MCQs in Pediatric DentistryMultiple Choice Questions in Pediatric Dentistry, 2/e Muthu ELSEVIER A division of Reed Elsevier India Private Limited Mosby, Saunders, Churchill Livingstone, Butterworth Heinemann and Hanley & Beljs are the Health Science imprinis of Elsevier © 2005, 2011 Elsevier First Edition 2005 Second Edition 2011 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means~electronic or mechanical, including photocopy, recording, or any information storage and retrieval system—without permission in writing from the publisher ISBN: 978-81-312-2815-9 Medical knowledge is consistently changing. As new information becomes available, changes in treatment, procedure, equipment and the use of drugs become necessary. The authors, editors, contributors and the publishers have, as far as it is possible taken care t0 ensure that the information given in this text is accurate and up-to- dare, However, readers are strongly advised to confirm that the information, specially with regard to drag dose/usage, complies with current legislation and standards of practice. ion of Reed Elsevier India Private Limited Published by Elsevier, a di Registered Office: 622, Indraprakash Building, 21 Barakhamba Road, New Delhi-110 001 Corporate Office: 14th Floor, Building No. 10B, DLF Cyber City, Phase I], Gurgaon-122 002, Haryana, India Publishing Manager: Ritu Sharma Commissioning Editor: Nimisha Goswami Managing Editor (Development): Anand K Jha Copy Editor: Anu Vig Manager, Operations: Sunil Kumar Production Executive: Arvind Boni Cover Designer: Raman Kumar ‘Typeset by County Caramels Printed and bound atContents Foreword. Contributors Preface to the Second Editi Preface to the First Edition. Acknowledgements wv Section I Fundamentals—Introduction to Pediatric Dentistry 1.__ Introduction to Pediatric Dentistry... History Taking, Examination, Diagnosis and Treatment Planning in Pediatric Dentistry... 3,__ Chronology and Morphology of Primary and Pecmanent reed 6 A. Tees jentification. 20 Section II Growth and Development—Changes in the Dentoficial Steuctures 5. Growth and Development. 6. Development of Dentition and Occlusion. Section III Psychology, Behavior and Behavior Management 7. Child Psychology... 8. Behavior Management. 9. Pharmacological Behavior Management ... Section IV Preventive Dentistry 10. First Dental Visi 11. Principles of Preventive Dentistry 12. Infant Oral Health and Anticipatory Guidance: mPa 4 14, Plague Control Measures in Pediassic Dentis alth Programs...xviii 16. Caries Risk Assessment and Caries Activity Tests 18. Early Childhood 9, ole of Diet 20. Recent Advances in Diagnosis of Dental Caries Section VE Restorative Dentistry and Endodontics a Fissure Se: Sa Preventive i es is " 'Z. Atraumatic Restorative Treatment. Pediatric Operative Dentistry Pulp ‘Therapy of Primary and Young Permanent Teeth Crowns in Pediatric Dentistry .. Section VII Injuries to the Teeth—Prevention and its Management 26. Traumatic Injuries of Teeth and its Supporting Structures. 5 27. Sports Dentistry for Children and Adolescents 2 Section VIIT Pediatric Orthodontics 28. Preventive and Interceptive Orthodontic: 29 Space Maintainers and Regainers.. 30. Oral Habits... Section IX Children with Special Health Care Needs and Medical Emergencies 31. Dental Care for Children with Special Health Care Needs 32. Management of Medically Compromised Children... 33. Cleft Lip and Palace Mani 34. Medical EmergenciesSection X Interdisciplinary Pediatric Dentistry Oral Surgical C Jerations and Local Anesthesia Prosthodontic Considerations for Children and Adolescents Pediatric Oral and Maxillofacial Pathology and Treatment Considerations ingival and Periodontal Diseases in Children Forensic Odontology. Section XI Miscellaneous 40. 41. 42 43. 44. 45. 46. 47. Dental Materials Used in Pediatric Dentistry. Radiology Indices Used in Pediatric Dentistry Genetic Aspects of Dental Anomalies Antimicrobials and Analgesics Used in Pediatric Dentistr Child Abuse and Negleet.. Pediatric Dentistry: Practice Management. Developmental Disturbances... Bibliography xixJASN ops Gp pe dae taeSection | Fund Is] fucti Pediatric Dentistry Chapter 1 Introduction to Pediatric Dentistry... 