Pedodontics 1 Section Overview

Pedodontics 1 {Section 1 to 8: Shobha Tandon}
Master Key & Explanations

Ans. 1
Ref: Shobha Tandon, 2nd/2 
• Stewart, Barber, Troutman, Wei (1982) 
“Pediatric dentistry is the practice and teaching of comprehensive, preventive and therapeutic oral health care of child from birth
through adolescence. It is construed to include care for special patients who demonstrate metal, physical or emotional problems.”
 
• American Academy of Pediatric Dentistry (1985) 
“Pediatric dentistry, also known as Pedodontics and as dentistry for adolescents and children, is the area of dentistry concerned
with preventive and therapeutic oral health care for children from birth through adolescence. It also includes special care for spe-
cial patients beyond the age of adolescence who demonstrate mental, physical or emotional problems.” 
• Boucher’s dental terminology (1993) 
“Pedodontics is the branch of dentistry, that includes having a child accept dentistry, prevention, detection, restoration of primary
and permanent dentition, applying preventive measures for periodontal therapy, dental caries prevalence, intercepting and cor-
recting various areas of malocclusion.” 
• American Academy of Pediatric Dentistry (1999) 
“Pediatric dentistry is an age-defined specially that provides both primary and comprehensive, preventive and therapeutic oral
health care for infants and children through adolescence, including those with special health care needs.” 
• Therefore with the experience of the author 
“Pedodontics can be defined as a science which deals with laying down the foundation of healthy dentition and oro-facial com-
plex from the prenatal period through adolescence.”
Ans. 2
Ref: McDonald, 9th/12 
The 2008 American Academy of Pediatric Dentistry guidelines on infant oral health care include the following recommendations:
 
1. All primary health care professionals who serve mothers and infants should provide parent/caregiver education on the etiology
and prevention of early childhood caries (ECC). 
2. The infectious and transmissible nature of bacteria that causes ECC and methods of oral health risk assessment (e.g., Caries As-
sessment Tool [CAT]), anticipatory guidance, and early intervention should be included in the curriculum of all medical, nurs-
ing, and allied health professional programs. 
3. Every infant should receive an oral health risk assessment from his or her primary health care provider by 6 months of age. 
4. Parents or caregivers should establish a dental home for infants by 12 months of age. 
5. Health care professionals and all stakeholders in children’s health should support the identification of a dental home for all in-
fants at 12 months of age.
Ans. 3
Ref: Shobha Tandon, 2nd/77 
• X-ray Cephalometry: Enables longitudinal investigations to be carried out and the information of human craniofacial growth
which has accumulated during recent years is mainly based on this technique. 
• This method does not describe actual growth changes but usually depicts only how the radiographic structure has changed in
relation to a certain reference structure. This problem is because X-ray cephalometry describes growth as a two-dimensional
phenomenon on which growth of structures is simplified to positional changes in a system of coordinates. 
• The X-ray film does not distinguish between changes in the position of a structure per se and changes due to remodeling of its
external surface.
Ans. 4
Numerous systems have been developed for classifying the behavior of children in the dental environment. An understanding of them
holds more than academic interest. The knowledge of these systems can be an asset to the dentist in several ways; it can assist in di-
recting the behavior guidance approach, it can provide a means for systematically recording behaviors, and it can assist in evaluating
the validity of current research. 
Wright’s clinical classification places children in three categories: 
• Cooperative 
• Lacking in cooperative ability 
• Potentially cooperative 
During examination of a child, the cooperative behavior of the patient is taken into account because it is a key to rendering treatment.
 
Most children seen in the dental office cooperate. Cooperative children are reasonably relaxed. They have minimal apprehension. 
They may be enthusiastic. They can be treated by a straightforward, behavior-shaping approach. When guidelines for behavior are
established, they perform within the framework provided.
Ans. 5
In India the first dental college, “Calcutta Dental College and Hospital”, was started in the year 1920 by Dr. Rafiuddin Ahmed in his
private chamber. Dr. Ahmed, the Father of Dentistry in India, is also known as “The Grand Old Man of Dentistry”. He is credited with
the first edition of “The Indian Dental Journal” in October 1925, foundation of the “All India Dental Association” in the year 1927,
drafting and passing of the Bengal Dentist Act in 1939, and passing of the Dentist Act in 1948.
Ans. 6
Postnatal period 
1-4 week Neonatal period: In prone position child lies flexed and turns head from side to side, head sags on ventral suspension. 
Motor response, grasp reflex are active. 
Shows visual preference to human face 
Face is round and mandible small. 
Abdomen is prominent with relatively short extremities. 
Criteria to assess premature newly born is – born between the 28th to 37th week of gestation 
Birth weight 2500 grams (5-8 lb) or less 
Birth length 47 cm (18 ½ inches) or less 
Head length below 11.5 cm (4 ½ inches) 
and head circumference below 33 cm (13 inches) 
4 week: Holds chin up. 
Head lifted momentarily to the plane of the body on ventral suspension. 
Watches person, follows moving object. 
Beginning to smile 
8week: Head sustained in plane of body on ventral suspension. 
Smiles on social contact 
Listen to voice and coos. 
12week: Lifts the head and chest 
Lifts head above plane of body on ventral suspension. 
Early head control with bobbing motion. 
Makes defensive movements 
Listens to music 
16week: Lifts head and chest, head in approximately vertical axis. 
Symmetric posture predominates, hands in midline. 
Enjoys sitting with full truncal support. 
Laughs out loud 
Excited at sight of food 
28week: Rolls over, crawls. 
Sits briefly 
Reaches out for and grasps large objects. 
Transfers objects from hand to hand 
Polysyllabic vowel sounds formed. 
Prefers mother, babbles 
Enjoys mirror 
40week: Sits up alone, without support. 
Pulls to standing position; “cruises” or walks holding on to furniture. 
Grasps objects with the thumb and fore finger; pokes at things with forefinger. 
Repetitive consonant sounds (mama, dada). 
Responds to sound of name 
Plays peek-a-boo, waves bye-bye 
52 week: Walks with one hand held, rises independently, takes several steps. 
Releases object to other person on request or gesture. 
Increase in vocabulary by a few words, besides ‘mama, dada’. 
Makes postural adjustments to dressing
Ans. 7
Moro reflex: Any sudden movement of the neck initiates this reflex. A satisfactory way of eliciting the reflex is to pull the baby half-
way to a sitting position from the supine and suddenly let the head fall back to a short distance. The reflex consists of a rapid abduc-
tion and extension of the arms with the opening of hands. The arms then come together as in an embrace. 
Clinical importance: its nature gives an indication of the muscle tone. The response may be asymmetrical if muscle tone is unequal
on the two sides, or if there is a weakness of an arm or an injury to the humerus or clavicle. This reflex usually disappears in 2 or 3
months. 
Startle reflex: It is similar to Moro reflex, but is initiated by a sudden noise or any other stimulus. In this reflex, the elbows are flexed
and the hands remain closed, there is less of embrace, outward and inward movement of the arms.
Ans. 8
Ref: Shobha Tandon, 2nd/493
Flow chart: Classification of oral habits
Obsessive Non-obsessive
(deep rooted) (easily learned and dropped)
International Masochistic Unintentional Functional habits,

or or or e.g., mouth breathing,
meaningful, Self-inflicting empty, e.g., tongue thrusting,
e.g., Nail biting, injurious habit, abnormal pillowing, bruxism
digit sucking, e.g., Gingival chin propping
lip biting stripping
Morris and
Author James (1923) Kingsley (1958) Klein (1971) Finn (1987)
Bohanna (1969)
Classification a) Useful habits a) Functional oral a) Pressure habits, a) Empty habits I. a) Compulsive habits
b) Harmful hab- habits Non-pressure b) Meaningful b) Non-compulsive
its b) Muscular habits habits habits habits
c) Combined ones b) Biting habits II. a) Primary habits
b) Secondary habits
Ans. 9
Buccal Pad of Fat (‘Corpus adiposum’ or Bichat’s fat pad) 
• It is the child’s reserve of energy. It is nothing but the cheek prominence giving the infant a chubby-cheek appearance. It is
formed of a firm encapsulated mass of fat lying between the subcutaneous fat and the muscle of the cheek. 
• Its exact role in suckling is not known. It probably plays no role in suckling, but it has been found to regress once the suckling
has ceased.
Ans. 10
Maxillary lateral incisor 
The outline of the maxillary lateral incisor is similar to that of the central incisor, but the crown is smaller in all dimensions. The
length of the crown from the cervical to the incisal edge is greater than the mesiodistal width. The root outline is similar to that of the
central incisor but is longer in proportion to the crown.
Ans. 11
• Photostimulable phosphors (PSPs) or storage phosphors are used for digital imaging for image acquisition. Unlike panoramic or
cephalometric screen materials, PSPs do not fluoresce instantly to produce light photons. Instead, these materials store the in-
coming x-ray photon information like a latent image in conventional film-based radiography until the plates are scanned by a la-
ser beam in a drum scanner. 
• The laser scanning excites the phosphor to give up the stored energy as an electronic signal, which is then digitalized, with vari-
ous gray levels assigned to points on the curve to create the image information. The currently available phosphor imaging sys-
tems are from Soredex (OpTime), AirTechniques (Scan X), and Gendex (Denoptix).
Ans. 12
Hypnosis: Hypnosis is an altered state of consciousness characterized by a heightened suggestibility to produce desirable behavioral
and physiological changes. Hypnosis is one of the most effective nonpharmacologic therapies that can be used with children for a
number of different procedures (Romanson, 1981). When used in dentistry, it can be termed as hypnodontics (Richardson, 1980) or
psychosomatic or suggestion therapy. Greatest benefit of hypnosis is to reduce anxiety and pain.
Ans. 13
Ref: McDonald, 9th/54
Paralleling technique
• In principle, the paralleling technique requires the object (long axis of the tooth) and the film to be parallel in all dimensions. To
achieve this, the film packet is placed farther away from the object, particularly the maxilla. This tends to magnify the image.
This undesirable effect is offset when a longer cone is used, which thus reduces magnification.
• Use of a longer cone also increases image sharpness by decreasing the penumbra. Striving for true parallelism will enhance im-
age accuracy.
• Because the film is placed farther away from the object, a film holder is necessary. Some of those holders also have beam-
aligning devices to help ensure parallelism reduce partial exposure of the film; thus unwanted cone cuts are eliminated.
• For the smaller child, the film holder may need to be reduced in size to accommodate the film and the child’s mouth.
• Film operator error and thus reduce exposure of the patient to radiation. Because of the shallowness of the child’s palate and
floor of the mouth, film placement is some-what compromised. Even so, the resulting films are satisfactory.
Ans. 14
COGNITIVE THEORY JEAN PIAGET (1952) 
Piaget formulated his theory on how children and adolescents think and acquire knowledge. He derived his theories from direct obser-
vation of children by questioning them about their thinking. According to Piaget, the environment does not shape child behavior, but
the child and adult actively seek to understand the environment. This process of adaptation is made up of three functional variants.
 
