Handbook of

PEDIATRIC
DENTISTRY
Content Strategist: Alison Taylor
Content Development Specialist: Barbara Simmons
Project Manager: Sruthi Viswam
Designer/Design Direction: Christian Bilbow
Illustration Manager: Jennifer Rose
 Handbook of
PEDIATRIC
DENTISTRY
4TH EDITION

Edited by

Angus C Cameron BDS (Hons) MDSc (Syd) FDSRCS(Eng) FRACDS FICD

Head, Department of Paediatric Dentistry & Orthodontics, Westmead Hospital, Sydney
Clinical Associate Professor and Head, Paediatric Dentistry, The University of Sydney
Visiting Senior Specialist, The Children’s Hospital at Westmead, Australia

Richard P Widmer BDSc (Hons) MDSc (Melb) FRACDS FICD

Head, Department of Dentistry, Sydney Children’s Hospital Network, Westmead, Sydney
Clinical Associate Professor, Paediatric Dentistry, The University of Sydney
Senior Consultant, Paediatric Dentistry, Westmead Hospital, Australia

Australasian Academy
of Paediatric Dentistry

Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto  2013
Text and illustrations in Chapter 14 (Orthodontic diagnosis and treatment in the mixed dentition) contributed by
John Fricker are published with the permission of Tidbinbilla Publishers, Canberra, Australia.

© 2013 Elsevier Ltd All rights reserved.

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First edition 1997

Second edition 2003
Third edition 2008
Fourth edition 2013

ISBN 9780723436959

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A catalogue record for this book is available from the British Library

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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
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 Contributors

Paul Abbott Peter J Cooper

BDSc (WA) MDS (Adel) FRACDS (Endo) BSc MB ChB MRCP (UK)
Winthrop Professor of Clinical Dentistry Paediatric Respiratory Physician
School of Dentistry/Oral Health Centre of Western The Sydney Children’s Hospital Network, Westmead
Australia (OHCWA) Campus
The University of Western Australia, Australia Westmead, Australia

Eduardo A Alcaino Julia Dando

BDS MDSc Grad Dip(Conscious Sedation) BDS(Wales) MMedSci(Sheffield) FDSRCS(Edin)
MRACDS(Paed) FRACDS MOrthRCS(Eng) MRACDS(Orth)
Specialist Paediatric Dentist Head of Orthodontics
Visiting Dental Officer, Paediatric Dentistry Westmead Department of Paediatric Dentistry & Orthodontics
Hospital, and Sydney Dental Hospital, Australia Westmead Hospital, Australia

Michael J Aldred Rebecca Eggers

BDS (Wales) PhD (Wales) GradCertEd (QUT) FDS RCS BDS(Syd) MDSc(Syd) FRACDS
(Eng) FRCPath (UK) FFOP(RCPA) Specialist Paediatric Dentist
Specialist Oral and Maxillofacial Pathologist Staff Specialist, Department of Paediatric Dentistry
Dorevitch Pathology, Melbourne, Australia Westmead Hospital, Westmead, Australia

Sherene Alexander John Fricker

BDS(Mangalore) MDS(Mangalore) MRACDS(Paed) BDS MDSc (Syd) Grad Dip Adult Ed FRACDS
FRACDS FICD Specialist Orthodontist
Staff Specialist, Department of Paediatric Dentistry Canberra, ACT, Australia
Westmead Hospital, Westmead
Clinical Senior Lecturer, Paediatric Dentistry Anastasia Georgiou
The University of Sydney, Australia BDS(Adel) MDSc(Syd) MRACDS(Oral Med) FRACDS
Staff Specialist, Oral Medicine
Wendy J Bellis Westmead Hospital, Westmead
MSc BDS Australia
Specialist Paediatric Senior Dental Officer and
Assistant Clinical Director Kerrod B Hallett
Community Dental Service of Camden and Islington BDSc (Hons) MDSc (Qld) FRACDS
Primary Care Trusts Director, Department of Dentistry
London, UK Royal Children’s Hospital, Melbourne, Australia

