this ppt contains important outline for recording case history in pediatric patients dental point of view

2. PRESENTED BY
DR. SWATI MANOHAR(PAPPULWAR)
PG STUDENT PEDODONTICS
CASE HISTORY EXAMINATION AND
TREATMENT PLANNING IN PEDIATRIC
DENTISTRY

3. INTRODUCTION
• Successful dental care for children is best achieved after
thorough examination, thoughtful diagnosis and
formulation of a proper treatment plan.
• Pediatric dentist has a specific skills in management,
diagnosis and treatment planning of a child which are
different from those experience with adult patients.

4. IMPORTANCE OF RECORDING CASE HISTORY

5. PERSONAL INFORMATION
• Name
• Age: diseases seen in infancy, childhood and young adult
- to determine exfoliation and eruption sequence
- determine treatment plan
- behavior management technique
- child drug dose
- growth assessment parameter
• Gender
• Address
• Language known

6. • Date birth
• Name of accompanying person
• Patient’s name and education
• Contact number

7. • Chief complaint of the patient

8. HISTORY OF PRESENT ILLNESS
• Information should be collect by asking various questions
include:
Mode and duration of onset
Cause of onset
Duration and progress
Any treatment done
Any medication taken

9. DETAILED HISTORY OF PAIN
History of pain should be elicited in detail which include
• Location of pain
• Origin or mode of onset
• Intensity of pain
• Nature
• Progression

10. • Duration
• Radiation of pain
• Effect of functional activity
• Association with any systemic effects

11. DETAILED HISTORY OF SWELLING
• Mode of onset
• Progress of swelling
• Symptoms
• Associated features
• Secondary changes
• Impairment of function
• Any medication

12. PAST MEDICAL HISTORY
• Child under any physician care
• Medication and allergy
• Hospitalization
• Blood transfusion
• Immunization status of child

13. IMMUNIZATION SCHEDULE

14. FAMILY HISTORY
• Siblings
• Socioeconomic status
- B.G PRASAD SCALE
- PAREEK CLASSIFICATION
- KUPPUSWAMY SCALE

16. PRENATAL, NATAL AND POST NATAL HISTORY
• Health of mother during pregnancy
• Diseases to mother
• Accident/ trauma during pregnancy
• Abnormal fetal position

17. Natal History :
Trauma, childhood disease
 Developmental mile stones :
Importance
Developmental milestones for infants- toddlers, 3- 6 years and
6- 12 years
Post natal history:
Feeding habit : breast feeding or bottle

18. SOCIAL/ BEHAVIORAL HISTORY
• School
• Performance at school
• Fear
• Learning, concentrating, reading, co operating
and understanding problem: IQ of the child

19. PERSONAL HISTORY
• Habits
• Tooth brushing techniques
Duration , frequency, technique
• Tooth paste – fluoridated and non
fluoridated

20. DIET HISTORY
• Diet diary
• 24 hour recall period

21. DENTAL HISTORY
• 1st dental visit
• Tooth ache, trauma in past
• Fluoride treatment

22. EXAMINATION OF THE PATIENT
• General examination – its importance in detail
Stature
Gait
Speech
Hands
Cyanosis
Icterus
Nails

24. Extra oral examination
• Shape of head
• Skin on the face
• Shape of face
• Facial profile & symmetry
• Ears
• Eyes
• Nose
• Neck

25. • Lymph nodes- its examination

26. • TMJ & function- its examination

27. BEHAVIOR RATING
• Behavior rating scale: frankel
classification
• Behavior management : verbal and non
verbal communication

28. PRESENTED BY
DR. SWATI MANOHAR
PG STUDENT
CASE HISTORY
EXAMINATION AND
TREATMENT PLANNING

29. • Protruding ears (also called prominent ears): Ears that,
regardless of size, stick out more than 2 cm from the side of the
head
• Constricted ears : A variety of ear deformities where the helical
rim is either folded over (also called lop ear), wrinkled, or tight
• Microtia : Underdeveloped external ear
• Anotia : Total absence of the ear
• Stahl's ear : Ears that have a pointy shape and an extra cartilage
fold (crus) in the scapha portion of the ear

30. • Ear tags: Also known as an accessory tragus or a branchial cleft
remnant, ear tags consist of skin and cartilage
• Earlobe deformities: earlobes with clefts, duplicate earlobes, and
earlobes with skin tags Cauliflower ear: Abnormal cartilage forms on
top of the normal cartilage, resulting in bulky misshapen ears
• Ear keloids: Caused by excessive scar tissue formation after minor
trauma, most commonly after ear piercing
• Ear hemangiomas: Most common benign tumor of infancy, can occur
anywhere on the body, including the external ear and the salivary
gland in front of the ear.

