Pediatric and Preventive Dentistry
What this domain tests
The differences between primary and permanent teeth, caries prevention at population and individual level, behaviour guidance, and the management of the child patient.
Core rules
- Primary teeth have thinner enamel and dentine, larger pulps, more convergent roots, and flatter contact points, so caries progresses quickly and proximally.
- Early childhood caries affects children under six; severe ECC involves smooth surfaces, and its main risk factors are frequent sugar exposure, night-time bottle feeding and poor oral hygiene.
- Fluoride: toothpaste at 1000–1500 ppm for most children; 5% sodium fluoride varnish (22,600 ppm) applied two to four times yearly for high-risk children; systemic supplements are rarely indicated and depend on water fluoride levels.
- Pulp therapy in primary teeth: pulpotomy preserves the radicular pulp in a vital, non-inflamed tooth (commonly with formocresol or MTA); pulpectomy is used when the radicular pulp is infected.
- Space maintenance prevents loss of arch length after premature extraction; a band-and-loop or transpalatal arch is chosen according to the missing tooth and dental age.
- Behaviour guidance: tell–show–do, voice control, and positive reinforcement; restraint requires clear justification and consent.
Worked example
A 4-year-old has rampant caries on the upper incisors and a carious lower molar, and drinks sweetened milk from a bottle at night. Reasoning: this is severe ECC. Management combines caries control (restoration or extraction as indicated), parent counselling on feeding and sugar frequency, fluoride varnish, twice-daily brushing with age-appropriate paste, and a recall interval based on risk.
Traps
- Recommending fluoride supplements without checking the local water fluoride level.
- Applying adult-strength high-fluoride paste to a preschool child without supervision guidance.
- Assuming primary molar roots resorb symmetrically - they resorb from the apical aspect as the premolar erupts.