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how to keep your patients’ records and how to write them. they look different and they are different from the permanent teeth in many aspects. Primary teeth (deciduous. endodontic therapy. how to diagnose. how to formulate a treatment plan. (This is according to studies that done on European children. 2|Page . how to diagnose dental caries and the indications for radiographs for children. They are important in all aspects of oral function such as mastication. The topics that will be discussed this semester are history taking.  The first set of teeth that appear. baby or milk teeth): As you see in the picture.  The sequence of eruption is A B D C E.  The sequence of calcification is almost the same. surgical therapy. the areas that it covers are all sorts of restorative therapy. everything that you can imagine that done in dentistry but with children. preventive therapy. the Jordanian child averagely start teething at the age of 8 months). however.  They are 20 teeth in number. Introduction To Paediatric Dentistry Paediatric dentistry is a branch of dentistry that deals with children. they appear between the age of 6 months up to 2 and half years. examination of children.  The root formation is 18 months post-eruption (year and half). speech etc… in addition. it is very necessary to avoid the infection of these teeth and dental caries to progress into the pulp because you will get other complications in the permanent teeth.Paediatric Dentistry 13 June This course is going to be an introduction to the main principles in paediatric dentistry and you will be gaining most of the knowledge in 4th year. according to a recent study that was conducted in Jordan. orthodontic therapy and actually.

Of course.  The root formation occurs 3 years after. Why this is important to know? Because we depend on this cervical undercut in our fitting of stainless steel crowns for these children (to hold the crown in its place). the root is not completely formed.  They are 32 in number. in both sets of teeth. dentine and pulp. you will get a big undercut cervically in the primary teeth compared to the permanent teeth.  They have a constricted neck and this is consistent with the big undercut that you have in the cervical area. we have enamel. the crown/root ratio will vary with time because as soon as the tooth erupts.  The crown/root ratio is less.  The sequence of eruption varies between the maxilla and the mandible. it depends on whether you get the wisdom teeth or not. therefore. the crown/root ratio is never the same at different times. it is between 2\3 to 3\4 completed.  The cervical ridge in primary teeth is more pronounced. The differences between the two sets of teeth: (All these points are related to the primary teeth)  There are histological differences between them and they are related to the thickness of each tissue. the thickness is much less in the primary teeth and the pulp chamber is much bigger in them.  The enamel rods histologically slop occlusally. (The doctor showed us pictures of deciduous and permanent teeth in each arch. however. it starts the resorptive process (the physiologic resorption). 3|Page . and as soon as it completes its formation. therefore.The permanent teeth:  They appear between the ages of 6 – 12 years. so please refer to the slides).  The sequence of calcification also varies.

very young patients (pre-school kids). we do not have a contact point in primary teeth. It is larger in the mandible than in the maxilla. The roots are more flared and this is to accommodate the permanent tooth bud underneath.  They have a narrower occlusal table. handicapped patients and bedridden patients (we go to the hospital. for example. we have a contact AREA.  They are narrower mesio-distally. Because of this. examine and treat them there). and however. What are the differences between a paediatric patient and an adult patient? Obviously. this is because economic reasons or health insurance reasons. (Usually. older patients like teenagers. We may see healthy patients. this is because the thickness of enamel and dentine is much less. Paediatric patients: Paediatric patients can be any patient from birth up to the age of 18. there is a pulp horn underneath each cusp). we are not allowed to see patients below 6 years old or above 12 years old. there is a big need for behaviour management. But the age that you may see in a certain clinic depends on the regulation of that country. In the paediatric clinic in JUST we only see patients between the ages 6 and 12 (student clinic). adolescents.  The colour is much whiter/lighter compared to the permanent teeth. the first difference is age  and size.  The pulp is larger.  They have a flat contact area. in some countries the health insurance system considers a child any person who is less than 12 years old. which is:  A collective term to describe the techniques that we use in order to manage the child and to shape the child behaviour in order to cooperate with us and become more interested in continuing the 4|Page . the mesial is larger than the distal and the form of the pulp chamber will follow the cusps in the primary teeth more than that in the permanent teeth.

