Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

Introduction to pediatric dentistry

The recommended book is: Paediatric dentistry for Welbury, 4th edition

Lecture outline:

1 .Definition of pediatric dentistry.

2 .Aims of pediatric dentistry.

3 .Functions of primary teeth.

4 .Scope of pediatric dentistry.

5 .Examination and treatment planning.

What is pediatric dentistry?

It covers all teeth during infancy and childhood until adulthood.

Definition from ASA: age defined speciality that provides both primary and comprehensive, preventive and therapeutic oral health care for infants and children through adolescence including those with special health care needs.

*Age defined:

most specialities are procedure defined. Ex. Orthodontic and endodontic, periodontic. In pediatric dentistry, you can do any procedure until a certain age.

So in pediatric dentistry you are providing care for a specific age group of patients.

There is no limitation to what type of treatement is providing. But sometimes you need to refer these patients to a specialist in other scopes.

*Primary and comprehensive care:

Pediatric dentistry patients are primary provided. Most of endotontically treated patients are refferred from a GP, So what we mean here is that parents should provide oral health care for their children to a pediatric dentist by their own without referring them to a GP before.

Most of the time pediatric patients are tertiary providers, which means they tried many GPs until consulting a pediatric dentist, which mostly been treated unde GA.

Nowadays people tend to treat their children by a pediatric dentist directly so its becoming a primary care.

Parents can choose to have their children treated and evaluated by a pediatric dentist just like they can choose to have their child treated by a pediatrician.

*Infants and children through adolscence:

Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

In pediatrics clinic you see patients at any age from birth up to their late teens. When these patients become 16 or 17 years old, they no longer like to be treated there, although you can still treat them.

*Special health care needs :

Health care for individuals with special needs requires specialized knowledge aquired by additional training so actually children with special health care needs are treated by a pediatric dentist, our problem with them is when they become older, for example an adult patient with dawn syndrome, a pediatric dentist can treat him but it is not that easy. Dr.Yazan Hassoneh solved that problem and he now treats patients with special health care needs.

What are the aims of pediatric dentistry?

1 .The child reaches adulthood in a state of good dental health .

2 .happily, the child develops positive attitude to dental care.

What is the scope of perdiatric dentistry? What does it cover?

It covers everything for children.

*You’re interested in the health of the child as a whole .

*You’re watching for early signs of disease not just oral disease .

*You’re studying growth and development of the individual as a whole, for example if he is too short in comparison with other children in the same age we try to investigate more, if nessecary refer the patinet for advice and

treatement .

*Oral health play an important role in the over all health of children. So if the patient has a poor oral health, he is in pain or has an infection and can’t go to school, this can affect his general health.

*We aim for prenatal counceling. Try to councel all parents prenatally-before delivering the baby, pregnant woman and her husband should attend the clinic and recieve advice about good oral health practice and proper nutrition early and to take a good care of the oral health.

-There are many wrong advices given by family members to the mother like telling her to feed the baby milk with honey and camomile to calm him down and sleep, but it is cariogenic.

If we cant achieve prenatal counceling, we try to see the parents and the child 6 months after eruption of the first primary tooth. What do you do in this case? We reinforce advice about oral health care and proper diet and oral hygeine instructions , and you start examining the child.

We have to make sure that the parents realize the importance of a healthy nutrition, topical and systemic flouride application.

*You want to be able to restore the child’s mouth to good health, you have to convince the child and the parents about the importance of dental treatment, because most of parents ignore the treatement because we are treating primary teeth which will be replaced at last. Eventhough they are not permanent but they must be pain free and infection free until replacing them with the permanent ones.

*You need to convince the child and the parents about the importance of dental treatment.

Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

*Work of high technical standard.

Good work and quality should ideally be enjoyable to the patient although it does not always happen.

*Early diagnosis leading to the simplest treatment is reqired. We should motivate the parent to show up for regular check-ups so we tend to do a simple filling instead of a pulpotomy and a crown.

