Pedodontia

PEDODONTIA- DEFINITON AND
SCOPE,PRINCIPLES OF
EXAMINATION IN PEDIATRIC
DENTISTRY
INTRODUCTION
Ø Paediatric dentistry or “pedodontics”-”pais” and

“dontics”.
Ø Acquisition and utilisation of vast dental
knowledge both common to adults and unique and
pertinent to children.
Ø Child-a dynamic organisation with constant mental,
physical and emotional changes.
“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence
Pinkham Nowak
“Introduction to pediatric dentistry”, textbook of pediatric denistry, shobha tandon
• Pedodontist /paediatric dentist - alters their
growth pattern and increase resistance of oral
tissues.
• Establishing an ideal oral structure, metabolically,

functionally and aesthetically

Pinkham Nowak
PEDIATRIC DENTISTRY
CARIES RESTORATIVE
EXTRACTIONS
INTERCEPTION TECHNIQUES
PREVENTION OF
ARCH PULPAL
DENTAL
INTEGRITY THERAPY
DISEAESE

Pinkham Nowak
HISTORICAL PERSPECTIVE
Ø 1743 -Robert Bunon
“Essay sur les maladies des Dentes”
Father of children’s dentistry
Ø Pierre Fauchard – Father of Dentistry
Ø 1780 John Greenwood, New York
One of the first dentists to provide
regular dental care to children
Ø 1800 CF Delabarre
Dental treatment in Parisian orphanages
“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence - Pinkham

Nowak
Ø 1851- A.F. Talma, dentist to King Leopold I of Belgium
First known proposal for a regular dental care program
for children aged 5 to 12 years
Ø 1902- Ernst Jason Strasbourg
First municipal dental clinic or first school dental clinic
Ø 1914 Alfred C. Fones, father of dental hygiene
Programme to employ graduates to provide dental care
in public schools.
“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence - Pinkham,
Nowak
Ø 1920 -Dr .Rafiuddin Ahmed, Father of dentistry in India
establishes
“Calcutta, dental College and
Hospital”
First dental College in India.
Ø 1924- M.Evangeline Jordan
“ Operative Dentistry for Children”- the first textbook of paediatric

dentistry
Ø 1940- Paediatric Dentistry- officially recognised as a speciality
Ø 1945- First Artificial Water Flouridation Plant, Grand

“TheRapids,Michigan.
practical Importance of Pediatric Dentistry -Infancy Through Adolescence - Pinkham Nowak
Ø 1947- American Academy of Paediatric Dentistry is formed
Ø 1949 -First week of February designated as National Children’s
dental health week in USA
Ø 1955 – Acid-Etching described
Ø 1979- Indian society of paediatric dentistry
and preventive dentistry is established
Ø Dr. B.R.Vacher is made the “Father of Paediatric
Dentistry in India”.
Ø November 14, 2010 “Paedodontist Day”
by ISSPD
“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence - Pinkham
Nowak
DEFINITION OF PAEDIATRIC DENTISTRY
Ø Stewart, Barber, Troutman, Wei(1982)
“Paediatric dentistry is the practice and teaching of

comprehensive, preventive and therapeutic oral
health care of a child from birth through adolescence.
It is constructed to include care for special patients
who demonstrates mental, physical or emotional
problems”
“Introduction to pediatric dentistry”, textbook of pediatric denistry, Shobha Tandon

American Academy of paediatric dentistry, 1985
Paediatric dentistry also known as paedodontics and

as dentistry for adolescents and children is the area of
dentistry concerned with preventive and therapeutic oral
health care for children from birth through adolescene. It
also includes special care for special patients beyond the
age of adolescence who demonstrate mental, physical or
emotional problems.

Vouchers dental terminology, 1993
Paedodontics is the branch of dentistry that

includes having a child, accept dentistry prevention,
detection, restoration of primary and permanent
dentition. Applying preventive measure for
periodontal therapy, dental caries, prevalence,
intercepting and correcting various areas of
Malocclusion

American Academy of paediatric dentistry, 1999
“Paediatric dentistry is the age-defined
speciality that provides both primary and
comprehensive, preventive and therapeutic oral
health care for infants and children through
adolescents, including those with special care
needs”.

