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
SPECIAL CONSIDERATIONS FOR
ORAL SURGEY IN PEDIATRIC
• Conditions that occur in pediatrics
• Preoperative evaluation:
– History of presenting complaint
– Medical history
– Dental history
• Behavioral management
Growth and Development
• Injuries may have adverse effect to growth
• E.g. Injuries to the mandible:
• Limited mandibular functions
• Restricted growth
• Surgery for acquired/congenital anomalies
may tamper with growth.
– Cleft Palate repairs cause palatal scarring resulting
in maxillary constriction
• Vary according to age:
– < 5 yrs Upper face infections: non-odontogenic
– >5 yrs lower face infections : odontogenic
• Non-odontogenic infections: Broad spectrum
antibiotics and hydration
• Odontogenic infections: Antibiotics, hydration,
drainage, treat underlying dental pblm
• 2nd most impacted tooth
• Treatment is by extraction of the primary
canine (normal space and no incisor
• No improvement in canine position in a year,
surgical and orthodontic treatment
• Most common supernumerary
– 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
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.
Epstein Pearl and Dental Lamina Cyst
• Reassure parents
•Disappear during the first 3
months of life.
• Congenital epulis of the newborn/ granular
cell tumor / Neumann’s tumor,
– Rare benign tumor seen only in newborns.
– Protuberant mass arising from the gingival
– Found on the anterior maxillary ridge.
– Patients typically present with feeding and/or
– Treatment: surgical excision.
• Eruption cyst (eruption hematoma)
– Soft tissue cyst that results from a separation of
the dental follicle from the crown of an erupting
– Fluid accumulation occurs within this created fol-
– Most commonly found in the mandibular molar
– Color range from normal to blue-black or brown
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.
Natal and Neonatal Teeth
• Natal teeth: teeth present at birth
• Neonatal teeth: erupt during the first 30 days
• Teeth most affected:mandibular primary
• In most cases they are part of the normal
complement of the dentition
– Reassure parents
– Preserve and maintain in a healthy condition unless
excessively mobile or causes feeding problems
– Monitor Closely
• Caused by the natal or neonatal tooth rubbing the
ventral surface of the tongue during feeding leading to
• Treatment :
– conservative :Create round, smooth incisal edges
– If it does not correct: extraction is the treatment of choice to
avoid ‘failure to thrive’