Pediatric Dentistry Fin
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Transcript of Pediatric Dentistry Fin
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Pediatric Dentistry
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Pediatric Dentistry encompasses allaspects of oral health care for children
and adolescents. Oral health: a state of sound and well
functioning dental and oral structures. Child: every human being below the age
of 18 years Robert Bunon- 1743 (Father of Pediatric
Dentistry) The first dental care program for children
was put forward by Dr Talma, dentist toKing Leopold of Belgium.
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Cognitive development
Child management
Dental caries and prevention
Dental Trauma
Oral conditions that can be first seen
by medical doctors
Use of antibiotics in paediatric dentistry
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Psychology of the child
Why do we learn the normal psychology?
o To meet the specific need of the child
o Interpretation of child behavior
o Understanding your own reaction
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Phases and stadia ofdevelopment
No universal line for development
Piaget's cognitive theory:
Cognitive cognito = thinking
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Piaget's cognitive theory
Sensorimotors
(0-2)
Formaloperation
12+
Concretephase(7-
12)
Preoperation
al phase(2-6)
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Sensorimotor phase (0-2)
contact with the environment by using hissenses.
Complete dependencyReacts through : Crying, arching his backObject permanence does not exist until the
6th monthImitate actions of adults.Understand simple commandsSocial contact: 2 m smiles at every one
3-4 m familiar faces7-12 m dislike
strangers(Medical care provider)
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Preoperational phase(2-7)2-3(early stage)
Ritualistic
Up to 3 egocentric Imitate animals
Still dependant
3 age of treatment maturity
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late stage 3+: Seeking independency
Understands symbols: word. Aware of gender.
Role playing.
Less egocentric
Imitation of animals: brave like a bear.. Fear of separations(3).
Visual fear (3), Auditory fear (4) bodily harmfear(5)
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Formal Operational stage 12+
Return to egocentrism
Think about future and consequences
They can discuss the management.
Perception of treatment can be idealized andinfluenced by the media
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Fear of the dentist is one of the top fivecauses of fear!!
Dental fear: reaction to threatening
stimuli. Dental anxiety: Non specific feeling of
apprehension.
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Principles of child managementtechniques
A-Non pharmacological:
Distraction
Modeling Dentist
Rewarding
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Method of application of localanalgesia
Topical (ointment, spray)
Infiltration: application of local anesthesiaaround the nerve endings.
Blocks: placement of anesthetic near amain nerve trunk.
Intraosseous anesthesia: involves
achieving access to the bone and injectingthe anesthetic solution.
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2-Sedation:
depressed level of consciousness that may vary
from light to deep.Indications :
Psychological indications
Phobia
Fainting during the procedureGagging reflex
Medical indications:
Controlled ischemic heart diseases
HypertensionEpilepsy
Spasticity disorders (cerebral palsy)
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Sedation
A. Oral sedation: Midazolam, diazepam
B. Intravenous sedationAnaesthetist
Drugs: propofol, ketamine, midazolam
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Sedation
C. Inhalation sedationTrained Dentist or
Anaesthetist
Drug : nitrous oxide (laughing gas)
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Contraindications of laughing gas:
Unaccompanied patientPsychiatric patients
Thyroid dysfunction
Pregnancy
Common cold (nitrous oxide sedation)Contraindications to sedation withbenzodiazepines:
hepatic insufficiency
PorphyryMyasthenia gravis
Allergy to benzodiazepine group of drugs.
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3- General anesthesia: a controlledstatus of unconsciousness accompanied bypartial or total loss of protective reflexes
Anaesthetist
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Dental caries
The most common chronic disease in childhood
Definition : local loss of dental hard tissuesmediated by dental plaque.
Dental plaque: is a biofilm formed when the totooth consist of microrganisms 75% of plaquevolume , organic components (extracellular
polysaccharides , glycoprotein, desquamatedcells) and inorganic components
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Dental caries
The main bacteria responsible for
initiation of dental caries are streptococcimutans. Others : Lactobacillusacidophilus, actinomyces viscosus.
