PEDIATRIC DENTISTRY PEDIATRIC DENTISTRY, Exams of Dentistry

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Pediatric Dentistry

Autonomy - Childhood process of becoming independent Avulsed - Torn away or dislodged by force Chronologic Age - Actual age in (months, years) of pediatric patients Down Syndrome - Chromosomal defect that results in abnormal physical characteristics and mental impairment; also called trisomy 21 Emotional Age - Measure of the level of emotional maturity of pediatric patients Extrusion - Displacement of a tooth from its socket as a result of injury Intrusion - Displacement of a tooth into its socket as a result of injury Luxation - Dislocation Open Bay -

Concept of open design used in pediatric dental practices Papoose Board - Type of restraining device that holds or hugs or wrap around a pediatric patients hands, arms, and legs to keep them still. Parent must provide consent Pulpotomy - Removal of the coronal portion of a vital pulp from the tooth. Remove inflamed portion and keep healthy portion. Pulpectomy - Complete removal of vital pulp from a tooth Pediatric Dentistry - Dental Specialty concerned with neonatal through adolescent patients, as well as patients with special needs in these age groups. It focuses on providing oral healthcare according to the needs of infants, children, adolescents, and individuals with special needs Emphasis of the pediatric dental practice is placed on: - Prevention, early detection, diagnosis, and treatment How many years after dental school must a pediatric dentist continue education? - 2-3 years in an accredited pediatric program based setting A pediatric dental assistant must have: - Compassion and patience to enjoy working with children, adolescents, and patients with special needs (usually certified) Certified Pediatric Dental Assistant Functions: - Perform legal preventive procedures such as coronal polishing, sealant application, and taking preliminary impressions

Open Bay Advantage: - Provides reassurance by allowing pediatric patients to see other children who are receiving care Sedation Room - "Quiet Room" separate of open area that can be used for children whose behavior may upset other children Would it be possible to see a 21 yr. old patient in a pediatric office? - Yes. If the patient has special needs What is unique about the treatment setting of a pediatric setting? - It displays a pleasant and non threatening decor usually with a theme and games for children to play with What types of patients are seen in a pediatric practice? - Infants, children, adolescents, and special needs Mental Age - Refers to the child's level of intellectual capacity and development Erikson's Stages of Development - Erik Erikson- well known pyschiatrist developed stages of behavior to understand the social and emotional development of children and teenagers. Consists of: Learning Basic Trust and Autonomy Play and School Age Adolescence Learning Basic Trust -

Period of infancy through the first year of life. Well-handled, nurtured, and loved child develops trust and security and a basic optimism; if handled badly, the infant becomes insecure and mistrustful Learning Autonomy - Children learn to sit, stand, walk, and run. Progress vocally from babbling to simple sentences. Socially they learn to identify familiar faces and alternate between fear of strangers and friendliness. Around 2 they begin to have basic fears of separation from parents and around strangers. Too young to cooperate so will be w\parents and maybe premeditated Play Age - 3-5 and has two primary and conflicting needs. 1st- Child has gone through autonomy and initiative. 2nd- Child requires control and structure in his\her environment. Can follow simple instructions and they welcome having an active role in treatment experience School Age - 6-11. In a period of socialization, which involves learning to get along and rules and regulations of society and accept social requirements. Through experience with others they have learned to overcome fears of objects and situations that were once frightening and usually have learned situations are not as scary as once thought Adolescence - Transitional stage of physical and psychological human development generally from puberty to young adulthood. From 12-20 young people acquire self-certainty, clear sexual identity is established and adolescent will seek leadership (someone to inspire them) and gradually develop a set of ideas- Hope they develop leadership and mature Frankl Scale - Scale designed to evaluate patient behavior developed by Dr. Spencer Frankl Frankl Scale-Definitely Negative: - Refusal of treatment; crying forcefully; fearful; other evidence of extreme negativism Frankl Scale- Negative -

Reluctance to accept treatment; Uncooperative; some evidence of negative attitude but not pronounced, that is, no sudden withdrawal Frankl Scale- Positive - Acceptance of treatment; cautious at times; willingness to comply, at times with reservation, but follows directions Frankl Scale- Definitely Positive - Good rapport with dentist; interested in dental supplies; laughing and enjoying the situation Guidelines for child behavior: - Be honest with the child, consider the child's point of view, always tell, show, do, and give positive reinforcement Be honest with the Child: - Be sure what is said is true from the child's point of view Consider the child's point of view: - Avoid words that provoke fear in the child. Child must understand the words used. Always "tell, show, and do": - Tell the child what is to be done, Show what is to be done and proceed to do exactly what the child has been led to expect. The team should not assume that a procedure or instrument is so harmless that it will not concern the child Give Positive Reinforcement: - Reinforce and reward appropriate behaviors; avoid rewarding undesirable behavior Golden Rule for Guidelines For Child Behavior: - ONLY 1 PERSON TALKS TO THE CHILD

