Transcript Chapter_057x

Chapter 57
Pediatric Dentistry
**With Recall**
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The Pediatric Dentist
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A pediatric dentist will continue his or her
education for an additional 2 to 3 years after
dental school
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The program of study and hands-on experience
prepares the specialist to meet the needs of
infants, children, adolescents, and persons with
special healthcare needs
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The Pediatric Patient
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Chronologic age
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Mental age
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The child’s actual age in terms of years and
months
The child’s level of intellectual capacity and
development most important
Emotional age
The child’s level of emotional maturity
Recall #1: Would it be possible to see a 21 y/o
patient in a pedo office?
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The Pediatric Dental Office
Treats patients from infants through adolescents as
well as special needs
 Display cheerfulness in a pleasant environment with
a nonthreatening décor
 Treatment areas are designed with an open-bay
concept in mind
 Dental personnel dress in bright coordinating colors
Recall # 2: What is unique about the treatment
setting of a pediatric office?
Recall # 3: What types of patients are seen in a
pediatric dental office?
Recall # 4: Is it possible for a child to be 10 years
old but act 7? If so, what are you describing about
this patient?
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Age & Behavior Management
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The initial examination is important for both the child
and the dental team
Children begin to want control and structure ages 3-5
(“play age”)
The rapport developed during the initial examination
can establish an attitude toward dental health that will
last for a child’s lifetime
Many dentists will follow a behavior scale early in the
treatment of a pediatric patient ** pg 980**
Recall # 5: What developmental stage to children
first want control and structure of their
environment?
Recall # 6: How would Dr. Frankl describe a
“positive” child? (pg 980)
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Guidelines for Child Behavior
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Be honest with the child
Consider the child’s point of view
Use “tell, show, do”
Give positive reinforcement
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The Challenging Patient
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Sedation
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Nitrous oxide–oxygen
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This is prescribed to calm the patient and put him
or her at ease before treatment
This method of mild sedation can help calm a
patient for treatment
Physical restraint
Restraints are used to prevent injury to the child
and dental team
Recall # 7: When would a “papoose” board be
used? (bottom right pg 980)
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Patients with Special Needs
Severely to profoundly mentally challenged
children and adults typically undergo dental
treatment under general anesthesia in the
operating room of a hospital. Patients have
limited IQ and adaptive skills.
 Moderately mentally challenged patients may
require sedation or treatment under general
anesthesia.
Recall #8: What types of skills are limited in
a mentally challenged patient?
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Down Syndrome (Trisomy 21)
Eruption of teeth may be delayed, with the primary
incisors not erupting until after 1 year of age.
 Teeth may be small and peg-shaped, often with
malocclusion.
 Periodontal problems are common because of
malaligned teeth, mouth breathing, or poor dental
care at home.
 The forward position of the mandible and
underdeveloped nasal and maxillary bones do not
provide sufficient space for the tongue. The resulting
open-mouth, forward-tongue position gives the
appearance of an enlarged tongue.
Recall # 9: What is another term for Down
Syndrome?
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Autism
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A developmental disorder that affects how
information is processed in the brain by altering
how nerve cells and their synapses connect and
organize
The patient may exhibit behavioral problems with
management difficulties
Patients who have autism have a known desire
for sweet foods and generally have poor oral
hygiene which puts them at an increased risk for
decay and periodontal disease
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Cerebral Palsy
This nonprogressive neural disorder is caused by brain
damage that occurred prenatally, during birth, or
postnatally before the central nervous system reaches
maturityhe two most
 Oral hygiene in most patients with cerebral palsy is poor, in part
because of the nature of their disease and the resultant physical
limitations.
 The patient and the caregiver should receive a thorough
orientation to a home care program, with modifications as
necessary to meet the patient’s special needs.
 Frequently an electric toothbrush can be used effectively.
Special adaptations of toothbrush handles and other aids to
hygiene also may be helpful
Recall # 10: Would it be common to treat a patient with
cerebral palsy in a wheelchair? If so, why?
