THE PRESENTATION INCLUDES VARIOUS ASPECTS IN PEDODONTIC AND PREVENTIVE DENTISTRY 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.

1. DR ASHWITHA BELLUDI
PEDODONTIST
SIDDHARTHA DENTAL COLLEGE, KARNATAKA

2. CONTENTS:
• INFANT ORAL HEALTH CARE
• VARIOUS DENTALANOMALIES SEEN DURING INFANCY
• GINGIVL DISEASES IN CHILDREN
• EARLY CHILDHOOD CARIES
• PEDIATRIC ENDODONTICS
• ORAL HABITS
• PREVENTIVE DENTISTRY
• TRAUMATIC INJURIES
• PROSTHETIC REHABILITATION
• SPECIAL CARE DENTISTRY
• CONCLUSION

3. Pediatric dentistry
• “Is 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”

4. INFANT ORAL HEALTH CARE
DEFINITION
Infant oral health care can be understood
as the foundation on which a life time of preventive
education & dental care can be built in order to
help acquire optimal oral health into childhood &
adulthood

5. Rationale for infant oral health:
• Break the Cycle of Early Childhood Caries
• Disrupt the Acquisition of Harmful Microflora
• Manage the Risk/Benefit of Oral Habits
• Establish a Dental Home for Health or Harm
• Impart Optimal Fluoride Protection
• Use Anticipatory Guidance to Parents
• Child abuse and neglect may also be detected
• Care of children with special health care needs.
• Problems of speech and language would require early
detection.

6. HOW TO PROCEED FOR INFANT ORAL
HEALTH CARE?
• The first step should be to establish a “Dental Home”
for each infant.
OBJECTIVES OF DENTAL HOME
 To enhance the dentist’s ability to assist children and their
parents/caregivers in the quest for optimum oral health care.
 To schedule early oral health examinations and preventive
services for cost effectiveness.
 To offer parents and caregivers resources which assist them in
making the best informed choice.

7.  Individual child risk assessment for dental diseases.
 Monitoring the growth and development.
 Referrals to dental specialists when care cannot directly be provided
with the dental home.
 Interaction with members of the medical and dental communities,
and other public and private community agencies to ensure
awareness of age specific oral health issues.
 To make the parents aware of when and how frequently should they
visit a dental home for their child.

8. ORAL HYGEINE PRACTICES
• Many parents would not be even aware of the fact that oral
hygeine practices can be essential at this age.
• A thorough intra oral examination may reveal the plaque on the tooth
surfaces and food debris as well.
• In such cases and in all other cases as well if the child has been
brought early,the proper technique for positioning and tooth cleaning
should be demonstrated.

9. Gum pad cleaning
-cleaning of gum pads should be started as early as within the
first week of birth.
-

10. • Small gauze between thumb and forefinger can
be used and wiped vigorously over the ridge of
the baby's jaws
• Specially designed infants tooth brushes, finger
cots and wipes are available
• Adequate pressure just to remove the film that
covers the gum pad
• Clean at least twice a day
• Spend at least two to three minutes.

11. • The positioning of the infant should be such
that they are supported all times and the
movements are slow and careful
• The baby can be laid down in the parents lap
with the feet pointing away.

12. Various dental anomalies seen
during infancy

13. Definition :
Natal teeth – observable at birth
Neonatal teeth – erupt during the first 30 days

14. syndromes associated
•Ellis-van crevald (chondro
ectodermal dysplasia)
•Pachyonychia congenita
•Hallermann-Streiff
•Rubinstein Taybi
•Steotocystoma multiplex
•Pierre Robin
•Cleft lip and palate
•Epidermolysis bullosa
•Vanderwoude
•Walker warburg syndrome

15. RIGA FEDE DISEASE
•Riga Fede disease is a reactive
mucosal disease as a result of
repetitive trauma to the
tongue by the anterior primary
teeth during forward and
backward movement
TREATMENT
•Smoothening lower incisors
•Composite coverage
•extraction

16. Eruption cyst
•Defined as odontogenic cyst that surrounds a
tooth crown that has erupted through bone but
not soft tissue and is clinically visible as a soft
fluctuant mass on the alveolus.
Rx:
Usually disappear when teeth erupts
Surgically exposing crown of the tooth may aid
in eruption process

