National Board Dental Examination / Integrated National Board Dental Examination (INBDE) Preventive, Pediatric, and Orthodontic Dentistry Syllabus

What is the recommended timing for the first dental visit and 'dental home' establishment?

By age 1 year (within 6 months of the first tooth eruption). The AAPD recommends establishing a dental home by age 1 for risk assessment and anticipatory guidance.

What is anticipatory guidance in pediatric dentistry?

Proactive, age-appropriate counseling to parents about a child's expected developmental changes and oral health needs (e.g., teething, diet, fluoride, oral hygiene, habits, injury prevention) before problems arise.

Describe the Frankl behavioral rating scale.

A 4-point scale of child cooperation: (1) Definitely negative (refusal, crying, fearful), (2) Negative (reluctant, uncooperative), (3) Positive (accepts treatment cautiously, willing to comply), (4) Definitely positive (good rapport, interested, laughing). 1-2 are uncooperative; 3-4 cooperative.

What is the 'tell-show-do' technique?

A behavior-guidance technique: TELL the child what will happen in age-appropriate terms, SHOW the procedure/instrument in a non-threatening demonstration, then DO the procedure exactly as described. Builds trust and reduces anxiety.

At what ages do the first primary tooth and first permanent tooth typically erupt?

First primary tooth: mandibular central incisor ~6-10 months. First permanent tooth: mandibular first molar (and/or mandibular central incisor) ~6 years.

State the rule for estimating the number of primary teeth a child should have.

Number of primary teeth ≈ age in months − 6 (valid roughly 6-24 months). The full primary dentition of 20 teeth is typically complete by ~2.5-3 years.

What pulp therapy is indicated for a primary tooth with a carious pulp exposure but reversible/healthy radicular pulp?

Pulpotomy: removal of the coronal pulp with retention of vital radicular pulp, medicament placement (e.g., ferric sulfate, MTA, or formocresol), and restoration (usually stainless steel crown).

When is a pulpectomy indicated in a primary tooth, and what fill material is used?

Pulpectomy is indicated for irreversible pulpitis or a necrotic primary tooth that is restorable. The canals are filled with a resorbable material (e.g., zinc oxide-eugenol, iodoform-based paste, or Ca(OH)2/iodoform) so it resorbs with the root.

Why is a stainless steel crown often preferred over a multi-surface amalgam in primary molars?

SSCs are more durable and have a lower failure/replacement rate for primary molars with multi-surface caries, after pulp therapy, in high-caries-risk children, or in hypoplastic teeth. Full coverage protects remaining tooth structure.

What is the management of an avulsed PRIMARY tooth?

Do NOT replant an avulsed primary tooth. Replantation risks damage to the developing permanent successor and complications (ankylosis, infection). Manage the space and reassure; ensure no aspiration/embedding of the tooth.

What is the management of an avulsed PERMANENT tooth, and what is the ideal storage medium?

Replant immediately if possible; time out of socket is critical (replant within 30-60 min). If not, store in Hank's Balanced Salt Solution (ideal), cold milk, or saliva/saline. Avoid water (hypotonic, kills PDL cells). Then splint and follow up.

What is a space maintainer, and name a common type for a single posterior tooth loss.

An appliance that preserves arch space after premature primary tooth loss to prevent drifting/space loss for the erupting permanent tooth. A band-and-loop maintainer is common for a single lost primary first or second molar.

Why is the primary second molar the most important tooth to maintain space for?

Its premature loss allows the permanent first molar to drift/tip mesially, causing significant arch-length loss and potential impaction of the second premolar. A distal shoe or other maintainer is critical, especially before first molar eruption.

What is the Nance appliance vs lingual arch vs distal shoe?

Nance: maxillary bilateral space maintainer with an acrylic button on the palate (anterior to rugae). Lingual arch: mandibular bilateral maintainer connecting molars via a lingual wire. Distal shoe: guides eruption of the unerupted first permanent molar after early loss of the primary second molar.

What special considerations apply to dental care for children with special health care needs (CSHCN)?

They have higher caries/periodontal risk and need individualized prevention (fluoride, sealants, diet), modified behavior guidance, possible sedation/general anesthesia, caregiver-assisted hygiene, and coordination with medical providers. Aggressive preventive strategies are emphasized.

What dental finding is characteristic of Down syndrome?

Common findings: macroglossia, hypodontia/microdontia, delayed eruption, malocclusion (Class III tendency, anterior open bite), and notably increased early-onset periodontal disease. Congenital heart defects may require antibiotic prophylaxis consideration.