3 Chapter 2 History Taking, Examination, Di tment Planning in Pediat 4 Chapter 3 Chronology and Morphology of Primary and Permanent Teeth .. rorscne eet eiitific: onJASN ops Gp pe dae taeAns Introduction to Pediatric Dentistry Which national society states the following message — “Every child has a fundamental right to his/her total oral health and we have an obligation to fulfill this faith”? a. European Academy of Pediatric Dentistry b. Indian Society of Pedodontics and Preventive Dentistry c. Japanese Society of Pediatric Dentistry d, American Academy of Pediatric Dentistry b ‘The quote mentioned above is the motto of Indian Socicty of Pedodontics and Preventive Dentistry (ISPPD). Characteristics of an ideal pedodontist a. Kindness b. Patience c. Empathy d. Allof the above d. All of the above-mentioned virtues are characteristics of an ideal pedodontist. Differences between child and adule patient are Physical, emotional and psychological development Dentist to the patient relationship Dentist ro the parent relationship a. b < d. Both (a) and (b) d. ‘The factors mentioned above in (a) and (b) are significant differences between child and adult patients, which may influence the management of children in the dental office.Planning in Pediatric Dentistry Ans History Taking, Examination, Diagnosis and Treatment The carious lesion always appears smaller on the radiograph than it actually is. Likewise, microscopic observation of ground sections of teeth reveal that the progress of the lesion through the enamel and dentin is more extensive than it is evident on the radiograph. Both the statements are false Both the statements are true First statement is true and the second is false a b. c d. First statement is false and the second is true b. The answer is self-explanatory. Which of the following is true regarding drug abuse? a. Symptoms of abuse may include depression, frustration, feeling of inadequacy, helplessness, immaturity, major deficiencies in ego structure and functioning . b. Substances commonly abused are solvents, inhalants, narcotics, stimulants, sedatives, tranquilizers and tobacco c. Glue sniffing and gasoline sniffing are also different forms of drug abuse d, All of the above d. All the above-mentioned factors are true regarding substance/drug abuse. In extraoral assessment, the height and weight information is recorded for a. Correlating it to dental disease b. Establishing the relationship with early childhood caries c. Comparing with the standard growth curves d. None of the aboveAns Ans 5. Ans c ‘The height and weight information is recorded to compare them with the standard growth curves. [fa patient is below the third perceatile or above the 97th percentile, referral to a pediatrician may be necessary. All of the following statements are true regarding pain in history taking except a. Child should be asked whether hot or cold food or drinks have any relation to pain b. Duration of pain following the exposure to stimulus should be questioned c. Spontaneous pain indicates reversible pulpitis Pain that is precipitated by pressure indicates periodontal damage © Spontancous pain indicates hiscory can be very useful in determining the treatmenc planning irreversible pulpitis. Eliciting an accurate pain for child, (i) Electrical and thermal stimulations are the most common methods of assessing vitality. (ii) Young children are not good candidates for vitality testing as false positive responses are common in primary dentition. a. Both the statements are true b. Both the statements are false c. First statement is true and the second is false d. First statement is false and the second is true The answer is self-explanatory. N History Taking and Treatment PlanningAns 2. 3. Ans Chronology and Morphology of Primary and Permanent Teeth Evidence of development of human tooth can be observed as early as a. 6th week of embryonic life b. 11th week of embryonic life c. 14th week of embryonic life d. 16th week of embryonic life a. Evidence of development of tooth can be observed as early as Gth week of embryonic life. According to Kraus and Jordan, the first macroscopic indication of morphologic development of tooth occurs at approximately 11 weeks in utero. Calcification of the primary maxillary central incisor begins ac approximately 14 weeks in utero, Evidence of developing primary canines can be observed between 14 and 16 weeks. Enamel hypoplasia is because of disturbance