Anthony Blinkhorn Linda Hayes-Cameron

OBE
Professor, NSW Chair of Population Oral Health
Faculty of Dentistry and Centre for Value, Ethics & Law
in Medicine
The University of Sydney, Australia
BPsyc(Hons)(UNE) MPsyc(Macq) BHeathSc(Nursing)
CertMidwifery CertChild&FamilyHealth
Clinical Psychologist
Department of Neonatology
The Royal North Shore Hospital, Sydney, Australia

Michael G Cooper Andrew A C Heggie

MB BS FANZCA FFPMANZCA MBBS(Melb) MDSc(Melb) LDS(Vic) FRACDS FFDRCSI
Senior Anaesthetist FACOMS FRACDS(OMS)
Department of Anaesthesia, Department of Pain A/Professor and Head, Oral and Maxillofacial Surgery
Medicine & Palliative Care Unit
The Sydney Children’s Hospital Network, Westmead Department of Plastic & Maxillofacial Surgery, Royal
Campus Children’s Hospital, Melbourne, Australia
Westmead, Australia
xii Handbook of Pediatric Dentistry

Sally Hibbert Jane McDonald

BDS MPhil (Liverpool) FDS(Paed Dent) RCS MB BS (NSW) FANZCA
Staff Specialist Visiting Medical Officer, Paediatric Anaesthetics
Department of Dentistry, The Children’s Hospital at Westmead Hospital and the Children’s Hospital at
Westmead Westmead
Clinical Senior Lecturer, Paediatric Dentistry Westmead, Australia
The University of Sydney, Australia
David J Manton
Timothy Johnston BDSc MDSc PhD FRACDS FICD
BDSc (WA) MDSc (Melb) FRACDS FADI Elsdon Storey Chair of Child Dental Health
Specialist Paediatric Dentist, Melbourne Dental School
Consultant Paediatric Dentist, Princess Margaret The University of Melbourne, Australia
Hospital
Clinical Senior Lecturer, University of Western Australia Daniel W McNeil
Perth, Australia PhD
Associate Professor and Director of Clinical Training
Om P Kharbanda Department of Psychology, West Virginia University,
BDS(Lucknow) MDS(Lucknow) MOthRCS(Edin) MMEd West Virginia, USA
(Dundee) Fellow, Indian Board of Orthodontics Honoris
Causa FAMS MAMS FICD Cheryl B McNeil
Professor and Head, Division of Orthodontics and PhD
Medical Superintendent Centre for Dental Education Assistant Professor
and Research (CDER) Department of Psychology
All India Institute of Medical Sciences West Virginia University, West Virginia, USA
Adjunct Faculty and Coordinator, KL Wig Centre for
Medical Education and Research Kareen Mekertichian
NEW Delhi, India BDS (Hons) MDSc FRACDS FPFA FICD
Specialist Paediatric Dentist
Nicky Kilpatrick Chatswood, Australia
BDS (Birm) PhD (Newcastle) FDSRCPS FRACDS(Paed)
Honorary Research Fellow Craig Munns
Murdoch Children’s Research Institute, Melbourne, MBBS PhD FRACP
Australia Conjoint Associate Professor and Senior Staff Specialist
Paediatric Endocrinology
Nigel M King The Sydney Children’s Hospitals Network, Westmead
BDS Hons (Lond) MSc Hons (Lond) PhD (Hong Kong) Campus
LDSRCS (Eng) FDSRCS (Edin) FDSRCS (Eng) MRACDS Westmead, Australia 
(Paed Dent) FHKAM (Dent Surg) FCDSHK (Paed Dent)
Winthrop Professor of Paediatric Dentistry Christopher Olsen
School of Dentistry/Oral Health Centre of Western MDSc (Melb) FRACDS
Australia (OHCWA) Clin Assoc Professor
The University of Western Australia, Australia Melbourne Dental School, The University of Melbourne
Paediatric Dentist, Royal Dental Hospital,
Erin Mahoney Melbourne, Australia
BDS(Otago) MDSc(Syd) PhD(Syd) FRACDS
Specialist Paediatric Dentist Neeta Prabhu
Hutt Valley District Health Board BDS(Bombay) MDS(Mangalore), MPhil(Newcastle upon
Clinical Senior Lecturer, University of Otago, New Tyne), MRACDS(Paed) FRACDS FICD
Zealand Staff Specialist
Department of Paediatric Dentistry
Simrit Malhi Westmead Hospital, Westmead
BDS(Hons)(Punjab) MDS(PGIMER) MRACDS(Paed) Clinical Senior Lecturer, Paediatric Dentistry
FDSRCS(Eng) FRACDS The University of Sydney, Australia
Staff Specialist
Department of Paediatric Dentistry, Westmead Hospital, Sarah Raphael
Westmead BDS (Adel) MDSc (Syd) FRACDS
Clinical Senior Lecturer, Paediatric Dentistry Specialist Paediatric Dentistry
The University of Sydney, Australia Sydney, NSW
 Contributors xiii

