Q1. When treating a child who is obviously afraid, the dentist should:

1. use restraint
2. use the hand-over-mouth technique (HOME)
3. permit the child to express his fear
4. avoid all reference to the child’s fear

Answer Key: permit the child to express his fear — identify the fear

• All behavioral patterns are motivated by anger and fear. The crying child is NOT an abnormal child.
• Anger is easier to treat than fear. Fear is most likely to be exhibited by a young child on his first visit to the dentist. This is related to the anxiety over being separated from a parent.
• The parent, not the dentist, has the greatest influence on the child’s reaction at this initial visit.

• The angry child:

– Separate the parent and the child

– Place the child in the chair abruptly and be firm

– Use the “hand-over-mouth” excercise (HOME) – get the parent’s permission !!!

– Display authority and command respect of the child by continuing with treatment if he/she is uncooperative

– Comfort parent at the end of the visit

– Compliment child at the end of the visit

• The fearful child:

– Have the parent stand quietly behind the chair

– Dentist must be consistent in tonal quality

– Permit the child to express his fears – identify the fear

– Change the child’s focus off fear

– Lastly, sedation

• Classification of behavior:

• Cooperative: children with minimal apprehension and respond well to behavior shaping
• Lacking cooperative ability: children are deficient in comprehension and/or communication skills (i.e., very young children and children with certain disabilities).
• Potentially cooperative: chidren are capable of behaving but are disruptive in the dental setting.

– Uncontrolled: characterized by temper tantrums. Typically 3-6 years of age.

– Defiant: characterized by “I don’t want to” attitude or passive resistance. All ages.

• Timid: typically preschool and younger grade school children. Hide behind parent or put hands over their mouth and face.

• Tense-cooperative: cooperative but are very nervous. “White-knuckler” patients because they grip the dental chair arm rests so tightly.
• Whining: they whine throughout the whole appointment.

Q2. A Class I cleft palate involves what structures?

1.  hard and soft palates
2.  soft palate only
3.  alveolar process only
4.  hard palate only

Answer Key : soft palate only

Four Classes of Cleft Palate:

• Class I : involves only the soft palate.
• Class II : involves soft and hard palates but not the alveolar process.
• Class II I: same as Class II but with alveolar process involvement on one side of the premaxilla.
• Class IV : involves the soft palate and continues through the alveolus on both sides of the premaxilla.

*** Females more often affected

Four Classes of Cleft Lip:

• Class I : a unilateral notching of the vermillion not extending into the lip.
• Class II : same as Class I but the cleft extends into the lip but not to the floor of the nose.
• Class III : same as Class II but extending into the floor of the nose.
• Class IV : any bilateral clefting of the lip whether incomplete notching or complete clefting.

*** Males more often affected

Q3. Ectodermal dysplasia is characterized by:

Select all that apply.

1. sparse hair
2.  lack of sweat glands
3.  oversized crowns
4. elongated roots
5. normal mental status
6. an enlarged mandible
7. absence of teeth

Answer Key : 

• sparse hair
• lack of sweat glands
• normal mental status
• absence of teeth

Ectodermal dysplasia

• It is a sex-linked recessive trait.
• Although both sexes are affected, more males are affected than females.
• It is characterized by a lack of sweat glands, sparse hair, dry skin, a concave nasal bridge, and the absence of teeth.
• There may be complete failure of the teeth to develop (anodontia) or oligodontia (partial anodontia).
• Alveolar bone development is lacking because of the absence of permanent teeth. 
• Note: 

• Anhidrotic ectodermal dysplasia is the X-linked recessive form of ectodermal dysplasia and the most well known.
• It is characterized by the conical shape of the anterior teeth.
• It is also characterized by lack of perspiration caused by the partial or complete absence of sweat glands.

Cleidocranial dysplasia (or dysostosis)

• It is a rare condition inherited as an autosomal dominant and characterized by partial or complete absence of the clavicles, defective ossification of the skull, and faulty occlusion due to misplaced or supernumerary teeth often ranging in number from 10-60.

• It is equally common in males and females.
• Prolonged retention of primary teeth and delayed or complete failure of eruption of permanent teeth are characteristic features.
• The presence of numerous supernumerary and unerupted permanent teeth is very common.

• Remember: 
• Supernumerary teeth are most often found in the maxillary midline region and are called mesiodens.
• Supernumerary teeth are also frequently found distal to the maxillary molars and in the mandibular premolar region.