children >12 years and adults: 325-650 mg every 4-6 hours OR 1,000 mg 3-4 times/day as needed (maximum 4 g/24 hours)
Hand Schuller Christian
Children > than 3 years old Diabetes type 1 Osteolytic lesions Exopthalmus
Airway
Children with OSA may have altered mu receptors and requires less opioid med Increased airway resistance Relatively larger head, tongue and epiglottis Narrow nasal passages (obligate nasal breathers) Significant lymphoid tissue possible Larger head to body size ratio Less developed mandible
Sedation with Developmental Delay
Children with developmental delay have been shown to have a 3x increased incidence of desaturation compared with children without developmental disabilities
Papillon Lefevre
Chromosome 11 abnormality; premature exfoliation of primary and permanent teeth; disease of periodontium; may involve Aggregatebacter actinomycetomitans; Cathepsin C gene deficiency Tx: oral hygiene routines; antibiotic therapy and extraction of affected teeth have been used with variable success Pitting hands and soles (palmoplantar keratoderma) Loss of bone attenuation + premature loss of teeth (AA, bacteroides, fusobacterium)
The chromosome associated with localized form of aggressive localized periodontitis?
Chromosome 4 Higher in AA, no systemic dz, no plaque AA in combo with Bacteroides like species
Cri-Du-Chat Syndrome
Chromosome 5 deletion syndrome; monotone, weak, cat-like cry Microcephaly, high arches palate, poor laryngeal muscle Tonge, micrognathia, hypertelorism, low nasal bridge, epicentral folds, distinctive palmar creases
Asthma
Chronic airway inflammation Altered wall morphology Smooth muscle spasms are secondary
Atopic Dermatitis (
Chronic dermatitis characterized by pruritic and relapsing inflammation Uncontrolled itching and rash takes chronic appearance of lichenification and hyperpigmentation without erythema Affects infants/young children along the extremity extensor surfaces, cheeks, forehead and neck
Hepatitis B Surface Antigen
Chronic hepatitis B
Hepatitis B - IgG
Chronic infection
Clark's Rule
Clark's rule is an equation used to calculate pediatric medication dosage based on the known weight of a patient and a known adult dose of medication to be used. Clark's rule equation is defined as the weight of the patient in pounds divided by the average standard weight of one hundred fifty pounds multiplied by the adult dose of a drug equals the pediatric medication dose, as is demonstrated below: (Weight* divided by 150 lbs.) x Adult Dose** = Pediatric Dosage.
RMGI Indications
Class 1 and Class II for primary teeth Permanent teeth with Class V lesions NO NEED FOR CAVOSURFACE BEVELING! Not good long-term evidence for permanent teeth restorations with RMGI Dovetail recommended for increased duration/durability of restoration RMGI - has LESS WEAR RESISTANCE and lower fracture strength than resin composite
Mercury
Class 2 from FDA 9some risk due to possible harm from mercury content 3 forms: Elemental - liquid at room temp, used in amalgam Organic - most dangerous - and ethyl mercury - formed in water or soil by bacteria and can build up in fish Inorganic - enters air from mining or deposits, burning coal, waste, manufacturing. Generally exists in solid state Elemental and inorganic mercury can be converted to methyl mercury intramurally by bacteria
Medial step molar relationship should bemonitroed for which type of malocclusion
Class III
Hemifacial microsomia
Class III malocclusion
Pfieffer Syndrome
Classified as craniosynostosis. Categorized by maxillary hypoplasia; parrot notes, brachycephaly, crowded dentition Pfeiffer syndrome is a rare genetic disorder characterized by premature fusion of certain skull bones (craniosynostosis), and abnormally broad and medially deviated thumbs and great toes. Most affected individuals also have differences to their midface (protruding eyes) and conductive hearing loss. Abnormal growth of these bones leads to bulging and wide-set eyes, a high forehead, an underdeveloped upper jaw, and a beaked nose. More than half of all children with Pfeiffer syndrome have hearing loss; dental problems are also common. In people with Pfeiffer syndrome, the thumbs and first (big) toes are wide and bend away from the other digits. Unusually short fingers and toes(brachydactyly) are also common, and there may be some webbing or fusion between the digits (syndactyly).
Mucous
Clear - thin - healthy/normal White/gray - thick/cloudy - onset of nasal congestion or viral infection/cold Yellow - thick - immune cells arrive, fight, die & are carried off in the mucus turning it yellow Green - Even thicker - higher concentrations of immune cells as attack intensifies Red - frothy - presence of blood - may indicated serious condition
Robin sequence
Cleft palate
Oro-facial-digital syndrome
Cleft palate, fine hair, and polydactyly (coarse hair)
Persistent viral infections
Defect in T-cells
Cleidocranial dysplasia
Deficient cellular cementum
Randomization
Clinical
Children who received composite had worse self-reported psychosocial functioning
Clinical maladjustment Emotional symptoms Personal adjustments
Neurofibromatosis
Coast of California Enlarged fungiform papillae 70% with oral involvement Lisch nodules --> brown pigment iris Neurofibrosarcoma-->malignant - multiple café-au lait macules and pigmented neurofibromas
McCune Albright Syndrome (AKA polyostotic fibrous dysplasia)
Coast of Maine Precocious puberty; endocrine dysfunction --> decrease calcium; increase phosphate in blood Bone pain § McCune-Albright Syndrome - large café-au lait macules, endocrine disease (precocious puberty), polyostotic fibrous dysplasia (radiograph = ground glass) - Poorly defined margins, ground-glass appearance; progresses from radiolucent to radiopaque - Albright syndrome (polyostotic fibrous dysplasia)
Prospective studies
Cohort (all experimental)
Protiens in pulp
Collagen - Type I and III are main subtypes Elastin in wall of arterioles
Complications of Primary tooth trauma
Color change - 53%; Premature tooth loss - 46%; pulp canal obliteration - 36%; Pulp necrosis - 25%
Pulp Canal Obliteration
Color change alone is not predctor of pulp necrosis Total PCO more likely Mohave necrosis Endo indicated if: PA lesion, p ain to percussion, negative EPT test
ETA Phase
Combination of Copper and Tin
Dental findings of Patients with Cerebral Palsy
Common Dental/Oral Findings: - Cerebral Palsy: o Periodontal disease o Dental caries/poor oral hygiene o Malocclusionsàanteior open bite, Class II o Bruxism o Increased dental erosion s o Hyepractive bite reflex o Increase gage reflex o Increased drooling
Pulp canal obliteration
Common occurrence following root fractures
To accommodate for incisor liability...
Compensation for incisor liability in primary dentition - interdental spacing (allows room for permanent teeth to come in and maxillary primate space Compensation for incisor liability: - Interdental spacing - Labial eruption of permanent incisors - Increased inter canine width (canines move distally) - 4 mm in maxilla and 2-3 mm in mandible
Adrenal disorders
Complications from stress in sedation ...inborn errors of metabolism would not be good either...
Polyacid modified
Compomer
Compomer handing vs. Composite handling
Compomer > composite handling
Resin Infiltration
Components: Icon etch = 15% hydrochloric acid Icon dry = ethanol Icon infiltrant = methacrylate based resin matrix, initiators, adhesives Indicators = noncavitated E1-D1 lesions
Hertwig's Epithelial Root Sheath
Composed of inner and outer enamel epithelial without stratum intermedium and stellate reticulum Root sheath loses continuity once first layer of dentin laid down Remanants persists as rest of Malassez Inner layer of root sheath induces dental papilla cells to become odontoblasts that secrete dentin Dentin forms and adjacent root sheath disintegrates Induce dental follicle cells to cementoblasts
Bonding agents are REQUIRED for...
Composites and composers (photo-initiator must be cured
Accepting social norms
Concrete operations
Delayed gratification
Concrete operations
Starts as cartilage and undergoes endochondral ossification
Condyle or sphenoid-occipital suture
Beckwith Wiedman Syndrome
Congenital growth disorder causing large body size, large organs (KIDNEYS, LIVER, SPLEEN), and other symptoms (ridge of forehead - metric ridge - is closed) Enlarged fontanelle (soft spot) Large size (90%) WILMS TUMOR Best time for tongue surgery = 3-6 months
Pre-eruptive hematologic disorders
Congenital hyperbilirubinemia -- biliary atresia = green teeth Congenital erythopoeitic porphyria Alkaptonuria
Reliable but NOT valid
Consistent results but not in the bulls eye
Non-critical
Contacts intact skin; radiograph head
Semi-critical
Contacts mucous membranes or non-intact skin Dental mirror; re-usable dental trays
Benign cementoblastoma
Continuous with root, which is resorbed
Naproxen
Contraindicated in breastfeeding - choose other NSAID if possible, some serious neonatal reactions reported and has long half-life
Build up after pulp therapy
May include composite into canal space, glass fiber-reinforced posts, orthodontic wire bent into an omega shape
Midazolam Interactions
Contraindicated with: Paradoxical reaction possible Reversible binding to CNS GABA receptors Alpha hydrazine midazolam metabolite may contribute to sedative effect Caution with: grapefruit juice erythromycin, clarityrocmyin Azole antifungals, ketoconazole, itraconazole Antivirals/indinavir, nelfinavir, ritonavir Some antidepressants (fluoxetine, fluovaxamine, trazodone) Valproic acid Narrow angle glaucoma (increased intraocular pressure CALCIUM CHANNEL BLOCKERS (verapamil and diltiazem) inhibits CYP3A enzymes required for midazolm metabolism, increasing bioavailability
Meperidine INteractions
Contraindicated: MAO inhibitors, SSRIs, TCAs (seizure/HTN crisis) with seizure disorder (proconvulsant active metabolite) Severe asthma (histamine release)
Triazolam
Contraindication: low amount of albumin proteins in the blood. psychotic disorder. suicidal thoughts. alcohol intoxication. drug abuse. depression. myasthenia gravis, a skeletal muscle disorder. chronic lung disease.
Nitrous Oxide Contraindications
Contraindications: - Moderate to severe asthma - Current respiratory infection - Acute otitis media (blocked eustachian tube) or recent middle ear surgery - Chronic obstructive pulmonary disease - Severe emotional disturbances - First trimester of pregnancy - Methylenetetrahydrofolate reductase deficiency - Severe psychiatric imbalance - Precooperative - Mouth breathers - Treatment with bleomycin sulfate - Cobalamin (vitamin B-12) defiency
Three different sealants were placed on extracted human molars after acid etching
Control-no bonding agent; adhesive Adper Single Bone Plus, Peak Universal Bond, Prime & Bond Elect. 1/2 of each adhesive group was cured, half not cured prior to sealant placement. Takeaway - teeth with uncured adhesive exhibited significantly lower bond strength than those were adhesive was cured prior to sealant placement
Most common injury in mucosa in children
Contusion (Contusion > laceration > scaring > bite marks)
A patient with Apert's Syndrome experiences premature closure of which suture?
Coronal suture Craniofacial Dysostosis Type I (Crouzon, Pfeiffer) Crouzons - maxillary hypoplasia Aperts - Class III; open bite; cerebral palsy in 30% of patins
Dens in Dente
Coronal type - enamel organ infolding into dental papilla
Down Syndrome
Correlated with severity of neutrophil chemotaxis defect
Treatment for Habit Cessation
Counseling; reminder therapy; reward system; adjunctive therapy
Crouzon's Syndrome includes
Cranial synostosis, hyperteloris, exophthalmos, and external strabismus, parrot-beaked nose, short upper lip, hypoplasic maxilla, and relative mandibular prognathasim
Latex allergy should avoid
Cross reactivity with BACK MCT - banana, avocado, chestnut, kiwi fruit; Mellon, tomato, passion fruit, celery
Taking a picture of moment in time
Cross sectional studies
Microdontia
Crouzon Syndrome Chondroectodermal Dysplasia Ectodermal Dysplasia Down Syndrome Hemifacial microsomia Pituitary Dwarfism Williams syndrome
Morphodifferentiation
Deficient development: Microdontia; peg lateral; mulberry molars; Hutchinson incisors; absence of cusp or root Excessive development: Macrodontia; tuberculated cusps; Carabelli's cusp; taurodontism; dens in dente; dens evaginates; dilaceration; gemination; fusion; concrescence
RMGIs
Cure by light, self, and resin cures Acid base polymerization supplemented by resin light cure polymerization Demonstrate "triple hardening" - Initial curing of light sensitive resin - Chemical resin cure GI acid/base neutralization matures over time (3rd one occurs in all GIs)
Radiographic crieriez categorize D1 inter proximal lesion as Initial
D1 - = initial lesion
HPV; Herpes
DNA virus
Retropharyngeal Space
Danger space - located behind the true retropharyngeal space Boundaries: superiorly by the skull base Anteriorly by the alar fascia Posteriorly by the pre-vertebral fascia Ends at the level of the diaphragm
Dantrolene MOA
Dantrolene depresses excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor 1, and decreasing intracellular calcium concentration. Ryanodine receptors mediate the release of calcium from the sarcoplasmic reticulum, an essential step in muscle contraction.
Fertilization to implantation
Days 0-14 - cell division (proliferation)
Steroids (prednisone)
Decrease inflammation, decrease lymphocytic systemic activity, increase appetite
Barbituates have which of the following effects not he myocardium?
Decrease myocardial contractility Induces VASODILATION and REFLEX TACHYCARDIA Indirectly INCREASES HEART RATE (reflex tachycardia) by inducing vasodilation
Beta 2 agonist
Decreased in salivary flow by 20-35% associated with increased # of lactobacilli (involved involved in caries)
Tin
Decreases strength and expansion and lengthens the setting time
Extractions are not recommended in patients that are brachycephalic/deep bite
Deepens bite
Duchenne's Muscular Dystrophy
Degeneration of muscle fibers, no cure/treatment X-linked Fatal-die before 30 delayed eruption of permanent dentition Predisposition to malignant hyperthermia so for paralytic agent CANNOT USE Succinylcholine. MUST USE MIVACURONIUM (short acting neuromuscular blocker) Although most affected boys are not intellectually disabled, the risk of cognitive impairment is increased in DMD patients. Therefore, up to 30.0% of patients have intellectual disability with a FSIQ of less than 70, including around 3.0% of them with severe impairment and FSIQ of less than 50
Premature birth <37 weeks and sedation - higher risk
Delayed airway development Early life intubation - possible pulmonary barotrauma - Increased incidence of laryngeal stenosis
Moisture contamination in amalgam
Delayed eruption
Cleidocranial Dysplasia
Delayed eruption, supernumerary teeth, mandibular prognathism (Class III), absence of clavicles
Gardner's
Delayed eruption; supernumerary teeth; osteomas of the jaw Autosomal dominant; epidermoid and dermoid cysts Supernumerary teeth and delayed eruption
Mask with reservoir
Deliveres FiO2 of about 60%
Factors that predict future caries
Demineralized or caveated lesions of enamel or dentin (WSL,which is a carious lesion) Stained occlusal pits or fissures
Ferric Sulfate
Denatures protein & forms a ferric ion complex that occludes cut blood vessels
2nd hand smoke effects
Dental caries in primary Enamel hypoplasia in primary and perm teeth Prenatal exposure to second hand smoke is associated with cognitive defects
Dental cartridge allergy
Dental cartridge with vasoconstrictor contains sodium (meta)bisulfite as an antioxidant Local anesthetics without vasoconstrictors are unlikely to cause reactions in patients with metabisulfite allergies (sulfites are found in wines and added to some foods (dried fruit, cheese) as preservatives There should be no cross-allergy
Which of the following determines the timing of alveolar bone grafting for cleft palate patients?
Dental development
Safety
Dental materials contribute to very low level BPA exposure for up to 3 hours after treatment... BPA is not used as formula ingredient in dental materials BPA can be releasesed in small quantities as materials are broken down by salivary enzymes BPA is a trace material left over from manufacture of Bis - GMA and Bis-DMA. Residual BPA
Mesoderm is responsible for
Dentin and pulp
Lidocaine toxicity
Depresses mycoardium Bradycardia Peripheral vasodilation Hypotension CNS-Biphasic Excitation followed by depression Tinnitus, tremor, change in vision, speech Lidocaine toxicity causes sinus bradycardia because lidocaine increases the effectivenesse refractory period relative to the action potential duration and lowers cardiac automaticity. The bradycardia is followed by impaired contractility, massive peripheral vasodilation, hypotension, and possible cardiac arrest Lidocaine may be used to treat premature ventricular contractions (PVCs)
Merging of two medial nasal processes
Derivates tip of the nose, columella, philtrum, primary palate (4 upper incisors)
Stimate Nasal Spray
Desmopressin acetate Hemophilia A, von Willebrand's disease (type I) Stimate® Nasal Spray contains 1.5 mg/mL desmopressin acetate in an aqueous solution at a pH of approximately 5.0. Stimate® Nasal Spray's compressionpump delivers 0.1 mL (150 mcg) of solution per spray. It is chemically defined as follows
Mesenchyme
Determines morphology
How do we know when growth will occur
Dev age-->biological age-->morphologic/skeletal/dental/cicrumpubertal
Antepartum dental radiography and infant low birth weight
Develops subclinical hypothyroidism
Teething
Diarrhea GERD Otitis Media Paroxysmal atrial tachycardia >101F - not attributed to teething - look for other causes
Alignment
Diastema - goes into aunt of spacing or crowding that you see
Sealing over caries
Did you have any pre-celebrations at all with your grandparents/parents in town also? Following sealant placement, dentinal lesions have been shown to be arrested Retention rates of sealants over sound and carious tooth surface are similar Difficult to determine the depth of fissure caries without opening the groove
Is drooling a result of excessive salivation?
No - it is a result of hypotonicity of muscles, decrease parasympathetic rx (increased parasympathetic = increased drooling ("rest and digest"
TMD
Difficult to determine due to subjectivity. 11.9% in adolescents, increasing with age. 16% for clinical signs and 14% for sounds. Onset correlated with puberty in girls. Gold standard for imaging: MRI Initial exam - panoramic Osteoarthritis 5-7% TMD require treatment The association of skeletal and occlusal factors and the development of TMD is weak Skeletal open bite, steep articular eminence of the temporal bone, OJ >6-7 mm, skeletal class II profile, class III malocclusion, unilateral posterior crossbite, posterior crossbite Mandibular range of motion less than 40 mm should be considered limited mobility Less than 8 mm lateral movement considered limited mobility Protrusive movement less than 5 mm considered limited mobility
Periosteal tissues
Difficult to modify
Hematologic disorders
Difficulty/issues with nasoendotracheal intubation... Is it possible to mange bleeding disorder with hematologist so they can have local injection...of not have to consider anesthetic
Gingival overgrowth drugs
Dilantin/phenytoion (anticonvulsant); Valproic acid (anticonvulsant), nifedipine/verapamil (calcium channel blockers); cyclosporine (immunosuppressants)
Resin Based Composited
Dimethacrylate oligomer such as Bis-GMA and UDMA larger molecule = less polymerization shrinkage and better properties over all Sioloraine monomer has been added to some composites. Cleaves molecular rings, gains space and counteracts volume shrinkage TEGDMA - low viscosity resin, added as dilutent BisEMA-6 - larger oligomer
Goldnehar Syndrome (oculo-auriculo-vertebral syndrome/hemifacial microsomia)
Diminished to absent parotid secretion - anomalies in function or structure of tongue 1st and 2nd branchial arches Diminished to absent parotid secretion; anomalies in function or structure of tongue
DTaP
Diphtheria, tetanus, acellular pertussis vaccine Given to infants and children age 2 mo, 4 mo, 6 mo, 15-18 mo; a fifth shot or booster dose is recommended between age 4 and 6 years Injection in the anterolateral thigh muscle
Immunization schedule - first dose of DTaP
Diptheria, tetanus, and acellular pertussis vaccine Given at 2 mo, 4 mo, 6 mo, 15-18 mo, 4-6 years Booster given at 11-12 years
Behavior Guidance: Fair Evidence
Direct observation modeling Positive reinforcement Nonverbal Memory restructuring Parental Presence/absence (To gain child's cooperation) Escape Guided Imagery Rhetorical Questions Coercing Coaxing Non-specific praise Giving Explanation Reassurance Punishment/belittling/humiliating Denying/ignoring
50%
Discontinue non-nutritive sucking habit by 24-28 mom of age
Alginate
Disinfect by immersion ONLY disinfectants with short-term exposure time (no more than 10 mins) Recommended disinfectants: chlorine compounds OR iodophors Comments: short term immersion in glutaraldehyde has been shown to be acceptable as well
Vit D deficiency
Disorder of defective chondrocyte differentiation and defective osteoid mineralization
Achondroplasia
Disproportion large head to body size; maxillary hypoplasia; disturbed genesis of teeth Disturbed development (partially formed); disturbed eruption; shape abnormalities
ICON
Dissolution
AP CHANGES
Distal step - class II Flush -- - convert to class 1 - 56% Class 2 - 44% Medial step - converts to class I - 68% - convert to class II - 13% - Converst to class III - 19%
Behavior Guidance: Excellent Evidence
Distraction Hypnosis
Dental Age
Does not correlate with developmental age; variations in timing of eruption Methods of staging--canine calcification and development of third molars
External validity
Does study subject represent definable population of interest? i.e. your patients?
Root formation
Doesn't complete until 2-3 years after tooth eruption OEE + IEE = hertwisg's epi root sheath guides shape and number of roots Breakup of HRS allows cells of dental sac to contact root dentin and differentiates into cementoblasts to lay down cementum
Y axis
Down's analysis - from Frankfort horizontal to to mandibular plane angle
Lesch Nyhan Syndrome
Dramatic and extreme loss of tissue - Hallmark - look very skinny Self mutiliation, excess uric acid
Adverse Sedation Events
Drug dosage more influential than drug choice Lack of appropriate monitoring Very young (<3 y/o) at greatest risk 41% involved local anesthesia overdose Dental office (vs hospital/surgery center) was listed in majority of claims
Deep Sedation/Analgesia
Drug induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
General Anesthesia
Drug induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. Cardiovascular function may be impaired.
Soft Tissue Injuries
Due to biting on electrical cord; consult/coordinate with plastic surgeons Expect sloughing of eschar in 7-10 days Appliance needed to minimize wound contracture Oral Electrical Burn: fixed commissure appliance delivered 10-14 days after injury Appliance worn for 6-12 months
Hypoplastic permanent tooth
Due to occurrence AFTER birth
Chrondroectodermal Dysplasia (Ellis Van Crevald)
Dwarfs, polydactyly, ED - Nails, teeth natal teeth, 50% heart defects
Epidermolysis Bullosa
EB Simplex - most common - Autosomal dominant; Junctional EB - severe form - autosomal recessive Scarring is common; blistering of hands/feet/mouth Vesiculobullous disease of skin and mucous membrane Enamel hypoplasia in junctional form of EB), Fibrous acellular cementum; excess cellular cementum
Intermediate - destroys vegetative bacteria and the majority of fungi and virus - Liquid contact
EPA disinfectant with label claim of tuberculocidal activity Chlorine containing products Quaternary ammonium compounds Types of patient care item: non-critical visible blood Environmental surfaces: clinical contact surfaces; blood spills
Low Level - destroys vegetative bacteria and the majority of fungi and virus BUT NO inactivate mycobacterium bovis - liquid contact
EPA disinfectant with label claim of tuberculocidal activity; Chlorine containing products; Quaternary ammonium compounds Type of patient care team - non-critical; NO blood Environmental surfaces - Clinical contact surfaces
New amalgam has Copper
ETA phase Cu6Sn5 oxidizes and transforms into CuCl2 and CuO2, taking twice as much time (2 years) to produce a similar marginal seal
Stable thermoplastic for sports guard
EVA (ethylene vinyl acetate)
Supplemental O2
Each L/min via cannula increases FiO2 by 4%
ICDAS - Initial lesion (ICDAS 1 or 2)
Earliest clinically detectable lesion compatible with mild demineralization. Lesion limited to enamel or to shallow demineralization of cementum/dentin. When established and active, lesions may be white or brown and enamel has lost its normal gloss. D1 = INITIAL LESION!
