pediatric dentistry

Copyright 2003, Elsevier Science (USA). All rights reserved.

Pediatric DentistryPediatric DentistryChapter 57Chapter 57

Copyright 2003, Elsevier Science (USA).

All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.

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ISBN 0-7216-9770-4


IntroductionIntroduction Pediatric dentistry is the specialized area of

dentistry that is limited to the care of children from birth through adolescence, with particular focus on providing oral health care to patients with special needs.

Pediatric dentistry is the specialized area of dentistry that is limited to the care of children from birth through adolescence, with particular focus on providing oral health care to patients with special needs.


The office should display cheerfulness, a pleasant environment with a nonthreatening decor.

Treatment areas are designed with an open bay concept.

Dental personnel dress in bright coordinating colors.

The office should display cheerfulness, a pleasant environment with a nonthreatening decor.

Treatment areas are designed with an open bay concept.

Dental personnel dress in bright coordinating colors.

The Pediatric Dental Office The Pediatric Dental Office


Chronologic age• The child's actual age in terms of years

and months. Mental age

• The child's level of intellectual capacity and development.

Emotional age • The child's level of emotional maturity.

Chronologic age• The child's actual age in terms of years

and months. Mental age

• The child's level of intellectual capacity and development.

Emotional age • The child's level of emotional maturity.

The Pediatric Patient The Pediatric Patient


Birth to age 2 • Children learn to sit, stand, walk, and

run. • Vocally, they progress from babbling to

using simple sentences. • Can identify familiar faces and progress

through periods of being friendly and then fearful of strangers.

• Too young to be expected to cooperate in dental treatment.

Birth to age 2 • Children learn to sit, stand, walk, and

run. • Vocally, they progress from babbling to

using simple sentences. • Can identify familiar faces and progress

through periods of being friendly and then fearful of strangers.

• Too young to be expected to cooperate in dental treatment.

Stages of Childhood Stages of Childhood


Ages 3 to 5 years• This child needs to be allowed to

develop autonomy and initiative.• This child requires control and

structure in his or her environment.• Able to follow simple instructions. • Welcomes an active role in the

treatment experience.

Ages 3 to 5 years• This child needs to be allowed to

develop autonomy and initiative.• This child requires control and

structure in his or her environment.• Able to follow simple instructions. • Welcomes an active role in the

treatment experience.

Stages of Childhood cont’d Stages of Childhood cont’d


Ages 6 to 11 years• Period of socialization. • Learning to get along with people.• Learning the rules and regulations of

society• Learned to overcome fears of objects

and situations.

Ages 6 to 11 years• Period of socialization. • Learning to get along with people.• Learning the rules and regulations of

society• Learned to overcome fears of objects

and situations.

Stages of Childhood cont’d Stages of Childhood cont’d


Be honest with a child. Consider the child's point of view. Use “tell, show, do.” Give positive reinforcement.

Be honest with a child. Consider the child's point of view. Use “tell, show, do.” Give positive reinforcement.

Behavior Management Behavior Management


The Difficult Patient The Difficult Patient Premedication

• Prescribed to calm and ease the patient prior to treatment.

Nitrous oxide oxygen• Method of mild sedation that can help

calm a patient for treatment. Physical restraint

• Used to prevent a possible injury to the child, dentist and or assistant.

Premedication • Prescribed to calm and ease the

patient prior to treatment. Nitrous oxide oxygen

• Method of mild sedation that can help calm a patient for treatment.

Physical restraint • Used to prevent a possible injury to

the child, dentist and or assistant.


Mental retardation • Mild mental retardation describes individuals

with IQs ranging from 50‑55 to 70. • Moderate mental retardation describes

individuals with IQs ranging from 35‑40 to 50‑55.

• Severe mental retardation describes individuals with IQs ranging from 20‑25 to 35‑40.

• Profound mental retardation describes individuals with IQs ranging from below 20 to 25.

Mental retardation • Mild mental retardation describes individuals

with IQs ranging from 50‑55 to 70. • Moderate mental retardation describes

individuals with IQs ranging from 35‑40 to 50‑55.

• Severe mental retardation describes individuals with IQs ranging from 20‑25 to 35‑40.

• Profound mental retardation describes individuals with IQs ranging from below 20 to 25.

Special Patients Special Patients


Down syndrome• Also named trisomy 21. These

individuals have a chromosomal aberration that usually results in certain abnormal physical characteristics and mental impairment. The mental impairment may range from mild to moderate retardation.

Down syndrome• Also named trisomy 21. These

individuals have a chromosomal aberration that usually results in certain abnormal physical characteristics and mental impairment. The mental impairment may range from mild to moderate retardation.

Special Patients cont’d Special Patients cont’d


Cerebral palsy is a nonprogressive neural disorder caused by brain damage that occurred prenatal, during birth, or postnatal before the central nervous system reached maturity. Characterized by paralysis, muscle weakness, lack of coordination, and other disorders of motor function.

Cerebral palsy is a nonprogressive neural disorder caused by brain damage that occurred prenatal, during birth, or postnatal before the central nervous system reached maturity. Characterized by paralysis, muscle weakness, lack of coordination, and other disorders of motor function.

Special Patients cont’d Special Patients cont’d


Medical and dental history • Past hospitalizations and surgeries.• Date of child's last visit to the physician.• Medications, daily medications. • Unfavorable reaction 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, or pacifier habits. • Fluoride and toothbrush habits. • Inherited family dental characteristics.

