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