in tooth development stage of a. Initiation/proliferation _c. Morphodifferentiation b. Histodifferentiation d. Apposition a. Refer to the explanation of Q. No. 2. Microdontia or macrodontia of teeth is because of damage in stage of tooth development a. Initiation/proliferation b. Histodifferentiation c. Morphodifferentiation d. Apposition © Microdontia or macrodontia of tecth is because of damage occurring in the stage of morphodifferentiation. (See Table 3.1 on next page)Table 3.1 S.No. | Aberration in stage of tooth| Result development 1. | Initiation/proliferation Supernumerary teeth Partial anodontia Odontoma 2 Histodifferentiation Amelogenesis imperfecta Dentinogenesis imperfecta Morphodifferentiation Peg teeth Mulberry molars Microdontia Macrodontia Talon cusp 4. | Apposition Enamel hypoplasia 4. The first macroscopic indication of morphologic development of primary incisors occurs approximately at a. 11 weeks in utero b. 14 weeks in urero ¢. 16 weeks in utero d. 6 weeks in utero Ans a. Kraus and Jordan have found that the first macroscopic indication of Ans morphologic development occurs at approximately 11 weeks in utero. The maxillary and mandibular central incisor crowns appear identical at this early stage as tiny, hemispheric, mound-like structures. ‘The first evidence of calcification of primary teeth begins approxi- mately at a. 11 weeks in utero b. 14 weeks in utero c. 16 weeks in utero d. 6 weeks in utero b. Calcification of the primary maxillary central incisor begins at approximately 14 weeks in utero, the upper central incisor slightly preceding the lower central. w Chronology and Morphology of Primary and Permanent Teethw Pediatric Dentistry: MCQs Ans Ans Ans Ans In primary teeth, cusp of Carabelli is seen in a. Maxillary first molar b. Maxillary second molar ¢. Mandibular first molar d. Mandibular second molar b. Cusp of Carabelli is seen in maxillary second primary molar. Mandibular first P Y P Y primary molar has a central ridge. Extreme curvature of the buccal side is characteristic of a. Mandibular first primary molar b. Mandibular second primary molar cc. Maxillary first molar d. Maxillary second primary molar ae Extreme curvature of the buccal side is characteristic of mandibular first primary molar. The buccal curvature of maxillary first primary molar is not as prominent as the mandibular first primary molar. The primary second molar (mandibular) resembles a, Maxillary first permanent molar Mandibular first permanent molar . Maxillary second permanent molar d. Mandibular second permanent molar b. Mandibular second primary molar resembles the mandibular first permanent molar. Maxillary second primary molar resembles the maxillary first permanent molar. Maxillary and mandibular second permanent molars do not resemble any primary tooth, All of the following are true of primary teeth except a. Crowns of the primary teeth are wider in comparison to their crown length than are permanent teeth b. Roots of primary molars are long and slender ce. Prim ry teeth are usually lighter in color than the permanent teeth Buccal curvature on primary first molars are not prominent d. Extreme curvature of the buccal side is characteristic of mandibular first primary molar. The buccal curvature of maxillary first primary molar is not as prominent as mandibular first primary molar.Ans ll. Ans 12. Ans -al emergence of a tooth occurs when a. One-fourth of the root formation is complete Half of the root formation is complete c¢. Three-fourths of the root formation is complete d. Root formation is complete e According to Gron, tooth emergence appeared to be more closely associated with the stage of root formation than with the chronological ot skeletal age of the child. By the time of clinical emergence, approximately three-fourths of root formation would have occurred. Teeth reach occlusion before the root development is complete. According to Moyer, the most favorable sequence of eruption of maxillary permanent teeth is a. 6,1,2,4,3,5,7 b. 6,1,2,3,4,557 ce 6,1,2:4;5;3;7 d. 6,1,2,5,4,3,7 ie In the maxillary arch, the first premolar ideally should erupt before the second premolar and they should be followed by the canine, The untimely lossof the primary molars in the maxillary arch, allowing the first permanent molar to drift and tip mesially, will result