Mark Schifter Meredith Wilson

BDS MDSc(Syd) MSND RCS(Edin) MOM RCS(Edin) FFD
RCSI(Oral Med) FRACDS(Oral Med) FICD
Head of Department of Oral Medicine, Oral Pathology
and Special Care Dentistry
Westmead Hospital
Clinical Associate Professor, University of Sydney,
Australia
Sarah Starr
B AppSci (Speech Path), M Health Sci (Ed),CPSP
Director of Speech Pathology Services
Burwood, Australia
MBBS, FRACP, MBioeth
Clinical Associate Professor
University of Sydney Western Clinical School
Clinical Geneticist (HGSA), The Children’s Hospital at
Westmead
Westmead, Australia
John Winters
BDSc MDSc (UWA) FICD
Specialist Paediatric Dentist
Chairman, Dental Department,
Princess Margaret Hospital, Perth, Australia

Neil Street
MB BS (NSW) MAppSci (UTS) FANZCA
Staff Specialist, Paediatric Anaesthetics
The Sydney Children’s Hospital Network, Westmead
Campus
Westmead, Australia
 Contributors xiii

Contributors to previous editions

The Editors would like to acknowledge the great support and contributions made to the
earlier editions by the following people, who made this book possible:

Louise Brearley Messer Peter Gregory

AM BDSc LDS MDSc (Melb) PhD (Minn)
Former Eldston Storey Professor of Child Dental Health,
The University of Melbourne
Adjunct Professor, Pediatric Dentistry, University of
Minnesota, USA
BDSc MDSc (WA) FRACDS
Specialist Paediatric Dentist
Visiting Paedodontist, Princess Margaret Hospital for
Children, Perth, WA
Clinical Lecturer, The University of Western Australia

Roland Bryant Roger K Hall

MDS (Syd) PhD FRACDS OAM MDSc (Melb) FRACDS FICD
Professor of Conservative Dentistry, The University of Associate Professor and Principal Fellow, The University
Sydney of Melbourne
Senior Dental Surgeon, Royal Children’s Hospital,
Santo Cardaci Melbourne
BDSc Hons (WA) MDSc (Adel) FRACDS
Specialist Endodontist, Perth, WA Fiona Heard
BDSc (Melb) LDS MDSc (Syd) FRACDS
Peter JM Crawford Specialist Endodontist, Sydney, NSW
BDS, MScD, FDSRCS(Edin), FDSRCS(Eng), FRCPCH Visiting Dental Officer, Westmead Hospital
Consultant Senior Lecturer in Paediatric Dentistry,
University of Bristol Dental Hospital Justine Hemmings
B App Sc (Speech Path)
Bernadette Drummond Senior Speech Pathologist, Royal Alexandra Hospital for
BDS (Otago) PhD FRACDS Children, Westmead
Professor of Paediatric Dentistry, The University of
Otago, New Zealand
xiv Handbook of Pediatric Dentistry

