for dental students

1. Part 2

2. Pediatric dentistry principle and practice M S Muthu
• Early intervention is aimed at
• Primary prevention of dental disease is based on
• prevention of oral injuries,
• management of oral habits
• assessment of oral development and consideration of other individual
• special needs enhance a child’s opportunity for a lifetime free from preventable oral disease.

3. Rationale
• Early oral examination,
oral health risk assessment
anticipatory guidance - are effective means of true primary prevention.
• Early identification
intervention of oral health problems - are cost-effective and lead to satisfactory outcomes.
Goals
• Timely delivery of family education on caries etiology/process, appropriate oral hygiene and feeding/dietary
habits for caries prevention with ultimate goal of avoiding future surgical intervention (if possible, initiate
educational process during pregnancy).
• Timely consideration of fluoride management and preventive strategies as the primary dentition erupts based
on individualized risk assessment.
• Provide anticipatory guidance and identify high-risk children for Early Childhood Caries (ECC) at an early age
(if possible, identify high-risk mothers during pregnancy).
• Establish a dental home by 12 months of age.
Pediatric dentistry principle and practice M S Muthu

4. Why infant oral health care?
• Infectious diseases of the oral cavity
• Traumatic injuries
• Habits
• Handicapped children
• Problems of speech, language

5. How to proceed......
• Recording - detailed medical and dental histories.
• Clinical examination - oral structures in parent-assisted (knee-to-knee) position.
• Counseling - about caries risk factors and provide anticipatory guidance in the areas of dental and oral
development, fluoride adequacy, teething, non-nutritive habits, injury prevention, dietary and oral hygiene
instructions.
• Counseling about bacteria transmissibility and provide anticipatory guidance directed to the mother or other
intimate caregiver in order to avoid or delay colonization.
• Assessment - of the infant’s caries risk using AAPD caries-risk assessment tool (CAT) in order to address current
problems and determine individual preventive strategies and follow-up intervals.
• Decision - on supplemental procedures which may include caries risk testing, such as assay of salivary mutans
streptococci (MS) levels by culture, selected radiographic examination, water fluoride analysis, consultation with
other dental and medical providers and other interventions deemed necessary by a child’s individual needs.
• Follow-up procedures.
Pediatric dentistry principle and practice M S Muthu

6. Source of information
• Timing of first visit
• Individualized comprehensive preventive programs
• Answering the quieries
• Knowing and guiding the traditional home remedies
Role of dentist in infant oral health

7. Feeding practice

8. Breast feeding
• Breast milk has the ideal composition for infants needs, provided in a safe
clean form at the right temperature.
• The feeds need no preperation and there is no equipment to sterile.
• Breast milk contain anti-infective factors which cannot be manufactured and
added to infant formula.
• psychologist says that it is of psychological advantage to mother and child,
increase bond strength and there is sence of accomplishment and
indispensability to mother.
• Breast fed child is less likely to have arterial disease because of fat, fat in
breast milk are better emulsified.
• Easily digestable and has low osmotic load.
• confers passive immunity to baby.
• Lack of breast feeding associated with developmental defects of primary
dentition particularly in premature children.

9. Function
It stimulates the muscles around the Muscles don’t have to work hard, hence
mouth and tongue activity for normal normal growth of the teeth and jaws may
growth of the teeth and jaws. get affected.
Breast feeding allows milk flow on Milk flows from the bottle in a continuous
demand flow thus does not allow muscles to work.
It allows gravity working correctly oh Bottle feeding while lying on their back
the muscles involved in swallowing keeps the tongue in a unnatural forward
position to keep from drowning
Bottle feeding VS Breast feeding

10. Bottle feeding VS Breast feeding
Nutrition:
Milk is more nutritious as it is a complete a It may not provide, complete nutrition as
source of all required nutrients some children are not able to digest it
Easily digestable easily because of the nature of its fat
Higher percentage of lactoalbumin rich in a Percentage is less
sulfur containing amino acids a Do not have sufficient amount
Higher percentage of certain vitamins like
vitamin C and D are present
Immunologic
Colostrum rich in certain antibodies like a It lacks this natural defence against
IgA and contains maternal macrophages infection
which protect the child against infections
Others'

11. Others
Colostrum may contain a gut control factor Does not contain colostrum
and stimulate growth of Gl tract No control on overfeeding and gain more
weight during the first year of life, which
Infant controls own intake and reduces is not desirable
possibility of feeding
Reduced risks of the ear and respiratory More common
infections Incidence is high
Decreased incidence of deleterious habits

