treating the pediatric patient · age 2-3 years: characteristics: toilet training terrible two’s...

TREATING THE

PEDIATRIC PATIENT

SEVERAL REASONS THAT BOTH PARENTS AND

CHILDREN EXPERIENCE ANXIETY REGARDING

THE DENTAL VISIT:

DENTIST’S MANNER

GENERAL ATMOSPHERE

FEAR OF NEEDLES

FEAR OF EXTRACTIONS

FEAR OF TOOTH PREPARATION

FEAR THAT A CHILD WITH CAVITIES

MEANS THEY ARE A BAD PARENT

ATTITUDES OF

CHILDREN TOWARDS

DENTISTRY

LIKE:

AN INTERESTING WAITING ROOM

BACKGROUND MUSIC/ TV

DENTIST TALKING WHILE WORKING

WATCHING THE WORK IN A MIRROR

EXPLANATION OF TREATMENT

GIGING A SIGNAL TO STOP WORK

DISLIKE:

BEING KEPT WAITING

UNATTRACTIVE OR HOSTILE ROOM

COTTON ROLLS

DRILLING

OPERATING LIGHT IN EYES

LYING ABOUT PAINFULL PROCEDURES

BEING COMPARED TO OTHER CHILDREN

STAGES

AGE 0-2 YEARS

CHARACTERISTICS:

CAN SIT

CAN CRAWL

BABBLE OR EXPRESS SINGLE WORDS

CAN POINT TO A FEW BODY PARTS

1-2YR OLDS CAN FOLLOW SIMPLE

COMMANDS

LISTEN TO SIMPLE STORIES/SONGS

IMPLICATIONS

CHILD IN STROLLER

KNEE TO KNEE EXAM

REMEMBER THEIR MOUTHS ARE

EVERYTHING

AGE 2-3 YEARS:

CHARACTERISTICS:

TOILET TRAINING

TERRIBLE TWO’S

SEPARATION ANXIETY

VOCAB OF 5-200 WORDS

ATTENTION SPAN OF 1-5 MINUTES

UNDERSTAND DIFFERENCES IN MEANINGS

(EG. BIG-LITTLE; STOP-GO)

CAN FOLLOW TWO REQUESTS

IMPLICATIONS:

TUNINTIMIDATING WORDS

KEEP VISITS SHORT

TALK IN SHORT SENTENCES

SIMPLE VOCABULARY

AGES 3-4 YEARS:

CHARACTERISTICS:

ATTENTION SPAN 4-8 MINUTES

ABLE TO COUNT TO TEN

VOCAB OF 800-900 WORDS

LEARNING ABC’S

IMPLICATIONS:

PROVIDE SIMPLE INSTRUCTIONS

CHILDREN IN THE DENTAL CHAIR

INDEPENDENTLY

AGES 4-5 YEARS:

CHARACTERISTICS:

TELL FANCIFULL OR LONG STORIES

VERBALIZE CLEARER SENTENCES

KNOW ABC’S

CAN PAY ATTN TO SHORT STORY AND ANSWER

QESTIONS ABOUT IT

HEARS AND UNDERSTANDS MOST OF WHAT IS

SAID AT HOME AND IN SCHOOL

CAPABLE OF PRETENDING THAT AN OBJECT

SYMBOLIZES ANOTHER (eg. DRILL BECOMES

A FIRE ENGINE

AGES 4-5 YEARS:

IMPLICATIONS:

SIT INDEPENDENTLY IN THE DENTAL CHAIR

ABLE TO CARRY ON A CONVERSATION

CHOOSE APPROPRIATE DESCRIPTIVE WORDS

GET CHILD INVOLVED IN THE PROCESS

EGOCENTRISM IS A LIMITATION TO COGNITIVE

REASONING (NOT ADEPT AT UNDERSTANDING

ANOTHER PERSON’S PPOINT OF VIEW

AGES 5-7 YEARS:

