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Pediatric Dentistry(2010全英班)
 

Pediatric Dentistry(2010全英班)

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    Pediatric Dentistry(2010全英班) Pediatric Dentistry(2010全英班) Presentation Transcript

    • Pediatric dentistry Zhao Wei
      • Synonymous with
      • dentistry for children
      • pedodontics
      • Exists because children have dental and orofacial problems
      Definition
      • An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs (1995, by ADA’S)
    • Historical perspective
      • Up until the middle 1950s,dental office gave the sign said: no children under age 13 treated in this office
      • Over the past several decades, specific educational guideline for pediatric dentistry have been adopted and are imposed on all dental school
      • Graduates of all accredited dental schools have not only a didactic education in dentistry for children but also a clinical education
      • The ignorant notion that the “baby teeth don’t deserve care because you lose them anyway” has largely disappeared save for the most uninformed persons
      • Advocate a routine dental appointment on or before the first birthday.
      • The customary age of the first dental appointment was on or after the third birthday,which is far too old for the initiation of appropriate preventive services
      • Addressing the needs of this age group remains a relevant challenge to the dental profession
    • Milestones in dentistry for children in the united states
      • 1900 few children are treatment in dental office.
      • 1924 first comprehensive textbook on dentistry
      • for children is published
      • 1927 American Society for the Promotion of Dentistry
      • for children is established at the meeting of (ADA)
      • 1940 the American society for the promotion of
      • dentistry of children changes its name the
      • American society of dentistry for children
      • (ASDC)
      • 1942 the council on dental education recommends
      • that all dental schools have pedodontics as
      • part of their curriculum
      • 1948 The American academy of Pedodontics is
      • formed
      • 1949 the first full week of February is designated
      • national children’s dental week
      • 1981 February is designated National children’s
      • dental health month
      • 1984 the American Academy of Pedodontics changes
      • its name to the American Academy of Pediatric
      • Dentistry
      • 1995 a new definition is adopted for the specialty of
      • pediatric dentistry by the ADA’S House of
      • Delegates
      • An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs (1995, by ADA’S)
    • In china
      • 1998
      • The Chinese Academy of pediatric dentistry is formed
      • 2000
      • The first edition of the textbook on pediatric dentistry in Chinese is published
    • Challenges for pediatric dentistry in 21 st century
      • Preventive dentistry
      • Infant oral health
      • Acid-etch techniques, sealants, and composite resins
      4 th
      • Dentistry of the disabled patient and other children with special needs
      • Early orthodontic diagnosis and treatment
      • More sophisticated modalities of pain and anxiety control such as sedation techniques
      • Eating disorders and their dental implications
      • Informed consent and risk management
      • Infection control
    • Application of the other disciplines
      • To be a complete clinician capable of handling the majority of needs of the children, a dentist need to know
        • Preventive dentistry techniques
        • Pulpal therapy
        • Instrumentation and restoration of teeth
        • Dental materials
        • Oral surgery
        • Preventive and interceptive orthodontics
        • The principle of prosthodontics
    • On the other hand
      • Certain basics in pediatric medicine
      • General and oral pathology
      • Growth and development
      • Knowledge of nutrition
      • The modes of management
      • A person would be happy dedicating a significant amount of practice time to children
    • Patient management
    • Patient behavioral ratings
      • Rating No.1: definitely negative(--)
        • Refuse treatment
        • Cries forcefully, uncontrallable behavior
        • Is extremely negative, associated with fear
      • Rating No.2: negative(-)
        • Is reluctant to accept treatment
        • Displays evidence of slight negativism
      • Rating No.3: positive (+)
        • Accepts treatment
        • Timid behavior: follows the dentist’s directions in a shy, quiet manner
      • Rating No.4: definitely positive(++)
        • Unique behavior: look forward to and understands the importance of good prevent care
    • The importance of conviction, experience,and good intentions
      • The self-confidence of the dentist is essential
    • Patient management by domain
      • Physical domain
      • Pharmacologic domain
      • Aversive domain
      • Reward-oriented domain
      • linguistic domain
    • Physical domain
      • From the use of hand restraint by a dental assistant to the use of tools
            • Papoose board
            • Tape
            • Sheet with tape
            • Cloth wraps
            • Belt
    • Pharmacological techniques
      • Local anaesthesia
      • Nitrous oxide/oxygen analgesia
      • General anesthesia
      This domain requires parental understanding about the techniques,risks and alternatives
    • Nitrous oxide/oxygen analgesia
    • Aversive domain
      • A technique can be describe as aversive if the use of the technique on a child is objectionable enough that the child will cooperate in order to avoid the technique
      • Parental spanking is an example of aversive management
      • Some physical techniques can be regards as aversive if they are used or seem to be used as a punishment
      • Hand over the mouth (HOM) is regarded by many to be an aversive technique
    • Reward-oriented domain
      • Reward can be used to secure the cooperation of a child
      • Be arranged by Dentist or Parent
    • Linguistic domain
      • Be those communication techniques that involve the conversation of the dentist with the child and the child with the dentist
      • No child is competent in language before second birthday
      • All normal children are competent in language after fourth birthday
