Earn

3 CE credits
This course was
written for dentists,
dental hygienists,
and assistants.

Minimally Invasive Dentistry

for the Pediatric Patient
A Peer-Reviewed Publication
Written by Hershel Ellenbogen, DMD

Abstract Educational Objectives Author Profile

Over the past century, modern dentistry has made During this course the participant will:
great advances in scientific knowledge, specifically in 1. Recognize the specific principles and
pediatric dental care. New technology and materials philosophies of pediatric dentistry.
have allowed practitioners to continue development 2. Describe early caries assessment and
in both research and clinical forums. These include, but diagnostics.
are not limited to, minimally invasive diagnostics and 3. Identify characteristics of minimally
greater understanding in the treatment of children. invasive dentistry vs. traditional
restorative care.
4. Recognize psychological methods
and techniques for enhanced patient
comfort and anxiety reduction.
Dr. Hershel Ellenbogen DMD graduated from the Boston
University Goldman School of Dental Medicine and completed
a General Practice Residency at the Albany Medical Center
Hospital in Albany, NY. He has been in Private Practice for
over 25 years, as well as working in Hospital and Academic
settings. He is also currently a Clinical Instructor in the Dept.
of General Dentistry at Boston University.
Author Disclosure
Dr. Ellenbogen has no commercial ties with the sponsors or
the providers of the unrestricted educational grant for this
course.