in the permanent canine being blocked out of the arch, usually to the labial side. The position of the developing sccond molar in the maxillary arch and its relationship to the first permanent molar should be given special attention. [ts eruption before the premolars and canine can cause a loss of arch length just as in the mandibular arch. The most favorable eruption sequence for mandibular permanent teeth is a. 6,1,2,3,4,5,7 b. 6,1,2,4,5,3,7 c. 6,1,3,2,4,5,7 6,1,2,3,7,4,5 The most favorable sequence in mandibular arch is first permanent molar, central incisors, lateral incisors, canines, first and second premolars. Ic is desirable that the mandibular canine erupts before the first and second premolars. This sequence will aid in maintaining adequate arch length and in preventing lingual tipping of the incisors. Lingual tipping of the incisors not only will cause a loss of arch length but also will allow the development of an increased overbite. w Chronology and Morphology of Primary and Permanent Teeth Jow Pediatric Dentistry: MCQs 13. Ans 14, 15. Ans 16. Ans Eruption sequestrum is made of a. A tiny spicule of nonviable bone b. Dentin and cementum c. Either osteogenic or odontogenic tissue d. Any of the above d. Eruption sequestrum is defined as a tiny spi le bone overlying the crown of an erupting permanent molar just before or immediately after the emergence of the tips of the cusps through the oral mucosa. Ir can be also composed of dentin, cementum, osteogenic or odontogenic tissue. Among the primary teeth, the problem of ankylosis is most commonly seen with a, Mandibular molars b. Mandibular incisors c. Maxillary incisors d. Maxillary molars a. Ankylosis is most commonly seen in mandibular molars among the primary teeth, Metallic sound on percussion is diagnostic of ankylosed and traumatically intruded tooth. Ankylosed teeth are also called submerged teeth, All are features of a Mongoloid child except a. Bridge of the nose is depressed b. Mental retardation c. Delayed eruption of primary teeth d. Eyes slope downward All the above-mentioned features are common to Down syndrome children except that the eyes of these children slope upwards. All of the following conditions areassociated with delayed eruption of teeth except a. Hyperthyroidism b. Hypopituitarism ¢. Cleidocranial dysplasia d. In hyperthyroidism, premature eruption of teeth is noticed. In hypopituitarism,17. Ans 19. Ans delayed eruption of tecth is seen. In severe cascs, primary teeth do not exfoliate. The underlying permanent teeth also do not erupt. In some cases of cleidocranial dysplasia, primary teeth are retained ill 15 years of age. Gardner’ syndrome is also associated with delayed eruption of teeth. Maxillary diastema frequently do not close until the eruption of permanent a. Maxillary lateral incisors b. Mandibular cuspids c. Maxillary cuspids d. Maxillary premolars c In the mixed dentition, physiologic spacing between incisors is normal because of the eruption pattern of permanent teeth. When the canines erupt, all the spaces will close. No treatment should be initiated if there is a possibility of diastema being physiologic or if the canines have not erupted. Abnormal diastema may also result from supernumerary or missing teeth, oral habits, macroglossia or frenula. Hence, an accurate diagnosis is necessary before the treatment is initiated ‘The crowns of all permanent tecth with the exception of third molars are calcified by the age of a. 6 years b. 8 years c. 12 years d. 16 years b. ‘The enamel formation of all permanent teeth except third molars is complete by the age of 8 years. Hence, drugs like tetracycline which can cause discoloration of teeth should not be given until 8 years of age. ‘The chronological age of a child is a. Closely related to the physiological age b. Closely relaced to the dental age c. Closely related to the skeletal age d. Independent of the dental and skeletal ages d. Chronological age is not related ro dental, physiological or skeletal age Ici the most obvious and easily determined developmental age which is simply figured out from the child’ date of birth. ‘The skeletal and the dental ages are based on che skeletal and dental development respectively. w Chronology and Morphology of Primary and Permanent Teethw Pediatric Dentistry: MCQs 20. Ina normal child, the teeth that are generally in the process of calcification at birth are a. Allprimary teeth only b. All primary teeth and first permanent molars c. Primary anteriors, canines and first primary molars only d. All primary teeth and all permanent teeth Ans b. All the primary ccth and the first permanent molars are in the process of calcification at birth. 