Pediatric Dentistry I Forth Year

1. Patient Records
• Health history, signed & dated;
update area
• Examination record
• Treatment plan
• Progress notes
• Parental or guardian consent
Clinical examination

2. Patient Records
• Should include:
– Developmental status and existing pathosis
– Record of each exam or procedure
– Facial and occlusal status
– Oral hygeine and periodontal status
– Prevention
– Charting system
• Primary and permanent dentition
• Developmental profile

3. Diagnosis
• Recognize problem--cc
• Treatment depends upon diagnosis
• Depends upon complete health history,
extraoral and intraoral exam and
additional diagnostic aids
– X-rays
– Lab tests
– Medical consult

4. Medical History
• Completed by parent or legal guardian
• Signed
• Dated
• Update on recall
• Contact physician regarding concerns or unclear
information
• Do not ask child for any confirmation
• Determine need for antibiotic prophylaxis
A thorough knowledge of medical conditions (physical
and psychological) that may predispose the patient
to development of a problem will prevent the majority
of emergency situations.

5. Medical History
• Should include
– Any medical or dental conditions, past or
present
– Allergies
– Hospitalizations
– Medications
– Heart problems
– Familial history
– Etc.
• Interview parent or guardian to clarify any
questions

6. Caries Risk Assessment
• Fluoride History
• Dietary Habits
• Sleep time Habits
• Medications
• Nonnutritive sucking habits
• Family History
• Oral Hygiene Habits

7. Fluoride History
• Dosage
• Frequency
• Source
• Water
• Supplements
• Rinses
• Dentifrices

8. ADA Recommended Supplemental
Fluoride Dosage Schedule

9. Family History
Dental history
Dental attitude

10. New patient 1st visit
• Complete Pediatric clinical chart
• Forming necessary radiographs
• Prophylactic fluoride application
• Patient & parent advices or education
• Diet analysis

11. New patient 1st visit
• Assessment of child behavior
• Communication with the child
• Assessment of caries risk
• Instructions for home
hygiene care

12. Clinical Examination:
• Visual Inspection – pain source is usually
evident.
• Palpation – sensitivity over apex of tooth
suggests periapical inflammation. Firm or
fluctuant swelling consistent with abscess.
• Percussion – pain/sensitivity consistent with
periapical inflammation. Percussion of each
cusp helps locate incomplete fracture.

13. • Mobility – check horizontal and vertical.
• Periodontal Probing – evaluate periodontal
status. Aids in decision regarding retaining
or extracting.
• Thermal Sensitivity – tests pulpal status.
Cold (ethyl chloride) is test of choice.
– Normal / reversible pulpitis: not prolonged
– Irreversible pulpitis: prolonged response
– Necrotic pulp: no response
– Heat test not usually done, difficult
Clinical Examination:

14. • EPT – pulp is responsive (vital) or it is not
(nonvital). False (+) and false (-).
• Translumination – helps detect enamel and
pulpal floor fractures.
• Radiographs:
– Panorex – overall survey
– PAs – provide definition of PA areas, caries, fxs
– BWs – bone level and interproximal caries
– Occlusal – buccal / lingual and floor of mouth
– Water’s – maxillary sinuses
• Selective Anesthesia – infiltration, blocks,
TPIs
• Test Cavity – prep suspected tooth with no

15. Examination
• Comprehensive exam: clinical & radiographic
• Systematic exam
• General appraisal
– Physical status
– Behavioral assessment*
• Head & Neck exam
– Extraoral evaluation
– Soft tissue evaluation*
• Orthodontic evaluation

16. Extraoral Evaluation
• Cranium
– Inspect for sores, flaking, inflammation, swelling &
symmetry
• Neck
– Thyroid gland-palpate/inspect for swelling
– Musculature-inspect/palpate for suppleness
– Lymph nodes-palpate for lymphadenopathy
• Hair
– Inspect for thickness, color, dryness, consistency
• Ears
– Inspect for normal appearance, cartilaginous
defects, pits and cutaneous lesions

17. Extra oral Evaluation
s Eyes
– Eyeball-inspect for inflammation, deviation or exophthalamos
– Eyelid-inspect for ptosis, inflammation
s Nose
– Evaluate potency, note any discharge
s Perioral
– Inspect for inflammation, scarring, eruptions,
ulcerations