INSTANT EXAM CODE 15139

Go Green, Go Online to take your course
Publication date: Sept. 2016
Expiration date: Aug. 2019
Supplement to PennWell Publications
PennWell designates this activity for 3 continuing educational credits.
Dental Board of California: Provider 4527, course registration number CA# 03-4527-15139
“This course meets the Dental Board of California’s requirements for 3 units of continuing education.”
The PennWell Corporation is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
program provider are accepted by the AGD for Fellowship, Mastership and membership
maintenance credit. Approval does not imply acceptance by a state or provincial board of
dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to
(10/31/2019) Provider ID# 320452.
This educational activity was developed by PennWell’s Dental Group with no commercial support.
This course was written for dentists, dental hygienists and assistants, from novice to skilled.
Educational Methods: This course is a self-instructional journal and web activity.
Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services
discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had
any input into the development of course content.
Requirements for Successful Completion: To obtain 3 CE credits for this educational activity you must pay the required
fee, review the material, complete the course evaluation and obtain a score of at least 70%.
CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products
or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.com
Educational Disclaimer: Completing a single continuing education course does not provide enough information to result
in the participant being an expert in the field related to the course topic. It is a combination of many educational courses
and clinical experience that allows the participant to develop skills and expertise.
Image Authenticity Statement: The images in this educational activity have not been altered.
Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents
the most current information available from evidence based dentistry.
Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the
data and information contained in reference section. The research data is extensive and provides direct benefit to the patient
and improvements in oral health.
Registration: The cost of this CE course is $59.00 for 3 CE credits.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by
contacting PennWell in writing.
Educational Objectives
At the conclusion of this educational activity participants will
be able to:
1. Recognize the specific principles and philosophies of
pediatric dentistry.
2. Describe early caries assessment and diagnostics.
3. Identify characteristics of minimally invasive dentistry vs.
traditional restorative care.
4. Recognize psychological methods and techniques for
enhanced patient comfort and anxiety reduction.
Abstract
Over the past century, modern dentistry has made great advances
in scientific knowledge, specifically in pediatric dental care. New
technology and materials have allowed practitioners to continue
development in both research and clinical forums. These include,
but are not limited to, minimally invasive diagnostics and greater
understanding in the treatment of children. Following the phi-
losophy that “no treatment is the best treatment,” dentists use
testing regimens such as the CAMBRA method and the Bacterial
Model to care for pediatric patients earlier and more consistently.
In addition, helping children who are anxious about receiving
dental care, will allow a more pleasant experience and allow the
treating dentist to work more efficiently.
Introduction
It has now been nearly 180 years since GV Black, the father of
modern dentistry, taught his groundbreaking techniques. His was
a time that heralded urbanization, development of new technolo-
gies, and codification of treatment modalities. During his lifetime
and the years that followed, dentistry moved into the modern age.
This included the realization that patients are individuals who
require unique evaluation and treatment. It took many decades
hence to realize that one group meriting special treatment was
children.
History of pediatric dentistry
As a specialty, pediatric dentistry has existed for nearly a cen-
tury. The International Association of Dentistry for Children
was established in 1925, and the American Society of Dentistry
for Children was established a year later.1 Although pediatric
dentistry was recognized as a specialty in 1940,2 it did not gain full
recognition until the mid-1960s. Patients of that era faced less-
than-ideal conditions, and many patients, especially children,
grew up highly anxious about receiving dental care.
Coinciding with the specialization of pediatric dentistry,
the entire dental field was undergoing a revolution. What we
now recognize as preventive care, by definition , preempts
the disease process. Composite restorations varied greatly
from the traditional GV Black cavity preparation philosophy
of extension for prevention, which included resistance, reten-
tion, and outline forms.3 New treatment models allowed the
pedodontist and general dentist to develop care that was gentler
2 www.DentalAcademyOfCE.com
for patients. This has come to include advanced nitrous oxide
delivery systems and sedation, as well as later-generation ad-
hesive dentistry that was more conservative and esthetic than
amalgam. While these components were developed over many
decades, they were signs that dentists realized the necessity to
treat pediatric patients (and patients in general) in a profoundly
different manner.
Minimally invasive dentistry (MID) or
microdentistry
Initially, the diagnosis and treatment of caries required the use of
a dental light, explorer, and radiograph followed by the removal
of decay and restoration of the cavity preparation. Over time, new
concepts and armamentaria were added, most notably near the
end of the 20th century. An expanding group of dental profession-
als started the MID (Minimally Invasive Dentistry) movement.
The objective of MID was to evaluate the conditions in the mouth
earlier and on a more regular basis in order to ascertain the extent
of problems and treat them as early as possible. It created new
systems that would diagnose and treat dental decay at its earliest
stages and improve patient care with the use of new medicaments.
The WCMID (World Congress of Minimally Invasive
Dentistry) was formed in 1999 by a group of concerned den-
tists, researchers, and educators committed to the concept of
minimally invasive care.4 The unwritten philosophy of the
organization was that the best restoration was no restoration at
all. Originally focused on treatment, The WCMID has shifted
its efforts toward accurate diagnosis and prevention. This new