• Assimilation concerns with observing, recognizing, taking up an object and relating it with earlier experiences or categories.
 
• Accommodation accounts for changing concepts and strategies as a result of new assimilated categories as ‘schemas’. 
• Equilibration refers to changing basic assumptions following adjustments in assimilated knowledge so that the facts fit better.
 
The sequence of development has been categorized into four major stages: 
1. Sensorimotor stage (0 to 2 year) 
2. Pre-operational stage (2 to 6 year) 
3. Concrete operation stage (6 to 12 year) 
4. Formal operation stage (11 to 15 year) 
Merits of Piaget’s Theory 
• Most comprehensive theory of cognitive development. 
• This theory propagated that we can learn as much about children’s intellectual development from examining their incorrect an-
swers to test items as from examining their correct answers. 
Demerits of Piaget’s Theory 
• Underestimates children’s abilities. 
• Overestimates age differences in thinking. 
• Vagueness about the process of change. 
• Underestimates the role of the social environment.
Ans. 15
This theory categorizes the early childhood objects relations to understand personality development.
The period of childhood is thus divided into three stages:
1. Normal autistic phase

2. Normal symbiotic phase
3. Separation-individualization phase
Normal Autistic Phase (0 – 1 year)
It is a state of half-sleep, half-wakefulness.

This phase involves achievement of equilibrium with the environment.
Normal Symbiotic Phase (3 – 4 weeks to 4 – 5 months)
The infant at this stage is slightly aware of the care taker but they both are still undifferentiated.
Separation – Individualization Process (5 to 36 months)
This phase is divided into four subphases
1. Differentiation (5 – 10 months)
2. Practicing period (10 – 16 months)
3. Rapprochement (16 – 24 months)
4. Consolidation and object constancy (24 – 36 months)
Merit of Mahler’s Theory

Can be applied to children
Demerit of Mahler’s Theory

Not a very comprehensive theory.
Characteristics of separation-individualization subphases
Differentiation Practicing period Rapprochement Consolidation and object constancy

• The infant becomes • Beginning of this • The infant, now a toddler, is more aware • The child achieves a definite senses
alert as cognitive phase is marked by of the physical separateness of individuality and is able to cope
and neurological upright locomotion • The child tries to overcome this by show- up with the mother’s absence
maturation occurs • The child learns to ing mother his newly acquired skills • He does not feel uncomfortable on
• Characteristic anx- separate himself • The mother’s efforts to help toddler are being separated from the mother
iety at this period is from mother by not successful, resulting in temper tan- since he knows that she will return
stranger anxiety crawling trums • He develops an improved sense of
• He differentiates • Separation anxiety • Rapprochement crisis develops as the time and can tolerate delay
between self and is present as the child wants to be soothed by the mother,
other child still requires but is unable to accept her help
the mother for • This crisis is resolved as the child’s skill
safety improves
Ans. 16
1. Acquisition: Learning a new response from the environment by conditioning. 
2. Generalization wherein the process of conditioning is evoked by a band of stimuli centered around a specific conditioned stimu-
lus. Thus a test stimulus similar to training stimulus results in a response, e.g., a child who has had a painful experience with a
doctor in a while coat always associates any doctor in white coat with pain. 
3. Extinction of the conditioned behavior results if the association between the conditioned and the unconditioned response is not
reinforced, e.g., in the above mentioned example subsequent visits to the doctor without any unpleasant experiences results in
extinction of the fear. 
4. Discrimination is the opposite of generalization. If the child is exposed to clinic settings which are different to those associated
with the painful experiences the child learns to discriminate between the two clinics and even the generalized response to any of-
fice will be extinguished.
Ans. 17
Anti-infective and anticariogenic agents in human milk 
1. Immunoglobulins. Secretory IgA, IgG, IgM 
2. Cellular elements. Lymphoid cells, polymorphs, macrophages, plasma cells. 
3. Opsonic and chemotactic activities of C3 and C4 complement system. 
4. Unsaturated lactoferrin and transferrin 
5. Lysozyme 
6. Lactoperoxidase 
7. Specific inhibitors (non immunoglobulins): Antiviral and antistaphylococcal factors 
8. Growth factors for Lactobacillus bifidus 
9. Para amino benzoic acid may afford some protection against malaria.
Ans. 18
Fluoride level States

