BDS Pedodontics Syllabus

List the steps of pit and fissure sealant application (resin-based).

1) Clean tooth, 2) isolate (rubber dam/cotton rolls) and dry, 3) etch with 37% phosphoric acid (15-30 s), 4) rinse and dry to frosty white appearance, 5) apply sealant into fissures, 6) light cure, 7) check occlusion.

State the etiology of dental caries according to Keyes' triad (plus the modern addition).

Keyes' triad: Host (tooth/saliva), Microorganisms (cariogenic bacteria), and Substrate (fermentable carbohydrate). Newbrun added Time as the fourth essential factor.

Explain the pathogenesis of dental caries in terms of critical pH.

Cariogenic bacteria ferment carbohydrates producing organic acids; when plaque pH drops below the critical pH of approximately $5.5$, hydroxyapatite demineralizes. Above it, remineralization occurs. Net demineralization leads to caries.

What is Early Childhood Caries (ECC) and how is it defined?

ECC is the presence of one or more decayed (cavitated or non-cavitated), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under 6 years (71 months) of age. Severe ECC involves smooth-surface caries or high dmf scores.

Which teeth are characteristically affected in nursing/bottle caries and which are spared?

Maxillary primary incisors, then first molars and canines are affected; the mandibular incisors are characteristically spared because they are protected by the tongue and proximity to salivary ducts during feeding.

Name the indices used to measure dental caries in primary and permanent dentition.

Permanent teeth: DMFT/DMFS (Decayed, Missing, Filled Teeth/Surfaces). Primary teeth: dmft/dmfs (lowercase). Also def index (decayed, extracted, filled) for primary teeth.

List the components of a caries risk assessment (CAMBRA-type) in children.

Disease indicators (existing lesions), risk factors (bacterial load, frequent snacking, low fluoride, reduced saliva, appliances), and protective factors (fluoride exposure, good hygiene, adequate saliva, sealants). Categorized as low, moderate, high, extreme risk.

What are the pulp therapy options for a primary tooth with caries, and when is each indicated?

Indirect pulp capping (deep caries, no exposure), direct pulp capping (small mechanical exposure), pulpotomy (coronal pulp inflamed, radicular pulp vital), and pulpectomy (irreversible pulpitis/necrosis with restorable tooth).

What material is traditionally used for primary molar pulpotomy, and name alternatives?

Formocresol (Buckley's) is traditional; alternatives include ferric sulfate, mineral trioxide aggregate (MTA), calcium hydroxide, and electrosurgery/laser. MTA and ferric sulfate are increasingly preferred over formocresol.

What restoration is recommended for a primary molar with extensive caries or after pulpotomy?

A stainless steel crown (SSC), which provides full-coverage durable restoration and is more retentive and longer-lasting than large multi-surface amalgam or composite restorations in primary molars.

Describe the Hall Technique for managing carious primary molars.

A minimally invasive technique where a preformed stainless steel crown is cemented over a carious primary molar with no caries removal, no tooth preparation, and no local anesthesia, sealing the caries to arrest its progression.

What is teething and what are its recognized signs?

Teething is the eruption of primary teeth through the gingiva, associated with irritability, drooling, gum irritation, and a desire to bite. It does NOT cause high fever or diarrhea; those signs warrant investigation for other illness.

Define and differentiate Epstein pearls, Bohn's nodules, and dental lamina cysts in neonates.

Epstein pearls: keratin cysts along the midpalatine raphe. Bohn's nodules: mucous gland remnants on buccal/lingual gingiva. Dental lamina cysts (gingival cysts of the newborn): on the alveolar ridge crest. All are benign and self-resolving.

What are natal and neonatal teeth?

Natal teeth are present at birth; neonatal teeth erupt within the first 30 days of life. Most commonly mandibular primary incisors. May be removed if excessively mobile (aspiration risk) or causing Riga-Fede ulceration.

What is Riga-Fede disease?

An ulceration on the ventral surface of the tongue in infants caused by repetitive trauma from natal/neonatal teeth during feeding/sucking. Managed by smoothing the incisal edge or extracting the offending tooth.

