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Iran Dental Specialty Board - Pediatric Dentistry study materials
Iran Dental Specialty Board - Pediatric Dentistry study resources

Iran Dental Specialty Board - Pediatric Dentistry practice questions

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Question 1Growth and Development, and Craniofacial Biology

During normal maxillary development, which process produces most of the increase in the transverse dimension of the maxillary arch between birth and the mixed dentition?

  1. Backward remodeling of the anterior nasal spine
  2. Apposition of bone at the midpalatal suture Correct answer.
  3. Downward drift of the entire maxilla
  4. Resorption along the nasal floor

Explanation

Transverse maxillary growth occurs predominantly by sutural apposition at the midpalatal and circummaxillary sutures, which widens the arch. Nasal floor changes and anterior nasal spine remodeling affect vertical and sagittal relationships rather than width. Downward drift is a vertical displacement phenomenon and does not itself increase transverse arch dimension.

Question 2Growth and Development, and Craniofacial Biology

A 6-year-old child is seen for a routine examination. Which permanent tooth is typically the first to erupt into the oral cavity?

  1. Mandibular first molar Correct answer.
  2. Maxillary first molar
  3. Maxillary central incisor
  4. Mandibular central incisor

Explanation

The mandibular first permanent molar usually erupts first, at about 6 years of age, slightly ahead of the mandibular central incisor. Maxillary teeth generally follow their mandibular counterparts by a few months. This eruption sequence is the basis for calling these teeth the 'six-year molars'.

Question 3Growth and Development, and Craniofacial Biology

Which primary dentition space analysis method compares the combined mesiodistal widths of the primary canines and molars with the predicted widths of the permanent canines and premolars using tables derived from a reference population?

  1. Nance analysis
  2. Hixon-Oldfather method
  3. Moyers prediction table
  4. Tanaka-Johnston analysis Correct answer.

Explanation

The Tanaka-Johnston method uses a simple formula based on half the width of the four lower incisors plus a constant to estimate the canine-premolar segment. It is a simplified derivative of Moyers probability tables and is widely used in mixed-dentition space analysis. Nance analysis and Hixon-Oldfather address arch length and tooth size estimation in different contexts.

Question 4Growth and Development, and Craniofacial Biology

A cephalometric assessment of a growing child shows an SNA of 84 degrees and an SNB of 78 degrees. Which skeletal pattern does this most likely represent?

  1. Skeletal Class II with maxillary protrusion Correct answer.
  2. Skeletal Class III with maxillary retrusion
  3. Skeletal Class III with mandibular prognathism
  4. Skeletal Class I with bimaxillary protrusion

Explanation

An increased SNA indicates a relatively protrusive maxilla, while an SNB near the normal range with a large ANB difference points to a skeletal Class II relationship driven by maxillary position. The ANB of about 6 degrees exceeds the usual norm of roughly 2 degrees. Class III patterns would show the opposite relationship, with SNB exceeding SNA.

Question 5Growth and Development, and Craniofacial Biology

According to the concept of functional matrices described by Moss, which structure is considered the primary determinant of mandibular growth?

  1. The nasal septum
  2. The developing tooth germs
  3. The condylar cartilage itself
  4. The periosteal envelope of the mandible Correct answer.

Explanation

In Moss's functional matrix theory, the periosteal capsule and its associated soft tissues constitute the functional matrix that drives skeletal growth. The condylar cartilage and other cartilages are viewed as secondary responders rather than primary growth centers. This contrasts with older theories that assigned the nasal septum or condyle a commanding role.

Question 6Growth and Development, and Craniofacial Biology

A 9-year-old presents with a unilateral posterior crossbite and a functional shift on closure. Which finding on examination most supports a skeletal rather than a purely dental cause?

  1. A transverse maxillary deficiency confirmed by a narrow palatal vault and constricted arch form Correct answer.
  2. Equal bilateral canine guidance in lateral excursions
  3. Crossbite limited to a single primary molar
  4. Midline deviation of the mandible toward the crossbite side on closure

Explanation

A narrow maxilla with a constricted arch form and high palatal vault suggests a true transverse skeletal deficiency rather than a tooth-position problem. Functional shifts and single-tooth crossbites can occur with a normal skeletal base. The combination of arch-form constriction with crossbite is the strongest indicator of a skeletal component.

Question 7Growth and Development, and Craniofacial Biology

Which statement best describes the pattern of mandibular growth rotation according to Bjork's structural method?