A student asked if the health of the primary teeth can affect the permanent ones, the doctor said that if there was a long term infection, the permanent tooth may be hypoplastic (turner tooth). And they found out that children with multiple caries in their deciduoud teeth might have multiple caries in their permanent ones, because the enviroment and the patient habits are the same which make an association between the caries rate in primary and permanent teeth within the same child. But you can surely achieve a good health by motivating a good oral hygiene.

So to achieve a desired diagnosis use a good exam tecnique at the dental chair and the light, you should firstly remove the plaque.

*Encourage regular attendance.

*Use local anaesthetic whenever necessary. Sometimes the pain of the injection is less than the pain of doing a very deep cavity, in this cases you give a LA.

*Use a moderate cutting equipement. To gain the cooperation of a child you have to be quick, so use burs that can quickly make the job done, for example 2 mins instead of 5 mins .

*You need to assess the dentition from an orthodontic point of view, you need to know the sequence, the pattern and the timing of eruption, and if you find something wrong you have to refer the patient.

*A patient diagnosed early can be referred at a correct time.

*You have to preserve deciduous teeth as much as you can, because teeth have the tendency to move when they have an adjacent tooth removed, so if a primary molar is extracted very early, you can have a loss of space, and there will be no space for the underlying permanent tooth.

*So consider the use of space maintaner when indicated.

*You have to convince the child to stop the bad oral habits like digit sucking or interfere early.

*Behavior management is the corner stone of pediatric dentistry, that will make you achieve a good job.

*The child has to be managed differentely than the adult.

We are talking about a wide range, from infants to adults so you have to deal differently among them.

In dental emergencies like trauma mostly-the patient fell down on his teeth, you have to deal with it firstly and quickly, so if you have a pulp exposure, close it and restore it with glass ionomer for example without making an ideal class 4 and give him another appointment to complete your work.

So the main consideration should be the good of the child as a whole, so in emergencies think of the child instead of the infection.

There is a statistic from 2004 showing that we’re a young population in Jordan, about 37% of our population are under 15 years old of age.

Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

So if you work in jordan you’ll face many children to treat. In germany and swedish you’ll mostly face adults.

There is an american concept which is called Dental home which is the same as Medical home.

In Medical home, the children is being treated by the same doctor from infancy, and the doctor has all his reports, records and vaccinations, knowing the exact case of the child.

We try to encorage the same concept dentally, the child is treated by the same dental pediatrician from infancy and attend regular check ups.

Unfortunately, children only come when they are in pain so you end up having extraction or pulp treatement, and you then see them when they are in pain again.

Ideally you would like to have a dental home which is the ongoing relationship between the dentist and the patient inclusive of all aspects of oral health care delivered in a comprehensive continuosly accesible cooardinated and family centered relationship.

We prefer to see the child when he is 12 months old for the first time.

It encourages To establish a dental home to begin no later than 12 months of age. You have to refer him when the pediatric dentist and a GP cannot provide the needed care. But the idea is to stay recieving the treatment with the same dentist.

This is a Cohort study of 9000 patients, at the end they found that children who have early dental visits at a very young age (12 months) will more likely to use sebsequent preventive services, like flouride application and its protective and not invasive, and they experience lower dentally related cost. If there were multiple carious teeth sometimes we are obliged to do the treatment under GA which is very costy financially and also traumatic. If we can inforce prevention from a very early age it will effect the dental effort.

So by establishing a dental home and taking preventive steps recommended by the dentist, parents can avoid their children having early childhood caries, you’ll face alot of children with early childhood caries; they are very young and having multiple carious teeth. This teeth decay results in pain, failure of thrive, the patient is always in pain and

can’t eat and grow normally, and needs an extensive restorative treatment .

What are the functions of primary teeth?

1 .Digestion and assimilation of food. So they can eat healthier food instead of soft food like biscuits which are cariogenic.

2 .Maintenance of space in the dental arches for the permanent teeth, although we can use space maintainers but the natural teeth act as the best space maintainer.

There is a picture showing a lower E holding the space for the lower 6 and the extra space is what we call the Lee way space.

So keeping the primary teeth is useful for keeping the space for the permanent ones.