17. ERUPTION HEMOTOMA
•When the circumcoronal cystic cavity is
filled with blood , the swelling appears
purple or deep red.
•Usually painless unless infected
•They may enlarge to approximately 1-1.5
cm
•Sometimes more than one hematoma
may be present
TREATMENT:
•surgical exposure of the crown

18. PALATAL CYST
•PALATAL CYST OF THE
NEONATES(Epstein pearls)
•Small, white or grayish white
lesions on alveolar mucosa
•Epithelial remnants
entrapped b/w palatal shelves
BOHN NODULES
Cysts originating from the palatal gland
structures
• Scattered widely over hard and soft
palate
• Superficial and ruptures
TREATMENT
• No treatment

19. EPULIS (NEUMAN’S TUMOR)
• type of embryonical hamartoma and not a true neoplasm
• Located in the maxillary or mandibular gingiva
• Resembles granular cell myoblastoma
• Single or multiple and interferes with respiration and feeding
• Pedunculated lesion on the crest of alveolar ridges
• The tumor has a marked female preponderance of 8:1.
TREATMENT : The recommended treatment is prompt surgical resection

20. • The child may complain slight soreness in the area ,probably by the
compression of the soft tissue over the spicule
• The condition corrects itself
“tiny spicule of nonviable bone overlyin
the crown of an erupting permanent molar
just before or immediately after the
emergence of the tips of the cusps through
the oral mucosa”
Eruption sequestrum

21. MUCOCELE
Mucous extravasation cyst:
• swelling of connective tissue consisting of a collection of fluid
called mucin. This occurs because of a ruptured salivary
gland duct usually caused by local trauma (damage)
Mucous retention cyst:
• due to obstructed salivary duct
• The mucocele has a bluish translucent color, and is more commonly
found in children and young adults.
TREATMENT
Excision

22. Gingival
diseases
22

23. Gingivitis
• Dental plaque induced gingival inflammation is
the most common form of gingivitis.
• It is characterized by inflammation of gingival
tissues without loss of attachment or bone.
• Local factors contributing to gingivitis in
children
• Crowded teeth
• Orthodontic appliances
23

24. • Gingivitis associated with poor oral hygiene is
usually classified as
• Initial lesion
• Early lesion
• Moderate lesion
• Advanced lesion
24

25. 25
stage Initial stage Early stage Established
stage
Time (days) 2-4 4-7 14-21
Blood vessels Vascular
dilatation
Vascular
proliferation
Vascular
proliferation,
Blood stasis
Junctional &
Sulcular epi.
Infiltration
by PMNs
Same as stage
1,
Same but
more
advanced
Predominant
immune cells
PMNs Lymphocytes Plasma cells
Collagen Perivascular
loss
Increased
loss
Continuous
loss
Clinical
findings
Gingival fluid
flow
Erythema,
Bleeding on
probing
Changes in
color, texture,
size
Stages of gingivitis

26. Plaque
removal
May progress
26

27. Acute gingival diseases
• Primary herpetic gingivostomatitis
• Recurrent aphthous ulcer
• Acute necrotizing ulcerative gingivitis (vincent
infection)
• Acute candidiasis (thrush, candidosis)
27

28. Primary herpetic gingivostomatitis
• Caused by Herpes simplex virus type 1
• Age-Children younger than 6 yrs, but also may be
seen in adolescents and adults.
• Primary infection is asymptomatic
• Location- lesions mainly involve hard palate,
attached gingiva and oral mucosa.
• Manifestations include blister outside the lip so
disease commonly called recurrent herpes
labialis.
28

29. • Characteristic oral finding:
• Diffuse erythmatous involvement of gingiva.
• Initial stage in characterized by discrete
spherical gray vesicles.
• Lip- excoriation involving lip become
hemorrhagic
• Course is self limited to 7-10 days.
29

30. • Oral symptoms:
• Generalized soreness
• Ruptured vesicles – focal site of pain
• Infants show irritability and refusal to eat
• Pain upon swallowing
• Extra oral symptoms:
• Cervical lymphadenopathy
• Fever ( 101- 105℃)
• Generalized malaise, irritability
30

31. Treatment
• Symptomatic & supportive.
• Application of mild anesthetic such as dyclonine
hydrochloride(0.5%)
• Bed rest , soft diet are recommended during the
febrile stage & the child should be kept well
hydrated.
• Pyrexia - paracetamol suspension and secondary
infection of ulcers may be prevented using
chlorhexidine.
• In severe case, systemic acyclovir(200 mg daily for 5
days).
31