The Challenging Patient: - Use Voice Control (speaking calmly but firmly) will usually prevent the need for restraint or a papoose board Restraint - Can be physical or pharmacologic to help keep patient movement to a minimal. Premedication may be used prior to calm and ease patient before treatment. May use mild sedation such as nitrous oxide. Sometimes parent or assistant may hold down hands to prevent injury Patients with Special Needs - Say Exceptional Children instead Mentally Challenged-Intellectual Disability - Particular state of functioning that begins in childhood and characterized by limitations in intelligence and adaptive skills. Mentally Challenged Individuals classified into 4 groups of intellectual disabilities (for descriptive purposes): - Mild, Moderate, Severe, Profound Mild Intellectual Disability: - IQ ranges from 50-70, they typically develop social and communication skills during preschool years and have minimal impairment in sensorimotor areas. Often indistinguishable from normal children until later age When communicating with a patient with mild intellectual disability, do the following: - Minimize distractions, use short explanations, use simple language, take more time to present information, avoid explanation of causes, focus on effects of lack of oral hygiene, teach activities rather than concepts, encourage consistencies, use "show,tell,do" positive reinforcement, and verbal praise Moderate Intellectual Disability: -

IQ from 35-55, they talk or learn to communicate during preschool years. May profit from vocational training and with moderate supervision, can take care of themselves; Unlikely to progress beyond 2nd grade level in academic subjects. Usually need supervision and guidance under stress and usually live in supervised group homes. My need premedication, restraints, or care under general anesthesia while receiving dental treatment Severe Intellectual Disability: - IQ from 20-40. Display poor development and acquire little or no communicative speech during preschool period. In adult years, may be able to perform simple tasks under close supervision. Typically require specialized dental treatment involving general anesthesia Profound Intellectual Disability: - IQ from 20-25. During early years, they display minimal capacity for sensorimotor functioning. A highly structured environment with constant aid and supervision is necessary throughout life. Require specialized dental care usually provided in an institutional setting Patients with Down Syndrome: - Mental impairment range from mild to moderate retardation. Reduced muscle strength and muscle tone and 1\3 have heart problems. Usually have abnormalities in dental development such as perio disease and peg laterals, mouth breathing, misaligned occlusion, poor oral hygiene. Forward position of mandible and underdeveloped nasal and maxillary bones provide little space for tongue resulting in open-mouth, forward-tongue position which makes tongue look enlarged. Approach in mental age not chronologic. They do not like uniforms Autism: - Effects how info is processed in the brain by altering how nerve cells and their synapses connect and organize. Signs evident before age 3 and is characterized by inability to get along with people, poor social skills, lack of interpersonal relationships and abnormal speech. Have desire for sweet foods. Often receiving psychotrophic meds which cause dry-mouth. Sedation, restraint, and general anesthesia may be necessary Cerebral Palsy - Group of non progressive neural disorders caused by prenatal or postnatal brain damage before the CNS has reached maturity. Paralysis, muscle weakness, lack of coordination, and other disorders of motor functions. Classified according to motor disturbances, spasticity and athetosis. Usually premed to

help them relax and for control. Maybe general anesthesia. Patient and caregiver should receive a thorough orientation to a home care program with modifications necessary to meet their needs Spasticity - Characterized by a state of increased muscle tension that manifests as an exaggerated stretch reflex. Athetosis - Marked by uncontrollable, involuntary, purposeless, and poorly coordinated movements of the body, face, and extremities; grimacing, drooling, and speech defects are present. Diagnosis and Treatment Planning: - According to American Academy of Pediatric Dentistry, 1st appointment should take place around 1st birthday. Regular exams at age 2. Radiographs every 6 mos. for patients with high risk of tooth decay Extraoral Examination - Used to evaluate the patient's profile to determine skeletal characteristics. Any facial deviation or asymmetry of the eyes, ears, or nose may be a symptom of an undiagnosed syndrome, and child should be referred to a professional Intraoral Soft Tissue Exam - Evaluate gingiva and periodontium through the use of a gingival score or a periodontal plaque score Exam and Charting of Teeth: - Use of mouth mirror and explorer to explore dentition and occlusion to determine spacing and crowding of teeth Preventive Dentistry for Children: - Involves entire dental team. It reaches to the community and local schools and the role is to communicate preventive dental health in areas such as oral hygiene, fluoride use, diet, and preventive procedures Fluoride -

