Dental Questions for the CPN Exam — Practice Free

According to current standards, the first dental visit should occur within 6 months of the eruption of the first tooth or by 12 months of age, whichever comes first. CPN Exam Strategy: PNCB emphasizes early prevention. Distractors often include 3 years (old standard) or when all primary teeth erupt. Early visits allow for risk assessment, fluoride varnish application, and education on avoiding Early Childhood Caries (ECC). Early intervention is key to establishing a dental home.

The priority is to reimplant the tooth immediately if possible. If not feasible, store the tooth in a physiologic medium: Hank’s Balanced Salt Solution (HBSS), cold milk, or the patient's own saliva (if the child is old enough not to swallow it). Key Steps: 1. Handle by the crown only (do NOT touch the root/periodontal ligament). 2. Rinse gently with saline/water if dirty; DO NOT scrub. 3. Reimplant and have the child bite on gauze. 4. Seek dental care within 30-60 minutes. CPN Tip: Primary teeth (baby teeth) are NEVER reimplanted as it may damage the underlying permanent bud.

The nurse must advise against the use of topical numbing gels containing Benzocaine or Lidocaine, as well as homeopathic teething tablets containing Belladonna. Rationale: Benzocaine can cause methemoglobinemia, a rare but fatal condition where oxygen-carrying capacity is reduced. Homeopathic tablets have shown inconsistent levels of belladonna, leading to toxicity. Recommended Interventions: Chilled (not frozen) teething rings, clean wet washcloths, or appropriate doses of acetaminophen/ibuprofen if the child is over 6 months.

The patient should receive Amoxicillin (50 mg/kg) orally 30-60 minutes before the procedure. If allergic to penicillin, use Cephalexin, Azithromycin, or Clindamycin (per latest AHA/AAP guidelines). CPN Context: Prophylaxis is indicated for patients with: 1. Prosthetic heart valves. 2. Previous infective endocarditis. 3. Certain congenital heart diseases (unrepaired cyanotic, or repaired with prosthetic material for 6 months post-op). 4. Cardiac transplant with valvular regurgitation. Note: Routine cleanings/fillings generally do not require prophylaxis unless gingival manipulation is significant.

When the ANC is <500/mm³ or platelets are <20,000/mm³, the nurse should switch from a standard toothbrush to soft foam swabs or toothettes and avoid flossing. Rationale: Patients with severe neutropenia and thrombocytopenia are at high risk for spontaneous gingival bleeding and systemic infection (sepsis) from oral microbes entering the bloodstream via micro-trauma from brushing. Clinical Pearl: Use saline or sterile water rinses. Avoid alcohol-based mouthwashes which dry the mucosa and increase the risk of mucositis.