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Pedia Preventive orthodontics

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Pediatric Dentistry I …

Pediatric Dentistry I
Forth Year

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  • 1. 1 Preventive measure Preventive measure taken to prevent development of any condition or impairment of dental health to the child so it focused on three essential aspects:- 1. Caries control 2. Maintenance of periodontal integrity 3. Prevent the developing malocclusion 4. Preventive orthodontics requires a continuing long range approach. 5. During primary dentition period child should be observed & closely supervised for evidence of incipient problems of abnormal symmetry or occlusion 6. Many unpredictable factors can affect the management of the developing dental arch & minimize the overall success of any treatment. Preventive orthodontics 1. The dentist must aware of normal development of occlusion during primary & mixed dentition. 2. know the development of dentition & sequence of eruption of teeth 3. Accurate & periodic oral examination of child to diagnosis any defect in the teeth or dental arch. 4. Examination of soft tissues like frenum, tongue, tonsils. 5. Early diagnosis of incipient caries by periodic cheek up using bite wing film 6. Preservation of arch length by accurate restoration of proximal contact areas using T band with wedge & good amalgam restoration. 7. Detection of any speech defect. 8. Detection of breathing way of the patient. 9. Examination of the swallowing mechanism. 10.Detection of any beginning of oral habit. 11.Prevent early loss of primary dentition.
  • 2. 2 12.Replacement of early loss of primary teeth by space maintainers. 13. Detection of retained deciduous tooth. 14.Detection of congenital missing teeth. 15.Detection of jaw movement. Eruption of primary teeth Root Completed EruptionHard Tissue Formation Begins Tooth Maxillary 1 ½ yr 7 ½ mo 4 mo in utero Central Incisor 2 yr 9 mo 4 ½ mo in utero Lateral Incisor 3 ¼ yr 18 mo 5 mo in utero Cuspid 2 ½ yr 14 mo 5 mo in utero First molar 3 yr 24 mo 6 mo in utero Second molar Mandibular 1 ½ yr 6 mo 4 ½ mo in utero Central Incisor 1 ½ yr 7 mo 4 ½ mo in utero Lateral Incisor 3 ½ yr 16 mo 5 mo in utero Cuspid 2 ½ yr 12 mo 5 mo in utero First molar 3 yr 20 mo 6 mo in utero Second molar
  • 3. 3 Causes of early tooth loss 1. Extraction resulting from caries 2. Trauma 3. Endocrine disorders Diabetes Hypophosphatasia 4. Immune disorders Neutropenia Neutophil defects Interleukin 1 abnormalities HIV infection 5. Miscellaneous Ehlers Danlos syndrome type VIII Eosinophilic granuloma Causes of delayed tooth eruption 1. Endocrine disorders • Hypothyroidism • Calcium/phosphorus metabolism problems • Hypopituitarism 2. Genetic disorders and bone disorders Ectodermal dysplasias • Down syndrome • Cleidocranial dysplasia • Gaucher disease • Osteoporosis 3. Local factors • Tooth in path of erupting tooth, insufficient space, impacted teeth • Dental infection • Radiation therapy
  • 4. 4 Chronology of the permanent dentition Root CompletedEruptionHard Tissue Formation Begins Tooth Maxillary 10 yr7-8 yr3-4 moCentral Incisor 11 yr8-9 yr10-12 moLateral Incisor 13-15 yr11-12 yr4-5 moCuspid 12-13 yr10-11 yr1 ½ - 1 ¾ yrFirst Bicuspid 12-14 yr10-12 yr2 – 2 ¼ yrSecond bicuspid 9-10 yr6-7 yrat birthFirst molar 14-16 yr12-13 yr2 ½ - 3 yrSecond molar Mandibular 9 yr6-7 yr3-4 moCentral Incisor 10 yr7-8 yr3-4 moLateral Incisor 12-14 yr9-10 yr4-5 moCuspid 12-13 yr10-12 yr1 ¾ - 2 yrFirst Bicuspid 13-14 yr11-12 yr2 ¼ - 2 ½ yrSecond bicuspid 9-10 yr6-7 yrat birthFirst molar 14-15 yr11-13 yr2 ½ - 3 yrSecond molar
  • 5. 5 Causes of delayed tooth eruption 1. Endocrine disorders • Hypothyroidism • Calcium/phosphorus metabolism problems • Hypopituitarism 2. Genetic disorders and bone disorders Ectodermal dysplasias • Down syndrome • Cleidocranial dysplasia • Gaucher disease • Osteoporosis 3. Local factors • Tooth in path of erupting tooth, insufficient space, impacted teeth • Dental infection • Radiation therapy Normal transient developmental stages 1. The Ugly Ducking Stage 2. The Newly Erupted Lower Permanent Incisor CARIES DETECTION METHODS 1. CLINICAL OBSERVATIONS The oldest and most used method for the detection of caries is visual by using probes combines to form the basic clinical evaluation method. Today, clinicians are enhancing their vision with magnification. 2. RADIOGRAPHIC DIAGNOSIS Dental radiographs have been the one diagnostic tool which dentists have used as their secret weapon.
  • 6. 6 Dentin caries in molar tooth The new direction of caries detection It has taken a path towards three basic areas:-  Electrical resistance,  Light illumination and  Digital imaging.  Another useful, older diagnostic tool, risk assessment. 1. Electrical resistance measurements:- Such as a.c. impedance spectroscopy, electrical conductance measurements (ECMs), electrical resistance monitors; 2. Light illumination:- Such as laser fluorescence, stereomicroscopy, fiberoptic transillumination; 3. Strip mutans test for risk measurement, and 4. Ultrasonic imaging. Caries prevention has also been applied in the form of: * Use of oral hygiene * Use of fluoride * Pit and fissure sealants * Diet counseling * Prevention of extension Examination of the breathing for the patient is done by holding a mirror in front of both nostrils. In nasal breathers the mirror will cloud