32. Recurrent aphthous ulcer
• Characterized by painful ulceration on the oral
mucosa
• Occurs between school age and adults
• Recurrent ulceration with painful discrete and
confluent lesions.
• Lesions are round to oval crateriform base,
raised and reddened margins.
32

33. • Etiology:
• Immunological abnormality: mucosal destruction T-
mediated immunological reaction.
• Microbial organism: ∝-hemolytic strept. And S. sanguis.
• Systemic factors: like nutritional deficiency
• Clinical features:
• Occur between second and third decade of life.
• Buccal and labial mucosa tongue and gingiva are commonly
involved.
• Symptoms- lesions are typically very painful.
• Signs- begins as single or multiple superficial erosion covered
by grey membrane, surrounded by localized area of erythema.
33

34. Treatment
• Symptomatic treatment
• Topical corticosteroid triamcinolone 3-4 times daily
by rinse and expectorate method.
• Nutritional diet.
• Maintenance of oral hygiene.
34

35. Acute necrotizing ulcerative
gingivitis
• Characterized by sloughing of gingival tissue
• Uncommon in children
• Predisposing factors:
• Local: poor oral hygiene, pre-existing gingivitis
and smoking
• Systemic: Emotional stress
• Nutritional deficiency –Vit B and C
35

36. • Clinical features
• Characteristic lesions are punched out, crater
like depression at the crest of interdental
papillae
• Surface of gingival craters is covered by
pseudomembranous slough.
• Linear erythma.
36
.
Atout RN, Todescan S. Managing patients with necrotizing ulcerative gingivitis. J Can Dent Assoc. 2013;79:d46.

37. • Extra oral and systemic symptoms:
• Local lymphadenopathy
• Elevation in temperature
• Increased pulse rate, leukocytosis, loss of
appetite, and general lassitude
• Systemic reactions are more severe in
children, insomnia, constipation, GIT
disorders, headache etc.
37

38. • Treatment:
• Perform debridement under local anesthesia.
• Remove pseudomembrane.
• Patient counselling should include specific oral
hygiene instructions, instruction on proper nutrition,
• For any signs of systemic involvement, the
recommended antibiotics are:
o Amoxicillin, 250 mg 3 x daily for 7 days and/or
o Metronidazole, 250 mg 3 x daily for 7 days
38

39. Acute candidiasis (thrush,
candidosis)
• Acute candidiasis:
1. Pseudomembranous
2. erythmatous
• Causative organism- C. albicans ( yeast like
fungus.
• Pathogenesis-
39

40. • Clinical features:
• Pearly white or bluish white plaque present on
oral mucosa which may extend to circumoral
tissues.
• Painless and noticed on careful evaluation. They
may be removed with little difficulty.
• Patient may complain of burning sensation.
40

41. • Treatment:
• Infants and very young children
• Nystatin 1ml (100,000U) dropped in to
mouth for local action four times a day.
• Clotrimazole suspension (10mg/ml) 1 to 2
ml applied over affected areas four times
daily
• Systemic fluconazole suspension
(10mg/ml) 6mg/kg body weight
41

42. EARLY CHILDHOOD CARIES

43.  The American academy of Pediatric
dentistry (AAPD) defines it as “the
presence of one or more decayed (non
cavitated or cavitated), missing (due to
caries) or filled tooth surface in any
primary tooth in a child 71 months of age
or younger.”

44. Night bottle
syndrome, baby
bottle caries, nursing
mouth
Dilley et al 1980 A unique pattern of
dental caries in young
children
Baby bottle mouth,
nursing mouth decay
Croll 1984 A very destructive
carious process which
can affect infants and
toddlers
Nursing bottle caries Tsamtsouris 1986 Caries caused by
prolonged use of a
bottle filled with any
liquid other than water
Baby bottle tooth
decay (BBTD)
Mim Kelly 1987 Caries caused by bottle
feeding only not by
breast feeding
Definitions and Terminologies

45. Milk bottle
syndrome
Ripa 1988 A specific form of rampant
decay of primary teeth of
infants
Tooth cleaning
neglect
Moss 1996 Shift the emphasis to need
for cleaning
RIECDD Horowitz 1998 The age group affected by
the disease and the usual
rapidity of its development
Definitions and Terminologies