David Isaacs Stephen O’Flaherty

MB BChir MD MRCP FRACP MB ChB FRACP FAFRM
Associate Professor and Head, Department of Head, Department Paediatric Rehabilitation, Royal
Immunology, Royal Alexandra Hospital for Children, Alexandra Hospital for Children, Westmead
Westmead
Tony Sandler
Tissa Jayasekera BDS (Witw) HD Dent (Witw)
MDSc (Melb) MDS (Syd) FRACDS Specialist Endodontist, Perth, WA
Specialist Orthodontist, Bendigo, Victoria
Visiting Dental Officer (Paediatric Dentistry), Westmead Sarah Raphael
Hospital BDS (Adel) MDSc (Syd) FRACDS
Specialist Paediatric Dentistry, Sydney, NSW
Allison Kakakios
MB BS (Hons) FRACP Julie Reid
Staff Specialist, Paediatric Immunology, Royal Alexandra BAppSci (Speech Pathol) (La Trobe) GradDip(Gerontol)
Hospital for Children, Westmead (Syd) PhD
Senior Speech Pathologist, Royal Children’s Hospital,
Linda Kingston Melbourne
B App Sci (Speech Path)
Senior Speech Pathologist, Royal Alexandra Hospital for W Kim Seow
Children, Westmead BDS (Adel) MDSc (Qld) DDSc PhD FRACDS
Associate Professor, Paediatric Dentistry, University of
Peter King Queensland, Queensland
MDS (Syd)
Former Head of Unit, Special Care Dentistry, Westmead Margarita Silva
Hospital CD (Mexico) MS (Minn)
Specialist Paediatric Dentist, Melbourne, Victoria
Judy Kirk
MB BS (Syd) FRACP Joe Verco
Staff Specialist Cancer Genetics, Medical Oncology, BDS (Adel) LDS (Vic) BSc Dent (Hons) MDS FAAPD
Westmead Hospital Specialist Paediatric Dentist, Adelaide, South Australia

Sandy Lopacki Peter Wong

MA (Speech Path) (Northwestern) CCC-ASHA BDS (Hons) MDSc (Syd) FRACDS
Formerly, Senior Speech Pathologist, Westmead Specialist Paediatric Dentist, Canberra ACT
Hospital Visiting Dental Officer (Paediatric Dentistry), Westmead
Hospital
James Lucas
MDSc (Melb) MS (LaTrobe) FRACDS LDS
Deputy Director, Department of Dentistry, Royal
Children’s Hospital, Melbourne
 Foreword

Handbooks on paediatrics and more recently, paediatric dentistry, have been produced
for some years now, by paediatric hospitals and departments of paediatric dentistry in
Australia, to assist trainee staff with ready-reference access to advice on common
paediatric problems.
This new more comprehensive publication is the outcome of an enthusiastic response
to the first Handbook of Pediatric Dentistry from the Department of Paediatric Dentistry
at Westmead Hospital Dental Clinical School and the University of Sydney, edited by
Angus C Cameron and Richard P Widmer. In this new publication, there are additional
contributions from members of the Australasian Academy of Paediatric Dentistry and
the Australian and New Zealand Society of Paediatric Dentistry, and the authors have
included many tables and colour plates. The addition of these good quality colour
illustrations of dental abnormalities is an important adjunct to the written descriptions
of disorders and facilitates diagnosis.
Most orofacial disorders in children have a developmental basis. Lesions or conditions
may be present at birth, or become evident soon after. They may appear, change
character or arrest and regress (or disappear) as growth proceeds. Certain diseases are
inherited and others may be acquired from parents, siblings or other children, but for
many, the actual aetiology is still unknown. While we may not yet know the precise
cause of many conditions, we do know how to manage them – often in close coop-
eration with our paediatric medical and surgical colleagues. This handbook sets out,
in concise form, the essentials of management of children with, e.g. oral and dental
trauma, dental caries, oral infections, cardiac disease, endocrine, haematological and
oncological disorders, and those who have received organ transplants.
Dental practitioners and students need information on all of these areas of dental care
for children, on a daily basis. This handbook provides the basic information necessary
in a clear and readily retrievable form, at the same time providing guidance on the
most appropriate texts or journals, where more detailed information may be found.