model of diagnosis and management of disease risk has dra-
matically changed the practice of dentistry.
Bacterial model
Although there are nearly 300 kinds of bacteria in the oral cav-
ity,5 the microorganisms primarily responsible for the disease of
dental caries are Streptococcus Mutans and the Lactobacilli. When
harbored in oral biofilm and nourished by simple and complex
carbohydrates, acid levels rise and tooth structure is compro-
mised. In the past the only way to treat his process was to remove
damaged tooth structure and replace it with restorative materials.
However, that sole option is now one of many methodologies,
ranging from diagnostics to full intervention.
Today there are a number of assessment and diagnostic
tools and tests available to determine the presence of bacte-
rial types and the extent of their progress. The most well
known is the Caries Management by Risk Assessment model
(CAMBRA).6 Developed by the CAMBRA Coalition, the as-
sessment is helpful in diagnosing the amount and variety of
bacteria present in the oral cavity. When done properly, it is
an in depth evidence-based approach of where and how caries
grows. It can be divided into a variety of risk factors, includ-
ing age, diet, fluoride exposure, and socioeconomics, among
others.7 Once this evaluation has been completed, a damage
assessment can be made without waiting for further damage to
develop. The CAMBRA Coalition also works toward educat-
ing dentists in incorporating these systems, especially when
treating children.
Medicaments
When it is determined that the bacterial count in the oral cav-
ity has the potential to or begun to cause damage, such as the
ability to visualize early demineralization, microbial load must
be reduced and remineralization of the affected areas initiated.8
Remineralization now involves topical gels, varnishes, and rinses,
with the goal of reducing the acidity in the mouth, normalizing
pH levels, and providing enhanced protection of tooth structures.
Pastes that have anticariogenic properties and the ability to rem-
ineralize damaged tooth structure are now available including
Low-Fluoride Dentifrices, Casein Phosphopeptide, Amorphous
Calcium Phosphate, Casein Phosphopeptide-Amorphous Cal-
cium Phosphate Fluoride, and Arginine.
Anti-cavity products containing fluoride can be helpful
for patients with tooth sensitivity, acid erosion, or a high in-
cidence of dental decay.9 However, excessive fluoride intake
during tooth brushing has been a downside, especially with
younger patients. LFD (Low-Fluoride Dentifrices) have been
recommended for young children with the aim of minimizing
this intake. Yet, given the uncertainties surrounding the clini-
cal efficacy of such formulations, alternatives to increase their
anticaries effects have been investigated.10 Current results in-
dicate that clinical efficacy of LFD supplemented with TMP11
(trimetaphosphate) is superior to that observed for a conven-
tional formulation containing 1100ppm flouride, while the
addition of CaGP12 (calcium glycerophosphate) leads to similar
efficacy when compared to 1100ppm flouride. Children brush-
ing with 500ppm flouride toothpastes containing phosphate
salts developed fewer carious lesions when compared with those
using 1100ppm flouride dentifrice. The tested toothpastes can
be regarded as a safe alternative to conventional formulations
for children less than 6 years of age, based on risk-benefit con-
siderations.
CPP (Casein Phosphopeptide) and ACP (Amorphous
Calcium Phosphate) are naturally occurring molecules that
release calcium and phosphate ions. They have been success-
ful in reversing white spot lesions or other minor tooth dis-
coloration caused by lack of calcium.13 A study by Talaat and
Mahmoud evaluated the acid resistance of enamel subsurface
lesions treated with CPP-ACPF (Casein Phosphopeptide-
Amorphous Calcium Phosphate Fluoride).14 Fifty extracted
primary molars were immersed in a demineralizing solution
for 72 hours to produce subsurface enamel lesions. They were
sectioned in a buccolingual direction. One half of the sample,
the control group, remained untreated. The other sample half
was treated with the remineralizing agent CPP-ACPF. After
10 days, the sample was evaluated quantitatively using energy
dispersive x-ray spectroscopy. The treated samples were reim-
mersed into the demineralizing solution for 72 hours and the
www.DentalAcademyOfCE.com 3
mineral content reevaluated. The mean calcium content of
these samples was significantly higher than that of the control
group (P<.001) and higher than after the values determined at
the second demineralization. The mean calcium content of the
second demineralization was significantly higher than those
of the control group (P<.001). The conclusion was that CPP-
ACPF increased the resistance of enamel surfaces to further
demineralization.
Arginine, an amino acid, has also been found to aid in
enamel health. A study by Yamashita et al. found that when
treated with various combinations of arginine and/or fluoride,
enamel microhardness was significantly better than the other
treatment groups in the prevention of erosive surface damage,
attributed to the possible effect of the arginine associated with
fluoride.15 A separate study by Huang et al. tested the remin-
eralization efficacy of toothpaste containing 8% arginine and
calcium carbonate with other toothpaste groups on enamel
surfaces.16 The group treated with the 8% arginine and calcium
carbonate combination presented significantly greater remin-
eralization than the other toothpaste groups.
Caries Diagnostics
A major advance in caries diagnostics, especially in pediatric
care, is non-invasive, early detection of carious lesions. Previous
studies have demonstrated that the structural changes of enamel
due to demineralization and remineralization can be exploited
through optical imaging methods.17 These methods include laser
fluorescence, DIFOTI (Digital Imaging Fiber-Optic TransIl-
lumination), and optical coherence tomography, among others.
Despite some limitations in technology, these tools have proven
invaluable in diagnosing caries that was previously undetectable
by traditional means of visual exam, explorer, or radiographs.18
Modes of treatment: Conservative adhesive
dentistry
Sealants
MID was developed at the same time as improvements in adhe-
sive dentistry, and while treatment may be required, it need not
be aggressive. The most well known preventive procedure is the
placement of occlusal sealants. Once it has been determined that
there is no presence of decay in the pits and fissures, resin-based
materials can be successfully used to protect these areas.
Resin sealants used on occlusal tooth surfaces were intro-
duced in the 1960s for protecting pits and fissures from dental