46. Etiological
agents in early
childhood
caries
Pathogenic
microorganisms
Substrate
(fermentable
carbohydrates)
Host Time
Other
predisposing
factors

47. ETIOLOGIC AGENTS IN NURSING
CARIES
• Bovine milk, milk formulas and human breast milk have all
been implicated in nursing caries because of their lactose
contents.
• Additional sweeteners in the form of juices,honey dipped
pacifier can also cause this type of caries.
• Pre-existing EHP(Enamel Hypoplasia) is also one of the
main reasons for Early Childhood caries

48. Enamel hypoplasia (EHP) has been linked :
• respiratory distress,
• Pre/post-natal infections,
• gastrointestinal tract infections,
• anemia,
• failure to thrive
• metabolic disturbances, including kidney and heart
disease, diabetes,
• infections with both viral and bacterial agents
• prematurity,
• Rh incompatibility, and allergies.

50. Nursing caries has four variables-pathogenic
microorganisms, substrates,host factor(tooth) and time
which are essential in causing demineralization.

51. Consequences of early childhood caries
• PAIN
The pain is of such severity that 73% of those affected
had been unable to eat, 31% had been unable to
sleep, 27% had stopped playing, and 11% had not
been able to attend school.

52. Consequences of early childhood caries
• Sepsis
• The greatest predictor of dental sepsis was
untreated decay; and failure to treat carious
primary teeth markedly increased the risk of
sepsis
• Dental sepsis can progress to cellulitis, and
then to Ludwig’s angina, a rapidly progressing
cellulitis of the floor of mouth that
compromises the airway.
• Management requires specialist care,
including IV antibiotics, securing of the airway
and drainage. General anaesthetic and
intensive care facilities are usually required

53. ECC COMPLICATIONS
ECC
PULPITIS,PERIAPICAL ABCESS DENTOALVEOLAR ABCESS, OSTEOMYELITIS

54. SPACE INFECTIONS, PAN SINUSITIS, MENINGITIS
CELLULITIS
LUDWIG’S ANGINA
BACTEREMIA, SEPTICIMIA

55. • Premature loss of
primary molars may
contribute to problems
such as deviation of the
mid-line, crowding,
dental impaction,
• ectopic eruption and
crossbite formation.
• the reduction in arch
length.
Space loss

56. ANTERIOR SPACE LOSS

57. Consequesences of early loss
• Delayed eruption of permanent tooth
• Unattractive appearance
• Development of deleterious habits
(tongue thrusting,forward resting posture of tongue)
• Improper pronunciation of fricative sounds( s, f
sounds)
• Lingual collapse of anterior segment
• Deep bite

58. TREATMENT
Acrylic partial dentures
Nance appliance with acrylic teeth

59. Nance appliance with acrylic teeth

60. • Disruption of quality of life.
• The ECC does affect QOL in children
and that, though the children may
not complain of pain, they manifest
its effects by disrupted eating and
sleep habits and/or exhibit negative
behaviour.
• Disruption of intellectual
development
Parents were 2.3 times more likely to
report poor school performance
when a child had poor oral health in
addition to poor general health.

61. ECC ( early childhood caries and FTT
(Failure to thrive)
• Over the past two decades, several studies have
revealed an association between ECC and FTT.
• children, aged two to four years, with otherwise
non-contributory medical history, treated for
“nursing caries” they found that these children
weighed significantly less than controls
(approximately 1kg less), and were significantly
more likely to weigh <80% of their ideal weight.

62. • Hospitalisation and emergency visits
• Emergencies related to dental caries in children constitute an
important public health problem, with dental pain a common
reason for attendance at hospital accident and emergency
departments.
• Pain due to ECC can lead to medical problems due to
inappropriate of over-the-counter medications, which may
ultimately result in the need for emergency hospital
admission. Paracetamol is frequently used for management
of ECC-related pain in children. Hepatotoxicity due to
excessive administration of the drug by parents for
management of their child’s odontogenic pain is a growing
concern in paediatric emergency medical care.