31. INTRA ORAL EXAMINATION IN CHILDREN
• Examination in infants and toddlers: differs form other age
group

32. • Lip and labial/ buccal mucosa
• Tongue,
• Palate,
• Floor of mouth,

33. GINGIVA
• Color , size, contour, shape, consistency,
surface texture, position.
• Stippling
• Bleeding on probing

34. FRENUM
• TYPES OF FRENUM
Type 1- mucosal attached frenum
Type 2- gingival frenal attachment
Type 3- papillary frenal attachment
Type 4 papillary penetrating frenal
attachment

35. Gingiva in children
Reddish in color Thinner epithelium, a lesser
degree of keratinization, and greater
vascularity
Gingiva in adults
Coral pink, due to thickness and degree of
keratinization , vascularity and pigmented
cells
Lack of stippling: Shorter and flatter papillae
from the lamina propria.
Stippling is present: it is a form of adaptive
specialization or reinforcement for function.
Degree of keratinization and prominence of
stippling appear to be related
Rounded and rolled gingival margins:
Hyperemia and edema that accompanies
eruption. Pronounced cervical ridge of the
crown in deciduous teeth
Knife edge margins
Consistency is flaccid and retractable:
immature connective tissue composition,
immature gingival fibres system, increased
vascularization
Firm and resilient: increase in collagenous
nature of the lamina propria and its
contiguity with mucoperiosteum of alveolar
bone

36. • Gingiva:
The connective tissue has comparatively less well-developed net of
collagen fibres than in adults. The surface of the col was said to be
covered by an odontogenically-derived epithelium that is atrophic,
(four cell-layers thick) and has a diminished proliferative activity.
• Alveolar Bone:
The lamina dura is thinner; there are fewer trabecular and larger
marrow spaces. There is a smaller amount of calcification greater
blood and lymph supply and the alveolar crest appears flatter.

37. • Periodontal Ligament: It is wider, has fewer and less dense fibers per
unit area and has increased hydration with a greater blood and lymph
supply than in adults. During eruption the principal fibres are parallel
to the long axis of the teeth. The bundle arrangement occurs after the
teeth encounter their functional antagonists
• Cementum: It is often thinner and less dense than of adults. It shows a
tendency to hyperplasia of cementoid apical to the epithelial
attachment. Before the tooth reaches the occlusal plane, a cellular
cementum is formed

38. • Williams periodontal probe is marked in millimeters at the following
distances from the probe tip. 1, 2, 3, 5 then 7, 8, 9 and 10 millimeters. The
spaces between the 3 and 5 millimeter marking and between the 5 and 7
millimeter marking are to avoid confusion in the reading of the
measurement.
• Probing depth is recorded for all teeth on each of six locations (buccal,
lingual, mesio-buccal, mesio-lingual, disto-lingual, disto-buccal).
• The probe should be inserted parallel to the long axis of the tooth and
walked around each surface of each tooth to detect the depth of pocket at
each -surface. A probing force of 25 grams (0.75 Newtons)

40. • Tonsils and adenoids
• Openings of salivary gland
ducts

41. INTRA ORAL HARD TISSUE EXAMINATION
• Examination of teeth:
Number, size, color and malformation of teeth
Nomenclature : universal system, Zsigmondy's,
and palmer method, FDI (Fédération Dentaire
Internationale system of nomenclature

42. Retained teeth
Dental anomalies
Supernummery teeth
Dental caries and oral hygiene status ( calculus and stains)

45. ORTHODONTIC EVALUATION
• Classification
Molar and canine relationship and classification

46. • Open bite is defined as a condition where a space exists
between the occlusal or incisal surfaces of the maxillary and
mandibular teeth in the buccal or anterior segments when the
mandible is brought into a habitual or centric occlusion
(Graber).
• Cross bite is a condition where one or more teeth may be
abnormally malposed buccal or lingually or labially with
reference to opposing teeth.
• Deep bite: condition of excessive overbite where the vertical
measurements between maxillary and mandibular incisal
margins is excessive when mandible is brought into habitual
centric occlusion