> 4.0 ppm Punjab, Haryana, Rajasthan, Gujarat, Madhya Pradesh, Andhra Pradesh, Tamil Nadu Gujarat (Kutch, West Jamnagar)
Madhya Pradesh (Chandi, Betul)
4-8 ppm Andhra Pradesh (Ananthpur, Karimnagar, Krishna districts)
> 5.0 ppm
Ans. 19
• The salivary glands are under the control of the autonomic (involuntary) nervous system, receiving fibers from both its parasym-
pathetic and sympathetic divisions. Stimulation of either the parasympathetic (chordatympani) fibers or the sympathetic fibers to
the submaxillary or sublingual gland causes a secretion of saliva. 
• The secretion resulting from parasympathetic stimulation is profuse and watery in most animals. Sympathetic stimulation, how-
ever, causes a scanty secretion of a thick, mucinous juice. Stimulation of the parasympathetic fibers to the parotid gland causes a
profuse, watery secretion, but stimulation of the sympathetic fibers causes no secretion.
Ans. 20
• There are many reasons for a reduction in salivary flow. Acquired salivary dysfunction may be the result of a psychological or
emotional disturbance and, again, may be either temporary or permanent. 
• During the acute stages, mumps may cause a temporary reduction in salivary flow. Immune disorders, such as hypohidrotic ecto-
dermal dysplasia, often exhibit chronic xerostomia. Many oncology patients receive head and neck or total-body irradiation that
also results in salivary gland dysfunction. 
• An interruption in the central pathways of the secretory nerves has been suggested as a cause of salivary failure, but this is usual-
ly overshadowed by definite neurologic signs and symptoms, similarly, a deficiency of vitamin B complex has been reported as a
cause of salivary gland dysfunction.
Ans. 21
• To evaluate the adequacy of salivary flow, Zunt recommends establishing the unstimulated salivaryflow (USF) rate. The USF
rate is measured after a period of 1 hour without eating, drinking, chewing gum, or brushing the teeth. 
• Sitting in the “coachman” position, on the edge of the dental chair, the patient passively drools into a funnel inserted into a grad-
uated cylinder for 5 minutes. The eyes should remain open except for blinking during the 5-minute collection period. The head
and neck should be bent, and the arms should rest comfortably on the thighs or knees. The volume of saliva collected in the cyl-
inder after 5 minutes is divided by 5 to determine the USF. 
• A USF rate of less than 0.1 mL per minute is diagnostic of salivary gland hypofunction. If the USF rate is less than 0.1mL per
minute, the next step is to measure the stimulated salivary flow (SSF). 
• The patient should chew unflavored paraffin for 45 chews or 1 minute and expectorate into a funnel inserted into a graduated
cylinder. The SSF rate should be 1 to 2 mL per minute; less than 0.5 mL per minute is scored as an abnormal rate. 
• A convenient alternative method for measuring USF is the modified Schirmer technique, which uses a calibrated paper test strip
to collect saliva in the floor of the mouth.
Ans. 22
Stages of weaning 
For ease, weaning can be divided into three stages: 
Stage 1: 4 – 6 months 
Stage 2: 6 – 9 months 
Stage 3: 9 – 12 months 
Stage 2 
• Child is now able to chew, and consequently minced and mashed food that includes small soft lumps can be given. 
• Some of the food that the rest of the family is eating can be mashed with a spoon and used. 
• During this stage, as the infant becomes more proficient at chewing, they should be encouraged to feed themselves. 
• Foods like soft cooked vegetables, for example carrots, and chopped soft fruit such as pear and banana, and finger foods such as
toast, should be introduced. 
• At this stage, babies must never be left alone while feeding because of the risk of choking, and babies or toddlers must not be
given small hard sweets or nuts because of the risk of accidental inhalation.
Ans. 23
The Pulp: The pulp chamber anatomy in both primary and permanent teeth closely approximates the surface shape of the crown
• Pulp chamber larger in relation to crown size • Pulp chamber smaller in relation to crown size
• Pulpal outline follows the DEJ more closely • Pulpal outline follows DEJ less closely
• The pulp horns are closer to the outer surface. Mesial pulp horn • The pulp horns are comparatively away from the outer
extends to a closer approximation of surface than does the dis- surface.
tal pulp horn
• High degree of cellularity and vascularity in tissue (at least in • Comparatively less degree of cellularity and vascularity
stages prior to advanced physiologic resorption of roots) in tissue.
• High potential for repair • Comparatively less potential for repair
• Comparatively less tooth structure • More tooth structure protecting for repair
• Greater thickness of dentin over the pulpal wall at the occlusal • Comparatively lesser thickness of dentin over the pulpal
fossa of molars wall at the occlusal fossa of molars
• Root canals are more ribbon like (Hibbard and Ireland 1957). • Root canals are well defined with less branching
The radicular pulp follows a thin, tortuous and branching path
• Floor of pulp chamber is porous. Accessory canals in primary • Floor of pulp chamber does not have any accessory canal
pulp chamber floor leads directly into inter-radicular furcation.
Ans. 24
Dr. GV Black has described the concept of “extension for prevention” for cavity preparation. His basic idea was to prevent the recur-
rence of caries by placing the margins of restorations along self-cleansing areas. 
• Incisors and canines: In these teeth the margins of the proximal cavities are placed beyond the contact area. 
• Molars and premolars: The contact between the adjacent teeth is broken. Occlusal step occupies the entire middle third of the
tooth buccolingually. Buccal groove and other sharp grooves are included in the preparation 
• Gingival third cavities: Cervical margin is placed subgingivally and the mesiodistal extension is placed in self-cleansing areas.
Ans. 25
Numerous systems have been developed for classifying the behavior of children in the dental environment. An understanding of them
holds more than academic interest. The knowledge of these systems can be an asset to the dentist in several ways: it can assist in di-
recting the behavior guidance approach, it can provide a means for systematically recording behaviors, and it can assist in evaluating
the validity to current research. 
Wright’s clinical classification places children in three categories: 
• Cooperative 
• Lacking in cooperative ability 
• Potentially cooperative 
During examination of a child, the cooperative behavior of the patient is taken into account because it is a key to rendering treatment.
Most children seen in reasonably relaxed. They have minimal apprehension. They may be enthusiastic. They can be treated by a
straightforward, behavior-shaping approach. When guidelines for behavior are established, they perform within the framework provid-
ed. 
The Frankl behavioral rating scale, Divides observed behavior into four categories, ranging from definitely positive to definitely nega-
tive. Following is a description of the scale: 
• Rating 1: definitely negative, refusal of treatment, forceful crying, fearfulness, or any other overt evidence of extreme negati-
vism. 
• Rating 2: Negative, Reluctance to accept treatment, un-cooperativeness, some evidence of negative attitude but not pronounced
(sullen, withdrawn) 
• Rating 3: Positive, Acceptance of treatment; cautious behavior at times; willingness to comply with the dentist, at times with
reservation, but patient follows the dentist’s directions cooperatively 
• Rating 4: definitely positive. Good rapport with the dentist, interest in the dental procedures, laughter and enjoyment. 
Although the Frankl method of classification has been a popular research tool, it also lends itself to a shorthand form that can be used
for recording children’s behavior in the dental office. One can identify those children displaying a positive cooperative behavior by
jotting down “+” or “++” or “—“. A shortcoming of this method is that the scale does not communicate sufficient clinical information
regarding uncooperative children. If a child is judge as well as categorize the reaction. By recording “−, tearful,” a better description of
the clinical problem is made.
Ans. 26
Growth Theories: Assumptions and Clinical implications
Theory Assumption Application

Genetic (Brodle, 1941) The assumption was that genes controlled all The external factors have a significant, modify-
aspects of growth. ing effect on it, thus reducing its effect vastly.
The inheritance that does take place is polygenic
in nature. For example, the pre-disposition of an
individual to class III malocclusion.
Scott’s hypothesis (1953) Cartilage grows actively, bone later replaces Mandibular growth has been explained that the
it. Thus cartilage has innate growth potential. condyles act as the diaphysis of a long bone
Transplantation and extirpation experiments with growth occurring at both the ends. Recent
prove that some innate potential is evident studies have proven that growth at the condyle
though results are equivocal. is mostly reactive and not of primary nature.
Maxillary growth can be explained due to the
translation of the nasomaxillary complex as a
unit.
Sutural dominance theory Proliferation of sutural connective tissue Explains maxillary growth as the result of pres-
(Sicher, 1955) causes appositional growth. sure created by growth at the sutures.
Genetic factor was accepted. Limitation being it could not explain
− Lack of growth in suture transplantation.
− Growth occurs in cleft palate cases.
− Sutures respond to external influences.
Membranous bones were considered as
growth centers.
Moss’s functional theory Functional matrices, which can be further di- Several examples can be cited such as the exces-
(1962) vided into capsular and periosteal matrices sive growth of the cranial vault in cases of hy-
have the primary control for the growth of the drocephalus.
craniofacial structures.
Bone responds to the matrices in a passive
manner and does not have any primary growth
potential.
Van Limborgh’s theory Factors controlling skeletal morphogenesis Explains the interaction between the genetic and
(1970) are: environmental factors. Thus what may be envi-
1. Intrinsic genetic factors ronment for the bone (muscle & soft tissue) is in
2. Local epigenetic factors turn dependent on the growth and function of the
3. General epigenetic factors soft tissues. The growth of the muscle and soft
4. Local environmental factors tissue has a genetic component.
5. General environmental factors Even if there were genetic disposition, it is poly-
genic, multifactorial in nature, thus precluding
any predictions of the facial dimensions of chil-
dren from the study of their parents.
Petrovic’s hypothesis Primary cartilage, in which growth occurs by It explains the mode of action of the functional
1974, Cybernetics differentiation of chondroblasts, can be modi- appliances directed at the condyle.
fied with factors which affect the direction on- The upper arch acts as a mould into which the
ly and not the amount of growth. lower arch adjusts itself, such that optimal oc-
Secondary cartilage has a direct cell multipli- clusion is established.
cation effect but more importantly indirect ef-
fects also play an important role.
Neurotropism (Work done The nerve impulse involving axoplasmic Effect has been reported to be negligible.
by Behrents 1976) in- transport has direct growth potential.
cludes epithelial visceral It also has an indirect effect on the osteogenic
and muscular components growth by influencing soft tissue growth.
Ans. 27
The three sub-stages of adolescence
Sub – stage Characteristics

Early adolescence Casting off of childhood role and emergence into adolescence
Middle adolescence Participation in teenage subculture and peer group identity
Late adolescence Emergence of adult behavior
Ans. 28
Important mechanisms of salivary factors related to dental caries
Effects on mineraliza- Effects on bacterial ag- Role in raising saliva

Salivary factors Effects on bacteria
tion gregation or adherence or plaque pH
Buffering factors
HCO3 Main buffer in saliva
Urea Releases NH3
Arginine-rich pro- Releases NH3
teins
Antibacterial fac-
tors Binds to iron, also inhib-
Lactoferrin its independently of iron
Hydrolyzes cell wall pol- May promote clearance
Lysozyme ysaccharides through aggregation
Produces OSCN, inhibits
Peroxidase glycolysis
Neutralizes toxins and Binds to bacterial sur-
Secretory IgA enzymes face, prevents adherence
Produces glucose & Indirectly produces
Alpha amylase maltose glucans
Factors affecting mineralization
Histatins Bind to hydroxyapatite, Some inhibition of
aid in supersaturation of mutans streptococci
saliva
Proline-rich proteins Bind to hydroxyapatite, Bind to oral bacteria
aid in supersaturation of promote adherence in
saliva some cases
Cystatins Bind to hydroxyapatite,
aid in supersaturation of
saliva
Statherin Bind to hydroxyapatite, Bind to oral bacteria
aid in supersaturation of promote adherence in
saliva some cases
Mucins Provide physical and Aggregation and clear-
chemical barrier in ance of oral bacteria
enamel pellicle (MG2)
HCO3 – bicarbonate; NH3 – ammonia; OSCN – hypothiocyanate Dowd
(1999)
Ans. 29
Milestones of Pit and Fissure Sealant 
Methods aimed at eliminating pits and fissures have been tried since the early 1920s: 
• Hyatt (1923): Proposed technique called prophylactic odontotomy. This technique consisted of filling the fissure with silver or
copper oxy-phosphate cement as soon as the teeth erupted into the oral cavity. Later when they are fully erupted, preparing a
small occlusal cavity and filling it with amalgam. 
• Bodecker (1929): Proposed technique called fissure eradication. This technique involved mechanical eradication of fissure in
order to transform deep, retentive fissures into cleansable areas. 
• Bumocore (1955): Advocated the filling of pits and fissures with bonded resin. He observed that after treatment of the enamel
with a concentrated phosphoric acid solution (85%) for 30 seconds, attachment od acrylic resin to the tooth surface is greatly in-
creased. 
• Mid (1960s): First materials used experimentally as sealants were based on cyanoacrylates but they were never marketed. 
• Bowen (1965): Reported BIS-GMA material development. The basis of BIS-GMA resin is the reaction product of bisphenol A
and glycidylmethacrylate. 
BIS-GMA is the base resin to most of the current commercial sealants. Urethane dimethacrylate and other dimethacrylates resin are
also used in the sealant materials.
Ans. 30
Classification of Pit and Fissure Sealants 
Mitchell and Gordon (1990) stared that the sealants can be differentiated in the following ways: 
1. Polymerization methods 
a) Self-activation (mixing two components) 
b) Light activation: 
− First generation: Ultraviolet light 
− Second generation: Self cure 
− Third generation: Visible light 
− Fourth generation: Fluoride releasing 
2. Resin system 
• BIS-GMA 
• Urethane acrylate 
3. Filled and unfilled 
4. Clear or tinted 
• Clear sealants have been shown to have better flow characteristics than tinted or opaque, but this can be an advantage or dis-
advantage depending on the position of the tooth to be sealed. Although the retention rates of the two types are similar, col-
ored sealants are more easily appreciated by the patient and monitored by the dentist at subsequent recalls. 
• The sealants is applied in a viscous liquid state that enters the micropores, which have been enlarged though acid condition-
ing. Then the resin hardens because of either a self-hardening catalyst or application of a light source. The extensions of the
hardened resin that have penetrated and filled the pores are called tags.
Ans. 31
Fluoride in Blood 
Approximately three-quarters of the total blood fluoride is in plasma and one-quarter in red blood cells. The regulation of plasma fluo-
ride concentration is due to a large volume of extracellular body fluid, which dilutes absorbed fluoride by deposition of fluoride in the
skeleton and by excretion in urine.
Ans. 32
Rubber dam 
Rubber dam, which is usually latex rubber, is one of the most effective means od isolating teeth. It was developed by Barnum (1864).
 