Streptococci mutans bacteria have theability to adhere to the tooth surface andmetabolize dietary sugars.
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Origin of the bacteria:
Colonization of streptococci mutans must first takeplace before caries develops.
Transmission of bacteria from the mother or thecare giver.
Presence of a tooth (needed for bacterialattachment!!).
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The acidic products of the bacteria
decrease the ph (> 5.5) and dissolve thedental hard tissues.
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Prevention of dental caries
Diet modification: decrease intake ofsnakes, soft drinks, bottle feeding withcarbohydrate sticky food.
Frequency of intake is more importantthan quantity.
Avoid sucrose containing food.
Use sucrose substitutes like sorbitol andxylitol.
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Tooth brushing and fluoride:
Tooth brushing should be initiated from theeruption of the first tooth.
Fluoride (tooth paste, water, food) leads todecrease in dental caries.
Attention:Fluoride concentration should be optimized
for young children.
6months-2years 500ppm
starting 1.5 years2-6 years 1000 ppm
6+ 1450 ppm
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Fissure sealants: is a thin plastic likecoating applied to the chewing surfaces ofthe molar teeth(posterior teeth).
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Should we treat caries in primaryteeth
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Pain.
Abscess Facial cellulites
Ludwigs angina: cellulites involving thefacial spaces
at the floor of the mouth (life threatening) Cavernous sinus thrombosis.
Premature loss of primary teeth
malposition of the permanent the teeth
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Early childhood caries
Severe dental cariesthat affect the childrenin young age( 71
months). Cause : interaction of
factorsBacteria + nursing bottle
at bed time.Unrestricted breast
feeding (controversial)
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Role of the medical doctors
The mouth is part of the body!!!
The physician should contribute to the oral healthby educating the parents about the importance oforal health and advising them to:
1. Initiate tooth brushing at least two times/day.
2. Use a fluoridated tooth paste when it is
applicable.
3. Decreases the frequency of snacks intake.
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Principles of child managementtechniques
Behavior management:
To prevent behavior management problems create
a safe and trustable environment: Every one in the clinic (Dentist, Nurse,..)
should transmit a positive behavior.
Use distracting objects in the surgery as well as
in the reception( posters , TV, toys.).
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Dental caries
4. The parents to start regular dental check up
5. Patients with congenital heart defectsshould be referred for dental check up notlater than 6 months after eruption of thefirst tooth.
6. Recognition of cases of Early childhoodcaries (ECC )and refer them to his dentalcolleague.
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Dental trauma
One of the common presentations of youngchildren to emergency clinics.
30% of children suffer trauma to primaryteeth
Boys: girls, 2:1. Upper anterior teeth are the most common
site. Etiology of trauma:falls, traffic accidents, sport, violence, child
abuse.
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Classification :1. Injuries to the dental hard tissues:
A. Crown fracture.B. Root fracture.C. Crown-root fracture2- injuries to the periodontal ligament:A. Concussion : tooth is sensitive but not
displaced.B. Subluxation: tooth is loose but not
displacedC. Luxation: tooth is displacedD. Avulsion: Complete displacement of the
tooth from the mouth
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Management:ABCsHistory taking.Examination:A. General assessment( head injuries ,
assessment of cranial nerves, etc).
B. Dental assessment.Attention: Dont forget to check tetanus
immunizationInvestigations:
radiographs: depends on the injury, intraoralradiographs, lateral oblique, occipitomental,c-t scan
etc..
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Management of dental trauma
1-Crown fracture:Reattachment of the
fractured part orrestoring the tooth
withdental filling materialAttention:Fractured part of the
tooth should bekept wet (stored inwater)awaiting forreattachment.
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Root fracture, concussion subluxation andluxation: the treatment varies from havingsoft diet to splinting the tooth
Soft tissue injuries: any debris should be
removed and cleaned with antiseptic(chlorhexidine acetate 0.5%).
suturing should be considered.