      • Dentist will be
      • Communicator, teacher
      • coach, rewarder, psychologist
    • Today’s offices are not frightening
    •  
    •  
    •  
    •  
      • Basics in managing children in
      • pediatric dentistry
    • The child is not a little man !
    • Most dentists agree that the preschool child clearly requires the most energy and talent for effective management
      • Entails bringing the child to the dental office for a tour and orientation
      • With nothing being done
      • The child meets the receptionist, dental assistant, and dentist
      Preappointment experience
      • Certain dental equipment can be shown and explained
      • In “childese” language
      • Should be kept as pleasant and simple as possible
      • An examination and fluoride treatment
      The First dental visit
    • Tell-show-do
      • Backbone of the educational phase
      • Simple and usually works
      • Dictates that before anything is done
      • the child is told what will be done
      • shown by some sort of simulation.
      • Choice of words is important
    • Voice control
      • To interject more authority into his or her communication with the child
      • The tone of voice is important
      • Can be used with deaf children
      • An essential technique for preschool children
    • Hand-over-mouth
      • Calls for the dentist to place his or her hand over the mouth of a hysterically crying child
      • Has to be paired with voice control
      • Not intended to scare the child
      • To get the child’s attention and quiet him
      • As a tap on the lips to remind the child crying is not appreciated
      • There is no airway restraint!
      • Remains somewhat controversial
      • A legitimate technique
    • Physical restraint
      • The use of hand restraint
      • The use of tools
            • Mouth props
            • Cloth wraps
            • Sheet with tape
    •  
      • To treat the emergencies on hysterical children and children who can not be reached in language because of their age
      • Developmentally disabled children
      • children who for whatever reason cannot cooperate with the dentist
      Indications
    • Note
      • The use of physical techniques necessitates explanations to parents
      • guardians
      • caretakers
      • A written consent to treatment
      ,
    • Reward and Praise
      • Reward be arranged by dentist or parent
      • Reward by parent may have a negative effect
      • Request that parents not promise things like ice cream or toys as a reward for going to the dentist before the dental appointment
      • The child may misreading the intentions of the parents as their offering a reward because they think the dental appointment will be difficult, frightening,or scary for the child
      • Child react favorably to praise
      • Reward, Praise and effective communication combined with tell-show-do can form an effective management technique
      • Tell-show-do was rated as the most acceptable
      • technique, followed by
      • nitrous oxide sedation
      • general anesthesia
      • Eaton JJ , McTigue DJ Attitudes of contemporary parents toward behavior management techniques used in pediatric dentistry. Pediatr Dent. 2005 Mar-Apr;27(2):107-13
      • Parents attendance in the dental operatory
      • Less than 8% of dentist want parents in attendance during the treatment
      • The parent is seen as a contributor to management or behavior problems
      Should parents stay with the child during the procedure or remain in the waiting room?
      • However
      • 66% parents wished to be present
      • They can act as an advocate for their child and verify his or her safety
    • There are several options: depending on the dentist’s office policy
      • Routinely exclude parents
      • If the parent wishes, allow him to enter
      • With the exception of parents of
      • very young child
      • patient with developmental disabilities
    •  
    • Four age groups
      • Conception to age three
      • The primary dentition years: 3 to 6 years
      • The transitional years: 6 to 12 years
      • adolescence
      • The child from conception to age 3 historically has not been involved in professional dental provision
      • In fact ,until recently dentistry has never actively encouraged children of this age to be involved in professional care
      Conception to age three
      • Conception to age three
      • The child from conception to age 3 historically has not been involved in professional dental provision
      • In fact ,until recently dentistry has never actively encouraged children of this age to be involved in professional care
      • Age 3 has for many years been the customary entry age of children to the dental experience
      • It is deeply believed that prevention programs must be started well before age 3 to ensure success
      • Therefore, focus on the needs of an age group the has been virtually overlooked previously
    • The primary dentition years: 3 to 6 years
      • Deal with children with a complete primary dentition
      • To understand the morphology and anatomy of the primary dentition
      • How to preserve dental arch integrity
      • How to intercept malocclusions in the primary dentition
      • Restoration
      • Pulp therapy
    •  
    • The transitional years: 6 to 12 years
      • The majority of children shed all of their primary teeth and gain all of their permanent teeth except the third molars
      • Treatment needs of young permanent teeth
      • Orthodontic considerations
      • Esthetic considerations
      • Prevention needs of the preschool child
      • Children responsibility for their own oral hygiene
    •  
    • Adolescence
      • Prevention
      • Treatment
      • Dental and facial esthetics
      • Periodontal disease
    • Early child caries (ECC) Bottle caries Bottle caries in an old Child showing arrested Caries
    • Rampant caries
    • Remarkable advances in dental restorative materials in the 1980s and 1990s are irrevobably changing pediatric Restorative dentistry
    • Restorative techniques
    •  
    •  
    • Pulpal therapy
    •  
    • Not conservative
    • partial luxation /complete luxation
    • Space maintenance Steelless crown
    •  
    • Interceptive orthodontics
    • Pits and fissure sealant
    •  
    • Thank you