  1. Anterior rotation is associated with a more vertical condylar growth direction and a steep mandibular plane.
  2. Rotation direction has no relationship to the mandibular plane angle.
  3. Anterior rotation tends to deepen the overbite and is associated with a more horizontal condylar growth direction. Correct answer.
  4. Posterior rotation is associated with a more horizontal condylar growth direction and a flat mandibular plane.

Explanation

In Bjork's framework, anterior (forward) rotation accompanies more horizontal condylar growth and tends to increase overbite by rotating the symphysis upward and forward. Posterior rotation accompanies more vertical condylar growth and an opening of the mandibular plane. Rotation direction is closely tied to the mandibular plane angle and to changes in anterior face height.

Question 8Growth and Development, and Craniofacial Biology

At approximately what age does the pubertal growth spurt in standing height typically reach its peak in girls?

  1. Around 10 years
  2. Around 15 years
  3. Around 12 years Correct answer.
  4. Around 8 years

Explanation

Peak height velocity in girls usually occurs around 11.5 to 12 years, roughly coinciding with menarche or slightly before it. Boys typically peak about two years later, around 14 years. Timing the spurt matters for planning growth-modifying orthodontic or orthopedic treatment.

Question 9Growth and Development, and Craniofacial Biology

During the mixed dentition, which phenomenon describes the temporary increase in arch length in the anterior region as the permanent incisors erupt?

  1. Leeway space
  2. E-space
  3. Primate space
  4. Incisal liability Correct answer.

Explanation

Incisal liability refers to the temporary increase in anterior arch length as the larger permanent incisors replace the smaller primary incisors and flare labially. This transient crowding resolves as the canines and premolars erupt and the arch lengthens posteriorly. Leeway space and primate spaces are separate concepts related to posterior and primary-dentition spacing.

Question 10Growth and Development, and Craniofacial Biology

A child with a repaired unilateral cleft lip and palate is assessed at age 8. Which growth-related finding is most characteristic of the maxilla in this population?

  1. Excessive anterior maxillary growth with a Class III tendency
  2. Bimaxillary protrusion with increased SNA
  3. Normal maxillary growth with isolated dental crowding
  4. Transverse and anteroposterior maxillary hypoplasia with a Class III tendency Correct answer.

Explanation

Children with repaired cleft lip and palate commonly show maxillary hypoplasia, particularly in the transverse and anteroposterior dimensions, often producing a Class III skeletal tendency as they grow. Scarring from surgical repair is thought to contribute to restricted maxillary growth. This pattern becomes more evident in the late mixed and early permanent dentition.

Question 11Growth and Development, and Craniofacial Biology

Which cranial base angle (N-S-Ba) is generally associated with a more Class III skeletal tendency?

  1. A small acute angle Correct answer.
  2. A large obtuse angle
  3. The cranial base angle is unrelated to sagittal jaw relationships
  4. A right angle

Explanation

A smaller, more acute cranial base angle is associated with a more anteriorly positioned mandible relative to the maxilla, contributing to a Class III tendency. A more obtuse angle tends to position the mandible more posteriorly, favoring Class II. The cranial base therefore influences sagittal jaw relationships.

Question 12Growth and Development, and Craniofacial Biology

A 7-year-old has a mandibular arch length deficiency of 4 mm in the mixed dentition. Which factor most favors spontaneous correction or space maintenance rather than active expansion?

  1. A severe Class II skeletal pattern with deep overbite
  2. Ankylosis of a primary molar
  3. Presence of adequate leeway space and a favorable eruption sequence Correct answer.
  4. Premature loss of a primary canine with midline shift

Explanation

Adequate leeway space together with a favorable sequence of eruption often allows the arch to accommodate the permanent teeth without intervention. Leeway space provides about 1.5 mm per side in the mandible and more in the maxilla. Unfavorable skeletal patterns, ankylosis, and premature loss with shift are less likely to self-correct.

Question 13Growth and Development, and Craniofacial Biology

Which primary dentition characteristic is most useful in predicting the available space for the permanent canines and premolars?

  1. The number of erupted primary teeth at age 3
  2. The degree of overjet in the primary dentition
  3. The crown height of the primary incisors
  4. The combined mesiodistal width of the primary molars and canines Correct answer.

Explanation

The combined mesiodistal widths of the primary canine and molars in a quadrant approximate the space needed for the permanent canine and premolars, forming the basis of leeway space calculations. This measurement is used in mixed-dentition space analysis. Crown height, tooth count, and overjet do not directly predict this segment's space.

Question 14Growth and Development, and Craniofacial Biology

Which of the following best describes the direction of condylar growth that contributes to the typical downward and forward displacement of the mandible?