63. MANAGEMENT
AIMS
• Management of existing emergency
• Arrest & control of the carious process
• Institution of preventive procedures
• Restoration & rehabilitation
FACTORS AFFECTING MANAGEMENT
• Extent of the lesion
• Age of the patient
• Behavioral problems due to young age of the child

64. White spot lesions
– White-spot lesions are an early stage of tooth decay formation. They're the first
one that can actually be visualized.
– They're caused by tooth demineralization. (This is the process that causes
cavities.)
– This loss of mineral content results in a visible change in the appearance of
tooth enamel
– The white spot lesion is completely reversible in the initial stage,

65. Type 1 (Mild to moderate) Early
Childhood Caries
• The existence of isolated carious lesion(s)
involving molars and/or incisors.
• cariogenic semi-solid or solid food and lack of
oral hygiene
• 2 to 5 years old

66. Type II (Moderate to severe) Early
Childhood Caries
• maxillary incisors, with or without molar caries and
unaffected mandibular incisors.
•inappropriate use of feeding bottle or at- will breast-
feeding or a combination of both, with or without poor
oral hygiene
•This type of Early Childhood Caries could be found soon
after the first teeth erupt.

67. Type III (Severe) Early Childhood Caries
• Carious lesions affecting
almost all the teeth including
the lower incisors
• combination of cariogenic food
and poor oral hygiene.
• age 3 and 5 years
• . The condition is rampant and
involves tooth surfaces which
are usually unaffected by
caries.

68. PROGRESSION OF THE LESION
Initially, a demineralization
dull, white area is seen
along the gum line on labial
aspect of maxillary incisors.
These white lesions
become cavities which
involve the neck of the
tooth in a ring like
fashion
Finally, the whole crown
of the incisors is
destroyed leaving
behind brown-black
root stumps.

70. PEDIATRIC ENDODONTICS

73. Oral habits
• Thumb sucking
• Tongue thrusting
• Mouth breathing
• Lip biting
• nail and pencil biting
• Self injurious habit

74. THUMB SUCKING

75. THUMB & DIGIT SUCKING
 ETIOLOGY
A number of theories have been put forward to explain why
thumb sucking occurs. The following are some of the more accepted
ones:
 FREUDIAN THEORY: This theory was proposed by Sigmond
freud in the early part of this century. He suggested that a child
passes through various distinct phases of psychological
development of which the oral and the anal phases are seen in
the first three years of life. In the oral phase, the mouth is
believed to be an oro-erotic zone. The child has tendency to
place his fingers or any other object into the oral cavity.
Prevention of such an act is believed to result in emotional
insecurity & poses the risk of the child diversifying into other
habits.

76.  ORAL DRIVE THEORY OF SEARS AND WISE: Sears & Wise
in 1950 proposed that prolonged suckling could lead to thumb
sucking.
 BENJAMIN’S THEORY: Benjamin has suggested that thumb
sucking arises from the rooting or placing reflex seen in all
mammalian infants.
 PSYCHOLOGICAL ASPECTS: Children deprived of parental
love,care & affection are believed to resort to this habit due to a
feeling of insecurity.
 LEARNED PATTERN: According to some authors, thumb
sucking is merely a learned pattern with no underlying cause or
psychological bearing.

77. PHASES OF DEVELOPMENT
 PHASE 1:(Normal & sub-clinically significant):This phase is seen during
first three years of life. The presence of thumb sucking during this phase is
considered quite normal & usually terminates at the end of phase one.
 PHASE 2:(Clinically significant sucking): This phase extends between 3-6
½ years of age. The presence of sucking during this period is an indication
that the child is under great anxiety. Treatment to solve the dental problems
should be initiated during this phase.
 PHASE 3:(Intractable sucking):Any thumb sucking persisting beyond the
fourth or fifth year of life should alert the dentist to the underlying
psychological aspects of the habit. A psychologist might have to be
consulted during this phase.

78. `
EFFECTS OF THUMB SUCKING
The following are some of the effects of thumb sucking:
a) Labial tipping of the maxillary anterior teeth resulting in proclination.
b) The overjet increases due proclination of the maxillary anteriors.
c) Some children rest their hand on the mandibular anteriors during the
sucking act. In such children lingual tipping of the mandibular incisors can
be expected which further increases the overjet.
d) Anterior open bite..
e) The cheek muscles contract during thumb sucking resulting in a narrow
maxillary arch, which predisposes to posterior crossbites.