Shobha Tandon 2008
Paedodontics can be defined as a science

which deals with playing down the foundation of
healthy dentition and ora facial complex from the
prenatal period through adolescence.
Mosby’s medical dictionary 2009
The branch of dentistry devoted to the diagnosis
and treatment of dental problems affecting the
children. Also called paedodontics.
Farlex medical dictionary, 2012
The branch of dentistry concerned with the dental

care and treatment of children
ADA(American dental Association) 2013
Paediatric dentistry is an age defined speciality

that provides both primary and comprehensive,
preventive and therapeutic oral health care for
infants and children through adolescents, including
those with special healthcare needs.
EAPD(European Academy of paediatric dentistry) 2015
The speciality of paediatric dentistry as the practice,

teaching of and research in the comprehensive, preventive
and therapeutic oral care of children from birth to
adolescence.
Shobha Tandon 2016
Paedodontics can be defined as science which deals with

laying down the foundation of healthy dentition, Oro facial
complex from the prenatal period through Ada lessons for
children and special need young persons.
AIMS AND OBJECTIVES OF PAEDIATRIC
DENTISTRY
Ø Health of a child as a whole

Ø Prevention of disease
Ø Early diagnosis and treatment
Ø Observe and control the developing dentition
Ø Relieve pain and sepsis
Ø Increase knowledge and improve techniques
“ The Aims of Dentistry for the Child Patient”,Child Dental Health-
P.J.Holloway J.N.Swollow
SCOPE OF PEDODONTICS

Restorative Dentistry
Ø Restrorative treatment are to repair or limit the damage

from dental caries.
Ø To protect and preserve the tooth structure
Ø To re-establish adequate function
Ø To restore esthetics
Ø To provide ease in maintaining good oral hygiene.
Pediatric Dentistry- Principles and Practice, MS Muthu N Sivakumar

Cariology
Ø The discipline of the study of dental caries is called

cariology.
Ø If dental caries is identified early, the disease process

can be interrupted and the progression can be
reversed/controlled/ arrested for lifetime.
Ø This chapter provides the knowledge base and rationale

that is required for prevention and control of dental
caries at the individual as well as at the population.
Preventive Dentistry
Ø Prevention of oral disease is preferable to

treatment, which is a well-accepted concept.
Ø Examining the levels of prevention is important,

especially when considering intervention or
elimination of the disease process.

Radiology
Ø Radiographs are essential if we are to treat children
successfully.
Ø Early diagnosis of dental caries is important in children,

especially for primary teeth, to prevent dental pain, early
extraction and emotional stress on both the child patient
and the parent.
Ø This chapter deals with the fundamentals of X-ray films,

different techniques for taking intraoral and extraoral
radiographs .
Oral Surgery
Ø They are trained to recognize and treat a wide spectrum of
diseases, injuries and defects in the head, neck, face, jaws
and the hard and soft tissues of oral and maxillofacial
region.
Ø They are trained to treat problems such as facial deformity

and misaligned jaws, tumors and cysts of jaw,tumors and
cyst of jaw.
Ø some perform dental implant surgery and extraction of

impacted
Pediatric tooth.
Dentistry- Principles and Practice, MS Muthu N Sivakumar
Endodontics
Ø It is concerned with the prevention, diagnosis and management of
diseases or injuuries to the pulp in primary and permanent teeth.
Ø Due to their specialization, they have extensive clinical and

scientific knowledge on the various forms of pulp treatment or
endodontic procedures: Direct or indirect pulp treatment
Root canal treatment
Apexogenesis/apexification
Pulpectomy/pulpotomy
Ø They also deal with cases of dental trauma, can perform

microsurgery on the tips of tooth’s root.
Periodontics
Ø It helps to prevent damage to the tissues and bone surrounding
the teeth.
Ø major role in the management of
Chronic gingivitis
Aggressive periodontitis
Frenectomies
Re-contouring of gummy smile
Gum grafting
Tethered oral tissues

Child Psychology
Ø It is the science deals with the study of a

child’s mind and its function.
Ø Management of a child’s behaviour in the
dental office is an essential prerequisite to
complete dental care.
Ø When dealing with a dental problem, the whole
patient, not just the tooth should be treated,
especially with the children.
Special care dentistry
Ø Children with special needs have greater than normal

unmet needs for treatment .
Ø The purpose of this chapter is to describe several of the

most common disabling conditions involving major motor
or skeletal problems, discuss their etiologies, examine
some of the treatment related problems that accompany
them and provide suugestions for treatment approaches
and methodologies.