Ear bruising
Early sign of child abuse (TEN torso, earns neck under 4 y/o)
Primary Germ Layers
Ectoderm - enamel - epidermis (skin), oral mucosa Mesoderm - skeletal muscle Endoderm - lining of the gut (pharynx) Neural crest: where dose the neural crest come from? CT proper cartilage, cartilage, bone, dentin, cementum, pulp, PDL
Jobes Syndrome - AD Hyper IgE
Eczema, recurrent skin and pulmonary infections Over-retained primary teeth Dental anomalies Ectopic eruption or non-eruption of perm teeth Susceptible caries and fungal infections Mucosal plaques and fissures Constriction of palate
Efficacy vs Effectiveness
Efficacy - potential to provide clinical benefit Effectiveness - benefit provided in routine "real world" use. Measured in surveillance systems (registries), after market incident reports, etc.
When to do alveolar graft - canine
El Deeb et al - recommended that grafts be placed between 9 and 12 years of age when the canine root is one quarter to half formed.
HCT Dental Considerations
Elective dentistry MUST be postponed until immunological recovery --> 9-12 months after HCT PMNs at this time will be almost zero and ANC will be ANC -- if emergency care than defer and they will need antibiotic prophylaxis
X-ray
Electromagnetic radiation of great penetrating power produced by bombardment of substance usually a heavy metal by a stream of high velocity electrons usually in a vacuum tube.
Concomitant hyper and hypodontia
Ellis Van Creveld
Which of the following have natal teeth association?
Ellis-van Creveld syndrome, Pachyonychia congenita (Jadassohn-Lewandowsky), Hallerman-Streiff Syndrome
Fragile X (Martin Bell Syndrome)
Elongated face (vertical maxillary excess; Larger testes (macroorchidism) Intellectual disability; seizure disorder Severe malocclusion and severe occlusal wear
Origins of Enamel, dentin and pulp
Enamel develops from the enamel organ, which is derived from ectoderm, whereas dentin and pulp develop from the dental papilla, which is derived from mesoderm.
29% of teeth had soquelaetraumtized
Enamel discoloration most common defect Intrusion most common injury causing defect Injury at 1 year most often caused sequelae
ICDAS 5 or 6
Enamel is fully caveated and dentin is exposed. Dentin lesion is deeply severely demineralized
Primary molars
Enamel thinner; Relatively greater dentin thickness over occlusal fossa Enamel rods clope occlusally
Maxillary Growth Modification
Encourage maxillary growth in the AP Create tension in circus-maxillary
Garres Osteomyelitis
Garre's osteomyelitis is a distinctive type of chronic osteomyelitis associated with gross thickening of the periosteum of the bones and peripheral reactive bone formation resulting from mild irritation or infections. The condition is seen exclusively in children or young adults.
Fluoroapatite
Endogenous acids have a pH of 1.2 well below the critical pH for fluoroapatite (FAP) (fluoride was ingfested systemically when teeth were developing making teeth stronger and more resistant to acid) and hydroxyapatitie (HA) dissolution - FAP has two main advantages over HA - Fluoride acts as a catalyst, assisting in the remineralization enamel with phosphate ions dissolved in saliva - The displacement of hydroxide with fluoride removes a weakness in HA to lactic acid
The 4 components of effective motivational interviewing are:
Engaging, focusing, evoking, and PLANNING (EF - EP)
Neurofibromatosis
Enlarged fungiform papilla Oral neurofibromas, hyperplasia of soft and oral tissues associated with bony hypoplasia; malposiitioned teeth; intrabony lesions Wide inferior alveolar canal - related to nervous system
Pediatric vs. Adult Airway
Epiglottis is long and flopy Increased airway resistance Larynx/Glottis (vocal cords) positioned more ANTERIOR and CEPHALAD (C2-C6) in child than adult (C4-5) Relatively LARGER TONGUE and EPIGLOTTIS A larger head to body size ratio Mandible is LESS DEVELOPED Potential for significant lymphoid tissue obstructing; nasopharynx, oropharynx, laryngopharynx Larynx of infants is funnel shaped VS adult which is cyndrical in shape In children younger than 5 y/o or 10 y/o the narrowest part of pediatric airway is CRICOID CARTILAGE; in adults the narrowest part of airway is THE GLOTTIS OPENING Narrow nasal pasage (obligate nasal breathers) Children with OSA may have altered mu receptors and may require less opioid meds Airway more reactive - more likely to develop laryngospasm
Epstein Pearl
Epithelial inclusion cyst Visible cysts in 80% of newborns Mid palatal raphe
What is seen with bulimia nervosa
Erosion of palatal enamel of maxillary incisors Buccal erosion of molars & premolars Unilateral or bilateral parotid gland enlargement
Inhalation oral side effects (albuterol inhaler)
Erosion, crenation of the tongue, ulcers, moderate generalized gingivitis, decrease salivary flow, increased calculus/gingivitis
Herpes Simplex
Erythema multiform
Kawasaki Disease
Erythema of the oropharynx Bloodshot or red eyes (without pus or drainage) Strawberry tongue, white coating not he tongue or prominent red bumps on the back of the tongue Skin rashes not he middle of the body, NOT blister-like Peeling skin in the genital area, hands, and feet (especially around the nails, palsy and soles) Joint pain and swelling, frequently on both sides of the body
Papillon Lefevre
Erythematous hyperkeratosis of the palms and soles - autosomal recessive; severe inflammation; premature loss of primary and permanent teeth
Communicating with Children
Establishment of Communication Establishment of the Communicator Message clarity (mediated generalization (hop in the chair); discrimination) Voice Control
Human trafficking
Estaimted >100,000 children are victims of prostitution in US each year Average age is 12; may be as young as 6 25% may still be seen by health care professionals Both boys and girls are victims of trafficking
Resin Technique
Etch enamel for 20-30 seconds, dentin no more than 15 seconds Rinse, leaving dentin moist to prevent collapse of exposed collagen network Bond should be in contact for at least 15 seconds for most adhesive systems 0.5-1 mm flowable composite liner to decrease voids at cavosurface of cavity margins 2-4 mm increments of conventional composite at a time Best contact for back-back restorations can be achieved by completing one restoration at a time Dovetails are recommended on F/L of primary canines and on primary incisors Most RBC systems have 1 - 5.7% polymerization shrinkage (newer composite have lowered this) vs. amalgam 0.2% shrinkage
Activa Technique
Etch prepared teeth for 10 sec Use bonding agent in non-retentive cavity preparations Dispense directly into preparation and allow material to be in contact for 20-30 seconds before curing May be applied in increments up to 4 mm (20 sec cure btw each layer) Can be used in sandwich technique ACTIVA without primer/bond agent = 24% failure!
Which of the following agents is associated with highest incidence of nausea and vomiting in the post-operative period? Etomidate, propofol, ketamine, clonidine
Etomidate - associated with high incidence of nausea and vomiting. Although ketamine can cause nausea and vomiting, incidence is much lower. Propofol has antiemetic effects at higher doses Clonidine (for tx of anti-HTN, vomiting, or ADHD) has lower incidence of post-operative nausea and may be beneficial in treatment of cyclical vomiting syndrome
MRI
Evaluates the hydrogen content of tissues and uses a magnetic field to differentiate among different tissue types. There are more hydrogen atoms in soft tissues than in cortical bone, useful in soft tissues.
87% of parents advocated dental treatments to save a primary tooth...
Even if chances of success were only 50%
Hurler Syndrome
Evertred lips, large tongue, small malformed teeth, hypertrophied alveolar ridges and gums
HR and Pulse-OX
Every 5 minutes
Bite Marks
Every bite marks that shows indentations should have a POLYVINYL SILOXANE IMPRESSION made immediately after swabbing the bite mark for secretions containing DNA Written observations and photographs should be repeated DAILY FOR AT LEAST 3 DAYS to document the evolution of the bite
Resting salivary pH varies between patients...
No caries activity pH can be 7.0, but those with high caries can be 5.5
Hypercementosis
Excessive deposition of cementum on roots Supraerupted tooth after opposing tooth loss Periapical inflammatory lesions Hyperocclusion or fractured Paget's disease Hyperpituitarism Smooth or irregular enlargement of root with lamina dura and PDL space
Digit non-nutritive sucking habit:
Excessive overjet
Dental findings from substance abuse
Excessive tooth decay, excessive tooth wear from grinding/clenching Xerostomia Hypersensitive teeth
Cold test
Excites intradental A fibers
Disadv of cohort
Expensive, long term,
25% of school children; 33% of adults
Experienced trauma
Hierarchy of Research Designs
Experimental designs > cohort studies > case-control designs > human trial without controls > descriptive studies > case reports > personal opinion
Prothrombin Time
Extrinsic pathway: II, V, VII, IX, X, Vitamin K 1-18 secs
Modified Glasgow Coma Scale
Eye opening (4), Verbal response (5), Best motor response (6); (EVM)
Glucose 6 Phosphate Dehydrogenase Deficiency
FAV Syndrome - can't eat fava beans Need to avoid antimalarials and sulfonamide antibiotics Causes hemolytic attack: jaundice, cyanosis, headache, fatigue, hemoglobinuria Greater tendency to develop methemoglobinemia and Methylene blue is not very effective in patient with G6Pd deficiency Use Mepivicaine as anesthetic of choice.
Best survival rate for ALL
FEMALE
Aperts, Crouzon, Pfeifer
FGFR Gene Fibroblast growth factor receptor 2 gene Example of expressivity in clinical genetics
TMJ composed of
FIBROCARTILAGE
FMX (rectangular)
FMX (rectangular) - 0.035 mSv - equivalent background radiation (days) - 4 days Bitewing (F-speed) 0.005 mSv - 0.6 days
Downs Analysis
Facial Angle - N-Pog & FH - determines mandibular growth Y Axis - S-Gn and FH (determines vertical growth patterns) Mandibular plane = tangent to Lower mandibular border & FH = 22 is normal angulation Normal facial angle + large angle of convexity = protrusive maxilla and normal mandible
2nd pharyngeal arch
Facial nerve; Richart's Cartilage; Stapes, Stylohyoid ligament, styloid process of temporals, superior hyoid body Muscles of facial expression: frontal; obicularis ores; buccinator; platysma; posterior digastric
Treacher Collins
Facial nerves affected; ectopic eruption of 1st molar; Enamel malformation; Normal intelligence
Changing from a D to F speed film reduces dose by what:
Factor 2
Rectangular collimation reduces radiation by a factor of what?
Factor of 4-5
Risk indicators
Factors that are MODIFIABLE by the individual or by the dentisT: Poor oral hygiene Inadequate fluoride exposure Freq of btw meal carb snacks Inadequate saliva (due to meds or medical conditions) Recreational drug use Radiation Therapy
Hyperhomocysteinemia
Homocysteine is an amino acid produced when proteins are broken down. A high homocysteine level, also called hyperhomocysteinemia, can contribute to arterial damage and blood clots in your blood vessels. High homocysteine levels usually indicate a deficiency in vitamin B-12 or folate.
Aneurysmal bone cyst
Honey combed
Odontogenic myxoma
Honey combed
Aggressive periodontitis
Familial aggregation; rapid loss of attachment and bone; patients are otherwise health Phagocyte abnormality...progression may be self arresting Microbrial deposits inconsistent with severity of perio destruction (decreased plaque)
Diabetes
Fasting blood glucose >126 mg/dL Glycosulated hemoglobin (HbA1C) > 6.5% Glucose tolerance test (GTT) at 2 hours of 200 mg/dL Target HbA1C for well controlled diabetes = 7.0% Treatment in consultation with pt's physician: Oral hypoglycemic agents usually continued day of surgery Short actein insulin may be discontinued Long acting insulin may have reduced dose Intraoral an dpostoperative assessment of blood glucose
Predisposing factors for Necrotizing Perio Dz
Febrile - debridement + antibiotics (metronidazole and penicillin) Factors that predispose children to NPD include VIRAL INFECTIONS, MALNUTRITION, EMOTIONAL STRESS, LACK OF SLEEP AND SYSTEMIC DISEASES
Cleft lip and palate obturator
Feeding and speech
SLE
Females - Systemic lupus erythematosus - steroids, other immunosuppressive agents, antifungal agents
Coagulant
Ferric sulfate
Lamina dura thinner in childre
Fewer trabecular and LARGER MARROW SPACES There is smaller amount of calcification greater blood and lymph supply and the alveolar crest appears flatter
Marfan Connectiv eTissue
Fibrillin 1. This mutation results in increased TGF-beta
Pulp cells
Fibrobalas are most frequent cell type (able to general odontoblast-like cells; many are undifferentiated (stem cells)) Macrophages - involved in signaling pathways, activated by inflammation Dendritic cells - induce T-cell dependent immunity T-lymphocyte Mast cells - rare in normal pulp, common in CHRONICALLY INFLAMED PULP
The most common cell found in the pulp
Fibroblast
Displacement of Teeth
Fibrous Dysplasia Ameloblastic Fibroma Acute Lymphocytic Leukemia Melanotic Neuroectodermal Tumor Central Giant Cell Granuloma (root resorption) Central ossifying fibroma (root resorption also) Juvenile Ossifying Fibroma (root resorption also) Displacement of teeth - 1: - Fibrous Dysplasia - Melanotic neuroectodermal tumor of infancy - Hemifacial hyperplasia - premature exfoliation and eruption of teeth - Peripheral ossifying fibroma - Leukemia - mobility of teeth - - Peripaical cyst (radicular cyst) - Cementoblastoma - Central ossifying fibroma - Juvenile ossifying fibroma - displacement of teeth, root divergence, root resorption Dentigerous cyst (can move and displace along with resorb adjacent teeth) Nasopalatine Duct cyst - Causes roots of central incisors to diverge and occasionally root resorption occurs) Adenomatoid Odontogenic Tumor (Displace rather than cause resorption of adjacent teeth) Ameloblastic Fibroma (may cause displacement of teeth; late finding = cortical expansion) ALL - displacement of unerupted teeth but no expansion
Epidermolysis Bullosa
Fibrous acellular cementum Excess cellular cementum
Maxilla > Mandible:
Fibrous dysplasia Radicular cyst
Giant Cell Fibroma
Fibrous tumor probabUly UNrelated with chronic trauma (difference w/ traumatic fibroma) Female; mandibular gingiva affected 2x/as often common differential = papilloma. Lesion occurs in younger age compared with irritation fibroma Slightly female predilection; mandibular gingiva is affected 2x as often as maxillary gingiva. Palate is also a common place. From histopathology perspective, hallmark is presence of fibroblast within the superficial connective tissue. Treatment is conservative surgical excision.
Composite crowns
First restorative choice of 46% of pediatric dentists for incisors (2010) - Durability is major concern -Retention 80% at 24-36 months
Malignant Hyperthermia
First sign = tachycardia Autosomal dominant Increased CO2, Increased HR, increased BP, muscle rigidity, increased temperature Hyper kalemia --> arrhythmias
Phagocytes
First steps of the innate immune response Recognized pathogen associated molecular patterns (PAMPs) Microbe-associated molecular patterns (MAMPs)
Alveolar Grafting
Fix this before bone grafting - NA molding
Fluoroapatitie has two main advantages over hydroxyapatite
Fluoride acts as a CATALYST assisting in the remineralization enamel with phosphate ions dissolved in saliva The displacement of hydroxide with fluoride removes a weakness in HA to lactic acid
Remineralization with fluoride
Fluoride alone results only in surface remineralization. Fluoride with phosphate and calcium ions however can PENETRATE DENTIN Saliva is critical for remineralization as it both acts as a vehicle to transport fluoride ions into the demineralized enamel and acts as a reservoir for calcium and phosphate ions
Improving enamel crystallinity is the mechanism of action for which agent?
Fluoride tablets/drops
General Features of Primary Dentition
Flush terminal plane molar relationship; dental arches ovoid in shape; deep bite present initially that changes to edge-to-edge Flat curve of Speed
Neurologic-epilepsy/seizures
Focal (seizure activity starts in one area of brain)-->focal (retains awareness; sensory; motor; autonomic; psychic Focal (altered awareness; dyscognitive) Generalized - seizure activity involves both hemispheres of brain --> absence; tonic clonic; myoclonic; clonic; tonic; atonic
Important nutrient fo the pregnant adolescent:
Folate, Vitamin B6, B12, Calcium, Zinc Total energy needs for a pregnant woman = 2500 kcal/day
Etiology of Spina Bifida
Folic acid deficiency (most common); maternal insulin dependent diabetes; maternal obesity
Hemangiomas
Follow trigeminal nerve when extra oral You are BORN WITH THAT!
Mouthguards
Football, ice hockey, field hockey, lacrosse, wrestling (in high school if wearing ortho appliances)
Contaiminated articles of protective clothing (gowns, lab coats, etc.) should be laundered using
Hot water laundry cycle
Simple bone cyst (bone lesion)
No effect on surrounding teeth (no displacement and no resorption) Associated with FIBROUS DYSPLASIA or CEMENTO-OSSEOUS DYSPLASIA
Remineralization
For formation of FAP, for every two fluoride ions, ten calcium ions and six phosphate ions are required. Inadequate calcium and phosphate can limit the remineralization process.
IDEAL BODY MASS
For overweight patients
Vagal nerve stimulator
For people who have seizures that don't respond well to medications, this can lessen or make them less severe
2nd branch of trigeminal nerve passes through which foramen?
Foramen rotundum
Growth Hormone
No effects on dental development
Tanakka Johnson
No need for radiograph for tooth analysis
Dens in Dente
Forms during morphodifferentiation
Peripheral Giant Cell Granuloma
Found only in gingiva FEMALES! Usually distal to incisors RED OR BLUE BROAD-BASED MASSES May cause BONE RESORPTION! Bone changes more likely in peripheral ossifying fibroma! Histology - see multinucleate giant cells
Static Reference Lines
Frankfort horizontal (porion to orbitale) Pteryoid vertical (FH) - from FH through distal radiographic outline of pterygomaxillary fissure (Ptm)
Asthma - severe
Frequent night symptoms, poor exercise tolerance, wheeze daily
First Transitional Period
From age 6-8 y/o - eruption of first permanent molars; replacement of incisors
Adolescent growth spurt
Frontal bone, brow, nose, and chin become more prominent Lowering of palatal vault Vertical maxillary growth is often greater in females
Cranial Base
Frontal bone, parietal bone, temporal bone (squamous portion), greater wings of sphenoid bone, squamous portion of occipital bone Bony replacement primarily at synchondroses (cartilage-lined contact areas) Spheno-occipital considered principal growth cartilage of cranial base and only one remaining active during childhood growth period
Cranial Base
Frontal bone; sphenoid bone; temporal bone; occipital bone Spheno-occipital Synchondroses - cartilage joint between bone...can continue to promote growth ... continued hyperplasia and hypertrophy nd extracellular matrix. Growth moves outwards. Growth goes outward. That would be what's happening at cranial base. Driven by cartilage growth
Mesenchyme
Fronto-nasal process (MF - mesenchyme - fronto-nasal)-->medial nasal process --> globular process OR mesenchyme --> frontonasal process --> lateral nasal process
Which material had highest increase in surface roughness?
Fuji IX
Hurler and Hunter
Full lips
Williams Syndrome
Full lips, cardiovascular, supravalvular aortic stenosis, infantile hyperacalciemia, outgoing personality; intellectual disability; hoarse voice; Stellate pattern in the iris; hypodontia; enamel hypoplasia; prominent lips; wide mouth
Necrotizing Ulcerative Gingivitis (NUG)
Fusiform bacteria, spirochetes, HHVs Predisposing factors: vitamin deficiencies, compromised immune function, stress, poor oral hygiene, cigarette smoking, viral infections (HIV, EBV, measles)
Concresence
Fusion after root formation Traumatic injury or crowding Pre-extraction x-ray check Maxillary molars; 3rd molar & supernumerary teeth
G6PD
G6P deficiency- don't give aspirin
Symptoms of LA Overdose
Generalized tonic-clonic seizures CNS depression Hypotension Bradycardia Respiratory depression
Stickler Syndrome
Genetic disorder of CT; joint hyper mobility; vision problems - retinal detachment; hearing problems - conductive hearing loss; sensorineural hearing loss; otitis media Maxillary hypoplasia; narrow dental arch; malocclusion; sub mucous cleft; bifid uvula; high arched palate
Atopy
Genetic tendency to develop the classic allergic diseases (hay fever, asthma)
Complex odontoma
Ghost cells
Cyclosporine
Gingival hypertrophy; release interleukin II
Positive Reinforcement
Given appropriate social feedback (facial expression, tone of voice, appropriate physical contact) to reward desired behavi ors
Glasgow Coma Scale...recommendations against using which of the following stimulation
Glasgow Coma Scale
Pfeiffer Syndrome
Glaucoma
3rd pharyngeal arch:
Glossopharyngeal nerve, inferior hyoid
Molecular markers of Localized Ag Perio
Glycoprotein GP-110 low; adherence receptors on enutraotphisl and monocytes such as LFA -1 and MAC - 1 are NORMAL
Mandibular Plane to Sella-Nasion Plane
GoGn - SN angle - normal = 32 DEGREES
Erythopoiesis
Human red blood cell production. Stimulated by erythropoietin (in kidney). RBC - continuously produced in red bone marrow by committed stem cells. 7 day process to form to maturity. Lifespan = 120 days. SICKLED RBC LIFESPAN - 12 DAYS. Bone & abdominal pain.
Freud
Humans are fixated on different objects throughout developmental stages
Langerhan Cell Histiocytosis
Gold standard for diagnosis - biopsy
Medical Experiences - Adultified child
Gone through chronic illnesses - have perseverance or grit and will do well
Hybrid
Good for anterior and posterior blend of 40 nm and small particles 200-300 nm Optimum handling and optimum durability
Adv of Cohort
Good info of risk favors, Allows risk to be expressed as incidence
Furcation radiolucency
Granulomatous inflammation - proliferative inflammation with cystic potential GRanuloma + epithelium or furcation cyst when radiolucency following pulptoomy - recommend extractions
Third pharyngeal arch
Greater 1/2 of the hyoid, lesser part of the body of the hyoid
Fasting Obese patients
Greater gastric fluid volume and lower fluid pH Increased risk of gastric regurgitation in obese patients Increased risk for aspiration pneumonitis if gastric fluid reaches lungs
Isoflurane
Greater incidence of laryngospasm, coughing Used for maintenance
Bonded RESIN cement for cementing SSC
Greater tensile strength and retention with least micro leakage, but may have practical drawbacks due to isolation concerns Lightly filled composites, similar to pit/fissure sealants Used extensively in all-ceramic most for esthetic dentistry/veneer
Maxillary 1st molar
Greatest dimension B/L 4 cusps (2 distal cusps small)
Secondary Hyperparathyroid
Ground glass
The Veau Classification - cleft palate
Group 1 - defects of the soft palate only Group 2 - defects involving hard and soft palate Group 3 - defects involving soft palate to alveolus, usually involving the lip Group 4 - complete bilateral cleft
In oral cancers, which strain of human papilloma virus is of primary concern?