12. Sucking VS Suckling
• The suckling reflex involves a front to back movement of the tongue. The
tongue is deeply cupped and this allows the infant to extract liquid from a
breast or bottle. It is the same motion children use when sucking on a
pacifier. This reflex comes under the baby’s control around 2-3 months and
should disappear or “integrate” between 6-12 months.
• The action of sucking is different. This action involves more of an up and
down movement. Sucking involves more active use of the lips and elevation
of the tongue than suckling. By 4 months, the true suck is established, with
the tongue sealing towards the first one third of the mouth. (Bahr, 2010)
• The main difference between suckling and sucking is that suckling is a
primitive reflex and sucking is a more mature pattern.
Sucking vs Suckling and Mouth Development
by Brooke Andrews | Mar 18, 2017

13. Weaning
3 stages:
stage 1: 4-6 months
stage 2: 6-9 months
stage 3: 9-12 months
• They do not have the nuromuscular coordination needed to move food
from the tip of tongue to back of mouth.
• GIT is too immature to digest and absorb food as the gasstric pancreatic and
intestinal enzymes are not fully developed.
• Kidney cannot regulate high solute load.

14. Pacifiers
• dipped in honey and sugars
• unhygienic conditions
leading to infections and
GIT disorders

15. Gumpads
The parents can be instructed to:
• Lay the baby down with his/her head in your lap and feet pointing
away.
• Open the baby’s mouth and slide the forefinger inside along the
cheek and press down on the back side lower gumpad.
• Take a small gauze (2” x 2”) between thumb and forefinger and wipe
vigorously over the ridge ofthe baby’stop and bottom jaws.
• Now a days specially designed for infant stooth brushes, finger cots
and wipes are available, which can also be used.
• Use adequatepressurejust to remove the film that covers the child’s
gum pad.
• Clean at least every day twice after morning and last feed inthe
night.
• Spend atleast twoto threeminutes in cleaning

16. Role of pediatrician
• The pediatricians or primary care physicians treat infants and monitor the growth and development
ofchildren. They are thus usually the first health care providers and can act to evaluate their oral health
status.
• In this respect, they can be the forebearers in providing information to the parents as they are more often in
contact with the child and parents.The dentist should establish a contact with pediatrician and formulate a
policy regarding dental health for the infant.
• Following topics needed to be discussed
- Tooth eruption
- Preventive oral hygiene
- Orofacial development
- Fluoridation
- Diet

17. • Johnson (1997) has also discussed the interation withc the pediatrician at the time of weaning.
When the child is 10 months old, the assertiveness ofthe child may make the parents to give in by
giving a sleep time bottle. A solution suggested is the gradual dilution ofthe liquid. Thus
• 1 week 1/3 bottle water
• 2nd week 2/3 bottle water
• 3rd week only water
• Weaning foods free of, or low in non-milk extrinsic sugars be recommended to the mothers.
• Depending on the amount offluoride present in community water, and the requirements of the child,
a fluoride supplementafiofiprogram can be instituted.
• Pediatrician should be made aware ofthe dentist population in Iris vicinity for the purpose of
referral. This in cases oflarge multi-specialty centersis easily done, but in smaller places with dental
centers spread over a larger area may be difficult.

18. Role of other personnels
• The need for commencement of tooth brushing or cleaning with gauze as soon as the first tooth erupts
can be emphasized through prenatal classes by the gynecologist or obstetrician.
• Neonatalogists can also play a significant role by advising and counseling the parents regarding any
congenital defect,such as cleft lip and palate, regarding the dental and the overall health aspect ofthe
child.
• Importance ofbreast feeding can be emphasized by these medical personnel.
• Mothers can be informed about the transmission of antibiotics via breast milk and their effect of dental
health.
• Importance of the mother’s own oral hygiene is equally important as poor oral healthofthe mother can
affect the health of the fetus and the newborn. Poor maternal periodontal health has been found to
increase the potential for pre-mature low birth weight of babies. High caries level in the mother can result
in an equally high level in the child.

19. Guidelines to parents
1. The parents should bring their child for his/her first dental visit early, at least by the time the baby is 6
months of age.
2. Breast feed the baby but do not indulge at will.
3. Avoid frequent use of the bottle with sugared milk or drinks as this can lead to nursing bottle caries.
Instead, give the child more attention.
4. Do not put the child to bed with the bottle or at the breast but take the bottle away immediately after
feeding.
5. Dilute the milk gradually in the bottle and end with plain water.
6. Feeding should be supervised at all times.
7. Startthe child on semi-solid foods by 5-6 months and reduce the use of bottle or breast feeding.
8. Do not use pacifiers or dummies dipped in honey or other sugaritems.
9. Avoid extended use of sugared medicines such as syrups.

