Download Introduction to peadiatric dentistry

Introduction to pediatric
dentistry
Pedo
• caries and associated diseases, periodontal
diseases, orthodontic diagnosis
• Works hand in hand with prevention
• Certain theories there is only one kind of
treatment for teeth doesn't matter in what
dentures
• But! Diseases in childhood may persist and
influence the ones in adulthood
Why is it important
•
•
•
•
0- 18 years
Dynamic and rapid development
Psychology!
Different diseases different sign and
symptoms than in adulthood (circular caries,
baby bottle caries, EEC
• Materials adverse reactions!
Associations
• (untreated tooth) gingivitis- pain when
chewing – soft diet – caries –gingivitis
• Caries-orthodontics – crowding- dental
plaque- caries. Caries – early extraction crowding
Importance
• caries continues to be a major problem all
over the world
• 5-6 years: only 27% healthy
• 12 year: caries prevalence „moderate” (DMFT 3.8)
• Northeast Hungary. – 7years DMF-T – 0.32
(0.17 national)
• 12 years DMF-T 4.26 (3.8)
• Oral health for infants, children plays a very
important part in the overall health.
• Caries and periodontal disease remain in
varying degree very important throughout the
world.
• Extremely important that all dentist be
prepared to deal with the most common oral
problems encountered in the pediatric
population
• Good- patient doctor relationship
• Good parent –doctor relationship
• The role of the dental assistant is very, very
important
• TEAM WORK
• Most oro-facial disorders in children have
developmental basis
• Lesions or conditions may be present at birth,
or become evident soon after.
• They may appear, change character or arrest
and regress as growth proceeds.
• Certain diseases are inherited and others may
be acquired from parents, siblings or other
children
• Although we may not know the precise cause
of many conditions, we do know how to
manage them- often in close cooperation with
pediatric medical and surgical colleagues.
• Today however, pediatric dentistry also
emphasizes prevention
• Pediatric dentistry is the most complex
field of dentistry!
To be a complete clinician capable of handling
the majority of needs of children, a dentist( or
dentists!) will need to know restorative
dentistry, endodontics, oral surgery,
preventive and interceptive orthodontics, the
principle of prosthodontics
• In addition the dentist needs to know certain basics
in pediatric medicine, general and oral pathology,
and growth and development, understanding the
children emotional and psychological needs and
processes of emotional change and social
maturation.
• The child has to be managed differently than the
adult, and in fact, the modes of management are
extremely age related!!!!!!
• To treat children properly requires a lot of
knowledge about age groups; the main
characteristics, development, most frequent
diseases etc..
• Therefore it is helpful to become acquainted
with certain developmental milestones in the
life of the child
• The most dramatic period in growth is the 2-5
month intrautery and the first year of life,
during which most children will undergo a
50% increase in length and almost a 200%
increase in weight.
• Infant and childhood fears are important
Fear of strangers is almost a universal finding after 7-12
month of age. Another very common fear in this age
group is a fear upon separation from the parents.
This fear starts around 6 month of age, peaks
between 13 and 18 month of life and than declines.
• The child’s first visit to the dentist should occur no
later than 12 month of age.
• The examination of the infants and toddler centers
around three major objectives:
Prevention: diet, tooth cleaning, fluoride
Introduction: develop a positive attitude toward
dentistry
Oral assessment: inspection of the oral cavity
Clinical examination
• The clinical examination should follow a logical
sequence:
–
–
–
–
Biographic data, family and social history (caries risk)
Perinatal, natal, neonatal history (dental anomalies)
Developmental history –eruption
Medical history (frequent episodes of ottitis media,
antibiotic, systemic disorders)
– Dental history-trauma, teething difficulties, oral habits
– Feeding history- bottle, duration…
3-6 years
• A variety of bodily changes take place.
– Heart rate, respiration rate slow down
– Blood pressure rises
– Whole body become more calcified and harder
(increased incidence on fracture)
– Mind and mental prowess developing (symbolic
thinking)
– Development of self-control
– Concentration improves
• Of particular interest in the examination of the
3-6 year-old are the following:
– Lack of an existing history
– No clinical baseline data
– Behavioral unknowns
– Unknown preventive needs
Patient record
• The bare essentials for a pediatric dental record are a
health history, examination record, treatment plan
and a series of visit notes.
