Pediatric Case Presentation STUDENT NAME

Pauline Tran
PD 347 (Pediatric Rotation seminar)
SUPERVISING FACULTY NAME
Dr. Peng

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Patient Name: Yousef Abdrabbou Axium Record # 1181319 Age: 4 y 0 m Gender: M

Reason for Visit / Chief Complaint: Clinical Significance:

Patient presented for his first ever dental visit to get his
teeth checked out.
Past/Present Medical History: Clinical Significance:
The patient was hospitalized when he was 18 months for
a bacterial infection in his cheeks. Otherwise, he is
healthy, has no medical conditions, and is not currently
taking any medications.
The American Academy of Pediatrics recommends that
children get their first oral evaluation by 6 months and
establish a dental home no later than the age of 1. There
was a significant delay in establishing a dental home for
Yousef as he is now 4 years 0 months old.
Although the patient's father did not report any other
significant medical history, we must still keep our eye out
for symptoms or behavior that may suggest any
undiagnosed conditions.

Social History: Clinical Significance:

The patient lives in Millbrae with his mom, dad, older It is important to know whether a patient has siblings
sister (6 years old), and older brother (8 years old). He because they may influence hygiene or dietary habits.
came into the clinic smiling and with a calm demeanor. Horizontal transmission of cariogenic bacteria can also
occur from siblings through sharing of utensils.

Past Dental History (brief): Clinical Significance:

This is was patient's first ever dental visit.
Oral (visual) Findings: introduce
Oral examination revealed that the patient had all of his
primary teeth present. His upper anterior teeth showed
shadowing in the interproximals. His upper posterior
teeth showed early signs of demineralization. All of his
lower teeth appeared clinically sound and showed no
signs of decay.
Clinical/Radiographic Findings: Clinical Significance:
A modified anterior occlusal radiograph confirmed there
was interproximal decay between the upper anterior
teeth. Bitewings also revealed interproximal decay
between the posterior teeth on both sides. These ranged
from E1-D2 lesions.
Since this was the patient's very first time at the dentist,
we didn't know what kind of behavior or reaction to
expect. To provide him with the most positive experience
possible, it was essential to utilize Tell-Show-Do and
euphemisms at his age. We made sure to gradually
new objects so as to not startle him with
Clinical Significance:
anything.
Caries in the upper anterior teeth is consistent with baby
bottle caries. It would be helpful to gather information
from the parents about the patient's current and previous
feeding habits to support or negate this.
During the clinical exam, none of the lower teeth
appeared as though there were any caries. The findings
from the radiographs serve as a reminder of how
valuable they are as a diagnostic tool and that the
carious process can go undetected if you are just looking
clinically.
Treatment Rendered:
At this appointment, I performed a head and neck exam, hard tissue exam, and took 3 radiographs. I discussed my
findings with the patient's dad and we came up with a plan to have the patient return for his prevention/prophy/fluoride
appointment next. I also interviewed dad to gather more information about his son and their siblings' hygiene and dietary
habits at home.

Unique or Interesting Features of the Case:

I chose to present this case because I learned so much from this appointment. This was my first time working with a
patient who had never been to the dentist before. Since he was so young, I wanted to make sure he had the most
positive experience possible and not grow up feeling fearful of the dentist. Tell-show-do and euphemisms were heavily
utilized during this appointment. Each instrument was introduced gradually and shown to the patient prior to placing it in
his mouth. Dr. Peng also suggested attempting to take radiographs that day but noted that we could also do it at the
prevention appointment if the patient was being uncooperative. Since Yousef started to tear up during the hard tissue
exam, it didn't seem like he would be up for taking radiographs. But luckily, he allowed me to take them and this was
successful through modeling with his dad. I got an extra sensor and Snap-A-Ray to demonstrate on his dad how I would
be taking the radiographs. Yousef responded really well to the demonstration and ended up being very cooperative.
Another remarkable aspect of this case was that during my hard tissue exam, all of Yousef's lower teeth appeared to be
intact and caries-free. However, the bitewings revealed that there were carious lesions well into the dentin in several of
his posterior teeth. They ranged from E1's to D2's and this was shocking because of how the teeth appeared clinically.
There was no shadowing present or any signs of demineralization. This reinforced the importance of taking radiographs
to supplement a clinical exam, as these caries could have easily been missed otherwise.

Anything You Would Have Done Differently:

I would have liked to work a little faster during this appointment with Yousef. Kids generally aren't as patient and aren't as
willing to be cooperative when things start taking longer than expected. Thinking back, I could have moved quicker when
taking his radiographs. I could have been better about placing the sensor because I had to fiddle around with it a lot to
get it in the proper position. All of my adjustments triggered Yousef's gag reflex even though he was very much willing to
take the radiographs.

Yousef currently brushes by himself with the occasional supervision of his 8-year old brother and enjoys snacking on
sweets. With all of the caries that I found, I would have liked to place a stronger emphasis on modifying hygiene and
dietary habits while speaking with the dad.

Take Away Points from this Experience:

1. 2. 3.
Don't be deceived by the clinical
appearance of teeth.
Tell-show-do and euphemisms
go a long way when working with
Utilizing the parent as a model if
they are in the same room helps
Radiographs contain valuable young children. It helps ease the to gain some cooperation from
information and should always child into a unfamiliar the child. It makes things appear
be used to supplement a clinical environment where new tools are less "scary" if they can see dad
exam when possible. being presented to them for the doing it too.
first time.