21. Soft Tissue Evaluation
s Gingiva
– Inspect for inflammation, bleeding
s Mucosa
– Inspect for inflammation, palate for swelling; inspect parotid duct opening for function
s Pharynx
– Inspect for inflammation, test gag reflex
s Tonsils
– Inspect for size, inflammation
Palate
Inspect for deviation, integrity
Tongue
Inspect for inflammation; coating, observe range of motion, inspect for atrophy
and deviation
Lips
Inspect for chapping, ulcers and cheilitis
Teeth
Inspect for development, morphologic appearance, color, integrity, mobility,
hygiene

22. Occlusion Summary
• Alignment
– Arch categorization--U-shaped or V-shaped
– Ideal arch in primary dentition has spacing between the teeth
• Two types: Primate space and developmental space
– Tooth size-arch length discrepancy
• Anterior segment
• Posterior segment
– Space loss
– Rotations
– Alignment
– Missing or supernumerary teeth
– Eruption abnormalities
– Ankylosis

23. Occlusion Summary
• Anterior-Posterior*
– Relation of mx and md arches to each other
– Primary molar relation--flush terminal plane, mesial step and
distal step
– Permanent molar relation--Class I, II, III
– Primary and permanent canines--Class I, II, III or end-to-end
– OJ (mm)--horizontal overlap of mx and md central incisors
– Lip posture (vertical, everted, tight, loose, mentalis strain
– Tongue thrusting (swallow)

24. Occlusion Classification Primary Dentition

25. Occlusion Summary
• Transverse
– Midline discrepancies
– Posterior cross-bite
– Facial type
– Facial asymmetry
– Md displacement
– Mx midline diastema--frenum

26. Occlusion Summary
• Vertical
– Overbite (%)--vertical overlap of the primary incisors based on
total height of md incisor crown
• Approx. 2 mm or 20% in the primary dentition
– Open bite (mm)--absence of vertical overlap
– Habitual lip posture (closed, open)
– Lip length (mx lip), relation to mx incisors (md lip)
– Tongue size, shape and position
– Skeletal lower face height (55% of total face height)
– Frankfort-md plane angle (approx. 26o
)

28. Dental charting

29. Treatment plan form
• Indicate sequence of care
• Progress note indicates what was done
• Phase I:-
o Prophylactic treatment
o Oral Hygiene instruction &education
o Fluoride application, fissure sealant
• Phase II:-
o Restorations
o Pulpotomy, St st crown
o Extraction
• Phase III:-
o space maintainer & orthodontic consultation
• Phase IV:-
o Maintenance & recall

30. Treatment plan form

31. The process of diagnosis
• Existence of an abnormal state
• Determination of cause
• Alternatives or options to correct the problem
• Anticipated benefits, immediate and long term
• Problems or requirements for accomplishing treatment
• A problem list helps to separate those abnormalities that
are in need of management from those that are simply
identified.
• Identification of the cause of the abnormality is critical to
determine short and long-term treatment.

32. Treatment plan
• No single treatment plan is ideal. A variety of
alternatives must be considered
• TP based on the child's health, cooperation,
parental finances, and the benefits
• The behavioral plan is critical to the success of
the treatment plan to be used must be included
in the treatment plan.
• The sequencing of be behavior management,
consent for medications, and reasonable
alternatives to recommended procedures should
be discussed with the parents.

33. • Acute infection and pain are managed first.
• Hopelessly involved teeth should be extracted
• This "first aid" approach reduces the chance of
decay progression with resultant pain and
reduces the difficulty in cleaning, reducing the
deleterious oral flora.
• The infiltration
• Injections are easiest for the patients to tolerate.
Treatment plan

34. Patients with Special Health Care
Needs
• Knowledge of the medical elements of
conditions , such as congenital heart disease
• Knowledge of oral health implications of
conditions, such as precocious periodontal
disease in Down syndrome or gingival
overgrowth in transplantation patients
• Essential management skills to communicate
with, stabilize, and manage patients in the care
setting
• Awareness of the social, therapeutic, and
cultural milieu of those with special healthcare
needs

35. Problem of special need pt
• Fear or difficulty in connection.
• Chronic or short-term medical problems that
are acquired during their life
1. Accessibility
2. Psychosocial
3. Financial
4. Communication
5. Medical
6. Mobility and stability
7. Preventive
8. Treatment planning
9. Continuity of core