HPV 16
Both girls and boys with HIV are at increased risk of developing genital and anal HPV
HPV lesions in oral cavity re more frequent
Erythema Multiforme
HTypically mild, self-limiting and recurring mucocutaneous reaction characterized by target lesions of the skin and mucous membrane Great variability btw episodes Typical age between 7 and 21 years. More FEMALES than MALES EM is characterized by symmetrically distributed skin lesions HSV is infectious agent in 60-70% of cases EM drugs precipitate some cases of EM (sulfonamides, NSAIDs, PNC, etc., trimethorpim-sulfamexhazole
Verruca Vulgaris
Hands common place, oral lips and anterior tongue
Necrotizing periodontal disease
Harbor high levels of spirochetes and P. Intermedia
Dentinogenesis Imperfecta Type II
Has characteristics similar to Dentin Dysplasia
Primary molar roots
Have less constricted apical foramina
Evaluate Continuously
Head position; breath sounds; chest movement; patient color (late stage development)
Treacher Collins
Hearing loss, coloboma of the lid, micrognathia, microtia and other deformity of the ears, hypoplastic zygomatic arches, and macrostomia
Generalized Aggressive Periodontitis
Heavy accumulation of plaque; P. gingivitis; T. Denticola, alterations in immunologic factor IgG
Multiple painless, sessile, white papule located on mucosa, tongue, palate, or gingiva caused by human papillomavirus
Heck's disease (focal epithelial hyperplasia) · Heck's disease (HPV 13 and 32) is multifocal epithelial hyperplasia with numerous lsightly raised, minimally keratinzed papules in labial or buccal mucosa; cobblestone appearance
Macrodontia
Hemangioma Hemihypertrophy of face Pituitary gigantism
Methemoglobin
Hemoglobin 4 ferrous ions associated with 4 heme groups. Methehmoglibinemai oxidize those groups which determine how severe methemoglobinemia is. Alters molecular shape Binds WATER INSTEAD OF OXYGEN! SIGNS OF HYPOXIA ARE SEEN WHEN BLOOD LEVELS ARE BETWEEN 15-20%. Under that percent probably not something that's clinically appreciable.
Adapative (acquired) immunity
Humoral immunity (antibodies) and cellular immunity (cytotoxicity)
Chronic Hepatitis B
Hepatitis B Surface Antigen and Antibody to Core
Which form of hepatitis can be transmitted by a needle stick and presently has no immunization?
Hepatitis C
Caries-Risk Assessment Form for 0-5 Years Old
High Risk: - Mother/primary caregiver has active dental caries - Parent/caregiver has life-time of poverty, low health literacy - Child has frequent exposure (>3 times/day) between-meal sugar-containing snacks or beverages per day - Child uses bottle or non-spill cup containing natural or added sugar frequently, between meals and/or at bedtime Moderate Risk: - Child is a recent immigrant - Child has special health care needs CARIES RISK ASSESSMENT - HIGH: - Child has non-cavitated (incipient/white spot) caries or enamel defects - Child has visible cavities or fillings or missing teeth due to caries - Child has visible plaque on teeth
Stating drugs
High cholesterol; reduce LDL (bad cholesterol), do NOT mix w/ grapefruit because it inhibits the drug (cytochrome P450)
Always go through acid etching and bond composer in place even when lab doesn't recommended it
Higher bond strength and better marginal adaptation when enamel was acid etched
Concentration Effect
Higher concentrations of gas, effective increases alveolar ventilation in lungs
The Weber Effect
Higher reporting with new drug with peak at 2 years following initial marketing. Then declines steadily despite steadily increasing prescribing rates
Undertriturated amalgam
Higher residual mercury content due to under triturated mix (by time, most serious error) appears dry and sandy, sets too rapidly, has high residual Hg content Higher trituration speed gives shorter working time Condensation of back-back restoration should be completed simultaneously Amalgam gains strength slowly for 24 hours
Hypothyroidism
Higher risk of over sedation
Excess Overjet
Higher with digit habits compared to pacifier
Posterior Crossbite
Higher with pacifier habits compared to digit
Rubenstein Taybe
Hirsutism; Heart defect (possibly requiring surgery); intellectual disability; seizures; retrognathia; small mouth; thin upper lip; TALON CUSP; high caries rate!
Increased risk for GVHD
History of GVHD Hematologic malignancy Female donor to male recipient Total body radiation Donor age above 5 y/o Recipient age above 10 y/o
Thick lips
Hurler, Hypothyroidism, Williams Syndrome
Physical properties:
Hybrid (40-300 nm) > nano (20-75 nm) >> Micro (40 nm)
Tooth bleaching: Intrinsic discoloration
Hydrogen peroxide Carbamide peroxide Sodium perborate Breakdown of hydrogen peroxide is accelerated by heat, the addition of sodium hydroxide, or light These solutions are therefore unstable and must be stored in a dark cool place
Polyether
Hydrophilic - good detail, will absorb water, so would not be immersed. Most popular method is via motorized mixing unit
MTA
Hydrophilic particles set in presence of moisture High biocompatibility pH 12.5 after setting - reaction product is CaOH2
Enamel surfaces when exposed to saliva become covered in proteinaceous pellicle
Hydroxyapatite crystals in enamel are negatively charged with a positively charged OUTER LAYER. Negatively charged macromolecules from saliva are attracted to the surface and adsorbed onto enamel.
Byrpoduct of hydrogen peroxide/carbamide peroxide
Hydroxyl free radical
Pyogenic granuloma
Hyper-reactivity lesion - Unrelated with infection and granuloma Local irritation or trauma Highly vascular proliferation Smooth, lobulated mass
Y axis of 70 degrees (when the normal Y axis is 59 degrees)
Hyperdivergent
Orofaciodigital syndrome
Hyperdontia Anodontia/hypodontia/oligodontia (Type 1) Type 2 - Mohr syndrome Hamartoma and choristoma of tongue = most common site - may be associated with syndromes such as oral-facial-digital syndrome
Carpenter Syndrome
Hypogenital, acrocephaly (pointed head), mild obesity
What can cause seizures?
Hypoglycemia and hyperglycemia causes seizures: Substantial changes in blood sugar—either low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia)—can affect the excitability of nerve cells (neurons), allowing seizures to occur more easily.
Fluorosis is result of...
Hypomineralization
Prader Willi Syndrome
Hypoplasia (thick; sticky saliva); poor hygiene, bruxism; ENAMEL HYPOPLASIA
Amelogensis Imperfecta
Hypoplastic - thin enamel- pitted, rough or smooth and glossy surface; yellowish to brown Undersized, squared crown, lack of contact Flat occlusal surface, and low cusps, attrition
Regional Odontodysplasia (Odontogenic Imperfecta)
Hypoplastic and hypo calcified of both dentin and enamel Central incisors > lateral incisors > canines (maxillary)
Regional Odontodysplasia (odontogenesis imperfecta)
Hypoplastic and hypocalcificed of both dentin and enamel Only a few adjacent teeth in quadrant affected either primary or permanent teeth central incisors > lateral incisors > canines (maxillary) Delayed eruption GHOST TEETH Large pulp chamber and WIDE ROOT CANALS! Roots are short and poorly outlined Thin enamel, less dense than usual
Fetal Alcohol Syndrome
Hypoplastic mandible, flat-mid face, smooth philtrum, thin upper lip, minor ear abnormalities; cleft palate often
Hallerman Streif
Hypotrichosis, natal teeth, dwarfism,
Hypoxia - diminished O2 in any tissue - seen with obstruction and hypoventilation
Hypoxemia - diminished O2 in the blood May result from inadequate pulmonary perfusion (acute heart failure, pulmonary embolus, cardiac arrest)
Akinosi
I can no see! Syringe along muccoginigval injection along max arch Quite deep,...probably more effective for LA than conventional
Phases of Hematopoietic Stem Cell Transplant
I: Preconditioning, II: Conditioning neutropenic stage (admission to hospital for HCT to 30 days post-HCT), III: Engraftment to hematopoietic recovery (Complication decrease 3-4 weeks after transplant), IV: Immune reconstitution/recovery from systemic toxicity (100th day post-HCT)
Inflammatory Bowel Disease - Crohn's Disease
IBS is chronic releasing disorder of unknown etiology IBS Anywhere in GI tract (including mouth) CD causes abdominal pain, diarrhea, weight loss and in some cases anorexia 10% of patients with crohn's disease have oral mucosa ulcers, and oral manifestations occasionally precede GI symptoms Oral ulcers in CD often have indurated borders and are histologically different from RAS
Cervical vertebrae maturation stage
If already taking lateral ceph trying to reduce radiation exposure When bottom starts to round out..that's how they're staging. CS1 - everything flat at bottom CS6 - concavity for each Cervical Stage 1- peak mandibular growth will occur 2 years after this stage -->growth modification in mandible may be possible bc still CS2 - peak mandibular growth will occur 1year after CS5 - growth is done may be ready for implant placement
If positive Biologic Indicator
If mechanical and chemical indicators were ok: if implantable - recall. If not, repeat spore test using same cycle If negative and operating procedures were correct, return sterilizer to service If positive, DO NOT USE until inspected and repaired - and there consecutive empty chamber negative results Document results of biological and monitoring sterilization
Oral astral communication
If there is an infection in the antrum, the defect is large (> 5 mm in diameter), the gingival tissue are not approximated, the wound is dehisced, or the patient does not follow the postoperative instructions, an oral-astral fistula occurs. Develop a buccal mucoperiosteal flap and advance it to achieve primary closure without tension
Cloased/non-spaced dentition have decreased probably of converting to class I molar relationship
If they're initially medial step if they're initially flush terminal plane
Anaphylactic mediated by...
IgE
ALL
Immature myeloid cells, thrombocytopenia
Impressions
Immersion disinfection recommended Heat sterilize re-usable impression trays
Seoncdary immune organs
Immune cells become activated: Spleen, lymph nodes; mucosa-associated lymphoid tissues (MALT)
Primary immune organs
Immune cells develop and mature Bone marrow: differentiation, B-cell maturation Thymus - T cell maturation BURSA OF FABRICIUS - B cell maturation
During the anti-retroviral treatment of HIV, the occurrence of many HIV-associated disease decline dramatically, except HPV associated lesions
Immune response is not a major determinant int he development of HPV
Behcet's Disease
Immunology disease Sores, eyes, mouth, and genitals More common in females Idiopathic condition, chronic, relapsing, multi-systemic, characterized by recurrent oral and genital ulcers, ocular disease and skin lesions Higher in countries around the Mediterainean sea Immunosuppressive treatment complicated to manage
Dental Implant Issues
Impact of growth on relative position of the implant Effect of the implant-supported prosthesis on dental and skeletal growth Implants have been placed in anterior mandible as young as 5 years lag age, which may decrease alveolar resorption caused by a removable prosthesis Young pets with ectodermal dysplasia may benefit from implants less saliva, mucosal drying-->>poor retention of conventional prosthesis Absence of teeth --> less bone, potential need for grafting
Bonding agent
Improves bond strength + minimizes micro leakage
ICON
Improves esthetic by replacing demineralized enamel with an infiltration with a SIMILAR REFRACTORY INDEX
Inverse relationship of birth weight and enamel hypoplasia conclusively demonstrated
In babies with birth weight of <1500 g the incidence of enamel hypoplasia was 62.3%
Mandibular Foramen
In child slightly below plane of occlusion and more ANTERIOR The distance from lingual to anterior border is fairly stable with growth, while other dimensions change
S-ECC
In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC.
Lean Body weight vs. Ideal body weight
In general, lean body weight is the most appropriate dose for most anesthetic drugs, with the exception of NDMB, where ideal body weight may be more appropriate. Succinylcholine should be dosed to total body weight.
Cranial vault
In infant is very large; in childhood growth in lower face
Humor
In limbic response - replace negative response (flight or fight) with positive limbic response (humor)
Blood pressure dependent on stroke volume, myocardial contractility, systemic vascular resistance and heart rate.
In the child, stroke volume, myocardial contractility, or systemic vascular resistance are relatively invariable. Blood pressure is almost entirely rate depndent. Bradycardia in children invariably leads to hypotension
In dental cartridge lidocaine is pH 6 and 1% is in non-ionized form
In tissue salutation pH rises to 7.4 s it is buffered by bicarbonate in the blood and 24% is in non-ionized form
Indications for Amalgam
Inappropriate for primary first molars in children 4 and younger Class 2 prep that don't extend beyond line angles
Innate Immunity
Inborn, first line of defense, components Macrophages, natural killer cells, antigen-presenting cells (APC link between innate and adaptive)
Signs of airway obstruction
Increase in sonorous breath sounds Nasal flaring Discordant chest wall motion Retration at suprasternal area Cyanosis Tripoding
N2O Adverse Effects
Increase volume fo any closed air pocket in body
ADHD
Increased (10X?) chance for DMFT
Sevofluroane
Increased HR, no change in BP
Lipid solubility of local anesthetic appears to be related to its intrinsic potency.
Increased lipid solubility permits the anesthetic to penetrate the nerve membrane (which is 90% lipid) more easily. Local anesthetics with greater lipid solubility produce more effective conduction blockade at lower concentrations (lower percentage solutions or smaller volumes deposited) than the less lipid soluble solution. Onset time is related to the pKa of the anesthetic. The degree of protein binding will determine the duration of the local anesthetic.
Side effects - nonmetal teeth
Increased marginal leakage of an existing restoration (external bleaching) External root resorption (internal bleaching) Ankylosis (internal bleaching) A combination of bleaching and a history of trauma is the most important predisposing factor for resorption Hydroxyl free radicals can cause periodontal tissue damage and root resorption
Multiple allergies (especially allergic reaction: increased histamine in body
Increased risk during sedation
Propofol
Increases bronchodilator Propofol has direct smooth muscle effect on bronchi, causing bronchodilator. Propofol decreases intracranial and intraocular pressure, and it does NOT potentiate neuromuscular blockade
Copper
Increases strength, reduces tarnish and corrosion and reduces creep and therefore marginal deterioration. Copper accomplishes these effects by tying up tin, preventing the formation of gamma 2, the weakest, most tarnish-and corrosion-prone phase, and the phase with the highest creep values
Epinephrine effects on cardiovascular system
Increases systolic and diastolic pressure Increases cardiac output heart rate contraction strength myocardial oxygen consumption
Antibiotic therapy
Indicated for elevated temperature (102-104 F), facial cellulitis, difficulty breathing or swollen, truisms, fatigue, or nausea IV antibiotics, I&D, referral/consult with OS may be indicated Complications - Ludwig's Angina and cavernous sinus thrombosis
Digital RAdiography
Indirect digital radiography - phosphor plates Direct radiography - sensors Digital radiology - easy retakes - so take another one...to get one you take 3 or 4 Dose reduction compared with F-speed film is between 0 to 50% (phosphorous plate carry risk of higher exposure than conventional films) Increase in the number of radiographs made: several studies indicated that definition to make a radiograph is reached more easily with a digital system Increase in number
Treatment of Acute Lymphoblastic Leukemia
Induction, Consolidation, Interim Maintenance, Delayed Intensification, Maintenance
Monoclinic
Industrial applications; can be used as a filler for radiopacity
Ibuprofen
Infants and children <50 kg: 4-10 mg/kg/dose every 6-8 hours as needed (maximum single dose 400 mg; maximum dose 40 mg/kg/24 hours) Children >12 years: 200 mg every 4-6 hours as needed (maximum 1.2 g/24 hours) Adults: 200-400 mg/dose every 4-6 hours as needed (maximum 1.2 g/24 hours)
Histology of irreversible pulpitis
Inflammatory cells and hyperemic
Histology of irreversible pulpitis (inflammatory cells and hyperemic)
Inflammatory cells, increased vascularity (hyperemia)
Factors associated with poor sedation
Inflexibility; emotionality; shyness; inadaptable; withdrawal (when doctor walks in)
Primary Failure of Eruption
Infraocclusion of the posterior teeth, especially if both sides are affected, is the hallmark of PFE. If a patient is affected by PFE, all teeth distal to the most mesial tooth are also affected by PFE. Primary teeth can also be impacted; however, this may not necessarily occur. If a patient is suspected of having PFE, a genetic test for mutation in the PTH1R gene should be recommended prior to any orthodontic treatment to avoid ankylosis.
Treacher Collins
Inheritance. When Treacher Collins syndrome results from mutations in the TCOF1 or POLR1D gene, it is considered an autosomal dominant condition, which means one copy of the altered gene in each cell is sufficient to cause the disorder.
Parent and providers assessed child's pain
No statitistically significant difference pain between any of the subgroups btw kids who had or didn't have LA for general anesthesia treatment
Lesch Nyhan Syndrome
Inherited as X-linked trait that affects how the body builds and breaks down purines (hypoxanthine guanine phosphoribzosyltransferase (HGP)) without this enzyme abnormal high levels of uric acid build up in body Intellectual disability (mild to severe); spastic CP, self-mutiliating behavior, choreathetosis (writhing, jerking movements)
N2O MOA
Inhibition of NMDA of excitatory glutamate receptor and stimulation of GABA May promote release of endogenous opioid neurotransmitters (endorphins/dynorphines)
RMGI - triple hardening
Initial curing of light sensitive resin Chemical cure resin GI acid/base neutralization matures over time Achieves same properties of conventional GI with improved wear resistance and esthetics + command cure Achieve same properties of GIs with improved wear resistance nd esthetics + command cure (probably not as moisture tolerant)
RMGI
Initial pH is 4.0-5.5; release bioactive materials in dentin matrix - irritating to pulp so good to have layer between pulp and material
Mesiodens forms during
Initiation
Initiation and Calcification: Primary Teeth
Initiation/calcification: CI - 6 weeks/14 LI - 6 weeks/16 PM1 - 6 weeks/15 Canine - 7 weeks/17 PM2 - 8 weeks/19 Initiation Perm Teeth: M1 - 5 mo CI - 5 mo LI - 5 mo Canine - 5 mo PM1 - 5 mo PM 2 - 10 mo PP M2 - 1 yr M3 - 5 yr
Progression of uncomplicated crown fracture dependent on:
Injury to PDL and extent of dentin exposed
Ketamine's direct effect on the heart is
Inotropic depression Ketamine direct action on myocardium is negative inotropic effect. Centrally mediated sympathetic responses (indirect activation of the sympathetic nervous system) usually override the depression. Ketamine causes an increase in circulating catecholamines, especially norepinephrine, by inhibiting reuptake at prostaglandins sympathetic neurons
Kappa
Inter-examiner reliability (want high kappa, close to 1.0)
Pharmacodynamics
Interaction of drug and receptors in site of action
Compensation for Incisor Liability
Interdental spacing in primary dentition (maxillary primate space) Eruption path - labial eruption - increased proclination of permanent incisors Increased inter canine width (4 mm in maxilla and 2-3 mm in mandible)
What foramen does facial nerve exit skull?
Internal auditory meatus
What epidemiological term refers to the extent to which a study is free from bias?
Internal validity
INR
International Normalized Ratio Measures: Warfarin dosage, Liver damage, and Vitamin K
Interstitial vs. Appositional
Interstitial - occurs throughout the tissue; soft tissues; uncalcified cartilages Appositional - occurs only on the surface of the tissue; hard tissues calcified tissues (where not yet mineralized)
Primary Prevention
Intervention before evidence of disease - protects grooves from bacterial biofilim/food Secondary prevention - intervention after disease begun, before symptoms = inhibits progression of noncavtiated lesions Tertiary prevention - intervention after disease is established = prevents decay from getting worse
IRB Required for all proposed research that involves:
Intervention or interaction with human subjects Collection or analysis of identifiable private data on living individuals
How to assess reliability?
Intra-rater - have same person rate the "case" more than once Inter-rater - have a different people aerate the "case) Expressed as measure of rater agreement: NOMINAL - Kappa CATEOGRICAL - Percent agreement, weighted Kappa CONTINUOUS - correlation, ICC
Intramembrnaous vs. Endochondral
Intramembranous - no structural precursor - secretion of bone matrix within connective tissues e.g. cranial vault, maxilla and mandible Appositional - cartilaginous precursor; replacement of cartilage with center of ossification; axial and appendicular skeleton, cranial base
Soft tissue exposures
Intraoral - decrease by 1/4 Extraoral - decrease by 1/2
Partial Thromboplastin Time
Intrinsic Pathway: XIII, IX, XI, XII Prolonged in Hemophilia A, B, C and von-Willibrand Disease
PTT = partial thromboplastin time
Intrinsic pathway Heparin
Disadv of case-control design
Investigator bias
Principle of Equipoise
Involves ethical treatment of human subjects in experimental conditions.
Paget's disease
Is extreme of fibrous dysplasia
Internal validity
Is the study well designed and analyzed? Can it be reproduced? Is it valid?
Who are perpetrators of child abuse
Isolated, young, single parents; poverty; depression ;substance abuse; unwanted parenthood
Most common class II alloy prep error
Isthmus cut too wide
Systemic administration of fluconazole for oral candidiasis
Its absorption is decreased at increased gastric pH (fluconazole is NOT affected by gastric pH)
Cubic Zirconia
Jewlery and some medical/industrial applications (e.g. scalpel blades)
One of the most sensitive organs
Juvenile thyroid (risk almost zero at 20 y/o) If radiated during pregnancy is associated with LOW BIRTH WEIGHT
Kasabach Merritt
Kasabach-Merritt phenomenon (KMP) is a rare, potentially life-threatening condition. It occurs when certain fast-growing vascular tumors [kaposiform hemangioendothelioma (KHE) or tufted angioma (TA)] trap and destroy platelets, interfering with blood clotting and raising the risk of serious bleeding.
Epinephrine is contraindicated in patient's with hyperthyroid
Keep epinephrine to a minimum in patient's taking tricyclic antidepressants (arrhythmias)
Significant difference in retention
Ketac Cement > BioCem > RelyX Unicem > FujiCem II > Rely X Luting 70% of cement failure occurred between the cement and the tooth
Which drug should be avoided in the patient with pre-existing renal dysfunction?
Ketorolac (Toradol) = NSAID Nephrotoxic - NSAIDs, Aspirin, Ketorolac (Toradol), Ibuprofen = Motrin; acyclovir, tetracylines; cephalosporins SAFE: acetaminophen, penicillin, LA
Avoid NSAIDs (increased bleeding with corticosteroids and potentiation of nephrotoxicity of cyclosporine and tacrolimus) Consider need for supplemental corticosteroids if patient is on or has recently discontinued taking corticosteroids
Kidney transplant considerations
Tobacco is a risk factor for 6 of the 8 leading causes of death in the world
Kills 50% of its users (450k deaths/year) Smoking = single greatest aoidable cause of death 20% of Highschool students use tobacco (smokeless: 14% M; 2% F) Caries in primary dentition is related to 2nd hand smoke in addition to enamel hypoplasia in both dentitions 90% of adult smokers began at 19 y/o
What is kVP?
