Pedologic anatomy

PEDOLOGIC ANATOMY
Chetan Basnet
BDS IV year
Roll no. 02


 Introduction
 Fetal Growth Changes
 General Post Natal changes In Dimensions & Proportions
 Oral Features Of Neonates
 External Features Of Newly Born Child
 Reflexes present at Birth
 Summary
 References
Contents

A child may appear as a MINIATURE ADULT to a LAYMAN
but the detail anatomy reveals that he/she is completely different
from an adult. The growth and development seems MIRACLE in
growing child.
These changes vary progressively till puberty after which
permanent features are established.
NOTE:-
the comparative knowledge of adult and child is
necessary to be known so as to recognize or diagnose
developing characteristics of a child which may be mistaken for
an Abnormality or Pathologic condition.


 Head flexed, neck longer and clearly defined
 Development of face with upper lip and nostrils
 The palate incompletely formed
 Enamel organs formed from dental lamina.
 The external ears and eyelids are developing and limbs are
forming.
 Skeletal and visceral tissue begins to form.
 Kidney begins to form with tubules.
 The back bone and vertebral canal form small buds that will
develop inner and upper extremities.
 Heart forms , starts functioning and body system begins to
form.
End of First Month


 Eyes are far apart with eyelids fused and nose flat.
 Ossification begins and limbs becomes distinct as upper and
lower.
 Digits are well formed.
 Major blood vessels forms.
 Internal organs continue to develop.
End of Second Month


 Eyes fully develop but eyelids still fused.
 Bridge of nose develop and external ears are
formed.
 Ossification continues, nails develop.
 Head flexion increases and neck becomes
proportionately larger.
 The umbilical protrusion of the gut is reduced
with a proportionate abdominal volume.
 Heart beat is detectable.
End of Third Month

 Head is large in proportion to rest of the body.
 Face takes on human features and hair appear on head.
 Skin is bright pink.
 Many bones are ossified and joints begins to form with continued
development of the body systems.
 The eyes have moved forward to anterior position but are still wide
apart.
 The external ear is on the side of the head and
no longer on upper part of the neck.
End of Fourth Month


 Head is less disproportionate to the rest of the body.
 Fine lanugo hair covers the body.
 Rapid development of body systems takes place.
 Skin is bright pink and sebaceous glands become active
forming a cheesy covering over the skin.
 Fetal movement called “quickening” can be seen.
End of Fifth Month


 Head becomes smaller but still less disproportionate to the rest
of the body.
 Eyelids separate and eyelashes form.
 Skin is wrinkled and pink.
 Increase in growth of sebaceous and cutaneous tissue occur.
End of Six Months


 Head and body becomes more proportionate .
 Skin is wrinkled and pink.
 Eyebrow hair and eyelashes are developed.
 Eyelid separate and the papillary membrane separate.
 Body is more plump.
End of Seven Month


 Sub-cutaneous fat deposition takes place.
 Skin is less wrinkled.
 Testes descends to scrotum.
 Bones of head are soft.
 There is progressive loss of lanugo, except of eyelid eyebrows
and scalp.
 The shape of body is more infantile.
 The thorax and abdomen broaden relative to head.
 The umbilicus is gradually centrally located.
 Chances of survival is much greater at this period.
End of Eight Month


 Additional subcutaneous fat accumulates.
 Lanugo sheds.
 Nails extend to tip of finger and even beyond.
End of Nine Month

General Post Natal changes in
Dimensions and Proportions


 The neonate has 270 bones as compared to
adult (206).
 Skull bones in neonate are 45 due to
incomplete ossification and in adult 22.
 The frontal bone at birth is in two halves
which fuses at 2 yrs.
Neonatal Skeleton


 There are two parietal bones.
 The occipital bone at birth consists of four pieces, which fuse by
3-4 yrs. of life.
 The sphenoid bone is made up of three parts at birth, which
fuse during the first year. Sinuses do not develop in the
sphenoid till the 5th year.
1. the body ,
2. the lesser and
3. the greater wings
 Mastoid process is absent in the neonate thus the stylomastoid
foramen lies superficial.
…

 The body proportions are a result of the differential rates of growth of the
cephalic and caudal ends. Massive changes in the body proportion occur
from the fetal life to adulthood.
 Mid point: The mid point of the stature of a two month old embryo is at
chest, close to chin.
 At Birth: This may shift to just above the umbilicus.
 In Adult: It is at the pubic-symphysis region.
Body Proportions