desensitization. There are certain skills and certain techniques that are based on scientific and psychological rules and on the cognitive and physiologic growth of the patient. if you agree and he agrees then you are happy . he probably agrees.treatment and become more motivated to take care of his teeth at home. voice-control. treating an adult is usually involves 1:1 relationship. you talk to the child. In the triangle. In the cons. therefore. you just talk to your patient. and for child it is 1:2 relationship. the child is located at the apex because he is the major point of attention of you and his parent. clinic for example. The paediatric triangle: (Please refer to slides to see the triangle) The paediatric triangle is also important for you to learn. the major difference between the treatment for children and adults is the relationship. it means that the communication is reciprocal (the child with his mother. 5|Page . If you look to the triangle. you will notice that the arrows that placed on the lines of the communication are RECIPROCAL. when you are talking to the parent. the father disagrees or the opposite. The way that you talk to each is different. you have to use a different language. Treatment procedures: We do all sorts of treatment procedures and they are the same in their names but the way that you do the procedure a bit different in deciduous teeth. because you have to know. and the mother with her child etc…). but when you are talking to the child. but in the paediatric clinic. you have to talk to both. In summary. positive reinforcement etc… so these are techniques that we will learn. Some of these techniques have terms like tell-to-do-show technique. you are dealing with him and with his parent or with the legal guardian. however. you are talking to an adult. in paediatric clinic you are not dealing with the child alone.

Once we took the x-ray. which is the form of supernumerary teeth. meaning: If you have a child who has an appointment and this is his first visit to the clinic. it is a new experience for him. The doctor showed us an example of this case: nine old female who attended to the students’ clinic. the central and the lateral incisors are not there they are not impacted. Of course. However. (Please refer to the slides to see the radiograph). and her mother was complaining of the absent teeth. to prove this. so you as a dentist have big chance to make it a pleasant experience for him (make it a positive thing). Dental conditions: The dental conditions that these children might have are:  Natal teeth: These teeth are teeth that are present at birth. one type of ectodermal dysplasia (sorry I could not hear the name exactly. you cannot confirm that any tooth is congenitally absent until you take a radiograph. her teeth were congenitally missing. this means that he does not know anything about dentistry. so please go back and check it). and although he does not know what is going to happen.  Supernumerary teeth: The doctor showed us a picture of the mesiodens. the child would sense that. Noonan syndrome and Turner’s syndrome. but I think it is mentioned in the slides. and they are associated with many syndromes that you should know as a dentist. When you take the x-ray.  Teeth agenesis: Agenesis means that there are some teeth that have not formed. he will be afraid just because his mother/older sibling or somebody else is afraid.The mother attitude: The mother attitude has been found by studies to affect the child behaviour. you find that 6|Page . if the mother had a bad experience or she worried for some reason. they are congenitally missing.

because it is hard to tell if it is gemination or fusion. this also occurs because of medical conditions or sometimes some medications. It is characterized by decalcification of the dental hard tissue through demineralization of the dental tissues by the acid producing streptococcus mutans bacteria. you will notice that the teeth are yellowish in colour (hypo-plastic). in addition to an abscess with pus drainage out of it.  Enamel hypoplasia: If you look to the picture.  Dental caries: We have many dental caries in Jordan. Imagine this child has to take anti-biotic three times a day and you know how anti-biotic syrups are loaded with sugar. so this increases the caries. the paediatrician prescribes daily anti-biotic for them to avoid having a crisis because of the infections.  Conjoined teeth: “Conjoined teeth” is a collective term for gemination and fusion. which is macrodontia. 7|Page . there is picture for a very large central incisor.  Children with low salivary flow. For instance. The doctor showed us a picture for one of her patients with sickle-cell anemia. he has many caries.  Macrodontia: In the slides. Children at high risk include:  Children who are frequently exposed to sugar through medications. chronically ill patients.there are supernumerary teeth that blocking the eruption of other teeth (the central incisor in this case).  Amelogenesis imperfecta & Dentinogenesis imperfeca: They are other hereditary conditions. sickle-cell anemia patients.

if the child becomes 12 months of age and there is no primary tooth erupted.  These are unique type of caries involving the primary teeth. they should come to the dentist. what kind of toothpaste to use. mainly in infants who still bottle-feeding (sleep with bottle in his mouth during night). we do certain treatment. we give an analgesic like ibuprofen or paracetamol. the plaque accumulated around these appliances because it easily stuck there. or we extract it. Then. appliance. tooth mousse. The first dental examination should follow the eruption of the first primary tooth. In addition. diet changes that the parents should be aware of. either the milk is sweetened. 8|Page . we do either root canal treatment for the tooth. metronidazole (for the gram-negative anaerobes). teaching the child how to brush. fluoride use either in the water or topically. The antibiotic of choice is penicillin (for the gram-positive). Dental abscesses: The microorganisms that are involved in dental abscess are streptococci and staphylococci. The doctor showed us a picture for a child with an Ortho. or juices or Pepsi!!  The other thing is using the pacifier dipped with honey and this affects the child negatively. In addition. so this leads to an early childhood caries. the bottle contains sweetened liquid. Prevention deals with oral hygiene. no later than 12 months of age. what kind of brushes to use. which are gram-positive and gram-negative anaerobes. the use of fissure-sealant to block caries and early visit to dentist. Children with orthodontic appliances who have poor oral hygiene are at high risk to develop caries. The other thing that we deal with in paediatric dentistry is Prevention: Your first four or five lectures in the 4th year will deal with this aspect. most of the times.