  1. Pure lateral growth of the condyle
  2. Posterior and superior growth of the condyle Correct answer.
  3. Anterior and inferior growth of the condyle
  4. Growth ceases at the condyle after age 6

Explanation

The condyle grows in a posterior and superior direction, which displaces the mandible downward and forward as the ramus lengthens. This is consistent with the concept that condylar growth translates the mandible away from the cranial base. The resulting displacement is what produces the characteristic facial growth pattern.

Question 15Growth and Development, and Craniofacial Biology

A child is in the late mixed dentition with a Class II division 1 malocclusion and a low mandibular plane angle. Which growth modification approach is most likely to be effective if the child is prepubertal?

  1. Functional appliance therapy to enhance mandibular growth Correct answer.
  2. Extraction of four premolars immediately
  3. Rapid maxillary expansion alone
  4. Observation until the permanent dentition is complete

Explanation

In a prepubertal child with a Class II pattern and favorable growth remaining, functional appliances can modify mandibular position and growth. A low mandibular plane angle suggests a favorable horizontal growth pattern. Extraction and expansion alone do not address the sagittal discrepancy in this growing patient.

Question 16Growth and Development, and Craniofacial Biology

Which of the following is a recognized limitation of using hand-wrist radiographs for assessing skeletal maturity in orthodontic patients?

  1. They require the patient to be sedated
  2. They are only useful after growth is complete
  3. They expose the patient to unnecessary radiation when a cephalogram already provides the needed information Correct answer.
  4. They cannot detect the onset of the pubertal growth spurt

Explanation

Hand-wrist radiographs provide additional radiation exposure, and cervical vertebral maturation on a lateral cephalogram can often supply comparable maturity information. This has led to greater reliance on cephalometric indicators. They can detect the growth spurt and do not require sedation.

Question 17Growth and Development, and Craniofacial Biology

Which developmental stage of the dentition is characterized by the presence of all primary teeth with spaces between them and no permanent teeth erupted?

  1. Mixed dentition stage
  2. Early permanent dentition stage
  3. Late permanent dentition stage
  4. Primary dentition stage Correct answer.

Explanation

The primary dentition stage spans roughly from 2.5 to 6 years, when all 20 primary teeth are present and physiologic spacing is common. The mixed dentition begins with the eruption of the first permanent molars and incisors. The permanent dentition stages follow completion of the mixed dentition.

Question 18Growth and Development, and Craniofacial Biology

A 5-year-old presents with a deep overbite and a decreased lower face height. Which growth-related factor most likely contributes to this pattern?

  1. A forward rotating mandibular growth pattern Correct answer.
  2. Excessive vertical condylar growth
  3. A backward rotating mandibular growth pattern
  4. A large cranial base angle

Explanation

Forward (anterior) mandibular rotation tends to reduce lower anterior face height and deepen the overbite. This pattern is associated with more horizontal condylar growth. Backward rotation, by contrast, increases lower face height and tends to reduce overbite.

Question 19Growth and Development, and Craniofacial Biology

Which statement about the timing of maxillary and mandibular growth completion is most accurate?

  1. Mandibular growth typically continues longer than maxillary growth Correct answer.
  2. Both jaws complete growth at the same time in all individuals
  3. Maxillary growth ceases by age 10 in most children
  4. Maxillary growth typically continues longer than mandibular growth

Explanation

Mandibular growth generally continues longer than maxillary growth, often into the late teens, particularly in males. The maxilla tends to complete most of its growth earlier. This difference is important when planning treatment that depends on growth cessation.

Question 20Growth and Development, and Craniofacial Biology

Which of the following best explains why the mandibular third molars are frequently impacted in the late teens?

  1. Early eruption of the second molars
  2. Lack of mandibular rotation
  3. Excessive mandibular growth in the anterior region
  4. Insufficient posterior arch length relative to tooth size Correct answer.

Explanation

Third molar impaction commonly results from insufficient posterior arch length to accommodate the last erupting molars, often combined with a mesial drift pattern. The discrepancy between available space and tooth size underlies the impaction. Anterior growth and second molar eruption timing are not the primary explanation.

Question 21Behavior Guidance and Child Psychology

According to Frankl's behavior rating scale, a child who accepts treatment but shows a cautious, withdrawn attitude with some reluctance and no overt protest is classified as:

  1. Definitely positive
  2. Definitely negative
  3. Positive Correct answer.
  4. Negative

Explanation

Frankl's four-point scale rates Positive as acceptance of treatment with caution and willingness to comply while showing some reservation, whereas Negative involves reluctance or minimal protest and Definitely negative involves outright refusal. The key distinction is that Positive children ultimately cooperate despite mild hesitancy.