• The length of the head doubles by adulthood, but the rest of the body grows
still more, hence at birth 22% of the body area is covered by the head.
• This decreases to 13% at 12 yrs. and 10% in an adult.
• There is an axis of increased growth extending from the head towards the
feet. This increased growth is the cephalo-caudal gradient.
• In a new born child the height is measured using measuring tape in a laying
position and referred as LENGTH.[ 40-45 cm]


 The new born is usually kept in supine posture but can be
literally folded to its most comfortable position i.e. the posture
simulating the fetal posture of partial flexion.
 Mild lordosis and protuberance of the abdomen is a common
finding at 2-3 yrs of age but disappears by 4 yrs.
Posture


 The neck is relatively short at birth and its muscles are not
developed for supporting the head.
 Functional development of the muscles begins after 2 mnths.
The Neck


 The girth of the chest at birth is smaller then the head
circumference.
 It becomes equal by 2 yrs and by 15 yrs its ratio becomes 3 : 2
 The final ratio is 5 : 3
 The chest is rounded in newborn.
The Chest


 The umbilicus of new born is shed off around 12- 15 day.
 The umbilicus is everted and in some cases umbilical hernia
may be present.
 At this stage abdomen is quite protuberant but soft.
 Circumference of abdomen is equal to the chest until two yrs
BUT after 2 yrs abdominal circumference is less than the chest.
Abdomen


 At Birth:
 legs are short , arms long
 Arms:
 birth – 2 yrs : length increase by 6.75%
 At 8 yrs – 50% longer than at 2 yrs
 By 16- 18 yrs – slow growth, increase development takes place.
 Legs:
 at birth: short & curved
 Birth – 2 yrs: length increase by 40% [a lot of fat deposits on
medial aspect of foot giving flat foot appearance]
 6 yrs: straight, the knock knee and flat foot gets corrected
 8yrs: 50% longer than at 2 yrs
 Adolescence: 4 times longer than birth
 Early maturer: shorter legs than the late maturer
Extremities


 The skeletal portion of craniofacial complex develops as a blend of
morphogenesis of primary skull components.
1. The Neurocranium : it consists of two parts:
a) The desmocranium: comprise the vault of skull or
clavarium. It protects the brain and is formed of
intramembranous bone.
b) The Chondrocranium: forms the base of skull which ossifies
as an endochondral bone.
2. The viscerocranium : formed by the bones of facial skeleton which
develop by intramembraneous ossification which is derived from
brachial arches.
Changes in Craniofacial Complex


 This changes can be appreciated even in IUL.
 3 mnth – Birth:
the entire cranium becomes longer and wider in its
relation to height.
 At Birth:
• Craniofacial skeleton undergoes changes between 30%-60%
of its total growth.
• head makes up about a greater part of total body length
whereas in adult accounts for about one- eighth of
total body height.
Dimensional changes in
Craniofacial Skeleton

 After birth:
Size of cerebral cranium increase by about 50% while the facial skeleton
will grow more than twice the original size.
 By 4 years:
This growth is completed. Cranial circumference increase from about 33cm
[ birth] - 50cm [at 3 yrs]. After which it only increase by 6cm.
 After 4yrs +:
Facial skeleton increases in all direction.
NOTE:-
Due to above craniofacial changes features of head and face are observed
to be different at different ages.
…..


 At Birth:
The head circumference is around 35 cm.
 6 months:
It increases by 44 cm.
 At 1 yrs:
Head circumference may be more then chest circumference. A
total 4 inches increase takes place.
 1+ year:
1 inches increment occurs between 1-2 yrs.
 At 10 yrs:
95% of total head growth completes with the width of head
completed by 3yrs while the length of head completes by 17-18 yrs.
Head


 Fontanel is one of the space, covered by membrane
between the bones of the fetal or young skull.
 They bridge the gap between the bones that limit
them.
 They are made up of:
a) Dura mater
b) Primitive periosteum &
c) Aponeurosis form inside
Fontanelles


Fontanells present at Birth:
1. Anterior Fontanelle : between two parietal bone & the frontal bone.
2. Posterior Fontanelle : between two prietal bone and the occipital bone
3. Sphenoid Fontanelle : between the frontal, parietal, temporal, sphenoid
bone.
4. Mastoid Fontanelle : between parietal, occipital and the temporal bone
…


Clinical Importance of Fontanelle :
 Enables the fetal skull to modify its size and shape as it passes through
the birth canal and permits rapid growth of brain during infancy.
 Helps the physician to gauze degree of brain development by their
state of closure.
 Anterior Fontanelle serves as landmark for withdrawal of blood for
analysis from superior sagital sinus.
 Depressed levels of Fontanelle suggests dehydration and increased
level indicate increase in Intra-cranial pressure.


