A child with fever of 102 degrees F and vesicles in the oral cavity is probably suffering from:

 # A child with fever of 102 degrees F and vesicles in the oral cavity is probably suffering from:

A. Herpes Simplex type I

B. Juvenile periodontitis

C. Acute herpetic gingivostomatitis

D. Neutropenia

The correct answer is C. Acute Herpetic Gingivostomatitis.

In some preschool children the primary infection of Herpes Simplex virus may be characterized by only one or two mild sores on the oral mucous membranes, which may be of little concern to the child or may go unnoticed by the parents. In other children the primary infection may be manifested by acute symptoms (acute herpetic gingivostomatitis). The active symptoms of the acute disease can occur in children with clean mouths and healthy oral tissues. The symptoms of the disease develop suddenly and include, in addition to the fiery red gingival tissues, malaise, irritability, headache, and pain associated with the intake of food and liquids of acidic content. A characteristic oral finding in the acute primary disease is the presence of yellow or white liquid-filled vesicles. In a few days the vesicles rupture and form painful ulcers, 1 to 3 mm in diameter, which are covered with a whitish gray membrane and have a circumscribed area of inflammation. The ulcers may be observed on any area of the mucous membrane, including buccal mucosa, tongue, lips, hard and soft palate, and the tonsillar areas. Large ulcerated lesions may occasionally be observed on the palate or gingival tissues or in the region of the mucobuccal fold. This distribution makes the differential diagnosis more difficult. An additional diagnostic criterion is a fourfold rise of serum antibodies to HSV-1. The lesion culture also shows positive results for HSV-1.

Reference: McDONALD AND AVERY’S DENTISTRY FOR THE CHILD AND

ADOLESCENT, TENTH EDITION, Page no 246.

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In performing mandibular nerve block for a child, the most probable cause of failure of anesthesia is:

# In performing mandibular nerve block for a child, the most probable cause of failure of anesthesia is:

A. More concentration of LA is required

B. Because of different angulation of needle

C. Because of position of mandibular foramen

D. None of the above

The correct answer is C. Because of position of mandibular foramen.

Olsen reported that the mandibular foramen is situated at a level lower than the occlusal plane of the primary teeth of the pediatric patient. Therefore the injection must be made slightly lower and more posteriorly than for an adult patient.

Reference: McDONALD AND AVERY’S DENTISTRY FOR THE CHILD AND

ADOLESCENT, TENTH EDITION, Page no 275

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Indirect pulp capping procedures on primary molars are indicated when:

 # Indirect pulp capping procedures on primary molars are indicated when:

A. Removal of decay has exposed the pulp

B. A tooth has a large, long-standing lesion with a history of continuous pain

C. The carious lesion has just penetrated to DEJ

D. The carious lesion is suspected of producing exposure of the pulp

The correct answer is C. The carious lesion has just penetrated to DEJ. 

Indirect Pulp Treatment (IPT)

• Indications: tooth with deep carious lesion, vital pulp

• Objectives: preservation of vitality, arrest of caries advance, formation of tertiary dentin.

• Technique: excavation of most affected dentin, application of medicament over thin layer of sound or carious dentin with no clinically evident pulpal exposure, place Ca(OH)2 or glass ionomer cement, restoration should seal completely, e.g. stainless steel crown

• re-entry for completion of caries removal is not necessary.

Reference: AAPD Handbook of Pediatric Dentistry, Third Edition. Page no 79

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The most caries susceptible teeth in permanent dentition are:

 # The most caries susceptible teeth in permanent dentition are:

A. Lower anterior

B. Second bicuspids

C. First molars

D. Second molars

The correct answer is C. First molars.

Based on the data analyses of the present study, it is concluded that first permanent molars had greatest caries prevalence followed by second permanent molars. Statistically significant associations were found between caries in first permanent molars and caries in other permanent teeth particularly central incisors, premolars, and second molars. Dental caries develops soon after the eruption of permanent first molars and can transmit to other permanent teeth; therefore, school-based oral health promotion programs should address younger children so that high prevalence of caries can be controlled in adolescents with early prevention. Oral health education should be raised in the community through oral health campaigns. Adequate access to public preventive and restorative dental programs and services should be ensured for all the children.

Reference:  First Permanent Molar Caries and its Association with Carious Lesions in Other Permanent Teeth, Muhammad Ashraf Nazir1 , Eman Bakhurji2 , Balgis Osman Gaffar3 , Asim Al-Ansari4 , Khalifa Sulaiman Al-Khalifa5

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