This document provides information on oral examinations and treatment planning for different age groups from infancy to adolescence. It discusses: 1. Examination techniques appropriate for infants and toddlers aged 0-3 years, including using the parent to immobilize the child and preferring the knee-to-knee position over dental chairs. 2. Common conditions seen in infants such as natal/neonatal teeth, Riga-Fede disease, and early childhood caries. 3. Recommendations for preventing early childhood caries from the American Academy of Pediatric Dentistry. 4. Assessment of facial profile, symmetry, intraoral structures for children aged 3-6 years and 6-

1. Examination, Diagnosis,
and Treatment Planning 2
By: Dr. P. Mahjoub
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2. Infant and Toddler
(0-3 years)
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3. Oral Examination And Assessment Of Clinical Risk Factors
 Use of a dental chair is unnecessary and the least preferred
approach
 The parent participates as a learner and immobilizer
 Teaching about the oral cavity occurs during the examination
process
 The child may cry, which is desirable and useful
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4. Oral Examination And Assessment Of Clinical Risk Factors
 The examination can occur wherever a suitable light source
can be found
 The preferred approach to infant examination is the knee-to-
knee position
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6. Normal Predentate Infant Oral Cavity
 No teeth present
 Rugae present on palate
 Tooth bud bulges prominently
 Tissues pink and healthy
 High labial frenum
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7. Natal And Neonatal Teeth
 Natal teeth present at birth
 Neonatal present within 30 days of birth
 Incidence 1-2 per 6000 births
 90% are primary
 10% supernumerary
 85% mandibular
 Extract supernumeraries
 Primary teeth left if not highly mobile
 Can be aspiration risk
 Nursing obstacle
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8. Natal And Neonatal Teeth
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9. Riga-Fede Disease
 Actually traumatic ulcer of ventral surface of tongue from tooth
 May cause active bleeding and discomfort
 Treatment options are observation, cessation of breastfeeding
or removal/smoothing of the offending tooth
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10. Early Childhood Caries (ECC)
 A specific form of severe dental caries that affects infants and
young children
 The presence of more than one decayed (noncavitated or
cavitated lesions), missing (due to decay), or filled tooth
surface in any primary tooth in a child 71 months or younger
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11. Severe Early Childhood Caries
 Younger than 3: any sign of smooth surface caries
 Between the ages of 3 and 5 years: one or more cavitated,
missing (due to caries), or filled smooth surface in primary
maxillary anterior teeth or a decayed, missing, or filled surface
(dmfs) score of greater than 4 (age 3 years), greater than 5
(age 4 years), or greater than 6 (age 5 years)
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13. The American Academy Of Pediatric Dentistry
Recommendations
 Infants not be put to sleep with a bottle and that unrestricted
nocturnal breastfeeding be avoided after the eruption of the first
primary tooth
 Parents should encourage their infant to drink from a cup as the
child approaches the first birthday
 Weaning from the bottle should be done at 12 to 14 months of
age
 Oral hygiene measures should be in place at the time of the
eruption of the first tooth
 The child's initial oral health consultation should occur within 6
months after the eruption of the first tooth but no later than 12
months of age
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14. The Primary Dentition Years
(3-6 years)
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15. Facial Profile
 The child should be seated upright, looking at a distant point
 Three points on the face are identified:
- The bridge of the nose,
- The base of the upper lip,
- The chin
 Line segments connecting these points form an angle that
describes the profile as convex, straight, or concave
 A well-balanced profile in this age group is slightly convex
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16. Facial Profile
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17. Vertical Facial Relationships
 Proportionality is judged by dividing the face into thirds:
• The upper third extends from approximately the hair line to the
bridge of the nose
• The middle third from the bridge of the nose to the base of the
upper lip
• The lower third from the base of the upper lip to the bottom of
the chin
 These thirds are approximately equal, or the lower third is
slightly larger in well-proportioned faces
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18. Vertical Facial Relationships
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19. Facial Symmetry
 The patient reclined in the dental chair
 The dentist seated in the 12 o'clock position
 Hair is pulled away from the face
 The mandible should be either at rest or in centric relation
position
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20. Intraoral Examination
 The ideal arch in the primary dentition has spacing between
the teeth
1. Primate space, is located mesial to the maxillary canine and
distal to the mandibular canine
2. Developmental space is the space between the remaining
teeth
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21. Intraoral Examination
 Primary molar relationships:
- Flush terminal plane
- Distal step
- Mesial step
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22. Intraoral Examination
 Overjet: 2-5 mm
 Overbite: 2 mm
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23. Treatment Planning For Nonorthodontic Problems
 Generally, acute infection and pain are managed first
 Hopelessly involved teeth should be extracted
 All factors being equal:
1. Maxillary posterior areas
2. Mandibular posterior area
3. Mandibular anterior area
4. Maxillary anterior area
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24. The Mixed Dentition Years
(6-12 years)
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25. Facial Profile
 The ideal soft tissue profile is slightly convex
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26. Vertical Profile
 Concentrate on the proportionality of the middle and lower
facial thirds
 The proportionality of the
well-balanced face remains
basically the same, but the
lower facial third is slightly larger
than the middle facial third
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27. Intraoral Examination
 Overjet: 2 mm
 Overbite: 2 mm
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28. Periodontal Evaluation
 Selective probing of anterior teeth and permanent first molars
 Sulcular depths of greater than 3 mm and attached gingiva of
less than 1 mm indicate possible periodontal problems
 Facial clefts of the lower anterior teeth
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29. Periodontal Evaluation
 The gingival index (GI):
0 = Normal gingiva
1 = Mild inflammation: slight change in color, slight edema, no
bleeding on probing
2 = Moderate inflammation: redness, edema, and glazing, or
bleeding on probing
3 = Severe inflammation: marked redness and edema, tendency
toward spontaneous bleeding, ulceration
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30. Adolescence
(12-18 years)
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31. Soft Tissue Profile
 Differences between adult and adolescent face:
- The adult profile tends to be straighter
- The adult soft tissue of the chin is slightly thicker
- The nose continues to grow both horizontally and vertically
through adulthood
- The adult lips are less protrusive
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32. Periodontal Evaluation
 A periodontal probe is used to measure:
- Pocket depth
- Width of keratinized gingiva
- The amount of attached gingiva
- Establish a bleeding index
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33. Thanks For Your
Attention
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