Question 1

During a well child exam, the primary care pediatric nurse practitioner notes yellowish-white serpentine-bordered lesions on the anterior portion of a child's tongue. What will the nurse practitioner do?

Accepted Answer

These lesions are likely benign migratory glossitis (also known as geographic tongue), which is a common, harmless condition. Reassurance is the appropriate response as the condition is benign and usually asymptomatic.

Question 2

What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?

Accepted Answer

Giving the infant a cold teething ring or wet washcloth to chew is a safe and effective way to provide comfort to a teething infant. Administering oral ibuprofen or applying topical salicylates can increase the risk of toxicity and should be avoided. Applying topical anesthetics such as benzocaine or Baby Orajel can also be harmful and are not recommended by the American Academy of Pediatrics.

Question 3

An 18-month-old child has horizontal, bright white lines along the upper gum line of the teeth. What is the most important question the primary care pediatric nurse practitioner will ask the child's parents?

Accepted Answer

Horizontal white lines along the upper gum line of the teeth are a sign of milk fluorosis, which can occur when a child consumes too much fluoride during the enamel-forming years. The most common source of excess fluoride is from drinking fluoridated water and using fluoride toothpaste. However, if the child is still drinking milk from a bottle, particularly if the milk is mixed with fluoridated water or the child is using formula that is mixed with fluoridated water, this could be a significant contributor to the fluorosis. Therefore, asking about the child's milk consumption is the most important question to determine the cause of the white lines.

Question 4

A 5-year-old child is hit in the face with a baseball bat and is brought to the clinic by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment?

Accepted Answer

DImmediate referral to a dentist is crucial for a comprehensive evaluation and management plan, including the possibility of reimplantation of the avulsed teeth. Placing the avulsed teeth in saline helps preserve them for potential reimplantation, which is a time-sensitive procedure.

Question 5

A 9-month-old infant has developed two teeth since the 6-month checkup. The local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to promote healthy dentition at this visit?

Accepted Answer

Sodium fluoride varnish is recommended for infants and children at high risk for caries, such as those with a fluoride-deficient water supply or who are not receiving regular fluoride exposure from other sources.

Question 6

The parents of a formula-fed newborn report that they get their drinking water from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant?

Accepted Answer

Testing the fluoride level of the well water is necessary to determine if the water contains adequate fluoride levels for the infant's needs. If the water does not contain enough fluoride, the pediatric nurse practitioner can then recommend supplementing the infant's diet with fluoride drops or prescribing fluoride-fortified formula. Using bottled water to prepare the infant's formula may not provide adequate fluoride levels, and using powdered formula with added fluoride is not recommended for infants who already receive adequate fluoride from their water source.

Question 7

A 4-year-old child who has asthma has teeth with smooth, cupped-out teeth on the chewing surfaces. Which is the most likely explanation for this finding?

Accepted Answer

Gastroesophageal reflux can lead to dental erosion due to the frequent exposure of teeth to stomach acid. This can result in the smooth, cupped-out appearance of the chewing surfaces of the teeth.

Question 8

A 4-year-old child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish applications?

Accepted Answer

Children who have had extensive dental surgery to treat dental caries are at increased risk for developing new caries. Fluoride varnish is recommended every 3 to 6 months for children who are at high risk for caries. This will help prevent the formation of new caries and may also help remineralize existing white spot lesions.

Question 9

A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded with an erythematous halo and covered by yellow plaques. What will the primary care pediatric nurse practitioner recommend?

Accepted Answer

The answer of A child has several shallow mucosal lesions...

Question 10

What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child's teeth?

Accepted Answer

The American Academy of Pediatrics recommends using a smear of toothpaste (about the size of a grain of rice) for children under 3 years old, and brushing without rinsing to maximize the fluoride exposure. It is also important to supervise the child during brushing and not let them control the toothpaste amount, as they may swallow it. Choosing a toothpaste with a mint flavor is a personal preference and not necessary. Toothpastes containing whitening agents are not recommended for children under 12 years old.

Question 11

An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do?

Accepted Answer

The adolescent is exhibiting symptoms of temporomandibular joint disorder (TMD), which is often caused by muscle tension and clenching of the jaw. The recommended treatment includes rest, application of ice packs, NSAIDs for pain relief, and a soft diet to avoid further discomfort. Referring to a mental health specialist or orthodontist is not necessary at this point. Botox is not the first-line treatment for TMD and should only be considered after other conservative treatment options have been exhausted.

Question 12

A school-age child has had herpes stomatitis for a week and continues to report pain. What will the primary care pediatric nurse practitioner recommend?

Accepted Answer

Topical application of diphenhydramine and Maalox can help soothe the pain associated with herpes stomatitis by providing a protective coating and reducing discomfort.

Question 13

A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the primary care pediatric nurse practitioner recommend to promote dental health in this child?

Accepted Answer

Daily chlorhexidine gluconate rinses can help maintain dental health and prevent bacterial growth in the mouth, which can lead to dental caries and periodontal disease. Applying topical iodine, prescribing prophylactic antibiotics, and ordering medications to prevent drooling are not effective in promoting dental health and may have potential adverse effects.

Question 14

An adolescent has localized bleeding of the gums when brushing the teeth. An exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose. What will the primary care pediatric nurse practitioner recommend?

Accepted Answer

Localized bleeding of the gums in an adolescent with the presence of plaque and calculus can indicate gingivitis. The first line of treatment for mild gingivitis is consistently brushing and flossing the teeth twice daily to remove the build-up of plaque and calculus. Referral to an oral surgeon or rinsing with chlorhexidine gluconate would not be necessary at this time. Using xylitol-containing gum after meals may also be helpful, but it should not be the primary recommendation for treating gingivitis.

Quiz 23: Dental Health