79. Management :Preventive treatment
Psychological
– Avoidance of scolding, frightening
– Reassurance and positive reinforcement
– Friendly reminders
– Brauer (1965)
• Constructive parental education
• Provide age specific suitable play
material
• Avoidance of unnecessary regulation

80. Management :Preventive treatment
• - Hypothesis or Dunlop’s hypothesis
– Forced purposeful repetition
– Abandonment of habit following unpleasant
reaction

81. Management: chemical treatment
• Least effective
• Bitter or sour chemical over the finger
– E.g. : Foul smelling Quinine, Asofoctine, Pepper , Caster
oil, Femite etc

82. Management: Mechanical or reminder
therapy
• Removable and fixed
appliance
– Palatal crib and rakes
• Breaks the suction and
force on anterior
segment
• Reminder
• Makes the habit
nonpleasurable
Symptoms of irritability,
night tremor, day
wetting

83. Reminder therapy using thumb guard to treat
thumb sucking

84. Management: Mechanical or reminder
therapy• Oral screen
• Redirection of muscular
and soft tissue pressure
– Prevention of placement of
thumb in mouth
– Blue grass appliance:
Bruce Haskell (1991)

85. • Tongue thrust (also called reverse swallow or
immature swallow) in which
the tongue protrudes through the anterior
incisors during swallowing, speech, and while
the tongue is at rest.
Tongue thrusting habit

86. ETIOLOGICAL FACTORS:
1. Genetic factor
1. Inherited variation in orofacial
form
• Constricted arch
2. Learned behavior
1. Acquired habits
2. Prolonged Tonsillar
hypertrophy, URTI
3. Maturational
1. Delayed progression from
infantile to mature swallow
4. Mechanical restriction
1. Macroglossia, constricted dental
arches, Enlarged adenoids
5. Neurological disturbances
1. Hyposensitive palate, motor
disability
6. Psychological factors
1. Effect from forced
discontinuation of other habit

87. Tongue Thrusting: Cl/F
CLINICAL FEATURES
The tongue thrust
habit can be associated with the
following features:
a) Proclination of anterior teeth
b) Anterior open bite
c) Bimaxillary protrusion
d) Posterior open bite in case of
lateral tongue thrust
e) Posterior crossbite

88. Tongue Thrusting :Treatment
• Mechano therapy
– Purpose
• Reeducation of tongue position
• Maintaining tongue in the confines
of dentition
• Maintaining the interocclusal
distance
– Prevention of over eruption and
narrowing of maxillary buccal
segment

89. 1 2
3
4 5
Tongue Thrusting :Treatment

90. Tongue Thrusting :Treatment
• Preorthodontic trainer for
myofunctional training
– Aids in correct positioning of
tongue with the help of
tongue tags
– Tongue guard

91. MOUTH BREATHING HABIT
CLASSIFICATION OF MOUTH BREATHERS
Mouth breathers can be classified into 3 types :
Obstructive
Habitual
Anatomic
OBSTRUCTIVE: Complete or partial obstruction of the nasal passage
can result in mouth breathing. The following are some of the causes of
nasal obstruction:
i. Deviated nasal septum
ii. Nasal polyps
iii. Chronic inflammation of nasal mucosa
iv. Localized begin tumors
v. Congenital enlargement of nasal turbinates
vi. Allergic reaction of the nasal mucosa
vii. Obstructive adenoids

92.  HABITUAL: A habitual mouth breather is one who continues to
breathe through his mouth even though the nasal obstruction is
removed. Thus mouth breathing becomes a deep rooted habit is
performed unconsciously.
 ANATOMIC: An anatomic mouth breather is one whose lip
morphology does not permit complete closure of the mouth, such as
a patient having short upper lip.

93. Appearance Dental and Skeletal Changes
• Adenoid facies
• Long narrow face
• Short upper lip
• Lips wide apart
• Anterior open bite
• High palatal vault
• Narrow maxilla
• Marginal gingivitis
• Protrusion of maxillary
and mandibular incisors
• High incidence of caries

94. Long face syndrome or the classic adenoid
facies
A. Long & narrow face
B. Narrow nose & nasal passage
C. Short & flaccid upper lip
D. Contracted upper arch with
possibility of posterior cross bite
E. An expressionless or blank
face
F. Increased overjet as a result of
flaring of the incisors
G. The dryness of the mouth
predisposes to caries

95. Mouth breathing: Cl / F
• Dental effect
– Protrusion with spacing of
upper incisors
– Decreased overbite
– Openbite
– Lower tongue position
– Posterior cross bite