caries. Although sealants have demonstrated their caries pre-
venting abilities, their efficacy may be related to the background
of caries prevalence in a given population. An evaluation of the
caries prevention of resin-based pit and fissure sealants and
glass ionomer cements or sealants in children and adolescents
was undertaken.19 It concluded that sealing with resin-based
sealants is a recommended procedure to prevent caries of the
occlusal surfaces of permanent molars.
Preventive resin restoration
By definition, a preventive resin restoration is the conservative
treatment of an active, asymptomatic carious lesion by topical ap-
plication of a caries-arresting or inhibiting medicament and with-
out mechanical removal of sound tooth structure. It is interesting
to note that this fairly new code specifically refers to conservative
treatment. (Established for CDT 2011.)
Primary Tooth Preparation
In situations where decay has penetrated the enamel and dentin,
minimally invasive procedures can be employed. For pediatric
care, several methods are available that remove the minimal
amount of healthy tissue. These include air abrasion, specialized
burs, and lasers. Conceptually, air abrasion has been around for
over 70 years, with the initial work being done in the 1940s by
Dr. Robert Black and formally brought to clinics in 1951.20 Due
primarily to technical issues and the simultaneous advent of the
high-speed handpiece, it lost favor for many decades. However,
air abrasion has gained a popular resurgence. Abrasives include
aluminum oxide powder and bioactive glass, among others. This
conservative technique is ideal for the removal of initial decalci-
fied enamel superficial layers and caries in deciduous teeth.21 In
addition, devices such as the disposable PrepMaster (Groman
Inc., Boca Raton, FL) has made this procedure simple, hygienic
and affordable.
In the early 1960s, research was underway in the use of lasers
for surgery of hard tissues in the oral cavity, specifically bone.
These early studies led to further devlopments with “the most
common dental lasers (identified) by acronyms associated with
how the laser light is produced. They include Diode, Nd:YAG,
Er:YAG, or CO2.”22 Coupled with easy-to-use handpieces,
in some cases with air and water for cooling, the sensation of
pain was eliminated in many cases making it ideal for treat-
ing pediatric carious lesions and pulpotomies. In the case of a
hard-tissue laser (Er:YAG), the interaction between the laser
and primary enamel and dentin depends on the composition of
the tissues—a higher presence of water and lower presence of
minerals—comparative to the permanent enamel and dentin.23
Thus, photoablation of primary enamel and dentin requires
lower energy. Studies have shown that the laser parameters
of the Er:YAG were efficient for the ablation of tissues of de-
ciduous teeth and demonstrated to be well accepted by young
patients.24
Bonding to Primary Teeth
Advances in adhesive therapy allow for simple, esthetic restora-
tions in the permanent dentition without the need to remove
healthy tooth structure. This is due to a low moisture/high min-
eral content in permamnent teeth. Primary teeth demonstrate the
opposite ratio a with high moisture/low mineral content. Thus,
traditional bonding methods and materials will demonstrate a
decreased ability to bond to primary teeth. Therefore, the use of
secondary retentive features should be made in the cavity prepa-
4 www.DentalAcademyOfCE.com
ration to increase bonding.25 A study of fifty pairs of anterior class
III carious teeth with mirror image lesions on their contralateral
proximal surfaces were selected.26 These teeth were prepared with
either a slot or a modified dovetail type of cavity preparation. The
patients were kept on recall to check the clinical characteristics
of the restorations at three, six, and 12 months. The criteria for
evaluation included marginal adaptation, anatomic form, surface
discoloration, and secondary caries. It was concluded that both the
slot and dovetail types of cavity preparations were equally effica-
cious when clinically reviewed for a period of 12 months. Hence
the use of the slot type of cavity preparation with reduced loss of
the tooth structure is indicated for class III cavities in primary
anterior teeth. In a separate study by Markovic and Peric,27 the
efficacy of tunnel preparations in primary molars restored with
glass-ionomer cement was clinically examined during a 36-month
period. They concluded that the tunnel preparation filled with re-
inforced restorative glass-ionomer cement is a suitable treatment
for minimal proximal caries lesions in primary molars.
Anxiety
It is estimated that nearly one-fifth of children experience anxiety
in the dental chair,28 thus, reducing or eliminating that stress is
vital. This enhances the visit experienced by the child and eases
stress for the dentist and his/her staff. It is crucial that the dentist
and staff develop a rapport with the patient, and parents. Inform-
ing children what to expect during their visit, to their level of
understanding, allows everyone to work through any difficulties
that may be encountered. Answering questions as they arise can
also be helpful. Often, positive reinforcement (such as offering
prizes) upon completion of the visit can prove successful.
Once most of the questions are answered, it is hoped that
patients will be much more relaxed and cooperative as treat-
ment begins. The Tell, Show, Do method as described by
Addleston in 195929 can give children more control of their
surroundings, increasing comfort and compliance. Another
key part of the treatment regimen may or may not involve the
parent. While many dental offices prefer that the parent stay in
the waiting room, this should not always be the case. Speaking
to the parent prepares them as well, and the office might even
provide them with a script to work from that can help to calm
their child (Figure 1).
Because the decay is often diagnosed at the hygiene appoint-
ment, the process of preparing the child for what to expect at
the restorative visit can begin immediately. During this initial
encounter, patients have completed an atraumatic visit, and the
dental team and parents should reinforce that impression in
that the restorative visit will be just as simple.
For patients who remain anxious, a series of distractions can
aid as well. Toys, balloons, puppets, dolls, and stuffed animals
can all help focus patients’ attention elsewhere so treatment can
begin. Many offices have monitors and other electronic viewing
in their operatories that help to distract the patient. In addition,
the positive reinforcement of a post-op visit trip to a prize filled
Figure 1: The following is a script that can aid the dental team.

