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Pediatric Dentistry

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  • 1. Pediatric Dentistry Training Module Training and Calibration Guidelines for The Arizona School of Dentistry & Oral Health Updated : 5/5/2009
  • 2. Preclinical Exercises
  • 3. Preclinical Pediatric Dentistry Preclinical Exercises • #J – OL/L amalgam • #S – Do and #T MO amalgam • Adaption of a T-band for class II preparation • #K – SSC, #L – DO composite • #A – SSC, #B – pulpotomy and SSC • #F – strip crown • #E – SSC
  • 4. Preclinical Exercises #J OL/L amalgam #S DO and #T MO amalgam Adaption of T Band for Class II restorations
  • 5. Preclinic Exercises #K SSC, #L DO Composite #A SSC, #B Pulpotomy/SSC #E SSC  Incisal/Lingual reduction for 1 mm clearance  Interproximal reduction to allow for close adaption  Similar to strip crown without a groove #F Strip Crown
  • 6. Daily Clinical Protocols
  • 7. Daily Clinical Protocols • Students expected to arrive on time in the Pediatric clinic. • All patients are scheduled by the Pediatric clinic assistant and students are not assigned pediatric patients to their family of patients. • The students should thoroughly review the chart prior to treatment. • The faculty hold seminars and discuss Tx planning, behavior management, charting and Tx sequencing among other topics.
  • 8. Daily Clinical Protocols Examination: • Medical and dental Hx. • Evaluation of hard and soft tissues. • Radiographs are based upon individual need and taken only when a diagnostic yield is expected. • Caries Risk Assessment. • Occlusal analysis and need for orthodontic assessment. • Other specialty consultations are requested, if needed.
  • 9. Daily Clinical Protocols Tx Plan Formulation: • “Worst first” approach • Quadrant dentistry/arch dentistry • Selective non-invasive procedures introduce the patient to the dental environment • Caries Risk assessment and Preventive follow-up
  • 10. Daily Clinical Protocols Behavior Management: • Tell, Show, Do • Positive Reinforcement/Ignoring Negative • Nitrous Oxide • Voice control • Modeling • Distraction • Papoose board used as needed – parents may or may not be in the operatory during procedures
  • 11. Daily Clinical Protocols Materials: • Local Anesthetics – Lido 2% with epi (max single dose 4.4 mg/kg/2mg/lb [300 mg], septo 4% w/ epi • Amalgams – Dispersalloy • Composites – Dyract, Esthet-X micro hybrid and composite, Clinpro Sealant • Matrix and Wedging – T bands, Palodent matrix, Tofflemier matrix bands
  • 12. Daily Clinical Protocols Stainless Steel Crowns: • Occlusal reduction, interproximal and B/L reduction to allow for proper adaption of the crown • 1 – 1.5 mm of occlusal clearance and no cervical ledge to prevent seating • Use 6888-012 flame diamond and 909-040 wheel diamond, 330 and 169L • Adapt 3M Ion primary molar crowns • Crimping pliers/Howe pliers for contouring • Cement with glass ionomer luting cement
  • 13. Daily Clinical Protocols Pulp Therapy for Primary/Immature Permanent Teeth: • Protective base – Fuji GI liner • Indirect pulp cap • Direct pulp cap (permanent only) MTA or CaOH
  • 14. Daily Clinical Protocols Pulpotomy Primary: • Access pulp chamber – 330 or 169 carbides • Remove pulp tissue - #4 or #6 round burs • Formocreosol or Ferric sulfate to fix tissue • IRM or Tempit in pulp chamber • Condense wet cotton pellet or amalgam condenser • Pulpectomy Primary – 30+ Vitapex, ZOE
  • 15. Daily Clinical Protocols Space Maintainers: • Band and Loop • Lower lingual holding arch • Transpalatal arch/Nance appliance
  • 16. Daily Clinical Protocols Pediatric Burs: • 331/2, 34, 35SS, 330, 556SS, 556, 169, 169L • #2, #4, #6, #8 round • 6358-023 football diamond, 6888-012 pointed tapered diamond, 909-040 wheel diamond, 6858- 014 pointed taper diamond, 7901 flame carbide, 7408 football carbide
  • 17. Assessment of Student Performance
  • 18. Pediatric Dentistry Clinical Requirements Essential Experiences = EE • 100 Procedures to include at least 1 space main. • 1 Pulpotomy • 1 SSC Competency Assessments = CA • 1 Pediatric Class II composite or amalgam • 2 Case-based Tx plans – 1 comprehensive exam and 1 dental emergency exam
