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Pedodontics Midterms

Pedodontics Midterms

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Published by Rosette Go

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Published by: Rosette Go on Aug 02, 2011
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PEDODONTICS MIDTERMS
INTRAORAL EXAMINATION
Examination of the oral cavity
 The breath of the healthy child is usuallypleasant and even sweet
BAD BREATH or HALITOSIS may be causedby local or systemic factors
o
LOCAL
Poor oral hygiene
Presence of blood in themouth
Presence of strongsmelling volatile food
o
SYSTEMIC
Dehydration
Sinusitis
Hypertrophy of upperalimentary tract
 Typhoid fever
Other enteric infectionsand GI disturbances
ACIDOSIS
usually produces and odor of acetone on the breath
o
Condition of the oral mucosa is anindicator of the general health of the child
o
Presence of inflammation, pallor,and ulcerations
SOFT TISSUES
LIPS & CHEEKS
o
Gateway to the oral cavity
o
 The most common lesions seen inthe labial and buccal mucosa of children are those associated withHSV
o
Addison’s disease and IntestinalPolyposis may cause a pathologicbrownish…
TONGUE
o
Pathologic enlargement of thetongue may be due to cretinism ormongolism or may be associatedwith a cyst or neoplasm
o
Desquamation of the surfacepapillae associated withavitamonoses, anemias, or stressdisorders
o
Abnormally short lingual frenummay prevent the tip of the tonguefrom coming forward and result tospeech difficulty
o
 Tongue habits should be observedfor possible association withmalocclusion
o
Dryness of tongue may be due todehydration for mouth breathers
o
RANULA or MUCOUSRETENTION CYST
SALIVARY GLANDS
o
Epidemic parotitis or Mumps ischaracterized by a tender, painful,unilateral or bilateral swelling of the salivary glands
HARD & SOFT PALATE
o
Scars may be caused by trauma orsurgical repair of developmentalanomalies
o
Color changes may be caused byneoplasms, infectious or systemicdiseases, trauma or chemicalagents
TONSILS
GINGIVA
o
Periodontal pocketing is rare in theprimary dentition unless there is anassociated medical condition
o
If generally the oral hygiene isgood, with few plaque…
TEETH
o
Oral cleanliness
o
 Teeth present/number of teeth
Partial anodontia
Supernumerary teeth(Mesiodens)
o
PRIMARY 
Crowns are completelyformed and start to erupt:6 months
Start of tooth formation: 6weeks intrauterine life
Completion of roots: 2years
Formation of roots start at1 year
o
PERMANENT
Crowns form: 3 years
Roots form: 3 years
o
Size of teeth
Macrodontia
Microdontia
o
Mobility
Exfoliating primary tooth
Abscess
Periodontitis
o
Color of the teeth
Extrinsic stains can becaused by chemogenicbacteria which mayinvade deposits of materiaalba and calculus, causingan array of colors onchildren’s teeth
Generalized discolorationof the enamel and dentinis due to intrinsic factorssuch as:
Blood dyscrasias
Amelogenesisimperfecta
Dentinogenesisimperfecta
Internalresorption
Drugs –tetracycline
Non-vital tooth
Caries
o
Structure/malformation
Hypoplasia
Hypomineralization
Dilacerations
Dwarfed tooth
Geminated tooth
Fused tooth
Nothced tooth – syphilis
Peg-shaped tooth
Due tohereditary,systemic ordevelopmentaldisturbances
OCCLUSION/OCCLUSAL ASSESSMENT
o
Permanent first molars and canines
Molar and caninerelationships
o
incisors
overjet
overbite
o
position
crowding
spacing
drifting
MORPHOLOGY OF THE PRIMARY TEETH
1 hour chair time at the most for pedo patients
Primary has flared roots
 