Rationale 
1. Maintains clean and visible field 
2. Patient protection − prevents aspiration of foreign bodies. 
3. Clinician protection 
4. Reduces risk of cross – contamination especially to the root canal system 
5. Retracts and protects soft tissues 
6. Increases efficiency by minimizing patient conservation and need for frequent rinsing 
7. Application of medicaments without the fear of dilution 
8. Improved properties of restorative material 
9. Psychological benefit to the patient
Ans. 33
Rubber dam sheet 
Rubber dam is available in various thicknesses as thin, flat latex sheets. 
• Thin 0.15 mm 
• Medium 0.20 mm 
• Heavy 0.25 mm 
• Extra-heavy 0.30 mm 
• Special heavy 0.35 mm 
It is available as rolls or in prefabricated sizes, i.e., 5” x 5” or 6” x 6”, while non-latex rubber dam is available only in 6” x 6” size.
 
The dam is manufactured in various colors. Darker color offers better visual contrast but the lighter color provides the advantage of
naturally illuminating the operating field and allows easier placement of film below the dam. 
Rubber dam has a shiny and a dull surface. The dull surface is kept facing occlusally since it is less reflective.
Ans. 34
Xylitol 
• Xylitol is a low-calorie sweetener that inhibits the growth of S. mutans. Numerous studies seem to confirm its anti-cariogenic
capability. Xylitol has been tested as an addictive to a variety of foods and to dentifrice. However, the vast majority of published
data come from studies in which xylitol was incorporated into chewing gum. 
• Makinen has reported numerous studies on the topic, most of them performed with many different coworkers in different parts of
the world. In 2000, he published a concise summary titled “The Rocky Road of Xylitol to its Clinical Application.” The available
data not only show that xylitol chewing gum reduces caries activity but also provide evidence that it decreases the transmission
of S. mutans from gum-chewing mothers to their children. 
• The use of xylitol chewing seems to be gaining popularity as another caries prevention strategy. It should be readily accepted by
many children.
Ans. 35
Polycarbonate crowns 
In pedodontic practice the most common lesions in anterior teeth are due to nursing bottle caries. These lesions occur beginning on the
labial face of all anteriors and they progress rapidly as a diffused demineralization of the entire surface of all existing teeth. The best
that can be offered at this time is the stabilization of the lesion without much in the way of a complete rebuild of the coronal anatomy.
 It is suggested that the first step should be to develop a clean periphery around the lesion using a small round bur while leav-
ing the central portion of affected dentin intact and undisturbed for fear of producing a pulp exposure. This will make it possible to
develop the ion exchange with glass ionomer and allow development of an effective seal. Polycarbonate crowns are temporary crowns
which can be given as fixed prosthesis to deciduous anterior teeth which will get exfoliated in future. 
These are contraindicated in: 
• Severe bruxism 
• Deep bite 
• Excessive abrasion 
Polycarbonate crowns are designed to provide various advantages: 
• They save time 
• Are easy to trim 
• Can be easily adjusted with pliers
Ans. 36
Porcelain Veneer Restoration 
A porcelain veneer restoration is a thin layer of restorative material bonded over the facial or buccal surface of a tooth. Veneer restora-
tions are considered conservative in that minimal, if any, tooth preparation is required. Porcelain veneers usually are placed on
permanent teeth. 
Indications 
• Restoration of anterior teeth with fractures 
• Developmental defects 
• Intrinsic discoloration 
• Other esthetic conditions
Ans. 37
TetricEvoFlow 
• TetricEvoFlow is the new nano-optimized flowable composite from IvoclarVivadent and the successor product of Tetric Flow. It
is characterized by optimum surface affinity. 
• It penetrates even into areas that are difficult to reach. In addition, it is suitable as an initial layer under medium-viscosity com-
posites, such as TetricEvoCeram. 
• At the same time, however, TetricEvoFlow is stable if required and thus ideally suitable for Class V restorations. The material
can be used for extended fissure sealing and the adhesive cementation technique.
Ans. 38
ACP composites are referred to as a “Smart Material” because 
• It only releases calcium and phosphate ions when the surrounding pH drops to a level where it can start to dissolve the tooth, i.e.,
at or below 5.8. 
• Once the calcium phosphate is released it will act to neutralize the acid and buffer the pH. 
• ACP acts as a reinforcement of the tooth’s natural defense system only when it is needed. 
• ACP has a long life. It does not wash out. 
• ACP is non-reliant on patient compliance.
Ans. 39
Colla Cote 
It is a soft, white, pliable, biocompatible sponge obtained from bovine collagen. It can be applied to moist or bleeding canals. It is an
absorbable collagen barrier which prevents or diminishes extravasation of root canal filling material during primary molar
pulpectomies. Apart from its use in endodontic therapy (surgical or non-surgical) it also provides a scaffold for bone growth and so it
can be applied on wounds.
Ans. 40
Videoscope / Endoscope 
• Endoscope technique is based on observing the fluorescence that occurs when tooth is illuminated with blue light in the wave-
length range of 400-500 nm. Difference seen in fluoresced tooth is viewed through a specific broad band gelatin filter; while spot
lesions appear darker than enamel. 
• It has been demonstrated that this technique allows visualization of small carious lesions in the enamel that are difficult to detect
with the naked eye or with radiograph. 
• Additionally, a camera can be used to store the image. The integration of the camera with the endoscope is called a
VIDEOSCOPE.
Ans. 41
DevitalisationPulpotomy (Two stage)
This is a two-stage procedure involving the use of paraformaldehyde to fix the entire coronal and radicular pulp tissue. The medica-
ments used to devitalize the exposed primary pulp are similar, in that they contain some formalin or paraformaldehyde. The medica-
ments used have a devitalizing, mummifying and bactericidal action.
The formulas of each agent used are as follows:
1. GysiTriopaste: Tricresol 10 ml
Cresol 20 ml
Glycerin 4 ml
Paraformaldehyde 20 ml
Zinc oxide 60 g
2. Easlick’s Paraformaldehyde 1 g
Paraformaldehyde Procaine base 0.03 g
paste: Powdered asbestos 0.05 g
Petroleum Jelly 125 g
Carmine to color
3. Paraform Paraformaldehyde 1 g
Devitalizing Lignocaine 0.06 g
paste: Propylene glycol 0.50 ml
Carbowax 1500 1.30 g
Carmine to color
Ans. 42
Optical Coherence Tomography (OCT) 
This technique utilizes broad bandwidth lighter sources and advanced fiber optics to achieve images. Similar to ultrasound, OCT uses
reflections of near infrared light to determine not only the presence of decay but also the depth of caries progression. 
Other newer methods of caries diagnosis at incipient stage include: Multi-photon imaging, infrared thermography, terahertz pulse im-
aging, frequency-domain infrared photothermal radiometry and modulated laser luminescence.
Ans. 43
Electra complex 
Similarly, young girls develop an attraction towards their father and they resent the mother being close to the father. Freud has report-
ed that little girls have a comparable Electra complex to resolve this. In Greek mythology, Electra helped her brother slay the lover of
their father Agamemnon, in order to win her father’s love.
Ans. 44
Developmental alteration of structure
Anomaly & classification Definition Etiology Clinical features Treatment

