NEET MDS Lessons
Pedodontics
Stages of Development
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Sensorimotor Stage (0-2 years):
- Overview: In this stage, infants learn about the world primarily through their senses and motor activities. They begin to interact with their environment and develop basic cognitive skills.
- Key Characteristics:
- Object Permanence: Understanding that objects continue to exist even when they cannot be seen.
- Exploration: Infants engage in play by manipulating objects, which helps them learn about cause and effect.
- Symbolic Play: Even at this early stage, children may begin to engage in simple forms of symbolic play, such as pretending a block is a car.
- Example in Dental Context: A child may play with toys while sitting in the dental chair, exploring their environment and becoming familiar with the setting.
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Pre-operational Stage (2-6 years):
- Overview: During this stage, children begin to use language and engage in symbolic play, but their thinking is still intuitive and egocentric. They struggle with understanding the perspectives of others.
- Key Characteristics:
- Animism: The belief that inanimate objects have feelings and intentions (e.g., thinking a toy can feel sad).
- Constructivism: Children actively construct their understanding of the world through experiences and interactions.
- Symbolic Play: Children engage in imaginative play, using objects to represent other things (e.g., using a stick as a sword).
- Example: A child might pretend that a stuffed animal is talking or has feelings, demonstrating animism.
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Concrete Operational Stage (6-12 years):
- Overview: In this stage, children begin to think logically about concrete events. They can perform operations and understand the concept of conservation (the idea that quantity doesn’t change even when its shape does).
- Key Characteristics:
- Ego-centrism: While children in this stage are less egocentric than in the pre-operational stage, they may still struggle to see things from perspectives other than their own.
- Logical Thinking: Children can organize objects into categories and understand relationships between them.
- Conservation: Understanding that certain properties (like volume or mass) remain the same despite changes in form or appearance.
- Example: A child may understand that pouring water from a short, wide glass into a tall, narrow glass does not change the amount of water.
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Formal Operational Stage (11-15 years):
- Overview: In this final stage, adolescents develop the ability to think abstractly, reason logically, and use deductive reasoning. They can consider hypothetical situations and think about possibilities.
- Key Characteristics:
- Abstract Thinking: Ability to think about concepts that are not directly tied to concrete objects (e.g., justice, freedom).
- Hypothetical-Deductive Reasoning: Ability to formulate hypotheses and systematically test them.
- Metacognition: Awareness and understanding of one’s own thought processes.
- Example: An adolescent can discuss moral dilemmas or scientific theories, considering various outcomes and implications.
Cariogram Dark Blue Color: Diet
Cariogram System:
- Purpose: Visual caries risk assessment tool
- Developer: Dr. Gunnel Hänsel Petersson (Sweden)
- Format: Pie chart representation
- Factors: 10 different risk and protective factors
Color Coding System:
| Color | Factor | Significance |
|---|---|---|
| Dark Blue | Diet | Dietary habits and sugar intake |
| Light Blue | Bacteria | Streptococcus mutans levels |
| Red | Circumstances | Medical conditions, medications |
| Yellow | Susceptibility | Fluoride exposure, saliva |
| Green | Chance to avoid caries | Protective factors |
Diet Factor Assessment:
- Sugar frequency: Number of sugar intakes per day
- Sugar amount: Quantity consumed
- Sticky consistency: Retentive nature of foods
- Eating patterns: Meal vs snacking habits
CLINICAL SIGNIFICANCE: Dark blue section size indicates dietary caries risk contribution to overall risk profile.
Erythroblastosis fetalis
Blue-green colour of primary teeth only. It is due to excessive haemolysis of
RBC. The Staining occurs due to diffusion of bilirubin and biliverdin into the
dentin
Porphyria
Purplish brown pigmentation. to light and blisters on The other features hands
and face e Hypersensitivity are are red red coloured urine, urine,
Cystic fibrosis
(Yellowish gray to dark brown. It is due to tetracycline, which is the drug of
choice in this disease
Tetracycline
Yellow or yellow-brown pigmentation in dentin and to a lesser extent in enamel
that are calcifying during the time the drug is administered. The teeth
fluoresce yellow under UV light
1. Carisolv
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Purpose: Chemomechanical caries removal system.
