1. When Should I Bring Jerad for
His First Dental Visit?
A.
My Answer: "At six months of age or when the first tooth erupts"
B.
Current
emphasis is being placed on exams as soon as the first tooth
appears
1. To create a dental home
2. Discuss caries risk assessment
3. Emphasize need for home care with first tooth
C.
Historically
three year olds were started-- why age 3?
1. These children are very curious
2. They want to please
3. Most 3 year olds have all their primary teeth
4. They can handle the treatment to be done
2. How Will Megan Do When You
Fill Her Tooth?
A.
My Answer: "Fine"
B.
What
to say"
1. Be realistic
2. Be optimistic
3. Be clear and layout out guidelines for parents
a. Do not overprepare child or frighten them
b. Use our terminology
c. Be an observer only
d. Leave when asked
3. My Husband Wants No Crowns--
Can These Teeth Just Be Filled?
A.
My answer: "Probably not"-- it may not be the correct thing to
do
B.
Crown
indications
1. Large lesion with or without loss of space
2. Expectation of life of the restoration is 4 or more
years
3. More than 2 surfaces involved with caries
C. Technique
1. Reduce occlusal surface about 1-2 mm
2. Remove all caries—check for pulpal involvement
3. Perform pulpotomy or place cavity liner (glass
ionomer)
4. Reduce mesial and distal surfaces with thin fissure
bur
5. Place counter-bevels on buccal-occlusal and
lingual-occlusal anges
6. Select snug-fitting crown (not too loose/not too
tight)
7. Check for proper length—if more than 1mm tissue
blanch, trim crown
8. Contour and crimp crowns for excellent adaption
9. Cement with appropriate luting cement
4. We Don't Want Any Pulp
Treatments-- Can't We Just Pull Colin's Teeth?
A.
My answer: "No"-- it is not the most appropriate treatment
B.
Extraction
may lead to problems
1. Drifting
and space loss with result of increased chance of orthodontic
care
2. Decreased
function
3. Potential
impaction of permanent teeth
C.
Spacer
can replace extracted tooth, but may be more expensive
D.
Loss
of a second primary molar, means unerupted six year molar will
likely drift
E.
Pulpotomy
techniques
1. If
exposure occurs open into pulp chamber with any high speed bur
2. Amputate
coronal pulp tissue
a.
Should only have two “snake eyes”
b. For ferric sulfate, need to countersink one round bur
smaller
3. Obtain
hemostasis
a. Use
cotton balls to dry
b.
Formocresol pellets 2-3 minutes to mummify stumps
c.
Ferric sulfate—instantaneous coagulation
d.
Electro-surge
e. MTA
4. Cover
fixed pulp stumps with ZOE
5. My Other Children Never Had
Cavities-- How Can Nicole Have Six?
A.
My answer: "It's common"
B.
We emphasize the variation in oral bacterial populations
C.
There
are often non-dental considerations
1. Parents
have less control with each consecutive child
2. Vigilence decreases
with more children
6. Aren't They Just Baby Teeth?
A. My
Answer: "Yes"
B.
Reasons
to move ahead with treatment though
1. Primary teeth provide function of chewing during years
of greatest body growth
2. Esthetically, they provide an attractive appearance
and smile
3. They play a role in speech
4. Permanent tooth guidance is greatly effected by
primary teeth
C.
Longevity
of primary teeth
1. Permanent incisors and first molars usually erupt
between 6-7 1/2 years of age
2. Permanent cuspids and biscuspids usually erupt between
10-13 years of age
7. Heather Bumped Her Front
Tooth and It's Dark-- Is It Dead?
A.
My Answer: "Probably Not"
B.
Most
primary teeth heal normally without treatment
C.
What
is normal?
1. Bleeding
2. Swelling
3. Mobility
4. Pain
5. Darkening
of tooth-- usually
progresses for about 6-8 weeks and eventually
lightens back up
D.
What
won't heal normally?
1. Root
fractures
2.
Avulsions-- partial and complete
3. Severe
displacements
4. Internal
resorption
8. Jessica is Still Sucking Her
Thumb-- Is This a Problem?
A.
My answer: "Yes and no"-- this will largely depend on the age of
the child
B.
Children
under 3-4 years of age
1. So common
as to be normal
2. Will often
cease spontaneously
3. Correction
of dental and skeletal changes are likely
C.