Melogenesisimperfecta Amelogenesis Gene mutations in • Hypoplastic: • For poor esthetics:
Type I imperfect is a the enamel matrix The teeth lack normal enamel • Primary teeth restored
IA- hypoplastic pitted au- group of heredi- produces one of the thickness. with glass ionomer
tosomal dominant tary disorders following results: Inadequate deposition of cement and composite
IB- hypoplastic local auto- characterized by Hypoplasia enamel matrix. veneer
somal dominant alteration of the Hypocalcification The enamel may be pitted, • Dentinal sensitivity:
IC- hypoplastic local auto- quantity and Hypomaturation have horizontal or vertical Full coverage with
somal recessive quality of Isolated defect with ridges. stainless steel crowns
ID- hypoplastic smooth enamel in hu- autosomal dominant • Hypomaturation: • Dental caries:
dominant mans and is autosomal recessive Normal deposition of enamel Dietary advice, fluo-
IE- hypoplastic X-linked frequently asso- and x-linked inher- matrix ride therapy, glass
dominant ciated with a itance also occur Defective crystal structure ionomer and compo-
IF- hypoplastic rough au- significant den- mineralization site restorations, stain-
tosomal dominant tal disease as The affected teeth show mott- less steel crowns
IG- Enamel agenesis, auto- stated by led, opaque white brown yel- • Gingival inflamma-
somal recessive Witkop and low discoloration. The enam- tion: Increased preven-
Type II Sauk 1976 el is softer than normal & tive oral health care
IIA- hypomaturation, pig- tends to chip from the under- practices
mented autosomal reces- lying dentin.
sive • Hypocalcified:
IIB- hypomaturation, X- Enamel matrix is laid down
linked recessive appropriately but no signifi-
IIC- snow capped teeth, X- cant mineralizationoccurs.
linked Enamel is orange yellow at
IID- snow capped teeth, eruption and consists of poor-
autosomal dominant ly calcified matrix, which is
Type III rapidly lost leaving dentin
IIIA- autosomal dominant cores
IIIB- autosomal recessive • Hypomaturationhypoplasti
Type IV c with taurodontism:
IVA- The enamel is mottled yellow
hypomaturationhypoplastic brown; thin with areas of
with taurodontism, auto- hypomaturation. Molar teeth
somal dominant have a taurodont shape and
IVB- other teeth may have enlarged
hypoplastichypomaturation pulp chambers, enamel hypo-
with taurodontism, auto- plasia in combination with
somal dominant hypomaturation
Ans. 45
Dentinogenesisimperfecta
Type I Dentinogenesisimperfe Genetically inherit- • All the teeth in both the The entire dentition is
Autosomal dominant cta is a hereditary de- ed disease. dentitions are affected. at risk because of the
Freq. 1 in 8-10,000 velopmental disturb- Autosomal domi- TheDeciduous teeth are numerous problems.
Type II ance of the dentin that nant affected most severely The root canals be-
Autosomal dominant may be seen alone or in followed by the perma- come thread like
Freq. 1 in 1,25,000 conjunction with the nent. Overlay dentures
Type III systemic hereditary • The dentitions have a placed on teeth that
Autosomal dominant disorder of the bone, blue to brown discolora- are covered with fluo-
Freq. 1 in 3,00,000 osteogenesisimperfecta tion, often with a dis- ride releasing glass
Type IV tinctive translucence. ionomer cement
Autosomal recessive • Enamel measures ought Preventive modalities
Frequency unknown frequently separates to be undertaken at the
from the underlying de- earliest
fective dentin
• The pulps are usually
obliterated by excess
dentin production.
Ans. 46
Acrodynia 
• The exposure of young children to minute amounts of mercury is responsible for a condition referred to as acrodynia or pink
disease. Ointments and medications are the usual sources of the mercury. 
• Dental amalgam restorations do not cause acrodynia. 
• The clinical features of the disease include fever, anorexia, desquamation of the soles and palms (Causing them to be punk),
sweating, tachycardia, gastrointestinal disturbance, and hypotonia. 
• The oral findings include inflammation and ulceration of the mucosa membrane, excessive salivation, loss of alveolar bone, and
premature exfoliation of teeth.
Ans. 47
Dens in Dente (Dens invaginatus) 
• The diagnosis of dens in dente (tooth within a tooth) can be verified by a radiograph. The developmental anomaly has been de-
scribed as a lingual invagination of the enamel. This condition can occur in primary and permanent teeth. Unusual cases of dens
invaginatus have been reported in a mandibular primary canine, a maxillary primary central incisor, and a mandibular second
primary molar. 
• Dens in dente is most often seen in the permanent maxillary lateral incisors. The condition should be suspected whenever deep
lingual pits are observed in maxillary permanent lateral incisors. 
• Anterior teeth with dens in dente are usually of normal shape and size. In other areas of the mouth, however, the tooth can have
an anomalous appearance. 
• A dens in dente is characterized by an invagination lined with enamel and the presence of a foramen cecum with the probability
of a communication between the cavity of the invagination and the pulp chamber.
Ans. 48
Discoloration in hyperbilirubiemia 
• Excess levels of bilirubin are released into the circulating blood in a number of conditions. If teeth are developing during periods
of hyperbilirubinemia they may become intrinsically stained. The two most common disorders that cause this intrinsic staining
are erythroblastosisfetalis and biliary atresia. Other less common causes are premature birth, ABO blood type incompatibility,
neonatal respiratory distress, significant internal hemorrhage, congenital hypothyroidism, biliary hypoplasia, tyrosinemia, α 1-
antitrypsin deficiency, and neonatal hepatitis. 
• Erythroblastosisfetalis results from the transplacental passage of maternal antibody active against red blood cell antigens of the
infant, which leads to an increased rate of red blood cell destruction. It is a significant cause of anemia and jaundice in newborn
infants despite the development of a method of prevention of maternal isoimmunization by Rh antigens; however, an infant from
an Rh-negative mother’s first pregnancy rarely contracts this hemolytic disease. 
• If an infant has had severe, persistent jaundice during the neonatal period, the primary teeth may have a characteristic blue-green
color, although in a few instance brown teeth have been observed. The color of the pigmented tooth is gradually reduced. The
fading in color is particularly noticeable in the anterior teeth. 
• Cullen reported on the occurrence of erythroblastosisfetalis produced by Kell immunization. In utero, the maternal antibodies
coat the fetal red blood cells and cause hemolysis. The fetus develops anemia with a resultant increase in the bilirubin content of
the amniotic fluid. The newborn appears pale and anemic. Shortly after birth, jaundice occurs as a result of the high bilirubin
levels.
Ans. 49
Discoloration in porphyria 
• The porphyrias are inherited and acquired disorders in which the activities of the enzymes of the heme bio-synthetic pathway are
partially or almost completely deficient. As a result, abnormally elevated levels of porphyrins and/or their precursors are pro-
duced, accumulate in tissues, and are excreted. 
• Congenital erythropoietic porphyria (günther disease) is a rare autosomal recessive form of the disease. 
• Children with congenital erythropoietic porphyria have red-colored urine, are hypersensitive to light, and develop subepidermal
bullous lesions when their skin is exposed to sunlight. 
• Their primary teeth are purplish brown as a result of the deposition of porphyrin in the developing structures. The permanent
teeth also show evidence of intrinsic staining but to a lesser degree.
Ans. 50
Maintenance of anesthesia (Inhalation) 
The maintenance of general anesthesia is generally by inhalation general anesthetics. 
They can be classified as: 
1. Volatile 
2. Gaseous 
a. Divinyl ether - was used for induction by open drop method. If used for more than 30 minutes causes severe liver toxicity. Thus
it is not used now. 
b. Diethyl ether – Guedal’s stages are seen. Slow induction, irritating to the respiratory mucosa, increased incidence of nausea and
vomiting – explosive. It has the advantage that there is little CVS or respiratory depression. It also maintains blood pressure.
 
c. Halogenated hydrocarbons as a group show following features: 
1) Progressive reduction in the BP as anesthesia deepens. 
2) Moderate to marked respiratory depression. 
3) Produce cardiac arrhythmias due to sensitization of the heart to endogenous catecholamines. 
4) Hepatotoxicity. 
Generally combined with nitrous oxide provides excellent anesthesia and little nausea or vomiting is encountered.
Ans. 51
Intravenous induction 
• This is the preferred route for the induction of anesthesia in adult patients. The maintenance of anesthesia is, however, not pre-
ferred with these agents. 
• The agent most commonly used is thiopental sodium. The advantage is a rapid onset of action and also recovery time. 
• EMLA cream, a powerful topical agent, is to be applied for comfortable securing of the IV line. 
• The preoxygenation concept is that the patient is to be kept on 100% oxygen 2-5 minutes before induction. In absence of
preoxygenation, during induction, the blood oxygen saturation is seen to drop to levels of 60% to 70% on induction with thio-
pental in healthy patients breathing room air. 
• A few ml of thiopental sodium (2.5%) is injected as a test dose. 
• 5% thiopental sodium injected rapidly is used, but may lead to apnea. It is suggested that 2.5% every 15 seconds, up to 0.5 g (in
avg. male) with 0.2 to 0.25 mg in children is given. 
• Too rapid induction can produce hiccuping and involuntary muscle movement. 
• Rarely epileptiform convulsions may occur. 
• It is inadvisable to administer thiopental as the principal agent for operations lasting more than 1 hour or that more than 1 g is
given to a patient. 
Absolute contraindications for the use of thiopental are: 
• Presence of respiratory obstruction 
• Cardio vascular instability, shock 
• Severe asthma or bronchospastic disease 
• Porphyria
Ans. 52
1. E Diazepam (Valium) (5 mg/5 cc elixir, 2, 5, 10, 15 – mg tablets) 
Indication and benefits: 
• Safe agent for mild to moderate anxiety particularly in children with cerebral palsy, mental retardation 
• Children less than 6 years of age 
• Oral absorption equally good as parenteral 
Limitations and risks 
• Multiple doses required to achieve sedation 
• Not effective in severe anxiety when used alone 
2. F. Triazolam (Halcion) (0.125, 0.25 mg tablets) 
Indication and benefits: 
• In addition has anticonvulsant activity 
• Good oral absorption 
Limitations and risks 
• Safety guidelines not fully established
Ans. 53
Externalization: It is a process by which the child’s attention is focused away from the sensations associated with the dental treat-
ment. There are two components of externalization: 
− Distraction 
− Involvement 
The objective is to interest and involve the child but at the same time not to let him into verbal or motor discharges which might inter-
fere with the necessary procedure.
Ans. 54
Anxiety 
• Is an emotion similar to fear but arising without any objective source of danger. 
• Is a reaction to unknown danger. 
• It is often defined as a stage of unpleasant feeling combined with an associated feeling of impending doom or danger from within
rather than from without. 
• It is a learned process being in response to one’s environment. As anxiety depends on the ability to imagine, it develops later
than fear. 
Sub-types of Anxiety 
Association 
• This is a process of classic conditioning whereby previously neutral stimuli become the cause for arousal and anxiety by pairing
them with pain or the negative experiences of others. 
Attribution 
• Arousal is in the biological sphere. 
Appraisal 
• Here anxiety is concerned with cognition or the way we think. It involves reconstruction of negative experiences rather than pos-
itive happenings that account for the arousal of anxiety.
Ans. 55
Self-correcting anomalies
Self-correcting anomalies Correction (Timing / Factors involved in)