48. • Primate space:
• Leeway space is the size differential
between the primary posterior teeth
(canine, first and second molars labeled
C, D and E in the picture), and
the permanent canine and first and
second premolar (labeled 3, 4 and 5)
• Incisor liability:
• Space loss: criteria by owen ( Mac
Donald's)

49. PROVISIONAL DIAGNOSIS

50. DIFFERENTIAL DIAGNOSIS

52. INVESTIGATIONS
• Types Of Film
• Intra Oral Radiographs-
Bitewing
Periapical
Occlusal Radiograph

53. EXTRA ORAL RADIOGRAPHY

54. APPLICATIONS OF CBCT IN DENTISTRY
• Investigate the exact location and extent of jaw
pathologies and assess impacted or supernumerary teeth
and the relationship of these teeth to vital structures
• CBCT imaging is a useful tool for diagnosing periapical
lesions
• CBCT is used widely for planning orthognathic and facial
orthomorphic surgeries,
• Detect root resorption (external or internal) and cervical
resorption, it can also identify the extent of a lesion
• It can be used to determine the number and morphology of
roots and associated canals (both main and accessory),
establish working lengths, and determine the type and
degree of root angulation

55. • Hematological investigation
Coagulation factor
deficiencies
Congenital Hemophilia A and B von Willebrand’s
disease Other factor deficiencies (rare) Acquired
Liver disease Vitamin K deficiency, warfarin use
Disseminated intravascular coagulation
Platelet disorders Quantitative disorder (thrombocytopenia)
Immune-mediated: Idiopathic ,Drug-induced,
Collagen vascular disease, Sarcoidosis
Non-immune-mediated: Disseminated intravascular
coagulation Microangiopathic hemolytic anemia
Leukemia Myelofibrosis
Qualitative disorder
Congenita:l Glanzmann thrombasthenia von
Willebrand’s disease
Acquired : Drug-induced Liver disease Alcoholism
Vascular disorders Scurvy, Purpura, Hereditary hemorrhagic telangiectasia,
Cushing syndrome, Ehlers-Danlos syndrome
Fibrinolytic defects S Streptokinase therapy, Disseminated intravascular
coagulation

56. • Histo pathological investigation it refers to
the microscopic examination of tissue in order to study the
manifestations of disease- oral diseases such as cyst, tumors etc

57. FINAL DIAGNOSIS
• It usually identify the diagnosis for the patients primary
complaint first with subsidiary diagnosis of concurrent problems
• Their may be possibility that more than one disease may be
present at the same time.
• Most important in an unusual cases consultation with other
specialist or general physician is necessary before a final
diagnosis.

58. TREATMENT PLANNING
Practitioner needs an organized approach to diagnose correct and
prevent problem with a proper treatment planning.
Advantages of treatment planning:

59. • General outline suggested by FINN
1. Medical treatment
Referral to physician
2. Systemic treatment
Premedication
Therapy for oral infection
3. Preparatory treatment
Caries control
Oral prophylaxis
Orthodontic consultation
Oral surgery
Endodontic therapy

60. 4. Corrective treatment
Operative dentistry
Prosthodontic correction
Orthodontic correction
5. periodic recall examination and maintenance treatment

61. ACC TO STEPHEN WEI
1. Preventive phase:
Caries stabilization
Oral hygiene instruction
Dietary analysis and advice
Prophylaxis, Topical fluoride application, Pit and fissure sealants
2. Surgical phase:
Extraction of teeth with poor prognosis
Surgical exploration of desirable teeth
Extraction of undesirable teeth and for orthodontic reasons

62. 3. RESTORATIVE PHASE:
Composite restoration
GIC restorations
Pulp therapy procedure
Stainless steel crown cementation
4. ORTHODONTIC PHASE:
Space management
Removable appliance therapy
Functional appliance therapy
Fixed appliance therapy

63. ACC TO BARBER AND LUKE
• Four basic areas of concern in diagnosis and treatment planning
are
1. Oral medical problem
2. Periodontal consideration for long term
3. Dental caries- restorative
4. Occlusion – craniofacial growth and development

64. ACC TO BRAHAM MORRIS
1. Systemic phase: premedication, medical consultation
2. Preparatory phase: preventive therapy, orthodontic consultation,
endodontic therapy
3. Corrective phase: prosthodontic correction, orthodontic
corrections, stainless steel crown cementation
4. Maintenance phase: recall for preventive and orthodontic visits.

65. CONCLUSION