Kilovoltage peak (kVp) is the peak potential applied to the x-ray tube, which accelerates electrons from the cathode to the anode in radiography or computed tomography. Tube voltage, in turn, determines the quantity and quality of the photons generated.
Korff fibers
Korff fibers, also von Korff fibers are thick collageneous fibers in the developing tooth that begin in the dental papilla, spiral between the cells of the odontoblast layer, and form the matrix of the dentin. They are often the first sign of dentin formation.
Local Anesthesia
LA facts: Onset - determined by pKa Duration - determined by protein binding Potency - lipid solubility
What determines anesthesia?
LA proximity to nerve Degree of ionization Concentration of solution (higher concentration likely less needed) Volume Time
Autosomal recessive:
LAD; chediak hagashi syndrome, papillon lefevre
Hypophosphatasia
Lacking cementum
Good indicator of CHO intake
Lactobacilli
Lactobacillus
Lactobacilli - caries progression and root caries
Ritalin (methylphenidate)
Non-amphetamine, CNS stimulant, xerostomia, potentiation TCA
Larger needle
Larger less likely to break Larger is easier to aspirate Larger less likely to deflect
Inspiratory capacity
Largest volume of air that can be inspired after a passive expiration
Presenting Sedation
Laryngospasm-->seizure-->respiratory depression-->respiratory arrest
The most common cause of POST ADOLESCENT MANDIBULAR INCISOR CROWDING
Late mandibular growth
Leeway space may be used to address incisor liability
Late medial shift can help transition to class I molar relationship from end on Maxillary diastema should be reassessed until canines erupt
Unilateral shift
Later development of TMD symptoms
Maxillary process + medial nasal process
Lateral aspect of upper lip, cheek, rest of maxillary teeth and secondary palate
Attachment occurs when?
Latter part of first year
Cleft lip/palate
Left side more often then right side Cleft lip with or without palate M>F Cleft palate - Females > Males 4th-12th weeks of gestation
Cherubism
Lesions similar to central giant cell tumor; multi-locular radiolucencies
Cells treated on ice:
Less apoptosis
3 y/o
Less egocentric, likes to please Active imagination Closely attached to parent
What nerve innervates palatal mucosa of molars
Lesser and greater palatine
Duration of LA
Lidocaine - 2% 1:100K epi - 60 min pulp, 170 min soft tissues vs mandibular block 85% pulp and 190 min soft tissue
Mitral Valve Prolapse
Likely inherited as autosomal dominant trait; more common in WOMEN Mitral valve prolapse occurs late systole and is NOT affected by respiration MVP is associated with ventricular premature beats, paroxysmal atrial tachycardia, atrial fibrillation, VON WILLEBRAND'S SYNDROME, polycystic kidney disease, atrial secundum, defect and MARFAN'S SYNDROME
Children 7-12 y/o juice
Limit juice to 8 oz/daily
Juice for 1-3 y/o
Limit juice to <4 oz with snacks or meals; fruit is preferred
Children 4-6 y/o juice
Limit juice to <6 oz
What is NOT typically seen in patients with bulimia nervosa?
Lingual erosion of molars & premolars
Prilocaine
Linked with methemoglobinemia (gray-blue lips, mucosa, nails + rest/circ distress) Do NOT use prilocaine in patient's with sickle cell
Lip Repair
Lip adhesion - 7 weeks Lip repair - 3-5 mo; Rule of 10... 10 weeks, 10 g Hg, 10 lbs Palate repair - 9-12 mo Ortho phase 1 - correct transverse; maxillary expansion Bone graft - 7-8 years Maxillary canine w/I bone Orthognathic - 18 y
Oral Child Abuse
Lips 50%; Mucosa, teeth, gums, tongue
Physical Abuse
Lips most common (54%) followed by oral mucosa, teeth, gingiva, and tongue 50% of injuries occur to head and neck 2-4 years M=F One of many siblings (4 or more) Mother is usually abuser
Child abuse
Lips most common > oral mucosa > teeth > gingiva > tongue
Intermediate and low level disinfection
Liquid contact - EPA disinfectant with label claim of tubercluoidal activity; CHLORINE CONTAINING PRODUCTS; quaternary ammonium compounds
Prothrombin Time (PT) elevated in...
Liver disease, impaired vitamin K production, surgical trauma, and blood loss, factor VII deficiency
Adenomatoid Odontogenic Tumor
Maxillary canine - unilocular but can be located; well defined margins Homogenous radiolucent area initially but later develops calcified "floccules" as content Cortical expansion may occur. Tends to displace rather than cause resorption of adjacent teeth Anterior maxilla or mandible; may mimic dentigfeorus cyst; canine area (most frequent) Radiolucent with radiopauqe foci
Most common teeth to be transposed
Maxillary canine and 1st premolar
Dilaceration
Maxillary premolars most common
Expiratory reserve volume
Maximal expiration of air beyond the volume of a passive end expiration
Pericornitis
Localized to immediate enveloping tissue gives no evidence of spread to adjacent tissues plane require local debridement and definitive treatment consisting of removal of the erupting tooth and/or pericoronal tissues. Antibiotics are not mandatory, and tooth extraction need not to be delayed to complete a course of antibiotics.
In permanent teeth
Location of root fracture does NOT affect pulp survival
Diazepam
Long half life - active metabolites (desmethyldiazepam) leads to long half-life Lipophilic, accumulating in fat and further increasing half-life
Velocardiofacial syndrome
Long lower face
Maxillary Lateral incisor
Longer than maxillary central (in greatest dimensions)
What sedation med is glucuronide conjugation?
Lorazepam
Early colonization of S. Mutans are associated with
Low Birth Weight
Profile of abused
Low birth weight Physical disability Mental disability Hyperactivity or aggressivity One of many siblings Age 2-4 y/o Lives in household with unrelated adults
Rapid onset of nitrous
Low blood solubility concentration, insoluble
Zinc Oxide Eugenol
Low compressive strength, Can increase compressive strength by adding poly-methyl-methacylate (IRM) Eugenol is inhibitor for polymerization and can interfere with cements, restorative materials, and even impression materials
Disadv of RCT
Low external validity
Most common low risk genotypes are HPV 6 and 11
Low risk HPVs
Sterilization - destroys all microorganisms including bacterial spores Low Temperature
Low temperature (ethylene oxide gas plasma sterilization) - types of patient care team - heat sensitive; critical and semi-critical)
Submasseteric Space AND Pterygomandibular Space
Lower 3rd molars Fracture of angle of mandible
Submental Space
Lower anterior teeth Fracture of symphysis Lower bicuspids/molars
Sublingual Space
Lower bicuspids and lower molars Direct trauma Contains sublingual glands, Wharton's duct, lingual artery, nerve, sublingual artery, vein, hypoplassal nerve
Moderate to severely crowded mixed dentition cases
Lower likelihood of transition to class I molar relationship from class IIg
Submandibular space
Lower molars Contains submandibular gland, facial artery, vein, lymph nodes
Orofacial clefting
Lowest in African Americans A syndromic diagnosis is more common with isolated cleft paalte
Sipple Syndrome
MEN 2A -
N2O can be used in what patients?
MH Indicated in: 1) Mentally and physically disabled 2) Medically compromised 3) Severe gag-reflex patients
Mivacron (Mivacurium)
MIVACRON (mivacurium chloride) is a short-acting, nondepolarizing skeletal muscle relaxant for intravenous (IV) administration.
Melanotic Neuroectoderaml Tumor of Infancy
MOST COMON PLACE - anterior maxilla Relatively uncommon osteolytic - pigmented neoplasm Primarily affects the jaws of newborn infants It is locally aggressive, benign lesion of neural crest origin that occurs exclusively in infants younger than 1 year of age High recurrence rate High urinary excretion of VANILLYL-MANDELIC-ACID
Dentistry
MOST common category of unmet health care for children with SHCN 10% GD treat pt with SHCN often, while 70% reported they rarely or never treat pts with SHCN 95% of pediatric dentist reported to a survey from the AAPD that they routinely provide care to patients with SHCN
IL-1
Macrophages - pro-inflammatory
MTA
Main soluble component is CaOH Stimulates reparative dentin formation Alkaline pH antibacterial activity Biocomaptabile
Protein buffer system
Major contributors to buffer capacity below pH 5
Supernumerary Teeth
Male:female 2:1
Language delay is more common in what sex?
Males
GERD
Malfunctioning/weak lower esophageal sphincter Erosive, non-erosive Enamel erosion Gingival inflammation Painful swallowing Increased caries risk Increased salivary microorganism colonization § Regurgitation is defined as a passage of refluxed gastric contents into the oral cavity § Vomiting is defined as explosion of refluxed gastric contents from the mouth § gastro oesophageal reflux disease (GERD) is defined as symptoms or complications of GER § Prevalence of GERD in patients of all ages in North America is estimated to be 10-20% of the population § Epidemiologic data does suggest there is some heritability of GERD involving chromosome 9 and 11 § Peak incidence of GERD in the frist year of life is 50% at 4 months of age tapering down to 5-10% of infants by 12 months of age § Incidence of GERD is less in breastfed infants versus formula-fed infants § Children with neurologic impairment such as cerebrla paly and esophageal atresia have an increased high risk of developing GERD § GERD is more common in males than females and peak age of diagnosis in children is age 8 § older children and adolescents complain of heartburn, epigastric pain, chest pain, nocturnal pain, dysphasia, and sour burps. In addition to these symptoms, they may report nocturnal coughing, wheezing, recurrent pneumonia, sore throat, hoarseness, chronic sinusitis, laryngitis, or dental erosions
Pharyngeal Arches 1:
Malleus, incus, sphene-mandibular ligament, Meckel Cartilage
Arch Length Changes
Mandible - peaks pre early medial shift Maxilla - peak arch length in mixed dentition phase...from after inter canine arch width expansion and incisor liability
MARA
Mandibular Anterior Repositioning Appliance
Down's Analysis
Mandibular Plane to Frankfort Horizontal (Norm is 22 degrees) (FMA)
Tanaka and Johnston Method
Mandibular incisors must be erupted Predicts unerutped permanent canines and premolars 1/2 the mesiodsital width of four lower incisors + 10.5 mm = estimated width of mandibular canine and premolars (one quadrant) 1/2 the mesiodistal width of the four lower incisors + 11.0 mm = the estimated with of maxillary canine and premolars (one quadrant) Compare space required with space available
ADHD
Many regions of the brain and neurotransmitters have been implicated: PRE-FRONTAL CORTEX and DOPAMINE
Bupivicaine
Marcaine
What cell type in pulp is common in chronically inflamed pulp
Mast Cells
MSDS Sheet
Material Safety Data Sheet for all materials. OSHA mandated.
Risk factors for Congenital Heart Defects
Maternal rubella, diabetes, alcoholism, irradiation; and drugs such as THALIDOMIDE, PHENYTOIN, and WARFARIN
Total Lung Capacity
Max amount of air that lungs can hold and the sump of VC and RV (60-65 mL/kg in children and 80-85 ml?kg in adults)
Vital capacity
Max volume of air expired after MAXIMAL inspiration
Incisor Liability
Maxillary 7.6 mm Mandible 6 mm (permanent incisors larger than primary incisors)
Valerian
May produce sedation through gamma aminobutyric acid
GNAS Mutation
McCune Albright Syndrome, Albright's Osteodystrophy, Pseudohyperparathyroidism
Perimolysis
Mechanical or chemical erosion of tooth enamel. It is frequently associated with conditions involving chronic regurgitation of acidic gastric contents (such as bulimia or anorexia nervosa) which affects the palatal surfaces of the maxillary anterior teeth (particularly the central and lateral incisors) and the occlusal surfaces of the posterior teeth.
Injection Pain
Mechanical trauma from needle penetration Distension of tissue from cartridge contents Anesthetic properties (temperature, pH, etc.)
Philtrum of lip
Medial Nasal Process (medial nasal process fuse at week 7 to form inter maxillary process). By
Cleft Lip
Medial nasal process + maxillary process
Cleft lip
Medial nasal process and maxillary process
Cleft palate
Medial nasal process unless posterior to primary palate lateral palatine shelves
Oral-Facial-Digital (OFD) Syndrome I and II
Median pseudo-cleft; cleft tongue, cleft palate Hyperplastic arena with clefts Hypodontia (mandibular laterals) Hyperdontia (maxillary canines) Syndactyly, clindactyly Hypoplastic alar cartilages Hypotrichosis Brachycephaly Mental retardation
Melanocytic Macule
Melanotic macules are the most common oral mucosal lesions of melanocytic origin.
You would not consider which sedative medication when performing conscious sedation on a patient with a history of asthma?
Meperidine (histamine release) § NOTE: Not to be used (or used with extreme caution) in patients with history of asthma; may shift production in respiratory tree from prostaglandins to leukotrienes which are bronchial irritants
Meperidine Metabolite
Meperidine is metabolized by N-demethylation via cytochrome P450 (CYP) 2B6, CYP3A4, and CYP2C19 to normeperidine, a potential neurotoxin. Both meperidine and normeperidine are then hydrolyzed to inactive meperidinic acid and normeperidinic acid. These metabolites undergo conjugation with glucuronic acid.
Gamma 1 Phase
Mercury and silver (most resistant to tarnish and corrosion - noblest phase)
Gamma 2 Phase
Mercury and tin (most amalgams fail because of this phase, most susceptible to corrosion)
Main human exposure concern?
Mercury vapor (Hg) from dental amalgam restorations Methyl mercury (MeHg) from seafood Inorganic mercury (I-Hg) from food Health hazard controversy has focused mostly on elemental and organic mercury
Vital bleaching - light activation
Meta-analysis showed no significant difference in color change with or without light Laser, LED, plasma arc, halogen lights may be used Heat peroxide, increasing rate of oxygen decomposition to free radicals
First Pass Effect
Metabolism of Sedation Drugs: - First pass phenomenon (oral sedation) o Drugs absorbed in enteric routes go to liver via portal circulation o If injection (submucosal) or nasal prob won't go through first pass metabolism
Compomer Primers
Methacrylate primers - bond to enamel, dentin, and composer restorative material
Sterilization (destroy all microorganisms including bacteria spores) Heat automated/High temperature
Method: heat automated high temperature - examples (steam and dry heat) - types of patient care item - heat tolerant critical and semi-critical
Treatment for Methemoglobinemia
Methylene blue (used for stain) - main use of product is rescue drug in cases of methemoglobinemia
CaOH
Not recommended for primary teeth pulpotomtmies Very high pH Thought to initiate inflammatory cascade
Metronidazole MOA
Metronidazole diffuses into the organism, inhibits protein synthesis by interacting with DNA and causing a loss of helical DNA structure and strand breakage.
Cri-Du-Chat
Micrognathia; dental erosions evoked by GERD bc of intense day and night bruxism Chromosome 5
Similar mechanism to nitrous
Midazolam - GABA receptor agonist and activates opioid receptors
Treatment Options for Crowding
Mild - 0-4 mm maintain space available Moderate - 4-8 mm - increase space available Severe - >8 mm- decreased space required
Contraindication for CPP-ACP - casein phosphopeptide w/ amorphous calcium phosphate
Milk protein allergy
Airport Screening
Millimeter-wave technology units- non-ionizing radio-frequencies in millimeter wave spectrum
Micro <0.1
Mini 0.1-1 Midsize 1-10 Macro 10-100
Infraposition
Minimal - <1/8 of crown height Moderate > or equal to 1/8 but <1/4 crown height Severe - greater or equal to 1/4 but <1/2 crown height Extreme > or equal to 1/2 crown height
OKC
Minimal expansion, can resorb teeth
N2O
Minor depression cardiac output and slight increase in peripheral vascular resistance results in no change in BP
Cri-du-Chat
Mircognathia; ant open bite or variable malocclusion Relaxations w/ label incompetence and short philtrum Dental erosions proved by GERD and attrition bc of intense day and nigh bruxism
Buffering Product
Mixing pen - 8.4% Sodium biacrbaonte cartridge. Injected into LA cartridge (connector)
IQ 36-51
Moderate mental challenges (35-49)
N2O CIs
Moderate to severe asthma Current respiratory infection Acute Ottis media (blocked Eustachian tube) or recent middle ear surgery Chronic obstructive pulmonary disease Severe emotional disturbances First trimester of pregnancy Methylene tetrahydrofolate reductase deficiency Severe psychiatric imbalance Precooperative Mouth breathers Treatment with bleomycin sulfate Cobalamin (vitamin B12) deficiency
Mongolian Spots
Mongolian spots are a kind of birthmark that are flat, blue, or blue-gray. They appear at birth or in the first few weeks of life
As tooth erupts...
More and more PDL will form
Complications of Diabetes Mellitus
More common and severe with Type I Macrovascular (large vessel) disease Accelerated atherosclerosis (heart: CHD, congestive heart failure, CVA, peripheral vascular resistance; gangrene) Microvascular (small vessel) disease - thickened capillary basement membrane NEPHROPATHY: kidney failure RETINOPATHY: blindness NEUROPATHY (50% of all diabetics) Impotence Bladder dysfunction Paresthesias Neuropathic pains
Skeletal age
More highly correlated with menarche than height, weight, or growth velocity Methods of staging - carpal index and cervical vertical maturation stages
Mitochondrial Disorders
More likely to have malignant hyperthermia Dental considerations: - Acid Erosion related to GERD - Dysfunctional swallowing Treatment: Early institution of preventive oral care - consider increased frequency of preventive visits Schedule appointments when patient is well-rested - Avoidance of physiologic stress (heat, cold, lack of sleep, lack of food) - If using general anesthetic, malignant hyperthermia, precautions should be used
Oligodontia
More than 6 missing primary or permanent teeth
Eosinophilic granuloma
Most benign
Glass Ionomer
Most biocompatible - similar thermal expansion and contractions and less shrinkage FLUORIDE RELEASE! Initial fluoride release and reservoir overtime for at least a year! )
EB Simplex
Most common - autosomal dominant - within BASAL KERATINOCYTE of epidermis Generalized; localized; EB herpetiformis
Naso-palatine duct cyst (Non-odontogenic cyst)
Most common cyst causes roots of central incisors to diverge and occasionally root resorption occurs
Von Willebrand Disease
Most common inherited bleeding disorder; Platelet adhesion
Turner's Hypoplasia
Most common place in lower premolars
Ameloblastic Fibroma
Most frequently found in children and adolescents Quite uncommon; - brother of dentigerous cyst is OKC 3rd sibling is ameloblastic fibroma Can be unilocular, crenelated or multilocular Outline well-delineated and corticated - small calcification in the lesion Homogenous radiolucency Cortical expansion a late finding. May cause displacement of teeth. Less aggressive locally than non-unicystic ameloblastoma
Ameloblastic Fibroma
Most frequently found in children and adolescents Unilocular, crenelated or multilocular Outline well delineated and corticated Homogenosu radiolucency Small calcifications IN the lesion. That's the only main difference between distinguishing ameloblastic fibroma with dentigfeorus cyst and OKC Cortical expansion later finding with minor displacement of teeth.
Prilocaine
Most risk of methemoglobinemia Metabolite: Ortho-toluidine - risk of methemoglbinema
Leterre Siew
Most severe - acute disseminated infants, fatal
Diptheria
Most severe form of membranous pharyngitis causing massive swelling of tonsils, uvula, anterior neck, cervical lymph nodes and posterior pharynx; ultimately obstructs breathing
Greatest trauma to primary teeth 2-3 years old
Motor coordination is developing
Relocation/Drift
Movement of a component party fo bone in response to remodeling use same reference point within structure
Displacement/TRanslation -
Movement of whole bone in response to -remodeling.
Lingual foramen position
Moves UP & BACK with age (therefore aim higher and more posterior in adolescents
Mandibular canine
Much narrower than maxillary counterpart Height similar to maxillary counterpart Cusp medially displaced, with longer distal slope
Hurler and Hunter Syndrome
Mucopolysarcccharidosis Type 1 Heart valve problems; claw hands for Hurler; widely spaced teeth, enlarged tongue; papular skin lesions; macrocephaly
Through and through laceration
Mucosa, muscle, skin
Early signs of head and neck radiation
Mucositis
Restoration of Primary Incisors
Multiple carious surfaces Incisor edge involvement Extensive cervical decalcification Pulpal therapy Hypoplastic enamel Poor moisture or hemorrhage control Large single-surface lesions Very poor oral hygiene Discolored incisors that are esthetically unpleasing
Cyclosporine
Multiple side effects including nephrotoxicity, HTN, hypercholesteremia, and gingival overgrowth
Sealant over topical fluoride?
Multiple studies confirm that sealant bond strength and retention are not affected by a topical fluoride treatment before sealant application
Pre-Operative Guidelines
Must rest with immediate adult supervision for the remainder of the day
Nerve Plexus of Raschkow
Myelinated nerve fibers located in cell rich zone Monitors of painful sensations Mediates inflammatory events and tissue repair
N2O CIs
N2O acts by oxidizing vitamin B12 from the active reduced cob[I]alamin form to the inactive cob[III]alamin form. In turn, this inactivates the enzyme methionine synthetase which requires both B12 and folate as cofactors.
N2O on Vit B12
N2O acts by oxidizing vitamin B12 from the active reduced cob[I]alamin form to the inactive cob[III]alamin form. In turn, this inactivates the enzyme methionine synthetase which requires both B12 and folate as cofactors.
N2O/O2 at less than 50% when used alone is generally minimal sedation
N2O/O2 at >50% with additional sedation/agents has the potential to result in moderate/deep sedation When >50% or with other agents moderate guidelines should be followed
MTHFR
NAutism spectrum...a lot of those kids will have genetic testing...this sometimes comes up Deficiency in MTHFR Autosomal recessive ; responsible for folate metabolism and homocysteine regulation N2O inhibits transformation of homocysteine to methionine and subsequently leads to accumulation of uncovered homocysteine in affected children Homocysteine levels can also stem from deficiencies in vitamin B12, folic acid, and vitamin B6
Formocresol
Nasopharyngela cancer association; leukemia and occupational exposure to formaldehyde
Pfeiffer Syndrome
Natal teeth + big toes/thumbs + premature cranial suture closure (cloverleaf skull) + exopthalmous + maxillary hypoplasia, normal intelligence, chromosome 8
TUBEROUS SCLEROSIS
NEUROCUTANEIOUS SYNDROME - hypomelanotic macules; facial angiofibromas; subungual fibromas Dental findings: enamel hypoplasia/pitted enamel - seen in 90% Gingival fibromas Gingival hyperplasia - secondary o seizure meds
Neurofibromatosis type 2
NF2 is less common and characterized by slow growing tumors on 8th cranial nerve Schwannomatoisis - dev of multipleschwannomas except on vestibular branch of 8th cranial nerve --> dominant symptom is PAIN
VITAL SIGNS OF CHILDREN!