3 .Stimulation of the growth of the jaw: when the teeth are extracted, the alveolar bone doesn’t grow normally.

4 .Development of speech. Certain letters cannot be spoken without the prescence of teeth especially the anteriors.

5 .Psychology of children: they help in Maintenance and Improvement of the appearance. When chidren have a good primary teeth they are happier about their appearance and the result is that they are more positive.

Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

Having primary teeth that are good and well maintained helps in maintanance and improvement of the appearance.

Examination, assessment and treatmnet plan.

History taking and examination in pediatrics differs from adults, mostly because we are having a 3 way communication which is between the dentist, the child, and his parents. But with adults you are talking with the patient himself which is responsible about his own disicions and can understand you well.

The provision of dental care for children presents some of the greatest challenges and rewards in clinical dental practice.

One of the most challenges is the need to device a comprehensive yet realistic treatment plan for these young patients, so we need to come up with a comprehensive plan, taking into consideration the patient’s age and the age of permanent teeth eruption and the cooperation of the patient.

History taking: taking a comprehensive case history is essential before clinical examination diagnosis and treatment planning, it is also an excellent opportunity for the dentist to establish a relationship with the child and his parents.

So it is very important to take your time taking the history and you should be relaxed; because children are very good in non verbal communication and they can read the body language, so if they feel that you’re tense it will affect them negatively.

Information is best gathered by way of relaxed converstation with the child and his parents.

The dentist is assumed to be an interested listener than an inquisitor. It all helps later on when giving the treatment.

Standard form are helpful reminder, but we shouldnt be rigid. We should make a relaxing atmosphere, and you need to make sure the the child is accompanied by a legal guardian; it is important for consent.

In history go over the personal details, chielf complaint, social history, medical history and dental history.

Personal details: you should know the name, the age, and write it down.

A note should be made of a patient’s name including any abbreviated name or nicknames (Abdelrahman : abood or Abed) and try to name him with the, because this will make him more comfortable, age , adress and telephone number to call him.

Chief complaint: ask the child first about his CC then the parents to establish communication and to know what he exactly needs. He might not be saying what you really need to know clinically so you need to double check with his parents.

It is important to find it out from the child and his parents while the visit has been made.

It is good practice to ask the question to the child before involving the parents.

Be prepare to recieve different answers from these two sources.

Social history: includes how many siblings does he have, what do his parents work, if he attends school or no. It establishes communication with the patient.

Rawan Kfoof Pedo Sheet No.1 Date 1/2/2015

Try to make an assessment of the social background in which the child comes from because it will affect the treatemnt plan because the child is a product of his environment. So it helps you in formulating a realistic plan, because it will show you how easy on parents to bring their child to the clinic regularly, if the mother has 6 children and one of them is special needs , it is difficult to ask her to brush the patient’s teeth 3 times a day so we ask her to do it twice or once.

Medical history: it should be reviewed systematically with relevant data taken. Consider medical conditions common in childhood. It is necessary for safe delivery of the dental treatement.

Behaviour management: Children who have been through alot medically, who have done many operations and have seen many doctors will be more apprehensive.so medically compromised children may have an aversion to strangers.

You go over all the systems which you’ll have in the logbook with the parents.

Dental history: what does the patient have done at the dentist so far.

Knowing the actual work that was done. It is important in the behaviour managemnet, if the work was done under GA or sedation, with LA or not, or what was his reaction, and the attendance of the parents. So if he extract his tooth 3 years ago and didn’t come back they are not cooperative so we don’t use a space maintainer in order to not make more damage than good if they didn’t come back.

To evaluate the child and parents attitude to dental treatment.past dental experience will give an indication wheter the child is going to cope with with dental treatment or not.

Do they attent the dentist regularly ? have they had any previous dental treatment? if the fillings were done with or without LA, if the extraction were done under LA or GA, whether any complication happened in the case of GA.

It is useful to end by asking the parents whether there is anything else they think the dentist should know about their child. Sometimes important details are not volunteered until this point. They may tell us things that we didnt go over while taking the history systematically.