NEET MDS Pedodontics Syllabus

State the formula for calculating safe, toxic, and lethal doses of fluoride.

Safe Tolerated Dose (STD) ~ 8-16 mg F/kg. Probably Toxic Dose (PTD) = 5 mg F/kg body weight (treatment threshold). Certainly Lethal Dose (CLD) ~ 32-64 mg F/kg.

What is dental fluorosis and what is the Dean's Index?

Fluorosis is hypomineralization of enamel from excess fluoride during tooth formation, causing white opacities to brown staining/pitting. Dean's Index grades it: normal, questionable, very mild, mild, moderate, severe.

What is the management of acute fluoride toxicity based on dose?

<5 mg F/kg: give milk/calcium orally, observe. 5-15 mg/kg: induce vomiting, give milk/calcium/antacids, monitor. >15 mg/kg: hospitalize, IV calcium gluconate, cardiac monitoring, gastric lavage.

What dietary advice reduces caries risk in children?

Reduce frequency (not just amount) of fermentable carbohydrate/sugar intake, avoid sticky retentive snacks and sugary drinks between meals, avoid nighttime bottle with milk/juice, and encourage non-cariogenic snacks (cheese, nuts, vegetables).

What is the Stephan curve?

A graph of plaque pH over time after a sugar exposure: pH drops below the critical level (~5.5) within minutes, then gradually returns to baseline over ~30-60 minutes. Frequent sugar intake keeps pH demineralizing for longer.

What is the critical pH for enamel demineralization?

Approximately 5.5 for enamel (hydroxyapatite). Below this, demineralization exceeds remineralization. Root dentin/cementum has a higher critical pH (~6.2).

What are pit and fissure sealants and their primary indication?

Resin or glass-ionomer materials placed in the occlusal pits and fissures to mechanically seal them from plaque/substrate. Indicated for caries-prone deep retentive fissures, especially newly erupted permanent molars.

Compare resin-based sealants with glass-ionomer sealants.

Resin sealants: better retention, require dry field and acid etching. Glass-ionomer sealants: release fluoride, more moisture-tolerant (good for partially erupted/uncooperative cases) but lower retention. Resin is preferred when isolation is achievable.

What is Early Childhood Caries (ECC) and Severe ECC, by definition?

ECC: presence of >=1 decayed (cavitated or non-cavitated), missing (due to caries), or filled tooth surface in a child under 6 years. Severe ECC: any smooth-surface caries under age 3, or age-specific surface counts (e.g., >=4 at age 3, >=5 at 4, >=6 at 5).

Describe the typical pattern/etiology of nursing (bottle) caries.

Caused by prolonged/nocturnal bottle feeding with sugary liquids/milk. Pattern: maxillary incisors affected first, then maxillary/mandibular molars; mandibular incisors are typically spared (protected by tongue and saliva from the submandibular gland).

What are the four interacting factors in the etiology of dental caries (Keyes/Newbrun)?

Host/tooth, Microflora (cariogenic bacteria), Substrate/diet (fermentable carbohydrate), and Time. All four must overlap for caries to occur (Newbrun added time as the fourth circle).

Which bacteria are the principal agents in caries initiation and progression?

Streptococcus mutans (and S. sobrinus) are key in initiation; Lactobacilli are associated with progression of established lesions. Actinomyces are linked to root caries.

What is the role of saliva in caries protection?

Saliva provides mechanical clearance, buffering (bicarbonate), antibacterial agents (lysozyme, lactoferrin, IgA), and minerals (calcium, phosphate, fluoride) that promote remineralization. Reduced flow (xerostomia) markedly increases caries risk.

What is caries risk assessment (CAMBRA / AAPD CAT)?

A systematic evaluation balancing risk/protective factors and disease indicators to classify a child as low, moderate, or high caries risk, guiding the frequency of recalls, fluoride, sealants, and dietary counseling.

What is the ICDAS classification used for?

International Caries Detection and Assessment System: a visual scoring (0-6) of caries severity from first visual change in enamel (1-2) through enamel breakdown (3-4) to dentinal exposure/extensive cavitation (5-6), enabling early non-cavitated detection.

What is the indication and technique difference between indirect and direct pulp capping in primary teeth?

Indirect pulp cap: deep caries near pulp without exposure; leave affected dentin and place a liner (Ca(OH)2 or MTA). Direct pulp cap: small mechanical/carious pin-point exposure in an asymptomatic vital tooth; place capping material directly. Direct capping on carious primary exposures has a poorer prognosis.

Differentiate pulpotomy from pulpectomy in primary teeth.

Pulpotomy: removal of the coronal pulp, retaining vital radicular pulp (for reversible/coronal pulp involvement). Pulpectomy: complete removal of coronal and radicular pulp with canal filling using resorbable material (e.g., zinc oxide eugenol) for irreversibly inflamed/necrotic pulp.

What is the most commonly used pulpotomy medicament and its alternatives?

Formocresol has traditionally been most common, but due to toxicity/carcinogenicity concerns, alternatives include MTA (high success), ferric sulfate, and Ca(OH)2. MTA is increasingly preferred.

Why is a stainless steel crown often preferred over amalgam for restoring primary molars?

Stainless steel crowns provide full-coverage, durable restoration with better longevity for large multisurface lesions, after pulp therapy, in high-caries-risk children, and for developmental defects, where intracoronal restorations would fail.

