Please answer these questions

( Paeds Dent 2 May 2023 1 - 3pm)

1. List the properties of each of these below and indicate where we can use them in primary teeth of
children.

Also List the advantages and disadvantages of use in children . 

a. 5%Sodium fluoride varnish

b. 38% silver diamine fluoride

c. Resin modified Glass ionomer cement

d. Composite resin

e. Amalgam

Sure! Here are the properties of each of the materials you mentioned and where they can be used in
primary teeth of children:

a. **5% Sodium fluoride varnish**: It is a topical fluoride that is applied to the teeth to help prevent
tooth decay. It is used in children who are at high risk for developing cavities. It can be applied every 3-6
months¹.

b. **38% silver diamine fluoride**: It is a liquid that is applied to the teeth to help prevent tooth decay.
It is used in children who have cavities and cannot tolerate dental treatment⁴.

c. **Resin modified Glass ionomer cement**: It is a tooth-colored material that is used to fill cavities in
primary teeth. It releases fluoride which helps prevent further decay².

d. **Composite resin**: It is a tooth-colored material that is used to fill cavities in primary teeth. It is
more esthetic than amalgam but requires more time and skill to place².

e. **Amalgam**: It is a silver-colored material that is used to fill cavities in primary teeth. It has been
used for many years and has a long track record of success².
Here are the advantages and disadvantages of use in children:

a. **5% Sodium fluoride varnish**: Advantages: Easy to apply, low cost, reduces the risk of cavities;
Disadvantages: May cause mild irritation or staining of the teeth¹.

b. **38% silver diamine fluoride**: Advantages: Can stop the progression of cavities without drilling or
anesthesia, low cost; Disadvantages: May cause staining of the teeth⁴.

c. **Resin modified Glass ionomer cement**: Advantages: Releases fluoride which helps prevent further
decay, tooth-colored; Disadvantages: May not last as long as amalgam².

d. **Composite resin**: Advantages: Tooth-colored, more esthetic than amalgam; Disadvantages:

Requires more time and skill to place, may not last as long as amalgam².

e. **Amalgam**: Advantages: Has been used for many years and has a long track record of success;
Disadvantages: Not tooth-colored, may require more tooth structure removal than composite resin².

Source: Conversation with Bing, 03/05/2023

(1) Effectiveness of Silver Diamine Fluoride for Preventing ... - PubMed.

https://pubmed.ncbi.nlm.nih.gov/35604758/.

(2) Silver Diamine Fluoride | American Dental Association.

https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/silver-
diamine-fluoride.

(3) Comparative cariostatic efficacy of a novel Nano-silver fluoride ....

https://pubmed.ncbi.nlm.nih.gov/30805113/.

(4) Remineralisation of enamel with silver diamine fluoride and sodium ....
https://pubmed.ncbi.nlm.nih.gov/30482611/.

(5) Silver Diamine Fluoride (SDF) Fact Sheet March 2017 - ASTDD.
https://www.astdd.org/www/docs/sdf-fact-sheet-09-07-2017.pdf.

(6) The Effectiveness of Silver Diamine Fluoride and Fluoride Varnish in ....
https://pubmed.ncbi.nlm.nih.gov/32543369/.
2. Describe the forceps required for extraction of the following

a. Lower second primary molars

b. Lower first primary molars

c. Lower anterior primary teeth

d. Upper primary molars

e. Upper primary anterior teeth 

Here are the forceps required for extraction of primary teeth:

a. Lower second primary molars: #15, #16, #17, #23 forceps¹

b. Lower first primary molars: #15, #16, #17, #23 forceps¹

c. Lower anterior primary teeth: straight forceps with a labiolingual movement³

d. Upper primary molars: Bader extraction forceps²

e. Upper primary anterior teeth: #101 forceps¹

I hope this helps! Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) Guide to Extraction Forceps - ProDentUSA. https://prodentusa.com/guide-to-extraction-forceps/.

(2) Extraction of primary dentition | Pocket Dentistry. https://pocketdentistry.com/extraction-of-

primary-dentition/.

(3) Top 5 Tooth Extraction Forceps | 2023 Update | Dental Country™.

https://dentalcountry.com/doctors/lists/tooth-extraction-forceps-top-5-options-for-modern-dentistry/.

(4) 12: EXTRACTION FORCEPS | Pocket Dentistry. https://pocketdentistry.com/12-extraction-forceps/.

