ADC - Australian Dental Council Paediatric Dentistry and Orthodontics Questions and Answers — Questions and Answers
Question 1: A 9-year-old child presents with an uncomplicated crown fracture of the maxillary right central incisor (tooth 11) following a fall. The fracture exposes a small area of vital dentine but not the pulp. The tooth is not mobile, and pulp vitality testing is positive. According to the International Association of Dental Traumatology (IADT) guidelines, what is the most appropriate immediate management?
- Perform a direct pulp cap with MTA and restore.
- Place a calcium hydroxide liner over the exposed dentine and restore with composite resin. (Correct answer)
- Initiate a Cvek (partial) pulpotomy.
- Extract the tooth and consider a space maintainer.
Correct answer: Place a calcium hydroxide liner over the exposed dentine and restore with composite resin.
For an uncomplicated crown fracture with dentine exposure, the primary goal is to seal the dentinal tubules to prevent bacterial ingress and protect the pulp. Placing a calcium hydroxide liner or a glass ionomer base over the exposed dentine, followed by a definitive restoration with composite resin, is the standard of care. Direct pulp capping or pulpotomy is only indicated if there is a pulp exposure (complicated crown fracture). Extraction is not indicated as the tooth is restorable and vital.
Question 2: A 7-year-old child in the mixed dentition stage presents with a unilateral posterior crossbite involving the permanent first molars. Upon closing, there is a clear functional mandibular shift towards the side of the crossbite. Which of the following is the most appropriate initial orthodontic intervention?
- Observation until all permanent teeth have erupted.
- Surgical-assisted rapid palatal expansion (SARPE).
- Fixed orthodontic appliances (full braces).
- Maxillary expansion using an appliance like a Quad Helix or RPE. (Correct answer)
Correct answer: Maxillary expansion using an appliance like a Quad Helix or RPE.
A unilateral posterior crossbite with a functional shift is indicative of a constricted maxillary arch. Early intervention in the mixed dentition is recommended to prevent asymmetrical mandibular growth and potential facial asymmetry. Maxillary expansion using an appliance such as a Quad Helix or a Rapid Palatal Expander (RPE) is the treatment of choice to correct the transverse discrepancy, which in turn eliminates the functional shift. Observation is inappropriate as the condition can worsen, and surgery (SARPE) is reserved for skeletally mature patients.
Question 3: A 4-year-old anxious child has a cavitated carious lesion on a primary molar with no signs of irreversible pulpitis. As a non-invasive management option that avoids local anaesthesia and tooth preparation, the clinician decides to cement a pre-formed metal crown over the tooth. What is this technique called?
- Atraumatic Restorative Treatment (ART)
- Interim Therapeutic Restoration (ITR)
- The Hall Technique (Correct answer)
- Silver Diamine Fluoride (SDF) Application
Correct answer: The Hall Technique
The Hall Technique is a specific, evidence-based method for managing carious primary molars by cementing a pre-formed stainless steel crown over the tooth without local anaesthesia, caries removal, or tooth preparation. It works by sealing the lesion from the oral environment, thus arresting the caries process. SDF is a liquid used to arrest caries but is not a restoration. ART and ITR involve caries removal (to varying extents) and placement of a restorative material like glass ionomer cement.
Question 4: In the context of Angle's classification of malocclusion, which of the following accurately describes a Class III relationship?
- The mesiobuccal cusp of the maxillary first molar occludes in the buccal groove of the mandibular first molar.
- The mesiobuccal cusp of the maxillary first molar occludes mesial to the buccal groove of the mandibular first molar.
- The distobuccal cusp of the maxillary first molar occludes in the buccal groove of the mandibular first molar.
- The mesiobuccal cusp of the maxillary first molar occludes distal to the buccal groove of the mandibular first molar. (Correct answer)
Correct answer: The mesiobuccal cusp of the maxillary first molar occludes distal to the buccal groove of the mandibular first molar.
Angle's Class III malocclusion is defined by the mesiobuccal cusp of the maxillary first permanent molar occluding distal to the buccal groove of the mandibular first permanent molar. This relationship often results in an anterior crossbite or 'underbite' appearance. Class I is when the cusp occludes with the groove, and Class II is when the cusp occludes mesial to the groove.
Question 5: A 6-year-old child requires extraction of the mandibular right primary second molar (tooth 85) due to an abscess. The permanent first molar (tooth 46) has not yet erupted but is visible on the radiograph. To prevent mesial migration and impaction of the unerupted permanent molar, what is the most appropriate space management appliance?
- Band and loop space maintainer
- Distal shoe space maintainer (Correct answer)
- Nance appliance
- Lower lingual holding arch
Correct answer: Distal shoe space maintainer
The distal shoe space maintainer is specifically indicated for the premature loss of a primary second molar BEFORE the eruption of the permanent first molar. It has a subgingival extension (the 'shoe') that physically guides the unerupted permanent first molar into its correct position. A band and loop is used after the permanent molar has erupted. A Nance appliance is for the maxillary arch, and a lingual holding arch is typically used for bilateral posterior space loss in the mandible after the permanent incisors have erupted.
Question 6: Which of the following is the primary objective of using formocresol as a medicament during a pulpotomy procedure on a primary tooth?
- To stimulate the formation of a reparative dentine bridge.
- To mummify and fix the radicular pulp tissue, rendering it inert. (Correct answer)
- To completely disinfect and sterilise the entire root canal system.
- To promote revascularisation of the coronal pulp tissue.
Correct answer: To mummify and fix the radicular pulp tissue, rendering it inert.
Formocresol is a fixative agent. Its primary objective in a pulpotomy is to fix (mummify) the remaining vital radicular pulp tissue, rendering it inert and resistant to bacterial breakdown. It does not stimulate a dentine bridge (like calcium hydroxide or MTA might), nor does it fully sterilise the entire canal system or promote revascularisation. It essentially preserves the radicular pulp in a fixed state until the tooth exfoliates naturally.
ADC - Australian Dental Council Paediatric Dentistry and Orthodontics Questions and Answers
A 9-year-old child presents with an uncomplicated crown fracture of the maxillary right central incisor (tooth 11) following a fall.
The fracture exposes a small area of vital dentine but not the pulp.
The tooth is not mobile, and pulp vitality testing is positive.
According to the International Association of Dental Traumatology (IADT) guidelines, what is the most appropriate immediate management?