When your child has a cavity

At this point, the treating dentist and/or staff have discovered that your child has developed a dental lesion of some sort.

Very often parents and children are not prepared for this news, and are confused about what will happen next. It is important to know that
thanks to advanced and updated treatment models, this is a very easily and comfortably treatable situation for your child (and you!).

As the parent, you are an important part of the treatment team, and you have a role to play before, during and after treatment to make this
a successful process.

Before During After

If you have any questions or concerns, speak
to the dentist and/or staff privately so that
you are as informed as possible. Although the
news will have already been shared during
the visit, please take the time to explain to
your child that a cavity has been discovered
and that there is a plan to treat it.
It is important that your child understand
that it is not their fault, but bacteria have taken
advantage of the opportunity to grow in their
mouth, and they will need to return to have
it treated. They should understand that this is
not something that they've done on purpose,
and that it is not uncommon, but also that this
can be treated quickly and comfortably. Please
do not use this as a time to chastise your child
for poor brushing habits or eating excessive
sweets – while this is something that should
be addressed, we do not want the child to
enter into the treatment situation feeling
badly or guilty.
It is important that parents use positive
language in explaining this to your child. Us-
ing technical words like restoration is a good
example. You may also suggest some “kiddie
words”… cavity bugs instead of bacteria
depending upon the age or awareness of your
child. Another example could be “sleepy juice”
instead of injection, needle, or anesthetic. We
do recommend staying away from language
such as hole or cavity, which might have
negative connotations.
Speaking to the child positively and
promptly will set a tone that this is “no big
deal”. It will also help counter any negative
stereotypes or misinformation that they might
encounter from the media, peers or family
members.
On the day of treatment, we are counting on When the procedure is complete, the staff will
you to reinforce in a positive way that this is not explain everything that you and your child
a difficult process. will need to know, for example; what kind of
We generally prefer to treat the patient restoration has been placed, how long to ex-
without a parent or guardian in the room; if pect the tooth to be numb (if local anesthesia
you feel that your presence will be helpful to was used), what if any kind of sensation will be
the process and your child, please make the expected later on, when eating or drinking can
treatment team aware of this. resume, and if follow up is required. Children
While you are in the room, we consider you have a tendency to play with or accidentally
part of the treatment team, which means that chew on the numb areas of the mouth. You
you must continue to reinforce the same posi- must monitor your child until the “puffy”
tive environment for the child as they have been sensation is gone.
experiencing until now. At that time, you will Once you and your child have left the
be advised where good spots are to stand or sit, office, please continue to reinforce that this
continued reinforcement of what to say, etc. experience was both necessary and positive.
Allow the treating staff to describe what will Should further treatment be required in
be happening and to answer any questions that the future, you will have helped to establish a
the child may have. solid foundation for your child to be relaxed
Please do not ask any questions or make and calm.
comments that may take your child, the team and
yourself "off message". If you have a question that
cannot wait until the procedure is over, ask to speak
to a staff member privately and outside the treat-
ment room. Positive remarks like “awesome job!”
or “you’re doing great!” are welcome; please refrain
from other types of comments such as “almost
done” or “that wasn’t so bad” or “be a big boy/girl”.
While some instances of dental decay are
small enough that they do not require the use
of an injection of anesthesia, many are not.
Allow the dentist to make that determination
without commenting. Observing the
administration of the anesthesia can be difficult;
please be sure you are prepared. Proper local
anesthesia will ensure that this process is as pain
free as possible for the child; we will establish a
means of communicating such as raising a hand
if they are not comfortable. Please do not try to
interpret other sounds or movements that the
child makes, as this could interfere with the trust
that the dentist has established with your child.