  • 19. Faculty Assessment of Student Performance • Faculty should consult the Clinical Procedure Guide Book (CPGB) for the clinical technical criteria for assessing each clinical procedure. Link to CPGB: G:DentalCPAF's_CLINICAL GUIIDEBOOK • On site faculty should utilize electronic CPAFs for pediatric assessment. Electronic CPAF can be accessed at: https://asd.icedentalsystems.com/ • External site faculty should utilize the daily CPAF. Link: G:DentalCPAF's_CLINICAL GUIIDEBOOKCPAFS Versions 4.07 • Hard copy CPAF for pediatrics is also available. Link: G:DentalCPAF's_CLINICAL GUIIDEBOOKCPAFS Versions 4.07
  • 20. D1351 Sealant D1351 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1 Procedure and Surface Appropriate sealant Failure to review Med Inappropriate Preparation product selected. Tooth and Dent Hx. Failure to understanding of what is surface clean and free clean surfaces in involved and how from debris preparation for sealant procedure is done Isolation Tooth is adequately Loss of isolation No isolation isolated to prevent contamination Etch/rinse/isolate Tooth etched Incomplete etch or No etch appropriately & rinsed contamination of site Sealant placement/cure Appropriate amount of Inappropriate amount, Inability to complete sealant applied and too much, too little, procedure allowed to cure for requiring adjustment appropriate amount of through further care time Sealant adhered Sealant checked for Incomplete retention of No retention of sealant complete adherence. sealant material material Tooth restored to ideal occlusion w/o assistance
  • 21. D2150 CL II Amalgam D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1 Outline Form and Outline does not weaken Over prepared or Grossly over prepared or Extension the tooth, no extended when caries extended OR demineralization and anatomy does not Preparation of wrong dictate tooth Proximal & gingival extension is optimal Optimal treatment of fissures Oblique ridge of upper second primary or permanent molar nor transverse ridge of lower are not crossed unless undermined by caries Proximal cavosurface angles at 90 degrees
  • 22. D2150 CL II Amalgam D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1 Internal Form Proximal walls are Over prepared or deeper Pulpal exposure when convergent occlusally than necessary none should have occurred Portions of the prep that extend into the buccal and lingual grooves should slightly diverge Pulpal floor, 1mm, free of defects, uniform depth, internal line angle slightly rounded, axio- pulpal line angle is rounded, gingival floor 1 – 1.5 mm wide – M-D Retention features (grooves) ideally placed, if necessary No fragile or unsupported enamel
  • 23. D2150 CL II Amalgam D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1 Operative Environment Rubber dam is optimal, Poorly adapted dam Failure to use dam preparation is dry Adjacent tooth contact is not damaged Amalgam material is handled in a safe manner Matrix band and wedge used appropriately Anatomical Form Restores harmonious form of existing tooth Proximal contour returns proper shape and position Optimal contact will allow lightly waxed floss to pass with proper resistance
  • 24. D2150 CL II Amalgam D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1 Margins No excess or deficiency Excessive or deficient Excessive or deficient at any margin margin that can be margin that requires new improved without new restoration restoration Finish, Function & Smooth surface, no pits, Damage to adjacent Damage to adjacent Damage voids or irregularities tooth which is noted but tooth causing loss of is managed with minimal tooth structure and involvement necessitating a restoration
  • 25. Examples of CL II Amalgam Preps Proximal walls are convergent occlusally, portions of the prep extend into buccal and lingual grooves, pulpal floor is flat and uniform depth, gingival floor is 1 – 1.5 mm wide mesiodistally. Acceptable Assuming a small interproximal lesion, just inside the DEJ. The size and axial depth of the box would rate this Improvable. If there was a pulpal exposure, it would be Unacceptable