sometimes it can harm the tooth that is underneath and can cause bone resorption. bruises etc… Neglect appears as poor nutrition. by emotional deprivation from the parents for example. which is how to take a history for the patient when he comes to the clinic. The resoption may reach the tooth bud. Lack of medical and dental care. There is another type of abuse. 9|Page . There are also verbal abuse (by speech). burns. hitting. because it is omitting certain act that should be done for the child. Trauma: Another thing that paediatric dentistry deals with is trauma. skin ulceration. so the child becomes emotionally deprived and this affects his health. Therefore. it can cause hypoplasia or hypo-mineralization in the permanent tooth and sometimes. slapping. and if it reaches the tooth bud. the child not growing and not gaining weight/height. that is why we do history. neglect is also a type of abuse. Child abuse and neglect. abuse is any type of trauma that it caused by burning. failure for seek treatment for pain and infections. it leads to broken teeth and bone. Now we will move to another topic. choking. History taking The fundamental philosophy of all branches of dentistry including paediatric dentistry is to treat the patient not the tooth. growth and personality. sexual abuse and neglect. This was a brief introduction to what we deal with in paediatric dentistry in order to have a prospective. Neglecting a child means not giving him his needs. we want to know about the history of the patient. and then we want to know about the tooth. abscess formation in the tooth bud (pus inside it). the objectives of history taking. examination and treatment planning cannot be over load. pulling and pinching. Remember always that you are dealing with a human being not just a tooth.There is an example in the slides that shows how much the abscess can be harmful. which are called physical abuse. which is emotional abuse.

this is very important. communication is established and you introduce dental procedures/dental environment to the child. the child will start slowly accommodate within the dental chair and within the surroundings in the clinic.  The child develops a positive attitude to dental care. because dentist X told him to start brushing his teeth and he came out of his clinic very happy. and he will do what the dentist told him. it does help you with the behaviour management of the child. Maybe because he likes his dentist he loves to brush his teeth at home. history taking allows a RAPPORT. you should be relaxed and to gain all the information from the patient.  Desensitization to fearful procedures by starting with simple ones. the important thing is to obtain pertinent information for many reasons:  History taking is important for diagnosis and treatment planning.  The significance for the parents is to establish a good relation with the parents. MOTIVATION.  For the child. dental. This should be done in systematic approach and relax manner. this means. In addition. how do we do that? By just hold a mirror and a probe inside the mouth.  It is important to gain the child‘s confidence and cooperation. During the first visit. to establish a friendly communication because you do end up communicating with the patient. this means. this start desensitizing him by having objects/instruments in the mouth. Now.History taking encompasses information of the patient’s medical. so that will give him a boost at home. by blowing air to examine the caries. talking and chatting. How we do it in a systematic approach? We always have a history sheet for examination of the patient. it is ready and contains all of the information. 10 | P a g e . he will always remember this as a pleasant experience. and so that we are always consistent with all of our patients. (you take the same information from all the patients). social and family history in all aspects. It should be documented accurately and should be updated at every visit.

You can also allow the parents to accompany the child to the equipment room especially during the first visit. according to the procedure and the behaviour of the child. Emotional support for the patient and higher success rate when the dentist involves the parents. and then when they come into the clinic you can review the information quickly. gain the proper information from them and then you review it with them later. you give it to them in the waiting room so they can fill it.  Another choice that dr. Ola prefer is to fill the sheet by yourself once the child and his parents come into your clinic and the nurse will help you during that. you can have the nurse go out.  Alternatively. sit with them in the waiting room. Then later you can decide if they should leave or they can stay. The components include:             The name Date of birth Date of examination Chief complaint History of present complaint Medical history Birth history and growth Diet history Dental history Family history Social history Behaviour 11 | P a g e . The techniques: The techniques are either by:  Letting the parents fill the standard examination sheet.

not eating well. you have to look at these sides concerning pain. swelling. if it happens during the day. speech/feeding/aesthetic problem. However. please check it in the slides) Onset Duration Frequency Aggravating Note: If it awakes the patient from sleep (spontaneous pain). Panadol for instance and it get relieved. this means the pain is very severe. if he takes a medication. so we have systemic symptoms. we are interested in noting the spontaneity of the pain. You have to look for:       Location Nature (I’m not sure. tired. if he is taking all sorts of painkillers and the pain is not stopping. dehydrated etc… and we might end 12 | P a g e . colour/shape/position of the teeth. then it is not that severe because you can avoid this stimulus. such as high temperature. However. then it is not that severe. the child will become feverish. Once you start have systemic symptoms. History: Especially in pain. lethargic. while if it is provoked by a certain stimulus. therefore. this is more severe. this is an indication for irreversible pulpitis. So you can conclude that you have an emergency.  Severity. The other thing that we are interested in is how the patient can relieve the pain. not just localized swelling in the mouth. if it is spontaneous. if the pain radiates to the other side (referred pain)  If there is a high temperature.Chief complaint/present complaint: What does chief complaint mean?  It means why did the patient come. so it is most probably provoked by a certain stimulus. It could be pain.