What is Angle's Class I molar relationship?

The mesiobuccal cusp of the maxillary first permanent molar occludes in the buccal groove of the mandibular first permanent molar (normal anteroposterior relationship). Malocclusion can still exist (crowding, rotations) within Class I.

Define Angle's Class II and Class III molar relationships.

Class II (distocclusion): mandibular molar is distal to normal — MB cusp of maxillary first molar is mesial to the mandibular buccal groove (Div 1 = proclined uppers; Div 2 = retroclined upper centrals). Class III (mesiocclusion): mandibular molar is mesial — maxillary MB cusp falls distal to the buccal groove.

What are the ideal mesiodistal terminal plane relationships of the primary second molars?

Flush (mesial step absent) terminal plane is most common in primary dentition; mesial step favors Class I/III permanent occlusion; distal step often leads to Class II. The flush terminal plane uses the leeway space/early mesial shift to become Class I.

What is leeway space?

The size difference between the combined mesiodistal widths of the primary canine + first and second molars and their permanent successors (canine + premolars). It is greater in the mandible (~3.4 mm total, 1.7 mm/side) than maxilla (~1.8 mm total), allowing mesial molar drift.

Define overjet and overbite.

Overjet = horizontal overlap of maxillary incisors over mandibular incisors (normal ~2-3 mm). Overbite = vertical overlap of maxillary over mandibular incisors (normal ~2-3 mm or ~30% of crown). Excess overbite = deep bite; negative = open bite.

What is the primary site of mandibular growth, and how does the mandible grow?

The condylar cartilage (secondary cartilage) is a major growth site; the mandible grows by endochondral ossification at the condyle plus surface remodeling (apposition posteriorly/inferiorly, resorption on the ramus anterior border), moving it down and forward.

What are the cranial base synchondroses, and which is most important for postnatal growth?

Cartilaginous joints of the cranial base; the spheno-occipital synchondrosis is the most important for postnatal cranial base lengthening (active until ~13-15 years), influencing the anteroposterior jaw relationship.

How does the maxilla grow, and what are sutures' role?

The maxilla grows by intramembranous ossification: passive displacement (downward/forward as the cranial base grows) plus active growth at the circummaxillary sutures and surface remodeling (apposition on the posterior tuberosity lengthens the arch).

What is the order of growth completion among skeletal, neural, and genital tissues (Scammon's curves relevance)?

Neural tissue (including the cranium) grows earliest and is nearly complete by ~6-7 years. General/skeletal (somatic) growth follows an S-shaped curve completing in late teens. This explains why early cranial vault grows fast while facial/jaw growth continues longer.

What is the SNA, SNB, and ANB angle in cephalometric analysis?

SNA (~82°) = maxillary position relative to cranial base. SNB (~80°) = mandibular position relative to cranial base. ANB (~2°) = difference indicating sagittal jaw relationship: increased ANB suggests Class II skeletal, decreased/negative suggests Class III.

What does the Frankfort-Mandibular Plane Angle (FMA) indicate?

The angle between the Frankfort horizontal and mandibular plane (~25°). High FMA indicates a vertical/hyperdivergent growth pattern (long face, open-bite tendency); low FMA indicates a horizontal/hypodivergent pattern (deep bite tendency).

What is serial extraction and when is it used?

A planned interceptive sequence of extractions (typically primary canines, then primary first molars, then first premolars) in severe arch-length deficiency/crowding to guide permanent incisors into alignment and relieve crowding in the mixed dentition.

What appliance is used to correct an anterior crossbite of a single permanent incisor in the mixed dentition?

Simple interceptive options include an inclined plane (lower) or a removable appliance with a Z-spring/finger spring to procline the locked-in maxillary incisor over the bite, often with bite opening to clear occlusion.

How is a posterior crossbite due to a constricted maxilla treated interceptively?

Maxillary expansion: a rapid palatal expander (RPE) opens the midpalatal suture in growing patients, or a slow expander/quad-helix/W-arch corrects dental/skeletal posterior crossbite. Early correction can prevent functional mandibular shift.

What is a habit-breaking appliance for thumb-sucking, and when should the habit be addressed?

Persistent nonnutritive sucking beyond ~3-4 years (and especially past eruption of permanent incisors ~6) can cause anterior open bite/proclination. After positive reinforcement fails, a palatal crib (or rake) appliance is used to deter the habit.