PEDODONTICS MIDTERMS

INTRAORAL EXAMINATION Examination of the oral cavity The breath of the healthy child is usually pleasant and even sweet BAD BREATH or HALITOSIS may be caused by local or systemic factors o LOCAL Poor oral hygiene Presence of blood in the mouth Presence of strong smelling volatile food o SYSTEMIC Dehydration Sinusitis Hypertrophy of upper alimentary tract Typhoid fever Other enteric infections and GI disturbances

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Tongue habits should be observed for possible association with malocclusion Dryness of tongue may be due to dehydration for mouth breathers RANULA or MUCOUS RETENTION CYST

ACIDOSIS usually produces and odor of acetone on the breath o Condition of the oral mucosa is an indicator of the general health of the child o Presence of inflammation, pallor, and ulcerations

SOFT TISSUES LIPS & CHEEKS o Gateway to the oral cavity o The most common lesions seen in the labial and buccal mucosa of children are those associated with HSV o Addisons disease and Intestinal Polyposis may cause a pathologic brownish TONGUE o Pathologic enlargement of the tongue may be due to cretinism or mongolism or may be associated with a cyst or neoplasm o Desquamation of the surface papillae associated with avitamonoses, anemias, or stress disorders o Abnormally short lingual frenum may prevent the tip of the tongue from coming forward and result to speech difficulty

SALIVARY GLANDS o Epidemic parotitis or Mumps is characterized by a tender, painful, unilateral or bilateral swelling of the salivary glands HARD & SOFT PALATE o Scars may be caused by trauma or surgical repair of developmental anomalies o Color changes may be caused by neoplasms, infectious or systemic diseases, trauma or chemical agents TONSILS GINGIVA o Periodontal pocketing is rare in the primary dentition unless there is an associated medical condition o If generally the oral hygiene is good, with few plaque TEETH o Oral cleanliness o Teeth present/number of teeth Partial anodontia Supernumerary teeth (Mesiodens) o PRIMARY Crowns are completely formed and start to erupt: 6 months Start of tooth formation: 6 weeks intrauterine life Completion of roots: 2 years Formation of roots start at 1 year o PERMANENT Crowns form: 3 years Roots form: 3 years o Size of teeth Macrodontia Microdontia o Mobility Exfoliating primary tooth Abscess

Periodontitis Color of the teeth Extrinsic stains can be caused by chemogenic bacteria which may invade deposits of materia alba and calculus, causing an array of colors on childrens teeth Generalized discoloration of the enamel and dentin is due to intrinsic factors such as: Blood dyscrasias Amelogenesis imperfecta Dentinogenesis imperfecta Internal resorption Drugs tetracycline Non-vital tooth Caries o Structure/malformation Hypoplasia Hypomineralization Dilacerations Dwarfed tooth Geminated tooth Fused tooth Nothced tooth syphilis Peg-shaped tooth Due to hereditary, systemic or developmental disturbances OCCLUSION/OCCLUSAL ASSESSMENT o Permanent first molars and canines Molar and canine relationships o incisors overjet overbite o position crowding spacing drifting o

MORPHOLOGY OF THE PRIMARY TEETH 1 hour chair time at the most for pedo patients Primary has flared roots

Primary may fracture easily at the neck portion

GENERAL MORPHOLOGIC CONSIDERATIONS IN THE PRIMARY DENTITION CROWN 1. Shorter crown 2. Occlusal table is narrower 3. More constricted cervical area 4. Enamel and dentin layers are thinner 5. Enamel rods in gingival 3rd extend slightly occlusal direction from DEJ 6. Contact areas are broad and flat 7. Mineral content is nearly the same 8. Color is more lighter 9. oral hygiene is not yet developed in children that is why they are more prone to acute caries PULP 1. Larger pulp 2. pulp horn is closer to outer surface 3. mesial pulp horns are closer to outer surface 4. mandibular has larger pulp chamber than maxillary 5. form of pulp chamber follows the surface of the crown 6. usually has pulp horns under each cusps 7. histologically, there are very little differences from permanent ROOT 1. Narrower M-D of anterior roots 2. Posteriors are longer and more slender 3. More flare as it approach the apex INFLUENCES OF PRIMARY TOOTH MORPHOLOGY

CLASS II GIC, Am, Co Gross carious breakdown or restoration after pulp therpy SSC PERMANENT Occlusal Table Fissure sealant Occlusal enamel caries Fissure sealant Occlusal caries with minimal involvement of dentin PRR (Preventive Resin Restoration) CLASS I Co CLASS II Am CLASS III Co CLASS IV GIC, Co CLASS V Co

With local anesthesia and liner placed in the exposed dentin Filled composite resin

PIT AND FISSURE SEALANT (preventive) Application and mechanical bonding of resin material to an acid-etched enamel surface, thereby sealing existing pits and fissures from the oral environment This mechanism prevents bacteria from colonizing in the pits and fissures and nutrients from reaching the bacteria already present Indications: o Be dependable on recall appointments o Be aged 6 15 years o Be motivated and effective in caries control o Have low caries activity o Caries-free permanent teeth with steep cuspal inclines o STAINLESS STEEL CROWNS (restorative) Are preformed extracoronal restorations Indications: o Primary or permanent teeth with extensive carious lesions o Primary teeth with three carious surfaces o Primary or permanent teeth with enamel or dentin defects o Hypoplastic enamel, amelogenesis imperfecta, or dentinogenesis imperfecta o Fractured teeth o Primary molars that have undergone pulp therapy o Teeth used as abutments for space maintainers ARMAMENTARIUM FOR SSC Stainless steel crowns numbered 2 7 Pliers o Johnson 114 o Crimping pliers or Adams pliers o Crown cutting scissors Reduce 1 1.5mm on the cuspal area Slice through Do not create a ledge Measure the tooth before reduction