if the patient has cough or tonsillitis this is important to know. or the patient have vesiculobullous diseases. everyone gets immunized in the maternity centre so usually we do not have this kind of problems. these will affect the teeth.  Cardiovascular system: Of course. these patients are hard to deal with especially with local anesthesia and sometimes we cannot give them certain medications.  Immunization: In Jordan the immunization is good . bleeding problems (especially in extraction). especially under GA (general anesthesia).  Urogenital and renal diseases. but. because these medications maybe get metabolite in the liver or the kidneys.up with serious problems so this is considered an emergency and we should deal with the problem immediately.  Respiratory system: Basically. it is listed here because in the developed countries. we are concerned about asthma and any respiratory infection.  Mental and physical handicaps are also important for us.  Hematological: anemia. Medical history: In the medical history.  Endocrine system: we are concerned mainly about diabetic patients and other endocrine problems. jaundice.  CNS: the most important is epilepsy. because we afraid to have epileptic attack during treatment.  The skin. the most important thing in the cardiovascular system we are concerned about is sub-endothelium endocarditis (infective endocarditis). we have a big sheet that we give it to the patient in the clinic that contains a review for all the systems. if it is fragile.  Gastrointestinal system: enteritis. 13 | P a g e . skin infections or thin skin (in ectodermal dysplasia).

if the birth weight is low. Birth details: Everything related to the child before birth. because we are dealing with children. Other things that we should ask about are:  Regular prescription or any recent medications  Any hospitalization. and then you prescribe it. Before you write any prescription for antibiotic (most of the allergies that we have are from penicillin). this type of patients (medically compromised) we (students) could not treat them in the clinic. For example. so these children catch severe disease like TB. all these collectively will lead to problems in the teeth. development and growth. drugs. between 1000 – 2000 gr this low. (Below 1000 gr this very low birth weight. and of course. gestational age (pre-mature baby or not) and if there was oxygen deprivation during delivery. Prenatal and postnatal history: (after birth) We ask about:  If the baby is breast or bottle fed. Neonatal details: birth weight. any trauma. the mother health before she gave birth to him.where they have immigrants. any complication. these immigrants come from countries where there do not have proper immunization system. 2000 – 2500 gr is okay but still low and the average is above 2500 gr). age and cause of admission  Allergies: The allergies are very important to know. this will affect the caries 14 | P a g e . this will affect the teeth. you have to make sure that your patient is not sensitive to penicillin. We have to ask about these details for the same reason. if this is the first time for him. we ask for sensitivity test. birth height and head circumference. These are the aspects of the medical conditions that we should be aware of them.

every one year usually. what was done previously for him?  Does he get fluoride usually?  What oral habits the patient has? Oral habits mean. we give it to the patient. It contains breakfast. this is what we use in the clinic. so it is mother. father and daughter (female. so it just gives a clue of how that disease transmitted through different ages. Every time we see the patient. because it usually contains the snacks. so we see the steady development of the child in several years. The patient fills this sheet in three days. this disease maybe an x-linked disease. we can notice that the father has that condition. we chart the date with the height/weight at that age. male. one of these days 15 | P a g e . so we ask. female). The bottle content  Immunization  Any childhood illnesses The growth chart: The doctor showed us the growth chart. evening meal and the most important part. night thumb sucking. X patient has amelogensesis imperfecta. Dental history:  Is this is the first visit for the patient to the dentist or the second one? If it is the second time. “Does anybody in the family who have this condition?” In the slides (there is an example). lunch. Family history: This is important for us especially in genetic conditions. biting certain objects… all of these habits affect the shape and the alignment of the teeth. which is between meals. for instance. which is also appear in his mother. Diet history: We will use it in the clinic. and he fills it. biting the nails. we have a diet sheet.

you assess the behaviour. End of lecture  Done by: Amanda Saffoury 16 | P a g e . is it good. After it is done.should be a weekend day. All of these will affect the psychology of the child and how he will behave with you in the clinic. because in the weekend the amount of the snacks will increase. the autistic or the abused children usually are withdrawn from their peers. social history: We are interested in the address. if he social in general or he has problems. phone number. moderate or poor (poor means he refuses to sit on the chair). the parents bring it to the clinic and the dentist highlights the cariogenic things. Behaviour: The last thing. for example.

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