Pl answ :
Sample Clinical Scenario & Questions
Beatrice is 5 years old, and has recently moved to your town. She has had sporadic dental care in the past, usually only when her father (a single parent) noticed a spot on her teeth or when Beatrice was complaining of discomfort. When you meet Beatrice you notice that she seems quite shy, and also seems small for her age; she does not yet attend school, but stays at home with her grandmother, who lives with Beatrice and her father.
When you review Beatrice's medical history with her father, he indicates that she is
"slow" but that he will know more when she gets tested at school when she starts next year. He also indicates that Beatrice had viral meningitis when she was 2 years old, and was in the hospital for 2 months. Since then she has had mild asthma which they control with a daily Albuterol inhaler used with a nebulizer. Aside from the asthma, Dad says that Beatrice is now healthy. Dad further tells you that every now and then Beatrice complains that her teeth hurt, and she refuses to eat popsicles, previously one of her favorite foods.
Beatrice reluctantly comes to your operatory, while tightly holding her father's hand. It takes some coaxing, but eventually you are able to look inside Beatrice's mouth. She seems to have some occlusal caries, and several of the marginal ridges of her posterior teeth appear to be shadowed. There is a lump on the soft tissue in the maxilla just above her primary incisors.
1. Based on her medical history, what might you expect to see on Beatrice's growth curve?
A. Beatrice's growth curve consistently follows the "normal" curve, at a level
several percentiles below.
B. Beatrice's growth curve consistently follows the "normal" curve, at a level
several percentiles above.
C. Beatrice fell from tracking the "normal" curve at age 2, and continues to
fall below (not track) the "normal" curve.
D. Beatrice fell from tracking the "normal" curve at age 2, but is now
tracking the "normal" curve at a lower level than her original.
E. Beatrice fell from tracking the "normal" curve at age 2, but is now
tracking her original growth curve.
2. In addition to the caries that you noted in Beatrice's mouth, you got a quick
glimpse of her tonsils, and they appear to be enlarged by about 50%, but appear
not to be inflamed. Is this a cause for concern?
A. No – Beatrice is at an age where her lymphoid tissue growth patterns are
heightened, so this is a normal finding.
B. No – Most children have enlarged tonsils until around age 10 or 11.
C. No – In the absence of inflammation there is no cause for concern.
D. Yes – Based on Beatrice's age, this is not a normal finding.
E. Yes – Based on Beatrice's age, her tonsils should not yet be visible
intraorally.
3. Which of Scammon's growth curves would be at the lowest point at the present
time for Beatrice?
A. Neural
B. General
C. Lymphoid
D. Genital
E. Mandibular
4. Which of Beatrice's primary teeth should have incomplete roots, assuming that
her dental development is "normal" for her chronologic age?
A. Primary incisors
B. Primary canines
C. Primary second molars
D. B and C
E. None of the above🙂
5. Which of Beatrice's primary teeth would you expect to have sustained coronal
damage from her meningitis at age 2?
A. Primary incisors & canines
B. Primary first molars
C. Primary second molars
D. All of the above
E. None of the above🙂
6. Which of Beatrice's permanent teeth would you expect to have sustained coronal damage from her meningitis at age 2?
A. Permanent incisors & canines
B. Permanent first molars
C. Permanent second molars
D. All of the above ans
E. None of the above
7. Assuming that Beatrice is mentally challenged, in the "borderline" category,
which of the following could be true?
1. Beatrice will show a delay in developmental milestones
2. Beatrice will have an IQ in the 68-83 range
3. Beatrice may be prescribed Ritalin for her condition
4. Beatrice would be considered "Trainable Mentally Challenged"
5. Beatrice will require general anesthesia for her dental treatment
A. 1, 2
B. 1, 3
C. 1, 2, 3
D. 4 only😕
E. 1, 2, 3, 4, 5
8. You note that Beatrice has only three erupted mandibular primary incisors, and
your radiograph confirms that there are no unerupted primary incisors. Her father
relates that at about 1 month of age, an incisor erupted which was removed
because it was loose. Which is the correct classification of the tooth which was
removed?
A. Natal, predeciduous tooth
B. Neonatal, predeciduous tooth
C. Natal, primary tooth erupted prematurely
D. Neonatal primary tooth erupted prematurely😉
E. It is impossible to know as the tooth is not available for examination
9. You decide to attempt to take bitewing radiographs of Beatrice's teeth, utilizing a Snap-A-Ray® instrument. Which is the appropriate film and orientation?
A. #0 film placed vertically
B. #0 film placed horizontally🙂
C. #1 film placed vertically
D. #1 film placed vertically
E. #4 film placed extraorally
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10. You note that Beatrice's lingual frenum seems to be attached close to the lingual gingival of her lower incisors. Under what condition would you suggest a
frenectomy?
A. Her father thinks it might help her speech delay
B. When you pull up on her tongue, the frenum causes the gingiva to blanche
and displaces the lingual gingival from the cingula of her lower primary
incisors
C. When you pull up on her tongue, the frenum causes some blanching of the
gingival but the lingual gingival is not displaced from the cingula of her
lower incisors
D. All of the above
E. B and C only🙂