Question 22Behavior Guidance and Child Psychology

Which statement best describes the mechanism of tell-show-do as a behavior guidance technique?

  1. It uses pharmacological sedation to suppress the child's anxiety
  2. It depends on parental presence to distract the child during treatment
  3. It uses verbal explanation, demonstration, and rehearsal before the actual procedure Correct answer.
  4. It relies on aversive conditioning to extinguish fear responses

Explanation

Tell-show-do is a shaping technique in which the clinician explains the procedure in child-friendly language, demonstrates the steps, and then performs them without deviation from what was described. It builds familiarity and predictability rather than relying on punishment, distraction by parents, or drugs.

Question 23Behavior Guidance and Child Psychology

A 4-year-old screams and physically resists as soon as the operatory door is opened, and the parent reports the child behaves this way at home before any medical visit. Which Frankl category does this most likely represent?

  1. Negative
  2. Definitely negative Correct answer.
  3. Positive
  4. Definitely positive

Explanation

Definitely negative behavior is characterized by refusal of treatment, forceful crying, fear, and physical resistance such as pushing away or covering the mouth. The pervasive, anticipatory nature of the reaction across settings supports this most severe category rather than simple reluctance.

Question 24Behavior Guidance and Child Psychology

At what approximate developmental stage does a child typically begin to understand that others can hold beliefs different from their own, a milestone relevant to explaining procedures and gaining cooperation?

  1. Around 2 years
  2. Around 12 to 18 months
  3. Around 4 to 5 years Correct answer.
  4. Around 9 to 10 years

Explanation

Theory of mind, the understanding that others have separate beliefs and perspectives, typically emerges around four to five years of age. This matters clinically because it allows the child to follow explanations about what the dentist will do and why, supporting techniques such as tell-show-do.

Question 25Behavior Guidance and Child Psychology

A child who has just received a restoration is given a small sticker and verbal praise. In behavioral terms, the sticker functions as:

  1. A punisher
  2. A negative reinforcer
  3. A positive reinforcer Correct answer.
  4. An extinction stimulus

Explanation

A positive reinforcer is a stimulus added after a behavior that increases the likelihood of that behavior recurring. Praise and a sticker presented after cooperative behavior fit this definition, whereas negative reinforcement would involve removing an unpleasant stimulus.

Question 26Behavior Guidance and Child Psychology

Which of the following is the most appropriate initial approach for managing a healthy 3-year-old who is mildly anxious but able to cooperate during a routine examination?

  1. General anesthesia
  2. Physical restraint with a papoose board
  3. Oral sedation as first-line management
  4. Tell-show-do with positive reinforcement Correct answer.

Explanation

For a mildly anxious but cooperative preschool child, basic communicative techniques such as tell-show-do combined with positive reinforcement are the appropriate first-line approach. Advanced pharmacological or restrictive measures are reserved for cases where basic guidance fails and are not justified here.

Question 27Behavior Guidance and Child Psychology

Which statement about the use of voice control as a behavior guidance technique is most accurate?

  1. It is contraindicated in all children under six years of age
  2. It modulates tone, volume, and pace to gain attention and establish authority without belittling the child Correct answer.
  3. It is equivalent to physical restraint in its behavioral effect
  4. It requires raising the voice in a harsh, punitive manner to be effective

Explanation

Voice control uses controlled changes in tone, volume, and pace to interrupt undesirable behavior and re-establish the child's attention, and it should never be harsh or demeaning. Its aim is to structure the interaction, not to frighten or punish the child.

Question 28Behavior Guidance and Child Psychology

A 7-year-old is scheduled for extraction of a primary molar. The parent asks to remain in the operatory. Which consideration is most consistent with current guidance on parental presence?

  1. Parental presence should be used only when physical restraint is planned
  2. Parental presence is always prohibited because it undermines the child's coping
  3. The decision should be individualized, considering the child's age, anxiety, and the parent's own ability to remain calm and supportive Correct answer.
  4. Parental presence should be mandatory for all children under ten years

Explanation

Guidance on parental presence is individualized rather than absolute; the child's age and anxiety and the parent's capacity to provide calm support are weighed. A highly anxious parent can transmit anxiety, whereas a calm parent may enhance the child's coping.

Question 29Behavior Guidance and Child Psychology

Which of the following best characterizes the technique known as modeling in pediatric behavior guidance?

