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Pedodontics - NEETMDS- courses
NEET MDS Lessons
Pedodontics

Cerebral palsy is a group of permanent disorders of movement and posture causing activity limitations, attributed to non-progressive disturbances in the developing fetal or infant brain.

Classification by Motor Type

A. Spastic Cerebral Palsy (70-80%)

Characteristics:

  • Increased muscle tone (hypertonia)
  • Exaggerated reflexes
  • Muscle stiffness
  • Contractures

Subtypes:

  1. Spastic Hemiplegia - One side affected
  2. Spastic Diplegia - Lower limbs more affected
  3. Spastic Quadriplegia - All four limbs affected

B. Dyskinetic Cerebral Palsy (10-20%)

Key Types

  1. Athetosis

    • Slow, writhing movements
    • Involuntary, continuous
    • Affects distal muscles more
    • Worsens with stress/excitement
  2. Choreoathetosis

    • Combination of choreic and athetoid movements
    • Choreic: Quick, jerky, irregular movements
    • Athetoid: Slow, writhing movements
    • Most common dyskinetic type
  3. Dystonia

    • Sustained muscle contractions
    • Repetitive twisting movements
    • Abnormal postures

C. Ataxic Cerebral Palsy (5-10%)

Characteristics:

  • Poor balance and coordination
  • Unsteady gait
  • Intention tremor
  • Speech difficulties

Dental Implications of Cerebral Palsy

  • Oral hygiene: Difficulty in maintaining
  • Feeding problems: Swallowing difficulties, drooling
  • Dental anomalies: Delayed eruption, enamel defects
  • Malocclusion: High prevalence
  • Trauma risk: Due to falls and poor coordination
  • Medication effects: Gingival hyperplasia (anticonvulsants)

  • Common injury age (primary teeth): 1.5 years
  • Extra-articulation of teeth: Avulsion
  • Contusion cause: Blunt trauma
  • Best medium for avulsed tooth: Viaspan > HBSS > Milk > Saliva > Water
  • HBSS shelf life: 24 months
  • Non-pharmacological aversive technique: Hand-over-mouth exercise
  • Lesch-Nyhan syndrome: Masochistic behavior
  • Autism speech pattern: Parrot-like speech
  • Diastema not closing naturally: >2 mm
  • Child operative position: Fully reclined

  • Arch criminal of caries: Sucrose
  • Rampant caries: ≥10 lesions/year
  • Fluoride contraindication: Chronic renal failure
  • Fluoride in toothpaste (pea size): 250 mg
  • Critical pH for demineralization: 5.2 – 5.5
  • Plaque pH drop duration: 120 min
  • Trace elements increasing caries: Selenium, lead, barium
  • Protective trace elements: Molybdenum, vanadium
  • Fluorosis etching acid (ortho bonding): Phosphoric acid

  • Plasma peak of fluoride: 180 min
  • Fluoride in breast milk: 5 – 10 mg/L
  • Earth’s crust fluoride: ~300 ppm
  • Dry tea leaf fluoride: 100 – 400 ppm
  • Renal clearance: 30 – 50 mL/min
  • Plasma fluoride level: 19 – 38 ng/mL
  • Plaque fluoride concentration: 15 – 64 ppm
  • Sweat fluoride concentration: 0.067 – 0.05 ppm
  • Reliable fluoride analysis method: Microdiffusion (Taves, 1983)
  • Fluoride in pea-sized toothpaste: 250 mg
  • Non-caloric sweeteners: Saccharin, Aspartame

Andreasen Classification (Most Important for Exams)

A. Injuries to Hard Tissues and Pulp

  1. Enamel Infraction - Crack in enamel only
  2. Enamel Fracture - Loss of enamel substance
  3. Enamel-Dentin Fracture - Loss of enamel and dentin, no pulp exposure
  4. Enamel-Dentin-Pulp Fracture - Loss of enamel and dentin with pulp exposure
  5. Crown-Root Fracture - Fracture involving enamel, dentin, and cementum
  6. Root Fracture - Fracture involving dentin, cementum, and pulp

B. Injuries to Periodontal Tissues

  1. Concussion - Injury without displacement or mobility
  2. Subluxation - Injury with increased mobility but no displacement
  3. Extrusive Luxation - Partial displacement out of socket
  4. Lateral Luxation - Displacement in directions other than axial
  5. Intrusive Luxation - Displacement into alveolar bone
  6. Avulsion - Complete displacement from socket

CARIDEX and CARISOLV

CARIDEX and CARISOLV are both dental products designed for the chemomechanical removal of carious dentin. Here’s a detailed breakdown of their components and mechanisms:

CARIDEX

  • Components:

    • Solution I: Contains sodium hypochlorite (NaOCl) and is used for its antimicrobial properties and ability to dissolve organic tissue.
    • Solution II: Contains glycine and aminobutyric acid (ABA). When mixed with sodium hypochlorite, it produces N-mono chloro DL-2-amino butyric acid, which aids in the removal of demineralized dentin.
  • Application:

    • CARIDEX is particularly useful for deep cavities, allowing for the selective removal of carious dentin while preserving healthy tooth structure.