Medical and dental history • Past hospitalizations and surgeries.• Date of child's last visit to the physician.• Medications, daily medications. • Unfavorable reaction 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, or pacifier habits. • Fluoride and toothbrush habits. • Inherited family dental characteristics.

Diagnosis and Treatment Planning Diagnosis and Treatment Planning


Clinical examination• Radiographic examination• Extraoral examination• Intraoral soft tissue examination• Clinical examination

Clinical examination• Radiographic examination• Extraoral examination• Intraoral soft tissue examination• Clinical examination

Diagnosis and Treatment Planning cont’d Diagnosis and Treatment Planning cont’d


Oral hygiene• Geared to improving a child's

brushing and flossing technique. Fluorides

• Children between 6 months and age 16 should take in fluoride daily.

Diet• Review specific nutrients a child

needs to grow.

Oral hygiene• Geared to improving a child's

brushing and flossing technique. Fluorides

• Children between 6 months and age 16 should take in fluoride daily.

Diet• Review specific nutrients a child

needs to grow.

Preventive Dentistry Preventive Dentistry


Sealants • Applied to the teeth to help keep them

cavity-free. Oral/Facial development

• To identify malocclusion, crowded or crooked teeth, bite problems, and actively intervene.

Sports safety• Protective face equipment worn during

any recreational sport that might injure the mouth area.

Sealants • Applied to the teeth to help keep them

cavity-free. Oral/Facial development

• To identify malocclusion, crowded or crooked teeth, bite problems, and actively intervene.

Sports safety• Protective face equipment worn during

any recreational sport that might injure the mouth area.

Preventive Dentistry cont’d Preventive Dentistry cont’d


Restorative• Amalgam• Composite

Endodontic procedures• Pulp capping• Pulpotomy

Prosthodontic procedures • Stainless steel crowns

Restorative• Amalgam• Composite

Endodontic procedures• Pulp capping• Pulpotomy

Prosthodontic procedures • Stainless steel crowns

Operative Procedures Operative Procedures


Causes of dental injuries to children• Automobile accidents• Bicycle accidents• Sports injuries• Child abuse

Causes of dental injuries to children• Automobile accidents• Bicycle accidents• Sports injuries• Child abuse

Traumatic Injuries Traumatic Injuries


Fig. 57-16 Educating school personnel about traumatic injuries. Fig. 57-16 Educating school personnel about traumatic injuries.


Types of InjuriesTypes of Injuries

Fractured anterior teeth Documentation of the accident includes:

• Clinical examination• Radiographs • Vitality testing

Fractured anterior teeth Documentation of the accident includes:

• Clinical examination• Radiographs • Vitality testing


Traumatic intrusion• The tooth is forcibly driven into the

alveolus so that only a portion of the crown is visible.

Traumatic intrusion• The tooth is forcibly driven into the

alveolus so that only a portion of the crown is visible.

Types of Injuries cont’dTypes of Injuries cont’d


Extrusion and lateral luxation• Teeth are actually displaced from

their position, causing damage to the periodontal ligaments.

• Displaced teeth repositioned.• Temporary splint placed.

Extrusion and lateral luxation• Teeth are actually displaced from

their position, causing damage to the periodontal ligaments.

• Displaced teeth repositioned.• Temporary splint placed.



Avulsed teeth• The process of a tooth being torn

away, or dislodged completely by force.

• Recover the tooth immediately.• Wrap the tooth in a moistened

gauze. • Go immediately to the dentist's

office.

Avulsed teeth• The process of a tooth being torn

away, or dislodged completely by force.

• Recover the tooth immediately.• Wrap the tooth in a moistened

gauze. • Go immediately to the dentist's

office.



Child abuse must be suspected when:• Injuries are in various stages of healing. • Chipped or injured teeth. • Scars inside the lips or on the tongue and tears of

the labial frena. • Battering or other injuries around the head and

neck. • Facial bruises, swelling of the facial structures, or

black eyes.• Bite marks.• Injuries not consistent with the explanation

presented by the parent.

Child abuse must be suspected when:• Injuries are in various stages of healing. • Chipped or injured teeth. • Scars inside the lips or on the tongue and tears of

the labial frena. • Battering or other injuries around the head and

neck. • Facial bruises, swelling of the facial structures, or

black eyes.• Bite marks.• Injuries not consistent with the explanation

presented by the parent.

Child AbuseChild Abuse


Required information• The name, address, gender, age, height, and

weight of the child.• The name and address of the adult with custody

of the child. • A description of the current physical and

emotional abuse or neglect of the child. • Evidence of previous injuries or negligence.• Any information that may assist in establishing

the cause of the injuries.• Sketches or photographs documenting the nature

and location of the injuries.

Required information• The name, address, gender, age, height, and

weight of the child.• The name and address of the adult with custody

of the child. • A description of the current physical and

emotional abuse or neglect of the child. • Evidence of previous injuries or negligence.• Any information that may assist in establishing

the cause of the injuries.• Sketches or photographs documenting the nature

and location of the injuries.

Reporting Child Abuse Reporting Child Abuse

pediatric dentistry

Documents

dental treatment

dental injuries

childs dental health

mental age

treatment planning contd

childs actual age

special patients contd

pediatric dental office