Chapter 57

Pediatric Dentistry

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Copyright 2003, Elsevier Science (USA). All rights reserved.

 Introduction
Pediatric dentistry is the specialized area of
dentistry that is limited to the care of children
from birth through adolescence, with particular
focus on providing oral health care to patients
with special needs.

Copyright 2003, Elsevier Science (USA). All rights reserved.

 The Pediatric Dental Office
 The office should display cheerfulness, a
pleasant environment with a nonthreatening
decor.
 Treatment areas are designed with an open
bay concept.
 Dental personnel dress in bright coordinating
colors.

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 The Pediatric Patient
 Chronologic age
• The child's actual age in terms of years and
months.
 Mental age
• The child's level of intellectual capacity and
development.
 Emotional age
• The child's level of emotional maturity.

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 Stages of Childhood
 Birth to age 2
• Children learn to sit, stand, walk, and run.
• Vocally, they progress from babbling to using
simple sentences.
• Can identify familiar faces and progress
through periods of being friendly and then
fearful of strangers.
• Too young to be expected to cooperate in
dental treatment.

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 Stages of Childhood cont’d
 Ages 3 to 5 years
• This child needs to be allowed to develop
autonomy and initiative.
• This child requires control and structure in
his or her environment.
• Able to follow simple instructions.
• Welcomes an active role in the treatment
experience.

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 Stages of Childhood cont’d
 Ages 6 to 11 years
• Period of socialization.
• Learning to get along with people.
• Learning the rules and regulations of
society
• Learned to overcome fears of objects and
situations.

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 Behavior Management
 Be honest with a child.
 Consider the child's point of view.
 Use “tell, show, do.”
 Give positive reinforcement.

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 The Difficult Patient
 Premedication
• Prescribed to calm and ease the patient
prior to treatment.
 Nitrous oxide oxygen
• Method of mild sedation that can help calm
a patient for treatment.
 Physical restraint
• Used to prevent a possible injury to the
child, dentist and or assistant.

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 Special Patients
 Mental retardation
• Mild mental retardation describes individuals
with IQs ranging from 50‑55 to 70.
• Moderate mental retardation describes
individuals with IQs ranging from 35 ‑40 to 50 ‑55.
• Severe mental retardation describes individuals
with IQs ranging from 20‑25 to 35 ‑40.
• Profound mental retardation describes
individuals with IQs ranging from below 20 to 25.

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 Special Patients cont’d
 Down syndrome
• Also named trisomy 21. These individuals
have a chromosomal aberration that
usually results in certain abnormal physical
characteristics and mental impairment. The
mental impairment may range from mild to
moderate retardation.

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 Special Patients cont’d
 Cerebral palsy is a nonprogressive neural
disorder caused by brain damage that occurred
prenatal, during birth, or postnatal before the
central nervous system reached maturity.
Characterized by paralysis, muscle weakness,
lack of coordination, and other disorders of
motor function.

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 Diagnosis and Treatment Planning
 Medical and dental history
• Past hospitalizations and surgeries.
• Date of child's last visit to the physician.
• Medications, daily medications.
• Unfavorable reaction to any medicine, allergies.
• Weight at birth and any problems at birth.
• Level of learning.
• Main concern about the child's dental health.
• Finger, thumb, or pacifier habits.
• Fluoride and toothbrush habits.
• Inherited family dental characteristics.

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 Diagnosis and Treatment Planning
cont’d
 Clinical examination
• Radiographic examination
• Extraoral examination
• Intraoral soft tissue examination
• Clinical examination

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 Preventive Dentistry
 Oral hygiene
• Geared to improving a child's brushing and
flossing technique.
 Fluorides
• Children between 6 months and age 16
should take in fluoride daily.
 Diet
• Review specific nutrients a child needs to
grow.

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 Preventive Dentistry cont’d
 Sealants
Applied to the teeth to help keep them
•
cavity-free.
 Oral/Facial development
• To identify malocclusion, crowded or crooked
teeth, bite problems, and actively intervene.
 Sports safety
• Protective face equipment worn during any
recreational sport that might injure the
mouth area.

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 Operative Procedures
 Restorative
• Amalgam
• Composite
 Endodontic procedures
• Pulp capping
• Pulpotomy
 Prosthodontic procedures
• Stainless steel crowns

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 Traumatic Injuries
 Causes of dental injuries to children
• Automobile accidents
• Bicycle accidents
• Sports injuries
• Child abuse

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 Fig. 57-16 Educating school personnel about traumatic injuries.

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 Types of Injuries
 Fractured anterior teeth
 Documentation of the accident includes:
• Clinical examination
• Radiographs
• Vitality testing

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 Types of Injuries cont’d
 Traumatic intrusion
• The tooth is forcibly driven into the
alveolus so that only a portion of the crown
is visible.

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 Types of Injuries cont’d
 Extrusion and lateral luxation
• Teeth are actually displaced from their
position, causing damage to the
periodontal ligaments.
• Displaced teeth repositioned.
• Temporary splint placed.

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 Types of Injuries cont’d
 Avulsed teeth
• The process of a tooth being torn away, or
dislodged completely by force.
• Recover the tooth immediately.
• Wrap the tooth in a moistened gauze.
• Go immediately to the dentist's office.

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 Child Abuse
 Child abuse must be suspected when:
• Injuries are in various stages of healing.
• Chipped or injured teeth.
• Scars inside the lips or on the tongue and tears of the
labial frena.
• Battering or other injuries around the head and neck.
• Facial bruises, swelling of the facial structures, or black
eyes.
• Bite marks.
• Injuries not consistent with the explanation presented
by the parent.

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 Reporting Child Abuse
 Required information
• The name, address, gender, age, height, and weight of the
child.
• The name and address of the adult with custody of the
child.
• A description of the current physical and emotional abuse
or neglect of the child.
• Evidence of previous injuries or negligence.
• Any information that may assist in establishing the cause
of the injuries.
• Sketches or photographs documenting the nature and
location of the injuries.

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