• Adjunctive records, such as study casts and
preventive and dietary forms or analysis also should
be kept with the record
• NO CLEAR-CUT GUIDELINES exist for choice of a
pediatric dental tooth chart, but some basic
requirements exist from a medico-legal standpoint
and from the standpoint of providing a
developmental history.
Patient record
• It is critical that the charting system address
both primary and permanent teeth
• In addition, presence or absence of a tooth,
restorations, abnormalities.
• Periodontal probing of all teeth in not a
routine
• Other helpful items on the examination record
are vital signs, medical alerts, behavior notes
and unusual findings.
Patient records
• The parent or guardian is the historian for the
child. Parents may provide wrong diagnoses,
so dentist better discuss these problems
directly with the physician to obtain accurate
information (general health history)
• A dental history should minimally cover past
problems and care, current hygiene habits and
eruption-developmental profile
7-14 years
• The dentition of the child in the transitional
years will go from a full complement of
primary teeth, through a mixed dentition, to a
full adult set of teeth. Dental management of
this group is as follows:
– Preventive considerations related to tooth sealant,
nutrition, fluoride
– Prevention and management of trauma
– Orthodontic anomalies
7-14 years
• Health history
– Personal history (name, age, sex, school, parents name,
telephone number..)
– Medical history. The name and address of the child’s
physician are important. The investigation must include,
but not be limited, allergic or unfavorable reactions to any
medication; rheumatic fever, heart problems, anemia,
bleeding problems, birth defect, seizures, asthma,
hepatitis, diabetes, kidney disease, neurological problems,
trauma, bone-joint problems, speech difficulties,
emotional and learning difficulties.
Dental history
• The most important question asked by the dentist
will involve the explanation of why the patient is
seeking dental care! The response to this question
can significantly influence the selection of future
behavior management modalities.
Furthermore, if the parent (or child) was not satisfied
with the previous care, the knowledge of what
caused the dissatisfaction may lead to better dentistchild-parent relationship.
Dental history
• Other features of a relevant dental history
would include history of oral trauma and any
oral habits such as lip, finger, thumb or
blancet sucking, nail and cheek biting, tonge
thrusting, mouth breathing, jaw popping or
clicking and teeth grinding.
• Home dental care. This section would include
information on the child’s fluoride history, oral
hygiene dietary habits
• Social and behavioral history.
Dental record
• The patient’s dental record provides an
accurate overview of the patient’s
involvement in the dental care system
• Initial oral status
– Occlusal: the developing occlusion and growth
and development of the orofacial complex are
assessed.
– Hard tissue: dental caries and any hard tissue
abnormalities are evaluated
• Soft tissue: The initial oral hygiene should be
recorded with plaque and gingivitis scores or
indices
• Radiographic examination: Radiograph
enables the diagnosis of dental caries, sequela
to dental caries, oral pathoses and other
anomalies.
• Laboratory studies: if needed
• Consultation with other health providers,
both verbal and written
• Diagnosis and treatment plan:
– A logical step-by-step process
– Means to prioritize the need of the patient
• In addition the following should be charted:
– Poor parent-patient conduct, including frequent
missed appointments, chronically poor oral
hygiene
– Use of appropriate methods of behavior
modification, including any specific method and
the result ( tell-show-do, voice control, hand over
mouth, conscious sedation, general anesthesia)
TOOTH ERUPTION
• There are several possible explanation.
• While normal variation on this pattern will
produce the differences that occure between
individuals
• The sequence – the order in which the teeth
erupt- is more important than the age at
which they erupt.
• Premature eruption may be a familiar feature and
children with high birth weights and with
endocrinological abnormalities tend to erupt their
teeth earlier
• Delayed eruption. There are number of conditions
associated with generalized retarded eruption
(chromosomal abnormalities, Down sy, Turner sy,
hypothydroidism, hypopituitarism, hereditary
gingival hyperplasia)