Pediatric Dentistry
This domain tests prevention from the first year of life, behaviour guidance, primary molar restorative and pulp decisions, and the trauma rules that differ between primary and permanent teeth.
Prevention and behaviour
- First dental visit by the first birthday or within six months of the first tooth erupting.
- Fluoride varnish 5 percent sodium fluoride every 3 to 6 months for at-risk children; toothpaste as a smear under three years and a pea-sized amount from three to six years.
- Silver diamine fluoride 38 percent arrests dentinal caries but stains lesions black; avoid in ulceration or silver allergy.
- Behaviour guidance: tell-show-do, positive reinforcement, the Frankl scale for recording cooperation, and nitrous oxide where indicated.
Restorative decisions
- Pulpotomy agents in order of preference: mineral trioxide aggregate, ferric sulfate, then formocresol where permitted.
- Stainless steel crowns for primary molars with multi-surface or post-pulpotomy caries. The Hall technique and interim therapeutic restorations are accepted alternatives in selected cases.
- Space maintainers: band and loop for a single missing primary molar, Nance or transpalatal arch for bilateral loss.
Trauma
- Avulsed primary tooth: never replant, because of the risk to the developing permanent germ. Avulsed permanent tooth: replant immediately, transport in milk or saline, flexible splint for two weeks, systemic doxycycline where appropriate, tetanus check.
- Maximum lidocaine 2 percent with epinephrine is 4.4 mg per kg; calculate by weight, never by cartridge count.
Worked example
A four-year-old avulses the upper right primary central incisor, and the parent brings the tooth in milk within 20 minutes. The correct answer remains: do not replant. Examine for alveolar fracture and adjacent injury, take a radiograph, reassure the parent about possible sequelae such as discolouration, ankylosis or ectopic eruption of the permanent tooth, and review. The distractor is replanting within 60 minutes, which applies only to permanent teeth.
Traps
- Replanting a primary tooth.
- Advising aspirin for paediatric pain.
- Exceeding the local anaesthetic dose.
- Failing to warn parents about possible damage to the permanent successor.