CARISOLV

  • Components:

    • Syringe 1: Contains sodium hypochlorite at a concentration of 0.5% w/v (which is equivalent to 0.51%).
    • Syringe 2: Contains a mixture of amino acids (such as lysine, leucine, and glutamic acid) and erythrosine dye, which helps in visualizing the removal of carious dentin.
  • pH Level:

    • The pH of the CARISOLV solution is approximately 11, which helps in the dissolution of carious dentin.
  • Mechanism of Action:

    • The sodium hypochlorite in CARISOLV softens and dissolves carious dentin, while the amino acids and dye provide a visual cue for the clinician. The procedure can be stopped when discoloration is no longer observed, indicating that all carious dentin has been removed.

Erikson's Eight Stages of Psychosocial Development

  1. Basic Trust versus Basic Mistrust (Hope):

    • Age: Infants (0-1 year)
    • Description: In this stage, infants learn to trust their caregivers and the world around them. Consistent and reliable care leads to a sense of security.
    • Positive Outcome: If caregivers provide reliable care and affection, the infant develops a sense of trust, leading to feelings of safety and hope.
    • Negative Outcome: Inconsistent or neglectful care can result in mistrust, leading to anxiety and insecurity.
  2. Autonomy versus Shame and Doubt (Will):

    • Age: Toddlers (1-2 years)
    • Description: As toddlers begin to explore their environment and assert their independence, they face the challenge of developing autonomy.
    • Positive Outcome: Encouragement and support from caregivers foster a sense of autonomy and confidence in their abilities.
    • Negative Outcome: Overly critical or controlling caregivers can lead to feelings of shame and doubt about their abilities.
  3. Initiative versus Guilt (Purpose):

    • Age: Early Childhood (2-6 years)
    • Description: Children begin to initiate activities, assert control over their environment, and develop a sense of purpose.
    • Positive Outcome: When children are encouraged to take initiative, they develop a sense of purpose and leadership.
    • Negative Outcome: If their initiatives are met with criticism or discouragement, they may develop feelings of guilt and inhibition.
  4. Industry versus Inferiority (Competence):

    • Age: Elementary and Middle School (6-12 years)
    • Description: Children learn to work with others and develop skills and competencies. They begin to compare themselves to peers.
    • Positive Outcome: Success in school and social interactions fosters a sense of competence and achievement.
    • Negative Outcome: Failure to succeed or negative comparisons can lead to feelings of inferiority and a lack of self-worth.
  5. Identity versus Role Confusion (Fidelity):

    • Age: Adolescence (12-18 years)
    • Description: Adolescents explore their personal identity, values, and beliefs, seeking to establish a sense of self.
    • Positive Outcome: Successful exploration leads to a strong sense of identity and fidelity to one's beliefs and values.
    • Negative Outcome: Failure to establish a clear identity can result in role confusion and uncertainty about one's place in the world.
  6. Intimacy versus Isolation (Love):

    • Age: Young Adulthood (19-40 years)
    • Description: Young adults seek to form intimate relationships and connections with others.
    • Positive Outcome: Successful relationships lead to deep connections and a sense of love and belonging.
    • Negative Outcome: Fear of intimacy or failure to form meaningful relationships can result in feelings of isolation and loneliness.
  7. Generativity versus Stagnation (Care):

    • Age: Middle Adulthood (40-65 years)
    • Description: Adults strive to contribute to society and support the next generation, often through parenting, work, or community involvement.
    • Positive Outcome: A sense of generativity leads to feelings of productivity and fulfillment.
    • Negative Outcome: Failure to contribute can result in stagnation and a sense of unfulfillment.
  8. Integrity versus Despair (Wisdom):

    • Age: Late Adulthood (65 years to death)
    • Description: Older adults reflect on their lives and evaluate their experiences.
    • Positive Outcome: A sense of integrity arises from a life well-lived, leading to feelings of wisdom and acceptance.
    • Negative Outcome: Regret over missed opportunities or unresolved conflicts can lead to despair and dissatisfaction with life.

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