3. Describe the use of the elevators below in children

a. Luxators
b. Coupland

c. Hospital elevators

d. Root picks

Here are the uses of the elevators below in children dentistry:

a. Luxators: Elevator instruments are used to luxate teeth, and this technique imparts forces to tooth
particles that sever the periodontal ligament around tooth roots inside the socket and expand alveolar
bone around tooth particles¹.

b. Coupland: Coupland elevators are used for the removal of deciduous teeth³.

c. Hospital elevators: Hospital elevators are used for the removal of deciduous teeth³.

d. Root picks: Root picks are used to remove root fragments after extraction².

I hope this helps! Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) Use of elevator instruments when luxating and extracting teeth in ....
https://pubmed.ncbi.nlm.nih.gov/28770164/.

(2) Dental Elevators in Oral Surgery - Indications, Classification and ....

https://www.juniordentist.com/dental-elevators-in-oral-surgery.html.

(3) Use of elevator instruments when luxating and extracting teeth in ....
https://www.researchgate.net/publication/318122051_Use_of_elevator_instruments_when_luxating_a
nd_extracting_teeth_in_dentistry_Clinical_techniques.

(4) DENTAL ELEVATORS | Basic Principles of ELEVATORS | Notes in Description ....

https://www.youtube.com/watch?v=mKin87zFa_M.

4. List some types of behaviour management techniques that you can use in children who are visiting a
dentist for a first time and require dental extraction. 

There are several behaviour management techniques that can be used for children visiting a dentist for
the first time and require dental extraction. Some of these techniques include:
- Tell-show-do technique: This technique involves the dentist explaining the procedure to the child in
simple terms, demonstrating the procedure using models or pictures, and then performing the
procedure on the child. This helps to reduce anxiety and fear in children¹.

- Positive reinforcement: This technique involves praising the child for good behaviour during the
procedure. This helps to encourage good behaviour and reduce anxiety¹.

- Distraction techniques: This technique involves using toys, music, or videos to distract the child during
the procedure. This helps to reduce anxiety and fear in children¹.

- Nitrous oxide sedation: This technique involves administering nitrous oxide (laughing gas) to help relax
the child during the procedure⁴.

- Oral sedation: This technique involves administering medication (such as midazolam) orally to help
relax the child during the procedure⁴.

It is important to note that each child is unique and may respond differently to different techniques. The
dentist will work with you and your child to determine which technique is best for your child⁵.

Source: Conversation with Bing, 03/05/2023

(1) Behavior Guidance for the Pediatric Dental Patient - AAPD. https://www.aapd.org/research/oral-
health-policies--recommendations/behavior-guidance-for-the-pediatric-dental-patient/.

(2) Behavior Management for Dental Procedures - Children’s. https://www.childrens.com/specialties-

services/treatments/behavior-management-for-dental-procedures.

(3) 5: Behavioural Management Techniques | Pocket Dentistry. https://pocketdentistry.com/5-

behavioural-management-techniques/.

(4) Newer Behaviour Management Techniques in Children - ResearchGate.

https://www.researchgate.net/publication/351548867_Newer_Behaviour_Management_Techniques_in
_Children.

(5) Review: behaviour management techniques in paediatric dentistry.

https://pubmed.ncbi.nlm.nih.gov/20840826/.

(6) Treatment Planning in Paediatric Dentistry - a Structured Approach.

https://www.researchgate.net/publication/344016012_Treatment_Planning_in_Paediatric_Dentistry_-
_a_Structured_Approach.
5. List materials and medicaments you would require for a pulpotomy

The materials and medicaments required for pulpotomy include:

- Calcium hydroxide: This is the most commonly used medicament for pulpotomy¹.

- Mineral trioxide aggregate (MTA): This is a more recent material used for pulpotomies with a high rate
of success².

- Bone morphogenic protein (BMP 2, 3, 4, 5, 6, 7 and OP-2): This is another material used in regenerative
pulpotomy¹.

- Collagen: This is another material used in regenerative pulpotomy¹.

It is important to note that the choice of material or medicament used for pulpotomy may depend on
the specific case and the dentist's preference. Your dentist will work with you to determine which
material or medicament is best for your child⁴.

Source: Conversation with Bing, 03/05/2023

(1) Pulpotomy medicaments continued search for new alternatives.

https://www.walshmedicalmedia.com/open-access/pulpotomy-medicaments-continued-search-for-
new-alternatives-a-review-2247-2452-13-694.pdf.

(2) Pulpotomy - Wikipedia. https://en.wikipedia.org/wiki/Pulpotomy.

