NEET MDS Lessons
Pedodontics
Causes:
The primary cause of CP is any factor that leads to decreased oxygen supply
(hypoxia) to the developing brain. This can occur due to various reasons,
including complications during pregnancy, childbirth, or immediately after
birth.
Classification of Cerebral Palsy:
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Based on Anatomical Involvement:
- Monoplegia: One limb is affected.
- Hemiplegia: One side of the body is affected.
- Paraplegia: Both legs are affected.
- Quadriplegia: All four limbs are affected.
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Based on Neuromuscular Involvement:
- Spasticity: Characterized by stiff and tight muscles; this is the most common type, seen in 70% of cases. Affected individuals may have limited head movement and a limp gait.
- Athetosis: Involves involuntary, writhing movements, seen in 15% of cases. Symptoms include excessive head movement and drooling.
- Ataxia: Affects balance and coordination, seen in 5% of cases. Individuals may exhibit a staggering gait and slow tremor-like movements.
- Mixed: A combination of more than one type of cerebral palsy, seen in about 10% of cases.
1. Spastic Cerebral Palsy (70% of cases)
Characteristics:
- Limited Head Movement: Individuals have restrictions in moving their head due to increased muscle tone.
- Involvement of Cerebral Cortex: Indicates that the motor control areas of the brain (especially those concerning voluntary movement) are affected.
- Limping Gait with Circumduction of the Affected Leg: When walking, the patient often swings the affected leg around instead of lifting it normally, due to spasticity.
- Hypertonicity of Facial Muscles: Increased muscle tension in the facial region, contributing to a fixed or tense facial expression.
- Unilateral or Bilateral Manifestations: Symptoms can occur on one side of the body (hemiplegia) or affect both sides (diplegia or quadriplegia).
- Slow Jaw Movement: Reduced speed in moving the jaw, potentially leading to functional difficulties.
- Hypertonic Orbicularis Oris Muscles: Increased muscle tone around the mouth, affecting lip closure and movement.
- Mouth Breathing (75%): The individual may breathe through their mouth due to poor control of oral musculature.
- Spastic Tongue Thrust: The tongue pushes forward excessively, which can disrupt swallowing and speech.
- Class II Division II Malocclusion (75%): Dental alignment issue often characterized by a deep overbite and anterior teeth that are retroclined, sometimes accompanied by a unilateral crossbite.
- Speech Involvement: Difficulties with speech articulation due to muscle coordination problems.
- Constricted Mandibular Arch: The lower jaw may have a narrower configuration, complicating dental alignment and oral function.
2. Athetoid Cerebral Palsy (15% of cases)
Characteristics:
- Excessive Head Movement: Involuntary, uncontrolled movements lead to difficulties maintaining a stable head position.
- Involvement of Basal Ganglia: Damage to this area affects muscle tone and coordination, leading to issues like chorea (involuntary movements).
- Bull Neck Appearance: The neck may appear thicker and less defined, owing to abnormal muscle development or tone.
- Lack of Head Balance, Drawn Back: The head may be held in a retracted position, affecting posture and balance.
- Quick Jaw Movement: Involuntary rapid movements can lead to difficulty with oral control.
- Hypotonic Orbicularis Oris Muscles: Reduced muscle tone around the mouth can lead to drooling and lack of control of oral secretions.
- Grimacing and Drooling: Facial expressions may be exaggerated or inappropriate due to muscle tone issues, and there may be problems with managing saliva.
- Continuous Mouth Breathing: Patients may consistently breathe through their mouths rather than their noses.
- Tissue Biting: Increased risk of self-biting due to lack of muscle control.
- Tongue Protruding: The tongue may frequently stick out, complicating speech and intake of food.
- High and Narrow Palatal Vault: Changes in the oral cavity structures can lead to functional difficulties.
- Class II Division I Malocclusion (90%): Characterized by a deep bite and anterior open bite.
- Speech Involvement: Affected due to uncontrolled muscle movements.
- Muscle of Deglutition Involvement: Difficulties with swallowing due to affected muscles.
- Bruxism: Involuntary grinding or clenching of teeth.
- Auditory Organs May be Involved: Hearing impairments can coexist.
3. Ataxic Cerebral Palsy (5% of cases)
Characteristics:
- Slow Tremor-like Head Movement: Unsteady, gradual movements of the head, indicative of coordination issues.
- Involvement of Cerebellum: The cerebellum, which regulates balance and motor control, is impacted.
