3. INTRODUCTION
• Ephebos is a Greek noun referring to a youth
entering manhood
• Ephebodontics encompasses total dentistry
for the individual undergoing the transition
from childhood to adulthood, ie.,the period of
life known as adolescence
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4. DEFINITION
• Ephebodontics or adolescent dentistry is the
science of dentistry which deals with the
children who are in the process of growing up
from childhood to manhood or womenhood
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5. COMMON DENTAL PROBLEMS
OBSERVED
• High caries attack rate or rampant caries
• Pulp size
• Partially erupted teeth which affect
Placement of rubber dam
Placement and retention of rubber dam
clamps
Taking impressions
Design of retainers
Placement of matrix bands
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6. • Gingival and periodontal problems
• Congenitally missing teeth
• Motivation for prevention
• Traumatically injured teeth
• Rapid changes in occlusion following removal of
teeth
• Gingival recession
• Esthetic results
• Social behaviour
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7. SUBTLE CHANGES OBSERVED
I. Physical changes
Body
• Increase in mass of muscles
• Redistribution of fat
• Increase in the rate of skeletal growth
• There is a growth spurt associated with the time
of life
• In females menarche serves as a signal that
growth is ending, but for males there is no such
marker
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8. Craniofacial (head and neck)
• Nose and chin becomes more prominent
• Face increases in height and becomes prognathic
• There is average increase in the palatal vault of
approximately 10 micrometer from birth through
adolescence, but simultaneously the palate
moves downwards, as a result of appositional
growth
• Mandibular growth has taken place at the
condyles in the same mode as interstitial cartilage
growth.
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9. • The adult facial skeleton is literally twice as
large as that of the newborn but the brain
differs in size by only 50%.
• By completion of adolescence, the 27 bones
that originally made up the skull have become
22 bones and are so closely adapted that the
skull can be considered as a single bone
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10. II. Dental changes
• All the permanent teeth generally will have
erupted by age 12, except possibly the four
second molars, which may erupt as late as age
13, and the third molars which usually erupt
between the ages of 17 and 21.
• The roots of all the teeth considered to have
been completed by age 16, except for those of
third molars, which could achieve completion as
late as 25 years
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11. III. Cognitive changes
• By the middle to late adolescence she or he is
capable of extremely sophisticated intellectual
tasks
• Formal operational thinking and the ability to
store information in the memory after
perceiving it are the hall marks of the
maturation of cognitive ability of adolescents.
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12. IV. Emotional changes
• The self confidence and personal identity of the
adolescent may be compromised if her or his
feelings about body images are wrong
• The following issues are seen to have possibly of
misinterpretation and anxiety for this age group:
a. Being attractive or unattractive
b. Being loved or unloved
c. Being strong or weak
d. Being masculine or feminine
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13. V. Social changes
• The dependence and relationships upon
parents starts to decline and the importance
of peers escalates
• The adolescent who gets along well with his or
her peer group seems to relate successfully
with adults
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14. THE PSYCHOLOGY OF ADOLESCENTS
Personal identity: the crucial problem of
adolescence
• The adolescent is faced with a major
developmental task of achieving a stable
personal identity
• Which will provide him with orienting
concepts of what sort of person he is, what his
strength and limitation are, and how he can
anticipate others response to him
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15. Typical personality types
1. The ‘self directed’ youth
• They have a very well developed sense of self and
display those aspects of a strong personality such
as leadership and achievement, providing a very
different picture from sociable, gregarious
teenager.
• He can be counted on to do what he says he will
do.
• He is strong willed and may be somewhat
stubborn.
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16. 2. Self adaptive person
• The adaptive adolescent is friendly, vivacious,
outgoing.
• Though he does not strive for it as does the
self directed youth, he accepts leadership and
responsibility naturally and easily.
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17. 3. The submissive person
• He feels more secure as a follower, avoids
conflicts, does not initiate action.
• But he is not submissive to everyone; he may
have a strongly developed sense of duty and
may vigorously resist demands that run
counter to his principles.
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18. 4. The defiant person
• This is an adolescent who is definitely
unsuccessful in establishing a true sense of his
own identity .
• He is defensive, counter attacking against a
frustrating world by assuming a negative
identity.
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19. 5. The unadjusted person
• The unadjusted person is not so openly hostile
and attacking of society and is not apt to
assume a negative identity.
• He is an anxious, insecure, unhappy youth in
need of help
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22. Emotional disturbances common to adolescents
: disturbance in body image
• The changes in the body which are so evident to
others are also the source of great concern and
interest to young person.