Fracture of the mandible and maxilla:fixation
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Management of avulsion(tooth is displaced outof the mouth):
A. First aid :timing is essential for survival of
the tooth. Replant the tooth immediately if the tooth is
clean If the tooth is dirty , rinse the tooth in milk
and then replant. Or restore the teeth in the Childs mouth
between anterior teeth and the lip. Or put the tooth in glass of milk, normal
saline. Seek dental aid immediately.Attention: dont use water as storage medium
for avulsed toothdont replant primary teeth!!
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Principles of child managementtechniques
Greet the child without a mask.
Presence or absence of family members.
Physical proximity: the intimate zone ofthe child is 45 cm.
Timing of the visit
Communication with the parents and thechild.
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B-The dentist will then splint the tooth
with wire and a dental compositematerial.
Antibiotics should be prescribed.
Role of the ph sician in dental
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Role of the physician in dentaltrauma
A. All physician should receive educationregarding dental traumas
B. They must be trained to provide first aid
(tetanus vaccination, avulsed teeth, etc..)
C. They must refer the child immediately to
the dental colleague, as in many casesthe early treatment by the dentist canhelp to improve the prognosis.
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Dental trauma
D. They can collaborate with their dental
colleagues to identify cases of NAI (nonaccidental injuries) and report them
A child is considered to be abused if he/she be treated in a way that isunacceptable in a given culture at a giventime
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NAI
L b R W lb
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Lecture by R.Welbury
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How to identify cases of child abuse
50% of abused children suffer injuries tothe head and neck.
Signs:
Injuries of various stage of healing. Repeated injuries
Injuries in babies and pre-mobile
children.
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NAI
Bruises is on of the most commoninjuries( in shape of implement used).
Injuries whose clinical presentation is notin consistent with the story of the patient
Attention: children normally lie to protectthe parents.
Lecture by R Welbury
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Lecture by R.Welbury
Oral conditions that could be recognized by
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Oral conditions that could be recognized bythe physician
Teething: a normal process of eruption ofa tooth but sometimes the infant showssigns of systemic distress by systemicdistress: slight fever, diarrhea, local
irritation, redness of the gum anddrooling.
Management:
Teething remedy (teething gel)Rehydration
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Natal teeth: is one that erupt within 30
days of birth.1 case per 2000-3000.
My cause trauma to the breast.
If extremely mobile ,then should beextracted.
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Bacterial infection:
Facial cellulites.
Signs and symptoms: patient is febrile, sick ,upset and dehydrated.
Parents are distressed and anxious.
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Management:
This is an emergency and can be a life
threatening condition .Antibiotics
Pain control
Fluids maintinance
Removal of the causative tooth (primarytooth)or root canal therapy(permanent tooth)
Warm saline mouth rinse
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Viral infection
Primary herpetic gingivostomatitis:Most common cause of severe oral ulceration.Self limitingCaused by herpes simplex type-1 virusIncubation time is 3-5 days.Signs and symptoms: irritability, pyrexia and
malaisered and edematous gingiva.Vesicles painful ulcers
healingManagement: oral fluids, mouthwashes, topical
anesthetic and analgesics.
rupture
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Fungal infection
CandidosisThe most common form in children is oral
thrush.White plaque hemorrhagic base.
Causative fungi: Candida albicansPredisposing factors: low immunity(HIV,
diabetes), broad spectrum antibiotics,chemotherapy and radiotherapy.
Diagnosis: clinicalManagement: Antifungal medication for 8 daysLocal: Nystatin ointment, systemic: Amphotericin
B.
removal
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Use of antibiotics in pediatric
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pdentistry
Conservative use of antibioticsresistance
1- contaminated intra oral wounds: minimum5-7 days.
2-Acute facial swelling of dental origin.Intravenous antibiotics may be indicated.
Attention : painful tooth without systemicinvolvement (fever, malaise) or extra-oralswelling is not an indication of antibiotics.
3-Dental trauma(Avulsion)4-Pediatric periodontal disease5-Prophylaxis .