I. Predentate period
a) Retrognathic mandible Corrects with differential and forward growth of the mandible Eruption of primary incisors
b) Anterior open bite During the first year of life with introduction of solid foods in diet
c) Infantile swallowing pattern
II. Primary dentition
1) Anterior deep bite Corrects with:
• Eruption of deciduous molars
• Attrition of incisal edges
• Forward and downward growth of mandible (early shift)
2) Flush terminal plane • Eruption of the first permanent molar
• (Late shift) Leeway space
3) Spacing • Eruption of first permanent molar
4) Edge to Edge (due to attri- • Eruption of permanent incisors
tion)
III. Mixed dentition
1) Anterior deep bite • Proprioceptive response condition of patient (with the eruption of first permanent molars
and premature contact of the pad of tissue overlying them as natural bite opener)
2) Mandible anterior crowding • Tongue pressure
• Increase in intercanine width
3) Ugly duckling stage • Maxillary canine eruption
4) End-on relation • With eruption of first permanent molars
• Late mesial shift in non-spaced dentition
IV. Permanent dentition
1) Overjet and overbite • Decrease with eruption of all permanent molars
• Differential growth of mandible
Ans. 56
Authoritarian mother 
The mother is very authoritarian and has got certain norms for the child to follow. This may vary from physical abuse to verbal ridi-
cule. 
Features of the child: 
a) Submission with resentment and later evasion. 
b) Evasive, dawdling child, obeys commands slowly and with delay. 
c) Parents are not supportive to the child and rather criticize them. Therefore, these children are often afraid of dentist and resist
dental treatment. 
d) The child shows a heightened avoidance gradient and seeks to evade or delay the response. 
Effects of maternal anxiety 
a) Attitudes and experience of one’s family in relation to dentistry seem to be the most important factor in determining how an in-
dividual will react to dentistry. 
b) People who come to the dentist conditioned to respond with tension and fear do so chiefly because of the way dentistry is pre-
sented to them in their homes. 
c) The mother’s reaction to dental treatment has a profound influence on the child’s attitude towards dentistry. Highly anxious
mothers may have their children displaying negative and uncooperative behaviors.
Ans. 57
Dyes 
Dyes have a widespread use in medicine, biology and dentistry. If an object is difficult to distinguish from its background, the color
induced by a dye can make it easier to visualize or, if several objects have a similar appearance, coloring by a dye may discriminate
between them and allow identification. 
• Various dyes have been used in the detection of enamel caries (Calcein, ZygloZL-22), and dentin caries (Fuschin, Acid red sys-
tem, 9-Aminoacridine).
Ans. 58
Ref: Damle, 3rd/160 
A fixed reminder appliance called as Bluegrass appliance can be used to discourage the thumb sucking habit. It was first describe by
Mink and Haskell in 1991. It consists of a Teflon roller on a palatal bar. This appliance has the advantage of being small in size, es-
thetic and may act as additional neuromuscular stimulant for the tongue which can help in speech therapy. The only disadvantage is
the initial difficulty in speech and mastication. Alternatively a plate may be fabricated for the child with two series of spikes or loops
which prevents the child from indulging in this habit.
Ans. 59
Ref: Damle, 3rd/179
Full mouth intra oral radiographs according to age
Age Number of films Type of radiograph

2 anterior – IOPA
3 – 5 years 4 films
2 posterior –bite –wing
2 anterior occlusal
6 – 7 years 8 films 4 posterior – IOPA
2 bite wing
2 anterior – IOPA
4 canine – IOPA
4 posterior – IOPA
2 bitewing
2 anterior – IOPA
4 canine – IOPA
8 posterior – IOPA (premolar & molar)
2 bitewing
Ans. 60
Tanaka Johnston analysis: 
Procedure: 
Measure the mesiodistal widths of mandibular incisors and divide by 2. Add 10.5 mm to this value to get the estimated width of man-
dibular canine and premolars on one side. Half of the width of lower mandibular incisors + 11 mm = estimated width of maxillary
canine and premolars of one side. 
Combination of radiographic and prediction table methods: 
Since major problems using radiographic images is due to the canines, it is reasonable to measure the size of permanent incisors from
the cast and size of premolars from X-ray films to predict the size of unerupted canines. 
Tanaka and Johnston analysis is most useful in mixed dentition. 
However, any analysis must be used with caution because: 
1. Analyses are based on populations of the other racial origin. 
Hence, the prediction must be done with care. 
2. Analyses have some inherent flaws. e.g. The Tanaka Johnston analysis tends to predict crowding more frequently.
Ans. 61
Oesteogenesisimperfecta: 
A hereditary disorder producing abnormal quality and quantity of bone, which leads to multiple fractures. It is generally associated
with dentinogenesisimperfecta and blue sclerae. Of the two jaws, the mandible is affected more commonly than maxilla.
Osteogenesisimperfecta is often fatal in utero or in early years of life. If the patient survives, susceptibility to fracture decreases after
puberty
Ans. 62
Pterygoid ulcer or Bednar’s ulcer: 
Occasionally, the palatal mucosa of newborn infants show superficial ulceration. These are located medial to greater palatine fossa and
heal spontaneously within a week.
Ans. 63
Hereditary hemorrhagic telangiectasis (Rendu-Osler-Weber syndrome): 
It is characterized by telangiectatic areas on the skin and oral mucosa. The skin of the face, neck and chest is most commonly affected.
Multiple red areas are produced because of dilatation of the vessels, which lie close to the skin or mucous membrane. Spontaneous
bleeding from oral, skin or nasal lesions is often a prominent feature of the disease.
Ans. 64
Herpangina: 
This is a disease of childhood, which occurs in summer and is caused by group A Coxsackie virus. Incubation period is 3 to 7 days.
Children have fever, malaise, anorexia and headache. The oral cavity shows vesicles in groups on the soft palate, uvula and pharynx.
The vesicles rupture and form ulcers. The disease runs a mild, short course of few days to two weeks.
Ans. 65
Disking of Primary Teeth 
• The primary teeth may sometimes prevent the incisors from aligning themselves. If the space required is not more than 3-4 mm,
the grinding/disking the mesial surfaces of the canines will help to align the incisors. 
• Disking may either be carried out by either means of a 169L bur or a disking strip. In cases where minimal disking is required,
the strip may be preferred for better control. The disked surfaces need to be protected with a fluoride application. 
• Once space is made available, the teeth may spontaneously correct themselves by tongue pressure. Should the laterals be locked
behind the centrals, however, modification of the lingual arch (with auxiliary springs) may be used to align the incisors. Should
an adequate space not be provided by disking the canines, the primary molars may be disked later.
Ans. 66
Ref: Pediatric Dentistry by Muthu, 171 
• “The examination room table can be used for examination. Alternate and the most often used method is the “knee to knee” posi-
tion. The dentist and the parent sit facing each other in a chair or a stool, with knees touching. The parent slowly places the infant
in the cradle formed by the legs. 
• The child’s head is placed gently in the lap of the dentist. The parent gently restricts the infant’s legs that his or her arms and
holds the arms and hand of the infant. The advantage of this position is that the infant is well supported and stable and the dentist
has good visibility and access to the mouth. 
• The behavior of a child, less than 3 years, varies widely during this examination procedure. Crying is a normal response to oral
manipulation at this time. Parents must be reassured about this prior to the infant examination.” 
• With gloved hands, the dentist lifts the upper lip and inspects the teeth (‘Lift the lip’ examination method). If plaque is present it
should be recorded. With a wet toothbrush the plaque is removed by gentle scrubbing and the teeth are inspected for white spots,
pitted enamel, stains and cavities using the mouth mirror, the back surfaces of the front teeth are checked.
Ans. 67
Ref: Pediatric Dentistry by Muthu & Sivalumar–2009, Pg. 67 
Retraining 
• This technique is used for a child with previous bad dental experience or with negative behavior due to other reasons. This is
similar to that of behavior shaping. It is designed to fabricate positive values to replace the negative behavior.
• The causes for the negative attitudes are to be established before using retraining. There are three main approaches for retraining
procedures as follows: 
• Avoidance: If a 3-year-old patient who underwent a bad dental experience recently, presents with a deep caries lesions, it might
be possible to avoid extensive pulp therapy at this time by doing an indirect pulp capping. This allows for the final treatment to
be delayed and performed at a more appropriate time until the child’s expectancies have been revised and he has been retrained.
 