  1. The child observes a cooperative peer or video model undergoing a similar procedure Correct answer.
  2. The child is asked to model the behavior of an imaginary superhero without any demonstration
  3. The parent models relaxation breathing while the child watches
  4. The dentist mimics the child's facial expressions to build rapport

Explanation

Modeling exposes the child to a peer or filmed model who copes successfully with the same procedure, allowing vicarious learning and reduced anxiety. Simply imitating expressions or instructing without a demonstration does not constitute modeling.

Question 30Behavior Guidance and Child Psychology

A child is asked to rate anxiety on a faces scale before and after a desensitization program. This instrument most directly measures which construct?

  1. Dental caries risk
  2. Parenting style
  3. Cognitive developmental stage
  4. Self-reported dental anxiety Correct answer.

Explanation

Facial image scales such as the Facial Image Scale ask the child to select a face representing current feelings, providing a self-report measure of dental anxiety. They do not assess caries risk, parenting, or developmental level.

Question 31Behavior Guidance and Child Psychology

Which behavioral phenomenon is illustrated when a child's tantrum behavior is inadvertently maintained because the dentist stops treatment each time the tantrum occurs?

  1. Stimulus generalization
  2. Extinction
  3. Punishment
  4. Negative reinforcement of the child's behavior Correct answer.

Explanation

When a tantrum leads to removal of the aversive treatment demand, the tantrum is negatively reinforced because it successfully terminates an unpleasant stimulus. The escape reinforces the behavior and makes recurrence more likely.

Question 32Behavior Guidance and Child Psychology

For a 5-year-old who is highly anxious and uncooperative for a needed restoration after basic guidance has failed, which sequence best reflects a graduated approach to management?

  1. Immediate general anesthesia without attempting other measures
  2. Physical restraint as the first adjunct after tell-show-do
  3. Postponing all treatment until the child reaches adolescence
  4. Basic guidance, then consideration of nitrous oxide or sedation, reserving general anesthesia for failure of these Correct answer.

Explanation

Management follows a hierarchy from least to most invasive: basic communicative techniques first, then adjuncts such as nitrous oxide or sedation, with general anesthesia reserved for cases where these fail or are contraindicated. This graduated approach minimizes risk while ensuring treatment.

Question 33Behavior Guidance and Child Psychology

Which statement about nitrous oxide/oxygen sedation for behavior management in pediatric dentistry is correct?

  1. It is contraindicated in all children with any history of dental anxiety
  2. It commonly produces deep unconsciousness and loss of protective reflexes
  3. It eliminates the need for any behavioral guidance techniques
  4. It provides anxiolysis and analgesia while the child remains conscious and responsive Correct answer.

Explanation

Nitrous oxide/oxygen sedation produces anxiolysis and some analgesia while preserving consciousness and protective reflexes, allowing the child to respond to instructions. It is an adjunct that complements, rather than replaces, behavioral guidance.

Question 34Behavior Guidance and Child Psychology

A parent reports that a 6-year-old cries at every dental visit but is calm during medical appointments. Which factor most strongly suggests a specific dental fear rather than a generalized anxiety disorder?

  1. The child's birth order
  2. The child's age
  3. The situational specificity of the response to dental settings Correct answer.
  4. The child's caries experience

Explanation

A response confined to dental settings points to a specific, situationally conditioned dental fear rather than a pervasive anxiety disorder. Situational specificity is the key discriminator among the listed factors.

Question 35Behavior Guidance and Child Psychology

Which technique involves the dentist systematically guiding the child through increasingly anxiety-provoking steps of a procedure while ensuring relaxation at each step?

  1. Systematic desensitization Correct answer.
  2. Hypnosis
  3. Aversive conditioning
  4. Flooding

Explanation

Systematic desensitization gradually exposes the child to progressively more anxiety-provoking aspects of care while maintaining relaxation, allowing the fear response to diminish. Flooding instead exposes the child to the most feared stimulus at once.

Question 36Behavior Guidance and Child Psychology

A 3-year-old is scheduled for a first dental visit. Which approach is most consistent with developmentally appropriate care?

  1. Immediate radiographic survey before any communication
  2. A brief visit emphasizing familiarization, tell-show-do, and positive reinforcement Correct answer.
  3. A lengthy verbal explanation of caries etiology before any examination
  4. Restraint for the examination to ensure efficiency

Explanation

Preschool children have limited attention spans and rely on concrete, sensory experience, so a brief introductory visit using familiarization, tell-show-do, and praise is developmentally appropriate. Lengthy verbal explanations and immediate invasive measures are poorly matched to this age.