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Diagnosis and Treatment Planning
First appointment should take place around
first birthday
 Regular exams begin at age 2
 Parental consent must be given before any
dental care is provided for persons under 18
Recall # 11: When should a child first see
the dentist?
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Medical and Dental History
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Past hospitalizations and surgeries
Date of the child’s last visit to a physician
Medications, daily medications
Unfavorable reactions to any medicine; allergies
Weight at birth and any problems at birth
Level of learning
Main concern about the child’s dental health
Finger, thumb, and pacifier habits
Fluoride and toothbrush habits
Inherited family dental characteristics
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Initial Clinical Examination
Radiographic imaging (to be taken every 6
months for patients at high risk for caries)
 Extraoral examination
 Intraoral soft tissue examination
 Examination and charting of teeth
Recall #12: If a patient is at a high risk for
decay, how often should radiographs be
taken?
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Preventive Dentistry for Children
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Oral hygiene
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Fluorides
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Efforts are geared to improving a child’s brushing
and flossing technique
Children between the ages of 6 months and 16
years should take in fluoride daily
Fluoride varnish is being used for caries
prevention on a routine basis
Diet
Review the specific nutrients a child needs to grow
Recall # 13: Would fluoride varnish be used on a
child?
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Sealants
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Orofacial development
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These are applied to pits and fissures to help keep
them cavity-free
Malocclusions, crowded or crooked teeth, and bite
problems must be identified, and the dental staff must
intervene (Ex. Appliance to stop thumb sucking as
preventative orthodontics)
Sports safety
Protective equipment should be worn during any
recreational sport that might injure the mouth area
Recall #14: What procedure is recommended for
children to protect the pits and fissures of posterior
teeth?
Recall #15: Is an appliance that is used to stop a
patient from sucking the thumb considered
interceptive or preventative orthodontics?
Recall # 16: As a swimmer, should you wear a mouth
guard?
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Pediatric Procedures
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Restorative procedures
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Endodontic procedures
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Instrument size
Matrix system (T-band and spot-welded)
Pulpotomy
Prosthodontic procedures
Stainless steel crown
Recall # 17: What types of matrices are commonly
used on primary teeth?
Recall #18: What endodontic procedure would most
likely be done on a primary tooth?
Recall #19: Would a child be referred to a
prosthodontist for placement of a stainless steel
crown?
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Dental Trauma
Fractured anterior teeth
 Traumatic intrusion
 Extrusion and lateral luxation injuries
 Avulsed teeth
Recall #20: Which teeth are injured most
frequently?
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Fractured Anterior Teeth
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Documentation of the accident includes:
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Clinical examination
Radiographs
Vitality testing
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Fractured Anterior Tooth
Courtesy Dr. Frank Hodges, Santa Rosa, CA.
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Avulsed Teeth
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A tooth is torn away or dislodged completely
by force
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Recover the tooth immediately
Wrap the tooth in a moistened gauze
Go immediately to the dentist's office
Recall #21: What happens when a tooth is
avulsed?
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Avulsion of Maxillary Central Incisors
Courtesy Dr. Frank Hodges, Santa Rosa, CA.
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Extrusion and Lateral Luxation
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Teeth are displaced from their position,
causing damage to the periodontal ligament
Displaced teeth are repositioned
 Often time a splint is used to stabilize teeth while
the heal
Recall # 22: How would a dentist stabilize a tooth
after an injury?
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Child Abuse
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Child abuse must be suspected when:
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Injuries are in various stages of healing
Teeth are chipped or injured
The child has scars inside the lips or on the tongue and
tears of the labial frena
The child exhibits battering or other injuries around the
head and neck
Facial bruises, swelling of the facial structures, or black
eyes are evident
The child has bite marks
Injuries are not consistent with the explanation
presented by the parent
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Child Abuse
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Recall # 23: Are you as a DA legally
required to report child abuse?
Recall # 24: Could a fractured or broken
nose be a result of child abuse?
Recall # 25: Who in the dental office
should report child abuse (and is legally
required to do so)?
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