• De-emphasis and substitutions: If the child is afraid of a particular instrumented or technique or does not like the taste of a ma-
terial, it mas be changed and substituted with another suitable one if possible. The child can be given different materials to
choose from, which makes him feel that you have recognized his dislike and also that you are prepared to help him.
If an instrument cannot be avoided or substituted, the child can be told that you understand the problem and it will be used as
minimum is possible. 
• Distraction is the technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure. Giving
the patient a short break during a stressful procedure can be an effective use of distraction. When the above two methods cannot
be used, distraction or diversion will be an effective method. When the child is uncomfortable with certain dental procedures dis-
traction can be done in the form of story telling, counting the number of teeth loudly, and repetitive statements of encourage-
ments, asking the child to recollect a favorite joke or a movie, or using audio visual aids. It can be an useful technique for admin-
istration of local anesthetic. 
Retraining 
• It is required for children displaying considerable apprehension or negative behavior. 
• During retraining, the objective is to build new series of associations in the child’s mind. 
• If a child had an unpleasant experience in the previous dental office, and is taken to another dental office, the child still tends to
generalize that an unpleasant event will occur in this new dental office also. This is known as “stimulus generalization”. 
• To remove this generalization, the dental team has to demonstrate a ‘difference’ and create new stimulus which is pleasant and
replaces the old.
Ans. 68
Ref: Clinical Textbook of Dental Hygiene & Therapy by Noble, 2012; Pedodontics by Arathi Rao, 2008, Pg. 225 
• Although excess cement could be the answer, the single best answer is retention of plaque as excess cement can be removed
from the overhang by the operator but regular removal of plaque from the undercut areas may be very difficult for the child.
Hence it is the single best answer. 
• “A crown is now selected and, as mentioned previously; there will be six different sizes for any particular tooth. A crown is cho-
sen to provide the best fit, particularly at the cervical margin. A crown which is too small will not seat into position whilst an
oversized crown will give rise to overhanging margins, resulting in plaque retention and ultimately poor gingival health. An ideal
crown should be a reasonably tight fit as it is pushed into place to engage the undercut just beyond the shoulder less preparation.”
 
• Irritation from a crown margin occurs if the crown is overextended and not from an overhanging margin.
Ans. 69
Ref: Dental Radiography by Haring Jansen, 2nd/400, 402 
“If a person cannot use upper limbs and a holder cannot be used to stabilize film placement, the dental radiographer may ask the care-
taker to assist with film holding, in such cases, the caretaker must wear lead apron & thyroid collar during exposure of films. Dental
radiographer must never hold a film for a patient during an x-ray exposure”. 
“If a child cannot hold still or stabilize the film, dental radiographer can ask the parent or accompanying adult to provide assistance:
 
Also know more related to pediatric radiology: 
− During primary dentition – use size 0 film 
− During transitional phase – use size 1 or 2 film 
− Exposure factors (ma, kv, time) must be reduced because of size of pediatric patient. A reduced exposure time is preferred; the
shorter exposure time will reduce the chances of blurred film should the child move.
Ans. 70
Ref: Shobha Tandon, 116 
• “School children tend to look unusual during the exchange of their incisors, especially in the upper arch when the permanent
incisors erupt. These appear to be much larger compared with the primary teeth with their longitudinal axis flared out like as an
inverse ‘V’. 
• As for the color of primary teeth, it is chalky white, whereas permanent teeth tend to be more yellowish. Because of the pressure
of erupting permanent canines, in the developing roots of lateral incisors, the crowns during the exchange period of upper anteri-
or teeth is called as “ugly duckling stage” (described first by Broadbent in 1937, so also called Broadbent Phenomenon). This
phenomenon is self-correcting and normally, the incisors gradually straighten with the eruption of lateral incisors and canines”.
Ans. 71
Ref: Bhalajhi, 3rd/43 
“The distal surface of the upper and lower second deciduous molar are in one vertical plane. This type of relationship is called flush or
vertical terminal plane. This is a normal feature of the deciduous dentition. Thus the erupting first permanent molars may also be in a
flush or end on relation.” 
Also know: 
• True Class III molar relations are almost never seen in primary dentition. 
• However a mesial step may later progress to C1 III molar relation due to subsequent excessive growth of mandible 
• To achieve Class I molar relation from flush terminal plane requires 3.5 mm (average) differential forward movement of lower
molar with respect to upper molar. This is supplied by: 
a) Utilization of leeway space in lower arch (2.5 mm in mandible / side: 1.5 mm in maxilla / side) 
b) Differential forward growth of lower jaw.
Ans. 72
Ref: Shobha Tandon, 2nd/48 
• Major development occurs in the head region. 
• 4 branchial arches present. 
• 2nd pharyngeal arch overgrows the 3rd and 
• 4th arches to form cervical sinuses. 
• Upper limbs differentiate into hand plates.
• Oticplacodes and optic vesicles are seen. 
• Heart beat can be detected ultrasonographically. 
• By the end of the 5th week, 42-44 pairs of somites are formed. Lower limb buds appear. 
• Spontaneous movement of the embryo such as twitching of the trunk and limbs seen.
Ans. 73
12 week: 
• Erythropoiesis decreases in the liver and begins in the spleen. 
• By the end of the 12th week skeleton especially in the skull and long bones. 
• According to clinicians convenience the 1st week to 12th week mark the 1st trimester of pregnancy. 
• During this period the embryo is sensitive to genetic, intra and extrauterine insults which could result in miscarriage or termina-
tion of pregnancy. Various deformities like deafness, mental retardation, congenital heart diseases, cataract, orofacial anomalies
result from radiation, infection, mechanical or psychological trauma.
Ans. 74
Fontanelles Present at Birth 
a) Anterior fontanelle, between the two parietal bones and the frontal bone. 
b) Posterior fontanelle, between the two parietal bones and the occipital bone. 
c) Sphenoid fontanelle, between the frontal, parietal, temporal and the sphenoid bone. 
d) Mastoid fontanelle, between the parietal, occipital and the temporal bone.
Ans. 75
• Gingival groove – it is the groove separating the gumpad from the palate. 
• Dental groove – it originates in the incisive papilla region and extends backwards to touch the gingival groove in the canine
region and then laterally to end in the molar region. 
• Lateral sulcus – it is a deepened groove separating the canine and deciduous first molar segments.
Ans. 76
Palmar / Grasp reflex: When the baby’s palm is stimulated, the hand closes. There is also a corresponding plantar reflex. Both nor-
mally disappear by 24 months. 
• Clinical significance: 
− An exceptionally strong grasp reflex may be found in the spastic form of cerebral palsy and in kernicterus. 
− It may be asymmetrical in hemiplegia and in cases of cerebral damage. It should have disappeared in 2 or 3 months and per-
sistence may indicate the spastic form of cerebral palsy.
Ans. 77
Pedodontics in India 
1920 – Calcutta Dental College and Hospital 
1st Dental College started by Dr. Rafiuddin Ahmed, “Father of Dentistry in India” 
1935 – BDS 
Licentiate in Dental Science becomes Bachelor in Dental Surgery 
1950 – Pedodontics is introduced 
Government Dental College, Amritsar, starts Pedodontics as a specialty 
1978 – Pedodontics for Undergraduates 
Pedodontics is introduced as a specialty in the undergraduate curriculum 
1979 – Indian Society of Pedodontics and Preventive Dentistry 
The association of Indian Pedodontics holds the 1st conference; Dr. BR Vacher is made the “Father of Pedodontics in India” 
1982 – Affiliated to IADC 
Indian Society of Pedodontics and Preventive Dentistry becomes an affiliate member of IADC
Ans. 78
Periodontal Probes 
a) Perio temp probe 
Helps to detect early inflammatory changes in the gingiva by detecting temperature rise. This probe detects pocket temperature differ-
ences of 0.1oC from a reference subgingival temperature. Higher temperature pockets are signaled with a red-emitting diode.
 