Newborn: -RR 30-50 bpm -HR 120-140 bpm and 230 while crying -BP 60-80/40-50 Ages 1-4: -RR 20-40 -HR 80-140 -BP 90-99/60-65 Ages 5-12 -RR 15-25 -HR 70-115 -BP 100-110/56-60
Multifocal Epithelial Hyperplasia (Heck's Disease)
Native Americans HPV 13 and 32 Runs in family (39% of children are affected) Multiple, flattened, soft, non tender papular, usually cluster and with same color of oral mucosa ALASKA NATIVES and NORTHERN MEXICO! - 40% prevalence
Langerhans Cell Histiocytosis
Neoplastic disease of myeloid cells Disseminated skin lesions: red rash, red-purple nodules Oral findings: ulcers, gingival masses, lymphadenopathy, premature exfoliation of teeth Disseminated - mandible; any bone; skull; jaw involved in 20% Langerhans cell histiocytosis - curettage, chemotherapy Disseminated disease - multiple periapcial radiolucencies; floating tooth appearance Multiorgan involvement Young children and infants Site: any bone; skull and mandible are common; jaw involved in 20% Skin lesions: red rash, red-purple nodules Oral findings: ulcers; gingival masses, lymphadenopathy, premature exfoliation of teeth Localized disease (eosinophilic granuloma) - multiple periapcial radioluncies; floating tooth appearance - may have soft tissue involvement; usually localized to bone; rapid alveolar bone loss and tooth mobility
Most common type of cancer to be diagnosed in age <1 y/o
Neuroblastoma
Hemifacial Hyperplasia associated with which syndromes?
Neurofibromatosis Beckwith-Wiedemann McCune Albright
Angelman Syndrome
Neurogenic disorder; ID/DD; sleep disturbance; seizures; Jerky movements (hand-flapping); frequent laughter or smiling, happy demeanor Caused by loss of maternal inherited genes (chromosome 15)
>50% of DM Type 1 complications
Neuropathy - impotence, bladder dysfunction, paresthesia, neuropathic pains (diabetic neuropathy including burning mouth)
Acid and Powder GI
Neutralization of acid groups by powdered glass base Sig amounts of fluoride ions are released during the reaction Requires presence of water If cement is mixed too thick, insufficient water will be available to complete reaction and dentin sensitivity will be encountered as water is taken from dentin
Leukocytes
Neutrophils (55%), Lymphocytes (30%) (viral infections) , Monocytes (6%), Eosinophils (3%) (parasite infections), Basophils (1%) (allergies)
SSC Composition
New gen Iron - 65-73%; 17-19% chromium (to make them stainless) , 9-12% nickel, <2% manganese, silicone, carbon (similar to ortho bands/wires)
Stainless Steel Crowns
New generation: Iron (65-73%), 17-19% chromium, 9-12% to make them stainless (nickel), <2% manganese, silicon, and carbon (similar to ortho bands/wires)
Odontogenic Keratocyst
Non-inflammatory odontogenic cyst that arises from dental lamina Unlike other cyst, epithelial appears to have innate growth potential Radiolucent, well defined, corticated, posterior mandible, SOME IN-GROWTH POTENTIAL Not malignant. Growth potential. Epithelium lining is keratinized and thin Inside cyst - viscous white material "cheese" OKCs - 1/10 of all cysts in jaws; 2nd-3rd decades of life with slightly male prevalence; no symptoms until mid size-->swelling; high recurrence Superior to inferior alveolar nerve
LA Ionization
Non-ionized (basic)% is determined by tissue pH and dissociation constant pKa of the anesthetic Tissue buffers rapidly (by sodium bicarboante in blood and tissues) to convert cationic form to nonionized base
Premature loss of temporary implants for purpose of ortho anchorage
Non-keratinized surrounding mucosa
Interincisal Angle
Norm - 1-1 = 131 degrees
Incisor to SN
Norm = 104 degrees
1 - NB (mm)
Norm = 4 mm
1-NA (mm) -
Norm = 4 mm
Overbite
Normal is 1-2 mm or 20-30%
AI Type 2 - Hypomaturation
Normal thickness of enamel, but mottled surface; cloudy white, yellow, or brown, opaque in color Softer than normal Same density as dentin
Hypomaturation
Normal thickness of enamel, but mottled surface; cloudy white, yellow, or brown, opaque in color Softer than normal Same density as dentin
Hypocalcified Type
Normal thickness of enamel, density less than dentin Normal size and shape when erupt, abrade or fracture away rapidly Permeability increase, darkened and stained
AI Type 3 - Hypocalcified
Normal thickness of enamel, density, less than dentin Normal size & shape when erupt, abrade or fracture away rapidly Permeability increase, darkened and stained
PTT
Normal value 25-35 seconds - evaluation of intrinsic and common pathways Prolonged in patients deficient in any plasma clotting factors except VII or XIII
Upper incisor to NA determines procumbency/retrusive
Norms = 4 and 22 degrees
Medical waste
Not considered infectious, discard with regular trash (98-99%)
Adv of Case Control Design
Not dependent on natural frequency of disease (used for rare disease or long latency diseases)
Idiopathic Bone Sclerosis (bone lesion)
Not odontogenic Radiopaque, well defined, well localized, NON-CORTICATED; located at apex of VITAL TEETH. No root resorption and no teeth displacement. Commonly molar/premolar area
GIC Contraindicated
Not recommended for class II restorations in primary molars Adhesion to tooth structure is greater than orthodonticc bands or crowns. Roughening internal surface may improve retention
Goldenhar Syndrome
Now referred to as oculo-auriculo-vertebral spectrum Seems to occur around 30-45 days of gestation; may be caused by an early bleed IN UTERO - hemorrhage in the areas of the 1st and 2nd pharyngeal arches Most cases are sporadic and not familial Dental Findings: - Oral diminished to absent parotid secretions, anomalies in function or structure of the tongue (bones and tissue both affected) - Hypoplasia of molar, maxillary, and/or mandibular region - Cleft palate with or without cleft lip often seen
Transmucosal agent for candidiasis
Nyastatin oral suspension 4 x/day Nystatin cream for angular cheilitis (triaminocinolone-acetanide - not FDA approved - not approved for less than 2 mo) Fluconazole - requires acidic pH to disintegrate and dissolve (so can't use in situations with high gastric pH - results in decreased absorption) Flucaonzole is a hepatic enzyme inhibitor
Amalgam problematic tooth
OB surface of primary first molar
Three siblings - posterior mandibular lesions
OKC, dentigerous cyst, ameloblastic fibromas - love to live in posterior mandible
Basis for onset of fear of separation from parent is...
Object permanence
Best treatment for TMD
Occlusal splint
Bacteremia
Occurs 15 minutes after dental treatment
Second Transitional Phase
Occurs between 10-12 years of age; replacement of primary canines and molars Leeway space Late medial shift Closure of maxillary diastema
Goldenhar Syndrome
Oculo-auriculo-vertebral syndrome 1st and 2nd pharyngeal arches Unilateral microbial-failure of mandibular ramus and condyle to form Ear abnormalities - hearing loss CL/CP 50% have cardiac problems - VSD, PDA
Goldenhard Syndrome
Oculo-auriculo-vertebral syndrome; hemifacial microsomia Facial asymmetry Epibulbar mermaids Coloboma of eye Heart problems Vascular malformation to first and second branchial arches by stapedial artery No ear, no condyle, no glenoid fossa, or ramus
Lowe Syndrome
Oculo-cerebra-renal syndrome Perio disease with severe bone loss due to defective INOSITOL PHOSPHATE METABOLISM Impaction of permanent teeth Taurodontism Underdevelopment of maxilla and mandible
Lowe Syndrome
Oculo-cerebro-renal syndrome - periodontal disease with severe bone loss (due to DEFECTIVE INOSITOL PHOSPHATE METABOLISM); taurodontism (1 of syndromes associated with this)
Lowe Syndrome
Oculo-cerebro-renal syndrome... Periodontal disease with severe bone loss (due to defective inositol phosphate metabolism) Impaction of perm teeth Taurodontism (1 of syndromes associated with this) Underdevelopment of the maxilla and mandible
Primary mediator of asthma
Of these IgE is the predominant antibody in asthma in humans. IgEis the antibody responsible for all types of allergic reaction and pathogenesis of allergic asthma and development of inflammation in the human body. Elevated levels of IgE are found in bronchial asthma.
Factors associated with successful sedation
Older age Persistance Desire to help
Factors associated with prolonged sucking habits
Older maternal age Higher maternal education level Having no older siblings
Nitrous Oxide
Oldest anesthetic - party drug in 1772 - 1799 - first machine for storage and inhalation 1824 - Laughing Gas parties 1850s introduced for extractions
Electric pulp test
On anterior teeth, incisor edge has lowest threshold for response
In order to exceed the FDA's safe exposure mites a 30 lbs child would need to consume approximately 1-3 million syringes (1200-3600 liters) per day of raw unpolymerized sealant resins
Once resin is polymerized there is virtually no release of BPA
Selective IgA deficiency
One of the MOST COMMON primary immunodeficiency (one of most candidiasis in mouth for patients not taking immunosuppressant meds) Many patients go undiagnosed bc are never sick enough to be seen by a doctor At risk of infection; about half have repeated infections af ears, sinus and airway Children with IgA deficiency are at increased risk for anaphylactic reactions
Lorazepam
Only drug not using the P450 cytochrome. it is glucoronidated in the liver.
Focal Cememento-Osseous Dysplasia (or florid if in many spots) - bone (not odontogenic)
Only one that goes into 3 different stages (initially radiolucent-->mixed--> (mature) radiopaque) FEMALE (9:1): Male Way more common latino hispanic and AA Well defined--irregulary shaped At apex of teeth Localized change in normal bone metabolism-->replacement of components of normal bone with fibrous tissue and cementum like material; abnormal bone or a mixture of the two
Total Hepatitis B Core Antibody (Anti-HBc)
Onset of symptoms in acute Hepatitis B and persists for life The presence of anti-abc indicates previous or ongoing infection with the Hepatitis B virus in an undefined time frame
Fluorosis
Opaque appearance caused by hypo mineralized enamel subsurface with more severe dental fluorosis
Cystic Fibrosis Association with what?
Open bite GERD; erosion; open bite; decreased caries (constant antibiotics); periodontal, calculus Oral implications associated with CF include enamel hypoplasia, and tooth discoloration, 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
Pathognomonic for Child Sexual Abuse
Oral and peri oral gonorrhea in pre-pubertal children, diagnosed with appropriate culture techniques and confirmatory testing, is pathognomonic of sexual abuse, but rare among pre-pubertal girls evaluated Females > Males Herpes simplex virus Streptococcal pharyngitis ANUG if gingiva involved
CHron's Disease and Ulcerative Colitis
Oral findings occur 8-10% its with chrohn's disease may precede einvolvmenet; IBD associated ulcers are PAINFUL Cobblestone or mucosal modularity of buccal mucosa and ingiga is unique oto Crohn's Dz
Koplic Spots
Oral manifestations of measles (rubeola); multiple tiny white, macule that wipe off (grains of sand appearance) Single stranded enveloped RNA paramyxovirus Pathognomonic for measles infection; present 2 days before rash; 1-3 mm whitish, gray, bluish elevations with erythematous base in buccal mucosa, labial mucosa, and hard and soft palate; often slough when rash begins · Asymptomatic yet highly contagious from 5 days before rash up to 4 days afterward · One third of patients will have complications including virus induced immunosuppression, pneumonia, encephalitis, and myocarditis · SEveremeasles and even death can occur among children who have T cell immunodeficiencies o Unvaccinated children exposed to measeles are referred immediately to primary care physician o Recognition of Koplik spots or toher clinical features of measles infection warrant immediate referral to primary care physician or hospital emergency department o In either case, proactively contact medical provider to inform them of suspected measles infection · Appraoch to dental scheduling and treatment: o Abort elective dental treatment upon identification of active measles infection o Defer scheduling elective dental treatment until resolution of rash occurs o Emergency dental care pursued in hospital environment to avoid airborne exposure in dental office · Necessary precautions: o Diagnosis or suspected measles in hospital or ambulatory surgical setting requires airborne isolation protocols for 4 days after onset of clinical signs and symptoms · Treatment: o Supportive care including antipyretics, fluids, and treatment of secondary bacterial infections o World Health Organization recommends administration of vitamin A for all children with acute measles o Post exposure vaccination considered within 3 days of exposure for susceptible individauls Measles is state health department reportable disease
Mandibular third molar
Orientation of the crown within the alveolus may be affected by underdevelopment or overdevelopment of its medial or distal roots
A 10 y/o patient undergoing CaOH specification on #8 undergoing ortho tx.
Ortho may continue with regular orthodontic recall visits
Round cells
Osteosarcoma;
Second gas effect -
Other anesthetic gasses administered with high concentrations of N2O rush inward to replace nitrous oxide that is absorbed by the pulmonary blood. Oxygen delivery is also enhanced
Sixth pharyngeal arch
Other cartilage of larynx (cricoid, arytenoid, corniculates, & cuneiform)
Hertwig's Epithelial Root Sheath
Outer enamel epithelium; inner enamel epithelium - function is to GUIDE the SHAPE and NUMBER of roots After extends, it breaks up and allows the cells of dental sac to contact root dentin and there it differentiates into cementoblasts to lay down cementum Breakup of Hertwig Epithelial Root Sheath allows cells of dental sac to contact root dentin and differentiate into cementoblasts
Hypodontia
Ovarian cancer, and colon caner
4% articaine and prilocaine
Over-represented in paresthesia
Oral Manifestation of Hyper IgE
Over-retained primary teeth
Bacteria in generalized gingivitis
P. Gingivalis, T. Denticola
Renal Failure oral manifestations
PALATAL ENLARGEMENT due to secondary hyperparathyroidism Brown tumor of hyperparathyroidism showing scattered MULTINUCLEATED GIANT CELLS Periapical radiograph showing GROUND GLASS appearance of trabecular and loss of lamina dura in patient with secondary hyperparathyroidism
Reliability of primary tooth sensitivity:
PERCUSSION = BEST Percussion > Thermal > Electrical for primary teeth
Antibiotic Prophylaxis
PO: Oral Amoxicillin 2 g/50 mg/kg Not able to tolerate PO: IV/IM Ampicillin 2 g/50 mg/kg IV/IM - Cefalozin/Ceftriaxone - 1 g/50 mg/kg Allergic PO: Oral Cephalexin 2 g/50 mg/kg Oral Clindamycin 600 mg/20 mg/kg Oral Azithromycin/Clarithromycin 500 mg/15 mg/kg Allergic IV/IM: IV/IM Cefalozin/ceftriaxone 1 mg/50 mg/kg IV/IM Clindamycin 600 mg/20 mg/kg
Curve becomes steep at 90% SaO2 (hemoglobin concentration)
PaO2 about 60 mm Hg with implications for cellular function "Edge of a cliff" Cyanosis not usually detectable until hemoglobin saturation are well below 80%›
At SaO2 of 95% patient is not hypoxemic
PaO2 about 80 mm Hg
Chronic sinusitis treatment
Packing the sinus with iodoform gauze saturated with triple antibiotics and perform a nasal antrostomy
Order of resistance to conduction block:
Pain Cold Warmth Touch Deep Pressure
Which type of nerve fibers requires the lowest concentration of anesthetics for conduction?
Pain < Temp < Touch < Pressure
Triad of sub mucous cleft palate
Palatal muscle diastase; bifid uvula, notch in posterior surface of the hard palate
Conventional IA Injection Technique
Palpate deepest part of coracoid notch Insert needle btw pterygomandibular raphe and deep tendon of temporalis
Eosinophils (4%)
Parasite infections; Basophils (2) = Allergy
GI Sedation considerations
Parenteral nutrtion (G-tube, J-tube) - speak with physician
Factor VII
Part of the Extrinsic pathway
Risk factor
Part of the causal chain or expose the host to the causal chain. Once disease occurs, removal of a risk factor may not result in a cure.
William Syndrome
Partial anodontia; prominent lips, microdontia; enamel hypoplasia; taurodontism; CARDIOVASCULAR PROBLEMS; LOW NASAL BRIDGE; CHEERFUL DEMEANOR
Excess moisture w/ amalgam
Particularly in zinc-containing alloys - due to hydrogen gas that is released when zinc reacts with water
URI
Patients with current URI with thick secretions demonstrated the highest rate of AE: 9.0% required suctioning, 8.7% developed cough, 8.1% had desaturation, and 22.2% overall development some type of adverse airway event
Pregnancy gingivitis peaks
Peaks at 8 months (
Primary herpes virus infections
Peaks btw 2 and 3 y/o Sig percent of primary herpes infections are subclinical or cause pharyngitis difficult to distinguish from URI Significant prodromal with generalized marginal gingivitis Primary HSV in healthy children is usually self-limiting disease Treatment: palliative - Antiviral
Critical
Penetrates soft tissue, contact bone, enters into or contact the bloodstream Dental instrument or items - surgical instruments, periodontal scalers, scalpel blades, surgical burs
Mandible
Resorption of anterior ramus and apposition of posterior ramus but condylar growth displaces mandible downward and forward - chin comes down and forward Growth occurs in upward and backward direction though Relocates ramus posteriorly Displaces mandible downward and forward
Which systemic antibiotic do you avoid in renal impairment or history of seizures
Penicillin V K (anaphylactic reaction associated with beta-lactam sensitivity. IgE mediated reactions. Degraded by acid and enzyme activity in stomach associated with ingestion of food. Requires empty stomach)
Radiolucent lesions
Periapical radiolucencies can only be seen radiographically after cortical bone at apex is destroyed and infected into cancellous bone
Antibiotics for compound or open mandible fracture; uncomplicated compound fracture, etc...
Perioperative antibiotics reduce infection rates. The use of post-operative courses of antibiotics has NOT been shown to affect the rate
End Stage Renal Disease
Peritoneal dialysis (< 5y/o) - continuous or cycles (majority of children); daily; usually at night
Eruption cysts
Permanent centrals or primary molars
Incisor Liability
Permanent incisor are larger than primary incisors 7.6 mm in maxilla 6 mm in mandible
Enamel rods of primary teeth are perpendicular to DEJ
Perpendicular to DEJ
Which is a probable pathogenesis of periodontal disease in Down syndrome patients?
Phagocytic defect of PMNs
Gonococcal Stomatitis
Pharyngeal gonococcal infections often asymptomatic; when symptomatic, sore throat, fever, and cervical lymphadenopathy noted Exudative tonsillitis, involvement of tongue, and soft palate Gingival involvement resembles acute necrotizing ulcerative gingivitis (ANUG) 2nd most common STI in US Most cases in 15-24 y/o equal distribution amongst both genders Presence in prepubertal children occurs through sexual abuse Neisseria gonorrhoeae infection transmitted via genital or oral sexual contact and vaginal delivery
Phases of Clinical Trials
Phase 1 - dose finding Phase 2 - efficacy at fixed dose Phase 3 - comparing treatment (RCT) Phase 4 - late/uncommon effects
HCT Steps
Phase 1 - pre-transplantation Phase 2 - conditioning/neutropenic phase Phase 3 - engraftment to hematopoietic reconstitution Phase 4 - immune reconstitution/laste post transplantation
Neutropenic stage
Phase 2 - ANC at this time will be pretty much 0. So must defer elective treatment
Leukopenia is not seen with which seizure medication?
Phenobarbital
Buffering components of saliva
Phosphate and bicarbonate
4th Generation vs. 5th generation
Phosphoric acid etch, then apply primer and finish with bond. (Scotchbond multi-purpose) 5th generation - etch and then combined prime and bond into one bottle so apply once (Prime and Bond)
Zinc Phosphate
Phosphoric acid liquid + zinc oxide powder Does NOT adhere to tooth structure or have anticariogneic effect
AI - Type 1 - hypoplastic
Pitted, thin enamel; rough or smooth glossy surface; yellowish to brown Undersized, squared crown, lack of contact Flat occlusal surface & low cusps, attrition
Microdontia
Pituitary dwarfism Supernumerary teeth, 3rd molars, lateral incisors
Management of LA OD
Place in supine position Administer O2 CPR Meds: seizure management w/ benzodiazepines (IV Midaz 0.1-0.2 mg/kg) 20% lipid emission (1.5 mL/kg over 1 min, traps unbound amide LA) Fluid bolus of 1-20 mL /kg balanced salt solution and phenylephrine
Cavity varnish
Placed under amalgam restorations in past and before zinc phosphate cement to edge micro leakage and sensitivity
PFA-100
Platelet function test
BIFIDOBACTERIUM
Play a role in more advanced lesion
Sevoflurane
Pleasant odor, low blood/gas partition coefficient (0.63) and is associated with less myocardial depression and less respiratory problems when used for induction
Omission or time-out
Pleasant stimulus withdrawn - probably of response decreases
Positive reinforcement or reward
Pleasant stimulus; probably of response increases
Mouthguard materials
Poly (vinyl acetate ethylene) copolymer clear thermoplastic Polyurethane Laminated thermoplastic Polyolefin "Game On" Mouthguard - first mouthguard to receive ADA seal of approval - made out of polymer VISTAMAXX
Compomer
Polyacid Modified Resin Composite Glass filler particles (glass powder + resin matrix) Glass filler particles and dehydrated poly acid are incorporated into resin matrix, releasing fluoride (considerably less than GIC) Do not "recharge" with fluoride like GIC Not considered to be hydrophobic NO bond to tooth structure (must be used with an ADHESIVE)
Full coverage crown materials
Polycarbonate - heat molder acrylic resin; no long term studies and very limited use in US
What type of cement is not recommended for cementation of stainless steel crowns?
Polycarboxylate - Cementing SSCs: - Bonded resin cements has greater tensile strength and retention with least micro leakage, but may have practical drawbacks due to isolation concerns - GI or RMGI acceptable (no significant difference in retention) - RMGI may be used with a bonding agent to increase retention - Polycarboxylate is least effective cement DON'T USE (more like a temp cement)
Cementing SSCs - Polycarboxylate
Polycarboxylate is the LEAST EFFECTIVE CEMENT (like a temporary cement)
Crack tooth syndrome treatmentt
Restorations with inlays, composite resin, or splinting with an orthodontic band is frequently successful. Extraction is necessary only if the tooth root fractures vertically
Sealants for community based program
Population at moderate to high risk Individual at increased caries
Research Study Concerns
Population, control group, sample size, placebo, control of operational procedures, validity and reliability of measures, duration, and statistical analysis
Sturge Webber Syndrome
Port wine stain/facial hemangioma, trigemin Calcified cerebral cortex; enamel hypoplasia;
Behavior Guidance: Good Evidence
Positive Pre-Visit Imagery
In Vitro Fracture Resistance
Positive correlation btw fracture resistance and thickness None of the crowns were as resistant to fracture as SSCs All of crowns exceeded maximum bite force of 6-8 year old children
Emergency O2 Requirements
Positive pressure O2 delivery system 15 L/min flow recommended when using bag valve mask to deliver positive pressure O2 Capable of administering >90% of O2 at 10 L/min for at least 60 mins E cylinder contins 650 L
premature loss of primary incisors
Possible impact on speech - lingual-dental sounds (s, z, th); especially prior to development of speech skills Especially prior to development of speech skills <2 years of age - possible space loss > 2 years of age - esthetic problems for parents
Low concentration of calcium and phosphate cause increase in critical pH
Possibly as high as pH of 7.0
Turner Syndrome
Posterior cross bite (bilateral)
Desensitizing agent in whitening toothpaste
Potassium nitrate
Desensitizing agent in a whitening toothpaste
Potassium nitrate and strontium chloride
Desensitizing agent in whitening
Potassium nitrate and strontium chloride
Regulated medical waste
Potential risk of infection during handling and dispose (1-2%) Solid waste soaked with blood or saliva Extracted teeth Surgically removed hard or soft tissues Contaminated sharps
Chloral hydrate
Potentiates warfarin, anticoagulants Also adverse reaction with furosemide (Lasiks) - diaphoresis, tachycardia, hypertension
WHICH OF THE FOLLOWING IS ASSOCIATED WITH SAMPLE SIZE?
