Clinical Cases in Pediatric Dentistry - 1st
Edition
What important questions need to be asked when taking a medical history from a patient with
congenital heart disease? - ANS Nature of diagnosis (acyanotic or cyanotic), supportive medications,
previous surgical corrections, future surgical corrections, current cardiac function, physical activity
limitations, risk of IE
What are some common medications to improve cardiac function and reduce congestive heart failure in
children? - ANS Oral elixirs including Digoxin and Furosemide, usually with sucrose or sorbitol base .
Why are children with congenital heart disease more likely to develop dental caries in primary teeth? -
ANS Enamel is often hypoplastic and susceptible to early childhood caries; high-caloric diet; use of
sucrose-rich medications; medications may induce xerostomia; parental indulgence with sweets, juices,
sodas, etc .
How would non-compliance with preventive advice alter treatment planning? - ANS It may be necessary
to extract all carious teeth, especially those with pulpal involvement, to reduce the risk of infection and
IE .
Why do CF patients have a high rate of calculus? - ANS They have altered amounts of calcium and
phosphate in their saliva, which affect calculus formation . However, pancreatin may have a role in
decreasing calculus formation and reducing dental caries in these patients
What two main systems are affected in this condition? - ANS Respiratory and GI (gastro-intestinal)
Studies have shown that caries rates are low in this condition. What reasons have been given for this? -
ANS This fact has been attributed to the long-term
antibiotic therapy of these children, high salivary
pH, and raised salivary calcium levels
,What precautions are required for treatment under general anesthesia in CF patients? - ANS - Avoid
general anesthesia if possible
- Make sure that there are no signs of pulmonary infection . May require sputum culture
- Chest radiograph
- Blood gases
- Pulmonary function testing
- Vigorous course of pre-op and post-op chest
physiotherapy to clear as much of the
secretions as possible
- Check for diabetes (blood glucose) and liver
disease (LFTs) pre-op• Check current antibiotic regimen
- Peri-operative frequent suctioning and removal
of secretions
- Nasal polyps are a contra-indication to nasal
intubation
What are the long-term complications of CF? - ANS Diabetes,liver disease, pneumothorax, sinusitis, nasal
polyps, osteopenia, failure to thrive, and infertility
Which laboratory screening test is affected by a reduced level of factor VIII or factor IX? - ANS The
activated partial thromboplastin time (aPTT) is usually two to three times the upper limit of normal
In addition to pre- and post-operative medications, what are special considerations for treatment under
general anesthesia for patients with hemophilia? - ANS Nasotracheal intubation is contraindicated due
to increased risk of airway trauma . Treatment venue is more appropriately in a hospital rather than in-
office
,Which analgesic medications are contra- indicated for a patient with a bleeding disorder and why? - ANS
Aspirin and nonsteroidal anti-inflammatory medications adversely impact hemostasis due to platelet
inhibition
What is the significance of inhibitors in hemophilia? - ANS Bleeding episodes continue despite
appropriate factor replacement levels . Care for these patients may include use of a bypassing agent
such as factor VIIa or activated prothrombin complex concentrate
What local anesthesia techniques should be done only after factor replacement? - ANS Infiltrations into
a highly vascularized area or into loose connective tissue, and posterior superior alveolar and inferior
alveolar nerve blocks .
What important questions need to be asked when taking a medical history from a patient with ALL? -
ANS Questions regarding the underlying disease,time of diagnosis, modalities of treatment the patient
has received since the diagnosis, planned treatment, surgeries, complications, prognosis, current
hematological status, allergies and medications
What are some common side effects of chemotherapy? - ANS Mucositis, opportunistic infections, oral
bleeding, salivary dysfunction, and neurotoxicity
Why are children with neutropenia at risk of oral sepsis? - ANS They do not have enough neutrophils
present in the immune system (weakened) to defend them from an infection
How would non-compliance with preventive advice alter treatment planning? - ANS Non-compliance
with preventive measures such as daily oral hygiene would indicate a poor prognosis for minimizing
adverse long-term oro-dental effects such as enamel demineralization and high caries rates
How would management differ if the child had a poor medical prognosis? - ANS Management of children
with a poor prognosis is generally palliative or symptomatic relief of pain and oral discomfort
What is the most common liver disease in children that requires transplantation? - ANS Biliary atresia
, What is the most likely cause of greenish staining of teeth in children with liver disease? - ANS The
incorporation of unconjugated bile
pigments, especially biliverdin, during the period
of calcification of teeth
What is the minimum platelet count that is recommended for dental extractions? - ANS 75,000/mm3
What analgesic should be prescribed with caution in children with liver disease and why? - ANS
Acetaminophen should be prescribed in reduced dosages for analgesia in children with liver disease
because high doses may be hepatotoxic
What immunosuppressant medication may induce gingival hyperplasia? - ANS Cyclosporine A
What is the absolute neutrophil count (ANC)? - ANS The absolute neutrophil count (ANC) is a measure of
the number of neutrophils in the blood expressed as the number cells/mm3 of blood
What is the normal range of ANC values in a
healthy child? - ANS The normal range of ANC in healthy children is 1,500 to 8,000 cells/mm3
What is one of the primary aims of medical management of a child with neutropenia? - ANS Prevention
of infections and their sequelae
What are the predominant types of pathogens likely to cause infection in a child with neutropenia? -
ANS Bacteria and fungi
What oral conditions may be typically seen in a patient with neutropenia? - ANS Gingivitis, periodontitis,
and/or oral ulceration, attachment loss, alveolar bone loss, premature tooth exfoliation