Closure of Fontanelle :
a) Anterior Fontanelle [Frontal] : 18-24 mnths after birth.
b) Posterior Fontanelle [occipital]: 2 mnths after birth
c) Antero-lateral Fontanelle [Sphenoid] : 3 mnths after birth
(paired)
d) Postero-lateral Fontanelle [mastoid]: begins to close 1-2 mnths
after birth, closed completely by 12 mnths (paired)

Sutures of cranium
1. Coronal Suture: between the frontal and parietal bone. Closes by 24-
35 yrs
2. Sagittal suture: between two parietal bone. Closes by 22-30 yrs of
age.
3. Lambdoidal Suture: Between two parietal and occipital bone.
Closes by 29 yrs of age.
4. Squamous Sutures and Lateral antero-posterior Sutures: between
the squamous portion of the temporal and parietal bone. The
squamous suture closes late in life.


Face
 At birth , lower third and the middle third of the face are underdeveloped
due to the absence of the teeth.
 The fore-head is high and bulging.
 The face of the newly born baby is round and flat.
 The eye dominate and owing to the absence of the root of the nose, appear
to be widely separated.
 After the onset of the puberty the forehead flattens and widens, lips thicken
and face acquires an oval shape, mainly due to growth of jaws.
 The child convex profile is straightened out, owing to the more anterior
position of the jaws.


Naso-Maxillary Complex
 The maxilla develops in the membranous tissue at the end of the
sixth fetal week.
 The maxilla is attached to the neurocranium directly with the
frontomaxillary sutures and indirectly by means of various other
facial structures such as the nasal, lacrimal and ethmoid bones, nasal
septum including vomer, palatine bones and zygomatic arch.
 Most of the structures mentioned above are joined together in an
edged – edge fashion.
 During the early phase of fetal development the sagittal interrelation
of the jaws is characterised by Mandibular protrusion, which is
gradually reversed.
 At birth the maxilla is placed more anteriorly giving Class II
relationship of the jaws.


…
 Later in course of post-natal development, both maxilla and
mandible with their associated soft tissues grow forward and
downward and establish a normal Class I relationship.
 Maxillary sinus at birth are not well developed and present like
slits.
 Development of orbital cavities is practically complete at birth.
 Nasal cavity is located between the two orbits of the eyes and
its floor is roughly at level with their bottoms.
 The alveolar process can only be faintly discerned and the
palate has a weak transversal curvature.
 The maxillary body is almost entirely filled with the developing
teeth.


Mandible
 Although still seperated by symphisis in the mid-line, the two
halves of the mandible fuse into a single bone by the age of 1-2
yrs.
 At birth:
 The two rami are short.
 Condylar development is minimal.
 A thin line of fibrocartilage and connective tissue exists at the
midline of the symphisis to separate the right and left mandibular
bodies.
 The symphysial cartilage is replaced by bone [ between 4 mnths of
age –end of the 1 year].
 Growth is quite general, with all surface showing bone apposition,
esp. at the alveolar border, distal and superior surface of the ramus,
condyle, lower border and lateral surface of the mandible.


 The alveolar process and the muscles are poorly developed at his age,
so that its basal arch mainly determines the shape of the mandible in
the neonate.
 At birth the structure of mandible is shell like with 10 alveolar sockets
for developing tooth gum.
 Of all the facial bones, the mandible shows not only the largest
amount of post-natal growth, but also the largest individual variation
in morphology.
 The position of the mandibular foramen changes by remodelling , to a
more superior position from the occlusal plane as the child matures
into the adult.
 The foramen is below the occlusal plane in a very young child, slightly
at occlusal plane at the period of primary dentition. It averages 7mm
above the occlusal plane in an adult.
 Angle of mandible is more obtuse in young children.
 Mental foramen is placed very close to the border of the mandible in
young children.