Question 37Behavior Guidance and Child Psychology

In behavior-analytic terms, a child who stops crying when the dentist removes the suction tip from the mouth and resumes crying when it is reinserted is demonstrating:

  1. Positive reinforcement of crying
  2. Punishment of crying
  3. Habituation of crying
  4. Negative reinforcement of crying Correct answer.

Explanation

Removal of the aversive suction tip contingent on crying strengthens crying through negative reinforcement, because the behavior successfully terminates an unpleasant stimulus. Reinsertion reverses the contingency and the behavior returns, confirming the escape function.

Question 38Behavior Guidance and Child Psychology

Which statement best reflects the ethical limits on the use of restraint in pediatric dentistry?

  1. Restraint may be used routinely whenever it shortens appointment time
  2. Restraint is justified only when less restrictive measures have failed and the procedure is necessary to protect the child's health Correct answer.
  3. Restraint requires no documentation if a parent is present
  4. Restraint is permissible at the dentist's sole discretion without informing the caregiver

Explanation

Restraint is a restrictive measure reserved for situations where less invasive techniques have failed and treatment is necessary for the child's welfare, and it requires appropriate consent and documentation. Convenience or time savings never justify its use.

Question 39Behavior Guidance and Child Psychology

A clinician notes that a child's cooperative behavior improves when the parent is asked to leave the operatory, but the parent insists on staying. Which analysis best guides the decision?

  1. Parental presence should always override clinical judgment
  2. The child's behavior is irrelevant to the decision
  3. The clinician should weigh the child's observed coping and discuss the rationale with the parent to reach an agreed plan Correct answer.
  4. The parent should be told the child is unmanageable and dismissed

Explanation

The decision about parental presence should be based on the child's observed coping and communicated transparently to the parent so that an agreed plan can be reached. Clinical judgment informed by observed behavior, not rigid rules, should guide the choice.

Question 40Behavior Guidance and Child Psychology

Which pairing of cognitive stage and appropriate behavior guidance strategy is most consistent with Piagetian theory?

  1. Formal operational stage: exclusive reliance on physical restraint
  2. Sensorimotor stage: verbal explanation of caries prevention
  3. Concrete operational stage: abstract lecture on microbiology
  4. Preoperational stage: concrete demonstration with tell-show-do Correct answer.

Explanation

Preoperational children learn through concrete, sensory experience, making demonstration-based techniques such as tell-show-do appropriate. Abstract verbal reasoning is better suited to older children in later stages.

Question 41Preventive Dentistry and Caries Risk Assessment

در یک کودک ۴ ساله با پوسیدگی مینایی فعال در سطح صاف دندان‌های شیری، کدام اقدام پیشگیرانه در اولین ویزه اولویت بالاتری دارد؟

  1. تجویز فلوراید موضعی حرفه‌ای همراه با آموزش بهداشت و اصلاح رژیم قندی Correct answer.
  2. برداشت ترمیمی همه ضایعات در یک جلسه تحت بیهوشی عمومی
  3. شست‌وشوی دهان با کلرهگزیدین ۰/۲ درصد به‌صورت روزانه
  4. تجویز مکمل کلسیم خوراکی روزانه

Explanation

پوسیدگی فعال مینایی در سطح صاف برگشت‌پذیر است و با کنترل پلاک، کاهش دفعات مصرف قند و کاربرد فلوراید موضعی حرفه‌ای می‌توان پیشرفت آن را متوقف کرد. این رویکرد کم‌تهاجمی با اصل حداقل مداخله در دندانپزشکی کودکان سازگار است. درمان ترمیمی گسترده یا بیهوشی عمومی برای چنین ضایعاتی بدون تلاش برای کنترل علت، توجیه ندارد.

Question 42Preventive Dentistry and Caries Risk Assessment

بر اساس مفهوم «تعادل مراقبت» (caries balance)، کدام مجموعه عوامل بیشترین نقش را در پیشگیری از پوسیدگی دندان شیری دارند؟

  1. افزایش ترشح بزاق، مصرف منظم فلوراید و کاهش دفعات مواجهه با قند قابل تخمیر Correct answer.
  2. مصرف زیاد لبنیات و کاهش مصرف میوه‌های تازه
  3. استفاده از دهانشویه الکلی پس از هر وعده غذایی
  4. افزایش تعداد جلسات جرم‌گیری و پالیش سالانه

Explanation

مدل تعادل پوسیدگی بر توازن میان عوامل حفاظتی مانند بزاق، فلوراید و مواد معدنی و عوامل خطر مانند باکتری‌های پوسیدگی‌زا و قندهای قابل تخمیر تأکید دارد. کاهش دفعات مواجهه با قند مهم‌تر از مقدار کل آن است، زیرا تعداد چرخه‌های افت pH را کم می‌کند. بزاق نیز با خاصیت بافری و شست‌وشوی طبیعی از دندان محافظت می‌کند.