ETHICAL PERSPECTIVE
ØThe children have rights

to be protected against bad/ unfair
treatment
to be respected as individuals.
Ø Their best interest should be a primary
consideration.
ØThe views of the child should be respected.
ØEducation and family support.
“Pediatric Oral Care - The Perspectives”, Pediatric Oral Care- A Clinical
Approach- Goran Koch,Sven Poulson
Ø Right to formal health care- emergency,
preventive and curative care.
Ø Ethical analysis of behaviour management

and scientifically based principles of
preventive and curative care
Ø Research to be conducted on children only if

it’s not possible on adults.
“Pediatric Oral Care - The Perspectives”, Pediatric Oral Care- A Clinical
Approach- Goran Koch,Sven Poulson
SPECIFIC DIFFERENCES BETWEEN
CHILD AND ADULT PATIENTS
Childhood-transitional stage characterised by

many changes
Ø Physiological and anatomic differences
Ø Pharmacokinetics
Ø Emotional and psychological differences.
Ø Treatment considerations.
“Topics in Pediatric Physiology”, Pediatric Dentistry -Infancy Through
Adolescence - Pinkham ,Fields, Nowak
Physiological and anatomic differences
Body size :
Ø Height and weight- lesser than adults
Ø Less amount of drug needed to reach an effective plasma level
Ø But less amount of drug needed to produce toxicity.
Body fluids :
Ø Larger volume of total body water(80% by weight ) compare to adult (50 to 60%
by weight)
Ø Volume of water-soluble drug distribution is large.

“Topics in Pediatric Physiology”, Pediatric Dentistry -Infancy Through Adolescence -
Pinkham ,Fields, Nowak
Respiratory system
Normal respiratory rate :
§ Pre-term neonates: 40 to 60 breathes per minute
§ Term neonates 30 to 50 breathes per minute
§ 1 month to 1 year 20 to 40 breathes per minute
§ 1-5 years 20-30 breathes per minute
§ 5-10 years 15- 20 breathes per minute
§ for adults 12-16 breathes per minute

§ Relatively large, head, narrow nasal passage,
smaller diameter of glottis and trachea larger
tongue, larger mass of lymphoid tissue, copious
secretion and loose glottic areolar tissue -
increased risk of airway obstruction .
§ Difficult to manage during sedation, general
anaesthesia and respiratory emergency.
§ At 20 to 30° head position is best for treating a
child.

§ Horizontally placed ribs-intercostal muscles are
inefficient
§ Diaphragm is the main
respiratory muscle and
diaphragm exertion is avoided.
§ Increased Alveolar Ventilation to Functional

Residual Capacity ratio-react more rapidly to
inhaled gases.

Cardiovascular system
Heartrate for newborn 120 beats per minute
for adults 60-100 beats per minute
Immature sympathetic system -Parasympathetic (Vagal) tone as
more pronounced
§ Decrease in heart rate during intubation, bladder distention and
pressure on eyes.
§ Children undergoing treatment under general anaesthesia should
be given parasympathetic blockers such as Atropine
§ Peripheral circulation is poorly developed in new-borns uptake
of intramuscular injections is low
Gastrointestinal system
ØImmature gut mucosa-acid concentration

is low
Ø Barbiturates-not well absorbed
Ø penicillin-well absorbed
Ø Hepatic enzymes -not well developed

Renal system
§ Glomerular Filtration Rate (GFR)-30 -50 % of an

adult.
§ GFR for children 40 to 60 ml/min
§ for adults 90 to 120 ml/min
§ Drugs primarily excreted by glomerular filtration have
longer half lives,e.g- aminoglycoside antibiotics,
digoxin and curare.
§ GFR reaches adult level by 3 to 6 months.
Emotional and Psychological Differences
• The Treatment Relationship

• “The Pedodontic Treatment
Triangle“ (Wright 1975)
CHILD
PARENT DENTIST

Modified Pedodontic Treatment
Triangle (McDonald 2004)
CHILD
SOCIETY
PARENT DENTIST

§ Children exhibit a fear of the unknown.
§ Child patient do not know how to rationalise .
§ Behaviour management modalities differ

depending on age and understanding
§ Lesser concentration time-Treatment not more

than 20 to 30 minutes

Treatment considerations in Children
§ Oral surgery consideration.
§ Modified Cavity Designs
§ Radiographic considerations
§ Endodontic considerations due to different