TemperoMandibular Joint [TMJ]
 Three phases of development are seen in the intrauterine life period .
- Valasco Merida et all. 1999
I. Blastemic Stage:
7-8 wks of sevelopment coresponding to the organization of
condyle, articular disc and capsule
I. Cavitation stage:
9-11 wks of development corresponding to the initial
formation of inferior joint cavity and then start of condylar
chondrogenesis.
I. Maturation stage:
after 12 wks of development


Post -natal Changes in TMJ
 At birth the articular disc is flat and develops an accentuated S-
shaped profile as the articular tubercle develops.
 Condylar cartilage is approx. 1.5 mm thick at birth, but soon
thins down to 0.5 mm. By 20-30 yrs of life it is completely
replaced by endo-chondral ossification.
 Mandibular condyle grows in a constant posterior, superior and
lateral direction and attains a mature contour by late mixed
dentition period.


Oral features of the Neonate
 The edentulous arches of a child varies from an edentulous
adults.
 The alveolar process of an infant are called gumpads, which are
firm and pink structures with a definite form.


Gumpads
 Each gumpad is divided
into 10 segments by a
transverse grooves.
 The groves between the
deciduous first molar and
canine are prominent and
called lateral sulci.


Upper Gumpad
It is a horse shoe shaped and shows:
 Gingival Groove:
separate gumpad from
palate.
 Dental Groove:
originates in incisive papillae
region and extends backwards to
touch the gingival groove in the
canine region and then laterally to
end in the molar region.
 Lateral Sulcus :
is a deepened groove
separating canine and deciduous
first molar segments.


Lower Gumpad
 Differs from upper.
 Is “U” shaped, with its
anterior portion everted
labially.
 Gingival groove- that
demarcates the lingual
extent of gumpads.
 Dental groove - running
from the mandible
backwards, laterally to join
the gingival groove in the
canine region.
 Lateral sulcus- deepened
groove separating the
canine and deciduous first
molar segments.


Relationship of Gumpads
 At rest gumpads are separated by the tongue lying over the
lower gumpad.
 There is no definite antero-posterior relationship of the
gumpads on occlusion, but lower gumpad being smaller, the
lateral sulcus of the lower gumpads lies distal to that of the
upper.
 There is no variable overjet with contact only in the first molar
segments.


 During function the mandibular movements at this stage are mainly
vertical and to a very small extent in the antero-posterior direction. Lateral
movement are absent.
 During the early phase of fetal development the sagittal interrelationship
of the jaws is characterized by mandibular protusion which is gradually
reversed.
 At birth lower jaw is situated posteriorly. This relationship has some
significances i.e. disturbed post-natal forward growth of development may
result in malocclusion


Growth of Gumpads
 At birth the width of gumpads are inadequate to accommodate
all the incisors.
 The growth is rapid in first year after birth
 Growth is more in transverse direction and in the labio-lingual
direction.
 Due to the growth the segments of each gumpads become
prominent.
 Eruption of deciduous teeth commence at 6 mnths of age.


Tongue
 It is comparatively large in relation to the small mouth.
 Then tongue is flat, thin and blunt tipped, probably due to
short frenum.
 The tongue at this stage performs only one function, i.e. acts as
a piston while suckling.


Tonsils & Adenoids
 At birth:
tonsils and adenoids are small in size. Clusters of yellow and white
follicles with erythematous border may appear initially. A few days after
birth these may regress.
 First few months:
the growth of tonsils and adenoids takes place as lymphoid tissue
starts proliferating and establishing function. This growth is more in
presence of infection.


 6 mnths – 2 yrs:
Max. growth occurs as the primary physiological enlargement.
 At 6 yrs:
the next hypertrophy, after a period of quiescence, occurs especially
when the child is exposed to infection at school. This is secondary
physiological enlargement.
 At puberty:
the regression and atrophy of naso-pharyngeal lymphoid tissue finally
occurs by the time child attains puberty.


Buccal Pad of Fat
[Corpus Adiposum / Bichat’s Fat Pad]
 It is a child reserve of energy. It is nothing but the child cheek
prominence giving a chubby appearance. It is formed of a firm
encapsulated mass of fat lying between the subcutaneous fat
and the muscle of the cheek.
 Its exact role in suckling is not known. It probably plays no role
in suckling, but it has been found to regress once suckling has
ceased


EXTERNAL FEATURES OF
NEWLY BORN CHILD


 The skin of the neonate is often reddish.
 A child may have an appearance of CYANOSIS due to thin skin
and high hemoglobin content of blood even when CO2 is high
 A deep red purplish appearance may be result of transient
anoxia resulting from closed glottis prior to vigorous cry.
 Deep red skin with fine soft immature lanugo hair is a
characteristics of premature infants.
 Post-term infants may show whitish, peeling, parchment like
skin.
Skin