Power - The ability of a test to detect a significant difference when one exists. Be particularly attentive to negative studies. Good power = good sample size
Beta
Power of statistics (how strong your study is)
Intrinsic tooth stain
Pre-eruptive - Fluorosis
3 phases of tooth eruption
Pre-eruptive - root formation begins and tooth is moving towards bony surface Eruptive (Prefunctional) - development of tooth root through gingival emergence; most roots are 1/2 to 2/3 developed upon gingival emergence Eruptive (functional) - from gingival emergence to the point where the tooth meets its antagonist
ADHD
Pre-frontal cortex, dopamine 3-5% or 7-8%
Melanotic Neuroectodermal Tumor of Infancy
Pre-maxilla most common site; Rapid onset, destructive in newborns Increase of vanillymandelic acid Anterior maxilla, soft and hard tissue Mobile teeth Intrabony, lucent, destructive Malignant looking but benign usually Melanocystic Neuroectermal tumor of infancy - anterior maxilla, most common site Expansile, displacement of teeth Excision with margins; 20% recur
Periodontal Disease linked with:
Pre-term, low birth weight, preeclampsia Mothers with periodontal disease have higher levels of PROSTAGLANDINS = associated with uterine contractions
Most malocclusion are due to
Retrusive mandible
GERD Syndromes:
Rett Syndrome Cornelia de Lange Syndrome (85%)
Walking Bleach
Pre-tx radiograph of RCT should be taken to verify obturation Open cavity access and ensure no pulpal restorative material remains Clean pulpal cavity with alcohol to dehydrate and reduce surface tension Create cervical seal 1-2 mm below the CEJ (IRM, Cavit, temporary resin, GI) Sodium perborate mixed with distilled water (2:1 ratio (easier to control than H2O2) 3% H2O2 can be used in lieu of water Should be changed very 3-7 days Effects should be noticed after 2-4 weeks
Odontoblasts are signaled by preamelobasts to make prevention - beginning the first dentin at th eDEJ
Preameloblats differentiate into mature ameloblasts when stimulated by dentin laid down by odontoblasts
Turnery Syndrome
Premature eruption of permanent molars
Apert and Crouzon
Premature suture closure (craniosynostosis) Apert - hyperdontnia OR tooth genesis (especially of canines); cleft palate/bifid uvula which is not a true cleft but a deep crevice Enamel hypocalcifiation/hypoplasia Supernumerary teeth Ectopic eruption of maxillary 1st molars Crouzon syndrome (AKA - craniofacial dysosotos type I) (hyperdontia)
Animism
Preoperational
Child starts demonstrating self-control?
Preoperational
Intrapulpal -
Pressure anesthesia
2% NaF varnish for avulsed tooth 1-60 mins
Prevents Replacement root resorption
E-aminocaproic acid
Prevents clot dissolution
Anti-retraction device = mechanism that prevents entry of fluids and microorganisms into water lines as a result of negative water pressure
Prevents cross contamination Flushing waterlines will NOT remove biofilm
Pin-indexed Yoke system
Prevents crossover of cylinder hookup (prevents switch up between nitrous and oxygen)
Slowest onset time?
Prilocaine
Malfunctioning complement system
Primary deficiency of C1q, C1r, C1s or C4 is closely linked to development of systemiclupus erythematosus (SLE) or rheumatoid arthritis (RA), thought to be due in part to the inability of complement to clear immune complexes and dying cells. May have more predisposition to opportunistic infection and candidiasis
Type II (coronal) Dentin Dysplasia
Primary dentition appears as DI, but permanent dentition is normal Obliterated of pulp chamber and reduce root canals after eruption Roots are normal in shape & proportion
Calcification/Eruption Times Primary Teeth
Primary dentition calcification begins at: 4 mo in utero Formation complete at... CI - 18-24 mo LI - 18-24 mo M1 - 24 - 30 mo Canine - 30-39 mo M2 - 36 Eruption: Md CI - 5-8 mo; Mx CI - 6-10 mo Md LI - 7-10 mo; Mx LI - 8-12 mo M1 - 11-18 mo (mx and md) Canine - 16-20 mo (mx and md) M2 - 20-30 mo (mx and md)
First inter transitional period
Primary dentition until eruption of permanent first molars - Vertical skeletal growth - Deepening of the bite due to attrition of the primary incisors
Median Nasal Processes
Primary palate; tip of nose, columella, philtrum
18% of immature teeth
Revascularize
What filtration system removes fluoride?
Reverse osmosis
Pharmakotherapeutics
Principles guiding choice of drugs Efficacy, toxicity, onset, duration of drug action
Radiation/Chemo/HCT Considerations
Priority: infections, extractions, periodontal care, and sources of tissue irritation
P value
Probably o not occurring by chance (want low P value)
Prolonged muscle relaxation from concomitant use of succinylcholine and which of the following local anesthetics?
Procaine bc succinylcholine is a depolarizing muscle relaxant metabolized by plasma cholinesterase Procaine is an ester anesthetics also requiring metabolism by plasma cholinesterase
Biliary atresia
Progressive obliteration of intra and extra hepatic duct system
Cephalocaudal gradient - growth is towards skull initially
Proportion of head is 50% of body and overtime proportions change and rest of body grows at a higher rate
Hemoglobin
Protein in red blood cells that carry O2 4 protein molecules - 2 alpha globulin chains - 2 beta globulin chains Children 11-13 gm/dl Adults - 12-18 gm/dl
GERD
Proton pump inhibitors to decrease acid production Prokinetics - strengthens sphincter and increase stomach emptying time H2 blockers Antacids - neutralize stomach acid
Extrusion, intrusion, and lateral lunation injuries have high rates of...
Pulp canal obliteration
Primary teeth
Pulp canal obliteration is common following luxation injuries
Uncomplicated Fracture Prognosis
Pulp necrosis most likely to occur in first 3 months Increased risk for necrosis with complete root formation and lunation
A primary tooth that presents with a deep yellow colored crown is most likely undergoing
Pulpal obliteration
Can articaine substitute for block in children?
Pulpotomies and pulpectomies (IAN block with Lidocaine or infiltration with articaine) Pain scores were HIGHER for block injections during administration of pulp extirpation
Bases and Liners
Purpose: reduce marginal microlekage and prevents sensitivity Minimum - 0.5 mm needed to provide effective thermal insulation
Most common subtype of vWF
Quantitiatve decrease - subtype I
Chemically bonded fillers
Quarts, colloidal silica (structure) Borosilicate glasses, glasses containing barium, strontium, zinc, zirconium (radiopacity)
Intermediate Level Disinfectant
Quaternanry ammonium compounds with alcohol
Soldering SSCs with flux
REDUCES corrosion resistance
Cleidocranial Dysplasia
RUNX2, 6p, AD delayed closure of cranial sutures, absent clavicles seq and array Enamel hypoplasia, deficient cellular cementum; may be related to lack of eruption, supernumerary teeth, Mandibular prognathism
Electromagnetic Spectrum
Radiation types as part of electromagnetic spectrum Radio > microwave > infrared > visible > ultraviolet > x-ray (10^-10) > gamma ray What is difference between x-rays, visible, light, ultraviolet light, etc. Answer is the WAVELENGTH!
Operator position to avoid radiation:
Radiographer should stand either at 90 degrees to or behind the radiation source; at least 6 feet from the radiation source is safe - McDonald and Avery 45 degrees from primary beam as it exits the pt 90-180 is scatter as it enters the patient; 2 m from tube head - Study Guide
Dentigerous Cyst
Radiolucent, well defined, corticated around crown of unerupted teeth (3rd molars or supernumerary teeth - from CEJ to CEJ) Comes from layers of Reduced Enamel Epithelium or between epithelium and crown of unerupted tooth Can move and displace (can displace and resorb adjacent teeth) Displaces associated teeth in an apical direction Differential diagnosis --> hyperplastic follicle; KOT (less likely resorb teeth; attach more apical); cystic ameloblastoma ; OKC - post mandible around the teeth
Fibrous dysplasia (bone lesion)
Radiopaque, ill defined; ground glass/orange peel 2X MAXILLA > MANDIBLE Female; associated with asymmetry; replacement of bone all components of normal bone by fibrous tissue with varied amount of bone (70% solitary - monostotic); pregnant (may become active active) SKULL INVOLVED (10-25% of time)
Hypoparathyroidism
Rare endocrinopathy with unknown origin Deficient parathyroid hormone causes: low serum calcium Increased phosphorous
Ideal Bolton Ratio
Ratio of mandibular to maxillary teeth: - Sum mandibular 12/sum maxillary 12 x 100 = 91.3% - Sum mandibular 6/sum maxillary 6 x 100 = 77.2% Bolton can only be done in permanent dentition Bolton is not a measure of crowding, but you are looking at tooth size discrepancy
Peripheral Ossifying Fibroma
Reactive inflammatory hyperplasia of gingiva in response to trauma or irritation Young children/females Predilcetion ofr maxilary arch Painless mass on gingiva or alveolar mucosa Common BONE INVOLVEMENT Excision biopsy
Management o Airway Obstruction
Repsoition airway --> perform jaw thrust --> insert oral airway-->nasal trumpt-->LMA--Intubated--surgical airway
Compound Odontoma
Recognize enamel, dentin, cementum - little tiny teeth Don't represent morphologically teeth of normal dentition, but in each one enamel, dentin, cementum and pulp are arranged as in normal tooth
Impression compound
Recommendations: Iodophors or chlorine compounds Comments: phenolic sprays can be used
Tylenol
Rectal, antipyretic
Deoxygenated vs oxygenated wavelength
Red 660 nm and infrared 940 nm wavelengths are used to determine ratio of oxygenated to deoxygenated blood. Deoxygenated blood absorbs more red light, oxygenated blood absorbs more infrared light.
Attached gingiva & primary teeth
Redder, thinner, less keratinized, large marrow spaces, thinner lamina dura, wider PDL space, less collagenous, less stippled, larger perio probe depths
Sealants on permanet molars
Reduce incidence of occlusal caries by 76% after 2-3 years
Sound recognition by the infant occurs when:
Regardless of whether there are other items that are learned even earlier than infants' own names, infants as young as 4.5 months of age are learning to recognize sound patterns that will have a special personal significance for them
RBC production
Regulated by thrombopoietin (produced by kidney and liver) Entire process takes ~10 days; new platelets stored in spleen for up to 3 days Life of platelets 7-10 days 60-75% of platelets are in circulation; remainder housed in spleen
Vitamin D - actions of it
Regulates SEROTONIN synthesis in brain
Water lines
Regulatory standard for safe drinking water --> less or equal 500 CFU/mL
Nonverbal
Reinforcement and guidance of behavior through appropriate contact, posture, facial expression, and body language
Median Rhombooid glossitis
Related with chronic fungal infection (oral candidiasis) Most often associated with children who take antibiotics for a long time. Treatment: Needs anti fungal
Weeks 2-8
Remainder of 1st semester (cell differentiation)
Avulsion with >60 minutes extra oral dry time
Remove PDL cells to prevent inflammatory resorption (3% citric acid for 5 minutes, scraping, pumice, etc) followed by 1.23% NaF immersion for 20 minutes to delay ankylosis
Beveling for resins
Removes prismatic layer of enamel which may not etch well (leaving islands of unetched enamel that can act as pathways for bacterial leakage) and more surface area for bond
Purpose of conditioner in glass ionomer and what its made of?
Removes smear layer but leaves tubules plugged 10% poly acrylic acid (10-15 seconds)
Kidney Disease
Renal Osteodystrophy - hypomineralized - not a good calcification of obones. Long term consequence of children with long term chronic kidney disease. Renal osteodystrophy - Delayed eruption of permanenet teeth
Dendritic cells
Resident in EPITHELIAL SURFACES AND LYMPHOID TISSUES!
Cyanotic Lesions (requiring antibiotic prophylaxis)
Right to left shunting of desaturated blood. Infants with mild cyanosis may be pink at rest but become more blue during crying or physical exertion. Children with cyanotic defects Arte at significant risk for desaturation during general anesthesia Most common: Tricuspid atresia, Tetralogy of Fallot, Transposition of Great Vessels
20% benzocaine
Risk methemogbinemia in young children. Under age 2 y/o consult healthcare professional
Localized aggressive periodontitis feature
Robust serum antibody response to infecting agents (AA)
S. Sobrinus
S. sobrinus - smooth surface and aggressive generalized caries
Confounders for caries risk
SEK-AB socioeconomic statues; education, knowledge, attitudes and behavior
Neutropenia
SEvere ulcerative gingivitis, alveolar bone loss (including of permanent teeth); splaying incisors because decreased support; early loss of primary teeth
Restorations after Pulp Treatment
SSCS demonstrate better long-term outcomes than composite restorations following pulp capping or pulpotomy Recently MTA has shown nearly equivalent results when used with bonded composite restorations
Condyloma Acuminatum
STD - soft, pink cauliflower like growth Highly contagious Peak incidence btw 17-20 y/o Papillary lesions
Initial demineralization is SUBSURFACE
SUBSURFACE
Huth 2005
Said FC had greatest success after 12 most
Compton Effect
Scatter - some x-rays will hit patients but they bounce back and scatter
Quad helix (younger <10 y/o), W arch (younger <10 y/o), Hyrax; Haas (to increase aunt of skeletal defects
Schwartz appliance - removable Crozat appliance - removable
Sealants - secondary prevention
Sealants can inhibit progression of incipient, noncavitated lesions
Sealants over resins
Sealed restorations (amalgam, composite) are superior to unsealed restorations in conservation of tooth structure and survival
Koplik Spots
Seen in Measles (Rubeola); rubella is German measles (a more mild form of measles)
Linear Enamel Hypoplasia
Seen on middle third of Primary Mx CI and incisal third of Mx LI
Sturge Webber Syndrome
Seizures accompanied by large PORT WINE STAIN birthmark on the forehead and upper eyelid of one side of face Malformation of blood vessels in Pia mater overlying brain on same side of head This causes calcification of tissue and loss of nerve cells in cerebral cortex Neurological symptoms include seizures that begin in infancy and may worsen with age. There may be muscle weakness on the same side Dental findings: - The lesions resemble a vascular hyperplasia or a large tumor like mass early eruption of teeth reported from increased vascularity
Stratttera (Amoxetine)
Selective nor-epinephrine reuptake inhibitor Xerostomia Increases blood pressure Avoid levonordefrin (mepivicaine vasoconstriction)
4 ingredients of communication
Sender, messenger, context/setting, receiver
Vital teeth side effects of extrinsic bleaching
Sensitivity 8-66% Tissue irritation Marginal leakage of an existing restoration
Side effects: vital teeth of bleaching
Sensitivity 8-66% Tissue irritation Marginal leakage of an existing restoration - can potentially decrease quality of restoration in tooth Sensitivity and tissue irritation are transient and cease once bleaching stops (typically a result of the tray, not the bleach)
Piaget
Sensorimotor - 0-2 y/o - experience through movement/senses Preoperational - 2-7 y/o - language literally and are EGOCENTRIC Concrete operations - 7-11 y/o - children can think LOGICALLY, but NOT abstractly Formal operations - 11+ - children can think abstractly and increasingly concerned about opinion of others
Jean Piaget Chart
Sensorimotor 0-2 Preoperational - 2-6 Concrete operational 7-11 Formal operational >12
Piaget 4 year old cognitive, sensory, functional
Sensorimotor 0-2 y/o - experience through movement and senses; direct sensations Pre-operational - 2-7 y/o - children use language literally and are egocentric; OWN PERCEPTIONS Concrete operations - 7-11 y/o - children can think logically but not abstractly; LOGICALLY but NOT ABSTRACTLY Formal operations - 11+ - children can think abstractly and are increasingly concerned about the opinion of others; ABSTRACT, CAN REASON OUT IDEAS
Larynx Neurovasculature:
Sensory Innervation: Supraglottic larynx: recurrent laryngeal nerve Infraglottic larynx: internal branch of superior laryngeal nerve Motor Innervation: Cricothyroid muscle - external branch of superior laryngeal nerve All other laryngeal muscles: recurrent laryngeal nerve
Contraindications to replantation
Severe cardiac disease, seizure disorder, severe mental disability, compromise healing; poor alveolar support
Binder Syndrome
Shortened nose, underdeveloped frontonasal sinus; convex upper lip; 40-50% case have cervicospinal issues
Columnella
Shorter on side of cleft Tip of nose goes
Distal step molar relsiaotnhsip
Should be evaluated for class II malocclusion
What kind of shoulder on ceramic crown?
Shoulder = 1.5 mm (porcelain part) Chamfer = <0.5 mm
Meta analysis
Showed non significant difference in color change with or without light
NuSmile crowns cemented with BioCem
Showed the least micro leakage
Brown tumor of hyperparathyroidism
Showing scattered multinucleate giant cells
Zinc deficiency
Shunted growth, impaired wound healing Xerosotmia; poor appetite ZINC and IRON doses should be staggered - they interfere with each other's absorption
Hyperchromatic nuclei and scant cytoplasm
Sign of malignant cancer
Sutures that cause inflammation
Silk
Amalgam
Silver (Ag); Tin - critical to setting reaction; controls dimensional change Copper - prevents corrosion, reduces fracture Zinc - oxygen scavenger forming Zn oxide in place of Cu/Ag/Sn oxides (weakened restoration Approximately 50% mercury - wets alloy and imitates setting run (when >54% reduces strength)
Amalgam:
Silver (Ag); Tin (Sn) - critical to setting reaction, controls dimensional change Copper (Cu) - prevents corrosion, reduces fracture (allows for a little corrosion to improve margin Zinc (Zn) - acts as a scavenger for oxygen, forming Zn oxide in place of Cu/Ag/Sn oxides (weakens restoration)
Gamma Phase
Silver and tin (strongest phase)
Apically positioned flap technique vs closed eruption technique for exposure fo labially uneruptd maxillary canine vs closed eruption technique
Similar periodontal attachment level but closed eruption technique had better aesthetics and less likelihood for relapse. Apical flap technique had more unaesthetic scarring, increased clinical crown length, and greater risk of intrusive relapse. Apical positioned flap technique - mor unaesthetic scarring, increased clinical crown length, and greater risk of intrusive relapse
ITR (success rates)
Single surface restorations 95% at 2 years Multi-surface restorations - 62% success at 2 years
Sipple Syndrome
Sipple - endocrine neoplasms (autosomal dominant syndrome) A rare, genetic disorder that affects the endocrine glands and causes a type of thyroid cancer called medullary thyroid cancer, pheochromocytoma, and parathyroid gland cancer. It may also cause benign (noncancerous) tumors in the parathyroid glands and adrenal glands.
Incontinentia Pigmenti
Skin lesions - neonatal rash, vesicles, warts, hypo pigmentation, hyperpigmentation
Learning is a function of change in behavior. Change in behavior results from one's response to stimuli that occurs in the environment.
Skinner
Eschar
Slough 7-10 days Appliance needed to minimize wound contracture Fixed commissure appliance delivered 10-14 days after injury Appliance worn for 6-12 months
Fillers
Smaller particle sizes - polish ability Larger particles - strength Substantially larger particles accelerate wear (when dislodged from resin matrix, significant material volume lost) Microfilled- composites can achieve better polish, more quickly used for esthetic restorations (class V, resin veneers) Hybrid - resins are typical universal (both anterior and posterior) restorative materials Flowable - resin 45-75% filler, increased shrinkage, greater wear Physical properties hybrid (40-300 nm) > nano (20-75 nm) >> micro (40 nm)
Primary Teeth Smear Layer; Hybrid player
Smear layer removed easier, hybrid layer thicker, greater reaction to acid conditioning. ETCHANT is what removes smear layer
S. Sobrinus
Smooth surface caries
Highest concentration of F- ion
SnF ???
1 - NA (deg - norm = 22 degrees
So if NA had 6 mm and 26 degrees that means incisors are protrusive and proclaimed
Categorical Variables
Socioeconomic status, stages of cancer, pulp vitality (yes vs. no)
Functional Matrix Hypothesis
Soft tissue are primary targets of genetic activity Skeletal structures grow in response to their extrinsic environment Functional cranial components
Adhesives
Solutions of resin monomers with hydrophilic groups and hydrophobic groups Two groups (both unfilled dimethacrylates) 1. Halophosphorous esters of Bis-GMA,, Bis-GMA more HYDROPHOBIC 2. Halophosphoarous esters of HEMA hydroxyethyl methacrylate, HEMA totally miscible in water Both rely on phosphate-calcium bond for retention Solvents are added as thinning agents: water, ethyl alcohol, butyl alcohol, acetone. Must be displaced by dryings or will be incorporated into bonding layer
Congenital Epulis of Newborn
Some have been detected in utero via ultrasound!
Rinse until etchant is fully removed
Some suggest 5-10 or 20-30 seconds Creating microporosieities to allow micro mechanicalretnetion of sealants
Compton effect (scattering)
Some x-rays bounce back/scatter radiation Some x-rays hit patient and scatter. Don't go through patient and hit the film... At least 6 feet from x-ray source Compton absorption occurs when an incident photon interacts with an outer electron, producing a scattered photon of lower energy than the incident photon is ejected from the target atom Compton scattering results in loss of an electron and ionization of the absorbing atom Scattered photons travel in all directions 30% of scattered photon formed during a dental x-ray exposure exit the patient head
Tet Spells
Sometimes, babies who have tetralogy of Fallot will suddenly develop deep blue skin, nails and lips after crying or feeding, or when agitated. These episodes are called tet spells and are caused by a rapid drop in the amount of oxygen in the blood.
Discontinue bottle feeding
Soon after 1 year birthday
Important Points
Space loss often occurs before extraction Greatest space usually occurs between 4-8 months after extractions
Spacing vs. Crowding
Spacing > 6 mm = no crowding 3-6 mm - 20% crowded <3 mm - 50% crowded No spacing - 66% Crowded - 100%
Cerebral Palsy
Spastic - contractures, lack of control (frequency, >75% of patients) Dyskinetic: slow, writhing involuntary movements (15%) Ataxic: tremors or uncoordinated voluntary movements (5%) Mixed: combination
ANUG
Spirochetes + P. Intermedia
Which bacteria with necrotizing ulcerative gingivitis?
Spirochetes and fusiform bacteria
Which laboratory study is the most informative in the diagnosis of asthma?