What is the Hall technique?

A minimally invasive method of cementing a preformed stainless steel crown over a carious primary molar with no caries removal, no tooth preparation, and no local anesthesia, sealing the lesion to arrest it.

What is Silver Diamine Fluoride (SDF) and its main side effect?

A topical liquid (typically 38%) that arrests dentinal caries via antibacterial silver and remineralizing fluoride. Its main drawback is permanent black staining of the arrested carious lesion.

Describe the clinical features of primary herpetic gingivostomatitis.

Caused by HSV-1, usually in children 6 months-5 years: fever, malaise, lymphadenopathy, painful fiery-red gingiva, and multiple vesicles/ulcers on the oral mucosa and perioral skin. It is self-limiting (~10-14 days); treat supportively.

What is the most common cause of localized aggressive findings like early severe gingival inflammation in children, and name a common eruption-related lesion.

Eruption-related: an eruption cyst/hematoma is a bluish, fluid-filled swelling over an erupting tooth that usually resolves spontaneously. Localized severe periodontal breakdown in adolescents suggests localized aggressive periodontitis (often affecting first molars/incisors).

List common oral manifestations seen in children with leukemia.

Gingival enlargement/hyperplasia, spontaneous gingival bleeding, mucosal pallor, petechiae/ecchymoses, oral ulceration, and increased susceptibility to infection (e.g., candidiasis, herpes).

What oral findings are characteristic of congenital syphilis (Hutchinson's triad components)?

Hutchinson's incisors (screwdriver/notched permanent incisors) and Mulberry/Moon's molars; the full Hutchinson's triad is Hutchinson's incisors, interstitial keratitis, and eighth-nerve deafness.

What space-maintainer is indicated after premature loss of a single primary first molar (with abutment present)?

A band-and-loop space maintainer — a fixed unilateral, non-functional appliance preserving the space of one tooth until the permanent successor erupts.

What appliance is used when primary molars are lost bilaterally in the mandible versus maxilla?

Mandible: lingual arch (lingual holding arch). Maxilla: Nance palatal arch (acrylic button on rugae) or transpalatal arch. These maintain arch length bilaterally.

What are the consequences of premature loss of primary teeth?

Loss of arch length due to mesial drift/space closure, leading to crowding, impaction or ectopic eruption of successors, midline shift, supraeruption of opposing teeth, and possible delayed/altered eruption.

Give examples of interceptive orthodontic procedures in the mixed dentition.

Space maintenance, space regaining, serial extraction, correction of anterior/posterior crossbites, habit-breaking appliances (e.g., for thumb-sucking/tongue-thrust), and management of ectopic eruption.

What is serial extraction and its classic sequence?

A planned interceptive extraction sequence in cases of severe arch-length deficiency: extract primary canines first (to align incisors), then primary first molars, then the erupting first premolars — guiding crowded permanent teeth into alignment.

Classify traumatic injuries to teeth (Ellis / WHO categories of crown-root fractures).

Includes enamel infraction (crack, no loss), enamel fracture, enamel-dentin fracture (uncomplicated), crown fracture with pulp exposure (complicated), crown-root fracture, root fracture, and luxation injuries (concussion, subluxation, lateral/extrusive/intrusive luxation, avulsion).

What is the emergency management of an avulsed permanent tooth?

Replant immediately at the site if possible; hold by the crown, do not scrub the root, rinse gently with saline/milk; if not replanted, store in a physiologic medium (HBSS, milk, saliva, saline — not water); seek dental care urgently and splint with a flexible splint.

Why are avulsed PRIMARY teeth NOT replanted?

Replantation of an avulsed primary tooth is contraindicated because it risks damaging the developing permanent tooth germ (ankylosis/aspiration and germ injury). The socket is left to heal.

What is the recommended extra-oral dry time limit and ideal storage media ranking for an avulsed tooth?

Periodontal ligament cells begin dying after ~15-20 minutes dry; prognosis falls sharply after ~60 minutes dry. Best media: HBSS/Viaspan, then cold milk, then saliva/saline. Avoid plain water (hypotonic, lyses PDL cells).

What defines a child with 'special health care needs' in dentistry?

Any individual with a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment/limiting condition requiring medical/health care management beyond routine, affecting their ability to receive standard dental care.

What dental precautions are needed for a child with congenital/rheumatic heart disease requiring antibiotic prophylaxis?

Provide antibiotic prophylaxis before invasive/bleeding dental procedures per guidelines — standard regimen amoxicillin 50 mg/kg orally (max 2 g) one hour before; for penicillin allergy use clindamycin/azithromycin. Aim to maintain excellent oral hygiene to reduce bacteremia risk.

What special considerations apply when treating a child with hemophilia?

Consult the hematologist; ensure factor replacement before invasive procedures; avoid intramuscular injections and IANB blocks (risk of deep hematoma) — use infiltration/intraligamentary/intraosseous techniques; use local hemostatic measures and antifibrinolytics (tranexamic acid); avoid aspirin/NSAIDs for analgesia.

What oral and management considerations are important for a child undergoing chemotherapy/radiotherapy?

Eliminate dental infection before therapy; expect mucositis, xerostomia, increased caries and bleeding/neutropenia risk; emphasize meticulous oral hygiene, fluoride, and bland rinses; defer elective invasive care during myelosuppression and coordinate timing with the oncologist (treat when counts are adequate).