Question 43Preventive Dentistry and Caries Risk Assessment

در ارزیابی خطر پوسیدگی کودک ۳ ساله‌ای که شب‌ها با شیشه شیر حاوی شیر مادر می‌خوابد، مهم‌ترین یافته تاریخچه‌ای چیست؟

  1. سابقه خانوادگی مصرف شیر مادر در دوران شیرخوارگی
  2. تعداد وعده‌های اصلی غذای روزانه کودک
  3. استفاده از شیشه شیر پلاستیکی به‌جای شیشه شیشه‌ای
  4. مواجهه مکرر و طولانی مدت دندان‌ها با مایع حاوی قند در طول خواب Correct answer.

Explanation

خوابیدن با شیشه شیر حاوی هر مایع قنددار، از جمله شیر مادر یا شیر گاو، باعث تماس طولانی دندان‌ها با قند در زمانی می‌شود که جریان بزاق کاهش یافته است. این الگو عامل خطر قوی برای پوسیدگی زودرس دوران کودکی است. جنس شیشه شیر یا تعداد وعده‌های اصلی غذا اهمیت تعیین‌کننده‌ای در این زمینه ندارد.

Question 44Preventive Dentistry and Caries Risk Assessment

کدام غلظت فلوراید در خمیردندان برای کودک ۲ ساله‌ای که خطر پوسیدگی بالایی دارد و مسواک زدن او توسط والد انجام می‌شود، توصیه می‌شود؟

  1. ۲۲۶۰۰ ppm به‌صورت هفتگی در مطب
  2. ۵۰۰ ppm با مقدار به‌اندازه یک نخود
  3. ۱۵۰۰ ppm فقط یک بار در هفته
  4. ۱۰۰۰ تا ۱۵۰۰ ppm با مقدار به‌اندازه یک دانه برنج Correct answer.

Explanation

برای کودکان زیر ۳ سال با خطر پوسیدگی بالا، خمیردندان حاوی ۱۰۰۰ تا ۱۵۰۰ ppm فلوراید با مقدار بسیار کم، حدود یک دانه برنج، توصیه می‌شود. مقدار کم، خطر بلعیدگی فلوراید و فلوروزیس را کاهش می‌دهد در حالی که اثر پیشگیری حفظ می‌شود. مسواک زدن توسط والد برای این سن ضروری است.

Question 45Preventive Dentistry and Caries Risk Assessment

کدام روش تجویز فلوراید برای کودک ۵ ساله با خطر پوسیدگی بالا و بدون سابقه مصرف مکمل، بیشترین شواهد را برای پیشگیری از پوسیدگی دندان شیری دارد؟

  1. وارنیش فلوراید ۵ درصد هر ۳ تا ۶ ماه Correct answer.
  2. دهانشویه فلوراید ۰/۲ درصد روزانه
  3. ژل فلوراید ۱/۲۳ درصد با کاربرد هفتگی خانگی
  4. قرص فلوراید روزانه بدون ارزیابی آب آشامیدنی

Explanation

وارنیش فلوراید ۵ درصد با کاربرد حرفه‌ای هر ۳ تا ۶ ماه در کودکان پرخطر، شواهد قوی برای کاهش پوسیدگی دندان شیری دارد و ایمن است. تجویز مکمل فلوراید نیازمند ارزیابی دقیق میزان فلوراید آب و سایر منابع است و بدون آن خطر فلوروزیس دارد. دهانشویه فلوراید برای کودکان خردسال به دلیل خطر بلع توصیه نمی‌شود.

Question 46Preventive Dentistry and Caries Risk Assessment

در یک کودک ۷ ساله با خطر پوسیدگی بالا، کدام برنامه فلوراید موضعی خانگی منطقی‌تر است؟

  1. خمیردندان ۵۰۰ ppm دو بار در روز
  2. دهانشویه سدیم فلوراید ۰/۰۵ درصد روزانه زیر نظارت والد Correct answer.
  3. دهانشویه سدیم فلوراید ۰/۲ درصد هفتگی بدون نظارت
  4. ژل فلوراید ۱/۲۳ درصد روزانه

Explanation

دهانشویه سدیم فلوراید ۰/۰۵ درصد برای مصرف روزانه طراحی شده و در کودک ۷ ساله که می‌تواند کنترل بلع داشته باشد، زیر نظارت والد مناسب است. غلظت پایین‌تر برای استفاده مکرر و غلظت بالاتر برای فواصل طولانی‌تر در نظر گرفته می‌شود. انتخاب خمیردندان کم‌فلوراید برای کودک پرخطر کافی نیست.