www.DentalAcademyOfCE.com 5
treasure chest is valuable. As discussed, MID techniques will
all help the dentist have an easier time of beginning treatment.
Once the child is relaxed, the dentist can quickly and efficiently
complete treatment. Atraumatic visits will make patients co-
operative in whatever dental offices they are treated, hopefully
throughout their lifetime.
Conclusion
We have now seen how assessment and treatment models devel-
oped throughout the history of dentistry have taken dental profes-
sionals to a point where patients can be treated quickly, easily, and
comfortably. These practices, techniques and methods benefit
our youngest patients. As these concepts become established in
dental school curricula and into common dental practice, a new
generation will continue to adapt them to the benefit of both prac-
titioners and patients.
References
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L®
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3. Steps of Cavity Preparation http://www.slideshare.net/
abhinavmudaliar9/steps-of-cavity-preparation pg10 accessed 07-04-
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4. WCMID History http://wcmid.com/about/history/ accessed 06-
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18. Mansour S, Ajdaharian J, Nabelsi T, Chan G, Wilder-Smith P.
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subjects. Lasers Surg Med. 2016 Mar 21.
19. Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä
M. Pit and fissure sealants for preventing dental decay in the
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20. Jingarwar MM., Bajwa NK., Pathak A. Minimal Intervention Dentistry
– A New Frontier in Clinical Dentistry. J Clin Diagn Res. 2014 July;
8(7): ZE04–ZE08.
21. Eshghi A, Khoroushi M, Rezvani A. Resin bonding using etch-
and-rinse and self-etch adhesives to decalcified deciduous enamel
after bioactive glass air abrasion. J Contemp Dent Pract. 2014 Sep
1;15(5):595-602.
22. Jablow M. Laser technology overview for general dentists. Dentistry
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overview-for-general-dentists.html Accessed July 22, 1916
23. Murdoch-Kinch CA, McLean ME. Minimally invasive dentistry.
JADA. January 2003 Volume 134, Issue 1, Pages 87–95
24. Zhegova G, Rashkova M, Rocca JP. Minimally invasive treatment of
dental caries in primary teeth using an Er:YAG Laser. Laser Ther. 2014
Dec 27; 23(4): 249–254.
25. Rathnam A, Nidhi M, Shigli AL, Indushekar KR. Comparative
evaluation of slot versus dovetail design in class III composite
restorations in primary anterior teeth. Contemp Clin Dent. 2010
Jan;1(1):6-9.
26. Markovic D, Peric T. Clinical evaluation of glass-ionomer tunnel
restorations in primary molars: 36 months results. Aust Dent J. 2008
Mar;53(1):41-5.
27. Zhegova G, Rashkova M, Jean-Paul Rocca JP. Minimally invasive
treatment of dental caries in primary teeth using an Er:YAG Laser.
28. Pop-Jordanova N, Sarakinova O, Markovska-Simoska S, Loleska S.
Anxiety and personality characteristics in children undergoing dental
interventions. Pril (Makedon Akad Nauk Umet Odd Med Nauki).
2013;34(3):93-103.
29. Maru VP, et al. Behavioral changes in preschoolers treated with/
without rotary instruments. J Int Soc Prev Community Dent. 2014
May-Aug; 4(2): 77-81
Author Profile
Dr. Hershel Ellenbogen DMD graduated from the Boston
University Goldman School of Dental Medicine and completed a
General Practice Residency at the Albany Medical Center Hos-
pital in Albany, NY. He has been in Private Practice for over 25
years, as well as working in Hospital and Academic settings. He
is also currently a Clinical Instructor in the Dept. of General Den-
tistry at Boston University.
Author Disclosure
Dr. Ellenbogen has no commercial ties with the sponsors or the
providers of the unrestricted educational grant for this course.
 Online Completion INSTANT EXAM CODE 15139
Use this page to review the questions and answers. Return to www.DentalAcademyOfCE.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete
the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your answers.
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Questions
1. The American Society of Dentistry 11. The CAMBRA model 22. The method for guiding patient
for Children (ASDC) was founded a. Diagnoses disease risks
b. Manages disease risks behavior as described by Addleston