Name common oral soft-tissue infections in children and their causative agents.

Primary herpetic gingivostomatitis (HSV-1), oral candidiasis/thrush (Candida albicans), herpangina (Coxsackie A virus), hand-foot-and-mouth disease (Coxsackie A16), and acute necrotizing ulcerative gingivitis.

What are the oral manifestations of measles and where are they seen?

Koplik's spots: small bluish-white papules on an erythematous base on the buccal mucosa opposite the molars, appearing 1-2 days before the skin rash of measles (rubeola).

List oral manifestations of leukemia in children.

Gingival enlargement/hyperplasia (especially in monocytic leukemia), spontaneous gingival bleeding, petechiae/ecchymoses, oral ulceration, mucosal pallor, and increased susceptibility to infection.

What are the oral findings in a child with congenital syphilis (Hutchinson's triad)?

Hutchinson's triad: Hutchinson's incisors (screwdriver/notched incisors), Mulberry (Moon's) molars, plus interstitial keratitis and eighth nerve deafness.

What is the primary consequence of premature loss of a primary tooth and how is it prevented?

Loss of arch length due to space closure/mesial drift of adjacent teeth, leading to impaction or crowding of the permanent successor. Prevented by placing a space maintainer.

Classify space maintainers and give an example of each type.

Fixed vs removable; unilateral vs bilateral; functional vs non-functional. Examples: Band-and-loop (fixed, unilateral), Lingual arch and Nance/Transpalatal arch (fixed, bilateral), Distal shoe (guides erupting first molar), and removable acrylic partial denture.

When is a distal shoe space maintainer indicated?

When the primary second molar is lost before the eruption of the permanent first molar; the distal shoe's subgingival extension guides the erupting first permanent molar into proper position.

Define interceptive orthodontics and give examples of interceptive procedures.

Interceptive orthodontics is the intervention to eliminate or reduce an already developing malocclusion. Examples: space maintenance, space regaining, serial extraction, correction of oral habits, and correcting incipient crossbites.

What is serial extraction and in which malocclusion is it indicated?

A planned, sequential removal of certain primary and permanent teeth (typically primary canines, then first primary molars, then first premolars) in Class I malocclusion with severe arch-length deficiency (crowding) to guide teeth into alignment.

Give the Ellis classification of tooth fractures (Classes 1-3).

Class 1: enamel-only fracture. Class 2: enamel and dentin fracture without pulp exposure. Class 3: enamel, dentin fracture WITH pulp exposure. (Higher classes cover root fracture, displacement, and avulsion.)

List the types of luxation injuries to teeth.

Concussion (no displacement, tender), subluxation (loosened, no displacement), extrusive luxation (displaced out of socket), lateral luxation (displaced sideways with alveolar fracture), and intrusive luxation (driven into the socket/bone).

What is the emergency management of an avulsed permanent tooth?

Reimplant immediately if possible; if not, store in a physiologic medium (Hank's Balanced Salt Solution, cold milk, or saliva—NOT water), avoid touching/scrubbing the root, reimplant within 30-60 minutes, splint flexibly for ~2 weeks, and give tetanus/antibiotic coverage.

Why are avulsed PRIMARY teeth NOT reimplanted?

Reimplantation of an avulsed primary tooth is contraindicated because it risks damaging the developing permanent tooth germ (ankylosis, enamel defects) and carries infection/aspiration risk.

Define management approaches for children with special health care needs in dentistry.

Behavior guidance (desensitization, TSD), physical stabilization when indicated, pharmacologic management (sedation or general anesthesia for extensive needs), aggressive prevention (fluoride, sealants, diet counseling), and multidisciplinary/caregiver involvement.

What oral/dental considerations are important for a child with Down syndrome?

Macroglossia, delayed and irregular tooth eruption, microdontia, hypodontia (missing teeth), fissured tongue, malocclusion (Class III tendency), early aggressive periodontal disease, and increased need for cardiac endocarditis prophylaxis when a cardiac defect is present.