(3) Pulpotomy: Procedure, What to Expect, and Recovery - Healthline.

https://www.healthline.com/health/dental-and-oral-health/pulpotomy.

(4) Pulpotomy: Modern concepts and materials - IJOHD. https://www.ijohd.org/html-article/15517.

(5) Materials for pulpotomy in immature permanent teeth: a systematic ....

https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-019-0917-z.
6. List instruments required for pulpotomy set- up.

The instruments required for pulpotomy set-up include:

- Dental Explorer 23

- Dental Explorer 9

- Dental Explorer DG16

- Dental William Probe (Color Coded)

- Dental Probe CP11.5/CP15

- Dental Mirror Octagon Handle

- Dental College Tweezer 16cm

- Dental Articulating Paper Forceps Curved 6"¹

It is important to note that the specific instruments used may depend on the dentist's preference and
the specific case. Your dentist will work with you to determine which instruments are best for your
child³.

Source: Conversation with Bing, 03/05/2023

(1) Dental Root Canal & Pulpotomy Tray Instruments Set of 13 - DynaIntl Shop. https://bing.com/search?
q=instruments+required+for+pulpotomy+set-up.

(2) Pulpotomy: Procedure, What to Expect, and Recovery - Healthline.

https://www.healthline.com/health/dental-and-oral-health/pulpotomy.

(3) Endo Primary Pulpectomy - columbia.edu.

http://www.columbia.edu/itc/hs/dental/d7710/client_edit/syllabus/endo_primarypulppectomy.html.

(4) Guideline on Pulp Therapy for Primary and Immature Permanent Teeth - AAPD.
https://www.aapd.org/globalassets/assets/1/7/g-pulp.pdf.

(5) Materials for pulpotomy in immature permanent teeth: a ... - PubMed.

https://pubmed.ncbi.nlm.nih.gov/31647004/.

7. List instrument set up for restorative dentistry 

Restorative dental hand instruments include the **amalgam carrier**, **burnisher**, **condensers**,
**composite placement instruments**, **carvers**, and **Woodsen**¹. The dental assistant should
set up the dental hand instruments on a tray in order of use in part to not delay the procedure. A
procedure tray is set up from left to right¹. Most dental hand instruments fall into four categories, they
include examination instruments, hand cutting instruments, restorative instruments and instrument
accessories¹.

I hope this helps. Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) Dental Hand Instruments: A Dental Assisting Guide. https://www.meridian.edu/dental-hand-

instruments-dental-assisting-guide/.

(2) 8: INSTRUMENTS USED IN BASIC RESTORATIVE PROCEDURES - Pocket Dentistry.

https://pocketdentistry.com/8-instruments-used-in-basic-restorative-procedures/.

(3) Dental Tools: Learn the Names and Different Types and Uses. https://www.dentaly.org/us/oral-
health/dental-tools/.

8. List instrument set up for extraction

The instruments needed for tooth extraction vary greatly depending on the number of teeth needing to
be pulled, the location of the tooth within the oral cavity and the reason for the procedure¹. However,
some common instruments used for tooth extraction include **periosteal elevator**, **small or large
elevator**, **forceps** and **root forceps**²³.

I hope this helps. Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) The Simple Extraction Tray Setup - Off the Cusp. https://www.offthecusp.com/simple-extraction-tray-
setup/.

(2) 12 Common Tooth Extraction Tools | Colgate®. https://www.colgate.com/en-us/oral-health/tooth-

removal/12-common-tooth-extraction-tools.

(3) Top 10 Instruments Used For Dental Extraction. https://www.healthsoothe.com/top-10-instruments-

used-for-dental-extraction/.
(4) Instruments Used for Dental Extraction | Intelligent Dental.
http://www.intelligentdental.com/2011/12/20/instruments-used-for-dental-extraction/.

(5) Tooth Extraction: Cost, Procedure, Risks, and Recovery - Healthline.

https://www.healthline.com/health/tooth-extraction.

9. List the types of local anaesthetic available for dental treatment in children

Lidocaine and articaine are the main local anaesthetics used in paediatric dentistry¹. There are two
general types of local anesthetic chemical formulations: (1) esters (eg, procaine, benzocaine, tetracaine);
and (2) amides (eg, lidocaine, mepivacaine, prilocaine, articaine)³. Infiltration anaesthesia is a preferable
method to anaesthetise deciduous/ primary teeth in children².

I hope this helps. Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) Techniques for effective local anaesthetic administration for the ....
https://www.nature.com/articles/s41415-020-2453-2.