Spirometry Asthma diagnosis rests upon the measurement of peak expiratory flow rate (spirometry) before and after administration of an inhaled beta. Adrenergic agonist; the reversibility of lowered expiratory flows being Diagnostic for this disorder. Alterations in plane chest radiographs, arterial blood gases, and in auscultation of the chest by stethoscope may occur with asthma, but changes in these ar not specific for diagnosis fo asthma
Intrusion
Splint 4 weeks - primary teeth following intrusion = 90% re-erupt w/I 2-6 months
Types of pain
Spontaneous, nocturnal, constant - irreversible Thermal, chemical, intermittent - Reversible
Mongloid Spots
Spots on the lower sacral region of Eskimos and Asians Mongolian spots are a kind of birthmark that are flat, blue, or blue-gray. They appear at birth or in the first few weeks of life.
Cast
Spray until wet - recommended disinfectant - chlorine compound
The purpose of in bone graft in primary dentition
Stabilizie the segment and eruption of the primary teeth Feeding and speech development
Guedel's Stages of anesthesia
Stage 1 - pt relaxed, able to follow instructions, some pain reduction Stage 2 - deepened CNS depression; excitement/delirium/jerky movements; laryngospasm may occur Stage 3 - patient unconscious, laryngeal and pharyngeal reflexes inactive; used for major surgical procedures; four planes Stage IV - medullary paralysis, death
Unfavorable outcomes associated with delayed tx:
Stages of root development and need for repositioning with splint
Pharyngeal arch 2 (hyoid)
Stapes, styloid process, stylohyoid ligament; part of hyoid cartilage (lesser horn of the hyoid; upper part of body of hyoid) Stapedeial artery
CPR
Start compressions within 10 seconds of recognition of cardiac arrest Rate of 100-120 compressions/min Ratio of 30:2 for healthcare provider whenever you are alone - 15:2 for children with 2nd rescuer Rescue breathing - adults 10-12/min (q5-6 secs) - Children (12-20/min (q 3-5 sec) - Advanced airway 10/min (6 sec) Deep compressions: Adult - at least 2 inches Child - 2 inches, 1/3 chest 1.5 inches, infants
Behavior Shapring
State goal or task Explain the necessity Divide the explanation for the procedure Give explanations at child's level of understanding Use successive approximation Reinforce appropriate behavior Disregard minor inappropriate behavior
Sterilization
Steam - 121 C - 15-20 min; 15 psi Dry heat - 160 - 1-2 hrs Rapid Heat Transfer - 180C - 6-12 min Ethylene Oxide - 25C - 10-16 hrs
Sterilization
Steam; dry heat; autoclave; chemical vapor; ethylene oxide gas
Mandibular central incisors
Straight incisor edge Narrowest primary tooth M/D
Atomoxetine
Strattera ADHD
Toxic Stress
Stress that continues over prolonged period and has lifelong effect Child abuse/englect, chronic exposure to drugs or violence in the home, parental depression or mental illness, economic hardship
Klinefelter
XXY Taurodontism (30%) Small cranial dimension Bimaxillary prognathism Language and learning problems; many men who have Klinefelter syndrome do not have obvious symptoms; some have language and learning problems; Taurodontism
Premature eruption of teeth
Sturge Webber Sotos Syndrome Turner syndrome (premature eruption of permanent molars) Tooth mobility/Premature exfoliation of teeth: - Langerhan Cell Histiocytosis - Disseminated and Localized - Leukemia - Burkitt Lymphoma - rapid multifocal expansion of jaws with loosening of teeth - Metastatic lesions - tooth mobility, paresthesia - Chediak-Higashi Syndrome - early exfoliation of teeth due to progressing childhood periodontits - Leukocyte Adhesion Deficiency - periodntis with premature loss of teeth - Hypophosphatasia: - Papillon LeFevre Syndrome - premature loss of primary and permanent teeth - Neutropenia - Hyperthyroidsim - accelerated dental eruption - Hypophosphatasia- premature loss of primary teeth with little/no resorption - Sturge Weber - vascular malformation - teeth around may move away and may exofilate before the time - Sotos Syndrome - premature eruption of teeth - Turner Syndrome - premature eruption of permanent molars
Millisievert (MSV) is the effective dose that facilities the comparison of radiation sources that expose the entire body (such as natural background radiation) with those that only expose a portion of the body
Such as dental radiographs
ADA Sealant Panel Recommendations
Suggested use of hydrophilic bonding layer as part of or under sealant enhances long-term retention. Upheld by 2014 ADA/AAPD Sealant Panel Total etch technique Routine mechanical prepration (air abrasion or enameloplasy) of enamel before acid etching is NOT recommended
Bolton Analysis
Sum of mandibular 12/sum of maxillary 12 x 100 = 91.3 (including 1st permanent molars) Sum mandibular 6/sum maxillary 6 x 100 - 77.2 (includes canines) Can only be done in full permanent dentition Not a measure of crowding, but looking at tooth size!
Ewing sarcoma
Sunday appearance (mixed radiopaque/Lucent); swelling, pain, loose teeth, paresthesia, trismus
Saethre-Chotzen Syndrome (Acrocephalosyndactyly Type III)
Supernumerary teeth; cleft lip/palate Craniosynostosis repair (9-12 months) Cleft palate repair Release of webbed fingers
Tacrolimus (Prograf)
Suppress T-cell humoral immunity; HTN, Anemia
Antibodies to HepB
Surface antigen - 1 mo after exposure IgM between 1-2 months after exposure Core antibody - 2 mo Surface antibody - 6 mo
HepB
Surface antigen then IgM then core antibody How many months after exposure to HepB
Early Carious Lesion
Surface layer: reprecipitations Intact surface zone - (20-50 um); Body of the enamel (>5%); Zones where the carious lesion is in progress - dark zone (2-4%) Zone of reaction (limiting zone: translucent zone) Normal enamel
Treatment for LAP
Surgical and non-surgical root debridement. Antibiotics: tetracycline + metronidazole OR amoxicillin and metronidazole
What analysis doesn't need chart or X-rays -
Tanaka Johnston
Color change in primary teeth usually evident 1-3 weeks post injury
Yellow discoloration have low incidence of plural necrosis Necrosis w/o discoloration = 25% Necrosis with dark gray in 50-80%
Sutures
Susceptible to pressurea nd tension Cartilage tissue - difficult to modify Synchondroses - questionable susceptibility to pressure and tension
Apert
Syndactly
Continuous Variable Tests
T-test (diff btw two groups? - mean and standard deviation ANOVA ANCOVA Multiple Linear Regression
Vascular malformation
T2 MRI is choice of exam
3RD order bending of orthodontic arch wire bending achieves
TORQUE (buccal/lingual) - twist in rectangular arch along long axis of arch wire
Deviations of at least 2% on a growth percentile chart is indicative of developmental problems such as illness or disease
TRUE
If epithelial cells become more fully differentiated or detached from the enamel organ, they produce an odontoma or supernumerary tooth
TRUE
The craniofacial skeleton increases in size by way of surface addition only and increases in shape through differential appositional resorptive bone growth
TRUE
Behavior Guidance: Weak Level of Evidence
TSD Ask-Tell-Ask Voice control Humor Deferred care/active surveillance
DDAVP
Takes 30-40 minutes to take effect following administration Desmopressin - to release more clotting factor for mild hemophilia or von Willebrand Disease o Desmopressin acetate (DDAVP) - is administered prophylactically prior to minor surgical procedures or with posttraumatic bleeding in mild vWD § Desmopressin is a question à hemophilia is a use - Desmopressin (DDAVP) is mostly used in the treatment of : o Plasmin thrombocytopenia o Aplastic anemia o Mild-moderate hemophilia o Cyclic neutropenia
Which of the following statement is true regarding toothpaste and chemotherapeutic agents
Tartar control is achieved by pyrophosphates: A sodium fluoride dentifrice, containing a mixture of soluble pyrophosphates, was used ad libitum in an adult population for 6 months after receiving a dental prophylaxis. In comparison with the control group, who used the sodium fluoride formula without the pyrophosphates, the test group had significantly less calculus by occurrence and severity. Thus, a significant reduction in newly forming calculus was obtained with the experimental dentifrice when used as an adjunct to regular professional care and personal oral hygiene procedures.
What is role of tartaric acid in GIC :
Tartaric acid is an important component of the GIC, as it has a significant influence on the working and setting times. First, it reacts rapidly with the calcium ions being released from the glass with the formation of calcium tartrate, which has the effect of extending the working time. This is followed by an enhancement of the rate of formation of aluminium polyacrylate cross-links, which speeds up the set
Late evagination of Hertwig's Epithelial Root Sheath
Taurdontism
Williams Syndrome
Taurodontism, hypodontia Supravalvular aortic stenosis, overtly friendly, smiling and happy demeanor; multiple peripheral pulmonary arterial stenoses, elfin face, mental and statuary deficiency, characteristic dental malformation and infantile hypercalcemia
Erythromycin contraindicated with
Tegretol (carbamazepine), theophylline, prozac (fluoxetine)
Contraindications for Behavior Management
Tell Show Do Voice control (hearing impaired) (hearing impaired) Ask-Tell-Ask - an upset or angry parent will not be able to comprehend and remember information
Leukopenia is seen with which seizure medications:
Teretol Zarontin (ethoxi
Tetracycline MOA
Tetracycline chelates with calcium ions
Cyanotic
Tetraology of Fallot, transposition of great vessels, tricuspid atresia
Reliability of measures
That was great...now do it again... Intra-rate reliability (same cases over time) Inter-rater reliability (comparison of some cases among raters) Instrumentation (what device are you using?)
Image Gently
The alliance for radiation safety in pediatric imaging
Amelogenin
The amelogenins of developing dental enamel are tissue-specific proteins, rich in proline, leucine, histidine and glutamyl residues, and synthesized by the ameloblast cells of the inner enamel epithelium.
Residual Volume
The amount of air that remains int he lung after forced maximal expiration
What childhood disorder patients will eat a low protein diet?
The best treatment for PKU is a diet of low-protein foods. There are special formulas for newborns. For older children and adults, the diet includes many fruits and vegetables. It also includes some low-protein breads, pastas, and cereals. Nutritional formulas provide the vitamins and minerals you can't get from their food.
Increase in caries scores in children who go to schools with vending machines
Yes
Inspiratory reserve volume
maximal inspiration of air beyond value of a quiet inspiration
Kava
may increase sedation through gamma aminobutyric acid (but not cause direct sedation vs. Valerian)
Diabetes Insipitidus
pituitary disorder - deficiency of vasopressin (ADH) that is characterized by excretion of excessive quantities of urine. Unrelated to diabetes mellitus.
Local anesthetics are not selective
may interfere with impulse transmission in any excitable tissue (e.g. CNS/the brain) Inhibitory cortical neurons are synapses are highly susceptible to transmission block Disruption of these pathways may result in disinhibition of excitatory neurons
MMR
measles, mumps, rubella MMR first given at 12-15 mo
Hypoxemic Drive
peripheral chemoreceptors - Carotid/aortic arch bodies sense low O2 tension
Moyers Prediction Analysis
True with mandible to predicted maxillary and mandibular 3, 4, 5 teeth
Male Adolescence
The definition of adolescence has changed due to accelerated onset of puberty, delayed timing of role transitions (i.e. completion of education, marriage, and parenthood), and the effect of social forces such as social media Now adolescence = 10-24; early = 11-14, middle = 15-17; late = 18-21
Early Childhood Caries
The disease of early childhood caries (ECC) is the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.
Focus to Skin Distance (McDonald and Avery)
The distance between the x-ray machine's anode and the skin of the patient's cheek or lip. Should be a minimum of 8 inches to reduce the amount of low energy x-radiation reaching the patient
Barbitutates and benzodiazepines both reduce GFR, but can be used in patients with renal failure Opioids such as morphine and meperidine have active metabolite that are really excreted and require cautious administration
The glucorondiated morphine compound is more potent than morphine itself Droperidol, although not generally used in out-patient anesthesia, currently produces an adrenergic blocking effect that reserves renal blood flow and hemodynamics.
7th generation - universal
Use like 6th generation with acidic primer if don't have time to acid etch. Scrub it in for 20 secs...bond to enamel is not as good with acidic primer. So that's why 6th generation is not as good for sealants. 7th get you you etch entire tooth and
Renal Disease - Parathyroid Hormone Issues
The kidneys cannot make active vitamin D (needed to absorb calcium)
Nifedipine
The most common calcium channel blocker associated with gingival overgrowth (6-85%) Gingival enlargement can observed 1-3 months after start of the therapy
AOT Origin
The most commonly thought origin of AOT is said to be from remnants of the dental lamina or enamel organ.
Lorazepam
The only drug not using the CYP450 cytochrome - it is gluocoronidated in the liver.
Deterministic radiation
The response is proportion with the MAGNITUDE of the dose (DM)
Stochastic radiation effect
The response is proportional with the FREQUENCY of the dose (SF)
How long GIC takes to set?
The setting reaction for the cement is a slow process, and it takes some time for the material to stabilize; the final translucency and colour of the material are not apparent until 24 hours after placement.
Carbonated soda is negatively associated with intake of which vitamin in all age strata?
Vitamin A
Deficiency of which vitamin is most likely to occur when following a vegetarian diet?
Vitamin B12
Hypophosphatemia
Vitamin D resistant rickets, X-linked (males affected), decreased capacity of phosphate reabsorption from renal tubules, teeth have large pulp chambers, plural exposures are possible
Transportation media (in order of preference) for an avulsed tooth is as follows (from most preferred to less preferred)
Vitaspan, HBSS, cold milk, saliva, saline, water
Functional Residual Capacity (FRC)
The volume of gas remaining in the lungs at passive end expiration (25-35 mL/kg in children and 30-40 mL/kg in adults
Null Hypothesis
There are no differences
Mandibular Growth
There is lingual resorption and buccal deposition Can lead to lingual positioning of the implant if placed too early
Child relies more on diaphragmatic breathing
Therefore, high intrathoracic pressure or abdominal dissension diminishes ventilation. The child possess low lung compliance and therefore ventilation is inefficient during respiratory distress
Decreased resistance to infection with Diabetes
Thicke basal membrane so more difficult for WBC to pass from blood vessels into tissues Chemotaxis of neutrophils is decreased Microvascular damage - makes difficult for immune system to arrive to place to injury
Frank Technique/apexification = necrotic tissue removed short of apex
Thin dentinal walls Unfavorable crown to root ratio CaOH replaced q3-6 most CaOH is bactericidal & produces a low grade irritation hat induces hard tissue formation
Cementum in children
Thinnera nd less dense than adults. Tendency to hyperplasia of cemetnoid apical to the epithelial attachment
ICON Technique
Thoroughly clean teeth Separator (for about 1 week prior to Appt) - Use supplied green wedge - Orthodontic separator 5-7 days before treatment (place separated fro a week) Remove separate, play rubber dam; natural latex or certain specific non-latex products Etch for 2 minutes, suction, rinse 30 seconds Place ethanol drying agent 30 seconds + dry Place infiltrate for 3 minutes, air dry, floss, cure 40 seconds. Replace resin for 1 minutes, air dry, floss, cure 40 seconds Slight polish with disc/strips as needed 100% success of E2 lesions 64% arrest of D1 lesions
Local Anesthesthetic Composition
Three parts Lipophilic (substituted benzene ring) - penetration of anatomic barriers Intermediate Chain (Amide or ester) Hydrophilic (amino terminus) - ensures drug will not precipitate in interstitial fluid
Resin Based Composite:
Three phases: MID Matrix (resin) Interfacial (continuous - coupling) Dispersed Phase (reinforcement, filler) - silicone, zirconia, etc. particles
Amalgam Safety
Threshold for health hazards from air/mercury is 5 g/m2 air for adults and 1 g/m2 for children/pregnant women. This is well above daily amalgam associated exposure
Aztithropine (after liver transplant - which med will result in leukopenia)
Thrombocytopenia, leukopenia, anemia
The most common oral problems see in children infected with HIV
Thrush (pseudomembranous candidiasis)
Fourth pharyngeal arch
Thyroid cartilage
Most sensitive to radiation and at what age does it disappear:
Thyroid, after 20 years
Cleft Lip
Tip of nose away from cleft and columella shorter on side of cleft ,
Merging of two medial nasal process
Tip of nose, columella, philtrum, primary palate (4 upper incisors)
Purpose of conditioner
To remove smear layer but leaves tubules plugged (poly acrylic acid 10%)
Aperts
Tooth genesis (especially of canines) Cleft palate/bifid uvula (often see Byzantine cleft" which is not true cleft but a deep crevice Enamel hypocalcification/hypoplasia Supernumerary teeth Ectopic eruption of maxillary 1st molars Supernumerary teeth; delayed eruption
Vit D
Toxicity: serum 25 hydroxyvitamin D > 250 nmol/L
First place of facial growth to complete
Transverse dimension
Post eruptive
Trauma-->pulp bleeding; dental procedures
Mupoiorcin
Treatment for impetigo
Age 5
Triangle drawing
Russel-Silver Syndrome
Triangular shaped head
4 y/o
Tries to impose power Develops small social groups Expansive period - reaches out form parent Many independent self-help skills
1st Pharyngeal Branch
Trigeminal nerve (not V1) Maxillary process; mandibular process (mandible); Meckel's cartilage Malleus Incus SPHENOMANDIBULAR LIGAMENT Muscles of mastication: master, temporals, pterygoid Anterior digastric Mylohyoid
Formation of reparative dentin
Triggered by: Transforming Growth factor beta
Edwards Syndrome
Trisomy 18
AS concentration of of filler particles increases the modulus of elasticity increases and tends to minimize resin shrinkage
True
Almost all Class III patients require expansion as an essential component of correction to coordinate arch widths, relieve crowding and enhance forward growth fo the maxilla
True
Conditioning by experience and vicarious learning are examples of exogenous sources of dental anxiety
True
Development of self-regulation is affected by a child's temperament, patients' approach to discipline, limit setting and conflict resolution as well as other family relationships
True
The host response in periodontal disease in children is cell mediated
True - T-cell mediated Adults - humoral B-cell (antibodies)
Adult at low caries risk
X-rays - 24-36 mo
Ewing's Sarcoma
Tumor of long bones that relatively are in jaws Arise from medullary portion of bone and spread to endosteal and laster to periosteal surface Patients btw 5-30 y/o. Males 2:1: Females Swelling, pain, loose teeth (floating teeth), paresthesia, and trismus Majority of cases are located in mandible (posterior area) Radiolucent, ill-defined and NEVER corticated; destruction of bone in an uneven fashion; lesions are usually solitary Periosteal (Sunday appearance) mixed radiopaque/Lucent (not well defined) DDX: osteomyeltiis
Gold standard bonding agent?
Two bottle
NUG
Tx: Mechanical debridement and adjunct antibiotics (penicillin, metronidazole)
Dentin Dysplasia
Type 1 (radicular) - normal in color & shaped in both dentition Misalgined arch, drifting and exfoliate with little or not trauma Short or abnormal root shaped; pulp chamber & root canals completely filled in before eruption 20% of teeth with type 1 disease will have APICAL RADIOLUCENCIES Vitality is NORMAL
Dentinogeneis Imperfecta (hereditary opalescent dentin)
Type 1 - DI + OI - COL1A1, COL1A2 Type 2 - isolated - DSPP Type III - DI of Brandywine type - DSPP Enamel fracture, attrition severely Dark brown to black Radiographic features of DI: - Bulbous crown, normal size, constriction of cervical area - Short & slender roots; occlusal attrition - Partial or complete obliteration of the pulp chamber, root canals absent or threadlike
Glass Ionomer Types
Type 1 - Luting (cement) Type 2 - restorative Type 3 - base/liner (in deep caries scenario in teeth)
The most common PROTEIN found in the pulp is
Type 1 collagen
Idiopathic Gingival Fibromatosis
Type 1 collagen (expansion and accumulation of CT, mainly collagen type 1)
Type 1 GIC - luting and bonding Type 2 GIC - used for restorative materials Type 3 GIC - liner and base
Type 4 GIC - fissure and sealants Type 5 GIC - ortho cement Type 6 GIC - core build up
Amelogenesis
Type I - hypoplastic Type II - Hypomaturation (brown, porous surface) Type III - hypo calcified (most common - normal enamel at eruption, but soft and lost) Type IV - hypomaturation + hypoplastic + taurodontism
Primary organic component of dentin is
Type I Collagen
Dentin Dysplasia
Type I: Rootless teeth; short, blunted roots or rootless in both dentitions; normal crown morphology; slightly translucent Obliterated pulp chambers (completely in primary teeth; crescent shaped chamber in permanent teeth) Multiple periodical radiolucencies Root sheath problem Severe mobility and malalignment Autosomal dominant Primary defect is epithelial root sheath that invaginate too early/often
Dentin Dysplasia
Type II - Coronal (and radicular) dentin dysplasia PRIMARY TEETH affected; amber color Looks like DI - II (bulbous crowns, cervical constriction, mild discoloration, pulp obliteration) Coronal dentin is involved as well as root dentin Permanent teeth looks normal, but radiographically demonstrates thistle tube shaped pulps, MULTIPLE PULP STONES
Confidence Interval
Type of interval estimate of a population parameter and is used to indicate the reliability of an estimate. 95% CI - we are 95% confident that the true value of the parameter is in our confidence interval. The desired lvel of confidence is set by the researcher. The confidence level corresponds with the level of significance, for example, 95% reflects significant level of 0.05 or less
Stainless Steel Crowns (SSC)
Typically 316 stainless steel (surgical grade, as used in orthodontic surgery) Old generation up to 72% nickel, 8% iron (3M Ion Ni-Chro) New generation: Iron (65-73%), 17-19% chromium, 9-12% to make them stainless) nickel, <2% manganese, silicon, and carbon similar to ortho bands/wires)
Resin monomers
UDMA or Bis-GMA Bis GMA is product of bisphenol A and gylycidyl methacrylate
Riga-Fede
Ulcerations due to neonatal/natal teeth
Contraindications:
Ulcerative gingivitis/stomatitis; silver allergy; abscessed tooth needing extraction ; irreversible pulpititis
What factor is deficient in Rosenthal's disease or hemophilia C?
XI - hemophilia C is caused by a deficiency of coagulation factor XI and is distinguished from hemophilia A and B by the fact it does not lead to bleeding into the joints
Beckwith-Wiedemann
Umbiliical hernia; crease in ear lobes; macroglossia, microcephaly; enlargement of some organs and tissues; metric ridge --> premature closure of bones in skull, high risk of film's tumor
Endotracheal tube sizing
Uncured tube size - (age/4) + 4 OR (age + 16)/4 Cuffed tube size = (age/4) + 3.5 When age unknown - width of pinky finger can be used to estimate the tube size
Greatest risk factors for adverse sedation events
Under age 5 y/o ; premature birth ; ASA III+ chronic reactive airway dz; current URI with opaque (gren/yellow secretions; obesity (OR 1.7-2.2) OSA; Dev Delay/intellectual disability
Mobius Syndrome
Underdevelopment of CN VI (lateral eye movement) and VII (facial expression) Hearing loss Limb and chest wall abnormalities Normal intelligence Associated with autism
Goldenhar Syndrome
Unilateral microtia, macrostomia and failure of formation of mandibular ramus and condyle Unknown etiology Frequent eye involvement 50% have cardiac issues Auricular skin tan often seen
localized juvenile spongiotic gingival hyperplasia
Unique form of inflammatory gingival hyperplasia seen in young children (avg age 11.8 yrs), predominantly female and generally found in the maxillary anterior region Appears as bright red raised overgrowth w/ papillary or finely granular surface, however, it does NOT SEEM TO BE PLAQUE RELATED LESION Avg age 6 mm localized, easily bleeding DDX: Pyogenic granuloma, and frequently seen in conjunction with orthodontic brackets, which may be purely coincident with patient population but NOT RELATED WITH BRACES!