Root Canal morphology
Responsibilities of a paedodontist
Towards the Patient

§ Use good judgement.
§ Best dental treatment.
§ Fair fees
§ Must be able to handle children well
§ Prevention – Main Aim
§ convey the value of good dentistry
“The Children's Dentist, His Practice and His Community”, Clinical Pediatric
Dentistry - Sidney B. Finn; Pages
Towards the Community
§ Community programmes-promote dental

health and instil a positive dental attitude.
§ Preventive programmes-play the role of an

educator.
Towards oneself
§ Be proud of one’s profession
§ responsibilities.
§ Continual improvement in knowledge and
practice;keeping up with changing trends.
§ Honesty
§ Referal to other, more experienced
professionals whenever needed.
Challenges for paediatric dentistry in
the 21st century
§ Child abuse
§ Children of Poverty
§ Informed consent and Risk Management
§ Evidence-based dental practice
§ Technology and materials
§ Health care delivery and payment strategies
§ Carries risk assessment
§ Advocacy
“The practical Importance of Pediatric Dentistry”, Pediatric Dentistry -Infancy

Through Adolescence - Pinkham ,Fields, Nowak
CONCLUSION
§ Paediatric dentistry encompasses all

aspects of oral health care for children and
adolescents
§ Pedodontist must produce a service for
the child as an individual, a population
which is generally educated and an ever-
increasing knowledge of paediatric
dentistry and an elevation of the status of
the profession.
TH THANK YOU

Pedodontia

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Pedodontia

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PEDODONTIA- DEFINITON AND

Ø Paediatric dentistry or “pedodontics”-”pais” and

• Establishing an ideal oral structure, metabolically,

“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence

“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence

“The practical Importance of Pediatric Dentistry -Infancy Through Adolescence - Pinkham

“Calcutta, dental College and

First dental College in India.

Ø 1924- M.Evangeline Jordan

“ Operative Dentistry for Children”- the first textbook of paediatric

Ø 1940- Paediatric Dentistry- officially recognised as a speciality

Ø 1945- First Artificial Water Flouridation Plant, Grand

Ø Stewart, Barber, Troutman, Wei(1982)

“Paediatric dentistry is the practice and teaching of

“Introduction to pediatric dentistry”, textbook of pediatric denistry, Shobha Tandon

Paediatric dentistry also known as paedodontics and

“Introduction to pediatric dentistry”, textbook of pediatric denistry, Shobha Tandon

Paedodontics is the branch of dentistry that

“Introduction to pediatric dentistry”, textbook of pediatric denistry, Shobha Tandon

“Introduction to pediatric dentistry”, textbook of pediatric denistry, Shobha Tandon

Paedodontics can be defined as a science

The branch of dentistry concerned with the dental

ADA(American dental Association) 2013

Paediatric dentistry is an age defined speciality

The speciality of paediatric dentistry as the practice,

Shobha Tandon 2016

Paedodontics can be defined as science which deals with

Ø Health of a child as a whole

“Introduction to pediatric dentistry”, textbook of pediatric denistry, Shobha Tandon

Ø Restrorative treatment are to repair or limit the damage

Ø To protect and preserve the tooth structure

Ø To re-establish adequate function

Ø To provide ease in maintaining good oral hygiene.

Pediatric Dentistry- Principles and Practice, MS Muthu N Sivakumar

Ø The discipline of the study of dental caries is called

Ø If dental caries is identified early, the disease process

Ø This chapter provides the knowledge base and rationale

Ø Prevention of oral disease is preferable to

Ø Examining the levels of prevention is important,

Pediatric Dentistry- Principles and Practice, MS Muthu N Sivakumar

Ø Early diagnosis of dental caries is important in children,

Ø This chapter deals with the fundamentals of X-ray films,

Ø They are trained to treat problems such as facial deformity

Ø some perform dental implant surgery and extraction of

Ø Due to their specialization, they have extensive clinical and

Root canal treatment

Ø They also deal with cases of dental trauma, can perform

Ø major role in the management of

Re-contouring of gummy smile

Tethered oral tissues

Pediatric Dentistry- Principles and Practice, MS Muthu N Sivakumar

Ø It is the science deals with the study of a

Ø Children with special needs have greater than normal

Ø The purpose of this chapter is to describe several of the

Pediatric Dentistry- Principles and Practice, MS Muthu N Sivakumar

ØThe children have rights

Ø Ethical analysis of behaviour management

Ø Research to be conducted on children only if

Childhood-transitional stage characterised by

Ø Height and weight- lesser than adults

Ø Less amount of drug needed to reach an effective plasma level

Ø But less amount of drug needed to produce toxicity.