- Lack of Balance Leading to Staggering Gait: Individuals may have difficulty maintaining equilibrium, leading to a wide-based and unsteady gait.
- Hypotonic Orbicularis Oris Muscles: Reduced muscle tone leading to difficulties with oral closure and control.
- Slow Jaw Movement: The jaw may move slower, affecting chewing and speech.
- Speech Involvement: Communication may be affected due to poor coordination of the speech muscles.
- Visual Organ May be Involved (Nystagmus): Involuntary eye movements may occur, affecting visual stability.
- Varied Type of Malocclusion: Dental alignment issues can vary widely in this population.
4. Mixed:
Mixed cerebral palsy involves a combination of the above types, where the
individual may exhibit spasticity, athetosis, and ataxia to varying degrees.
Dental Considerations for Mixed CP:
- Dental care for patients with mixed CP is highly individualized and depends on
the specific combination and severity of symptoms.
- The dentist must consider the unique challenges that arise from the
combination of muscle tone issues, coordination problems, and potential for
involvement of facial muscles.
- A multidisciplinary approach, including occupational therapy and speech
therapy, may be necessary to address oral function and hygiene.
- The use of sedation or general anesthesia might be considered for extensive
dental treatments due to the difficulty in managing the patient's movements and
ensuring safety during procedures.
Associated Symptoms:
Children with CP may exhibit persistent reflexes such as the asymmetric tonic
neck reflex, which can influence their dental treatment. Other symptoms may
include mental retardation, seizure disorders, speech difficulties, and joint
contractures.
Dental Problems:
Children with cerebral palsy often experience specific dental challenges:
- They may have a higher incidence of dental caries (tooth decay) due to difficulty in maintaining oral hygiene and dietary preferences.
- There is a greater likelihood of periodontal disease, often exacerbated by medications like phenytoin, which can lead to gum overgrowth and dental issues.
Dental Treatment Considerations:
When managing dental care for children with cerebral palsy, dentists need to
consider:
- Patient Stability: The child’s head should be stabilized, and their back should be elevated to minimize swallowing difficulties.
- Physical Restraints: These can help manage uncontrolled movements during treatment.
- Use of Mouth Props and Finger Splints: These tools can assist in controlling involuntary jaw movements.
- Gentle Handling: Avoid abrupt movements to prevent triggering the startle reflex.
- Local Anesthesia (LA): Administered with caution, ensuring stabilization to prevent sudden movements.
- Premedication: Medications may be given to alleviate muscle hypertonicity, manage anxiety, and reduce involuntary movements.
- General Anesthesia (GA): Reserved for cases that are too challenging to manage with other methods.
TetricEvoFlow
TetricEvoFlow is an advanced nano-optimized flowable composite developed by Ivoclar Vivadent, designed to enhance dental restorations with its superior properties. As the successor to Tetric Flow, it offers several key benefits:
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Optimum Surface Affinity: TetricEvoFlow exhibits excellent adhesion to tooth structures, ensuring a reliable bond and minimizing the risk of microleakage.
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Penetration into Difficult Areas: Its flowable nature allows it to reach and fill even the most challenging areas, making it ideal for intricate restorations.
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Versatile Use: This composite can serve as an initial layer beneath medium-viscosity composites, such as TetricEvoCeram, providing a strong foundation for layered restorations.
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Stability for Class V Restorations: TetricEvoFlow maintains its stability when required, making it particularly suitable for Class V restorations, where durability and aesthetics are crucial.
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Extended Applications: In addition to its use in restorations, TetricEvoFlow is effective for extended fissure sealing and can be utilized in adhesive cementation techniques.
The American Academy of Pediatric Dentistry (AAPD) Caries Risk Assessment
Tool is designed to evaluate a child's risk of developing dental caries
(cavities). The tool considers various factors to categorize a child's risk
level as low, moderate, or high.