  • 7. 7 with condensed moisture during expiration. Oronasal or mouth breather the alar muscles of external nares of a patient do not change their size or shape. There is a characteristic of adenoid face which there is long face, lips are a part and anterior teeth are protruded between the two lips. Examination of the swallowing of the child must be performed. In normal swallowing the tongue touch the palate papillae of anterior teeth & dorm surface of the tongue in contact with the palate and lips are tightly closed together. While abnormal swallowing teeth are separated, tongue thrust forward between upper & lower anterior teeth, dorm surface of the tongue away from the palate and lips are separated. Examination for retained or ankylosed primary molar must be done by periapical & clinical examination. It is important to observe the eruption of these permanent teeth. Occasionally they will erupt out of position if the primary tooth is retained. To prevent the mal- positioning of the permanent tooth it might be necessary to remove the retained primary tooth. Prevention of premature loss of primary teeth is very important factor to prevent development of malocclusion. The general factors which influence the development of malocclusion in the presence of premature loss : - 1. Abnormal oral musculature E.g. high tongue position coupled with strong mentalis muscle will damage the occlusion after tooth loss leading to collapse of lower dental arch & distal drifting of anterior segment. 2. The presence of abnormal oral habit Thumb or finger sucking provides abnormal forces on dental arch leading to collapse after tooth loss. 3. Existence of malocclusion
  • 8. 8 Arch length inadequacies as in class II D I become more severe after mandibular molar loss. 4. Stage of developing dentition More space loss occurs if a tooth actively erupting adjacent to space left after premature tooth loss. Prevention of crowding of teeth 1. Crowding takes place when there is not sufficient space for the teeth. Since the premature loss of primary teeth results in crowding, it is important for the primary teeth to remain in position until the permanent teeth replace them. 2. Here are some preventive measures and considerations relating to crowding: • A regular routine of tooth cleaning, together with a low sugar diet will help to keep the primary teeth healthy, until they are ready to be replaced. • Regular visits to the dentist from the age of 2 or 3 will ensure that problems are detected and treated in time. • If a primary tooth is lost before the permanent tooth is ready to replace it, a space maintainer can keep the space open for the permanent tooth • Mean the procedure taken to intercept a malocclusion that is develop or lessen its severity in such away as to facilitate future orthodontic treatment. Or • It is a science & art of orthodontics employed to recognize & eliminate potential irregularities and malposition in developing dentofacial complex. The measure of interceptive are:- • Cross-bites • Anterior diastema • Ankyloglossia • Anterior crowding (Serial extraction) • Space regaining
  • 9. 9 • Ectopic eruption • Treatment of oral habit Conditions cause orthodontic problems are 1. Crowding  Teeth affected by crowding are difficult to clean and are prone to decay.  Crowding may prevent other teeth from erupting, causing them to become impacted.  Crowding spoils the appearance of the mouth and smile. 2. A mismatch of tooth and jaw size • Teeth can be too big or too small for the size of the jaws. • This can be a congenital or inherited problem. 3. Upper and lower jaws out of proportion to each other • The lower jaw may be too large or too small for the upper jaw, and vice versa. • This can also be a congenital or inherited problem. 4. Missing or extra teeth • This is not uncommon and can be an inherited problem. 5. Premature loss of teeth caused by: • Injuries. • Tooth decay. 6. Breathing problems • When adenoids or tonsils obstruct normal nasal breathing, this can affect the teeth and jaws. 7. Thumb sucking or dummy sucking • This can and often does affect the development of the jaw and the position of the teeth. 8. Hypotonic muscles  Lip exercises with a piece of card-board to improve the lip seal. The cardboard should be held loosely in horizontal position with the lips. 9. Ectopic eruption of the first molar
  • 10. 10  Using ligature wire to guide the permanent first molar to erupt in its normal position. Or extraction of the deciduous second molar & guiding the first permanent molar to erupt in normal position. The general factors which influence the development of malocclusion in the presence of premature loss : 1. Abnormal oral musculature E.g. high tongue position coupled with strong mentalis muscle will damage the occlusion after tooth loss leading to collapse of lower dental arch & distal drifting of anterior segment. 2. The presence of abnormal oral habit Thumb or finger sucking provide abnormal forces on dental arch leading to collapse after tooth loss. 3. Existence of malocclusion Arch length inadequacies as in class II D I become more severe after mandibular molar loss. 4. Stage of developing dentition More space loss occurs if a tooth actively erupting adjacent to space left after premature tooth loss. General effects of premature loss:- 1. Mesial drift distal to extracted tooth. 2. Distal drift mesial to extracted tooth. 3. Midline shift. 4. Delayed or accelerated eruption of permanent tooth. 5. Falling of anterior segment toward the affected side with increase in over bite. 6. Development of thrusting habit. 7. Loss of tooth without immediate replacement considered one of etiology of malocclusion.
  • 11. 11 Corrective orthodontic • It is measurement taken to correct the already develop malocclusion. • It performed at late mixed dentition and early permanent teeth. • The variables that can affect the outcome of treatment may include:- 1. The chronologic or emotional age of the patient. 2. The intensity, frequency & duration of oral habits 3. Parental interest, support & compliance. 4. Variation in facial growth 5. Accuracy of the clinician’s diagnosis & appropriateness of care.

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