(2) Guideline on Use of Local Anesthesia for Pediatric Dental Patients - AAPD.
https://www.aapd.org/assets/1/7/G_LocalAnesthesia.pdf.

(3) Dental anesthesia - Wikipedia. https://en.wikipedia.org/wiki/Dental_anesthesia.

(4) Use of Local Anesthesia for Pediatric Dental Patients - AAPD. https://www.aapd.org/research/oral-
health-policies--recommendations/use-of-local-anesthesia-for-pediatric-dental-patients/.

10. What is the maximum amount of local anaesthetic (lignocaine with adrenaline) you can give to a
child below 10 years old? 

The maximum amount of local anaesthetic (lignocaine with adrenaline) you can give to a child below 10
years old depends on the child's weight and age. The American Academy of Pediatric Dentistry
recommends that the maximum dose of lidocaine (lignocaine) with epinephrine (adrenaline) should not
exceed 4.4 mg/kg for children. However, it is important to note that the dosage should be determined
by a qualified dentist or physician based on the child's individual needs and medical history.
I hope this helps. Let me know if you have any other questions.

11. In the case a child faints in your practice after local anaesthetic, List the emergency steps you will
take to ensure child's safety and survival?

If a child faints after local anesthesia, the following emergency steps should be taken to ensure the
child's safety and survival²:

1. Protect the child from getting hurt.

2. Ease the child to the floor or lay a very small child face down on your lap.

3. Check to make sure your child is breathing. Put your ear over your child's mouth to listen for
breathing sounds.

4. If your child is not breathing, call 911 and stay on the phone.

I hope this helps. Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) Is There Such A Thing As Fainting In Dental Clinic?. https://www.healthsoothe.com/is-there-such-a-

thing-as-fainting-in-dental-clinic/.

(2) Fainting in Children: Care Instructions - Alberta.

https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=uh3088.

(3) Why do Children Faint? - Children's Health. https://www.childrens.com/health-wellness/why-do-

children-faint.

(4) Fainting: First aid - Mayo Clinic. https://www.mayoclinic.org/first-aid/first-aid-fainting/basics/art-

20056606.

(5) What You Should Know About Fainting in Children. https://health.clevelandclinic.org/what-you-

should-know-about-fainting-in-children/.
12. What are the treatment options for the follow

a. Exposed pulp, buccal abscess tooth

b. exposed pulp, pain 

c. Carious tooth, pain, facial swelling

d. unexposed pulp, sensitivity when eating, or thermal changes

e. Unexposed pulp, pain when eating

Here are some treatment options for the following:

a. Exposed pulp, buccal abscess tooth: Various therapeutic approaches ranging from minimally invasive
techniques such as vital pulp treatment, through removal of the pulp (pulpectomy) to tooth extraction
can be used for the management of pulp exposure¹.

b. Exposed pulp, pain: The exposure of dental pulp generally occurs as the result of accidental trauma or
preparation techniques utilized during the restoration of carious lesions. While frank carious exposures
are optimally treated with pulpectomy and root canal therapy².

c. Carious tooth, pain, facial swelling: Full pulpectomy and RCTx of vital mature permanent teeth with
irreversible pulpitis or carious pulp exposure can be considered as a prophylactic procedure to prevent
further pulpal infection³.

d. Unexposed pulp, sensitivity when eating, or thermal changes: Indirect pulp treatment is a procedure
performed in a tooth with a deep carious lesion approximating the pulp but without signs or symptoms
of pulp degeneration. The caries surrounding the pulp is left in place to avoid pulp exposure and is
covered with a bio-compatible material⁴.

e. Unexposed pulp, pain when eating: Emerging clinical and histologic evidence is challenging the long-
established dogma that root canal treatment (RCTx) is the only therapeutic option for preservation of
vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure³.

I hope this helps. Let me know if you have any other questions.

Source: Conversation with Bing, 03/05/2023

(1) Pulp exposure management | SpringerLink. https://link.springer.com/article/10.1007/s41894-019-
0043-y.

(2) Treatment options for the exposed vital pulp - PubMed.

https://pubmed.ncbi.nlm.nih.gov/10635232/.

(3) Minimally invasive endodontics: a new era for pulpotomy in mature ....
https://www.nature.com/articles/s41415-022-5316-1.

(4) Guideline on Pulp Therapy for Primary and Immature Permanent Teeth - AAPD.
https://www.aapd.org/globalassets/assets/1/7/g-pulp.pdf.