Low Risk:
- No carious (cavitated) teeth in the past 24 months
- No enamel white spot lesions (initial stages of tooth decay)
- No visible dental plaque
- Low incidence of gingivitis (mild gum inflammation)
- Optimal exposure to fluoride (both systemic and topical)
- Limited consumption of simple sugars (at meal times only)
Moderate Risk:
- Carious teeth in the past 12 to 24 months
- One area of white spot lesion
- Gingivitis present
- Suboptimal systemic fluoride exposure (e.g., not receiving fluoride
supplements or living in a non-fluoridated water area)
- One or two between-meal exposures to simple sugars
High Risk:
- Carious teeth in the past 12 months
- More than one area of white spot lesion
- Visible dental plaque
- Suboptimal topical fluoride exposure (not using fluoridated toothpaste or
receiving professional fluoride applications)
- Presence of enamel hypoplasia (developmental defect of enamel)
- Wearing orthodontic or dental appliances that may increase caries risk
- Active caries in the mother, which can increase the child's risk due to oral
bacteria transmission
- Three or more between-meal exposures to simple sugars
Age-Related Psychosocial Traits and Skills for 2- to 5-Year-Old Children
Understanding the psychosocial development of children aged 2 to 5 years is crucial for parents, educators, and healthcare providers. This period is marked by significant growth in motor skills, social interactions, and language development. Below is a breakdown of the key traits and skills associated with each age group within this range.
Two Years
- Motor Skills:
- Focused on gross motor skills, such as running and jumping.
- Sensory Exploration:
- Children are eager to see and touch their environment, engaging in sensory play.
- Attachment:
- Strong attachment to parents; may exhibit separation anxiety.
- Play Behavior:
- Tends to play alone and rarely shares toys or space with others (solitary play).
- Language Development:
- Limited vocabulary; beginning to form simple sentences.
- Self-Help Skills:
- Starting to show interest in self-help skills, such as dressing or feeding themselves.
Three Years
- Social Development:
- Less egocentric than at two years; begins to show a desire to please others.
- Imagination:
- Exhibits a very active imagination; enjoys stories and imaginative play.
- Attachment:
- Continues to maintain a close attachment to parents, though may begin to explore social interactions with peers.
Four Years
- Power Dynamics:
- Children may try to impose their will or power over others, testing boundaries.
- Social Interaction:
- Participates in small social groups; begins to engage in parallel play (playing alongside peers without direct interaction).
- Expansive Period:
- Reaches out to others; shows an interest in making friends and socializing.
- Independence:
- Demonstrates many independent self-help skills, such as dressing and personal hygiene.
- Politeness:
- Begins to understand and use polite expressions like "thank you" and "please."
Five Years
- Consolidation:
- Undergoes a period of consolidation, where skills and behaviors become more deliberate and refined.
- Pride in Possessions:
- Takes pride in personal belongings and may show attachment to specific items.
- Relinquishing Comfort Objects:
- Begins to relinquish comfort objects, such as a blanket or thumb-sucking, as they gain confidence.
- Cooperative Play:
- Engages in cooperative play with peers, sharing and taking turns, which reflects improved social skills and emotional regulation.
Dental stains in children can be classified into two primary categories: extrinsic stains and intrinsic stains. Each type has distinct causes and characteristics.
Extrinsic Stains
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Definition:
- These stains occur on the outer surface of the teeth and are typically caused by external factors.
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Common Causes:
- Food and Beverages: Consumption of dark-colored foods and drinks, such as berries, soda, and tea, can lead to staining.
- Bacterial Action: Certain bacteria, particularly chromogenic bacteria, can produce pigments that stain the teeth.
- Poor Oral Hygiene: Inadequate brushing and flossing can lead to plaque buildup, which can harden into tartar and cause discoloration.
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Examples:
- Green Stain: Often seen in children, particularly on the anterior teeth, caused by chromogenic bacteria and associated fungi. It appears as a dark green to light yellowish-green deposit, primarily on the labial surfaces.
- Brown and Black Stains: These can result from dietary habits, tobacco use, or iron supplements. They may appear as dark spots or lines on the teeth.
Intrinsic Stains
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Definition:
- These stains originate from within the tooth structure and are often more difficult to treat.
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Common Causes:
- Medications: Certain antibiotics, such as tetracycline, can cause grayish-brown discoloration if taken during tooth development.
- Fluorosis: Excessive fluoride exposure during enamel formation can lead to white spots or brown streaks on the teeth.
- Genetic Factors: Conditions affecting enamel development can result in intrinsic staining.
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Examples:
- Yellow or Gray Stains: Often linked to genetic factors or developmental issues, these stains can be more challenging to remove and may require professional intervention.
Management and Prevention
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Regular Dental Check-ups:
- Schedule routine visits to the dentist for early detection and management of stains.
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Good Oral Hygiene Practices:
- Encourage children to brush twice a day and floss daily to prevent plaque buildup and staining.