Punishment
Unpleasant stimulus introduced - punishment
Negative Reinforcement/Escape
Unpleasant stimulus withdrawn
Autism
Unpredictability of sedation, behavioral meds may cause sedation) ADHD (stimulant medications) ODD (oppositional defiant disorder)
Gamma Phases
Unreacted alloy particles (mainly silver and tin) Gamma 1: AgHg Gamma 2: SnHg - responsible for early fracture and failure. Copper replaces gamma 2 (Sn2Hg) phase with copper/tin (Cu5Sn5) phase, decreasing corrosion and preventing weakening/fracture
Salivary Flow Rate
Unstimulated: 0.3-0.4 mL/min (<0.1 mL/min) Stimulated (1-2 mL/min (<0.5 mL/min))
Xylitol in pregnant women
Until age 6 y/o
35-37% phosphoric acid etch for 20-30 seconds 2-3 mm beyond expected margins
Up to 50 um depth of etch
Buccal Space
Upper bicuspids, upper primary molars, lower molars, lower bicuspids, lower primary molars
Studies on oral health benefits associated with use of xylitol:
Use large doses and high frequency unrealistic for clinical practice
Vagal Nerve Stimulator - Treatment Seizures
Used in children >12 y/o Vagus nerve stimulation prevents seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. It is sometimes referred to as a "pacemaker for the brain." A stimulator device is implanted under the skin in the chest. A wire from the device is wound around the vagus nerve in the neck.
INR
Used to monitor patients taking warfarin PT (patient)/PT (control) ISI
Steiner Analysis
Uses GoGn to SN (norm is 32 degrees)
Distal Step
Usually results in full class II; some shift to end-on class II molars
Cranial Nerves and Foramen of Exit from Skull
V1 - Superior orbital fissure V2 - Foramen Rotundum V3 - Foramen Ovale VI - Superior orbital fissure VII - Internal auditory meatus VIII - Internal auditory meatus IX - Jugular foramen X - Jugular foramen XI - Jugular foramen XII - Hypoglossal foramen
2nd order bending of orthodontic arch wire bending achieves
VERTICAL; TIPPING (OCCLUSAL/GINGIVAL); AND UPRIGHTING
4th pharyngeal arch/6th pharyngeal arch
Vagus; laryngeal cartilage, muscle
Which of the following seizure medication can result in prolonged bleeding?
Valproic acid = Depakote Valproic acid causes bone marrow suppression, compromising the production of red blood cells and platelets and reducing platelet aggregation, prolonging the bleeding times, because of its toxic effect on the hematopoietic stem cells, exhibiting values over 120 mcg/ml. Valproic acid is indicated for use as an anticonvulsant drug in people of all ages. It is used mainly as monotherapy or adjunctive therapy for simple or complex absence seizures, either alone or with other seizure types (such as for juvenile myoclonic epilepsy). It is also effective for partial seizures.
Recurrent herpes most common location
Vermillion border Oral lesions: macula-papula-vesicular lesions at mucocutaneous junction of lip Intraoral occur on hard palate and maxillary gingiva - possibly following dental treatment in the area
Last facial plane to complete growth
Vertical dimension
Meperidine
Very bitter taste Direct stimulation of chemotrigger zone in medulla may cause nemeses May be spasmogneic to smooth mjuscle of GI tract
Flumazenil
Very short half-life likely to have to push repeat doses Half life of benzodiazepines is greater than flumazenil (20-30 mins only) initial onset 1-2 minutes) 0.01 mg/kg (not to exceed 0.05 mg/kg or 1 mg whichever is lower)
Mandibular 2nd molar
Very similar to permanent counterpart Narrower buccolingually and less pentagonal than permanent 1st molar
Maxillary 2nd molar
Very similar to permanent counterpart, including Cusp of Carabelli Most similar to permanent counterpart
Zirconium Flexural strength
Very strong - lithium dislocate (eMax) is very strong for crowns at 360-400 mPa) Zirconia (Bruxzir, Lava) is 2-3x stronger at 1000-1200 mPa
Best transport media:
Viaspan >HBSS > Cold milk > saliva> physiologic saline/water
ICDAS 3 and o4
Visible signs of enamel breakdown or signs the dentin is moderately demineralized Established early caveated, shallow cavitation, microcavitation
Vital signs (pt's level of consciousness and responsiveness; heart rate; blood pressure; respiratory rate; oxygen saturation) were monitored until the patient attained predetermined discharge criteria
Vital signs in eluding oxygen saturation and heart rate, must be documented at least every 10 minutes (5 min when asleep/deep sedation) in a time-based record
Nonvital Bleaching
Walking bleach - cervical seal 1-2 mm below CEJ (IRM, Cavit, Temporary resin, GI) Sodium perborate mixed with distilled water 2:1 ratio - easier to control than H2O2) Should be changed every 3-7 days; effects should be noticed after 2-4 visits In office nonmetal bleaching May apply carbamide peroxide gels with or without tooth access open; may be used if "walking"bleach technique is not effective. Usually requires 3-4 visits Side effects: nonmetal teeth: - Increased marginal leakage of existing restoration (external bleaching) - External root resorption (internal bleaching) - Ankylosis (internal bleaching) A COMBO OF BLEACHING AND A HISTORY OF TRAUMA IS THE MOST IMPORTANT PREDISPOSING FACTOR FOR RESORPTION Hydroxyl free radicals can cause periodontal tissue damage and root resorption
Chloral Hydrate Interactions
Warfarin - competition for plasma protein binding increases anticoagulant effect Furosemide (Lasiks) - diaphoresis, tachycardia, hypertension
High Level Disinfection- Destroys all microorganisms but not necessary all spores - Heat Automated
Washer disinfector types of patient - heat sensitive, semi-critical
Correlation between toothbrushing and caries risk
Weak relationship between frequency of brushing and decreased dental caries
BMI
Weight (kg)/height (m^2)
Mercury in amalgam
Wetting agent to initiate setting. When >54% strength is reduced
Melanotic Neuroectodermal Tumor of Infancy
What age, where and what test used?
Modified Aldrete Score
What score is needed for discharge? 9
Asthma - mild intermittent
Wheezing <2 day/week with no night symptoms and good exercise tolerance -
Midazolam vs Diazepam
When compared to diazepam, midazolam was more potent and decreased induction time by more than 2.5 min (p less than 0.001). Recovery time and endoscopist and patient satisfaction were similar (p greater than 0.1), but patient recall was significantly less in the midazolam group (p less than 0.01). Conclusions: Midazolam was 3.4 times more potent than diazepam. The duration of oxygen desaturation emphasizes the importance of monitoring SpO2 until ventilation and oxygenation have recovered. Although the degree of hypoxemia was comparable, midazolam led to higher end-tidal carbon dioxide tensions.
Average fluoride concentration in the cord blood was 60% of that in mothers' blood
When concentration in the mother's blood exceeded 0.4 ppm, the placenta acted as a selective barrier Also low levels in breast milk
Mixed Dentition, Alveolar Bone Graft
When root of canine 1/3 to 1/2 developed prior to its eruption
Remineralization - Precipitin
When saliva secretion is stimulated, a rapid rise in PH to above neutrality occurs A complex of calcium, phosphate, and glycoprotein called Salivary Precipitin is formed This complex is readily incorporated into dental plaque
Disease Indicators:
White spot lesions Cavities Restorative within last 2-3 years
Mandibular 1st Molar
Wider M/D than B/L 2 medial cusps considerably larger than distal cusps Prominent S curve of gingival tissues Broad contact btw mesial 1st molar and canine
Mandibular Lateral incisior
Wider, less symmetrical than mandibular central Rounded distoincisal edge
Single rescuer CPR for unresponsive child
With a witnessed collapse, call 911 before initiating CPR
Periodontitis as manifestations of systemic dz
With eruption of primary teeth up to 4 or 5 y/o Localized or generalied Neutrophils with abnormalities in surface glycoprotines Leukocyte adhesion deficiency A. Actinomycetemcomitans, P. intermedia, Eikenella corrodes, and Capnocytophaga sputigena
Lesch-Nyhan Syndrome
X-linked condition Intellectual Disability May have cerebral palsy Choresathetosis Bizarre, self-mutilating behavior - including lip destruction with teeth Absence of hypoxanthine-guanine Phosphoribosyltransferse (enzyme involved in purine metabolism)
Lesch-Nyan Syndrome
X-linked recessive
Hemophilia A
X-linked recessive: usually due to new mutation; deficiency of VIII:c Correlates with severity of disease to symptoms; bleeding
SCID
X-linked- The most common type is X-linked SCID, due to mutations in the gene encoding the common γ chain for multiple cytokine receptors; the second most common cause is adenosine deaminase deficiency (ADA def.), and the third most common cause is IL-7Rα-chain deficiency.
Interactions of X-rays with matter (tissue)
X-ray hits soft tissues. We want some x-rays to go through and hit the film... 1. Coherent scattering 2. Photoelectric absorption 3. Compton effect (scattering)
Congenital Vascular Malformations
You are NOT born with that! Many of these malformations become evident during puberty because they have hormone receptors. The most common subtype congenital vascular malformations are the venous (low-flow) malforatmions Clinical presentation of vascular malformations is highly variable. Lesions can be localized, well defined, or extensive, diffuse and infiltration. On palpation, a compressible, sometimes tender mass is often found. Pain possible but majority are asymptomatic. vascular malformations can grow suddenly after trauma or infection. Lesions are usually soft compressible and non-pulsatile Doppler ultrasound and MRI are generally preferred methods for an adequate and complete assessment and follow-up. The treatment for small, asymptomatic lesions is conservative. More extensive lesions the treatment include sclerotherapy or surgical resection.
p = 0.002
You can reject the null hypothesis and accept the hypothesis. P value is measure of consistency of results. Widely used P value = < 0.05
Young's Rule
Young's Rule is an equation used to calculate pediatric medication dosage based on the patient's age and the known recommended adult dose. The definition of Young's Rule is the age of the patient, divided by the age added to twelve, all multiplied by the recommended adult dose.
What cement is considered an irritant:
Zinc Phosphate
Mouth breathing
adenoid facies (long lower face, maxillary constriction Normal for 3-6 y/o children to be lip incompetent; roughly equivalent percentage fo nasal and oral breathers before age 8 y/o
Fourth branchial arch
all muscles of larynx; all muscles of pharynx (except stylopharyngess) all muscles of soft palate (except tensor palatine) Pouch - superior parathyroid gland; C-cels of thyroid
Spherical mercury
amalgamates more readily, concdenses more readily, requiring less mercury (42% vs 50%) than lathe-cut alloy and gaining strength more quickly
Tetracycline following avulsion
antimicrobial properties but is also anti-resorptive Doxycycline - 4.4 mg/kg/day q12 h on day one, then 2.2-4.4 mg/kg/day for 7 days
MTA reparative dentin
as soon as 3 weeks
Benign cementoblastoma
attached to apex of tooth in 2nd or 3rd decade; usually before 18 y/o Slow growing mesenchymal neoplasm Composed principally of cementum-like tissue and attached to the apex of tooth root More common in males than females Continuous with root, which is RESORBED Pulp vitality unrelated, but the involved tooth is OFTEN PAINFUL More mandible in premolar or molar area
Dental Sac
becomes PDL and cementum
Dental Papilla
becomes dentin and pulp
High risk dietary practices
begin at 1 year old
Ameloblastic fibroma
benign mixed mesodermal and ectodermal tumor
Window of infectivity
birth to 2 years of age
Oral complications of bone marrow transplantation include
candidiasis, mucositis, herpetic infection, and xerostomia
MI Paste
casein phosphopeptide-amorphous calcium phosphate - The expert panel emphasized that 10% CPP-ACP should not be used as substitute for other fluoride products - To arrest or reverse noncavtated carious lesions on facial or lingual surfaces of primary teeth, the expert panel suggests clinicians use 1.23% acidulated phosphate fluoride gel or 5% sodium fluoride varnish
GI or RMGI acceptable (no siginciaint diff in retention) RMGI may be used with a bonding agent to increase retention
cementing SSCs
Hypercapnic Drive
central chemoreceptors - Medulla chemoreceptors -sense acidity generated by carbonic acid from CO2 entering the brain
Beckwith-Wiedemann Syndrome
chromosome 11 Autosomal dominant A ridge in forehead caused by premature closure of the bones (Metopic Ridge) Severe hypoglycemia, umbilical hernia (omphalocele), cytomegalovirus of adrenal cortex, renal dysplasia, gigantism, Macroglossia Exomphlaos Gigantism Neonatal hypoglycemia Mental retardation Organomegaly Abdominal wall defect Earlobe pits Wilms tumor
Disease Indicators
clinical signs of disease or history of the disease: White spot lesions, cavities; restorations within last 2-3 years
Hypercementosis
completely diff from benign cementoblastoma
Transverse dimension first to compelte/slow down prior to anterior/posteior dimension
completes before anterior/posterior completes before vertical
Low concentration of calcium and phosphate cause increase in critical pH...
possibly as high as 7.0 in some people
Zirconium Dioxide -
preformed zirconia crowns
Prevalence vs. Incidence
prevalence = percent of people affected in a population incidence = new incidents in a given time period/total population at risk
P value
probability of not occurring by chance (want low p value)
Amalgam - % composition
current amalgam alloy consists of silver (40%), tin (32%), copper (30%) and other metals.
Cleidocranial dysostosis
delayed suture closure; Brachycephaly Wormian bones Absent clavicles · Delayed development and eruption of permanent teeth · Supernumerary teeth · Delayed primary exfoliation · Enamel hypoplasia § Cleidocranial dysplasia · Deficient cellular cementum · May be related to lack of eruption
Zirconia crowns - tetragonal
dental applications (YTZP)
Enamel organ
differentiates into 4 layers (OEE, IEE, stellate reticulum and stratum intermeidium (lines IEE) - ameloblasts that produce the enamel
Linear enamel hypoplasia
disruption of appositional phase in neonatal period. More common in malnourished children. Caused by disruption during appositional stage of enamel formation - NEONATAL PERIOD Most common in middle third of maxillary central incisors and incisor third of lateral incisors
Pacifier cessation
earlier than digit habits - 90% before age 5 y/o 100% before age 8 y/o
Patient taking theophylline for asthma, you would not prescribe...
erythromycin
Leading cause of cancer death among children 1-5 years,
especially for infants with ependymomas and primitive neuroectodermal tumors (PNET) - CNS and Brain Tumors
Glutaraldehyde
fixative with cross-linking properties
Dental papilla (neural crest origin)
formative organ of dentin and primordial of pulp
N2O.- oxidizes Vitamin B12
from active (reduced Cobolamin) to inactive form (which inactivates METHIONINE SYNTHETASE ENZYME). This functions to decrease DNA production (interferes with cell proliferation)
The Mandibular process
fuses at 12 months post-fatally to produce synostosis
Admixed (comminuted) amalgam
has stronger proximal contacts
Extrusive luxation
if minor (<3 mm) reposition in socket; if >3 mm extract
Cesamoid and epiphysis
implies growth is done
Visible plaque was best INDICATOR of caries
in a study of adult patients at UCSF, visible plaque was significantly associated with cavitation of enamel and/or dentin
LOW VIT D
in mothers more likely to have children with ECC
The first sign of ossification of the mandible is:
initial osteogenesis lateral to mocker's cartilage
Radicular type of dens in dente
invagination of Hertwig's epithelial root sheath, lined with cementum
GI bond strength to dentin and enamel
is 10
Smear layer (organic)
is about 1-5 micrometers
Which suture type for internal wound closure
is monofilament nylon
Therapeutic margins
is related to effective dose and lethal dose
Gingiva in children
less well developed net of collagen fibers than in adults
Alpha
level of statistical significance (want high alpha)
Glutaraldehyde
lower pH 7.5-8.5 2% w/ exposure
Calcium gluconate
med given at hospital via IV for fluoride toxicity
N2O
mild myocardial depressant, mild sympathomimetic effects cancer each other
Products that slow absorption for fluoride toxicity:
milk, calcium carbonate, aluminum-magnesium based antacids
A patient has a asymmetrical headgear. The longer arm provides for...
more distalizing movement
Idiopathic bone sclerosis (bone lesion)
most common bone lesion
Chlorhexidine
most effective against mutans streptococci (compared to lactobacilli, sanguines = thus SELECTIVE for anti-caries effect) Bisguanide, + charge, bactericidal, gel/varnish > rinse, disrupts bacterial membranes and enzymes Disadvantages: staining, bad taste
NSAIDS avoided in asthma
naproxen 10-20% of asthmatics are sensitive to aspirin and NSAIDS
Maxillary process + lateral nasal process
nasolacrimal duct
Cyclic neutropenia
neutrophile elastase gene - causing defect in stem cell regulation; childhood form. Autosomal dominant Normal to <500 q 21 days Granulocyte colony stimulating factor to increase neutrophil count
- Deep compressions:
o At least 2 inches - adult o 2 inches, 1/3 chest - child o 1.5 inches - Infants
Renal transplant considerations
o Avoid NSAIDs (increase bleeding with corticosteroids and potentiation of nephrotoxicity of cyclosporine and tacrolimus)
Copper in amalgam
o Copper (Cu) - prevents corrosion, reduces fracture § Allows for a little corrosion to improve margin
Langerhans Cell Histiocytosis
o Disseminated disease - multiple periapical radiolucencies; floating tooth appearance o Localized disease (eosinophilic granuloma) - multiple periapical radiolucencies; floating tooth appearance (usually localized to BONE; may have soft tissue involvement; rapid alveolar bone loss and tooth mobility
Kawasaki Disease
o Mucocutaneous lymph node syndrome o Bilateral conjunctivitis o Fissured lips o Infected pharynx o Strawberry tongue o Erythema of psalm and soles o Rash o Cervical adenopathy
Asthma considerations
o Optimal asthma control is desireable before dental treatment o Aspirin as well as other non-steroidal anti-inflammatory medicaitons should be avoided in asprin-sensity persons o Approximately between 10-28% of children with asthma may be intoleratne to aspirin o Opiates may be used with caution (respiratory depression) o Macrolid antibotiics (erythromycin; (azithromycin and clarithromycin also) may elevate theophylline levels
Latex Allergy
o Some of the latex proteins share a similar epitope to that of proteins found in fruits such as avocados, bananas, chestnuts, figs, kiwis, turnips, tomatoes, potatoes o Estimated that a patient with a history of fruit allergy has an 11% risk of concurrent latex allergy
Tin in amalgam
o Tin (Sn) - critical to setting reaction, controls dimensional change
Zinc in amalgam
o Zinc (Zn) - acts as a scavenger for oxygen, forming Zn oxide in place of Cu/Ag/Sn oxides (weaken restoration)
GERD
o acid suppresses have been found more effective in pediatric patients than prokinetic medications that promote gastric emptying o the main classes of gastric acid suppression are anti acids, histamine two receptors antagonist and proton pump inhibitors · children who had failed pharmacologic treatment may be candidates for surgical management o Nissen fundoplication, where by the gastric fundus is wrapped around the distal esophagus is most common o Pyloroplasty to increase the diameter of the pie loris and thereby facilitate gastric emptying can aid in preventing GERD
Koplic spots
oral manifestations of measles (rubeola) - multiple tiny white, macule that wipe off (grains of sand appearance)
Bicarbonate buffer system
pH 7 to pH 5
pKa of common LAs
pKa - Mepivicaine - 7.7 pKa - Articaine, lidocaine, prilocaine = 7.8 pKa of bupivicaine - 8.1
pH to pKa of LAs
pKa are weak bases - 7.5-9.5 but prepared in salt form by addition of HCl to make them stable in solution
Complex Odontoma
radiopaque surrounded by radiolucent area and then by radiopaque again Malformation in which all dental tissues are respected Ian unorganized pattern GOLF BALL
MORE SEVERE GRAFT VS HOST DISEASE WILL RESULT IN LESS LIKELY TO HAVE RECURRENT ALL
recurrent ALL less likely with more severe GVHD
Maxillary process
secondary palate
TGF-beta
sequested in dentin matrix during tooth development May be released when caries or acid etchant causes dissolution of matrix Growth factors interact with pulp to cause proliferation and differentiation of mesenchymal cells to form reparative dentin CaOH ha similar effect- high pH causes slight demin and releases TFG-beta leading to reparative dentin and apexification
Calcium silicate
set time 9-12 minutes
Articaine
shortest half life of dental anesthetics due to its: characteristic structure containing an ester side-chain Articaine - ester group at the lipophilic terminus
Ortho Appliances
should be removed if poor OH or HCT conditiotioning regain caries risk for dev of mod to sev mucositis
What is the coupler
silane
Consider intervention by 3-4 years of age
since 5-6 years of age teeth erupt
Asthma - moderate
some night symptoms, limited exercise tolerance, wheezing 2-5x/day
CaOH
superficial necrosis sof pulp Not great seal
ANOVA and T - test
tests that are typically done when variables are continuous
shaping behavior
the process of guiding learning in graduated steps using reinforcement or lack of reinforcement
Stylopharyngeus muscle
third branchial arch
Larson' maneuver
to break laryngospasm - push at point posterior and superior to earlobes Push both sides firmly inward towards the skull base. Simultaneously push anteriorly similar to a jaw thrust maneuver. Should break the laryngospasm within 1-2 breaths
Veau Classification
type 1 - lip notch not passing vermillion border Type 2 - lip passing vermillion border but not nasal Type 3 - lip passing vermillion border but into nasal Type 4 - bilateral
Most common neurofibromatosis
type I (NF1)
Rubber cup can remove how much enamel?
up to 0.6-0.4 microns of enamel
CBC and peripheral blood smear
used to determine adequacy of platelets, red cell morphology
BMI
weight (kg) / (((height (m^2))^2)
Carbamide peroxide
what is the benefit over hydrogen peroxide? Longer shelf life
Use biologic indicators
whenever a new type of packaging material or tray is used After training new sterilization personnel After repair After change in loading procedures
Maxillary canine
wider, more symmetrical than mandibular canine. Cusp tip is offset to the distal (in contrast to mandibular which is lean towards medial side)
How does voice control work?
§ Alteration of voice in, volume and pace to influence behavior § Goal is to gain child's attention in an effort to extinguish negative behaviors and re-establish communication between dentist and child
Incontinentia Pigmenti
§ Incontinentia pigmenti · Conical crowns · Delayed eruption · Premature teeth (erupt prior to 3 months of age) · Cleft lip/palate
Hypophosphatasia
§ Most likely to affect primary incisors but may affect additional teeth § Pulp chambers may be abnormally large Low serum alkaline phosphate Increased phosphoethanolamine in urine or elevated pyridoxal phosphate in serum Deficient or defective cementum by histologic examination