Primary may fracture easily at the neck  portion
GENERAL MORPHOLOGIC CONSIDERATIONS INTHE PRIMARY DENTITION
CROWN
1.Shorter crown2.Occlusal table is narrower3.More constricted cervical area4.Enamel and dentin layers arethinner
5.
Enamel rods in gingival 3
rd
extendslightly occlusal direction from DEJ6.Contact areas are broad and flat7.Mineral content is nearly the same8.Color is more lighter
9.oral hygiene is not yet developed in children that iswhy they are more prone toacute caries
PULP
1.Larger pulp2.pulp horn is closer to outer surface3.mesial pulp horns are closer toouter surface4.mandibular has larger pulpchamber than maxillary5.form of pulp chamber follows thesurface of the crown6.usually has pulp horns under eachcusps7.histologically, there are very littledifferences from permanent
ROOT
1.Narrower M-D of anterior roots
2.
Posteriors are longer and moreslender3.More flare as it approach the apex
INFLUENCES OF PRIMARY TOOTHMORPHOLOGY 
Progress of caries and it is necessary torestore incipient lesions in primary teethbecause of the ff. factors:
Enamel is much thinner
 Thus, dental caries ismore active in primaryteeth
Dentin is proportionally thinnerINDICATIONS FOR USE OF MATERIALS INPEDIATRIC DENTISTRY 
PRIMARY 
CLASS I
GIC, Am, Co
CLASS II
GIC, Am, Co
Gross carious breakdown orrestoration after pulp therpy
SSC
PERMANENT
Occlusal Table
Fissure sealant
Occlusal enamel caries
Fissure sealant
Occlusal caries with minimalinvolvement of dentin
PRR (Preventive ResinRestoration)
CLASS I
Co
CLASS II
Am
CLASS III
Co
CLASS IV
GIC, Co
CLASS V
Co
PREVENTIVE RESIN RESTORATIONS
Most conservative approach towardconfined, incipient occlusal caries in youngpermanent teeth whereby restorationoccurs with a minimum of tooth preparationwhile ensuring the prevention of futurecaries formation through sealant placement
PRR preserves sound tooth structure byincorporating a conservative compositeresin restoration with sealant application
Counterpart in adult/permanent: SPOTFILLING
PROPHYLACTIC ODONTOTOMY –
removedefect part of tooth to prevent decay
3 TYPES OF PRR1.TYPE A
Comprises suspicious pits andfissures where caries removal islimited to enamel
Unfilled sealant
2.TYPE B
Is indicated where the exploratoryremoval of caries has includeddentin to a slight extent
Diluted composite resin (flowable)
3.TYPE C
Characterized by the need forgreater exploratory preparation indentin
With local anesthesia and linerplaced in the exposed dentin
Filled composite resin
PIT AND FISSURE SEALANT
(preventive)
Application and mechanical bonding of resinmaterial to an acid-etched enamel surface,thereby sealing existing pits and fissuresfrom the oral environment
 This mechanism prevents bacteria fromcolonizing in the pits and fissures andnutrients from reaching the bacteria alreadypresent
Indications:
o
Be dependable on recallappointments
o
Be aged 6 – 15 years
o
Be motivated and effective incaries control
o
Have low caries activity
o
Caries-free permanent teeth withsteep cuspal inclines
o
STAINLESS STEEL CROWNS
(restorative)
Are preformed extracoronal restorations
Indications:
o
Primary or permanent teeth withextensive carious lesions
o
Primary teeth with three carioussurfaces
o
Primary or permanent teeth withenamel or dentin defects
o
Hypoplastic enamel, amelogenesisimperfecta, or dentinogenesisimperfecta
o
Fractured teeth
o
Primary molars that haveundergone pulp therapy
o
 Teeth used as abutments for spacemaintainers
ARMAMENTARIUM FOR SSC
Stainless steel crowns numbered 2 – 7
Pliers
o
 Johnson 114
o
Crimping pliers or Adams pliers
o
Crown cutting scissors
Reduce 1 – 1.5mm on the cuspal area
Slice through
Do not create a ledge
Measure the tooth before reduction
Crowns are placed lingual first so that thefilling will flow at the buccal for easierremoval of excess
 