36. Early caries detection techniques
• Electrical conductivity measurements (ECM)
• Laser fluorescence using the Diagnodent unit
(KaVo-IR)
• Ultrasound measurements (UM)
• Quantitative light fluorescence (QLF)
• Optical coherence tomography (OCT)
• Fiberoptic transillumination (FOTI)
• Digital imaging fiberoptic transillumination
(DIFOTI)
• Direct digital radiography (DDR)

37. • Birth-12 Months
• 12-24 Months
• 2 - 6 Years
• 6 - 1 2 Years
• 12-18 Years
Examination and Oral Treatment
for Children

38. Examination and Oral Treatment
for Children
Birth-12 Months
• Complete the clinical oral assessment and
appropriate diagnostic tests to assess oral growth
and development and/or pathology.
• Provide oral hygiene counseling for parents,
guardians& caregivers.
• Remove supra- and subgingival stains or deposits.
• Assess the child's systemic and topical fluoride
status (type of infant formula used, fluoridated
toothpaste). Prescribe systemic fluoride supplements
if indicate after assessment of total fluoride intake.
• Assess appropriateness of feeding practices (bottle
feeding and breast-feeding).
• Provide dietary counseling related to oral health.

39. Birth-12 Months
• Provide age-appropriate injury prevention counseling for
orofacial trauma.
• Provide counseling for non-nutritive oral habits (e.g., digit,
pacifiers).
• Provide diagnosis and required treatment and/or appropriate
referral for any oral diseases or injuries.
• Provide anticipatory guidance for parent/guardian.
• Consult with the child's physician as indicated.
• Based on evaluation and history, assess the patient's risk
for oral disease.
• Determine interval for periodic reevaluation.
Examination and Oral Treatment
for Children

40. 12-24 Months
1. Repeat birth to 12-month procedures every 6
months or as indicated by patient's needs/
susceptibility to disease.
2. Review patient's fluoride status, including any
child care arrangements that may affect
systemic fluoride intake and provide parental
counseling.
3. Provide topical fluoride treatments every 6
months or as indicated by the individual
patient's needs.
Examination and Oral Treatment
for Children

42. 2 - 6 Years
1. Repeat 12- to 24-month procedures every 6 months or
as indicated by patient's needs/susceptibility to disease.
Provide age-appropriate oral hygiene instructions.
2. Complete a radiographic assessment of pathology
and/or abnormal growth and development.
3. Scale and clean the teeth every 6 months or as
indicated by the individual patient's needs.
4. Provide topical fluoride treatments every 6 months or as
indicated by patient's needs.
Examination and Oral Treatment
for Children

43. 2 - 6 Years
5. Provide pit and fissure sealants for primary and
permanent teeth as indicated by patient's needs.
6. Provide counseling and services (athletic mouth guards)
as needed for or orofacial trauma prevention.
7. Provide assessment/treatment or referral of developing
malocclusion as indicated by patient's needs.
8. Provide diagnosis and required treatment and/or
appropriate referral for any oral disease, habits, or
injuries as indicated.
9. Assess speech and language development, and provide
appropriate referral as indicated.
Examination and Oral Treatment
for Children

44. 6 - 1 2 Years
• Repeat 2- to 6-year procedures every 6
months or as indicated by patient's
needs/susceptibility to disease.
• Provide substance abuse counseling
(e.g., smoking, smokeless tobacco).
Examination and Oral Treatment
for Children

45. 12-18 Years
1. Repeat 6- to 12-year procedures every 6
months or as indicated by patient's
needs/susceptibility to disease.
2. At an age determined by the patient,
parent, and dentist, refer the patient to a
general dentist for continuing oral care.
Examination and Oral Treatment
for Children

46. Examination and Oral
Treatment for Children
• A thorough medical history (questions
about medications, current illnesses,
hepatitis, weight loss, lymphadenopathy,
oral soft tissue lesions, or other infections.
• Clean all reusable instruments in an
ultrasonic cleaner or washer/disinfector.
Wear heavy rubber gloves, mask, and
protective clothing and eyewear to protect
against puncture injuries and splashing.

47. E M E R G E N C Y D E N T A L
T R E A T M E N T
• The emergency appointment tends to
focus on and resolve a single problem or a
single set of related problems rather than
provide a comprehensive oral diagnosis
and management plan for the patient.

48. Early examination
To prevent oral pain and infection,
To prevent the occurrence and progress of
dental caries,
To prevent the premature loss of primary
teeth, the loss of arch length, and
To prevent the development of an
association between fear and dental care.