Orthodontics and Pediatric Dentistry

Vital primary molar with deep caries

A 6-year-old has a deep occlusal carious lesion on a primary mandibular second molar. The tooth is vital, with no swelling or radiographic pathology. Upon caries removal, a small pulpal exposure with normal bleeding occurs. Best treatment?

Space maintenance

A 7-year-old prematurely lost a primary mandibular first molar; the permanent first molar and incisors have erupted. What is the most appropriate space maintainer?

Crowding & extraction decision

A 15-year-old has 10 mm of crowding in each arch and protrusive incisors. Skeletal relationships are Class I. Which orthodontic plan is most likely?

Functional appliance

A 10-year-old with skeletal Class II due to mandibular retrusion may benefit from which appliance during growth?

ECC pattern

A 3-year-old drinks sweetened milk in a bottle at bedtime and rarely brushes. Maxillary incisors show extensive decay; mandibular incisors are spared. This pattern is typical of:

Posterior crossbite in child

A 9-year-old with unilateral posterior crossbite shows a functional shift of the mandible to the right when closing. The recommended timing for correction is:

Anchorage

In orthodontics, anchorage refers to:

Fluoride ingestion

A 4-year-old weighing 16 kg accidentally ingests one 0.5 mg fluoride tablet. Which is the best action?

Late mandibular growth

Which statement best describes mandibular growth relative to maxillary growth?

Serial extraction

Serial extraction is primarily indicated for:

Avulsed permanent incisor

An 11-year-old avulses a permanent maxillary central incisor and brings it to the clinic in milk 30 minutes after injury. Best initial management?

Which orthodontic condition is best treated with a rapid palatal expander (RPE)?

Avulsed permanent incisor

A 9-year-old avulses a maxillary central incisor at school. Tooth is found on ground and stored dry for 45 minutes. On arrival, what is the best approach?

Pulp therapy primary molar

A primary molar has a deep carious lesion, provoked pain to cold but no spontaneous pain, and no radiographic pathology. Coronal pulp is inflamed but radicular pulp is likely healthy. Appropriate treatment?

Early mixed dentition crowding

A 9-year-old shows mild crowding (2–3 mm) of maxillary incisors but has spacing between primary canines and molars. Most appropriate management?

Early childhood caries risk factor

Which habit is most strongly associated with early childhood caries (ECC)?

Space loss prevention

A 6-year-old loses a primary mandibular second molar prematurely; the first permanent molar has not yet erupted. Best approach?

Anterior open bite cause

A 10-year-old has an anterior open bite and a strong habit of thumb sucking. Which statement is most accurate?

Cephalometric landmark ANB

In cephalometric analysis, an ANB angle significantly greater than normal (e.g., > 4°) suggests:

Stainless steel crown

A 6-year-old has a grossly carious primary second molar with multi-surface involvement but restorable and asymptomatic. Best restoration?

Behavior: positive reinforcement

You want to encourage cooperative behavior in a 5-year-old. Which is positive reinforcement?

Crowding & arch length

A 12-year-old has 4 mm mandibular anterior crowding, but arch length analysis suggests mild deficiency with no skeletal discrepancy. Common conservative solution?

Retention after fixed appliances

Following comprehensive fixed appliance therapy, the primary reason for retainers is:

Fluoride varnish use

Which statement about fluoride varnish in children is correct?

Primary tooth trauma, no radiographic root fracture

A 4-year-old bumps a primary maxillary incisor; it is slightly mobile but not displaced, no root fracture radiographically, no occlusal interference. Best management?

Functional shift and crossbite

A child closes in centric occlusion and the mandible shifts to one side, producing a unilateral posterior crossbite. This is best described as:

Airway and mouth breathing

Chronic mouth breathing in a growing child may lead to:

Class II growth modification timing

A Growing patient with Class II malocclusion due to mandibular retrusion is best treated with functional appliances:

Crowding vs spacing in primary dentition

Which primary dentition finding most strongly suggests future crowding of permanent incisors?

Avulsed primary incisor

A 3-year-old child avulses a primary maxillary central incisor. The tooth was found on the ground. Best management?

Early childhood caries (ECC)

Which pattern best describes early childhood caries?

Serial extraction concept

Serial extraction is primarily indicated in:

Fixed retainer purpose

A lingual fixed retainer bonded canine-to-canine on mandibular incisors is used mainly to:

Behavior management “tell–show–do”

“Tell–show–do” is best described as:

Space maintainer

A 7-year-old loses a primary mandibular second molar prematurely. First permanent molars are erupted and stable. Best approach?