Children
over 4- 4 1/2 years of age
1. More
important to bring habit to a stop
2. Now
approaching eruption of permanent anteriors
3. Likelihood
of more difficult skeletal corrections becomes greater
D. Suck-cess progress
1. Behavior
modification program
2. Only the
child can truly stop the habit
3. Takes
parents out of the loop and eliminates power struggle
E.
The program
1. Parent
paints Suck-cess on child's finger after breakfast and dinner
2. Child
scores on calendar with non-judgemental system
3. Reward is
given after 30 consecutive days without sucking
F.
Pacifiers
1. Will also
tend to open the bite
2. Solutions
a. Cold turkey
b. Snip the Tip over time
9. Marlene Never Eats Any
Sugar-- How Can She Have 8 Cavities?
A.
My answer: "It's common"-- it may have to do with the nature of
the snack foods
B.
Cariogenicity
of foods
1. Sugar
content is generally well known
2. Frequency
is not as often understood by parents
3. Physical
properties, such as stickiness is rarely known
a. Fruit rollups
b. Raisins
c. Gummy bears, etc.
10. I Will Not Allow Any X-rays
For My Child
A.
My answer: "I can agree to disagree, but I cannot see your
child""
B.
Without
radiographs, no examination is complete
C.
Potential
problem areas
1. Cysts
2.
Supernumerary or congenitally missing teeth
3. Pathology,
such as odontomas, etc.
D.
Our criteria
1. A minimum
of bitewings every other year
2. We do not
insist on annual x-rays when caries rates are low
11. Does Madison Really Need a
Space Maintainer?
A. Band and Loop
1.
Unilateral single tooth loss
2.
First primary molar space
3.
Can be used in either dental arch
B.
Lingual
Arch
1.
Bilateral mandibular tooth loss
2.
Unilateral multiple tooth loss in mandible
3.
Single second primary molar loss in mandible
C.
Nance
Appliance
1.
Bilateral maxillary tooth loss
2.
Unilateral multiple tooth loss in maxilla
3.
Single second primary molar loss in maxilla
12. Will You Put Sealants on
Bob's Baby Teeth?
A. My
answer: "No"-- success on primary teeth is not as great
B.
Statistics
1. 70 percent
of caries in primary teeth occur interproximally
2.
Retentiveness in broader and shallower grooves is not as
predictable
C.
Sealants
on permanent teeth
1. We always
use a rubber dam to isolate and keep dry
2. We use
topical anesthetic for placement of clamps
3. Cleaning
of grooves is done by air abrasion
4. Etching is
brief
5. Unfilled
bonding agent is used to increase flow of filled sealant
material
6. Filled
sealant material will increase strength and wear resistance
13. Why is Erin the only one in
her class who hasn't lost a tooth?
A.
My answer: "This is common and well within normal growth limits"
B.
Let's
define terms
1. Average= a
human invention that indicates the mid-point of a series of data
2. Normal= a
range of possibilities within a series of data
C.
Some
other thoughts
1. We see 4
year olds with permanent teeth and 9 year olds without any
2. Many children get
their molars first, then incisors, but this is less noticeable
14. School Pictures Are
Tomorrow, So Would You Treat Diana's Front Tooth First?
A.
My answer: "No" (not the top priority and may disrupt the
success of future visits)
B.
The long-term strategy:
1. Build on successful visits
2. Start simple and painless
3. Prioritize for function and longevity of teeth
4. Keep them coming in for complete care
15. Isn't 8 A Little Early For
Orthodontics?
A.
My answer: "Probably not"-- timing is often critical in some
situations
B.
Early
orthodontic situations that lend themselves to early treatment
1. Skeletal
descrepancies
a.
Class II
b.
Class III
c.
Deep bites and Open bites
2. Functional problems
a.
Crossbites
b.
Ectopic eruption
3. Dental
problems
a.
Severe crowding
b. Congenitally missing teeth
c.
Ankylosis
d.
Supernumeraries
C.
Rationales
for early treatment
1.
Enthusiastic patient
2. Take
advantage of growth
3. Prevent
trauma
4. Esthetic
improvements
16. Does Bill Really Need To
Come For Checkups Each Six Months?
A.
My answer: "Yes"-- for children every examination is a new
patient exam
B.
In addition to caries detection, children need development
checked
1.