96. Mouth breathing: Treatment
• Elimination of cause
– Removal of nasal or pharyngeal
obstruction
• Interception of habit
– Exercises
• Physical – deep inhalation exercise
• Lip
– Upper lip extension exercise
– Upper, lower lip combined
exercise
• Playing wind pipe
• Water holding exercise
Oral screen

97. Lip habits
– Lip biting types:
– Basic type
• Wetting of lip with tongue
• Pulling the lip into mouth
between teeth
– Lip sucking-
• Entire lower lip with
vermilion border pulled in
mouth
– Mentalis habit-
• Vermilion border everted

98. Lip habits: Treatment
• Appliance therapy
– Oral shield
• Cl I malocclusion
• Lip exercise for
improvement of lip tonus
– Lip bumper
• Prohibits excessive force on
mandibular incisors
• Reposition of lower lip
away from upper incisors

99. LIP BITING HABIT

100. BRUXISM
• Bruxism can be defined as the grinding of teeth for non functional purposes.
Some authors refer to nocturnal grinding as bruxism while the team
bruxomania is given for grinding during day time.
ETIOLOGY
1. Psychological & emotional stresses have been attributed as one of the
causes of bruxism.
2. Occlusal interference.
3. Pericoronitis, & periodontal pain is said to trigger bruxism in some
individuals.

101. Bruxism: Treatment
 TREATMENT
Night guards or
other occlusal splints that cover the
occlusal surfaces of teeth help in
eliminating occlusal interference,
prevent occlusal wear interference
& break the neuromuscular
adaptation.

102. Bruxism: Treatment
• Restorative
– Severe abrasion
• Pulp therapy
• Stainless steel crown
• Psychotherapy
– Counseling
• Tension relief
• Habit awareness -Increase
voluntary control

104. BRACES MYOBRACE TM ACTIONS
P P STRAIGHTENS TEETH
O P NO BRACES
O P NO PERMANENT RETAINERS
O P REMOVABLE AND CONVENIENT
O P WEAR FOR 1-2 HOURS
O P TREATS THE CAUSE OF CROOKED TEETH
O P MINIMIZE ROOT AND ENAMEL DAMAGE
O P EASY TO MAINTAIN GOOD ORAL HYGIENE
O P IMPROVED COMFORT OVER BRACES
O P NO ONE KNOWS YOU’RE HAVING TREATMENT
ADVANTAGES OVER TRADITIONAL METHODS

105. CROWDING
OPEN BITE
CROSS BITE

106.  Treatment of white spot
lesions or first sign of tooth
decay
PREVENTIVE DENTISTRY

107. Indications for the use of topical fluoride:
•Caries active individuals (defined as those with past caries
experience or those who develop new carious lesions on smooth
surfaces).
•In children shortly after periods of tooth eruption, especially those
who are not caries free.
•In patients with reduced salivary flow due to medications.

108. •Patients with fixed or removable appliances, e.g. before
cementation of bands
•After placement or replacement of restorations and before
cementation of stainless steel crowns.
•Patient with eating disorders or undergoing a change in
lifestyle which may affect eating or oral hygiene habits
conducive to good oral health.
•Mentally and physically challenged individuals

109. GC Tooth Mousse- CPP-ACP: casein
phosphopeptide-amorphous calcium
phosphate
• BABY MOUSSE
• Newly erupted teeth have yet to complete
their enamel maturation and until this occurs
they are more vulnerable to acid attack.
• Boosting levels of calcium and phosphate in
the saliva facilitates the normal post-
eruption maturation process and replaces
mineral loss on a daily basis.
RECALDENT™
• (CPP-ACP) is derived from cows’ milk
and is ideal for protecting deciduous teeth
at a time when oral care is difficult.