Children between 6 months -16 years should have a daily intake of fluoride.Varnish is a gel-like substance designed to release fluoride on the enamel and root structure and is brushed on and sticky Sealants - Made of clear or shaded plastic and applied to posterior pits and fissures to prevent cavities Space Maintainer - Used to reserve the space until the permanent tooth erupts- band and loop Corrective Appliances - Correct oral habits such as thumb-sucking, placed to interfere with the finger position during thumb sucking Pulp Therapy - Attempt to stimulate and preserve pulpal regeneration in primary teeth. 2 effecting factors are deep caries and trauma. Deep caries most likely in posteriors and Trauma most likely in anteriors. Indirect and direct pulp capping may be indicated for newly erupted permanent teeth, to promote pulpal healing and stimulate production of reparative dentin Pulpotomy can be accomplished by: - The formocresol pulpotomy- most often used for primary teeth. Medicament is 50:50 formulation of 19% formaldehyde and 35% cresol in an aqueous glycerin solution The Calcium Hydroxide Pulpotomy- Primarily for young permanent teeth with open apices. A common indication on the fractured tooth is significant exposure of the pulp. This treatment allows continued apical development so that endo can be performed later Stainless Steal Crown - Restoration of choice because- can be prepared and placed in a single appointment, durable to last until permanent teeth erupt, almost always well tolerated by the gingiva of young patients, and much less expensive than cast restorations 2 Types of SS Crowns in Pediatrics: -

Pretrimmed- straight sides but need festooning to follow a line parallel to the gingival crest. Must be trimmed and contoured to fit tooth. Precontoured- already festooned and contoured. May need minimal trimming and contouring Dental Trauma - Discoloration and possible loss of tooth. Primary teeth typically around 1-2 1/2 yrs of age. Most frequently Max. central incisors. Permanent could also potentially be damaged. Fractured Anterior Teeth: - Needs to be seen ASAP. Dentist often prefers to delay restorative treatment 3-6 wks to avoid any further trauma to the pulp of injured tooth. This time allows pulp to recover without additional injury. During this period the dentist provides temp. relief by covering exposed dentin with calcium hydroxide, places an interim coverage of resin material, and radiographs are taken. Traumatic Intrusion - Result of injury where the tooth is forcibly driven into the alveolus so that only a portion of the crown is visible. Primary or Permanent dentition. Intruded teeth should be allowed to erupt naturally; often require endo treatment later. Damage to permanent tooth can occur but extent cannot be determined until tooth erupts. Extrusion and Lateral Luxation Injuries: - Occur when teeth are displaced from their position. Severe damage to PDL usually occur with these injuries. Dentist repositions displaced teeth ASAP. Temp. splint of resin material or ligature wire is used to stabilize the repositioned permanent teeth. Endo often required later. Primary teeth often undergo root resorption more quickly and may become more mobile Avulsed Teeth - Permanent teeth that have been avulsed can be replanted with varying degrees of success, the more quickly replanted, the greater the success. Instructions for Avulsed Teeth: - Recover tooth immediately, Wrap tooth in moist gauze, go immediately to dentist office Success rate highest when replanted within 30 min.

Anesthesia administered, X-ray taken to reveal tooth/bone fragments, clotted blood removed from socket with curette, tooth washed in saline and inserted, tooth is splinted in place with wire, acrylic, or ortho splints, post-op x-rays taken, endo treatment 6-8 wks after. Child Abuse - In All states, healthcare professionals must report any suspicions of abuse or neglect to the state or county child protective service agency. Dental Assistant or clerical staff is not responsible in reporting this but has a moral responsibility to report unknown or suspected abuse cases to the dentist. Reporting may be done by phone, in person, or writing. Specific info is required. Suspected Child Abuse Signs: - Injuries at various stages of healing, repeated injuries, chipped or injured teeth, scars inside the lips or on tongue, tears of labial frena, battering or other injuries around head or neck, facial bruising, swelling of the facial structures, or black eyes, fractured nose, bite marks, injuries not consistent with the explanation presented by the parent. What to include when reporting Child Abuse: - Name, address, gender, height, weight of child. Name and address of adult who has custody of child Description of the current physical and emotional abuse or neglect of the child Evidence of previous injuries or negligence Information that may assist in establishing the causes of injuries Sketches or photographs documenting the nature and location of injuries