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Dietary Considerations:
- Limit the intake of sugary and acidic foods and beverages that can contribute to staining.
CARIDEX and CARISOLV
CARIDEX and CARISOLV are both dental products designed for the chemomechanical removal of carious dentin. Here’s a detailed breakdown of their components and mechanisms:
CARIDEX
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Components:
- Solution I: Contains sodium hypochlorite (NaOCl) and is used for its antimicrobial properties and ability to dissolve organic tissue.
- Solution II: Contains glycine and aminobutyric acid (ABA). When mixed with sodium hypochlorite, it produces N-mono chloro DL-2-amino butyric acid, which aids in the removal of demineralized dentin.
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Application:
- CARIDEX is particularly useful for deep cavities, allowing for the selective removal of carious dentin while preserving healthy tooth structure.
CARISOLV
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Components:
- Syringe 1: Contains sodium hypochlorite at a concentration of 0.5% w/v (which is equivalent to 0.51%).
- Syringe 2: Contains a mixture of amino acids (such as lysine, leucine, and glutamic acid) and erythrosine dye, which helps in visualizing the removal of carious dentin.
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pH Level:
- The pH of the CARISOLV solution is approximately 11, which helps in the dissolution of carious dentin.
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Mechanism of Action:
- The sodium hypochlorite in CARISOLV softens and dissolves carious dentin, while the amino acids and dye provide a visual cue for the clinician. The procedure can be stopped when discoloration is no longer observed, indicating that all carious dentin has been removed.
Natal and neonatal teeth, also known by various synonyms such as congenital teeth, prediciduous teeth, dentition praecox, and foetal teeth. This topic is significant in pediatric dentistry and has implications for both diagnosis and treatment.
Etiology
The etiology of natal and neonatal teeth is multifactorial. Key factors include:
- Superficial Position of Tooth Germs: The positioning of tooth germs can lead to early eruption.
- Infection: Infections during pregnancy may influence tooth development.
- Malnutrition: Nutritional deficiencies can affect dental health.
- Eruption Acceleration: Febrile incidents or hormonal stimulation can hasten the eruption process.
- Genetic Factors: Hereditary transmission of a dominant autosomal gene may play a role.
- Osteoblastic Activities: Bone remodeling phenomena can impact tooth germ development.
- Hypovitaminosis: Deficiencies in vitamins can lead to developmental anomalies.
Associated Genetic Syndromes
Natal and neonatal teeth are often associated with several genetic syndromes, including:
- Ellis-Van Creveld Syndrome
- Riga-Fede Disease
- Pachyonychia Congenital
- Hallemann-Steriff Syndrome
- Sotos Syndrome
- Cleft Palate
Understanding these associations is crucial for comprehensive patient evaluation.
Incidence
The incidence of natal and neonatal teeth varies significantly, ranging from 1 in 6000 to 1 in 800 births. Notably:
- Approximately 90% of these teeth are normal primary teeth.
- In 85% of cases, the teeth are mandibular primary incisors.
- 5% are maxillary incisors and molars.
- The remaining 10% consist of supernumerary calcified structures.
Clinical Features
Clinically, natal and neonatal teeth may present with the following features:
- Morphologically, they can be conical or normal in size and shape.
- The color is typically opaque yellow-brownish.
- Associated symptoms may include dystrophic fingernails and hyperpigmentation.
Radiographic Evaluation
Radiographs are essential for assessing:
- The amount of root development.
- The relationship of prematurely erupted teeth to adjacent teeth.
Most prematurely erupted teeth are hypermobile due to limited root development.
Histological Characteristics
Histological examination reveals:
- Hypoplastic enamel with varying degrees of severity.
- Absence of root formation.
- Ample vascularized pulp.
- Irregular dentin formation.
- Lack of cementum formation.
These characteristics are critical for understanding the structural integrity of natal and neonatal teeth.
Harmful Effects
Natal and neonatal teeth can lead to several complications, including:
- Laceration of the lingual surface of the tongue.
- Difficulties for mothers wishing to breast-feed their infants.
Treatment Options
When considering treatment, extraction may be necessary. However, precautions must be taken:
- Avoid extractions until the 10th day of life to allow for the establishment of commensal flora in the intestine, which is essential for vitamin K production.
- If extractions are planned and the newborn has not been medicated with vitamin K immediately after birth, vitamin K supplements should be administered before the procedure to prevent hemorrhagic disease of the newborn (hypoprothrombinemia).