21. A radiograph of a 4-year-old child reveals no evidence of calcification of mandibular sccond premolars. This means that a. These teeth may develop later b. The child will probably never develop second premolars c. Itis too early life to make any predictions concerning the development of any permanent tooth d._ Extraction of primary second molar should be performed ro allow the permanent first molars to drift forward Ans a. The hard tissue formation of mandibular second premolars begins between 2.25 and 2.5 years. Sometimes it can be delayed and may start after 4 years also. Hence, second primary molar should not be extracted. 22. A disturbance during the calcification stage of tooth development is the cause of a. Peg teeth b. Microdontia c. Oligodontia d.Interglobular dentin Ans d. Disturbance during the calcification stage can result in interglobular dentin formation, Refer to the explanation of Q. No. 2. 23. Tooth buds generally initiated after birth include a, Entire permanent dentition only b. All permanent teeth and some primary teeth c. Ist, 2nd premolars and 2nd and 3rd molars only All primary teethAns c All the primary teeth buds are initiated in the intrauterine period itself whereas the tooth buds generally initiated after birth include Ist, 2nd premolars and 2nd and 3rd molars. Hard tissue formation begins at birth for the first permanent molars and in the intrauterine period itself for all primary teeth. 24. Oblique ridge is formed by union of Ans 25. Ans 26. Ans 27. a. Mesiobuccal and mesiopalatal cusp b. Distobuccal and distolingual cusp c. Mesiopalatal cusp and distobuceal cusp d. Mesiopalatal and distolingual cusp © ‘The mesiopalaral cusp joins the distobuceal cusp through the oblique ridge which is very characteristic on the occlusal surface of the maxillary primary second molar. The largest cusp on mandibular first primary molar is a. Mesiobuceal cusp b, Distobuceal cusp c. Mesiolingual cusp d. Distolingual cusp «. ‘The largest cusp is mesiolingual cusp. The primary mandibular first molar as four cusps; ewo on the buccal and two on the lingual. The mesial cusps ate larger than the distal ones and the pulp horn of the mesiobuccal cusp may extend high till the DE junction. ‘The largest cusp on mandibular second primary molar is a. Mesiobuceal cusp b. Distobuceal cusp ¢. Mesiolingual cusp d. Distolingual cusp “The primary mandibular second molar has five cusps: three on the buccal and two on the lingual. The largest cusp is the distobuccal cusp. ‘The incisal edge of the primary mandibular lateral incisor slopes towards the distal aspect of the tooth. This tooth more closely resembles the maxillary primary lateral incisor than it does the mandibular primary central incisor. w Chronology and Morphology of Primary and Permanent Teethw Pediatric Dentistry: MCQs Ans 28. Ans a. Both the statements are true b. Both the statements are false c. The first stacement is true and the second is false d ‘The first statement is false and the second is true a “The incisal edge slopes towards the distal aspect of the cooth differentiating i from the central incisor. The distoincisal angle is more rounded. The largest and sharpest cusp of maxillary first primary molar is a. Mesiobuceal cusp b. Distobuccal cusp cc. Mesiolingual cusp d. Distolingual cusp Mesiobuccal cusp is the largest and sharpest cusp occupyi ga major portion of the bucco-occhusal surface. 