 Size:
The eye of the neonate are small at birth, the size being one third of
the adult size. Maximal growth occurs in 1 year and continues rapidly
decelerating rate till 3 yrs and further slows down till puberty.
 Cornea:
At birth, cornea is relatively more and nearly fills the palpebral
fissures. It reaches an adult size by 2yrs. After which the posterior aspect of
the eyes grows giving ball its final spherical shape.
 The Lens:
it is more or less spherical with greater refracting power.
Eyes


 The Fundus:
It is less pigmented than adults. It acqiure its adult form by 4-6 mnths.
 The Retina:
It has fine peppery mottling. The peripheral retina appears pale or
greyish since peripheral vasculature is immature.
…


 The nose of the neonate is small and flat with narrow nostrils.
 The bridge of the nose is depressed.
 Maximal growth of the nasal cartilage occurs till puberty, after
which it attains its final form.
 The hair around the nose become thicker around the puberty.
Nose


 The lips of new born is reddish pink, soft and supple.
 The midline of upper lip has a small projections, the labial tubercle, which is
said to disappear after cessation of suckling.
 It may undergo slow transformation to form the transition zone between
the outer and inner aspect after one year.
Lips


 The ears of child are almost developed.
 The external auditory canal is short, straight and full of
secretion.
 The tympanic membrane has a dull grey translucency and the
structures of the middle ear can be easily studied through it.
Ear

Reflexes Present At Birth
Reflex is an involuntary, or an automatic, action that your body does in
response to something, without even having to think about it.
The various reflexes are:
1. General Body Reflexes
2. Facial Reflexes
3. Oral Reflexes

General Body Reflexes
1. Moro Reflex
2. Startle reflex
3. Palmar reflex/ Grasp Reflex
4. Walking/ stepping Reflex
5. Limb placement reflex
6. Asymmetric Tonic Reflex
7. Babiniski’s Reflex
8. Parachute Reflex
9. Landau Reflex
10. Tendon Reflex
11. Abdominal Reflex

Moro Reflex
Any sudden movement of the neck initiates this reflex. A
satisfactory way of eliciting the reflex is to pull the baby half way to a
sitting position from the supine and suddenly let the head fall back to a
short distance.
This reflex consists of a rapid abduction and extension of the arms with
the opening of hands. The arms come together as in an embrace.

Clinical Importance:
o This reflex gives an indication of muscles tone.
o The response may be asymmetrical if muscle tone is unequal on
the two sides, or if there is a weakness of arm or an injury o the
humerus or clavicle
o This reflex usually disappear in 2-3 months.

Startle Reflex
It is similar to Moro reflex, but it is initiated by a sudden noise
or any stimulus. In this reflex, the elbows are flexed and the hands are
remained closed, there is less of embrace, outward and inward
movement of arms.

Palmar / Grasp Reflex
o When the baby palm is stimulated, the hand closes. There is
also corresponding Planter Reflex.
o Both normally disappear after 24 months.

Clinical Significance:
An exceptionally strong grasp reflex may be found in the
spastic form of cerebral palsy and in Kernicterus.
It may be asymmetrical in hemiplegia and in cases of
cerebral damage. It should have disappeared in 2- 3
months and persistence may indicate the spastic form of
cerebral palsy.

Walking / Stepping Reflex
When the sole of the foot is pressed against the couch, the
baby tries to walk. It persists as voluntary standing.

Limb Placement Reflex
When the front of the leg below the knee, or the arm below the
elbow is brought in contact with the edge of table, the child lifts the limb
over the edge.

Asymmetric Tonic Reflex
When the baby is a rest and not crying, he lies at intervals with
his head on one side, the arm extended to the same side, and often
flexion of the contralateral knee. This reflex normally disappears after
2/3 months, but may persists in spastic children.

Babiniski’s Reflex
Stroking of lateral surface of planter surface of the foot from the
heel to the toe results in flexion of the toe.

Parachute Reflex
It appears at about 6-9 months and persists there after. This
reflex is elicited by holding the child in ventro suspension and suddenly
lowering him in the couch. The arms extended as a defensive reaction.
In children with cerebral palsy, the reflex may be absent or abnormal. It
would be asymmetrical in spastic hemipalgia.

Landau Reflex
It is seen in vertical suspension, with the head, spine and legs
extended. If the head is flexed, the hips , knees and the elbows also
flex. It is normally present from 3 months and is difficult to elicit after 1
year.
• Absence of reflex occurs in Hypotonia, hypertonia, or severe mental
abnormality.