• Short stature in boys, tallness and big bones in
girls, failure in the maturation of identifiable
secondary sexual characteristics all may cause
alarm and defensive belligerence or withdrawal
within the young person
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23. Negative identity
• For the adolescent to embrace a negative
identity constitutes a maladaptive solution to
his problems.
• In certain circumstances however it appears
the only avenue open to him to escape the
acute identity confusion.
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24. Peer group influences
• It is the peer group that the adolescent finds a base of
acceptance security from which to solidify his changing
body image and independence from parents
• To ‘belong’ to a group and to develop a language,
mode of dress and behavior uniquely their own, which
clearly sets them off from adults, provides the
adolescents with a temporary refuge with others of
their own kind for making a transition from childhood
to adulthood
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25. Parents’ influences
• Overbearing parents who allow little freedom
and independence to their adolescent
offspring can anticipate trouble.
• Submissive parent who can’t cope with adult
responsibilities and conveys the attitude to
the adolescent that “anything goes”.
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26. COGNITIVE THEORY
• By Jean Piaget in 1952
• The environment does not shape child
behavior, but the child and adult actively seek
to understand the environment.
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27. • This process of adaptation is made up of three
functional variants
• Assimilation
concerns with observing, recognizing, taking
up an object and relating it with earlier experiences
or categories.
• Accommodation
accounts for changing concepts and strategies
as a result of new assimilated information.
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28. • Equilibration
refers to changing basic assumptions
following adjustments in assimilated knowledge
so that the facts fit better
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29. • The sequence of development has been
categorized in to 4 major stages
1. Sensorimotor stage (0 to 2 yr)
2. Pre- operational stage (2 to 6 yr)
3. Concrete operation stage (6 to 12 yr)
4. Formal operation stage (11 to 15 yr)
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30. SPECIAL CONSIDERATIONS DURING
ACCESSMENT
i. Rapid, unpredictable and irregular skeletal
and dental growth
ii. Drugs, smoking, sexually transmitted
diseases, peer pressure, acne, more
competitive education, career decisions,
alcohol, family pressure make up for some of
the challenges facing today’sadolescent.
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31. Behavioral assessment
1) Sexual abuse
• The young adolescent who has been sexually
abused with oral penetration may exhibit
reluctance in accepting dental care from a
dentist of the same sex as the perpetrator.
• It may be the limit of the dentist’s role to
recommend counselling for the child.
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32. 2)Rampant caries leading to personality problems
• Personality problem manifestations can be varied
with an girl crying silently or not saying a word
during the appointment
• Time and engagement in conversations are often
the most successful behavioral management keys
in dealing with these adolescents
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34. 3)Extreme anxiety
• The behavioral management can be achieved by
desensitization by psychological intervention
4)Anorexia nervosa
• Treatment of child with an eating disorder can be
difficult
• Experience indicate that these patients will
develop a dependency on a male authority figure.
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35. 5) Illicit drug use
• Manifestations of drug use can be varied from
a slight mental dissociation or drifting to
outright verbal aberrations or extreme
changes in personality
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36. POSSIBLE CLINICAL FINDINGS IN
EXAMINATION OF ADOLESCENT
STRUCTURE FINDING COMMENT
Skin
Mucosa
Tongue
Acne
Generalized
erythema ,
Hyperkeratosis
Coating, odor
Adolescent may be
taking antibiotics
Effect of smoking,
STDs
Smokeless tobacco
Poor oral hygiene,
medication 36
40. Common adolescent behavioral
problems and suggested solutions
1. The adolescent is basically insecure and is often
unable to cope with many situations. Be kind
and understanding.
2. Adolescents have varied interests. Determine
what these are and encourage discussions on
these issues.
3. Frequently adolescents regress to child like
behavior in the dental office. Be extremely
careful not to cause the patient obvious
embarrassment
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41. 4. Adolescents tend to worry about many
circumstances. Dentist should encourage
conversation on these matters to a reasonable
extent.
5. Motivate the patients toward adequate
nutritional intake and proper dietary practices
from the perspectives of obesity and oral health.
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42. THE ROLE OF THE PEDODONTIST
• The pedodontists should have a knowledge of
the crucial psychological tasks to be mastered
that will provide a framework for understanding
the problems facing the young person
• The dentist must perceive his young patient as a
unique individual deserving respect and capable
of independent action
• It is important not to involve the parents
unnecessarily in the adolescent’s treatment to
the point he is excluded from all participation.
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43. • He should be given as much responsibilities as
possible for making his own appointments, for
discussing the nature of his treatment and for
carrying out, on his own, necessary prophylactic
and remedial procedures
• Educating the adolescent regarding the
importance of various procedures and the
necessity of adopting good oral hygiene practices
serve as significant aid in the success of
treatment
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