Formocresol pulpotomy

Which statement about formocresol pulpotomy in primary molars is most accurate?

Removable vs fixed appliances

Which advantage is specific to fixed orthodontic appliances compared with removable ones?

Fluoride supplementation

A 4-year-old lives in an area where drinking water has <0.3 ppm fluoride and primarily drinks tap water. Assuming no other fluoride sources, an appropriate daily supplement is:

ECC pattern

A 3-year-old who sleeps with a bottle of sweetened milk shows maxillary anterior decay and molar lesions, but lower incisors are spared. This pattern suggests:

Space maintainer

A 6-year-old loses a primary mandibular second molar prematurely. The permanent first molar has erupted, and the permanent second premolar has not. Best management?

Class II division 1 features

Which clinical finding is most characteristic of Angle Class II division 1 malocclusion?

Indication for extraction

Which is a primary indication for premolar extractions in orthodontic treatment?

Open bite from habits

A 9-year-old with anterior open bite and long-standing thumb sucking habit is treated with a habit-breaking appliance and behavior modification. Primary goal?

Crossbite and functional shift

A unilateral posterior crossbite with mandibular shift on closure is primarily:

Pulp therapy in primary tooth

A vital primary molar with deep caries shows no spontaneous pain, but has exposure during caries removal. Radiograph shows no pathology. Best treatment?

Fluoride supplements

Which child is most appropriate for systemic fluoride supplementation (assuming no fluoride in local water)?

Silver diamine fluoride (SDF)

A 4-year-old with multiple cavitated lesions and poor cooperation is treated with silver diamine fluoride. Main advantage?

Behavior management – tell–show–do

The tell–show–do technique in pediatric dentistry is primarily used to:

Timing of growth modification

For a Class III skeletal pattern with maxillary deficiency in a growing child, the ideal time for maxillary protraction (facemask) is:

Removable vs fixed appliances

A removable appliance is least effective for which movement?

Root resorption risk

Which factor is most strongly linked to external apical root resorption during orthodontic treatment?

Avulsed permanent incisor

An 11-year-old avulses a maxillary permanent central incisor; the tooth has a closed apex and has been stored in milk for 30 minutes. Best management?

Intruded primary incisor

A 3-year-old presents with a primary maxillary incisor intruded toward the labial bone. It is not impinging on the permanent tooth bud radiographically. Best management?

Space maintenance

A 7-year-old child loses a mandibular primary second molar prematurely. The first permanent molar has not yet erupted. What is the best management to prevent space loss?

Class II Division 1 malocclusion

Which feature is most characteristic of a Class II Division 1 malocclusion?

Nursing caries pattern

Which teeth are usually spared in early childhood caries (“nursing caries”)?

Pulp therapy choice

A 5-year-old has a deep carious lesion in a primary molar. After caries removal, a small mechanical exposure of a vital, uninflamed pulp occurs. What is the best treatment?

Serial extraction

In a patient with severe crowding and good skeletal relations, a serial extraction approach might involve removal of:

ANB angle

A patient’s cephalometric tracing shows SNA = 82°, SNB = 76°. What is the ANB angle and what class of skeletal relationship does it suggest?

MIH vs fluorosis

A child presents with demarcated creamy-white to yellow-brown opacities on permanent first molars and incisors. The enamel is soft and may chip. The defects are localized to some teeth, not generalized. Which is the most likely condition?

Tell-Show-Do

Which behavior management technique is described by explaining a procedure in simple terms, demonstrating it on a model or finger, then performing it on the child?

Open bite etiology

A 10-year-old child has an anterior open bite and a history of prolonged thumb sucking. Which is the most likely primary etiologic factor?

Interproximal reduction

What is the main purpose of interproximal enamel reduction (stripping) in orthodontic treatment?

Fluoride varnish

Which statement about fluoride varnish is most accurate for managing high caries risk children?

Complicated crown fracture

A 9-year-old fractures a maxillary central incisor with exposed vital pulp but no root development completed. The tooth is immature with open apex; pulp is otherwise healthy. Best treatment?

Functional appliance timing

Functional appliances (e.g., Twin Block) to correct Class II due to mandibular deficiency are most effective when used:

Retainers after treatment

What is the main purpose of retention after orthodontic treatment?

ECC (early childhood caries) risk factor

Which behavior is most strongly associated with early childhood caries (ECC)?

Space loss after primary incisor loss

A 3-year-old loses both maxillary primary central incisors due to trauma. What is the typical impact on space?