Question 1

During a well child exam, the primary care pediatric nurse practitioner notes
yellowish­white serpentine­bordered 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

A 5­year­old 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

The recommended treatment is to refer the child to a dentist immediately for further examination. The avulsed teeth may be able to be reimplanted if done within a certain time frame and with proper technique. Delaying treatment or improper handling of the teeth can greatly decrease the chance of successful reimplantation. The dentist will also be able to assess any further damage to the teeth or surrounding structures and provide appropriate treatment. The use of tetracycline is not indicated in this situation and removing the teeth without attempting to reimplant them should only be a last resort.

Question 3

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 promote dental health in children receiving all nutrition via gastrostomy tube. Topical iodine is not recommended for dental health, and medications to prevent drooling or prophylactic antibiotics are not necessary for this purpose.

Question 4

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 (TMJ) disorder, which can be managed with conservative measures such as ice packs, NSAIDs, and a soft diet. Referral to a mental health specialist, orthodontist for surgical intervention, or Botox injection treatments are not necessary at this time.

Question 5

A 4­year­old child who has asthma has teeth with smooth, cupped­out teeth on the chewing surfaces. Which is the most likely explanation for this finding?

Accepted Answer

Gastroesophageal reflux can cause erosion of the teeth on the chewing surfaces due to the acid from the stomach. Bruxism is grinding or clenching of teeth, which may cause flattened or worn down teeth. Bulimia may cause erosion of the enamel on the back surfaces of the teeth due to stomach acid, but it is unlikely in a 4-year-old child. Decreased saliva may also contribute to dental erosion but would not likely result in specifically cupped-out teeth on the chewing surfaces.

Question 6

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 that parents use a smear or grain of rice-sized amount of toothpaste on a soft-bristled toothbrush to clean their infant's teeth. It is not recommended to rinse the mouth after brushing as this may wash away the fluoride in the toothpaste that helps prevent cavities. The infant should not be allowed to control the amount of toothpaste used as they may ingest too much fluoride, which can lead to fluorosis. Mint-flavored toothpaste may be too strong for an infant's palate and there is no need for a toothpaste with whitening agents at this age.

Question 7

A school­age child has had herpes stomatitis for a week and continues to
complain of 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 numbing effect.

Question 8

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 an infant a cold teething ring or wet washcloth to chew on can help soothe their sore gums and provide relief during the teething process. It is important to avoid using oral analgesics, such as ibuprofen or salicylates, as they can have harmful side effects in infants. Similarly, topical anesthetics such as benzocaine should be avoided due to the risk of methemoglobinemia. Baby Orajel and other similar products should also be avoided as they have been linked to serious adverse events in young infants.

Question 9

An 18­month­old 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

The presence of horizontal bright white lines along the upper gum line of teeth in an 18-month-old child indicates enamel hypoplasia, which is commonly caused by the excessive intake of fluoride. This can occur if the child is still drinking milk from a bottle that is prepared with fluoridated water. Therefore, the most important question the primary care pediatric nurse practitioner will ask the child's parents is if the child is still drinking milk from a bottle.

Question 10

A 4­year­old 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 and have white spot lesions on primary teeth should receive fluoride varnish every 3 to 6 months to prevent further decay and remineralize the teeth.

Question 11

A parent asks about ways to promote dental health in school­age children while
on a family vacation that are convenient while camping and picnicking. What will the primary care pediatric nurse practitioner recommend?

Accepted Answer

Offering gum containing xylitol after meals can help promote dental health by stimulating saliva production, which neutralizes acid and helps wash bacteria off teeth. Xylitol also has anti-bacterial properties and can help prevent the formation of cavities. It is also convenient for camping and picnicking. Fluoride varnish treatments and chlorhexidine gluconate oral rinses are not convenient options for a vacation and fluoridated water may not be readily available.

Question 12

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 description of the lesions suggests a possible diagnosis of oral herpes (herpetic gingivostomatitis). Oral acyclovir is the recommended treatment for herpes and can help alleviate symptoms and reduce the duration of the outbreak. Chlorhexidine gluconate may be used to help prevent secondary bacterial infections, but it will not treat the primary cause of the lesions. Diphenhydramine and Maalox may provide symptomatic relief for pain, but they will not treat the underlying infection. Topical antiviral medications are not typically used for herpetic gingivostomatitis in children.

Question 13

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 with the presence of plaque and calculus suggest gingivitis, which is inflammation of the gums caused by poor oral hygiene. Therefore, the primary care pediatric nurse practitioner will recommend consistently brushing and flossing the teeth twice daily to improve oral hygiene and reduce gingivitis. Referral to an oral surgeon or the use of chlorhexidine gluconate or xylitol-containing gum after meals are not necessary for mild gingivitis.

Question 14

A 9­month­old infant has developed two teeth since the 6­month 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

The answer of A 9­month­old infant has developed two teeth...

Question 15

The parents of a formula­fed 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 their water source is the best recommendation as it will provide information about the fluoride content in their drinking water. Based on the results, the pediatric nurse practitioner can then make an informed decision about the need for fluoride supplementation or using alternative sources of water for the infant's formula.

Quiz 34: Dental and Oral Disorders

During a well child exam, the primary care pediatric nurse practitioner notes yellowishwhite serpentinebordered lesions on the anterior portion of a child's tongue. What will the nurse practitioner do?

A 5yearold 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?

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?

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?

A 4yearold child who has asthma has teeth with smooth, cuppedout teeth on the chewing surfaces. Which is the most likely explanation for this finding?

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

A schoolage child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?

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

An 18monthold 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?

A 4yearold 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?

A parent asks about ways to promote dental health in schoolage children while on a family vacation that are convenient while camping and picnicking. What will the primary care pediatric nurse practitioner recommend?

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?

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?

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

The parents of a formulafed 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?

Quiz 34: Dental and Oral Disorders

During a well child exam, the primary care pediatric nurse practitioner notes yellowish­white serpentine­bordered lesions on the anterior portion of a child's tongue. What will the nurse practitioner do?

A 5­year­old 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?

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?

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?

A 4­year­old child who has asthma has teeth with smooth, cupped­out teeth on the chewing surfaces. Which is the most likely explanation for this finding?

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

A school­age child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?

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

An 18­month­old 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?

A 4­year­old 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?

A parent asks about ways to promote dental health in school­age children while on a family vacation that are convenient while camping and picnicking. What will the primary care pediatric nurse practitioner recommend?

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?

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?

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

The parents of a formula­fed 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?

During a well child exam, the primary care pediatric nurse practitioner notes yellowishwhite serpentinebordered lesions on the anterior portion of a child's tongue. What will the nurse practitioner do?

A 5yearold 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?

A 4yearold child who has asthma has teeth with smooth, cuppedout teeth on the chewing surfaces. Which is the most likely explanation for this finding?

A schoolage child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?

An 18monthold 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?

A 4yearold 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?

A parent asks about ways to promote dental health in schoolage children while on a family vacation that are convenient while camping and picnicking. What will the primary care pediatric nurse practitioner recommend?

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

The parents of a formulafed 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?