Roger K Hall OAM

Foundation President
Australasian Academy of Paediatric Dentistry
Associate Professor and Principal Fellow, The University of Melbourne
Senior Dental Surgeon, Royal Children’s Hospital, Melbourne
 Preface

After 15 years, our undergraduate student notes have expanded to become a con-
temporary handbook, now in its 4th edition and translated into eight other languages.
We are extremely grateful to all the members of the Australasian Academy of Paediatric
Dentistry and our international colleagues for their support in the publication of this
book. As we complete the final preparation for this 4th edition, it is time to reflect
upon what the contemporary goals for paediatric oral health care are for clinicians,
patients and the wider community.
For the clinician, it is striving to practice with a mindset that is tempered and improved
by life-long learning and practice that brings with it the immense, spiritual satisfaction
of helping others. For the child patient who has a “good” experience of dentistry,
there is an everlasting positive memory that hopefully brings about a desire for main-
taining their oral health as they become adults.
As far as the community is concerned, it is now recognised, more than ever, that oral
health is part of total health and cannot be ignored. A recent declaration from the
United Nations provides a new impetus for this integration to be actively promoted
by dental clinicians.

The United Nations High-lever Meeting on Prevention and Control of Non-communicable

Disease (NCD), held in New York in September 2011, was a truly historic occasion as it
was the first time that oral diseases were recognised as a public health problem. The
summit called for sustained action to address the rising burden of non-communicable
disease such as diabetes, cancer, cardiovascular and respiratory diseases, with oral
diseases as an integral part. Oral diseases share many of the same determinants and risk
factors as the four main targeted non-communicable diseases, that is, high sugar and
salt intake, tobacco and alcohol use, lack of physical activity, and also trauma and
violence. They are part and parcel of the global silent tsunami of chronic disease. It is
widely accepted that there is strong evidence that the general health status of young
children directly influences their health, development and wellbeing throughout life. This
is also true for oral health. Dental problems in early childhood have been shown not only
to be predictive of future dental problems but also to influence general growth and
cognitive development, by interfering with sleep, appetite and eating patterns, and
leading to poor school behaviour and negative self-esteem. The impact is more
significant on children from lower socioeconomic groups. Therefore, it is crucial that oral
health is seen as part of total health.

Benzian et al., 2012 Editorial Journal of Public Health Dentistry, 72: 91–93.

What is our role in society? Paediatric dental clinicians need to be integral in this drive
to raise awareness of the problems to which poor oral health leads. There needs to
be a greater involvement with our local “health community” and regular communica-
tion with all our other health colleagues, health bureaucrats and government organiza-
tions. This contact may be in the form of a “care plan“ for a patient, sent to their
general medical practitioners; or outlining concerns about a government programme
xviii Handbook of Pediatric Dentistry

to bureaucrats. Whatever the activity, it will help raise awareness of paediatric dental
health. While there is a perception that we are only paediatric dental surgeons, we
should also act as paediatric oral physicians. In some ways, this concept is understood
better by our fellow paediatric health practitioners. It embraces the aspiration of
total patient care, a model expressing the broad scope of child development and oral
health.
It is our hope that this, the 4th edition of our Handbook, can go some way to providing
the contemporary evidence and clinical practice necessary to address these huge chal-
lenges, and help support and inspire an improvement in oral health globally, placing
the importance of oral health at the forefront of our children’s total health.

Angus C Cameron and Richard P Widmer

Westmead, Sydney, Australia
October 2012
 Acknowledgements

The editors are extremely grateful for the support of all those involved in the teaching
of Paediatric Dentistry throughout Australia and New Zealand and the members of the
Australasian Academy of Paediatric Dentistry. The list of contributors reflects the depth
of experience in child dental care that has been gathered to complete this publication
and we would like to thank all those who have been intimately involved or have offered
advice. We would especially like to thank the staff of Westmead Hospital and the
Children’s Hospital at Westmead and, in particular, Mrs Maggie Melink for her invalu-
able secretarial efficiency and patience. Thanks also, for their photographic assistance,
to Mr Paul De Sensi, Chief Medical Photographer and Mr John Yeats, Medical Pho-
tographer at The Children’s Hospital at Westmead and Dr Helen Fung, Paediatric
Dentist, at Westmead Hospital. We would also like to give special thanks to the reg-
istrars in our departments for their support and Dr Anastasia Georgiou for her assist-
ance in reviewing the manuscript.
Our families and close friends must not go unmentioned for their quiet support and
encouragement and finally, we would like to thank our child patients, the responsibility
of whose care we are entrusted. They give us wonder as we watch them grow, the
joy in our daily work and the motivation for our endeavours.