Question 47Preventive Dentistry and Caries Risk Assessment

کدام یافته بالینی نشانه پوسیدگی فعال مینایی در دندان شیری است؟

  1. حفره‌ای با کف سخت و رنگدانه‌دار بدون نرمی
  2. خطوط سفید افقی روی مینای با ساختار طبیعی
  3. سطح مات و سفید گچی در ناحیه مجاور لثه که پس از خشک کردن براق نمی‌شود Correct answer.
  4. ناحیه براق و سخت با رنگ قهوه‌ای در سطح اکلوزال

Explanation

ضایعه فعال مینایی معمولاً مات، سفید گچی و بدون درخشش سطحی است و در نواحی تجمع پلاک مانند یک‌سوم gingival دیده می‌شود. سطح براق و سخت نشانه ضایعه غیرفعال یا متوقف‌شده است. تشخیص فعالیت ضایعه، نه فقط وجود آن، تعیین‌کننده شدت مداخله است.

Question 48Preventive Dentistry and Caries Risk Assessment

در تشخیص افتراقی ضایعات سفید مینایی در کودک ۶ ساله، کدام ویژگی بیشتر به نفع فلوروزیس دندانی است؟

  1. سابقه مصرف مکرر نوشیدنی شیرین بین وعده‌ها
  2. پوسیدگی همزمان در دندان‌های شیری خواهر یا برادر
  3. محل ضایعه محدود به یک‌سوم مجاور لثه دندان‌های فک بالا
  4. درگیری متقارن دندان‌های متناظر در دو قوس و الگوی منتشر بدون ارتباط با نواحی تجمع پلاک Correct answer.

Explanation

فلوروزیس دندانی ناشی از مصرف بیش از حد فلوراید در دوران تکامل دندان است و به‌صورت متقارن و منتشر در دندان‌های متناظر دو قوس ظاهر می‌شود. ضایعات پوسیدگی معمولاً نامتقارن و در نواحی تجمع پلاک قرار دارند. سابقه رژیم قندی و پوسیدگی خانوادگی به پوسیدگی اشاره دارد.

Question 49Preventive Dentistry and Caries Risk Assessment

کدام شاخص برای ارزیابی شدت پوسیدگی دندان‌های شیری در یک مطالعه اپیدمیولوژیک کودکان ۵ ساله مناسب‌تر است؟

  1. DMFT که فقط دندان‌های دائمی را می‌شمارد
  2. dmft بر پایه معاینه بالینی با آینه و نور کافی Correct answer.
  3. شاخص PUFA به‌تنهایی بدون شمارش ضایعات
  4. شاخص CPI برای وضعیت پریودنتال

Explanation

شاخص dmft تعداد دندان‌های شیری پوسیده، از دست رفته به دلیل پوسیدگی و پرشده را می‌شمارد و برای کودکان ۵ ساله مناسب است. نسخه حروف بزرگ DMFT به دندان‌های دائمی اختصاص دارد. شاخص PUFA شدت عوارض ضایعات را نشان می‌دهد و جایگزین شمارش کامل نیست.

Question 50Preventive Dentistry and Caries Risk Assessment

کدام اقدام برای پیشگیری از پوسیدگی زودرس دوران کودکی در کودک ۱۸ ماهه‌ای که با شیشه شیر می‌خوابد، مناسب‌ترین توصیه است؟

  1. مسواک زدن فقط یک بار در هفته با خمیردندان کم‌فلوراید
  2. قطع شیشه شیر شبانه و جایگزینی تدریجی با آب در فنجان Correct answer.
  3. شروع دهانشویه فلوراید روزانه
  4. افزودن شکر به شیر برای پذیرش بهتر فنجان

Explanation

حذف مواجهه شبانه با شیشه شیر حاوی قند، مهم‌ترین گام در پیشگیری از پوسیدگی زودرس دوران کودکی است. انتقال تدریجی به فنجان و آب، هم الگوی خواب و هم مواجهه با قند را اصلاح می‌کند. مسواک زدن منظم با خمیردندان فلورایددار مکمل این اقدام است.