CHARACTERISTICS:

ATTENTION SPAN OF 12-25 MIN

SPEAK MORE FLUENTLY

INTERACT WITH MANY OTHER PEOPLE

IMPLICATIONS:

NEED TO DISPELL MYTHS LEARNED FROM

OTHERS

TEND TO BELIEVE EVERYTHING THEY

HEAR

AGES 7-12 YEARS:

CHARACTERISTICS:

INFLUENCE OF PEERS AND OUTSIDE INTERESTS

DEVELOPING THE ABILITY TO THINK

ABSTRACTLY

IMPLICATIONS:

NEED TO BE ABLE TO TALK ON THEIR LEVEL

NEED TO BE ABLE TO TALK ABOUT THEIR

INTERESTS

EXPLAIN REASONS FOR NECESSARY TX

AGES 12-17 YEARS:

CHARACTERISTICS:

MOST PROBLEMATIC PERIOD

FEEL STRONG NEED FOR CONTROL AND

INDEPENDENCE

APPEARANCE OF TEETH/MOUTH IMPT.

ARROGANT; DISRESPECTFUL ATTITUDE

(AS NORMAL AS THE TERRIBLE 2’S)

DISTRUSTFUL OF AUTHORITY

AGES 12-17 YEARS:

IMPLICATIONS:

ALLOW SUFFICIENT TIME FOR PT TO ADJUST

ALLOW AS MUCH CONTROL OVER THE

PROCEDURE AS POSSIBLE WITH GOOD

COMPLIANCE

LET PT KNOW THAT YOU ARE AWARE THEY

HAVE TO DO THE WORK

PROVIDE CHOICES WHENEVER POSSIBLE

CHOOSE YOUR WORDS

WITH CARE

Potentially

Threatening Words

This part will hurt (“hurt” tends to increase anxiety)

The medicine will burn

This medicine will taste (smell) bad

As big as…….

As long as….

It may feel sore, achy, tight etc. (use manageable, descriptive terms.)

Some children have said the medicine feels very warm

This medicine may taste or smell different from anything you have ever had before. After you take it you can tell me how it was for you

Smaller than….

For less than it takes you to……

less Emotionally

Charged Words

Kid SpeakExplorer

High Speed

Handpiece

Slow Speed

Handpiece

Local anesthetic

Numb

Rubber dam

Mouth Prop

cavity

Tooth Counter

Fire Engine

Mr. Bumpy

Sleepy Juice

Sleepy

Raincoat

Tooth Pillow

Cookie Bug

TEMPERMENT

ONE’S PERSONAL STYLE AND WAY

OF INTERACTING WITH OR

REPSONDING TO THE ENVIRONMENT

CHARACTERISTIC OF TEMPERMENTACTIVITY LEVEL

BIOLOGIC RYTHMS

APPROACH/ WOTHDRAWL

ADAPTABILITY

MOOD

INTENSITY OF REACTION

SENSITIVITY

DISTRACTIBILITY

PERSISTENCE

FLEXIBLE/ EASY

HAVE REGULAR RYTHMS

ADAPT QUICKLY TO

ENVIRONMENT

GENERALLY (+) MOOD

LOW SENSITIVITY

LOW INTENSITY IN RXNS

FEARFUL/CAUTIOUS

SLOW TO ADAPT TO ENVIRONMENT

WILL WITHDRAW/BE SHY

CAUTIOUS IN NEW SITUATIONS

MAY OFTEN SEEK OUT CAREGIVER

NEED SECURITY OF PROXIMITY OF 1*CARGIVER

MAY NEED MORE TIME TO WARM UP TO NEW

SITUATIONS OR SETTINGS

FEISTY/DIFFICULT

ACTIVE

INTENSE IN THEIR REACTIONS

DISTRACTIBLE

SENSITIVE

IRREGULAR BIOLOGIC RYTHMS

MOODY

OFTEN EXERT A STRONG INFLUENCE ON THEIR

CAREGIVERS AND ENVIRONMENT

Treatment of the Pediatric Dental

Patient

part 2

Infant Oral Health Care

Infant oral health care visit should be seen as a foundation on which a lifetime of preventative education and dental care can be built.

