Texas Dental Journal l www.tda.org l November 2010 1165

Restorative Dentistryfor the PediatricPatientSteven P. Hackmyer, D.D.S.

Kevin J. Donly, D.D.S., M.S.

Hackmyer Donly

IntroductionIn April, 2002, the American Academy of Academy of Academy Pediatric of Pediatric ofDentistry (AAPD)Dentistry (AAPD)Dentistry sponsored a Pediatric a Pediatric a RestorativeDentistry ConsensusDentistry ConsensusDentistry Conference (1). The purpose ofthe conference was to bring together bring together bring experts in eightrecognized areas (risk assessment, sealants, glassionomer cements, amalgam, dentin/enamel adhe-sives, resin-based composites, stainless steel crowns,and anterior restorations) to provide literature re-views to aid in the development of evidence-based, of evidence-based, ofscientifically supported position papers supporting pediatric restorative techniques and approaches.

The purpose of this paper is to revisit those findings and recommendations in terms of current of current of pediatricrestorative techniques.

AbstractThe American Academy ofPediatric Dentistry sponsoredthe Pediatric Restorative Den-tistry Consensus Conference in2002. This paper will review theconsensus statements that wereissued as a result of the confer-ence. Since the conference therehave been advances in proce-dures, materials, and techniquesthat need to be considered interms of some of the consensusstatements. The introductionof the First Dental Home, in-terim therapeutic restoration andnanotechnology are examplesof some of the materials andtechniques that are now part ofeveryday pediatric dentistry. Thispaper will discuss the updatesas it relates to each of the 2002consensus statements.

Key worKey worKey DS: Pediatric,restorative dentistry, risk assess-ment, sealants, amalgam, resin-based composite, glass ionomercement, stainless steel crowns,bonding adhesives

Tex Dent J;127(11):1165–1171.

Dr. Hackmyer is a clinical associate professor, Department of Developmental Dentistry, University ofTexas Health Science Center at San Antonio Dental School, San Antonio, Texas.

Dr. Donly is a professor and chair, Department of Developmental Dentistry, University of TexasHealth Science Center at San Antonio Dental School, San Antonio, Texas.

Corresponding Author: Steven Hackmyer, D.D.S., Clinical Associate Professor, Department ofDevelopmental Dentistry, University of Texas Health Science Center at San Antonio Dental School,7703 Floyd Curl Drive, San Antonio, Texas 78229-3900; Phone: (210) 567-3535; Fax: (210) 567-3526;E-mail: hackmyer@uthscsa.edu.

Texas Dental Journal l www.tda.org l November 2010 1175

Indirect Pulp Therapy: An

Alternative to Pulpotomy

in Primary TeethN. Sue Seale, D.D.S., M.S.D.

AbstractPreservation of the primary teeth until their normal exfoliation is essential for normal oral function and facial growth of the child. To that end, treatment of primary teeth with large carious le-sions approximating the pulp should be aimed at preserving the tooth. Current-ly, the pulpotomy is the most frequently used pulp treatment for cariously involved primary teeth. The purpose of this manuscript is to describe the use of an alternative to the pulpotomy, indirect pulp therapy (IPT), for the treat-ment of vital, primary teeth with cari-ous involvement approaching the pulp. Accurate diagnosis of the vitality status of the pulp is critical to the success of IPT and involves careful radiographic and clinical assessment of the teeth to be sure they are healthy or at worst, reversibly inflamed. The indications for IPT are the same as for pulpotomy. The technique involves one appointment, requires that some carious dentin be left to avoid pulp exposure and requires the placement of a biologically seal-ing base and sealing final restoration. Teeth treated with IPT have success rates at least as good as those treated with pulpotomies, and IPT offers an acceptable alternative to pulpotomy as a treatment for vital, asymptomatic, cariously involved primary teeth.

Key worDS: Indirect pulp therapy, primary teeth, pulp therapy

Tex Dent J 2010;127(11): 1175-1183.

Dr. N. Sue Seale, Department of Pediatric Dentistry, Baylor College of Dentistry – Texas A&M Health Science Center, Dallas, Texas.

Correspondence to: N. Sue Seale, D.D.S., M.S.D., 3302 Gaston Avenue, Dallas, Texas 75246; Phone: (214) 828-8241; Fax: (214) 874-4562; E-mail: sseale@bcd.tamhsc.edu.

The author has no declared financial interests. This article has been peer reviewed.

IntroductionPreservation of the primary teeth is of para-mount importance in maintaining the integ-rity of the dental arch and supporting normal growth and development of the face of the child. The tooth is the best space maintainer and best contributes to normal function and growth. Therefore, the primary tooth with a large carious lesion approximating the pulp presents the challenge of managing the lesion with the intent of maintaining the tooth un-til normal exfoliation. To meet this challenge, several pulp therapy techniques have been ad-vocated. Among the earliest recommendations was indirect pulp therapy (IPT), then called in-direct pulp capping. As far back as the 1950’s, IPT was recommended for primary teeth with large carious lesions in which complete caries removal would expose the pulp (1-8).