Tendon Reflex
They are present in neonate. They are of great value for the
diagnosis of cerebral palsy.
• In spastic children the tendon reflex are exaggerated.

Nasal Reflex
Stimulation of the face or nasal cavity with water or local
irritants produce apnea in neonates. Breathing stops in expiration with
laryngeal closure and infants exhibit bradycardia and lowering the
cardiac output.
Blood flow to the skin splanchnic areas, muscles and kidney
decrease, whereas flow to the heart and brain is protected. Midwives
have for many years blows on the face of neonates to induce the first
breathe.

Blink Reflex
Various stimuli provoke blinking. Where the child is awake or
asleep, pupils of the eye react to change in intensity of light.

Corneal Reflex
It consists of blinking when the cornea is touched. The
satisfactory demonstration of these reflex shows that the stimulus,
whether sound light or touch has been received, that cerebral
depression is unlikely, and that appropriate muscles can contract in
response.

Doll’s Eye Reflex
Through a complex mechanism, infants hold fixation of faces,
movements or changing intensity of light within their visual fields. During the
first week they are able to maintain these fixations against passive movement
of their bodies.

Pupil Reflexes
The pupil reacts to the light but in the preterm baby and some
full term babies the duration of exposure to the light may have to be
prolonged to elicit the reflex. The light used should not be bright, for a
bright light will cause closure of the eyes.

ORAL REFLEXES
• Rooting Reflex
• Sucking Swallowing
• Gag Reflex
• Cry
• Mastication

Rooting Reflex
When the infants cheek contact the mother’s breast, the baby
mouth results in vigorous sucking movements resulting the baby
rooting for milk. When corner of the mouth is touched, the lower lip is
lowered, the tongue moves toward the point stimulated. When the
finger slides away, the head turns to follow it. When the center of the
upper lip is stimulated, the lips elevates.

• Onset: 28 wks IU
• Well established: 32- 34 wks IU
• Disappear: 3-4 months
• Elicited by:
the “rooting” or “search” reflex is present in normal full term
babies. When the baby cheek contacts the mother’s breast or the other
parts, he “roots” for milk. It enables him to find the nipple without his
being directed to it.

Sucking
• Onset: 28 wks IU
• Well established: 32-34 wks IU
• Disappears: starting around 12 mnths
• Elicited by: It is tested by introducing a finger or teat into the mouth,
when vigorous sucking will occur.

Swallowing
• Onset: begins around 12 ½ wks IU life.
full swallowing and sucking established 32-36 wks of IU life
Sucking & swallowing reflexes are present in full term babies.
Their absence in a full term baby would suggest a developmental
defect.

Infantile Swallow:
Until the primary molars erupt, infants swallow with
the jaws separated and tongue thrust forward using facial
muscles (Orbiculars oris& Buccinator). This is non
conditional congenital reflex.
Acquired Conginetal Reflex:
After eruption of the posterior primary teeth, from the 18
months of age onwards the child tends to swallow with the teeth
brought together by the masticatory muscles action, without a tongue
thrust.

Gag Reflex
It is seen in 18 ½ wks. IU life. In the buccal cavity and pharynx,
the ectoderm / endoderm zone is towards the posterior third if the
tongue. Touching here elicits a gag reflex, a protective reflex.

Cry
It is a non conditional reflex which accounts for its lack of
individual character and is of sporadic nature. Its starts as early as 21-
29 wks IU life.

Mastication
It is a conditioned reflex, learned initially by irregular and
poorly coordinated, chewing movements. The proprioceptive response
of the TMJ and the periodontal ligament of the erupting dentition
establishes a stabilized chewing pattern, aligned to the individual dental
inter-cuspation.

Summary
• Knowledge of PEDOLOGIC ANATOMY is very helpful to PEDODONTIST as it
not only serves as an adjunct in DIANOSIS but also aids in TREATMENT
PLANNING.
• The knowledge of different growth spurts helps in planning treatment
especially in Interceptive Orthodontics where growth can be modified or
surgery is indicated. [ e.g. Cleft lip & Palate]
• The knowledge of development of motor skills and language helps to
know whether development is going on proper rate or not.
• The knowledge of reflexes helps to identify whether child is developing
normally or not. It also helps to know what abnormalities child may be
having if reflexes are not proper.

REFERENCES
• TEXTBOOK OF PEDODONTICS- 2nd edition
-Shobha Tandon
• Internet sources

Pedologic anatomy

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