b) Florida Probe 
− Used to measure pocket depth 
Advantages 
1. Constant probing force 
2. Digital readout 
3. High degree of accuracy 
It is a computerized periodontal probe consisting of a probe, handpiece, a digital readout, a foot switch, a computer interface and a
computer. 
c) Foster-Miller Probe 
Couples pocket depth determination with detecting of CEJ from which clinical attachment level is automatically assessed. 
d) Toronto Automated Probe 
To measure clinical attachment levels. Sulcus is probe with a Ni-Ti wire that is extended under air pressure. 
e) DNA Probe 
Helps to identify the organism associated with periodontal disease. It identifies species-specific sequences of nucleic acids that make
up DNA, thereby permitting identification. The DNA library includes probes for A.actinomycetem-comitans, P.gingivalis,
B.intermedius, C.rectus, E.corrodens, F.nucleatum and T.denticola.
Ans. 79
PHASES OF TREATMENT PLANNING 
1. Systemic phase 
• A patient with a history of medical disease may require the condition to be stabilized before dental treatment commences. In
this respect the patient may have to be referred to the pediatrician. 
• Keeping in mind the systemic condition, premedication (as in antibiotic prophylaxis, sedation) needs to be given to the
child, with the consent of the pediatrician. 
2. Preventive phase 
Caries risk assessment (described in section 5) and assessment for various preventive measures (personal oral hygiene, fluoride
application, pit and fissure sealant, diet counseling). 
3. Preparatory phase 
a) Behavior management – The child’s behaviour shaping should start right from the reception itself. 
b) Oral prophylaxis – It presents a clearer view of the caries process which facilitates its diagnosis. It also give an idea whether
the patient will cooperate. 
c) Caries control – Further progress of carious lesions should be controlled. Sometimes multiple lesions may need to be tempo-
rized. 
d) Orthodontic consultation – preventive orthodontic programme should be planned before any orthodontic intervention. 
e) Oral surgical procedure – Unrestorable caries, orthodontic reasons etc. may necessitate the extraction of teeth. 
f) Endodontic therapy – If required, a tooth may be saved with endodontic treatment. 
4. Corrective phase 
a) Restorative dentistry – permanent fillings, stainless steel crowns etc. 
b) Prosthetic rehabilitation – tooth replacement, jacket crowns etc. 
c) Early orthodontic intervention – minor tooth movements, serial extraction, space management etc. 
5. Maintenance phase 
Depending on the risk of the individual and his oral hygiene status, a 3-6 month recall visit can be established for the following:
 
• Review of oral health status by repeating indices and comparing with initial indices 
• Caries activity tests may be repeated 
• Reinforcement of home care measures 
• Motivation and re-counseling of parents if required 
• Follow-up of treatment procedures
Ans. 80
The extraoral films used in dental practice vary in their size depending on the individual projection for which they are employed.
 
• 5 x 7 inches films: These films are used for temporomandibular joint (TMJ) views and lateral oblique views. 
• 8 x 10 inches films: These films are used for lateral cephalograms, paranasal sinus view, etc. 
• 6 x 12 inches film: These films are used for orthopantomography.
Ans. 81
The bisecting angle technique is based on a principle called the “Rule of Isometry” Which basically states that two triangles are equal
if they have 2 equal angles and common side.) The central ray is directed perpendicular to a plane that bisects the angle created by
long axis of teeth and film.
Ans. 82
Four-Film Survey 
• This series consists of maxillary and mandibular occlusal radiographs and 2 posterior bitewing radiographs. 
Eight-Film Survey 
This survey includes: 
• Maxillary and mandibular anterior occlusal radiographs 
• 4 molar periapical radiographs 
• 2 posterior bitewing radiographs 
Twelve-Film Survey 
• Maxillary and mandibular permanent incisor periapical radiographs 
• 4 primary canine periapical radiographs 
• 4 molar periapical radiographs 
• 2 posterior bitewing radiographs 
Sixteen-Film Survey 
• 12-film survey and the addition of permanent molar radiographs.
Ans. 83
Xeroradiography 
Xeroradiography found its application in the medical field in the early part of 1950s. Dental xeroradiography began in 1975 when the
application of xeroradiography techniques to intraoral radiography, the most common dental radiographic procedure, was being inves-
tigated.
Ans. 84
Digital imaging has been available for more than a decade. The first direct digital imaging system, RadioVisioGraphy (RVG) was in-
vented by Dr. Frances Mouyens and manufactured by TrophieRadiologie (Vincennes, France) in 1984.
Ans. 85
TACT (tuned aperture computed tomography) is a technique for the diagnosis of the external root resorption in which a new type
of imaging digital radiographs and subtraction radiographs are used. This has an advantage over the current radiographic modalities in
viewing an object while decreasing the superimposition of the overlying anatomical structures.
Ans. 86
Radiation Safety Symbol
The traditional symbol to denote radiation hazard is called Trefoil. The symbol can be magenta or black, on a yellow background. This
should be displayed on the door of the radiology operatory to alert people about radiation hazard.
Ans. 87
Approved disinfectants by National AIDS Control Organization are: 
− Povidone iodine 1% 
− Sodium hypochlorite 5% 
− Glutaraldehyde 2%
Ans. 88
Likes Dislikes
• An interesting waiting room with background music • Being kept waiting
• Be truthful, do not lie to the patient • Unattractive waiting room
• To be called by the first name • Untruthfulness of a painful procedure
• Have everything ready before the child arrives • Being made fun of
• Educate both the child and the parent • Using fear provoking words
• Dentist to talk while working • Using undesirable mannerisms or facial expression
• To watch in a mirror while the dentist is working • Using words such as drill, sharp, needle, etc.
• To be told repeatedly that he or she is a good patient • Scolding by the dentist
• Allow the child to get into the dental chair unassisted and adjust • Being compared to other children
the chair for comfort • Adjusting the chair without consulting the child
• Giving the child a preview of what will occur at the next ap-
pointment, and postoperative gift.
Ans. 89
Ref: McDonald, 8th/217
The American Academy of Pediatric Dentistry (AAPD) recognizes that caries risk assessment is an essential element of contemporary
clinical care for infants, children and adolescents.
The AAPD Caries – Risk Assessment Tool (CAT) is as follows-
CARIES RISK INDICA-

LOW RISK MODERATE RISK HIGH RISK
TOR
Clinical Conditions • No carious teeth in past • Carious teeth in the • Carious teeth in the past 12
24 months. past 24 months. months.
• No enamel deminerali- • One area of enamel • More than one area of enamel de-
zation (enamel caries, demineralization mineralization (enamel caries,
‘White spot’ lesions). (enamel caries, ‘White ‘White spot’ lesions).
• No visible plaque; no spot’ lesions) • Radiographic enamel caries.
gingivitis. • Gingivitis. • Visible plaque n anterior (front)
teeth.
• High titres of mutans streptococci.
• Wearing of orthodontic appliances.
Environmental Characteris- • Optimal systemic and • Suboptimal systemic • Suboptimal topical fluoride expo-
tics topical fluoride expo- fluoride exposure with sure.
sure. optimal topical expo- • Occasional between meal expo-
• Consumption of simple sure. sures to simple sugars or foods
sugars or foods strongly • Occasional between strongly associated with caries.
associated with caries meal exposures to • Low level caregiver socio-
initation, primarily at simple sugars or food economic status (e.g. eligible for
meal times. strongly associated Medicaid).
• High cariogenic socio- with caries. • No usual source of dental care.
economic status. • Midlevel caregiver
• Regular use of dental socio-economic status
care in an established (e.g. eligible for school
dental home. lunch program or
SCHIP).
• Irregular use of dental
services.
General Health Conditions − − • Active caries present in the mother.
• Children with special health care
needs.
• Conditions impairing saliva com-
position / flow.
Ans. 90
Ref: Shobha Tandon, 1st/86
Diphyodont Two sets of teeth Human beings

Monophyodont One set of teeth Sheep, Goat
Polyphyodont Teeth replaced throughout life Shark
Homodont A single type of teeth present −
Heterodont Various types of teeth Human beings
Acrodont Teeth attached to the jaw by a connective tissue −
Pleurodont Teeth are set inside the jaw −
Thecodont Teeth are inserted in a bony socket −

Pedodontics 1 Section Overview

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Pedodontics 1 {Section 1 to 8: Shobha Tandon}

Master Key & Explanations

Ref: Shobha Tandon, 2nd/493

Flow chart: Classification of oral habits

International Masochistic Unintentional Functional habits,

Ref: McDonald, 9th/54

Ref: Shobha Tandon, 2nd/127

The period of childhood is thus divided into three stages:

1. Normal autistic phase

Normal Autistic Phase (0 – 1 year)

It is a state of half-sleep, half-wakefulness.

Normal Symbiotic Phase (3 – 4 weeks to 4 – 5 months)

Separation – Individualization Process (5 to 36 months)

This phase is divided into four subphases

Merit of Mahler’s Theory

Demerit of Mahler’s Theory

Characteristics of separation-individualization subphases

Differentiation Practicing period Rapprochement Consolidation and object constancy

Ref: Shobha Tandon, 2nd/274

Fluoride level States

> 5.0 ppm

Ref: Shobha Tandon, 2nd/305

Ref: Shobha Tandon, 2nd/73

Growth Theories: Assumptions and Clinical implications

Theory Assumption Application

Ref: Shobha Tandon, 2nd/177

The three sub-stages of adolescence

Sub – stage Characteristics

Ref: Shobha Tandon, 2nd/198

Important mechanisms of salivary factors related to dental caries

Effects on mineraliza- Effects on bacterial ag- Role in raising saliva

Ref: Shobha Tandon, 2nd/406

DevitalisationPulpotomy (Two stage)

The formulas of each agent used are as follows:

Ref: Shobha Tandon, 2nd/103

Developmental alteration of structure

Anomaly & classification Definition Etiology Clinical features Treatment

Ref: Shobha Tandon, 2nd/103

Ref: Shobha Tandon, 2nd/116

Self-correcting anomalies Correction (Timing / Factors involved in)

Ref: Damle, 3rd/179

Full mouth intra oral radiographs according to age

Age Number of films Type of radiograph

Ref: Shobha Tandon, 2nd/31

Radiation Safety Symbol

Ref: Shobha Tandon, 2nd/39

Ref: McDonald, 8th/217

The AAPD Caries – Risk Assessment Tool (CAT) is as follows-

CARIES RISK INDICA-

Ref: Shobha Tandon, 1st/86

Diphyodont Two sets of teeth Human beings

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