material
 
CROWNS
Are often times associated with an adultdentition for restoration of a tooth thatneeds full crown coverage
Casted crowns are better fitting thatpreformed crowns
A restoration that covers a tooth to restoreit to normal shape and size
It helps in strengthening and improving theappearance of the tooth
A crown is necessary when the tooth istotally broken down where fillings can’trestore tooth’s function and anatomy
 The crown should represent the naturaltooth
 The color of the crown should match withthe teeth adjacent to it
 The dimension of the crown – MD widthshould be in proportion
 The crown should restore the function andesthetics of the tooth it represents andshould help in maintaining adequate archlength
Should be biocompatible with thesurrounding structures should beeconomical
INDICATIONS:
A primary tooth with more than twosurfaces destroyed due to caries
A tooth which has undergone pulp therapy
Moderate caries involvement in…
After traumatic dental fracture involvingsignificant portion of the crown
CONTRAINDICATIONS:
Primary teeth in which conservativeamalgam restorations can be placed
 Teeth to be exfoliated within a brief period
Retainer for space maintainers appliance
o
 The preformed crown should beconsidered as a means of restoringa primary tooth, not as a means of fabricating a space managementappliance
CLASSIFICATION OF PREFORMED CROWNS
According to Form and Contour
o
Untrimmed, uncontoured,uncrimped crowns
o
Precontoured and untrimmedcrowns
o
Pretrimmed, precontoured,precrimped crowns
According to Materials used
o
Stainless steel crowns
o
Nickel chromium crown
o
Polycarbonate crown
o
Pedo strip crown
SSC STEPS:
1.The occlusion of the patient is noted2.Anesthetize the tooth to be prepared3.Placement of the rubber dam is essential4.Removal of decay
For pulpotomy, instead of using ZOE for sealing, use Calcium Hydroxide for the apicesto close (APEXOGENESIS)
TOOTH PREPARATION
1.Occlusal reduction2.Proximal reduction3.Selection and seating of the crowns(measure M-D width first)4.Adaptation of the crown (check theocclusion; do crimping)5.Cementation of the crown
PROPERLY SEATED CROWNS
Correspond to marginal ridge height of theadjacent tooth
Does not rotate on tooth
Adapts closely to the tooth in cervical 3
rd
No blanching of gingival tissues
o
Crown normally extends 1mm intothe gingival sulcus
Adjacent proximal contact must bemaintained
Occlusal relationship must be established
o
A thumb must always be kept overthe occlusal surface of the crownduring removal
ADAPTATION OF THE CROWN
Adjustment the crown is required
Crown should adapt to the walls of the toothon Bu, Li, M, D
Sudden forceful jerks on sharp dislodgingmovements must be avoided
CEMENTATION
Adapt first on Li then Bu
o
For easier removal of cementexcess
OBJECTIVES FOR ANTERIOR
Restoring esthetics
Preventing psychological trauma
Restoring function
Maintaining occlusion
Prevents fracture
INDICATIONS
Primary anteriors with severe caries
A tooth which has undergone pulp therapy
Moderate caries involvement in…
After traumatic dental fracture involvingsignificant portion of the crown
POLYCARBONATE CROWNS
Provisional crowns, acrylic crowns
Polycarbonate CrownStrip – off CrownAdvantages:
Improvedesthetics
Helps inphonation
Advantages:
More estheticcrown
Improvedretention
Better wearresistant
Disadvantages:
Difficult to place
Poor retention
Prone toexcessive wear
Brittle, highincidence of fracture
Limited shadeselection
Uncrimpablemargin
Disadvantages:
POLYCARBONATE CROWN PREP
1.Caries removal2.Administration of local anesthesia3.Selection of crown size4.Placement of rubber dam5.Shoulderless prep of tooth6.Adaptation of crown7.Roughening of interior surface of crown8.Cementation9.Finishing of margin
STIP – OFF TECHNIQUE
1.Crown selection and prep2.Tooth prep3.Crown placement
SELECTION OF STRIP – OFF CROWN
Select the appropriate celluloid crown sizefrom the MD measurement (in mm) at thetooth’s incisal edge
 Trim off excess cervical collar and tab withcurved scissors
Punch holes in the incisal edge of the crown

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