PREVENTIVE RESIN RESTORATIONS Most conservative approach toward confined, incipient occlusal caries in young permanent teeth whereby restoration occurs with a minimum of tooth preparation while ensuring the prevention of future caries formation through sealant placement PRR preserves sound tooth structure by incorporating a conservative composite resin restoration with sealant application Counterpart in adult/permanent: SPOT FILLING

PROPHYLACTIC ODONTOTOMY remove defect part of tooth to prevent decay

Progress of caries and it is necessary to restore incipient lesions in primary teeth because of the ff. factors: Enamel is much thinner Thus, dental caries is more active in primary teeth Dentin is proportionally thinner

INDICATIONS FOR USE OF MATERIALS IN PEDIATRIC DENTISTRY PRIMARY CLASS I GIC, Am, Co

3 TYPES OF PRR 1. TYPE A Comprises suspicious pits and fissures where caries removal is limited to enamel Unfilled sealant 2. TYPE B Is indicated where the exploratory removal of caries has included dentin to a slight extent Diluted composite resin (flowable) 3. TYPE C Characterized by the need for greater exploratory preparation in dentin

Crowns are placed lingual first so that the filling will flow at the buccal for easier removal of excess material

CROWNS Are often times associated with an adult dentition for restoration of a tooth that needs full crown coverage Casted crowns are better fitting that preformed crowns A restoration that covers a tooth to restore it to normal shape and size It helps in strengthening and improving the appearance of the tooth A crown is necessary when the tooth is totally broken down where fillings cant restore tooths function and anatomy The crown should represent the natural tooth The color of the crown should match with the teeth adjacent to it The dimension of the crown MD width should be in proportion The crown should restore the function and esthetics of the tooth it represents and should help in maintaining adequate arch length Should be biocompatible with the surrounding structures should be economical INDICATIONS: A primary tooth with more than two surfaces destroyed due to caries A tooth which has undergone pulp therapy Moderate caries involvement in After traumatic dental fracture involving significant portion of the crown CONTRAINDICATIONS: Primary teeth in which conservative amalgam restorations can be placed Teeth to be exfoliated within a brief period Retainer for space maintainers appliance o The preformed crown should be considered as a means of restoring a primary tooth, not as a means of fabricating a space management appliance CLASSIFICATION OF PREFORMED CROWNS According to Form and Contour o Untrimmed, uncontoured, uncrimped crowns o Precontoured and untrimmed crowns o Pretrimmed, precontoured, precrimped crowns According to Materials used

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Stainless steel crowns Nickel chromium crown Polycarbonate crown Pedo strip crown

Prevents fracture

SSC STEPS: 1. The occlusion of the patient is noted 2. Anesthetize the tooth to be prepared 3. Placement of the rubber dam is essential 4. Removal of decay For pulpotomy, instead of using ZOE for sealing, use Calcium Hydroxide for the apices to close (APEXOGENESIS) TOOTH 1. 2. 3. 4. 5. PREPARATION Occlusal reduction Proximal reduction Selection and seating of the crowns (measure M-D width first) Adaptation of the crown (check the occlusion; do crimping) Cementation of the crown

INDICATIONS Primary anteriors with severe caries A tooth which has undergone pulp therapy Moderate caries involvement in After traumatic dental fracture involving significant portion of the crown POLYCARBONATE CROWNS Provisional crowns, acrylic crowns Polycarbonate Crown Advantages: Improved esthetics Helps in phonation Disadvantages: Difficult to place Poor retention Prone to excessive wear Brittle, high incidence of fracture Limited shade selection Uncrimpable margin Strip off Crown Advantages: More esthetic crown Improved retention Better wear resistant Disadvantages:

PROPERLY SEATED CROWNS Correspond to marginal ridge height of the adjacent tooth Does not rotate on tooth

Adapts closely to the tooth in cervical 3rd No blanching of gingival tissues o Crown normally extends 1mm into the gingival sulcus Adjacent proximal contact must be maintained Occlusal relationship must be established o A thumb must always be kept over the occlusal surface of the crown during removal

ADAPTATION OF THE CROWN Adjustment the crown is required Crown should adapt to the walls of the tooth on Bu, Li, M, D Sudden forceful jerks on sharp dislodging movements must be avoided CEMENTATION Adapt first on Li then Bu o For easier removal of cement excess OBJECTIVES FOR ANTERIOR Restoring esthetics Preventing psychological trauma Restoring function Maintaining occlusion

POLYCARBONATE CROWN PREP 1. Caries removal 2. Administration of local anesthesia 3. Selection of crown size 4. Placement of rubber dam 5. Shoulderless prep of tooth 6. Adaptation of crown 7. Roughening of interior surface of crown 8. Cementation 9. Finishing of margin STIP OFF TECHNIQUE 1. Crown selection and prep 2. Tooth prep 3. Crown placement SELECTION OF STRIP OFF CROWN Select the appropriate celluloid crown size from the MD measurement (in mm) at the tooths incisal edge Trim off excess cervical collar and tab with curved scissors Punch holes in the incisal edge of the crown

Reduce interproximal surfaces with a tapered diamond abrasive, produce knife edged cervical margin Reduce the incisal edge by approximately 1mm Round all line angles Place cervical undercut Remove caries with spoon shaped excavator

CROWN PLACEMENT Trial fitting Acid etching Bonding Pack crown with resin Position the filled crown over the prepared tooth Polymerize Remove crown by stripping or slicing it on the lingual surface with a sharp scaler Finishing STRIP OFF CROWN Quick and simple method for restoration of primary Parents and children are often delighted with the improvements that can be achieved without resorting to extraction -Rosette Go 012211