Oral examination, anticipatory guidance including preventive education and appropriate therapeutic intervention for the infant can enhance the opportunity for a lifetime of freedom from preventable oral disease

Infant oral health care ideally begins with prenatal oral health counseling for parents.

An initial oral evaluation visit should occur within 6 months of the eruption of the first primary tooth and no later than 12 months of age

At the infant oral evaluation visit, the dentist

should:

Record a thorough medical and dental history (prenatal,

peri-natal and postnatal periods)

Complete a thorough oral examination

Assess the patient’s risk of developing oral and dental

disease and determine appropriate prevention plan and

interval for periodic reevaluation based on that

assessment

Discuss and provide anticipatory guidance regarding

dental and oral development, fluoride status, non-

nutritive oral habits, injury prevention, oral hygiene and

effects of diet and medications on the dentition

Risk assessment before age 1 affords

opportunity to identify high risk patients

and provide timely referral and

intervention

Primary thrust of early risk assessment is

to screen for parent-infant groups that are

at risk for ECC

CLINICAL ORAL EXAMFirst exam at time of eruption of the first tooth and no later than 12 months of age

Developing dentition and occlusion monitored throughout eruption at regular intervals

Unrecognized disease can exacerbate problems leading to more extensive and expensive care

Early detection and management improve overall health of the child

Early diagnosis of developing malocclusions allow for timely intervention

COMPREHENSIVE ORAL EXAMINATION

General health/Growth

Pain

Extra-oral soft tissue

Tempromandibular joint

Oral hygiene andperiodontal health

Intraoral soft tissue

Intraoral hard tissue

The developing occlusion

Caries risk

Behavior of child

RECOMMENDATIONS FOR PREVENTIVE

PEDIATRIC ORAL HEALTH CARE

Anticipatory Guidance and

Parent/Patient Education

Anticipatory Guidance for caregiver Oral hygiene

Diet

Fluoride (use of FL toothpaste/FL rinses)

Caries removal

Delay of colonization

Xylitol chewing gum

Anticipatory guidance for the young patient (0-3yrs) Oral hygiene

Diet

Fluoride

medications

Dietary Recommendations

RADIOGRAPHS

Clinical situations for which

radiographs may be indicated include:

Positive Historical Findings

Previous periodontal or endodontic therapy

History of pain or trauma

Family History of dental anomalies

Postoperative evaluation of healing

Presence of implants

Positive Clinical Signs/Symptoms Clinical evidence of periodontal disease

Large or deep restorations

Deep carious lesions

Malposed or clinically impacted teeth

Swelling

Evidence of Facial trauma

Mobility of teeth (pathologic)

Fistula or sinus tract infection

Clinically suspected sinus pathology

Growth Anomalies

Oral involvement in known or suspected systemic disease

Positive neurological findings in head and neck

Evidence of foreign objects

Pain and/or dysfunction of the TMJ

Facial Asymmetry

Abutment teeth for fixed or removable prosthesis

Unexplained bleeding

Unusual eruption, spacing or migration of teeth

Unusual tooth morphology, calcification or color

Missing teeth with unknown reason

Patients at high risk for caries may

demonstrate any of the following:High level of caries experience

History of recurrent caries

Existing restorations of poor quality

Poor oral hygiene

Inadequate fluoride exposure

Prolonged nursing (bottle or breast)

Diet with high sucrose frequency

Poor family dental health

Developmental enamel defects

Developmental disability

Xerostomia

Genetic abnormality of teeth

Many multisurface restorations

chemo./radiation therapy

CARIES ASSESMENT TOOL

(CAT)