1 special considerations for oral surgey in pediatric patients


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  • odontogenic whose primary cause is dental in origin non-odontogenic infections include systemic infections with oral manifestations.
  • 1 special considerations for oral surgey in pediatric patients

    2. 2. OBJECTIVES • Background • Conditions that occur in pediatrics • Treatment
    3. 3. BACKGROUND • Preoperative evaluation: – History of presenting complaint – Medical history – Dental history – Examination • Behavioral management
    4. 4. Growth and Development • Injuries may have adverse effect to growth • E.g. Injuries to the mandible: – Ankylosis • Limited mandibular functions • Restricted growth • Surgery for acquired/congenital anomalies may tamper with growth. – Cleft Palate repairs cause palatal scarring resulting in maxillary constriction
    5. 5. Maxillofacial Infections • Vary according to age: – < 5 yrs Upper face infections: non-odontogenic – >5 yrs lower face infections : odontogenic Treatment • Non-odontogenic infections: Broad spectrum antibiotics and hydration • Odontogenic infections: Antibiotics, hydration, drainage, treat underlying dental pblm
    6. 6. Impacted Teeth Impacted Canines • 2nd most impacted tooth • Treatment is by extraction of the primary canine (normal space and no incisor resorption) • No improvement in canine position in a year, surgical and orthodontic treatment
    7. 7. Supernumerary Teeth • Mesiodens • Most common supernumerary • Treatment – No surgery for non-erupting primary mesiodens (damage to succedeneous tooth) – Mixed dentition extract the mesiodens ensure 2/3rd of root formation of incisor – Allow erupted primary mesiodens to shed
    8. 8. Mesiodens
    9. 9. Pediatric Oral Pathology • Epstein’s pearls – Found in the median palatal raphe area – Due to trapped epithelial remnants along the line of fusion of the palatal halves. • Dental lamina cysts, – Found on the crests of the dental ridges, most commonly seen bilaterally in the region of the first primary molars. – From remnants of the dental lamina. • They are both asymptomatic 1 mm to 3 mm nodules. Smooth, whitish in appearance, and filled with keratin.
    10. 10. Epstein Pearl and Dental Lamina Cyst Treatment: • Reassure parents •Disappear during the first 3 months of life.
    11. 11. • Congenital epulis of the newborn/ granular cell tumor / Neumann’s tumor, – Rare benign tumor seen only in newborns. – Protuberant mass arising from the gingival mucosa. – Found on the anterior maxillary ridge. – Patients typically present with feeding and/or respiratory problems. – Treatment: surgical excision.
    12. 12. Neumann’s tumor
    13. 13. • Eruption cyst (eruption hematoma) – Soft tissue cyst that results from a separation of the dental follicle from the crown of an erupting tooth. – Fluid accumulation occurs within this created fol- licular – Most commonly found in the mandibular molar region. – Color range from normal to blue-black or brown
    14. 14. Eruption Cyst Difference from hemangiomas • Hemangiomas may undergo a rapid growth phase in the first year of life but then regress spontaneously. • Eruption cysts resolve with eruption of the tooth.
    15. 15. Natal and Neonatal Teeth • Natal teeth: teeth present at birth • Neonatal teeth: erupt during the first 30 days of life • Teeth most affected:mandibular primary incisors. • In most cases they are part of the normal complement of the dentition
    16. 16. • Treatment – Reassure parents – Preserve and maintain in a healthy condition unless excessively mobile or causes feeding problems – Monitor Closely Riga-Fede disease • Caused by the natal or neonatal tooth rubbing the ventral surface of the tongue during feeding leading to ulceration. • Treatment : – conservative :Create round, smooth incisal edges – If it does not correct: extraction is the treatment of choice to avoid ‘failure to thrive’
    17. 17. Riga-Fede disease
    18. 18. REFERRENCES • AAPD. Guideline on Pediatric Oral Surgery. Reference Manual. 2010. 34:6;264-271. • AAOMS. Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery. Journal of Oral and Maxillofacial Surgery. 2012. • Cawson R.A. and Odell E.A. Essentials of OralPathology and Oral Medicine. 7th Edition. Churchill Livingston Publishers. 2002.
    19. 19. THANK YOU