20. 10.Clean thrums and laterteeth with a cloth or soft brush after every meal or before sleep.
11.Parents should brush or clean their baby’s gums/ teeth everyday till the child is old enough to manage
himself.
12. Contact the dentist immediately ifthere is any accident or trauma to the baby'steeth.
13. Parents should know about the benefits of fluoride and its proper use such asthat used in infant formulas
and dentifrices.
14. Half- yearly visit to the dentistshould be routine

21. History
• Detailed history - prenatal natal postnatal
• Socioeconomic factors
• sociodemographic factors

22. Infant Examination
The eruption of upper or lower front teeth signals the need to begin regular examination. This screening should
occur between 5-8 months of age for most children or as soon as the first tooth erupts into the oral cavity.
Armamentarium
1. Light source
2. Mouth mirror
3. Soft bristled toothbrush
4. Gloves
Method
The examination room table can be used for examination.
Pediatric dentistry principle and practice M S Muthu

23. Objectives of infant examination
1. To record any abnormalities of tooth eruption and soft tissues
2. Presence of plaque on the teeth
3. Presence of white spots or demineralised areas
4. Presence of cavities
5. To record any developmental abnormalities like Epstein’s pearls and Bohn’s nodules, etc.
Pediatric dentistry principle and practice M S Muthu

24. PURPOSE OF CARIES RISK ASSESSMENT IN CLINICAL PRACTICE
• Evaluate the degree of the patient’s risk of developing caries to determine the intensity of prevention and
frequency of reevaluation/recall appointments.
• Identify the main etiological agents that contribute to past and present disease and which thus may
contribute to future disease, to determine the specific type of appropriate interventions.
• Determine whether additional diagnostic or testing procedures are required.
• Aid in preventive or restorative treatment decisions, or both.
• Improve the reliability and the prognosis of the planned interventions.
• Provide a basis to explain and empower the patient on how to prevent dental caries and to communicate and
facilitate needed change in health behaviors to prevent caries.
• Assess the efficacy of the interventions and preventive plan at reevaluation/recall appointments and adjust
preventive strategies as needed.
Prevention in clinical oral health care - David p cappeli

27. Anticipatory guidance wth respect to Interceptive orthodontics
History recording
Clinical examination
Councelling
Assessment
Treatment planning
Reviews
6-12 months
Dental and oral development
• milestones
• patterns of eruption
• environmental and genetic
• teething
• infant oral cavity
Non-nutritive habits
• pacifier use and types/safety
12-24 months
Dental and oral development
• occlusion
• spacing issues
• speech and teeth
• tooth calcification
Non-nutritive habits
• digit habit issues
• effect on occlusion
24-36 months
Dental and oral development
• last primary tooth erupted
• exfoliation
• future orthodontic needs
• radiographs

28. At each stage of occlusal development, the objectives of intervention/ treatment
include:
(1) reversing adverse growth,
(2) preventing dental and skeletal disharmonies,
(3) improving esthetics of the smile,
(4) improving self-image, and
(5) improving the occlusion.

29. Special child
1-4 years
• When parents express concerns about how their child is developing, the health care professional
should listen and observe carefully.
• A wait-and-see attitude will not suffice, particularly if the child falls into an at-risk group. A proactive
approach is essential.
• Some disorders have well-organized societies, such as the National Down Syndrome Society19 to
offer specific guidance on Down syndrome, while other problems or less common congenital
anomalies may require individualized expertise.
5-10 years
• During this period, children with special needs continue to define their sense of self and improve
their ability to care for their own health, supported by their interactions with their care providers.
• Many children and youth with special health care needs require extra support from their schools,
including resource room services, special classes and aides, and adaptations in the school
environment, including accommodations for physical activity and sports.

30. 11-21 years
• Careful assessment of medical conditions, strengths, and risk-taking behaviors, followed by
sensitive discussions of the youth’s perceived needs and goals, can assist the adolescent with a
special health care need to maximize physical and emotional development and support the
attainment of full emotional development and maturity.

31. CONCLUSION
• A properly planned first dental visit with appropriate anticipatory guidance on regular intervals and
commitment from the parents to follow the instructions can definitely bring children decay free till
adolescence. As this information is new to many professionals themselves, the limitation in passing this
information to the common man still exists

32. References
• Textbook Of Pedodontics, Shoba Tandon
• Textbook Of Paedodontics , Nikhil Marwah
• Early childhood oral health, Joel H Berg
• Pediatric dentistry principle and practice M S Muthu
• Management of developing dentition and occlusion in pediatric dentistry aapd 2019
• Bright Futures Guidelines for Health Supervision of Infants, Children, and
Adolescents