29. All the primary teeth are erupted into the oral cavity by Ans 30. Ans a. 18 months b. 24 months c. 36 months d. 16 months c. All primacy tceth are present in the child’s mouth by the age of 3 years. What single morphologic characteristic of the permanent first molar necessitates early restorative procedures in most children? Mesial proximal contact b. Deep grooves and fissures c. Large pulp chamber d. Farly beginning of calcification Presence of an auxiliary cusp b. Deep grooves and fissures act like a niche for bacteria and food debris. ‘The manual dexterity in children has to be good enough t remove the retained debris. Children also tend to focus on brushing the anterior teeth rather than the posterior teeth. Pit and fissure sealants are advocated in children with moderate risk of caries,3. Spacing between primary teeth indicates a. Bitewings are not needed b. Greater chance of ectopic eruption c. An increased likelihood thar the larger permanent teeth can be accommodated d. Increased probability of malalignment later Ans c. 32. Ans 33. Ans 34. Ans Spacing beween primary anterior teeth is desirable co accommodate the larger permanent teeth The most frequently impacted permanent tooth is the a. Mandibular second premolar b. Maxillary lateral incisor c. Mandibular canine Maxillary canine d. ‘he desired sequence of eruption of permanent teeth is 6,1,2,4,5,3,7. Premature loss of primary molars cause permanent firse molar to drift mesially and block out the canines labially or get impacted due to insufficient space. Refer to the explanation of Q. No. 11 also. In females, the permanent maxillary canine usually erupts at age b. 9 years c. 10 years d. 12 years e. 14 years d. “The answer is self-explanatory. ‘The last primary tooth to be replaced by a permanent tooth is usually the a. Mandibular canine b. Maxillary canine c. Maxillary first molar d. Mandibular second molar b. Refer to the explanation of Q. No. 32. w Chronology and Morphology of Primary and Permanent Teethw MCQs Pediatric Dentistr 35. Ans 36. Ans 37. Ans 38. Ans After eruption ofa permanent tooth, the time required for complete formation of its root is approximately a, 1/2-1 year b. 2-3 years c. 4-5 years d. None of the above. ‘The time required is unpredictable b. In case of primary teeth, root completion occurs 1 year after tooth eruption. Premature exfoliation of a primary canine may indicate a. An arch length excess b. Amarch length deficiency c. A skeletal malocclusion d. Anarch length excess more than 10 mm b. Arch lengch reduces on premature exfoliation of primary canines. Loss on one side of che quadrant may cause a midline shift. In examining the primary dentition, if it is observed that a lateral incisor is congenitally missing, it is likely that the ing Permanent lateral incisor will also be missing a. Permanent canine will be miss ¢. Permanent lateral incisor will be slow in erupting d. Normal eruption of the permanent lateral incisor is reasonably certain b. Congenitally missing primary tecth isa rare entity. When there isa congenitally missing primary tooth, there isa possibility that the successor may also be missing. Thecolor of the primary teeth compared with that of the permanent teeth is a. Whiter b. Redder c. Browner d. Yellower a. The refractive index of primary teeth is close to that of milk and hence called inilk teeth. They are whiter than their successors.39. Ans 40. Ans Al. Ans 42. The sum of the widths of primary first and second molars is generally a. ‘The same as that of the permanent successors 2 mm greater than that of the permanent successors c. 1-2 mm lesser than that of the permanent successors dd. 8 mm lesser chan that of the permanent successors b. ‘The combined mesiodistal width of C, D, E is greater than 3, 4, 5. The difference is called leetay space of Nance. If the eruption sequence of permanent teeth is normal, one can expect a. Maxillary second premolars to precede maxillary first premolar b. Maxillary second premolars to precede maxillary canines c. Maxillary canines to precede mandibular canines d. Both (a) and (c) ¢. Both (b) and (c) b. Refer co the explanation of Q. No. 11. ‘The permanent anterior tooth that is most often atypical in size is the a. Mandibular canine Mandibular central incisors c. Maxillary canine Maxillary central incisor e. Maxillary lateral incisor e Every lase tooth in the particular sequence has a tendency co have a morphological variation. Lateral incisor, second premolar and third molars show more morphological variations than other teeth. These teeth are last teeth in their corresponding group, namely incisors, premolars and molars. Dental age refers to the a, State of dental maturation b. Age at which a given tooth erupts Time periods of an eruption potential d. Number of years elapsed since a given tooth erupted w Chronology and Morphology of Primary and Permanent Teeth