Seale

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Texas Dental Journal l www.tda.org l November 2010 1195

Infant Oral Exam and First Dental Home

AbstractThe purpose of this article is to familiarize general practitioners with the components of a dental home including an infant oral exam, and to the First Dental Home initiative, which is unique to the State of Texas. This article encourages the general practitioners to actively participate in providing care for young children under the age of 3. Components of an infant oral examination are described here with emphasis on knee-to-knee or lap exam, caries risk assessment, pre-ventive treatment, age-appropriate anticipatory guidance, and parent education. The First Den-tal Home is uniquely de-signed to help pediatric clients 6 months through 35 months of age to establish a dental home. The objectives, goal and components of FDH are discussed in detail.

Key worDS:dental home, Texas Health Steps, knee-to-knee exam, prevention, early childhood caries

Tex Dent J 2010; 127(11): 1195-1205.

Dr. Viswanathan is an assistant professor, Department of Pediatric Dentistry, Baylor College of Dentistry – Texas A&M Health Science Center, Dallas Texas.

Requests for reprints should be sent to Kavitha Viswanathan, D.D.S., M.S., Ph.D., Assistant Professor, Pediatric Dentistry, Baylor College of Dentistry, #207, 3302 Gaston Ave., Dallas, Texas 75246, USA; Phone: (214) 828-8317; Fax: (214) 874-4562; E-mail: kviswanathan@bcd.tamhsc.edu.

IntroductionEarly Childhood Caries (ECC), also known as ‘baby bottle car-ies’ or ‘nursing bottle decay’ is a severe form of childhood dental caries that is chronic, rampant and infectious in young children under 6, most commonly seen in poor and minority populations (1, 2 ). ECC (Figure 1) is defined as “the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to car-ies) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age (3).” ECC usually affects maxillary primary incisors but when severe, can progress to involve primary molars and cuspids. ECC, like caries has a multi-factorial etiology but its high prevalence in poor minority children is attributed to improper feeding practices, familial so-cioeconomic background, lack of parental education and dental knowledge, and lack of access to dental care (1). ECC is a dis-ease that, when severe, can affect growth, cause pain and infec-tion and have lasting detrimental effects on the quality of life of patients and parents. Even though ECC is preventable through parental education, early and regular checkups, topical fluoride treatments, appropriate diet control and proper oral hygiene practices, it is still the most common chronic childhood disease in America. The prevalence of ECC is alarming — 40 percent of children are affected by the time they reach kindergarten; 70 percent of these carious lesions are found in approximately 20 percent of our nation’s children (4). Approximately, 51 million school hours are lost due to dental-related illness (5, 6).

Viswanathan

Kavitha Viswanathan, D.D.S., M.S., Ph.D.

Texas Dental Journal l www.tda.org l November 2010 1187

Comprehensive Oral Rehabilitation with General Anesthesia and Prosthetic Care in the Primary Dentition: A Case ReportGisela M Velasquez, D.D.S., M.S.; Sanford J. Fenton, D.D.S., M.D.S.; Laura Camacho-Castro, C.D., D.M.D.; Bhavini S. Acharya, B.D.S., M.P.H.; Aaron Sheinfeld, D.D.S., D.M.D.

Abstract

This case report describes the oral rehabilitation of a 5- year-old male referred by a general dentist to a pediatric dentist due to acute psychological stress to dental treat-ment and extensive dental caries. The patient’s dental resto-rations and extractions were completed under general anesthesia. Maxillary and mandib-ular prostheses were completed in the out-patient clinical setting. The treatment plan for this child provided options to improve ap-pearance, self-image and oral function.

Key worDS:General anesthesia, pediatric, primary dentition, removable prosthesis

Tex Dent J 2010; 127(11): 1187-1192.

Dr. Gisela M. Velasquez is an assistant professor, Department of Pediatric Dentistry, University of Texas at Hous-ton Dental Branch, Houston, Texas.

Dr. Sanford J. Fenton is a professor and chair, Department of Pediatric Dentistry, University of Texas at Houston Dental Branch, Houston, Texas.

Dr. Laura Camacho-Castro is a clinical assistant professor, Department of Pediatric Dentistry, Tuft University School of Dental Medicine, Boston, Massachusetts.

Dr. Bhavini S. Acharya is an assistant professor, Department of Pediatric Dentistry, University of Texas at Houston Dental Branch, Houston, Texas.

Dr. Aaron Sheinfeld is a prosthodontist, private office, Boca Raton, Florida.

IntroductionPediatric dentists seldom consider removable prosthesis in children after loss of multiple primary teeth due to dental caries or trauma because it is often thought unrealistic to expect a child to be compliant with this type of treatment (1). However, it is important to consider not only esthetics but also the psychological and emotional development of the child as an individual (2, 3). General anesthesia is one of the many procedures that pediatric dentists use to treat patients with extensive dental caries associated with psy-chological or emotional maturity or physical or mental dis-abilities where there is no expectation of behavior improve-ment over time (4, 5).

The following case report describes the prosthetic rehabili-tation of a 5-year-old male whose pre-treatment behavior might have discouraged a practitioner from considering a re-movable prosthesis. However, not only was the patient com-pliant with treatment, he was very happy with the results.