Exfoliation and eruption
2. Habits
that may alter function
3. Skeletal
descrepancies
4. Ankylosis
5. Fusion and
gemination
6. Pathology
17. Will the Shot Hurt When You
Fill Ben's Tooth?
A.
My Answer: "I don't know"
B.
Some
scream with prophy cups, others say nothing during extractions
C.
My injections:
1. Use
appropriate, positive terminology
a.
I "put teeth to sleep"
b. I don't "give shots"
c.
This is not deceptive and it does work
2. Techniques
a.
Use topical anesthetic
b.
I don't show the child the needle
c.
Talk throughout procedure, using positive words to describe
sensations
3. Types of injections
a.
Mandibular
infiltrations
b. Bilateral mandibular blocks are OK
c.
Palatals go through papillae
4. Onset by OnPharma
a. Buffering system to neutralize acidity of local
anesthetic
b. Takes “sting” out of injections and shortens uptake
time for anesthesia
c. Mixed chairside with unique “pen”
18. I Don't Want Tyler To Miss
School--Can We His Appointment Be After School?
A. My
answer: "No" -- Tyler
is better able to cope in the morning, and so are we
B.
Scheduling
of children should serve their ability to succeed
1. Age of child
a.
Young children earlier in day
b.
Older children (8+) later in day
c.
Teenagers after school
2. Length of appointment
a.
Usually 30-45 minutes
b.
Want to complete all treatment in 3 or fewer appointments
3. Type of visit (procedures to be done)
a.
Sedation and heavier restorative visits earlier in day
b.
Simpler restorative visits later in mornings or early afternoon
c. 6
month checkups anytime in day
19. I've Been Told That Nursing
Can't Hurt Michael's Teeth-- Is This True?
A.
My answer: "No"-- ad lib nursing in conjunction with
carbhoydrates can be harmful
B. It is important to
identify the parent's issue
1. If nursing
is important, focus on restorative plan and deal with nursing
later
2. If person
is truly open to information, explain relationship of nursing to
caries
C.
It is difficult to NOT fall into the "they are wrong" attitude
20. I Want A Good Experience For
My Child Without Sedation, Restraint or Verbal
A.
My answer: "Yes and no"-- this will depend on the child and the
situation
B.
For very young, anxious child with large treatment plan= "No"
C.
For older children and/or small treatment plans= "Yes"
D.
What
to say
1. Be honest
2. Be
realistic
3. Discuss
all possibilities
E.
These
parents probably don't need much to be disappointed or angry
21. How Soon Should I Start
Brushing Beth's Teeth?
A. My
answer: "As soon as the first teeth erupt into the mouth"
B.
Some
tips to increase success
1. Start with
Q-Tip, washcloth or “Tenders”
2. Recommend
that the parent let the child watch the parent brush
3. Avoid
strongly flavored toothpastes, especially mint flavored, which
is "hot"
4. May want
to use child in parents' lap technique
C.
This
is also an opportunity to educate parents about fluoride, diet
and checkups
22. Can I Come Here For
Treatment?
A.
My Answer: "No"
B.
What
are they saying?
1. We like what you do here
2. This experience is different
3. I want what you provide
C.
How does this happen?
1. Pay attention to what patients like about dental
offices
a. This is usually not a technical factor
b. They want to have a “good feeling” in the office
2. Pay attention to what patients would change about a
dental office
a. This is also not usually technically related
b. They are looking for relationships
23. Ashley Has a New Tooth
Coming In Behind The Front Ones-- Is This a Problem?
A.
My answer: "Probably not"-- it is a possible indicator of
crowding, though
B.
Nature
will sometimes take care of this by itself
1. Centrals
blocked lingually, then primary laterals exfoliate
2. Tongue then pushes
centrals into proper location
3. Permanent
laterals erupt lingually-- final lateral growth of anterior
mandible
4. This is
better time for evaluation
C.
When
to "do something"
1. No
mobility of primary teeth
2. Permanents
are fully erupted
3.
Development of crossbite
24. Daniel's Teeth Just Came in
Rotten-- Does He Have Soft Teeth?
A.
My answer: "No" (sometimes the case, but Daniel doesn't fit a
usual pattern)
B.
Nature
of the problem
1. Is it generalized or only in a limited area?
2. Any changes in the shape and size of root canals?
3. Is it removeable or intrinsic?
C.
Bottle
syndrome
D.
Enamel
hypoplasia
E.
Intrinsic
stains
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