in what year? c. Both a and b in 1959 was
a. 1914 d. None of the above
b. 1926 a. See one, teach one
c. 1933 12. The primary microorganism b. Tell, show, do
d. 1945 responsible for the cause of dental c. Eeny, meeny, miney, mo
2. The ADA recognized pediatric decay is d. None of the above
dentistry as a specialty in what year? a. Streptococcus mutans
b. Staphylococcus aureus 23. The CAMBRA Coalition is not
a. 1927
b. 1935 c. Lactobacillus acidophilus a. A study club of dentists in Australia
c. 1948 d. None of the above b. A group of dentists in the US teaching the aspects
d. 1955 13. There are how many forms of of MID to dentists
c. A group of dentists incorporating MID into dental
3. Some of GV Black’s steps of cavity bacteria in the oral cavity?
a. Too many to count accurately school curricula
preparation include d. None of the above
a. Outline form b. Numbers vary among different population groups
b. Resistance form c. Nearly 300
c. Retention form d. All of the above 24. Goals of remineralization include
d. All of the above a. Balancing pH levels
14. The Bacterial Model is helpful in
a. Diagnosing the amount and variety of bacteria b. Reducing the acidity in the mouth
4. Extension for prevention refers to c. Providing enhanced fluoride for dental caries
a. Preventing recurrence of caries at the margins of the present in the oral cavity
tooth b. An in depth evidence-based approach of where and protection
b. The minimally invasive model how caries grows d. All of the above
c. a and b c. Being divided into a variety of categories
d. None of the above d. All of the above 25. Sodium fluoride 1.1% products can
5. Later generation adhesive dentistry 15. Recaldent be helpful for patients with
a. Is a milk derived protein a. Tooth sensitivity
has become b. Releases calcium and phosphate ions
a. More difficult to handle c. Can remineralize early breakdown of tooth b. Acid erosion
b. More conservative structure c. A high incidence of dental decay
c. More attractive then amalgam d. All of the above d. All of the above
d. b and c
16. The Diagnodent 26. The first air abrasion units were
6. Minimally Invasive Dentistry is also a. Is a laser-based caries detection system
known as b. Can diagnose caries through any type of restoration marketed in
a. Conservative prep form c. Is a transillumination system a. 1940
b. Microdentistry d. a and b b. 1951
c. MID
d. b and c 17. Slot preparations require c. 1984
a. Tooth reduction of approximately 1.5 mm of tooth d. 2006
7. The objective of MID is to structure
a. Manufacture smaller instruments b. Undercuts 27. The Er:YAG laser was approved
b. Diagnose and treat dental decay at a much earlier c. Extension into pits and grooves
stage d. None of the above for use
c. Improve patient care with the use of new medica- a. To cut into soft tissue
tions and equipment 18. The term for vibration of the bur is b. To remove tooth decay
d. Both b and c a. Chop
b. Wash c. To cut into bone
8. The World Congress of Minimally c. Chatter d. Both a and c
Invasive Dentistry was formed in d. None of the above
a. 1986 28. Dentist and staff members must
19. Originally lasers were tested in
b. 1997
dentistry using develop a rapport
c. 1999 a. With the patient
d. 2004 a. Er:YAG
b. Ruby b. With each other
9. The unwritten philosophy of the c. ytterbium c. With the parent
the World Congress of Minimally d. None of the above d. All of the above
Invasive Dentistry is 20. The Er:YAG laser was approved
a. The smaller, the better 29. Decay is usually diagnosed
for use by the FDA in a. When the patient presents in pain
b. The best restoration is no restoration at all a. 1978
c. Maximum results with minimal care b. 1997 b. By the parent
d. None of the above c. 2001 c. During the routine hygiene visit
10. The World Congress of Minimally d. 2010 d. None of the above
Invasive Dentistry has now shifted 21. What percentage of children feel 30. The laser handpiece utilizes
efforts toward dental anxiety? a. Air for cooling
a. Dental care for children only a. 10%
b. Accurate diagnosis and prevention b. 20% b. Water for cooling
c. Late stage treatment c. 40% c. a and b
d. All of the above d. 60% d. Neither a nor b

www.DentalAcademyOfCE.com 7
INSTANT EXAM CODE 15139 ANSWER SHEET

Minimally Invasive Dentistry for the Pediatric Patient

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