PEDIATRICS

NDEB 2014 PAGE 400 Q4Q4) A 7 year old patient presents with a fracture of the crown of a permanent

maxillary central incisor that occurred 2 hours ago. The incisal half of the crown is missing, resulting in a 3mm exposure of vital pulp. What is the most appropriate initial management for this tooth?

• A. Apexification. • B. Apexogenesis. • C. Pulp capping. D. Pulpectomy.

Answer: C Pulp Capping.As the trauma occurred just 2 hours earlier and there is enough tooth structure

remaining, it is possible to pulp cap the tooth.

Historically, the Ellis and Davey classification of crown fractures is useful in recording the extent of damage to the crown.7 The following is a modification of their classification (Fig. 21-3):

Class I—Simple fracture of the crown involving little or no dentin Class II—Extensive fracture of the crown involving considerable dentin but not

the dental pulp Class III—Extensive fracture of the crown with an exposure of the dental pulp Class IV—Loss of the entire crown

If the patient is seen within an hour or 2 after the injury, if the vital exposure is small, and if sufficient crown remains to retain a temporary restoration to support the capping material and prevent the ingress of oral fluids, the treatment of choice is direct pulp capping (Fig. 21-7). If the final restoration of the tooth will require the use of the pulp chamber or the pulp canal for retention, a pulpotomy or a pulpectomy is the treatment of choice.

Figure 21-7 Class III injury to a permanent central incisor. A small pulp exposure is evident that should be capped and protected with a bonded restoration.

Reference: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter 21, page 405, 411 and 413

NDEB 2013 PAGE 180 Q4Pulpotomy is the treatment of choice in pulp exposures of asymptomatic vital teeth with incompletely formed apices. Pulp capping is the recommended procedure for carious exposures on primary teeth.

A. The first statement is true, the second false.

B. The first statement is false, the second true.

C. Both statements are true.

D. Both statements are false.

Answer: A the first statement is true, the second false

The removal of the coronal portion of the pulp is an accepted procedure for treating both primary and permanent teeth with carious pulp exposures. The justification for this procedure is that the coronal pulp tissue, which is adjacent to the carious exposure, usually contains microorganisms and shows evidence of inflammation and degenerative change. The abnormal tissue can be removed, and the healing can be allowed to take place at the entrance of the pulp canal in an area of essentially normal pulp.

This procedure is particularly indicated for permanent teeth with immature root development but with healthy pulp tissue in the root canals. It is also indicated for a permanent tooth with a pulp exposure resulting from crown fracture when the trauma has also produced a root fracture of the same tooth. The procedure is completed during a single appointment. Only teeth free of symptoms of painful pulpitis are considered for treatment.

Reference: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter 19, page 357

It is generally agreed that pulp-capping procedures should be limited to small exposures that have been produced accidentally by trauma or during cavity preparation or to true pinpoint carious exposures that are surrounded by sound dentin. Pulp capping should be considered only for teeth in which there is an absence of pain, with the possible exception of discomfort caused by the intake of food. In addition, there should be either no bleeding at the exposure site, as is often the case in a mechanical exposure, or bleeding in an amount that would be considered normal in the absence of a hyperemic or inflamed pulp.

Reference: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter 19, Page357

NDEB 2013 PAGE 183 Q7 The success of indirect pulp capping is dependent upon A. removal of all caries at the enamel-dentin junction. B. use of calcium hydroxide C a well sealed restoration D. All of the above.

Answer D all of the above

The procedure in which only the gross caries is removed from the lesion and the cavity is sealed for a time with a biocompatible material is referred to as indirect pulp treatment

The clinical procedure involves removing the gross caries but allowing sufficient caries to remain over the pulp horn to avoid exposure of the pulp. The walls of the cavity are extended to sound tooth structure because the presence of carious enamel and dentin at the margins of the cavity will prevent the establishment of an adequate seal (extremely important) during the period of repair. The remaining thin layer of caries in the base of the cavity is covered with a radiopaque biocompatible base material and sealed with a durable interim restoration

Reference:: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter 19, page 346

NDEB 2014 PAGE 388 Q.6

Oral hygiene for infants’ teeth should begin when

A. first primary molars erupt. Answer: A

B. all primary teeth erupt.

C. the first tooth erupts.

D. the infant is weaned from the nursing

bottle or breast.

Reference: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter 11 page 218

NDEB 2012 PAGE 178 Q 6 The majority of nitrous oxide is eliminated from a patient's circulatory system through the

A. lungs

B. kidneys. Answer: A lungs

C. liver enzymes.

D. plasma enzymes.

E. intestinal gas.

Reference: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter 14 page 261

NDEB 2014 PAGE 395 Q3 Conscious sedation differs from general anesthesia in that the

A. patient retains all reflexes. B. patient is not responsive. C. patient's pain threshold is not altered Ans A. Patient retains all

reflexes

D. patient's heart rate is increased.

Reference: McDonalds and Avery’s, Dentistry for the child and Adolescent, 9th Edition Chapter

REFERENCE: MCDONALDS AND AVERY’S, DENTISTRY FOR THE CHILD AND ADOLESCENT, 9TH EDITION CHAPTER 14, PAGES253, 254 AND 260

NDEB 2012 PAGE 186 Q1 Compared to primary mandibular incisors, permanent mandibular

incisors erupt

A. lingually.

B. facially.

C distally.

D mesially.

Answer A. Lingually

REFERENCE: MCDONALDS AND AVERY’S, DENTISTRY FOR THE CHILD AND ADOLESCENT,

9TH EDITION CHAPTER 9, PAGE 154 AND 155