SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS

OBJECTIVES

• Background• Conditions that occur in pediatrics• Treatment

BACKGROUND

• Preoperative evaluation: – History of presenting complaint– Medical history– Dental history– Examination

• Behavioral management

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

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

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

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

Mesiodens

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

Treatment:• 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

mucosa. – Found on the anterior maxillary ridge.– Patients typically present with feeding and/or

respiratory problems.– Treatment: surgical excision.

Neumann’s tumor

• 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

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.

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

• 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’

Riga-Fede disease

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.

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