110. Preventive Dentistry
• GC Tooth Mousse- CPP-ACP:
casein phosphopeptide-
amorphous calcium
phosphate is an exciting
addition to the preventive
dentistry armamentarium of
the modern dental practice,
offering the ability to deliver
biologically available calcium
and phosphate
• ions in exactly the 5:3 ratio
required for regeneration of
hydroxyapatite

111. Pit & fissure sealant:
• “ a material that is introduced into the occlusal pits
and fissures of caries susceptible teeth, thus
forming a micro-mechanically bonded, protective
layer cutting access of caries-producing bacteria
from their source of nutrients”
Preventive Dentistry

113. Various topical fluorides
• In solution form:
- Sodium fluoride, stannous fluoride, APF .
• In gel form:
- APF
• fluoride varnish
• foam

114. PROFESSIONAL TOPICAL F
Recommendations:
1. Determine total F exposure.
2. Administer 0,1,2,3,4 times a
year as indicated by caries
risk level.
3. Apply for 4 minutes.
4. Use only 2 ml of gel in
trays, keep patients from
swallowing the gel.
5. No rinsing, drinking or
eating for 30 min.
afterwards.
.

115. Topical fluoride
< 4yr old Fl tooth paste not recommended
4-6 yr old Brush once daily with Fl, other two times without a
paste
6-10 yr old Twice with Fl tooth paste, other time without paste
>10 yr old Thrice daily with Fl tooth paste

116. CONSEQUENCE OF EARLY LOSS OF PRIMARY TEETH
•Drifting of teeth into space
•Loss of arch length
•Crowding and malocclusion
•Ectopic eruption of teeth
•Phonetic alterations
•psychological, morphological and functional problems
may result from premature loss of primary teeth.

117. Various space maintainers
Space maintainer therapy for early loss of maxillary tooth

118. Sports Trauma
• Mouth Guards
• A mouthguard is a flexible
appliance made out of plastic
that is worn in athletic and
recreational activities to
protect teeth from trauma.
• Advantages :
– Protection of teeth and intraoral
structures
– Jaw fracture & edentulous areas.
– Reduction of other Head & neck
injuries with mouthguards.
– Athletic confidence
– Facial injuries.
– Economic considerations

119. Custom fabricated mouth guards
• Superior to tock made or commercially available
ones
• Does not interfere with breathing
• Does adapt well & possess superior retention
• More likely accepted by athletes due to superior
fit.

121. Fractured tooth
up to cervical
third.
Core build up
done.
Restored teeth
with porcelain
veneer crown

122. AVULSION

123. Minor oral surgical procedure
Lingual
frenectomy
procedure for
tongue tie

124. LABIAL FRENECTOMY
•Thick labial frenum can cause a large gap between teeth and
gum recession by pulling the gums off the bone.
• A labial frenectomy removes the labial frenulum.

125. Prosthetic rehabilitation

126. Various syndromic conditions associated
with anodontia or hypodontia
• Ectodermal dysplasia
• Pierre Robin syndrome
• Vander Woude syndrome
• Incontinentia pigmenti
• Oral-facial-digital syndrome type 1
• Witkop tooth-nail syndrome
• Fried syndrome
• Böök syndrome (PHC)
• Rieger syndrome
• Down syndrome (trisomy 21)
• Hemifacial microsomia

127. Prosthetic
rehabilitation in
syndromic
patients

128. ORO-FACIAL THERAPY
STIMULATING PALATAL PLATE
The purpose of this therapy is to eliminate tongue dysfunctions and
improve the function of the orbicularis oris muscle, which produces
improvements in respect of sucking, articulation, swallowing and
nasal breathing

129. Obturator &Naso alveolar
molding for cleft patients

131. Special Care Dentistry
Special Care Dentistry address the oral health
needs of people with a range of conditions which
may result in their oral health being compromised
directly through the condition itself, or indirectly
through medication or poor access to care.

132. • One technique often
recommended is the
horizontal scrub method
because it is easy to perform.
• Modifications that may be
made to a toothbrush to help
persons with poor fine motor
skills improve their brushing
techniques.

133. PROGRAMS TO TEACH ORAL HYGIENE
• Three groups (Bensberg): Special Health Care Children
• SELF-CARE GROUP:
– Easiest to deal with – MINIMAL SUPERVISION
– Children who can maintain excellent oral hygiene
– Modification – rheumatoid arthritis pts/chronic
joint damage
– Modifications of toothbrush handles
– Attend special academic schools

134. • PARTIAL CARE GROUP:
– Moderately disabled
– Require CLOSE SUPERVISION
– Motivation difficult
– DO NOT EXPECT RAPID LEARNING
– Break task into small and easy steps
– social reinforcement
• TOTAL-CARE GROUP:
– Severely disabled – confined to wheelchairs
– Individual assistance needed
– Power toothbrush