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Composition:
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Amino acids: Leucine, lysine, glutamic acid
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Sodium hypochlorite: Softens decayed dentin
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Advantages:
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Minimally invasive
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Painless and anxiety-reducing for pediatric patients
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Preserves healthy tooth structure
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2. Vitapex
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Purpose: Root canal filling material for primary teeth.
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Composition:
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Calcium hydroxide (Ca(OH)₂): 30.5%
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Iodoform: 40.4%
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Properties:
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Antibacterial
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Resorbable with the root
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Radiopaque
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Indications:
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Pulpectomy in primary teeth
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Apexification procedures
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Tooth Replantation and Avulsion Injuries
Tooth avulsion is a dental emergency that occurs when a tooth is completely displaced from its socket. The success of replantation, which involves placing the avulsed tooth back into its socket, is influenced by several factors, including the time elapsed since the avulsion and the condition of the periodontal ligament (PDL) tissue.
Key Factors Influencing Replantation Success
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Time Elapsed Since Avulsion:
- The length of time between the loss of the tooth and its replantation is critical. The sooner a tooth can be replanted, the better the prognosis for retention and vitality.
- Prognosis Statistics:
- Replantation within 30 minutes: Approximately 90% of replanted teeth show no evidence of root resorption after 2 or more years.
- Replantation after 2 hours: About 95% of these teeth exhibit root resorption.
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Condition of the Tooth:
- The condition of the tooth at the time of replantation, particularly the health of the periodontal ligament tissue remaining on the root surface, significantly affects the outcome.
- Immediate replacement of a permanent tooth can sometimes lead to vitality and indefinite retention, but this is not guaranteed.
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Temporary Measure:
- While replantation can be successful, it should generally be viewed as a temporary solution. Many replanted teeth may be retained for 5 to 10 years, with a few lasting a lifetime, but others may fail shortly after replantation.
Common Avulsion Injuries
- Most Commonly Avulsed Tooth: The maxillary central incisor is the tooth most frequently avulsed in both primary and permanent dentition.
- Demographics:
- Avulsion injuries typically involve a single tooth and are three times more common in boys than in girls.
- The highest incidence occurs in children aged 7 to 9 years, coinciding with the eruption of permanent incisors.
- Structural Factors: The loosely structured periodontal ligament surrounding erupting teeth may predispose them to complete avulsion.
Recommendations for Management of Avulsed Teeth
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Immediate Action: If a tooth is avulsed, it should be replanted as soon as possible. If immediate replantation is not feasible, the tooth should be kept moist.
- Storage Options: The tooth can be stored in:
- Cold milk (preferably whole milk)
- Saline solution
- Patient's own saliva (by placing it in the buccal vestibule)
- A sterile saline solution
- Avoid: Storing the tooth in water, as this can damage the periodontal ligament cells.
- Storage Options: The tooth can be stored in:
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Professional Care: Seek dental care immediately after an avulsion injury to ensure proper replantation and follow-up care.
Primary Teeth Development
Root Development & Completion
- Root completion (primary teeth): 3-4 years 🎯
- Clinical significance: Important for treatment planning and prognosis
Detailed Timeline by Tooth Type
| Tooth | Crown Initiation | Crown Completion | Eruption | Root Completion |
|---|---|---|---|---|
| Central Incisor | 14 weeks IU | 1.5 months | 6-8 months | 1.5-2 years |
| Lateral Incisor | 16 weeks IU | 2.5 months | 8-10 months | 1.5-2 years |
| Canine | 17 weeks IU | 9 months | 18-20 months | 3-3.5 years |
| First Molar | 15.5 weeks IU | 6 months | 14-16 months | 2.5-3 years |
| Second Molar | 19 weeks IU | 11 months | 24-26 months | 3-4 years |
IU = In Utero
KEY POINT: Primary tooth root completion occurs at 3-4 years, with second molars completing last.
- 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